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Review
. 2014 Jan-Feb;12(1):66-74.
doi: 10.1370/afm.1593.

Systems and complexity thinking in the general practice literature: an integrative, historical narrative review

Joachim P Sturmberg  1 , Carmel M Martin, David A Katerndahl
Affiliations
Free PMC article
Review

Systems and complexity thinking in the general practice literature: an integrative, historical narrative review

Joachim P Sturmberg et al. Ann Fam Med. 2014 Jan-Feb.
Free PMC article

Abstract

Purpose: Over the past 7 decades, theories in the systems and complexity sciences have had a major influence on academic thinking and research. We assessed the impact of complexity science on general practice/family medicine.

Methods: We performed a historical integrative review using the following systematic search strategy: medical subject heading [humans] combined in turn with the terms complex adaptive systems, nonlinear dynamics, systems biology, and systems theory, limited to general practice/family medicine and published before December 2010. A total of 16,242 articles were retrieved, of which 49 were published in general practice/family medicine journals. Hand searches and snowballing retrieved another 35. After a full-text review, we included 56 articles dealing specifically with systems sciences and general/family practice.

Results: General practice/family medicine engaged with the emerging systems and complexity theories in 4 stages. Before 1995, articles tended to explore common phenomenologic general practice/family medicine experiences. Between 1995 and 2000, articles described the complex adaptive nature of this discipline. Those published between 2000 and 2005 focused on describing the system dynamics of medical practice. After 2005, articles increasingly applied the breadth of complex science theories to health care, health care reform, and the future of medicine.

Conclusions: This historical review describes the development of general practice/family medicine in relation to complex adaptive systems theories, and shows how systems sciences more accurately reflect the discipline's philosophy and identity. Analysis suggests that general practice/family medicine first embraced systems theories through conscious reorganization of its boundaries and scope, before applying empirical tools. Future research should concentrate on applying nonlinear dynamics and empirical modeling to patient care, and to organizing and developing local practices, engaging in community development, and influencing health care reform.

Keywords: complex adaptive systems; family medicine; general practice; historical review; integrative review; nonlinear dynamics; philosophy of general practice; philosophy of medicine; systems biology; systems theory.

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Figures

Figure 1
Figure 1
Timelines of the emergence of systems and complexity sciences, the discipline of general practice/family medicine, and the stepwise adoption of systems and complexity sciences into general practice/family medicine research and literature. GP = general practice; FM = family medicine; AAFP = American Academy of Family Physicians; DEGAM = German Society of General Practice and Family Medicine; NAPCRG = North American Primary Research Group; RACGP = The Royal Australian College of General Practitioners; RCGP = Royal College of General Practitioners; WONCA = World Organization of National Colleges and Associations.
Figure 2
Figure 2
Search strategy. MeSH = Medical Subject Headings. Note: Journals retrieved: Annals of Family Medicine, Archives of Family Medicine, Asia Pacific Family Medicine, Australian Family Physician, Australian Journal of Primary Health, British Journal of General Practice, Canadian Family Physician, Family and Community Health, Family Medicine, Family Practice, Family Process, Informatics in Primary Care, Journal of the American Board of Family Medicine, Journal of Ambulatory Care Management, Journal of Epidemiology and Community Health, Journal of Family Practice, Journal of Interprofessional Care, Journal of the Royal College of General Practitioners, Journal of Integrated Care, Journal of Informed Primary Care, Scandinavian Journal of Caring Sciences, Zeitschrift für Allgemeinmedizin.
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