Towards evidence-based practice via practice-based evidence: the Italian experience

Research is a fundamental tool for GPs' clinical practice. Independent research should be the answer to important questions on population needs not yet answered. To have a democratic approach, the results of the studies should be available not only to GPs but also to patients participating to the research. Research has also a formative value for investigators: a process of learning by doing. Risk and Prevention Study is a model of the 'Italian experience' in doing research in primary health care.

To describe the collaboration between Centro Studi e Richerche in Medicina Generale and Mario Negri Institute in producing observational and experimental research in the setting of family medicine such the Risk and Prevention Study.

Risk and Prevention Study has two main aims and two different methods: the first, to establish the effectiveness of an intensive recommended treatment and lifestyle advice in cardiovascular (CV) prevention is an observational design. The second, the efficacy of n-3 polyunsaturated fatty acid in patients with CV risk is a randomized controlled trial design.

The Risk and Prevention trial has enrolled up until now 860 Italian GPs and over 12 500 high CV risk patients that will be followed during 5 years. They will visit their GP at least once a year. The first year of follow-up of the study has been completed. Relatively few patients (2.5%) have withdrawn. The treatment was well tolerated.

Enrolment of large number of GPs in research appears feasible when an independent design with clear benefit for the patient's needs is offered.