This paper outlines the importance of Implementation Research
in primary health care and the context in which it operates. The
first section gives background to the vital role of implementation
research in developing and supporting health care delivery,
systems and services, and the importance of closely linking
implementation research to primary health care to achieve this.
The second section outlines the background, purpose and role
of the IIRNPC and to discuss network activities in 2014

Australian National University. Australian Primary Health Care Research Institute (APHCRI)

English

The Australian National University

ANU College ofMedicine, Biology  & EnvironmentAustralian Primary Health Care Research InstituteBuilding 63 Cnr Mills and Eggleston Roads The Australian National University ACT 0200T +61 2 6125 0766 F +61 2 6230 0525aphcri.anu.edu.auA U S T R A L I A N  P R I M A R Y  H E A L T H  C A R E R E S E A R C H  I N S T I T U T EA N  I N T R O D U C T I O N  T O  T H E I N T E R N A T I O N A L  I M P L E M E N T A T I O N R E S E A R C H  N E T W O R K  I N  P R I M A R Y  C A R E International Implementation Research Network in Primary Health Care 1C O N T E N T SBackground 5Implementation research and its role 6Implementation research and primary health care: 9An important, interdependent relationshipMembership of the IIRNPC 10Conferences in 2014 12References 13International Implementation Research Network in Primary Health CareAustralian Primary Health Care Research Institute2 Australian Primary Health Care Research Institute International Implementation Research Network in Primary Health Care 3Implementation research, as it applies specifically to health, is a type of health policy and systems research concerned with the study of clinical and public health policies, programs and practices, with the basic intent being to understand not only what is and isn't working, but how and why implementation is going right or wrong, and to test approaches to improve implementation. - (Peters DH et all, WHO 2013 p27)4 Australian Primary Health Care Research Institute International Implementation Research Network in Primary Health Care 5BackgroundP U R P O S EThis paper outlines the importance of Implementation Research in primary health care and the context in which it operates. The first section gives background to the vital role of implementation research in developing and supporting health care delivery, systems and services, and the importance of closely linking implementation research to primary health care to achieve this. The second section outlines the background, purpose and role of the IIRNPC and to discuss network activities in 2014.In 2011, the Commonwealth Fund, US Agency for Healthcare Research and Quality, and the Australian Primary Health Care Research Institute (APHCRI) funded an international collaboration titled, International Learning on Increasing the Value and Effectiveness of Primary Care (I LIVE PC) (special issue JABFM April 2012). The collaboration concluded that a solid foundation of primary care is an essential ingredient for effective, efficient and equitable delivery of health care. Health systems in most developed nations, other than the United States, have long recognised this and supported robust primary care capacity.  Several countries have undertaken major health system transformations in the past decade, often including experiments with primary care to try to improve their outcomes. These system transformations hold lessons for other countries to share. Examples include the United Kingdom and The Netherlands which are reducing primary care patient panel size and moving more to group practice models. Australia recently created primary health care organisations with geographies of accountability, borrowing from the United Kingdom and Denmark and is also creating “superclinics” with broader primary health care team capacities. The Dutch are receiving new payments to support chronic care management through practice consortia. The success of this initiative resulted in a follow-up meeting during the International Health Care Reform Conference in Brisbane, Australia in March 2012 when the International Implementation Research Network in Primary Care (IIRNPC) was established jointly by APHCRI and the APHCRI Centre of Research Excellence (CRE) in Primary Health Care Microsystems (University of Queensland). The purpose of forming the IIRNPC is to create a learning collaborative focused on shared lessons and the science of practice and health system transformation. Following the Brisbane conference, an initial program of IIRNPC activity commenced with the CRE creating a basic infrastructure to support the IIRNPC including mailing lists, website, e-newsletter, forums and a repository of publications and resources.  APHCRI has since been establishing contacts, particularly in Asia, to extend the IIRNPC. In 2013, a follow-up to the Brisbane meeting was organised in Ottawa to refine the aims and objectives of the IIRNPC and to identify areas of work that could be undertaken in 2014.6 Australian Primary Health Care Research Institute International Implementation Research Network in Primary Health Care 7Implementation research and its role"Implementation research is the scientific enquiry into questions concerning implementation - the act of carrying an intention into effect, which in health research can be policies, programmes, or individual practices (collectively called interventions)." (Peters DH et al, BMJ 2013). One of the most critical issues impeding improvements in health today is the enormous inconsistency between those interventions which we know can optimise population health and health care delivery and those which are actually implemented in everyday practice (Green et al 2009). Further, it is well documented that only a fraction of primary care research is translated to policy and practice (Woolf 2008, Green et al 2009). Implementation research seeks to address this gap by using scientific methodologies that support the movement of evidence-based research into policy and practice in order to benefit individuals and society (Brownson et al 2012, Rubenstein and Pugh 2006). No single set of methods define implementation research however there are approaches to research that are more suited to a focus on implementation and which support the critical principles of relevancy and engagement with stakeholders. Multiple stakeholders are involved in the development and implementation of new approaches to heath care including: patients/users of health care, community leaders, policymakers, primary health care professionals, scientists and experts in the field of implementation science. These stakeholders each represent vital, unique expertise in the design process and application of innovations in health care. Their interaction will ultimately determine the success of health care reform/improvement. “Primary health care is socially appropriate, universally accessible, scientifically sound first level care provided by health services and systems with a suitably trained workforce comprised of multi-disciplinary teams supported by integrated referral systems in a way that: gives priority to those most in need and addresses health inequalities; maximises community and individual self-reliance, participation and control; and involves collaboration and partnership with other sectors to promote public health.” - WHO Alma Ata on Primary Health Care8 Australian Primary Health Care Research Institute International Implementation Research Network in Primary Health Care 9‘Research on implementation requires the engagement of a wide range of stakeholders and draws on multiple disciplines in order to address complex implementation challenges… at its best, implementation research is often a collective and collaborative endeavour. It is therefore essential that all stakeholders understand the importance of collaboration in the implementation of the research endeavour.' - Peters. D. H. et al, WHO 2013 p5Primary health care has been identified as a critical function in the health care system, for effectiveness and cost-effectiveness of population health (Starfield B et al 2005). Better primary health care is related to better population health at lower health care costs. The World Health Organisation (WHO) considers primary health care to be the pivotal factor in the design and implementation of robust health care systems and has ‘strongly reaffirmed the values and principles of primary health care, including equity, solidarity, social justice, universal access to services, multisectoral action, decentralization and community participation as the basis for strengthening health systems’ (WHO 2009). In addition, through its functions, primary health care can have an impact beyond health on the resilience and wellbeing of individuals and communities. The implementation research approach is consistent with the values of primary health care and is able to reflect the widely different social and environmental context of individuals and communities in all parts of the world. Coordinating this focus on implementation and strengthening the impact of research is an innovative approach to health care improvement and reform.Benefits of an IIRNPCThe benefits of an IIRNPC, focussed on promoting implementation in primary health care research and supporting national multi-stakeholder forums through international collaboration, will make research more central and relevant to primary health care policy and service delivery. The focus may also help with translating learning from one country to others and develop a research community capable of studying and improving this process.Given the alignment of the intent of the IIRNPC with APHCRI’s role, it was agreed that APHCRI will be the strategic lead for the IIRNPC with the CRE in Primary Health Care Microsystems (University of Queensland) providing operational support to the IIRNPC. The draft purpose, objectives and work program for the IIRNPC are presented below for discussion. Role of the IIRNPC The IIRNPC is an international collaboration of primary health care researchers and stakeholders with a shared vision of advancing the field of implementation research and its specific application to bridging the gap between primary care research, policy, and practice in order to speed translation and transformation of care. Purpose of the NetworkThe IIRNPC‘s overall purpose is to create an international learning collaborative to enable primary health care to effectively fulfil its central functions in equitable and sustainable health systems through the sharing of research that informs policy and service development and improves the quality of health care.ObjectivesThe Network has six specific objectives to:1. Support and promote the conduct of high quality implementation research in primary health care and disseminate findings2. Demonstrate the value and appropriateness of implementation research to the development of primary health care policy and services3. Develop the skills and expertise of primary health care researchers and stakeholders in implementation research4. Promote the value of implementation research methods in the assessment criteria for primary health care research funding5. Provide opportunities for international collaboration to share learning, identify mutual priorities, test translation of innovation, and implement evidence-based primary health care services. 6. Develop international collaborations to translate research findings into evidence useful to policymakers and service providers.Implementation research and primary health care: an important, interdependent relationship10 Australian Primary Health Care Research Institute International Implementation Research Network in Primary Health Care 11Membership of the IIRNPC Membership of the IIRNPC is open to groups and individuals who share this vision. IIRNPC members are likely to play an active role on a national or international level in the implementation of primary health care research. They are also likely to be involved in national multi-stakeholder collaborations to promote, support and develop implementation research in primary health care policy and service delivery. It is envisaged that members will contribute to IIRNPC activities, including sharing of their work with a national and international audience. Membership is free of charge. Members are responsible for any costs of their participation in IIRNPC activities, unless specific funding has been secured through the IIRNPC. Country contacts for the IIRNPC are available on the APHCRI website.Initially a basic infrastructure to support the IIRNPC’s work will be established. Some of this work has already commenced and will include developing and maintaining IIRNPC communication modes including website, mailing list and forum and identifying international networks and organisations representing the interests of policymakers, consumers and primary health care service providers.Communication and enlisting of members will continue through existing networks of contacts and promotion at various conferences scheduled for 2014. In some cases these will provide venues for face-to-face meetings of IIRNPC members. Contact detailsAssociate Professor Terry Findlay; Head of Programsterry.findlay@anu.edu.au Professor Chris van Weel; Professor of Primary Health Care Researchchris.vanweel@anu.edu.auEmma Whitehead; Research Implementation Coordinator emma.whitehead@anu.edu.auAustralian Primary Health Care Research Institute The Australian National UniversityBuilding 63, cnr Mills and Eggleston RoadsACTON ACT 0200AUSTRALIAPhone: +61 2 6125 2384Fax:  +61 2 6230 0525Mobile: 61 (0)412949620 (Terry Findlay)     5   Building mechanisms for stakeholder collaboration • Promoting and supporting national collaborative networks of PHC researchers and stakeholders by facilitating sharing of international experience about evidence-based PHC development •Example: support development of individual country platforms for collaboration as requested •Example: program of visiting experts eg APHCRI Visits [Australian visiting experts program] and USA's Washington embassies program Developing skills and experience of researchers •Establish mechanisms for developing PHC researcher skills in implementation including an understanding of PHC provider and policy enviroments •Example: developing international exchange programs  focused on implementation between academic institutions (eg Radboud University Nijmegen, Robert Graham, ICIS, joint Australian & NZ/Canadian Research CREs) •Example: conduct workshops to develop researcher skills in Implementation Research such as in Brisbane, March 2014 and consumer engagement training  program for researchers being conducted in Australia in 2014  Communications and networks •Promote and establish communciation methods and modes •Example: regional WONCA conference, Malaysia 2014 to engage national networks of PHC stakeholders •Example: develop IIRNPC website functions •Example: establish annual network forum meeting (eg NAPCRG New York, USA, November 2014) IIRNPC network activities 2014   The Australian Primary Health Care Research Institute (APHCRI) plays a key role in Australia’s primary health care system through leading, funding and otherwise supporting priority-driven research into primary health care. APHCRI has three main objectives to:1. Support priority-driven primary health care research2.  Increase the capacity to undertake primary health care research3. Drive the implementation of research into primary health care policy and practice.12 Australian Primary Health Care Research Institute International Implementation Research Network in Primary Health Care 131. IIRNPC website (as at 27.02.14) http://www.aphcricremicrosystems.org.au/international-implementation-research-network-iirnpc 2. I LIVE PC produced a special issue of the Journal of the American Board of Family Medicine (http://www.jabfm.org/content/25/Suppl_1.toc). 3. Peters DH, Adam T, Alonge O, Agyepong IA, Tran M. Implementation research: what it is and how to do it. BMJ 2013; 347:f6753 4. Green LW, Ottoson JM, Garcia C, Hiatt R. Diffusion theory and knowledge dissemination, utilization and integration. Annual Review of Public Health 2009; 30:  151-174 5. Woolf SH, The Meaning of Translational Research and Why It Matters. JAMA. 2008;299(2):211-213. doi:10.1001/jama.2007.26. 6. Brownson RC, Allen P, Duggan K, Stamatakis KA, Erwin PC. Fostering More-Effective Public Health by Identifying Administrative Evidence-Based Practices: A Review of the Literature.  AJPM 2012; 2012;43(3):309-319 7. Rubenstein LV, Pugh J. Strategies for Promoting Organizational and Practice Change by Advancing Implementation Research J Gen Intern Med. 2006 February; 21(Suppl 2): S58–S64. doi:  10.1111/j.1525-1497.2006.00364.x 8. David H. Peters, Nhan T. Tran, Taghreed Adam, I.Peters,. Implementation Research In Health; A Practical Guide Alliance for Health Policy and Systems Research. World Health Organization 2013. ISBN 978 92 4 150621 2  (pages 27 and 5) 9. Starfield B, Shi L, Macinko J. Contribution of primary care to health systems and health. Milbank Q 2005;83(3):457–502. 10. World Health Organization. World Health Assembly: Primary Health Care, including health systems strengthening Resolution WHA62.12, 22 May 2009. 11. APHCRI Statement of Strategic Intent 2013-2016 [The description of Primary Health Care provided is used by APHCRI, based on the World Health Organisation definition].Rocking the Boat: 2nd International Primary Health Care Reform ConferenceMarch 2014, Brisbane, Australia>  Workshop for researchers; developing implementation research skills, linking to policy makers and service providersPrimary Health Care Research ConferenceJuly 2014, Canberra, Australia>  Promoting IR methods and funding opportunities>  Engaging multi discipline stakeholders to collectively establish an international implementaton research CRENorth American Primary Care Research Group (NAPCRG) Annual ConferenceNovember 2014, New York, USA>  Annual Forum of the Network>  Multi discipline stakeholder engagement, including consumer voicesConferences in 2014 References

International Implementation Research Network in Primary Health Care

https://openresearch-repository.anu.edu.au/bitstream/1885/139349/1/Introduction to IIRNPC.pdf

International Implementation Research Network in Primary Health Care

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