title: Primary care practices' perceived constraints to engaging in research: the importance of context and 'Flow'.
abstract: OBJECTIVE
  The primary purpose of this study is to understand primary care practices' perceived constraints to engaging in research from micro-, meso-, and macro-level perspectives.
  
  
  BACKGROUND
  Past research has spotlighted various barriers and hurdles that primary care practices face when attempting to engage in research efforts; yet a majority of this research has focused exclusively on micro- (physician-specific) and meso-level (practice-specific) factors. Minimal attention has been paid to the context - the more macro-level issues such as how these barriers relate to primary care practices' role within the dominant payment/reimbursement model of U.S. health-care system.
  
  
  METHODS
  Semi-structured focus groups were conducted in five U.S. practices, all owned by an independent academic medical center. Each had participated in at least one research study but were not part of a practice-based research network or affiliated with a medical school. Data were analyzed using NVIVO-9 by using a multistep coding process. Findings The perceived constraints offered by the participants echoed those featured in previous studies. Secondary analyses of the interconnected nature of these factors highlighted a valuable and sensitive 'Flow' that is evident at the individual, interaction, and organizational levels of primary care practice. Engaging in research appears to pose a significant threat to the outcomes of Flow (i.e., revenue, patient health outcomes, and the overall well-being of the practice). It is posited that the risk of not meeting expected productivity-based outcomes, which appear to be dictated by current dominant reimbursement models, frames the overall process of research-related decision making in primary care. Within the funding/reimbursement models of the US health-care system, engaging in research does not appear to be advantageous for primary care practices.
authors: 1 Department of Sociology, University of Delaware, Newark, DE, USA.
authors: Barret
authors: B
authors: Michalec
authors: 3 Department of Family and Community Medicine, Christiana Care Health System, Wilmington, DE, USA.
authors: Heather Bittner
authors: HB
authors: Fagan
authors: 3 Department of Family and Community Medicine, Christiana Care Health System, Wilmington, DE, USA.
authors: Brian
authors: B
authors: Rahmer
mesh_terms: D000046:Academic Medical Centers / Q000191:economics* / Q000592:standards; D001291:Attitude of Health Personnel; D003219:Confidentiality; D003691:Delaware; D017144:Focus Groups; D006302:Health Services Research / Q000191:economics* / Q000379:methods / Q000592:standards; D018578:Hospital-Physician Relations; D006801:Humans; D009515:New Jersey; D010358:Patient Participation / Q000523:psychology*; D011320:Primary Health Care / Q000191:economics* / Q000458:organization & administration / Q000592:standards; D012051:Reimbursement Mechanisms; D019036:Suburban Health Services / Q000191:economics / Q000458:organization & administration; D013997:Time Factors; D014481:United States; D000078329:Workforce; D016526:Workload