Advancing clinical research in the Spanish primary care service: Challenges, opportunities, and lessons from other...

As the first point of contact with the healthcare system, primary care (PC) provides a unique setting for clinical research, enabling longitudinal follow-up, early disease detection, and study of prevalent illnesses. In Spain, however, PC research remains largely untapped, despite the country's leadership in overall clinical trial initiations within the European Union.

To analyse the main challenges and opportunities of PC research in Spain and to draw lessons from successful European models to inform future priorities.

This opinion paper presents a narrative, cross-country comparative synthesis (1993-2025) of peer-reviewed and gray literature.

European models demonstrate how interoperable data, dedicated infrastructure, and protected research time enable pragmatic and decentralised trials with high external validity. In Spain, major barriers include heavy workloads, limited research training, uneven infrastructure, and regulatory hurdles. Nevertheless, opportunities are emerging through digital platforms, interoperable registries, remote monitoring, and the integration of patient-reported outcomes (PROs).

Spain can unlock the untapped research capacity of PC by prioritising four reforms: (1) interoperable registries across care levels; (2) protected time and support roles for PC professionals; (3) targeted, sustained funding and minimum viable infrastructure; and (4) streamlined ethical/regulatory pathways for multicentre and decentralised trials. These steps would align research with daily practice, enhance inclusivity and equity, and strengthen PC as a hub for patient-centered innovation.