Identification of key issues of successful recruitment (using tools such as surveys, panels, forums, professional events, site visits, or face-to-face meetings)

Development and implementation of a recruitment strategy

Leveraging prior relationships with university faculty (personal/professional relationships, teaching practices, residency programs)

Leveraging previous research experience or PBRN experience

Recruiting members of existing PBRNs

Leveraging the potential of recently retired clinicians

Leveraging the experience of practitioner champions or research-motivated practitioners

Identifying practitioner motivation through surveys

Personal motivators for PBRN membership

Practitioner scientific interest, self-motivation, and commitment

Flexibility in research participation (time, level of effort, methods) or protected time for research and research training

Expanding membership to all primary care professionals

Tailoring research to practitioner interests and encouraging practitioner empowerment

Engagement in development of research ideas and research prioritization and proposals

Research with direct impact on practice improvement

Higher degree of education that facilitates PBRN activity

Professional benefits and career development linked to participation

Educational opportunities

Participation in QI activities

Participation in research that is valued or what the practitioners perceive as rewarding

Financial and other incentives

Integrating new knowledge from research into teaching and linking research with practitioner growth

Relevant and easily applicable projects

Development of an integral relationship between practice and research

Structural benefits of data sharing

Direct incentives for investing time and effort into innovations

Research participation that is made motivating or even fun

On-site, hands-on research assistance

Other support or benefits/perks incorporated into membership

Access to more robust resources and benefits derived from economies of scale

Reaching a large sample size

Enabling research on unexplored/understudied topics

Access to large, geographically dispersed, and demographically diverse populations allowing research that cannot be conducted otherwise

Access to technological, administrative, and scientific resources and expertise through a shared infrastructure

More rapid diffusion of learning and resources

Rich diversity of member experiences and backgrounds

Availability of highly research-motivated academics who can help initiate the network

Knowledge and resources that reside within the academic discipline

Academic contribution to the development of a real-world research laboratory

Academic research expertise, scientific rigor, and fundraising potential

Academic contribution to research capacity building and practitioner empowerment including mentoring and supervising emerging researchers

Publications that enhance the primary care discipline

Better fundraising potential by leveraging the reputation of academics

Academic contributions to infrastructural funding and in-kind support (including academic and PBRN staff, logistics, administration, technology)

Academic engagement in the governance of PBRN

Academic support for career development (fellowships, grants, support for further education)

Academic initiatives to link medical students and residents to PBRN activity (“pipelining”)

Development of PBRNs that can supply data for external research

Practice-based research infrastructure may become cost-effective over time

Low-cost research assistance by involving medical learners

Cost-effective research by leveraging longitudinal data flowing from the membership

Networks that can be built more rapidly through academic connections

Dedicated funding for infrastructure or long-term funding commitment (eg, from national agencies, national professional organizations or health organizations, international governing bodies)

Contributions from members

Dedicated funding for research capacity building

Development of business models for research and QI activities

Development of shared vision and common identity

Sustainable relationship building through on-site visits

Development of long-lasting collaborative relationships within and beyond the PBRN

Multidirectional communication, participatory membership model, appreciation of each other's preferences, values, and culture

Fostering research relationships by establishing partnerships along common interests, collegiality, and maintaining enthusiasm

Establishing collaborations across various disciplines and levels of seniority

Developing relationships of trust and respect between clinician members and academics and between members, governing boards, and practice managers/staff

Peer support from practitioners-champions (in research) to novice practitioner-researchers

Linking academicians with novice practitioner-researchers through mentoring

Satisfaction emerging from the achievements of small start-up projects

Developing strong bonds with academic mentors

Skill development based on mutual support and shared resources that add value to network products

Leveraging prior relationships with academia

Leveraging relationships established during previous QI activities or training

Partnering for shared learning and best practice implementation

Building on the ties between residents and community preceptors

Linking students to network activities

Linking practitioner research capacity building to asking timely research questions and the integration of practice-based research and QI outcomes into practice

Setting up a network upon a core of practice-based research motivated and experienced members

Governance that provides benefits for all members

Leaders who are champions and possess knowledge, energy, enthusiasm, and commitment to promoting PBRNs or practitioners with strong bonds to academic faculty

Reputation/track record of recognized academics involved in organizational leadership that help sustain the network

Strong leadership that applies close monitoring and frequent multidirectional communication

Data that are representative of the populations of interest

Data interoperability that facilitates collaborative medicine and the implementation of multiple functions such as clinical decision tools

Data that can support QI activities

"Big data” aggregation that allows population-level information on primary care delivery and building capacity for multiple concurrent (or longitudinal) studies

A specific QI-informed mission that becomes an incentive for PBRN membership

Social and collaborative learning aspects of QI

Development of combined research and QI methodology promotes faster research translation

The impact of QI activities on daily practice through the implementation of best practices

Supporting QI activities using well-designed HIT tools

Training activities as a bridge to building relationships between practitioners and academics

Linking professional development with PBRN activity and providing dedicated funding to academic departments to participate in PBRN activity

Dedicated funding and supportive initiatives for training

Engagement in PBRN activity during and as a follow-up to residency

Building learning communities as one of the main objectives of a PBRN

Member motivation to share resources and to learn from and share practice-based knowledge and best practices

Member motivation to participate in the development and sharing of practice innovation and/or transformation

Member motivation to experience an exchange of knowledge and expertise between academia and practitioners

Open and frequent communication using multiple means of synchronous and asynchronous methods

On-site visits of practitioner champions/exemplars/peers when they may exchange hands-on experience and advice and teach by example

Frequent on-site visits for research assistance to maintain interest and enthusiasm

Facilitating problem solving in everyday practice as part of a community

Events that promote interaction between members (academic–practitioner/practitioner–practitioner), intellectual exchange, and matching

Breaking down practitioner isolation

Sharing information about the progress of research (feedback, eg, via newsletters)

Frequent meetings of the oversight bodies

Empowering practitioners through ongoing communication

Clinician and staff turnover

The burden (time, effort, and cost) of research

Larger practice size may result in increased research demands

Competing organizational priorities and workflow changes

Concerns for lost productivity due to research

Research ethical oversight-related challenges

Attracting and maintaining practice interest

Lack of support for research activities by practice leadership

Lack of cooperation from the clinic staff

Lack of research champions in the practice

Limited research support by experts

Low research capacity resulting in low engagement in research

Reorganization or transformation of practices

Limited practice space available for research activity

Negative research experiences in the past

Not valuing practitioner contributions to research

Time constraints to participate in PBRN activities

Competing priorities between providing clinical services and research participation

Sustained participation in network activities (membership retention)

Moderate motivation for research

Barriers related to professional role (eg, nurses have no access to clinician records)

Lack of research skills and support to develop research skills

Lack of understanding the research methodology and low scientific rigor in research procedures

Restricted career opportunities for FPs/GPs and other primary care professionals

Lack of skilled mentorship

Insufficient access to a pool of scientific knowledge and resources necessary for research and evidence-based practice

Lack of academic connections or knowing who to turn to for information

Lack of remuneration for practitioner time spent with research

Poor self-image of FP/GP when envisioning their role and their position in the health care system or seeing themselves as researchers—lack of confidence in their ability as researchers

A delayed development of family medicine/general practice as a distinct discipline

Lower capacity of primary care academics to attract external funding

Academia-driven PBRN research, which may not be important for the practitioners in the field

Academic-dominated research topics and top-down research processes

Lack of continuity in administrative and/or overall infrastructural funding and dependence on project-based grant funding for infrastructure support

Discrepancies between network mission and funder interest

Lack of systematic support to cover infrastructure cost

Lack of financial compensation for PBRN member participation in research

Limited funding for practice-based research

A vicious circle where outside project-related funding is difficult to obtain until the network has a track record, but it is difficult to develop a track record without outside start-up funding

Criticizing instead of supporting low-performing practices in research projects

Low trust between academics and practitioners

A fear of displacement of practitioners by academics in research

Creation of a sense of identity

Geographic dispersion of networks as a logistical challenge

Lower generalizability of research due to small numbers of participating practices

Challenges related to local and national realities, cultures and structures, and the additional length and cost of processes that define wide-scale activity in large networks

Complexity of maintaining a multilevel infrastructure in international PBRNs

Research data quality pertaining to recording (documentation), coding, and confidentiality

The importance of patient data privacy for the primary care practitioner

Setting agreements/rules about research data ownership, security, use, and sharing

Health data quality as it relates to the quality of documentation

Maintaining data quality in longitudinal studies

Data duplication as it relates to overlapping care episodes and care sites

Small network size may affect the validity of outcomes

Retrospective collection/analyses of recorded data

No uniform diagnostic and classification criteria or terminology for health conditions across the network

Variable primary care service coding practices

Representativeness of practices, practitioners, and patient population

Selection bias when establishing patient database

Voluntary membership may affect the quality of data

Interpretation bias may occur in research where different cultures and education are involved in international networks

Multipractice studies require more personnel time, travel, equipment, and supplies

Research may be more difficult in international networks that interact with populations associated with different language, means, and social context

Increased complexity of research coordination, lengthened timelines, and higher research costs in large networks

Identifying appropriate research study designs for specific studies that are also sensitive to the network environment

The model of health care delivery affects research planning and sufficient subject recruitment and retention

Restricted opportunities to frame and translate research results when practitioners have no strong participation in research

Risk for communication gaps between practitioners and academics in large networks where communication happens through conveners

Communication clarity may be challenged by time constraints

Lack of good communication and understanding during research activities

Problems deriving from distance communication during research studies