Towards evidence-based practice via practice-based evidence: the Italian experience.

Abstract

BACKGROUND: Research is a fundamental tool for GPs' clinical practice. Independent research should be the answer to important questions on population needs not yet answered. To have a democratic approach, the results of the studies should be available not only to GPs but also to patients participating to the research. Research has also a formative value for investigators: a process of learning by doing. Risk and Prevention Study is a model of the 'Italian experience' in doing research in primary health care. OBJECTIVE: To describe the collaboration between Centro Studi e Richerche in Medicina Generale and Mario Negri Institute in producing observational and experimental research in the setting of family medicine such the Risk and Prevention Study. METHODS: Risk and Prevention Study has two main aims and two different methods: the first, to establish the effectiveness of an intensive recommended treatment and lifestyle advice in cardiovascular (CV) prevention is an observational design. The second, the efficacy of n-3 polyunsaturated fatty acid in patients with CV risk is a randomized controlled trial design. RESULTS: The Risk and Prevention trial has enrolled up until now 860 Italian GPs and over 12 500 high CV risk patients that will be followed during 5 years. They will visit their GP at least once a year. The first year of follow-up of the study has been completed. Relatively few patients (2.5%) have withdrawn. The treatment was well tolerated. CONCLUSIONS: Enrolment of large number of GPs in research appears feasible when an independent design with clear benefit for the patient's needs is offered.