See patients, ask questions, spark research

Observations in doctors’ offices propel practice-based research networks

SAN ANTONIO (Oct. 15, 2009) — It takes 17 years, on average, for a research discovery to find its way to use in the community. Practice-based research networks (PBRNs), such as those in operation at The University of Texas Health Science Center at San Antonio, overturn scientific convention and start with the community.

“This is not the academic center telling the community physicians what they ought to study, but the university going to them and asking, ‘What are the big questions and issues you are seeing?’” said Michael L. Parchman, M.D., M.P.H., professor of family and community medicine in the Health Science Center’s School of Medicine. He directs the PBRN Resource Center, which encourages academic-community physician interaction for the benefit of patients. The resource center is funded by the Health Science Center’s Clinical & Translational Science Award (CTSA).

Abel Muñoz, M.D., an Austin physician, authored a paper with Dr. Parchman on community-acquired staph infections after observing an upward trend to them in his practice. “I was talking to a physician from Bastrop about seeing skin infections,” Dr. Muñoz said. “Ten years ago we never saw them, so this was unusual. My questions were, ‘Is this as common as I think it is? Is it a problem in other places? What antibiotics are people using?’”

Dr. Muñoz and colleagues in other practices began collecting patient data on postcards. They cultured 94 specimens from skin and soft tissue infections over 10 months and found a surprising result: 63 were positive for MRSA.

The outcome was a paper on risk factors for methicillin-resistant Staphylococcus aureus (MRSA) infections. Drs. Muñoz and Parchman urged family physicians to presume that skin and soft tissue infections could be MRSA-positive and to test for MRSA. This paper was published in the July-August 2009 issue of the Journal of the American Board of Family Medicine.

Federal research support
The CTSA grant, awarded in May 2008 to the Health Science Center and eight South Texas consortium partners, is helping the partners establish framework for turning research discoveries into community interventions. The National Center for Research Resources of the National Institutes of Health has granted CTSAs to more than 40 consortiums nationwide.

The PBRN Resource Center assists four active networks — one for primary care physicians and internists, one for physicians in residency training, one for psychiatrists and one for dentists. Dr. Parchman and other leaders are developing networks in pharmacy, nursing, pediatrics and interdisciplinary studies.

San Antonio dentist Kevin Scott, D.D.S, a graduate of the Health Science Center Dental School, is a member of the South Texas Oral Health Network launched about eight months ago. “A lot of dentists get into practice and become ‘mom and pop’ operations without a lot of communication between academia and community practice,” he said. “Bringing the two together is a major positive of this initiative.”

Finding diabetes at the dentist
Members of the oral health network are waiting on results of their first research project, a study to determine whether doing diabetes screening in dental offices is effective and beneficial for patients walking in with undiagnosed diabetes. “This is kind of like the 1980s when it was studied whether it was important to look at blood pressures in the dental office,” Dr. Scott said. “Dentists now are required once a year to check blood pressures.”

PBRNs are embraced by practitioners, who “tell us it has really helped them avoid burnout because of the intellectual stimulation,” said Sandra Burge, Ph.D., director of RRNet, the PBRN for resident physicians. RRNet is designed to interest up-and-coming physicians in research. “If they are part of health discovery, they are more likely to use it in their practice,” Dr. Burge said.

Dr. Parchman summarized the intent of PBRNs in this way: “This is about translational research. Instead of going from bench to bedside to bookshelf, we are going from bench to bedside to community and back again.”

Note: Dr. Parchman sees patients at the University Health Center in downtown San Antonio, including patients of the School of Medicine’s clinical practice, UT Medicine San Antonio. He is the Mario E. Ramirez Endowed Distinguished Professor of Family and Community Medicine at the Health Science Center.



The University of Texas Health Science Center at San Antonio is one of the leading research institutions in Texas and one of the major health sciences universities in the world. With an operating budget of $753.4 million, the Health Science Center is the chief catalyst for the $16.3 billion biosciences and health care sector in San Antonio’s economy. The Health Science Center has had an estimated $37 billion impact on the region since inception and has expanded to six campuses in San Antonio, Laredo, Harlingen and Edinburg. More than 26,750 graduates (physicians, dentists, nurses, scientists and other health professionals) serve in their fields, including many in Texas. Health Science Center faculty are international leaders in cancer, cardiovascular disease, diabetes, aging, stroke prevention, kidney disease, orthopaedics, research imaging, transplant surgery, psychiatry and clinical neurosciences, pain management, genetics, nursing, dentistry and many other fields. For more information, visit

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