The challenges and recommendations for the implementation of PC-PBR indicate operational, structural and political issues. One of the key aspects learned about planning a PC-PBR study is to identify and include all stakeholders (patients, employees, doctors and administration) in the development phase of the project, allowing for discussions about the study design and its implementation phases. This approach must become a constituent part of the study, being comprehensive to addressing barriers to participation, to obtain data, to analyze and interpret the results and, finally, to discuss its findings and implications. Additionally, planning data collection that demands little effort from the health professionals can strengthen the study’s realization and the involvement of everyone in the study.
PC-PBR only happens if the professionals who are directly involved in patient care and health service management are integrated as part of the team of researchers, not being only the subjects of the research. Though it is a great challenge, training health care professionals to conduct research in primary care is fundamental for the success of these projects7,18,20,36,39.
Alternative research approaches, such as implementation research, have advanced and grown as new strategies to reduce the gap between research and practice, mainly because they systematically approach the factors that contribute to this gap, understanding the context and identifying barriers and solutions for delivering sustainable and effective health care.41 Thus, to make progress in overcoming these structural barriers it is important to understand the essential pieces of the research process, without which a project will likely die prematurely. One of these elements is the minimal infrastructure required for PC-PBR research projects to be long-lasting and sustainable.9,36
The studies under analysis point out that the most promising way for this to happen is through collaboration between primary care services, universities and research institutes. In addition, these collaborations can provide training in research skills for health professionals, creating an conducive environment to exchanging experiences, ideas and questions about the practice. All of these suggestions will help to create a research agenda oriented towards solving real issues related to taking care of patients in primary care, which is the main objective of conducting PC-PBR7.
The distance between universities and primary care settings is recurrently cited. This issue reinforces the idea that there is a place where knowledge is produced (universities and academia) that is different from the places where health care occurs. In other words, primary care seen as a place where scientific evidence produced by academia is put into practice.
Conducting scientific research within primary care practices is innovative and can create ruptures and conflicts when it affects the way the job is done or when it takes people out of their comfort zone. By placing health professionals—and at times, patients—as agents of research production, PC-PBR can change the way new knowledge is produced. If knowledge is traditionally produced in academia and then taken as a truth by the place where patient care happens, PC-PBR can not only generate new knowledge to change its own professional practice, but it can also bring new evidence to change the way academia works, guiding new research that is better aligned with reality.37
In some countries, a more horizontal construction of new evidence and knowledge translation can be seen between academia and health care practice. In Australia, for example, PBR protocols are designed with the aim of building a sustainable collaboration between a PBRN and an Advanced Center of Research and Translation in Health to build a research platform for planning, conducting and translating research evidence to improve care across the health care spectrum.42
Aligned with the need for partnership between universities and practices, international collaborations are also an opportunity to guide professionals in places where universities and research institutes are not yet established. Cases like Australia and New Zealand, where two PBR networks were established to incentivize research in the area of osteopathy, show that PBRN has the potential to facilitate the access of professional researchers and clinics that are interested in collaborating with clinical tests and, thus, offer the scientific community an opportunity to conduct research with different methodologies in diverse contexts.42
Regarding the difficulties in engaging health professionals in PC-PBR, some examples listed in the articles were little experience in scientific writing, difficulties reading articles in foreign languages, limited self-trust and lack of training to start and conduct studies. Thus, studies recommend that universities and research institutes organize training courses to develop research skills, as well as exchanging experiences to determine shared research priorities7.
Though essential, the development of research skills is not enough for the professionals to engage with and incorporate studies into their places of practice. For PC-PBR projects to advance, leadership is necessary to influence policy makers and managers, and advocate for studies to be directly connected with the practice where health care happens.
The majority of the selected studies highlighted the medical category in the discussion about PBR. However, it is important to expand the professional composition of PC-PBR beyond and consider other categories with the goal of organizing more participative and multidisciplinary studies. All health professionals must be invited to interact and collaborate with scientific activities and implement new projects. The inclusion of all health professionals, including community health workers, nursing assistants, and dental hygienists, who are commonly found in LMIC, can improve the development of research projects that will better take into consideration the patients’ and the territory’s needs.7
Implementing PC-PBR goes beyond research production, since the results of the studies produced by researchers, health professionals, users and managers, in addition to the lessons learned, are shared with the health service where the study was held, bringing greater transparency to the entire process and motivating more health professionals to actively participate in future research projects.33
Limitations
As this review was limited to literature that reported lessons learned and experiences conducting PC-PBR, few empirical studies with primary data from the practice were found. Additionally, there is little representation from LMIC. This limits the conclusions of this review to the contexts described here, i.e., HIC where PHC already has a solid structure and a robust research production. Exploring studies performed in PC-PBR networks and identifying their strengths and weaknesses would be a step forward in this sense, but it would demand greater operational efforts. However, this is a first review that is necessary for the advance of primary care research mainly in LMIC.