Concepció Violán: “We need more healthcare professionals to do research”

The researcher of IDIAPJGol, an entity that she directed for 16 years, talks about her vision of research in primary care and the challenges facing the Institute. Her career has been recognised with the ICS 2024 Research Career Award in Primary Care

Concepció Violán, a physician and researcher who directed IDIAPJGol for 16 years, has been recognised with the 2024 Research Career Award in Primary Care at the latest Research Conference of the Catalan Institute of Health. This distinction highlights more than forty years of dedication to research, teaching and management in this field.

Dr. Violán, who currently works as a doctor in the Northern Metropolitan Research Support Unit of IDIAPJGol and ICS, has been a key figure in the development of research in primary care. In this interview, he talks about primary care and the essential role that research plays in the first level of care. He also talks about his vision of IDIAPJGol and the challenges he faces.

What does this award mean to you?

It is very exciting to receive recognition for your career when you are approaching the end of professional life. However, in research, and especially in primary care, the work is never the work of just one person. Therefore, I have received this recognition on behalf of all the people who have worked with me during these years.

You have dedicated most of your professional life to research in the field of primary care. How did your interest in this field begin?

I started researching very young. In fact, when I had not yet finished my degree, at the Hospital Clínic. This is where my interest in research began. When I finished Medicine, I was already clear that I wanted to do a doctorate. I went to do my residency at the Virgen de la Arrixaca Hospital, in Murcia, where I completed my PhD thesis, which dealt with hypertension, specifically with Holter monitors, the devices that measure blood pressure over the course of 24 hours.

In total, I have spent more than forty years of professional life, dedicated to research, but also to management: at IDIAPJGol, where I was for 16 years, and in primary care departments in Murcia, Madrid and also in Catalonia, where I had the satisfaction of working on the reform of primary care and completing it.

How do you see primary care? What is its situation?

From the late eighties until before the pandemic, primary care, both in Catalonia and in Spain, improved a lot, in resources, but also in something very important, which is longitudinality, comprehensive care of the person, which was a basic aspect of the primary care reform that we carried out during the last two decades of the twentieth century.

After the pandemic, we have incorporated other professional profiles, physiotherapists, nutritionists, mental health professionals, which is good, but we have lost that global vision of care. Largely due to the lack of family doctors and nurses, which are the axes on which primary care should pivot. Now it is necessary, not only to rethink, because there are already many people who think about it, but to act to change the health system, integrating and valuing the tasks of the new professionals who join primary care.

And how should we act, considering the lack of professionals and resources?

The key is to prioritize. We need to review what is necessary to do and what is not, but, above all, we need to rethink what adds value to improve people’s health. We need to review which diagnostic procedures we can request and perform in primary care. Coordination with specialized care is also an aspect that needs to be reviewed. We also have primary care centres that are overwhelmed because there are problems that cannot be addressed from primary care, and it is necessary to identify them and find solutions to be evaluated and adapted in each territory.

It is also important that each person has a healthcare reference, which should be medical and nursing professionals. From primary care itself we are breaking the longitudinality of the family doctor. We are atomizing care for the person, not only in primary care, but also in hospitals, and this is not good for the health of the population nor is it efficient, especially considering the aging of the population, which is associated with chronicity and multimorbidity. This means that very often two persons with hypertension, for example, cannot be treated equally; It is necessary to take into account other illnesses that they may have, their social and cultural conditions, and personalize care for each patient.

How can technology help improve the system?

Technology has helped us in some things: telematic visits, telephone visits, the ability to connect with your doctor through La meva salut... But in the end, this also ends up overwhelming professionals. We are providing telecommunication tools that are taking away time from face-to-face visits, which could perhaps allow the problem to be resolved sooner.

In any case, before deciding what changes we should make, we must know what things work and what don’t, and this is where research comes in: before deciding what organisational changes we make, we need to ask ourselves questions; the answer will allow us to analyse what decisions are best to improve care.

This year we celebrate the centenary of the birth of Dr. Jordi Gol i Gurina. What do you think we can learn from his thinking, from his way of seeing primary care and family medicine in general?

Jordi Gol was a family doctor through and through, who was clear that the family doctor, who in his time was called a general practitioner, was the professional who should approach the person in a comprehensive manner, considering their environment and also physical, mental, social, spiritual factors...

He introduced clinical history, which has been fundamental for research in primary care, because what is not recorded cannot be evaluated. Thanks to Jordi Gol we are aware that all the conditions of a person influence their health.

Today, apart from what the doctor records in clinical history, there is a lot of information relevant to the person’s health: the data recorded by smart watches, information from the environment, temperature, pollution... These health conditions can help us to better treat diseases. Jordi Gol made us aware that there are many health factors that we must consider, beyond biochemical or biological parameters.

What is the current situation of research in primary care?

In Catalonia we are better off than in the rest of Spain, and we lead research in primary care, but we still have a long way to go if we want to be leaders at European level. One of the things we need to achieve this is for healthcare professionals to be able to do research. Because research has grown a lot today among other professionals who are not clinical, such as computer scientists, engineers, mathematicians, statisticians, physicists... and the collaboration between basic technical professionals and doctors has allowed us to grow a lot. But we need more healthcare professionals to do research.

The problem is that doctors and nurses, and other professionals who provide direct assistance in primary care, do not have time to do research. But it is essential that these professionals do research, because they are the ones who ask questions, who know people’s health needs more closely. Because a pharmacist or a chemist can help us a lot, but the key question will continue to be asked by the healthcare professional.

You were saying that, in recent years, research in primary care has grown, although it could have grown more. What role has the covid-19 pandemic played in this growth?

The pandemic has allowed research into vaccines and, in general, into all preventive activities. The entities that fund research and the professionals themselves have realized that this research cannot be carried out outside of primary care, which is the gateway to the system and where preventive activities can be promoted.

As a result of the pandemic, there has also been a significant growth in international projects that have allowed research in primary care to grow. I must also say that the current management of IDIAP Jordi Gol has known how to take advantage of this and has made a significant effort to promote European projects and projects related to innovation and the implementation of new techniques in clinical practice in primary care.

IDIAPJGol is one of the few centres in the world dedicated exclusively to research in primary care. What is its role?

IDIAPJGol is recognised as a leading and pioneering institution in primary care research. It is a unique and singular model that, in Spain, has been adopted by the Community of Madrid. We lead the RICAPPS [Research Network on Chronicity, Primary Care and Prevention and Health Promotion], which is the reference network in primary care research in Spain, a structure that has allowed us to consolidate research at the first level of care.

You have managed IDIAPJGol for 16 years. During this period, the institution grew considerably. What was that experience like?

It was a very rewarding experience, like watching a child grow up. When I joined the centre in 2004, we were only seven people and we had to set up the whole structure, establish procedures... All of this required a lot of time and the work of a great team that accompanied me throughout this period.

As we did not meet the requirements to be accredited as a research centre, because, legally, only institutes linked to a hospital could access it, we were certified with an ISO standard that allowed us to demonstrate and prove the quality of the work we do. This allowed us to create a management structure and work procedures that guaranteed that the resources that researchers deposit with us were well managed. This is a very important part of the responsibility we have, because the money we manage is not ours, but that of the researchers who lead the research projects. Therefore, we had to create an orderly and transparent mechanism that could be audited and accredited. Another thing we also did was to promote research grants that would allow health professionals to have time to research, and this has been maintained and strengthened.

I planted the seed, and the child was able to start growing. Now, at over 25 years old, the Institute has reached adulthood. The current management is steering the ship in a very orderly manner and can continue to grow.

And in what direction should IDIAPJGol continue to grow? What challenges does it face?

It is necessary to be able to attract more health professionals who do research, because research, like training and teaching, is essential to offering good care. You cannot offer good care if you do not answer the questions you ask yourself during the care practice.

Is it just a question of time or is there a need for more interest in research on the part of primary care professionals?

There is one factor that we must take into account, and that is that the current generations have a different perception of life than my generation had. I am not saying that it is worse, but values ​​have changed. Today people want to work to live, and in my time, working was a priority and living perhaps not so much… Then there is the pressure on healthcare, which is very high today. For healthcare professionals, research is a burden that can become very heavy. We should consider models that allow research to be compatible with care.

And how do we do it? 

If we want to do research in healthcare centres and we do not want professionals to work more hours, we have to employ more people and, in some cases, resize some of the centres’ staff. It is not necessary for all professionals to do research either. Research is not obligatory, although it is necessary to provide good care.

Another thing is to improve their collaboration with other professionals. The interdisciplinary approach is key to being able to carry out quality research. Having the collaboration of professionals who provide different perspectives, who can interpret the data...

Speaking of data, one of the jewels in the crown of IDIAPJGol is SIDIAP, which was developed when you were director of the Institute. How important is this database for research in primary care?

SIDIAP was launched in 2010. At that time, we were one of the pioneering institutions in using what is now called real-world data. SIDIAP is a very powerful tool, which has offered very relevant data that has allowed us to modify treatments and clinical actions based on evidence. With the application of epidemiological techniques, statistics and artificial intelligence, we are obtaining very relevant information from SIDIAP, which is allowing us to improve clinical practice.