北美基层医疗健康科研网络体系早期的创建和发展：一项基于历史视角的文献综述

doi:10.12114/j.issn.1007-9572.2021.00.291

摘要/Abstract

摘要： 背景　发展基层卫生和全科医学研究对于发展这一学科至关重要。回顾历史，基层医疗健康科研网络体系（PBRNs）对于欧美基层卫生和全科医学研究的发展起到了关键性的推动作用。目的　归纳1977—1994年北美地区PBRNs的规模、组织形式和目标、研究问题和方法设计、数据收集、资金来源及其他发展经验的历史信息。方法　本研究是一项基于历史视角的文献综述。研究者对北美地区PBRNs文献数据库、PubMed Central、Embase、Web of Science、Cochrane Library、Google Scholar 6个文献数据库进行了4个阶段的迭代检索。纳入的非原创性研究需要涉及与本研究目的相关的经验性信息；纳入的原创性研究则需要由PBRNs实施，且基于多个基层医疗卫生机构间的数据共享和跨机构合作完成。结果　最终纳入27篇介绍PBRNs发展经验的非原创性研究、74篇由PBRNs产出的原创性研究、2篇提供了总结性经验的灰色文献。文献分析结果显示，绝大多数PBRNs在发展初期得到了基层卫生、全科医学或相关学科学会和科研机构的支持。PBRNs的成员包括管理者、研究者、联络员、实践者等，规模一般在50~300人。PBRNs的共同目标为发展基层卫生和全科医学知识、培养科研型全科医生和改进基层卫生实践；其研究方法的主要特征是通过横断面调查探索基层医疗卫生机构的服务、患者及医生特点，并从多个诊所临时或稳定地收集数据。PBRNs的资金需求包括研究基金（来自政府、私人基金会、商业公司）、维护资金（来自学会、学术机构）、数据收集资金（来自全科医生）。北美PBRNs构筑的核心经验包括：争取充足的初始资金，由首席科学家和全科医生共同进行严谨的设计，发展平等、团结和沟通的文化，以及减少临床医生的科研工作负担等。结论　在基层卫生系统中建设早期PBRNs的成功要素包括：争取学会和科研机构的支持，建设足以凝聚管理者、研究者和实践者的组织体系，确立发展基层卫生学科、科研及实践的共同目标，以基层医疗卫生机构为中心确定科研问题和对象，对研究进行严谨的共同设计，创建可靠且使基层医生负担较低的数据收集方法，以及获得充足的初期资金支持。

关键词: 基层医疗健康科研网络体系, 全科医学, 初级卫生保健, 研究, 综述

Abstract: Background　Developing primary care research is essential to the development of discipline. In history，building practice-based research networks（PBRNs） made key contribution for developing primary care research in Europe and the North America. Objective　Summarize historical information on the scale，structure，aims，research questions and designs，data collection approach，funding sources，and other experiences of PBRNs in North America from 1977 to 1994. Methods　This study is a literature review from historical perspective. Researchers conducted a four-stage search on 6 databases：PBRNs Literature database，PubMed Central，Embase，Web of Science，Cochrane Library，and Google Scholar. Included papers need to be published in peer-reviewed journals or by reputable institution（grey literature），and have full text or abstract with key information. Non-original researches need to provide empirical information about PBRNs development. Original researches need to be conducted by PBRNs based on multi-clinic cooperation. Results　27 editorial papers and 2 grey literatures introducing the development experience of PBRNs，and 74 original articles published by PBRNs were included. The result show that most PBRNs were supported by family medicine or related academies and institutions. Most of the networks have 50-300 organizers，researchers，liaisons，and physician members. Their aims are developing primary care knowledge，supporting academic family physicians and improving primary care practice. Their research work focuses on exploring primary care services，patients，and physicians by cross-sectional design and stably or temporarily collected data from multi-clinics. Its main funding source are：government，private foundations，companies，academies，academic institutions，and family physicians. Their core experience includes：obtaining sufficient initial funding，rigorous co-design by principle investigators and general practitioners，developing the culture of equality，unity and communication，and reducing the burden of clinicians in conducting research. Conclusion　The successful elements of building early PBRNs in the primary care system include：seeking support from academies and scientific research institutions，building an organizational structure that can unite organizers，researchers，practitioners，establishing a common goal for the development of primary care disciplines，research and practice. develop primary care institution-centered research question and object，conduct rigorous co-design of research，create trustful data collection approach with low workload of clinicians，and obtain sufficient initial funding.

Key words: Practice-based research networks, General practice, Primary health care, Research, Review

汪洋,徐志杰,LI Li,等. 北美基层医疗健康科研网络体系早期的创建和发展：一项基于历史视角的文献综述[J]. 中国全科医学, 2021, 24(28): 3525-3542. DOI: 10.12114/j.issn.1007-9572.2021.00.291.
WANG Yang,XU Zhijie,LI Li, et al. The Development of Practice-based Research Networks in North America in Early Stage：a Literature Review from Historical Perspective　[J]. Chinese General Practice, 2021, 24(28): 3525-3542. DOI: 10.12114/j.issn.1007-9572.2021.00.291.

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