Aims and activities
The overall aim and mission statement of the Primary Health Care Field is as follows:
"To promote the quality, quantity, dissemination, accessibility, applicability and impact of Cochrane systematic reviews relevant to people who work in primary care".
The specific objectives are:
To ensure proper representation in the interests of primary care clinicians and consumers in Cochrane reviews and Cochrane Review Groups, and in other Cochrane entities.
To develop a network of potential users of Cochrane reviews: consumers, professionals, and organizations.
To disseminate Cochrane reviews to primary care clinicians via a Cochrane Primary Health Care website as a means of implementing evidence from Cochrane reviews.
To communicate interests and expertise from Field members to Cochrane Review Groups.
To identify and develop a register of clinical prediction rules (CPRs) relevant to Primary Health Care, in keeping with the Cochrane Screening and Diagnostic Methods Group. (Contact will occur after the transfer of administration - this will initially be conducted by the Dublin arm.)
To identify potential authors and peer referees with a primary health care perspective who can contribute to existing Cochrane Review Groups.
To develop and promote a specialized database of Cochrane reviews relevant to primary health care.
To promote liaison between the Cochrane Collaboration and key primary health care organizations at national and international levels.
To identify funding to support the production of Cochrane reviews with relevance to primary health care.
To develop and disseminate ?Primary care pearls? which will be mini POEMS (Patient oriented evidence that matters) and consist of minimum clinical information from primary care relevant Cochrane reviews. This will initially be conducted by the Auckland arm.
Elaboration of Clinical prediction rules work
Clinical prediction rules are clinical tools that quantify the contribution of the history, physical examination and diagnostic tests and stratify patients according to the probability of having a target disorder. Clinical prediction rules can be used to estimate the probability of diagnosis, prognosis or response to therapy in a wide range of disease specific areas. The objective of clinical prediction rules is to reduce the uncertainty inherent in medical practice by defining how to use clinical findings to make predictions. Every rule should assist the clinician in making a decision based on a combination of factors drawn from the history, physical examination or available diagnostic tests. There are many examples of clinical prediction rules that have improved clinician practice, either in the form of appropriate diagnostic testing or treatment. For example, the Ottawa ankle rule has improved appropriate investigation in the form of x-rays and reduced costs for people presenting to accident and emergency departments with injuries to their ankle, whilst a clinical prediction rule has been developed to stratify patients according to their risk of stroke in patients with atrial fibrillation.
In the primary health care setting there is, as yet, no easily accessible resource of relevant clinical prediction rules. It is proposed that the Dublin arm of the Cochrane Primary Health Care Field develops a register of clinical prediction rules relevant to primary health care. Though not directly related to conventional Cochrane activities in terms of systematic reviews of therapeutic interventions, there is an increasing emphasis and focus on the development of methods for systematic reviews of diagnostic test accuracy studies. It is envisaged that the clinical prediction rule register would relate to the Cochrane Collaboration?s plan to extend systematic reviews to diagnostic test accuracy studies. A register would also provide added value in terms of linkage between the evidence-based therapy resource of the Cochrane Library with evidence-based diagnostic and prognostic clinical prediction rules.
It is acknowledged that methods for producing systematic reviews of clinical prediction rules are less advanced, and not all of the methods for carrying out diagnostic test accuracy systematic reviews apply to clinical prediction rules. In particular, studies of clinical prediction rules involve different quality issues to standard diagnostic test accuracy studies, different methods of analysis, and methods for identifying relevant clinical prediction rules require further development. For these reasons, it is planned that a register of clinical prediction rules is the first step in producing systematic reviews in this process.
Elaboration on the Diet and Nutrition Subfield
Roles for the subgroup include the following:
Promote the conduct of Cochrane reviews of the effects of diet and nutrition on health outcomes
Identify primary studies of diet and nutrition and ensure that these are included in Cochrane databases
Raise awareness of the Cochrane Collaboration in the nutrition and primary care communities
Communicate and collaborate with individual CRGs
Collaborate with Cochrane Methods Groups to develop appropriate methods for including nutrition related studies into Cochrane reviews
Assist in the provision of evidence-based nutritional guidance in the clinical practice
Leadership in this effort was provided by:
Prof Jaap van Binsbergen (who will serve as co-ordinator for the group)
Prof Chris van Weel, Department of General Practice/Family Medicine Radboud University Nijmegen Medical Centre, The Netherlands
Prof Pieter van 't Veer, Division of Human Nutrition, Wageningen University, The Netherlands.
Since the exploratory meeting, approximately 25 Nutritionists, General Practitioners, Epidemiologists, and Methodologists from: The Netherlands, United Kingdom, Australia, Japan, Canada, United States, Finland and New Zealand have signed on as members of the new group. A stable funding source for the subgroup is currently being sought.
Primary Health Care became the first registered field in October 1993. Initially, consideration was given to establishing a Collaborative Review Group, but it was decided to establish a new type of entity known as a "field". This field would serve to coordinate and promote the mission of the Cochrane Collaboration within the primary health care disciplines, as well as ensuring that primary care perspectives are adequately represented within the Collaboration. The Field started in 1993 under the leadership of Prof Chris Silagy and was taken over by Prof Lorne Becker in Syracuse USA.
Diet and nutrition subfield of the Cochrane Primary Health Care Field
In December 2004, an exploratory meeting for a proposed Diet and Nutrition subfield was held in conjunction with the Fourth Heelsum International Meeting in The Netherlands. The Heelsum Workshops are held every 3 years and bring together nutritionists, general practitioners and behavioural scientists to discuss recent research and clinical issues relevant to nutrition in primary care. One half day of the meeting was devoted to the discussion of the potential formation of a Cochrane Diet and Nutrition Field. There was general enthusiasm about a Field from those in attendance. Several issues led to detailed discussion. One involved the inclusion of evidence from non-randomised studies, which are generally not included in Cochrane Reviews, but which form an important part of the evidence base for nutrition. A second issue involved the potential scope of the new entity.
Current structure of the Primary Health Care Field
In 2007, a collaboration of three academic departments of general practice in Auckland (New-Zealand), Dublin (Ireland) and Nijmegen (The Netherlands) took over the leadership from the department of Family Medicine, Upstate Medical University in Syracuse (New York, USA, Prof. Lorne Becker).
Currently, the new collaborators are channelling efforts into new areas such as developing a register for clinical prediction rules (CPRs), setting up a website and tagging existing reviews with ICPC-coded in order to make them more accessible to workers in primary care, enabling the products of the Collaboration to be accepted and adopted into practice.
The Cochrane Collaboration is an international not-for-profit organisation, providing up-to-date information about the effects of health care. We produce the Cochrane Database of Systematic Reviews, part of The Cochrane Library, the definitive resource for evidence-based health care.