The 4 steps to promote family medicine research in Japan
By Makoto Kaneko MD, PhD
As stated by Prof. Ian McWhinney, one of the legends in family medicine, to be recognized as a discipline “an active area of research” is indispensable (McWhinney 1966). In Japan, although the Ministry of Health Labour and Welfare (MHLW) has indicated the importance of primary care, a range of stakeholders have debated the necessity of family medicine as a medical discipline in the Japanese healthcare system (Kaneko et al. 2019). Therefore, we Japanese family physicians, need to conduct clinical research and promote constructive evidence-based discussions based this research. I would like to propose 4 steps to promote family medicine research in Japan.
Step 1: Grasp the current situation
Step 2: Share a roadmap and encourage multidisciplinary collaboration between clinicians and researchers
Step 3: Create the right environment for building research capacity
Step 4: Develop a strong academic department of family medicine to build strong primary care
Step 1: Grasp the current situation
A recent study revealed the proportion of Japanese articles in a high-impact international primary care journal was only 0.15% (Aoki et al. 2017). Also, the proportion of qualitative and mixed methods research presented at the Japanese primary care conference was lower than that presented in the UK and the US (Kaneko et al. 2018). Such a description is useful to keep in mind regarding the current situation in Japanese family medicine research. We need to detect an appropriate indicator to promote clinical research. Also, we should reassess the indicator periodically.
Step 2: Share a roadmap and encourage multidisciplinary collaboration between clinicians and researchers
In 2019, Goodyear-Smith and colleagues reported research priorities in low- and middle-income countries (Goodyear-Smith et al. 2019). According to their results, below are the top-ranked research questions for primary health care (PHC) organization and financing:
Organization
“What are the factors to be considered and negotiated for successful referral from primary to secondary care and back (Brazil)?”
“How should care be horizontally integrated and coordinated among the multidisciplinary PHC team (South Africa)?”
“How can the public and private sectors work more collaboratively to improve and integrate PHC coverage and prevent segmentation of services (Malaysia)?”
“How can different stakeholders (e.g. policy makers, health system managers, health workforce organizations, academic institutions and communities) support and assist the primary health care workforce and successful team functioning (Nigeria)”
Financing
“What is the most appropriate payment system to increase access and availability of quality PHC (Croatia)?”
“What mechanisms have been found to be effective in persuading governments to invest in PHC (Kenya)?”
“What are the factors or incentives that can improve distribution of PHC workforce or equity of accessing PHC services (Caribbean)?”
“What is the ideal proportion of the total health care budget that guarantees the development of quality PHC (Turkey)?”
Japan may have similar problems but not the same. We need to create our own roadmap. The roadmap can enable us to collaborate with each other. Now, our project team is tackling the issue.
Step 3: Create the right environment for building research capacity
To foster research capacity in family medicine, there are multiple approaches: research capacity building initiatives, an active research department, collaborations with non-clinician researcher and the formation of a practice-based research network (PBRN). (Grant Russel 2019)
Examples of research capacity building initiatives in other countries:
In Canada: Transdisciplinary Understanding and Training on Research in Primary Health Care (TUTOR-PHC)
In the UK: The Oxford International PC Research Leadership programme
http://www.oxfordleadershipprogramme.com/
Primary Care Academic CollaboraTive
The Grant Generating Project of the North American Primary Care Research Group (NAPCRG):
Although there are several programs about clinical research in Japan, few programs focus on family medicine research. e.g. Jikei Clinical Research Program for Primary-care
http://www.jikei.ac.jp/ekigaku/primarycare.pdf
These programs may foster future leaders in Japanese academic family medicine.
Regarding collaboration with non-clinician researchers, the Japan Primary Care Association has 11,890 members including 1,420 non-MD members. Increasing research with these members may be the next step to promote research in the discipline.
In terms of a PBRN, to the best of our knowledge, 4 PBRNs in Japan are registered with the Agency for Healthcare Research and Quality, in the US. Increasing the research network and promoting collaboration amongst the PBRNs are necessary for conducting clinical research and improving patient outcomes efficiently.
Step 4: Develop a strong academic department of family medicine to build strong primary care
Of all the 81 university hospitals in Japan, 69 hospitals (85.2%) had “a department of Family Medicine” as a clinical department or division (Takeoka et al. 2017). However, the research capacity is various.
Now, I am a part-time student of the Master of Family Medicine, Western University, Canada.
This course provides “Theoretical Foundation of Family Medicine”, “Research Methods in Family Medicine”, “Teaching and Learning in Family Medicine” etc. The students join the course from across Canada and all over the world. I think establishing a Master or PhD of family medicine in Japan can foster research capacity and build strong primary care.
English Advisor: Maham Stanyon
References
1. McWhinney IR. General practice as an academic discipline. Reflections after a visit to the United States. Lancet. 1966;1(7434):419–423.
2. Kaneko M et al. Research evidence is essential for the development of family medicine as a discipline in the Japanese healthcare system. BJGP Open. 2019:bjgpopen19X101650. doi:10.3399/bjgpopen19X101650
3. Takuya Aoki et al. Japanese Representation in High-impact International Primary Care Journals. An Off J Japan Prim Care Assoc. 2017;40(3):126–130.
4. Kaneko M et al. An analysis of qualitative and mixed methods abstracts from Japanese, UK and US primary care conferences. Asia Pac Fam Med. 2018;17(1):11. doi:10.1186/s12930–018–0048–8
5. Goodyear-Smith F et al. Primary Care Research Priorities in Low- and Middle- Income Countries. 2019:31–35.
6. Grant Russel. A systems approach to building research capacity: Individuals, networks and culture.
Goodyear-Smith et al. How To Do Primary Care Research (WONCA Family Medicine) CRC Press.
7. Takeoka et al. Trends in Departments of General Medicine in University Hospitals in Japan Searched from Websites. Med. Bull. Fukuoka Univ. 44(2)81–86, 2017
