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Section title:

Primary Care CSG

Introdution:
Introdution:

Chair:  Dr Steve Iliffe, University College London

Research into neurodegenerative diseases in primary care is as underdeveloped as primary care services for patients with these diseases. Because they are either relatively uncommon (like some dementia and Parkinson’s disease) or just rare (for example MND and Huntington’s disease) primary care practitioners do not easily develop experience in their management.
 
Primary care researchers also tend to focus on very common problems (the management of respiratory tract infections), or at least those that are relatively common but with a high impact (like heart disease, diabetes and hypertension). DeNDRoN’s Primary Care Clinical Studies Group therefore starts from a low baseline of research activity, but at least this means that any progress is immediately obvious.
 
The Primary Care CSG has met twice, first to consider its terms of reference and to initiate debate about research priorities in neurodegenerative diseases, and subsequently to develop research ideas further. Its founder members include three general practitioners, two clinical psychologists, a health services researcher, an academic social worker, a neurologist and an old age psychiatrist. All have research and development expertise, as well as clinical/service experience in neurodegenerative disorders. We are co-opting an epidemiologist and an additional general practitioner to extend the range of expertise available to the CSG. We have had user involvement from the outset and are expecting to increase this.
 
Research priorities:
  • Clinical predictors of conversion from MCI to dementia syndrome
  • Secondary prevention of progression from MCI to dementia syndrome
  • Improving early recognition in primary care (dementias, Parkinson’s disease)
  • Characterising pathways into services (for diagnosis, treatments and support)
  • Secondary prevention of disablement in diagnosed dementia syndromes
  • Effects of co-morbidities on dementia progression
  • Effects of case management of comorbidities on dementia progression
  • ‘Best buy’ models of generalism/specialism in neurodegenerative disorders
 
These themes were matched against research methodologies like: prospective longitudinal studies in unselected populations; development, feasibility testing and trialling of interventions, particularly educational ones; retrospective database analysis; and Fourth generation/Realist approaches to service evaluation. The debate in the CSG is now about refining and prioritising themes, and focusing on specific research questions that could be the basis of future research proposals, or that could inform calls for research from major funders.
 
A gratifying number of funded research projects relevant to the CSG are now coming on stream, including two NIHR five year programme grants led by CSG members, and a smaller study funded by the Alzheimer’s Society on developing psychosocial interventions for dementia in general practice. The Primary Care CSG has two further objectives: to develop its ideas about primary care research in Parkinson’s disease, and to explore the overlap between its current research agenda and that of the Dementia CSG.



 
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