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Clinical trials in primary care

BMJ 1998; 317 doi: (Published 31 October 1998) Cite this as: BMJ 1998;317:1168

Targeted payments for trials might help improve recruitment and quality

  1. Robbie Foy, Research fellow,
  2. Jayne Parry, Lecturer,
  3. Brian McAvoy, Professor
  1. Department of Obstetrics and Gynaecology, University of Edinburgh, Edinburgh EH3 9EW
  2. Centre for Cancer Epidemiology, University of Manchester, Manchester M20 4QL
  3. Department of Primary Health Care, School of Health Sciences, Medical School, Newcastle upon Tyne NE2 4HH

    “Why is it every time that I mention the word reform' GPs reach nervously for their wallets?” These cynical words from Kenneth Clarke, former secretary of state for health, contain a grain of truth. Most British general practices are small businesses, understandably influenced by financial incentives and disincentives—or “the imagination, enterprise and investment assumptions of corner shopkeeping.”1What effect does this have on research in primary care? And would explicit financial incentives improve the amount and quality of primary care research?

    Demand for high quality research in primary care is growing, particularly multicentre randomised controlled trials. But such studies are difficult to conduct, disruptive to routine practice, and may fail to recruit enough general practitioners or patients.2 The Mant report advocates expanding recruitment of multidisciplinary researchers and redistributing funds to support the required infrastructure.3 Such a long term strategy to build capability is essential but will not be sufficient on its own to improve rates of practice recruitment to clinical trials.

    Several factors are known to influence general practitioners' participation in research. One is the level of personal interest in the research topic.4Concern has grown recently that “enquiry led research is becoming endangered with the growth in the …

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