Primary care research should lead on pandemic preparedness

Primary care being key to future pandemic preparedness is one of the key findings from a landmark Covid-19 research study conducted by the National Institute for Health and Care Research (NIHR).

An NIHR learnings paper looked into the PANORAMIC study, which was launched after health leaders realised that some novel antiviral drugs needed testing in primary care settings—rather than just in secondary care.

PANORAMIC study

The PANORAMIC trial (Platform Adaptive trial of NOvel antiviRals for eArly treatMent of COVID-19 In the Community) was delivered by the NIHR Research Delivery Network (RDN) and led by the University of Oxford. It represents the fastest recruiting and largest trial of a therapeutic agent for Covid-19 ever in primary care.

The idea that primary care should lead future pandemic research was the main recommendation from author Professor Phil Evans, who is deputy health and care director at the NIHR RDN, although further recommendations have been made too.

Further recommendations

They include that platform studies should be the blueprint for future pandemic research in primary care. PANORAMIC was a platform study, which allowed the standard of care to change, ultimately enabling several drugs to be evaluated simultaneously.

Another recommendation comes in the form of undertaking work to see how recruitment could be improved in care homes. PANORAMIC recruited fewer than 1% of its participants from care homes. The paper concluded that complex contracting requirements and patient capacity were roadblocks in this regard—putting letters of agreement in place with the next of kin or power of attorney could quicken up the process. Evaluations need to be conducted on how medicines can be delivered to people’s homes.

A fourth recommendation comes in the form of building trust with diverse communities so research can be as inclusive as possible.

Expert reaction

“The PANORAMIC study was central to the UK’s approach to COVID-19,” said the NIHR’s CEO, Professor Lucy Chappell. “Today's learnings paper shows the importance of engaging with primary care and the impact the innovative study had on the direction of the pandemic.”

She added: “The study has given us a legacy of record-breaking trials in primary care and the community.”

Prof Evans commented: “PANORAMIC recruited just under 30,000 participants into a randomised platform trial using innovative methods of recruitment – such as self-referral through a website coupled with recruitment through a GP hub and spoke model – that had not previously been tested in a primary care setting.

“For this reason, PANORAMIC has been recognised globally as a trailblazing study for primary care, this is evidenced by the fact it has inspired a similar trial in Canada and the results have been used in other nations to inform policy.”

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