Table 4.

List of Facilitators and Barriers

Practitioner Participation
  • 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

Membership in Large Networks/Networks of Networks
  • 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

Academic–Practitioner Partnership
  • 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

Infrastructure and Operations
Infrastructure Funding
  • 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

Relationship Building between Academics and Practitioners in the Field
  • 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

Governance and Organizational Leadership
  • 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 Collection and Management
  • 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

QI Activities
  • 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

Learning Environment
  • 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

    Fostering Learning Communities
  • 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

Clinical Practices
  • 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

Financial Barriers
  • 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

Relationship Building
  • 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

PBRN Structure
  • 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 Concerns
  • 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

Research Study Design
  • 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

  • FP, family physician; GP, general practitioner; HIT, health information technology; PBRN, practice-based research network; QI, quality improvement.