The Norwegian Primary Care Research Network

Contact form (in Norwegian)

Users of The Norwegian Primary Care Research Network
All researchers who are interested in recruiting patients in primary care to research projects may use The Norwegian Primary Care Research Network. If you are a non-Norwegian speaking researcher, we encourage you to look for Norwegian researchers in the field, who may act as your liaison in the project. Your Norwegian counterpart may register interest in using PraksisNett for your common research project through this form. You can also look at our procedure for user projects (in Norwegian).

The researcher must have financing in place before the study can start, but completing the contact form can be done early in the process. Before the study starts, all permissions (Regional Committees for Medical and Health Research Ethics (REC) approval, Data Protection Impact Assessment) must also be in place. Depending on the type of research project, PraksisNett will be helpful in planning and executing the study.

Please contact the Coordinating Node, if you have any questions about the use of PraksisNett in your research.

Examples of research projects

- Simple data extraction study: How many patients receive treatment x for disease y?
- Complex data extraction study: Laboratory results, use of medication and symptoms described in the medical records for patients with a specific condition.
- Clinical study: Patients with diagnosis x are included in a qualitative study (interviews or focus groups)
- Randomised Controlled Trials (RCT): Patients with disease x are included in a randomised controlled trial where treatment y is compared with treatment z. Patients are identified using name lists generated by the data tool, or as a pop-up when the patient is diagnosed during consultation.

Planning a study based on data extraction from the network
If you wish to plan a study and extract data, please contact the Coordinating Node at praksisnett@uib.no.

Examples of dataset extraction when planning a study:

Extraction 1: How many of the patients in the network use medication x (based on 12 months’ data extraction)
Extraction 2: How many of the patients in the network have disease x (based on 6 months’ data extraction)

Costs involved in using the network
Costs associated with using the network will be lower while the infrastructure is being established. During the establishment phase, the costs will be related to the amount of work the GPs undertake for each study. GPs will receive compensation according to the time used for each research project. Researchers who want to use the infrastructure must budget for these costs as agreed with the coordinating node.

Click here to send us a request for your GP office to join PraksisNett (form in Norwegian).
Why should GP offices join PraksisNett? Here are some good reasons (in Norwegian):

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PraksisNett

• Deliver aggregated data according to an agreed variable list (attachments in the contract) to a common database for PraksisNett, data that:
  • makes it easier to plan studies by allowing researchers to obtain information about, for example, prevalence among PraksisNett patients.
  • provides a basis for scientific reports and publications from researchers who have been approved to perform analysis on aggregated data in PraksisNett.
• At the request of PraksisNett, continuously consider inviting your patients to research projects that are carried out via PraksisNett.
• At the request of PraksisNett, participate in at least one research project annually (if there are available projects).
• Be joint controller with a researcher in connection with recruitment for a given study, cf. Article 26 of the General Data Protection Regulation (GDPR).
• Fulfil patients' rights in accordance with Chapter 3 of the General Data Protection Regulation (GDPR).

By joining PraksisNett, you as a GP contribute to new knowledge that will benefit you and your patients.

Why have we established PraksisNett – The Norwegian Primary Care Research Network?
Our aim is to make it easier to recruit patients in general practice (GP) to research. The researchers who will use PraksisNett will conduct research on issues that are important to these patients. We need research on patients to improve treatment.

What does it mean that a GP office is part of PraksisNett?
The GP offices that are part of PraksisNett have said yes to invite patients to research. If you, due to your current or past illness, are eligible for a study, your GP will contact you. After receiving information about the study, you can freely decide if you want to participate. You will not be included in clinical studies without your written consent.

Participation in research studies is always voluntary. Whether you choose to participate, or not, does not affect the further treatment you receive from your GP.

Can I participate in a research study?
We want all patients to have the opportunity to participate in research studies. When a researcher recruits patients through PraksisNett, your GP assesses whether or not you are eligible for the study. The GP determines this based on the research study's purpose and criteria for joining. Feel free to ask your GP if there are any studies you can participate in.

Why should I participate in a research study?
By participating in a study, you can help us gain more knowledge about your illness and the treatment that works. This will benefit patients with the same illness as you.

What happens to my patient data in PraksisNett?
No sensitive personal data will be obtained without your consent in connection with a specific study. In special cases, however, the Regional Committee for Medical and Health Research Ethics (REK) may grant exemption from the requirement for consent (cf. the Health Personnel Act § 29, the Health Register Act § 19 e, and the Public Administration Act § 13 d). There are very strict requirements for such exemptions, and all projects will undergo a careful assessment by REK, a Data Protection Officer and the Management Board of PraksisNett. You can rest assured that no data in PraksisNett will be astrayed.

All the GPs who are part of PraksisNett have a Snow box installed in their office. The Snow box is a small computer that extracts data from the electronic medical record. When the data are transferred to the Snow box, they are transformed so that the data on the box can no longer be associated with your name: The data are pseudonymized, that is, any data that can identify you are replaced with a code.

Where is my data stored?
Your data are stored in the Snow box inside the GP's office. If you have agreed to participate in a study, your data are encrypted before they are sent to a secure analysis server. The University of Oslo, the University of Bergen and NTNU have such secure analysis servers. Data transferred will not identify you or your GP unless the researcher has requested it and you have approved this with a written consent.

How is my personal data processed in research studies?
In studies conducted using PraksisNett, the GP's office and the researcher's institution are joint controllers responsible for processing data on the Snow box at the GP office, cf. Article 26 of the General Data Protection Regulation (GDPR).

In such research projects, the GP processes personal information about you that she/he has already documented in your medical record, to find out if you are eligible for being invited to a study. The purpose of the GP's processing of personal data in this context, is to invite you or other patients to research studies. You can gain access to the information the GP has collected about to see if you match the inclusion criterion in a specific research project, by contacting your GP. The GP will find an overview of this in the GP's IT system. It is only your GP that has access to this information.

If you agree to participate in a research study, the researcher responsible for the study will have access to the data that you give her/him permission to receive. In such cases, your data is transferred encrypted to a secure server to which no one other than authorized researchers have access. The purpose of the researcher's processing of personal data in this context is to use data to investigate one or more research questions in accordance with research protocols that the researcher has had approved by the Regional Committee for Medical and Health Research Ethics (REK). You can access the information the researcher has collected about you by contacting the researcher. The information will correspond with the data you have given your consent to being retrieved. The researcher is obliged to keep a record of this information in the researcher's account on a secure server. The researcher has sole responsibility as a data processor for data transferred from PraksisNett and for data the researcher obtains with the consent of the patient.

Both GPs and researchers are obliged to fulfill your rights in accordance with Chapter 3 of the General Data Protection Regulation (GDPR). Here you can read more about these rights.

Since PraksisNett is a data processor for both the doctors' offices and the researchers, PraksisNett has signed data processor agreements with the doctors' offices that are part of the network and with the institutions of the researchers who may use PraksisNett. PraksisNett has conducted and is annually conducting risk assessments for both the doctor's office and the researcher and has implemented satisfactory security measures. You can read more about data security and privacy in PraksisNett here.

Please contact PraksisNett if you need more information.

Purpose
The Norwegian Primary Care Research Network (in Norwegian: PraksisNett) is a research infrastructure that provides a foundation for enhancing the quality of primary care research in Norway. The infrastructure facilitates recruitment of primary care patients to clinical studies and increases the power and predictability of these studies.

Initiators
PraksisNett is a joint national initiative by the primary care research communities at the partner institutions.

Funding source and partner institutions in PraksisNett
PraksisNett is a research infrastructure funded by the Norwegian Research Council and the Norwegian Minestry of Health and Care Services. The partners in project are:

• University of Bergen (UiB)
• NORCE - Norwegian Research Centre
• University of Oslo (UiO)
• The Arctic University of Norway (UiT)
• Norwegian University of Science and Technology (NTNU)
• Norwegian Centre for E-health Research (NSE) at the University Hospital of Northern Norway (UNN)

PraksisNett is organised as a two-layer interdependent model: A human, resource-based infrastructure of clinical practices; and an advanced, secure IT infrastructure.

The human resource-based network
Once the network is fully established, it will consist of around 90 clinical practices in Norway spread over four regional networks. The PraksisNett staff in the regional networks will actively support the clinics during data collection.

The Coordinating Node is the first point of contact for researchers intending to use the network for their studies. It also acts as the receiving point for research project applications to the network.

The Project Management Board will assess all applications. Research projects will be prioritised based on quality, relevance and feasibility.

The Snow box
The Snow Health Appliance Box is a solution that enables the initiation and coordination of computing processes in integrated data resources (IDRs) on a large number of IDR datasets stored at the clinical practices. These are protected by data privacy regulations. 

By connecting the Snow Box server to the electronic medical record (EMR) all personal data remain within the practice; aggregated data and statistics are accessed using the distributed data analysis tool through the Snow Coordinator server located in the healthcare network. The aggregated data will be used to describe the population within the network to facilitate planning of research studies.

Traditional information-sharing systems usually store data in a central storage location. However, this poses challenges concerning privacy and the right to use the data.

Our basic idea for reuse of information in the healthcare system is that it should be safe to exchange health data, and that systems should be so secure that they are trusted by patients, the authorities and health professionals. To ensure this, the Snow team has developed a system for reuse of data that does not store personally sensitive information outside health institutions. Instead, all information is anonymised before leaving the GP’s office. This method enables NPCRN to protect the patient's privacy as well as the GP’s right to determine how the patient’s data are used.

Informed consent will be obtained from every patient recruited to clinical trials conducted under the auspices of NPCRN.

Data Management Plan
Data Protection Impact Assessment (DPIA).

- Simple data extraction study: How many patients receive treatment x for disease y?
- Complex data extraction study: Laboratory results, use of medication and symptoms described in the medical records for patients with a specific condition.
- Clinical study: Patients with diagnosis x are included in a qualitative study (interviews or focus groups)
- Randomised Controlled Trials (RCT): Patients with disease x are included in a randomised controlled trial where treatment y is compared with treatment z. Patients are identified using name lists generated by the data tool, or as a pop-up when the patient is diagnosed during consultation.

• ValueDx - Community Acquired acute respiratory infection (CA-ARTI) in community care in Europe
• Young marginalized patients with depression in general practice
• BASIC del 1 - Better Treatment for Acute Sinusitis in Primary Care – interview study
• CovidNor del 1 – Experiences of patients and primary health care professionals during the COVID-19 epidemic in Norway - registration of information from GP consultations
• CovidNor del 2 - Experiences of patients and primary health care professionals during the COVID-19 epidemic in Norway - mapping of changes in treatment
• Hearing loss, balance and mobility in older adults: associations and interventions
• Trygg på skulder - Confident management of shoulder pain in general practice – implementing an evidenced based guideline for shoulder pain, a hybrid design cluster randomised study
• Use of laboratory tests in general practice
• BASIC del 2 - Better Treatment for Acute Sinusitis in Primary Care  - clinical epidemiological study
• IDA-study - a national study on personalized blood pressure treatment
• Anti-inflammatory drug (Naproxen) for sciatica
• BASIC del 3 - Better Treatment for Acute Sinusitis in Primary Care  - randomized controlled drug trial
• Development of a care pathway for patients with hand osteoarthritis
• Samsnakk – a new interaction model for people on sick leave
• Maternity care at the GP
• Sleep problems and infections in general practice
• Conversations between doctors and patients about medically unexplained ailments and symptoms
• The use of hypnotics in general practice
• SupportPrim - stratified treatment for patients with musculoskeletal disorders
• Ung Face IT - a study on the effect of the intervention program
• Genetics and neuropathic pain

Espen Saxhaug Kristoffersen, Bjørn Bjorvatn, Peder Andreas Halvorsen, Stein Nilsen, Guro Haugen Fossum, Egil A. Fors, Pål Jørgensen, Berit Øxnevad-Gundersen, Svein Gjelstad, Johan Gustav Bellika, Jørund Straand & Guri Rørtveit. The Norwegian PraksisNett: a nationwide practice-based research network with a novel IT infrastructure. Scandinavian Journal of Primary Health Care 13 May 2022.

Ekeberg OM, Pedersen SJ, Natvig B, Brox JI, Biringer EK, Endresen Reme S, Engebretsen KB, Joranger P, Mdala I, Juel NG. Making shoulder pain simple in general practice: implementing an evidence-based guideline for shoulder pain, protocol for a hybrid design stepped-wedge cluster randomised study (EASIER study) BMJ Open. 2022 Jan 7;12(1):e051656.

Alike van der Velden, Alma C van de Pol, Emily Bongard, Daniela Cianci, Rune Aabenhus, Anca Balan, Femke Böhmer, Valerija Bralic Lang, Pascale Bruno, Slawomir Chlabicz, Samuel Coenen, Annelies Colliers, Anna Garcia-Sangenis, Hrachuhi Ghazaryan, Maciek Godycki-Cwirko, Siri Jensen, Christos Lionis, Sanne R van der Linde, Lile Malania, Jozsef Pauer, Angela Tomacinschii, Akke Vellinga, Ihor Zastavnyy, Susanne Emmerich, Adam Zerda, Theo J Verheij, Herman Goossens and Christopher C Butler. Point of care testing, antibiotic prescribing and prescribing confidence for respiratory tract infections in primary care: Prospective audit in 18 European countries. BJGP Open 17 December 2021; BJGPO.2021.0212. DOI: https://doi.org/10.3399/BJGPO.2021.0212

Nilsen S, Bjorvatn B, Kristoffersen ES. «PraksisNett – status etter tre år». Utposten 2021; nr. 2: 18-20.

Bjorvatn B, Kristoffersen ES, Halvorsen PA, Fors EA, Nilsen S, Rørtveit G: "New infrastructure for research in general practice". Tidsskrift for Den norske legeforening. Published: 14 January 2019. Tidsskr Nor Legeforen 2019. doi: 10.4045/tidsskr.18.0689

Bjorvatn B, Straand J, Halvorsen P, Wensaas K-A, Bellika JG, Fors EA, Gjelstad S, Kristoffersen ES, Øxnevad-Gundersen B, Rørtveit G. «PraksisNett - et nettverk av fastlegepraksiser. En storsatsing på forskning i allmennpraksis». Utposten 2018; nr. 4: 40-43.

Annual report 2023

Status report 2018-2022

• Centre for Quality Improvement in Medical Practices (SKIL)
• Inven2
• Medhjelper
• NorCRIN
• Research Unit for Health Surveys (RUHS) at the University of Bergen
• The Norwegian Association of General Practitioners
• The Norwegian College of General Practice