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Conducting health policy analysis in primary care research: turning clinical ideas into action
  1. Alina Engelman1,
  2. Ben Case2,
  3. Lisa Meeks2 and
  4. Michael D Fetters3
  1. 1 Health Sciences, California State University, East Bay, Hayward, California, USA
  2. 2 Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
  3. 3 Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
  1. Correspondence to Dr. Alina Engelman; alina.engelman{at}


Healthcare guidelines play a prominent role in the day-to-day practice of primary care providers, and health policy research leads to the formation of these guidelines. Health policy research is the multidisciplinary approach to public policy explaining the interaction between health institutions, special interests and theoretical constructs. In this article, we demonstrate how primary care providers can conduct high-impact health policy research using Eugene Bardach’s eightfold policy analysis framework in a primary care context. In a medical case, a woman with a history of total hysterectomy had scheduled a visit for a Papanicolaou (Pap) smear screening test as part of a well-woman health check-up with a family medicine resident. Conflicting recommendations on Pap smear screening after total hysterectomy sparked an investigation using the US Preventive Services Task Force criteria for conducting a health policy analysis. We illustrate broadly how clinical care dilemmas can be examined by using Bardach’s broadly applicable health policy framework in order to inform meaningful policy change. Bardach’s framework includes (1) defining the problem, (2) assembling evidence, (3) constructing alternatives, (4) selecting criteria, (5) projecting outcomes, (6) confronting trade-offs, (7) decision-making and (8) sharing the results of the process. The policy analysis demonstrated insufficient evidence to recommend Pap test screening after hysterectomy and the findings contributed to national recommendations. By following Bardach’s steps, primary care researchers have a feasible and powerful tool for conducting meaningful health policy research and analysis that can influence clinical practice.

  • health policy research
  • family medicine
  • limited resources
  • primary health care
  • Cervical Cancer

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors AE developed the conceptual framework, wrote and revised the manuscript. BC contributed to revisions, including references and formatting. LM contributed to manuscript writing and analysis. MDF contributed to manuscript edits.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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