Intended for healthcare professionals


Primary care is natural place for clinical research and practice

BMJ 2000; 321 doi: (Published 16 December 2000) Cite this as: BMJ 2000;321:1529
  1. Maurizio Bonati, head (mother_child{at}
  1. Laboratory for Mother and Child Health, Mario Negri Research Institute, 20157 Milan, Italy

    EDITOR—In his editorial Thomas pointed out that primary care, because of its complexity, is not an easy place to conduct research, despite the great need for more research to be carried out.1 In Italy collaborative groups of general and paediatric practitioners have been performing observational studies for some time but cannot, by law, organise or participate in randomised clinical trials. A few studies reported in the literature have therefore to be considered illegal for doctors in Italy. 2 3

    The voluntary participation of practitioners in formal clinical research is a core resource for independent and qualified research, but a recognised body of legislation is fundamental for defining mechanisms and for stimulating participation. More efforts, especially those that are characterised by a more formal participation, are needed in every country. In Europe these should take into account the new European health strategy recently proposed in an attempt to harmonise the delivery of health care and to overcome political and economic misinterpretations.4 Unfortunately, once again, primary care is hardly considered; proposed networks seem more oriented towards arranging guidelines and statements than harmonising different priority issues in different settings.

    The challenge of carrying out clinical research in primary care while creating networks of general practitioner researchers should be one of the priorities at regional, national, and European levels. Since most patient contacts with health professionals occur in primary care this is the natural laboratory of clinical research and practice, where effectiveness, efficacy, and safety of care can be assessed and guaranteed to all.5


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