Primary care research in Norway: going in the right direction

Although the goals for research based in secondary care in Norway are ambitious – and are accompanied by strong financial incentives following a hospital reform in 2002 – primary care research has not been given the same resources or attention. In 2001, we implemented a registered list system for GPs, which boosted enthusiasm and recruitment to primary care – at least initially [1]. Since then, several white papers and reforms have emphasized that primary care should be even more comprehensive and have more responsibilities [2,3]. In particular, the Coordination Reform initiated in 2012 transferred many and often severely ill patients from secondary to primary care. This should call for more and better primary care research. However, two barriers are apparent when addressing research in primary care: First is the difficult access to GPs, primary care patients, and data due to missing infrastructure [4]. Second are the small primary care research environments, with limited resources for taking on larger projects. In the scientific evaluation of the Coordination Reform, researchers from different disciplines admitted that the evaluation would have benefitted from data from GPs. However, getting access to such data was considered an extremely difficult, not to say hopeless, enterprise. The result was that important aspects of the reform simply were not evaluated [2]. Some countries have managed to do something about this situation [5], and in Norway there is a joint initiative among all general practice research departments and units to get funding and to establish a primary care research network [4]. In the interim, the health authorities want to set up a nationwide Primary Care Registry, which will initially be based on two existing administrative registries (one for general practitioners’ remuneration data and one for receivers of municipal care). The registry is supposed to be running from 2017. Although the primary goal is quality improvement and health service planning, research is a secondary aim. Substantial work must be done to validate the data, in particular, the diagnoses. The registry will improve access to data and, provided competent validation, the research output of relevance to GPs is expected to rise. In the past 10 years, primary care research institutions have been strengthened through the establishment of four research units for general practice, a national competence center for emergency primary health care, a center for antibiotics in primary health care, a center for rural medicine and five centers for care research. Although all of these are relatively small on their own, all health research centers have been collocated with university departments, which assure collaboration, mutual support and synergetic effects. This has had a tremendous effect on research output, documented recently in the first report on primary care research in Norway [6]. These centers have basic funding from the Ministry of Health, but receive considerable external funding from the Norwegian Medical Association’s Funds for Research in General Practice, the Research Council of Norway, as well as from other sources. The four general practice research units were established with the Danish research units as models, which demonstrates the importance of Nordic exchanging of ideas. Until now the total research output and funding resources of primary care has been barely documented. This is contrary to the situation in secondary care research, which has been closely monitored for several years by the Nordic Institute for Studies in Innovation, Research and Education (NIFU), commissioned by the Research Council and the Ministry