title: Series: The research agenda for general practice/family medicine and primary health care in Europe. Part 4. Results: specific problem solving skills.
abstract: The 'Research Agenda for General Practice/Family Medicine and Primary Health Care in Europe' summarizes the evidence relating to the core competencies and characteristics of the Wonca Europe definition of GP/FM, and its implications for general practitioners/family doctors, researchers and policy makers. The European Journal of General Practice publishes a series of articles based on this document. The previous articles presented background, objectives, and methodology, as well results on 'primary care management' and 'community orientation' and the person-related core competencies of GP/FM. This article reflects on the general practitioner's 'specific problem solving skills'. These include decision making on diagnosis and therapy of specific diseases, accounting for the properties of primary care, but also research questions related to quality management and resource use, shared decision making, or professional education and development. Clinical research covers most specific diseases, but often lacks pragmatism and primary care relevance. Quality management is a stronghold of GP/FM research. Educational interventions can be effective when well designed for a specific setting and situation. However, their message that 'usual care' by general practitioners is insufficient may be problematic. GP and their patients need more research into diagnostic reasoning with a step-wise approach to increase predictive values in a setting characterized by uncertainty and low prevalence of specific diseases. Pragmatic comparative effectiveness studies of new and established drugs or non-pharmaceutical therapy are needed. Multi-morbidity and complexity should be addressed. Studies on therapy, communication strategies and educational interventions should consider impact on health and sustainability of effects.
authors.affiliation: Institute of General Practice, Hannover Medical School, Hannover, Germany. hummers-pradier.eva@mh-hannover.de
authors.forename: Eva
authors.initials: E
authors.lastname: Hummers-Pradier
authors.forename: Martin
authors.initials: M
authors.lastname: Beyer
authors.forename: Patrick
authors.initials: P
authors.lastname: Chevallier
authors.forename: Sophia
authors.initials: S
authors.lastname: Eilat-Tsanani
authors.forename: Christos
authors.initials: C
authors.lastname: Lionis
authors.forename: Lieve
authors.initials: L
authors.lastname: Peremans
authors.forename: Davorina
authors.initials: D
authors.lastname: Petek
authors.forename: Imre
authors.initials: I
authors.lastname: Rurik
authors.forename: Jean Karl
authors.initials: JK
authors.lastname: Soler
authors.forename: Henri Ejh
authors.initials: HE
authors.lastname: Stoffers
authors.forename: Pinar
authors.initials: P
authors.lastname: Topsever
authors.forename: Mehmet
authors.initials: M
authors.lastname: Ungan
authors.forename: Paul
authors.initials: P
authors.lastname: van Royen
mesh_terms: D035843:Biomedical Research / Q000458:organization & administration*; D002983:Clinical Competence; D003142:Communication; D003657:Decision Making; D005060:Europe; D005194:Family Practice / Q000458:organization & administration / Q000592:standards; D058005:General Practitioners / Q000458:organization & administration / Q000592:standards; D006801:Humans; D010821:Physicians, Family / Q000458:organization & administration / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011785:Quality Assurance, Health Care