research article is considered as primary literature

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Articles and Primary Literature in Biology

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In the sciences, a primary source describes original research, while a secondary source analyzes or comments on a primary source or sources.   For example, a research article is primary literature because it describes an original experiment and its results, while a review article is secondary literature because it collates multiple research articles to describe the current state of the field.

Examples of primary sources: 

• Research articles
• Theses and dissertations
• Conference proceedings
• Patents 
• Unrefined data sets 

Examples of secondary sources:

• Review articles
• Data compilations

The databases below can help you find primary literature in the sciences. While searching, you can narrow your results to primary literature by using filters on the left of the page.

• Web of Science This link opens in a new window A large interdisciplinary database with a strong collection in the sciences. Filter for primary literature by selecting Article under Document Type on the left of the page. more... less... Easily explore an article bibliography, as well as sources that have cited the article since its publication, via the Citation Network feature. Create a free personal account to keep a comprehensive search history, create search alerts and citation alerts. Additional features related to author and journal profiles are available. Language: English, Russian, French, German, Chinese, Spanish, Japanese, Portuguese, etc. Text Mining: Allowed; only through Clarivate APIs Keywords: Social Science Citation Index Science Citation Index Arts and Humanities Citation Index Conference Proceedings Citation Index Emerging Sources Citation Index WoS Knowledge
• PubMed This link opens in a new window A massive biomedical database run by the NIH, with articles stretching back to the 1950s. Filter primary literature by selecting Clinical Trial under Article Type on the top left of the page. more... less... Includes advanced search tools such as Medical Subject Headings (MeSH) and the Clinical Queries feature. Personalized MyNCBI account features, such as email alerts, are only available by leaving the Library's instance of PubMed and accessing the resource through the open web site (pubmed.gov). Language: English Keywords: Pub Med
• USDA National Agricultural Library This link opens in a new window Why search here? Good for indexed citations from AGRICOLA, PubAg, and the NAL Digital Collections (NALDC) on agriculture topics, food and human nutrition, forestry, aquaculture and fisheries, animal and veterinary sciences. Content type: Abstracts of scholarly articles, book chapters, theses, patents, technical reports. Coverage dates: 1970 - present more... less... Language: English Keywords: Pub Ag U.S. US Department
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Distinguishing Scholarly Articles

• What Is a Scholarly Article?
• Where Can I Find Scholarly Articles?
• Types of Scholarly Articles

Source Provenance

• Glossary of Specialized Terms

For preliminary assessment of reliability or authenticity, academics frequently distinguish between Primary and Secondary sources of information.  Note that this distinction is based on content, and not format.

Primary sources are those that adhere most closely to the original experience or evidence being presented.

In history and the humanities, a primary source is a person, document or account relating direct experience from the time period under study (for example an eyewitness report to an event) or a later recapitulation of events from someone with direct experience (for example an oral history, autobiography or memoir).  Historical artifacts such as letters, diaries, interviews, or photographs are all considered primary sources, as are government documents presenting original work, e.g. legislation, hearings, speeches, reports, etc.  Creative works such as films, plays, music, poetry and art works can also be considered primary.

In the sciences, a primary source is the original publication of new data, research or theories by the individual(s) producing the data, conducting the research, or formulating the theory.  Examples of primary scientific sources include experimental studies, opinion surveys, clinical trials, and data sets.  Typically, primary research articles are published in peer-reviewed journal articles with standardized sections, often including a Literature Review , description of Methods , tables of Data , and a summary of Results or formal Conclusion .

Secondary sources are those that summarize, critique or comment on events, data or research presented previously.  Since they are one or more steps removed from the event, these sources are considered less reliable in terms of evidence.

Examples of secondary sources include textbooks, review articles, magazine articles, histories, news reports, encyclopedias and other reference books.  There can be significant variation in how strictly the terms "primary" and "secondary" are applied by academics, e.g. history professors may consider news articles that were published in the same time period as an historical event to be primary, for purposes of instruction.  If in doubt, a student should consult the classroom instructor for guidance.

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• URL: https://research.ewu.edu/scholarly_articles

Understanding Scientific Literature

Primary sources, secondary sources, tertiary sources.

• Identifying a Research Article
• Scholarly vs. Popular Literature

What are primary sources?

In the sciences primary sources are original research or data. Primary sources can include any of the following publications 

• Journal Articles -- Journal articles can be primary sources if they contain original research, but keep in mind that not all journal articles are primary sources.
• Reports -- Reports are publications on research that are published independently of a journal. They are often published by governments or companies.
• Theses and Dissertations -- Theses and Dissertations are the original research of an academic working on a degree. 
• Conference Proceedings -- Conference Proceedings are a collection of papers that have been presented at a conference. 
• Published Data -- Data can be considered a primary source, as it is the product of original research.

Why use primary sources?

  Primary sources are a researchers firsthand account of their research. They provide an in depth view into how the research was conducted, and may contain supplemental materials like questionnaires used. A summary of a study or experiment in a book or review paper may not discuss all the findings, and you can gain more insight into a particular topic or issue by looking at the primary sources. 

How to find primary sources:

Resources for finding primary sources include: 

• Databases and Indexes -- The exact database or index you choose to search will depend on the discipline you are searching in. 
• Review Papers -- Review papers are often synthesized from other researchers to give an in-depth understanding of the current state of knowledge on a topic. If you have found a review paper when you are looking for a research paper don't fear! If the review paper is on the write topic it will cite plenty of research papers on your topic of interest. 

What are secondary sources?

In the sciences secondary sources analyze, interpret, summarize, or evaluate the findings of primary sources. Secondary sources can include any of the following publications: 

• Journal review articles -- A review article summarizes past research on a given topic. Review articles can range from highly intensive systematic or integrative reviews or less rigorous literature reviews.
• Textbooks -- The information in textbooks in the sciences is the product of past research.  
• Monographs -- A monograph is a book-length scholarly publication dedicated to a single topic. 

Secondary sources can save you time by providing information on the current state of knowledge on a given topic, and also as a way to find primary resources. If you are interested to know what are important, seminal papers in on a topic look at what papers are cited in a textbook on that topic. Review papers can give you in-depth information on a particular research area. Secondary resources are also often less technical than primary resources. 

How to find secondary sources:

Resources for finding secondary sources 

• Databases and Indexes -- Databases and indexes are particularly useful for finding review articles.  
• The Library Catalog or Ram Search -- The library catalog or Ram Search will help you locate books on the topic you are interested in. 

What are tertiary sources?

In the sciences tertiary resources are synthesized from primary and secondary resources. They usually provide summaries on the current state of knowledge. Tertiary sources can include the following publications: 

• Encyclopedias
• Dictionaries 
• Factbooks 
• Almanacs 

Why use tertiary sources?

Tertiary sources can be viewed as a jumping off point for your own research. They provide succinct  summaries on topics, and can be a good way to familiarize yourself with the terminology on a topic before you begin searching the databases.

How to find tertiary sources:

Resources for finding tertiary sources include: 

• The Library Catalog or Ram Search -- Keep in mind a majority of our encyclopedias are in the reference room. 
• LibGuides and the Library Website -- We have a number of digital encyclopedias. Check the LibGuide for your field to see what digital encyclopedias we might offer!
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• Last Updated: May 13, 2024 2:38 PM
• URL: https://libguides.framingham.edu/scienceliterature

Identifying Primary and Secondary Research Articles

• Primary and Secondary

Primary Research Articles

Primary research articles report on a single study. In the health sciences, primary research articles generally describe the following aspects of the study:

• The study's hypothesis or research question
• Some articles will include information on how participants were recruited or identified, as well as additional information about participants' sex, age, or race/ethnicity
• A "methods" or "methodology" section that describes how the study was performed and what the researchers did
• Results and conclusion section

Secondary Research Articles

Review articles are the most common type of secondary research article in the health sciences. A review article is a summary of previously published research on a topic. Authors who are writing a review article will search databases for previously completed research and summarize or synthesize those articles,  as opposed to recruiting participants and performing a new research study.

Specific types of review articles include:

• Systematic Reviews
• Meta-Analysis
• Narrative Reviews
• Integrative Reviews
• Literature Reviews

Review articles often report on the following:

• The hypothesis, research question, or review topic
• Databases searched-- authors should clearly describe where and how they searched for the research included in their reviews
• Systematic Reviews and Meta-Analysis should provide detailed information on the databases searched and the search strategy the authors used.Selection criteria-- the researchers should describe how they decided which articles to include
• A critical appraisal or evaluation of the quality of the articles included (most frequently included in systematic reviews and meta-analysis)
• Discussion, results, and conclusions

Determining Primary versus Secondary Using the Database Abstract

Information found in PubMed, CINAHL, Scopus, and other databases can help you determine whether the article you're looking at is primary or secondary.

Primary research article abstract

• Note that in the "Objectives" field, the authors describe their single, individual study.
• In the materials and methods section, they describe the number of patients included in the study and how those patients were divided into groups.
• These are all clues that help us determine this abstract is describing is a single, primary research article, as opposed to a literature review.
• Primary Article Abstract

Secondary research/review article abstract

• Note that the words "systematic review" and "meta-analysis" appear in the title of the article
• The objectives field also includes the term "meta-analysis" (a common type of literature review in the health sciences)
• The "Data Source" section includes a list of databases searched
• The "Study Selection" section describes the selection criteria
• These are all clues that help us determine that this abstract is describing a review article, as opposed to a single, primary research article.
• Secondary Research Article

• Primary vs. Secondary Worksheet

Full Text Challenge

Can you determine if the following articles are primary or secondary?

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Peer Review and Primary Literature: An Introduction: Is it Primary Research? How Do I Know?

• Scholarly Journal vs. Magazine
• Peer Review: What is it?
• Finding Peer-Reviewed Articles
• Primary Journal Literature
• Is it Primary Research? How Do I Know?

Components of a Primary Research Study

As indicated on a previous page, Peer-Reviewed Journals also include non -primary content. Simply limiting your search results in a database to "peer-reviewed" will not retrieve a list of only primary research studies.

Learn to recognize the parts of a primary research study. Terminology will vary slightly from discipline to discipline and from journal to journal.  However, there are common components to most research studies.

When you run a search, find a promising article in your results list and then look at the record for that item (usually by clicking on the title). The full database record for an item usually includes an abstract or summary--sometimes prepared by the journal or database, but often written by the author(s) themselves. This will usually give a clear indication of whether the article is a primary study.  For example, here is a full database record from a search for family violence and support in SocINDEX with Full Text :

Although the abstract often tells the story, you will need to read the article to know for sure. Besides scanning the Abstract or Summary, look for the following components: (I am only capturing small article segments for illustration.)

Look for the words METHOD or METHODOLOGY . The authors should explain how they conducted their research.

NOTE: Different Journals and Disciplines will use different terms to mean similar things. If instead of " Method " or " Methodology " you see a heading that says " Research Design " or " Data Collection ," you have a similar indicator that the scholar-authors have done original research.

Look for the section called RESULTS . This details what the author(s) found out after conducting their research.

Charts , Tables , Graphs , Maps and other displays help to summarize and present the findings of the research.

A Discussion indicates the significance of findings, acknowledges limitations of the research study, and suggests further research.

References , a Bibliography or List of Works Cited indicates a literature review and shows other studies and works that were consulted. USE THIS PART OF THE STUDY! If you find one or two good recent studies, you can identify some important earlier studies simply by going through the bibliographies of those articles.

A FINAL NOTE:  If you are ever unclear about whether a particular article is appropriate to use in your paper, it is best to show that article to your professor and discuss it with them.  The professor is the final judge since they will be assigning your grade.

Subject Guide

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Primary Literature: What is Primary Literature?

A super-brief definition of primary scientific literature.

Primary scientific literature, what is it and how do I find it?

Two things are true for all primary scientific literature:

• It is peer-reviewed.
• It reports actual or original experiments.

What is peer review?

Peer review is a step in the process of publishing scientific findings. An article which has been submitted to a journal for publication is critically scrutinized and evaluated by a group of experts in the field. These experts will look at the entire article for flaws in the design, method, results, and analysis of the experiment. 

How can I tell if an article is reporting an actual experiment?

You have to read. Sometimes the title is a good clue. Sometimes the abstract will tell you. Sometimes you have to read a little further. What you are looking for is the fact that the author(s) performed an experiment, got results, and analyzed and/or summarized their findings. Look for sections called "Methods" or "Methodology" and "Results" and "Discussion" or Analysis". 

• Last Updated: Sep 28, 2015 9:23 AM
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Primary and Secondary Literature in the Sciences

Category: Primary sources

Purpose: General Interest

Audience(s): Undergraduate student

Primary Literature

Scientists advance scientific knowledge through the publication their original research results. Publication of a scientist’s results is known as primary literature. In general, most primary literature follows a pattern containing an abstract, the authors’ names and affiliations, an introduction, a methods/materials section, results, discussion, conclusion and reference list. Most of primary scientific literature comes in the form of a journal article, where each article represents one consistent theme of experimentation and results. Because the methodology is described, primary literature provides the opportunity for others to duplicate, repeat or extend the research protocols. Examples of primary sources include journal papers, conference papers, technical reports and thesis and dissertations.

Secondary Literature

When scientists integrate, condense or summarize results from primary literature into review articles or books, this represents secondary literature. They are extremely useful in providing a broad overview of a field and usually provide more background information and less technical methodology. Secondary literature usually has no abstract and the data, figures or images are taken from other sources. Examples of secondary sources include reviews, monographs, books, treatises, and manuals.

Peer-Review

Primary resources are usually vetted through other researchers who are familiar with the topic. This is the process of peer-review. This lends credence and authority to a publication. Peer-review is not a process for detecting fraud but a way of ensuring that scientists are reading quality work from other researchers. [NOTE: Do not confuse peer-review and a review article. Peer-review is a process that a particular article will undergo and is a designation given to a particular journal. A review article is an article that represents a summary of a particular topic and is a designation given to an article.]

Comparison between Primary and Secondary Literature Table.

Examples of Primary Sources in the Sciences

• Journal articles
• Technical reports
• Conference papers or proceedings
• Thesis & dissertations
• Lab notebooks (may not be published)
• Field notes (may not be published)

Examples of Secondary Sources in the Sciences

• Dictionaries
• Directories
• Encyclopedias
• Government Policy
• Law and Legislation
• Public Opinion
• Social Policy

Getting Started

Begin by looking for secondary literature. Most databases (electronic collections of journal articles that are searchable) will allow you to filter your results to look for review articles. This is helpful because it provides context to your searching. Understand that the Library has paid millions of dollars for resources so searching our databases will provide you with information and access that you cannot always get through Google. If you use information from a website make sure you provide the reference information for that site. Decide on a citation style and stay consistent. This is where an online Reference Manager like Mendeley ( www.mendeley.com ) and Zotero ( www.zotero.org ) can be very helpful. Remember these tools are not fool proof and you will have to read over any reference list generated for you.

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Have a Question?

A typical scholarly, scientific journal article (aka “ORIGINAL RESEARCH ARTICLE” or “PRIMARY RESEARCH ARTICLE”) is PEER REVIEWED (more on this later), discusses the authors’ original research, offers thoughtful analysis of the results, and cites relevant papers from other authors that relate to the research.

A slightly different type of journal article (called a “REVIEW ARTICLE”) will not report on original research, but will outline the current state of research in a particular field, citing the appropriate literature and connecting the various pieces of research together. Review articles are generally peer reviewed.

Review articles and original research articles can often look the same at first glance, and most search engines or databases won’t tell you what type of an article it is. To tell them apart, you need to identify whether the authors are discussing their own research and experiments or someone else’s. Often, the “Materials and methods” section (aka “Experimental procedures” or something similar) will be your best clue. This section is occasionally stored online, separate from the article as a part of the “supplementary materials”.

If the authors are discussing research and experiments that they carried out, and giving you an outline of the experiment, it will be an original research article.

When you are searching for information on a research topic, you may also run across some other types of information. Shorter news articles (1-2 pages) may appear in some scientific and popular publications reporting on recent developments in a particular field, or reporting on a particular piece of research. These news articles are not peer reviewed, and are normally written by science journalists, not researchers. The news articles may be easier to read, but since they are normally one or two steps removed from the original research, a news article may not be the best source for your paper or project. However, news articles can lead you to a piece of original research, and can help you easily stay informed about recent research developments.

If you conduct your searches online, via Google, Yahoo or another popular search engine, you may find journal articles, but you may also come across other scientific information that can take many forms. Wikis, blogs and personal websites can often contain a lot of scientific information, but these resources are generally very far removed from the original research where the ideas were first developed. Each of these sources needs to be evaluated very carefully to determine if the information is credible, and these sources won’t be suitable for a research paper. There is a lot of great scientific information on the web, but there is also a lot of bad science, pseudo-science, and non-science-pretending-to-be-science available and distinguishing them can be tricky.

From "A Very Brief Introduction to the Scientific Literature," by Bonnie Swoger, September 12, 2014. Reprinted with permission. Text has been edited for brevity and clarity. Original text can be found on  her website .

Peer review is the process that allows scientists to trust the reliability of published journal articles. Here’s how it works:

• A scientist submits an article to a journal saying “please publish this article.”
• The journal finds 2 or 3 people who know a lot about the research topic, called REVIEWERS or REFEREES, and asks them to look at the article.
• The reviewers look at the article carefully. They check to see if the experiment is designed and conducted well, they look at the analysis of the data, they see whether the conclusions are justified by the data, and they make sure the article can be understood by other scientists. They also make a judgment about how “important” the article is. Some journals only accept really innovative and important research, other journals accept research that advances the field just a little bit.
• The reviewers say “yes, we should publish this article”, “no, we shouldn’t publish this article” or “if the author makes some changes, maybe we should publish this article”
• If the article is published, we can say that it has been PEER REVIEWED.

Scientists rely on their colleagues, the reviewers, to make sure that good science is given a wide audience and that not-so-good science stays out of the science journals. Because blogs, wikis and personal websites don’t automatically have this expert filter, you have to do a lot more digging to determine if the information is reliable.

The only way to tell if a journal article has been peer reviewed is to look for information about the journal itself, normally on the publishers website. Most databases won’t indicate if an article is peer reviewed or not.

From "A Very Brief Introduction to the Scientific Literature," by Bonnie Swoger, September 12, 2014. Reprinted with permission. Text has been edited for brevity and clarity. Original text can be found on  her website .

• Research articles (“original research articles” or “primary research articles”) – These are your standard scientific articles. Most often published in peer reviewed journals, primary research articles report on the findings of a scientists work. They will almost always include a description of how the research was done and what the results mean.
• Review articles – These can be easily confused with primary research articles. They are also published in peer reviewed journals, but seek to synthesize and summarize the work of a particular sub-field, rather than report on new results. Review articles will often lack a “Materials and Methods” section. 
• Editorials / Opinion / Commentary / Perspectives – An article expressing the authors view about a particular issue. This may be an issue of science policy, urging a particular research agenda, or even taking a side in a particular scientific dispute. These articles can be well researched and include a lot of citations to the peer reviewed literature, or simple items without citations. 
• Trade publication articles – Between the standard scholarly journals ( Nature ) and the popular publications ( Scientific American ) lie the Trade publications. These publications are often aimed at medical professionals or particular disciplines. Articles in these publications may be several pages long and include a few references, but they are usually summarizing research published in other publications or reporting on industry news. 
• News – Science news articles can be found in a wide variety of publications. Popular newspapers and magazines, trade publications and scholarly publications can all have science news articles. These articles often will refer to a recent study published as a primary research article.
• Technical Reports – Government agencies and NGO’s often do scientific work. The reports they produce are not often peer reviewed, but can be an important part of the scientific literature. Reports from the World Health Organization or the USGS can provide vital information to scientists. These reports can be found in scholarly databases and on the web, and are classified by some folks as gray literature (see below).
• Gray literature – The term “gray literature” largely refers to items that are distributed or published outside of the traditional journal and book publishers. It typically referred to items that could be difficult to find, although I believe this distinction is becoming less important as these items are now often discoverable in internet search engines.
• Books (including reference materials like handbooks and dictionaries) – Most scientific books cannot be considered ‘primary research’. In general, they describe and interpret the primary research published in the journal articles.  
• Dissertations / Thesis – These are the final products that result from research conducted for a PhD or a Masters degree. These items can often be very long, going into great detail about methods and with lots of appendices of data. While they undergo exhaustive review by academic advisers and committee members, they wouldn’t be considered “peer-reviewed”.

From "Types of Scientific Literature," by Bonnie Swoger, September 12, 2014. Reprinted with permission. Text has been edited for brevity and clarity. Original text can be found on  her website .

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Literature Reviews: Types of Literature

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Types of Literature

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Different types of publications have different characteristics.

Primary Literature Primary sources means original studies, based on direct observation, use of statistical records, interviews, or experimental methods, of actual practices or the actual impact of practices or policies. They are authored by researchers, contains original research data, and are usually published in a peer-reviewed journal. Primary literature may also include conference papers, pre-prints, or preliminary reports. Also called empirical research .

Secondary Literature Secondary literature consists of interpretations and evaluations that are derived from or refer to the primary source literature. Examples include review articles (such as meta-analysis and systematic reviews) and reference works. Professionals within each discipline take the primary literature and synthesize, generalize, and integrate new research.

Tertiary Literature Tertiary literature consists of a distillation and collection of primary and secondary sources such as textbooks, encyclopedia articles, and guidebooks or handbooks. The purpose of tertiary literature is to provide an overview of key research findings and an introduction to principles and practices within the discipline.

Adapted from the Information Services Department of the Library of the Health Sciences-Chicago , University of Illinois at Chicago.

Types of Scientific Publications

These examples and descriptions of publication types will give you an idea of how to use various works and why you would want to write a particular kind of paper.

• Scholarly article aka empirical article
• Review article
• Conference paper

Scholarly (aka empirical) article -- example

Empirical studies use data derived from observation or experiment. Original research papers (also called primary research articles) that describe empirical studies and their results are published in academic journals.  Articles that report empirical research contain different sections which relate to the steps of the scientific method.

      Abstract - The abstract provides a very brief summary of the research.

     Introduction - The introduction sets the research in a context, which provides a review of related research and develops the hypotheses for the research.

     Method - The method section describes how the research was conducted.

     Results - The results section describes the outcomes of the study.

     Discussion - The discussion section contains the interpretations and implications of the study.

     References - A references section lists the articles, books, and other material cited in the report.

Review article -- example

A review article summarizes a particular field of study and places the recent research in context. It provides an overview and is an excellent introduction to a subject area. The references used in a review article are helpful as they lead to more in-depth research.

Many databases have limits or filters to search for review articles. You can also search by keywords like review article, survey, overview, summary, etc.

Conference proceedings, abstracts and reports -- example

Conference proceedings, abstracts and reports are not usually peer-reviewed.  A conference article is similar to a scholarly article insofar as it is academic. Conference articles are published much more quickly than scholarly articles. You can find conference papers in many of the same places as scholarly articles.

How Do You Identify Empirical Articles?

To identify an article based on empirical research, look for the following characteristics:

     The article is published in a peer-reviewed journal .

     The article includes charts, graphs, or statistical analysis .

     The article is substantial in size , likely to be more than 5 pages long.

     The article contains the following parts (the exact terms may vary): abstract, introduction, method, results, discussion, references .

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Evidence Based Practice

• 1. Ask: PICO(T) Question
• 2. Align: Levels of Evidence
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• 3b. Acquire: Searching
• 4. Appraise

Primary vs. Secondary Sources

• Qualitative and Quantitative Sources
• Managing References

Sources are considered primary, secondary, or tertiary depending on the originality of the information presented and their proximity or how close they are to the source of information. This distinction can differ between subjects and disciplines.

In the sciences, research findings may be communicated informally between researchers through email, presented at conferences (primary source), and then, possibly, published as a journal article or technical report (primary source). Once published, the information may be commented on by other researchers (secondary sources), and/or professionally indexed in a database (secondary sources). Later the information may be summarized into an encyclopedic or reference book format (tertiary sources). Source

Primary Sources

A primary source in science is a document or record that reports on a study, experiment, trial or research project. Primary sources are usually written by the person(s) who did the research, conducted the study, or ran the experiment, and include hypothesis, methodology, and results.

Primary Sources include:

• Pilot/prospective studies
• Cohort studies
• Survey research
• Case studies
• Lab notebooks
• Clinical trials and randomized clinical trials/RCTs
• Dissertations

Secondary Sources

Secondary sources list, summarize, compare, and evaluate primary information and studies so as to draw conclusions on or present current state of knowledge in a discipline or subject. Sources may include a bibliography which may direct you back to the primary research reported in the article.

Secondary Sources include:

• reviews, systematic reviews, meta-analysis
• newsletters and professional news sources
• practice guidelines & standards
• clinical care notes
• patient education Information
• government & legal Information
• entries in nursing or medical encyclopedias Source

More on Systematic Reviews and Meta-Analysis

Systematic reviews – Systematic reviews are best for answering single questions (eg, the effectiveness of tight glucose control on microvascular complications of diabetes). They are more scientifically structured than traditional reviews, being explicit about how the authors attempted to find all relevant articles, judge the scientific quality of each study, and weigh evidence from multiple studies with conflicting results. These reviews pay particular attention to including all strong research, whether or not it has been published, to avoid publication bias (positive studies are preferentially published). Source

Meta-analysis -- Meta-analysis, which is commonly included in systematic reviews, is a statistical method that quantitatively combines the results from different studies. It can be used to provide an overall estimate of the net benefit or harm of an intervention, even when these effects may not have been apparent in the individual studies [ 9 ]. Meta-analysis can also provide an overall quantitative estimate of other parameters such as diagnostic accuracy, incidence, or prevalence. Source

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Characteristics of a Primary Research Article

• Goal is to present the result of original research that makes a new contribution to the body of knowledge
• Sometimes referred to as an empirical research article
• Typically organized into sections that include:  Abstract, Introduction, Methods, Results, Discussion/Conclusion, and References.

Example of a Primary Research Article:

Flockhart, D.T.T., Fitz-gerald, B., Brower, L.P., Derbyshire, R., Altizer, S., Hobson, K.A., … Norris, D.R., (2017). Migration distance as a selective episode for wing morphology in a migratory insect. Movement Ecology , 5(1), 1-9. doi: doi.org/10.1186/s40462-017-0098-9

Characteristics of a Review Article

• Goal is to summarize important research on a particular topic and to represent the current body of knowledge about that topic.
• Not intended to provide original research but to help draw connections between research studies that have previously been published.  
• Help the reader understand how current understanding of a topic has developed over time and identify gaps or inconsistencies that need further exploration.

Example of a Review Article:

https://www-sciencedirect-com.ezproxy.oswego.edu/science/article/pii/S0960982218302537

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Primary research or a primary study refers to a research article that is an author’s original research that is almost always published in a peer-reviewed journal. A primary study reports on the details, methods and results of a research study. These articles often have a standard structure of a format called IMRAD, referring to sections of an article: Introduction, Methods, Results and Discussion. Primary research studies will start with a review of the previous literature, however, the rest of the article will focus on the authors’ original research. Literature reviews can be published in peer-reviewed journals, however, they are not primary research.

Primary studies are part of primary sources but should not be mistaken for primary documents. Primary documents are usually original sources such as a letter, a diary, a speech or an autobiography. They are a first person view of an event or a period. Typically, if you are a Humanities major, you will be asked to find primary documents for your paper however, if you are in Social Sciences or the Sciences you are most likely going to be asked to find primary research studies. If you are unsure, ask your professor or a librarian for help.

A primary research or study is an empirical research that is published in peer-reviewed journals. Some ways of recognizing whether an article is a primary research article when searching a database:

1. The abstract includes a research question or a hypothesis,  methods and results.

2. Studies can have tables and charts representing data findings.

3. The article includes a section for "methods” or “methodology” and "results".

4. Discussion section indicates findings and discusses limitations of the research study, and suggests further research.

5. Check the reference section because it will refer you to the studies and works that were consulted. You can use this section to find other studies on that particular topic.

The following are not to be confused with primary research articles:

- Literature reviews

- Meta-analyses or systematic reviews (these studies make conclusions based on research on many other studies)

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Primary Research Articles

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How Can I Find Primary Research Articles?

Many of the recommended databases in this subject guide contain primary research articles (also known as empirical articles or research studies). Search in databases like ScienceDirect  and MEDLINE .

Primary Research Articles: How Will I Know One When I See One?

Primary research articles  to conduct and publish an experiment or research study, an author or team of authors designs an experiment, gathers data, then analyzes the data and discusses the results of the experiment. a published experiment or research study will therefore  look  very different from other types of articles (newspaper stories, magazine articles, essays, etc.) found in our library databases. the following guidelines will help you recognize a primary research article, written by the researchers themselves and published in a scholarly journal., structure of a primary research article typically, a primary research article has the following sections:.

• The author summarizes her article
• The author discusses the general background of her research topic; often, she will present a literature review, that is, summarize what other experts have written on this particular research topic
• The author describes the study she designed and conducted
• The author presents the data she gathered during her experiment
• The author offers ideas about the importance and implications of her research findings, and speculates on future directions that similar research might take
• The author gives a References list of sources she used in her paper

The structure of the article will often be clearly shown with headings: Introduction, Method, Results, Discussion.

A primary research article will almost always contains statistics, numerical data presented in tables. Also, primary research articles are written in very formal, very technical language.

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Q. How do I know if an article is a primary or secondary research article?

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Answered By: Jay Trask Last Updated: Oct 21, 2020     Views: 239079

A primary research article reports on an empirical research study conducted by the authors. It is almost always published in a peer-reviewed journal. This type of article:

• Asks a research question or states a hypothesis or hypotheses
• Identifies a research population
• Describes a specific research method
• Tests or measures something
• Includes a section called "method" or "methodology." This may only appear in the article, not the abstract.
• Includes a section called "results."

Words to look for as clues include: analysis, study, investigation, examination, experiment, numbers of people or objects analyzed, content analysis, or surveys.

To contrast, the following are not primary research articles (i.e., they are secondary sources):

• Literature reviews
• Meta-Analyses/Review articles (These are studies that arrive at conclusions based on research from many other studies.)
• Chapters in books
• Encyclopedia articles
• Speeches and interviews

Please note: if you are seeking information about primary and secondary sources for historical research, please find information here: https://libguides.unco.edu/history-primary-resources

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• Primary vs. Secondary Sources | Difference & Examples

Primary vs. Secondary Sources | Difference & Examples

Published on June 20, 2018 by Raimo Streefkerk . Revised on May 31, 2023.

When you do research, you have to gather information and evidence from a variety of sources.

Primary sources provide raw information and first-hand evidence. Examples include interview transcripts, statistical data, and works of art. Primary research gives you direct access to the subject of your research.

Secondary sources provide second-hand information and commentary from other researchers. Examples include journal articles, reviews, and academic books . Thus, secondary research describes, interprets, or synthesizes primary sources.

Primary sources are more credible as evidence, but good research uses both primary and secondary sources.

Table of contents

What is a primary source, what is a secondary source, primary and secondary source examples, how to tell if a source is primary or secondary, primary vs secondary sources: which is better, other interesting articles, frequently asked questions about primary and secondary sources.

A primary source is anything that gives you direct evidence about the people, events, or phenomena that you are researching. Primary sources will usually be the main objects of your analysis.

If you are researching the past, you cannot directly access it yourself, so you need primary sources that were produced at the time by participants or witnesses (e.g. letters, photographs, newspapers ).

If you are researching something current, your primary sources can either be qualitative or quantitative data that you collect yourself (e.g. through interviews , surveys , experiments ) or sources produced by people directly involved in the topic (e.g. official documents or media texts).

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A secondary source is anything that describes, interprets, evaluates, or analyzes information from primary sources. Common examples include:

• Books , articles and documentaries that synthesize information on a topic
• Synopses and descriptions of artistic works
• Encyclopedias and textbooks that summarize information and ideas
• Reviews and essays that evaluate or interpret something

When you cite a secondary source, it’s usually not to analyze it directly. Instead, you’ll probably test its arguments against new evidence or use its ideas to help formulate your own.

Examples of sources that can be primary or secondary

A secondary source can become a primary source depending on your research question . If the person, context, or technique that produced the source is the main focus of your research, it becomes a primary source.

Documentaries

If you are researching the causes of World War II, a recent documentary about the war is a secondary source . But if you are researching the filmmaking techniques used in historical documentaries, the documentary is a primary source .

Reviews and essays

If your paper is about the novels of Toni Morrison, a magazine review of one of her novels is a secondary source . But if your paper is about the critical reception of Toni Morrison’s work, the review is a primary source .

Newspaper articles

If your aim is to analyze the government’s economic policy, a newspaper article about a new policy is a secondary source . But if your aim is to analyze media coverage of economic issues, the newspaper article is a primary source .

To determine if something can be used as a primary or secondary source in your research, there are some simple questions you can ask yourself:

• Does this source come from someone directly involved in the events I’m studying (primary) or from another researcher (secondary)?
• Am I interested in evaluating the source itself (primary) or only using it for background information (secondary)?
• Does the source provide original information (primary) or does it comment upon information from other sources (secondary)?

Prevent plagiarism. Run a free check.

Most research uses both primary and secondary sources. They complement each other to help you build a convincing argument. Primary sources are more credible as evidence, but secondary sources show how your work relates to existing research. Tertiary sources are often used in the first, exploratory stage of research.

What do you use primary sources for?

Primary sources are the foundation of original research. They allow you to:

• Make new discoveries
• Provide credible evidence for your arguments
• Give authoritative information about your topic

If you don’t use any primary sources, your research may be considered unoriginal or unreliable.

What do you use secondary sources for?

Secondary sources are good for gaining a full overview of your topic and understanding how other researchers have approached it. They often synthesize a large number of primary sources that would be difficult and time-consuming to gather by yourself. They allow you to:

• Gain background information on the topic
• Support or contrast your arguments with other researchers’ ideas
• Gather information from primary sources that you can’t access directly (e.g. private letters or physical documents located elsewhere)

When you conduct a literature review or meta analysis, you can consult secondary sources to gain a thorough overview of your topic. If you want to mention a paper or study that you find cited in a secondary source, seek out the original source and cite it directly.

Remember that all primary and secondary sources must be cited to avoid plagiarism . You can use Scribbr’s free citation generator to do so!

If you want to know more about ChatGPT, AI tools , citation , and plagiarism , make sure to check out some of our other articles with explanations and examples.

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Common examples of primary sources include interview transcripts , photographs, novels, paintings, films, historical documents, and official statistics.

Anything you directly analyze or use as first-hand evidence can be a primary source, including qualitative or quantitative data that you collected yourself.

Common examples of secondary sources include academic books, journal articles , reviews, essays , and textbooks.

Anything that summarizes, evaluates or interprets primary sources can be a secondary source. If a source gives you an overview of background information or presents another researcher’s ideas on your topic, it is probably a secondary source.

To determine if a source is primary or secondary, ask yourself:

• Was the source created by someone directly involved in the events you’re studying (primary), or by another researcher (secondary)?
• Does the source provide original information (primary), or does it summarize information from other sources (secondary)?
• Are you directly analyzing the source itself (primary), or only using it for background information (secondary)?

Some types of source are nearly always primary: works of art and literature, raw statistical data, official documents and records, and personal communications (e.g. letters, interviews ). If you use one of these in your research, it is probably a primary source.

Primary sources are often considered the most credible in terms of providing evidence for your argument, as they give you direct evidence of what you are researching. However, it’s up to you to ensure the information they provide is reliable and accurate.

Always make sure to properly cite your sources to avoid plagiarism .

A fictional movie is usually a primary source. A documentary can be either primary or secondary depending on the context.

If you are directly analyzing some aspect of the movie itself – for example, the cinematography, narrative techniques, or social context – the movie is a primary source.

If you use the movie for background information or analysis about your topic – for example, to learn about a historical event or a scientific discovery – the movie is a secondary source.

Whether it’s primary or secondary, always properly cite the movie in the citation style you are using. Learn how to create an MLA movie citation or an APA movie citation .

Articles in newspapers and magazines can be primary or secondary depending on the focus of your research.

In historical studies, old articles are used as primary sources that give direct evidence about the time period. In social and communication studies, articles are used as primary sources to analyze language and social relations (for example, by conducting content analysis or discourse analysis ).

If you are not analyzing the article itself, but only using it for background information or facts about your topic, then the article is a secondary source.

Cite this Scribbr article

If you want to cite this source, you can copy and paste the citation or click the “Cite this Scribbr article” button to automatically add the citation to our free Citation Generator.

Streefkerk, R. (2023, May 31). Primary vs. Secondary Sources | Difference & Examples. Scribbr. Retrieved June 9, 2024, from https://www.scribbr.com/working-with-sources/primary-and-secondary-sources/

Is this article helpful?

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Primary, Secondary, and Tertiary Literature

Primary literature, secondary literature, tertiary literature.

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• Text only document for primary, secondary, tertiary sources

Graphic adapted from UC San Diego:  http://ucsd.libguides.com/MCWP/sources

Primary Literature in the Sciences

In the sciences, the primary literature presents the immediate results of research activities.  It often includes analysis of data collected in the field or laboratory.  Primary literature presents original research and/or new scientific discoveries.  

Examples of Primary Literature in the Sciences:

• Original research published as articles in peer-reviewed journals.
• Dissertations
• Technical reports
• Conference proceedings

Identifying Primary Literature in the Sciences

When looking at a journal article to determine whether or not is it primary literature, look for the following common components of a primary research article:

• Introduction
• Methods or Materials and Methods 
• Conclusions

Secondary Literature in the Sciences

The secondary literature in the sciences summarizes and synthesizes the primary literature.  It is usually broader and less current than primary literature.  Since most information sources in the secondary literature contain extensive bibliographies, they can be useful for finding more information on a topic.  

Examples of Secondary Literature in the Sciences: 

• Literature review articles

Tertiary Literature in the Sciences

Tertiary literature presents summaries or condensed versions of materials usually with references to primary or secondary sources.  They can be a good place to look up facts or get a general overview of a subject.  

Examples of Tertiary Literature in the Sciences:

• Dictionaries
• Encyclopedias
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• Published: 29 May 2024

Knowledge, attitudes, and practices of primary healthcare practitioners regarding pharmacist clinics: a cross-sectional study in Shanghai

• Xinyue Zhang 1   na1 ,
• Zhijia Tang 1   na1 ,
• Yanxia Zhang 1   na1 ,
• Wai Kei Tong 1 ,
• Qian Xia 1 ,
• Bing Han 1 &
• Nan Guo 1  

BMC Health Services Research volume  24 , Article number:  677 ( 2024 ) Cite this article

183 Accesses

Metrics details

Pharmacist clinics offer professional pharmaceutical services that can improve public health outcomes. However, primary healthcare staff in China face various barriers and challenges in implementing such clinics. To identify existing problems and provide recommendations for the implementation of pharmacist clinics, this study aims to assess the knowledge, attitudes, and practices of pharmacist clinics among primary healthcare providers.

A cross-sectional survey based on the Knowledge-Attitude-Practice (KAP) model, was conducted in community health centers (CHCs) and private hospitals in Shanghai, China in May, 2023. Descriptive analytics and the Pareto principle were used to multiple-answer questions. Chi-square test, Fisher’s exact test, and binary logistic regression models were employed to identify factors associated with the knowledge, attitudes, and practices of pharmacist clinics.

A total of 223 primary practitioners participated in the survey. Our study revealed that most of them had limited knowledge (60.1%, n  = 134) but a positive attitude (82.9%, n  = 185) towards pharmacist clinics, with only 17.0% ( n  = 38) having implemented them. The primary goal of pharmacist clinics was to provide comprehensive medication guidance (31.5%, n  = 200), with medication education (26.3%, n  = 202) being the primary service, and special populations (24.5%, n  = 153) identified as key recipients. Logistic regression analysis revealed that education, age, occupation, position, work seniority, and institution significantly influenced their perceptions. Practitioners with bachelor’s degrees, for instance, were more likely than those with less education to recognize the importance of pharmacist clinics in medication guidance (aOR: 7.130, 95%CI: 1.809–28.099, p -value = 0.005) and prescription reviews (aOR: 4.675, 95% CI: 1.548–14.112, p -value = 0.006). Additionally, practitioners expressed positive attitudes but low confidence, with only 33.3% ( n  = 74) feeling confident in implementation. The confidence levels of male practitioners surpassed those of female practitioners ( p -value = 0.037), and practitioners from community health centers (CHCs) exhibited higher confidence compared to their counterparts in private hospitals ( p -value = 0.008). Joint physician-pharmacist clinics (36.8%, n  = 82) through collaboration with medical institutions (52.0%, n  = 116) emerged as the favored modality. Daily sessions were preferred (38.5%, n  = 86), and both registration and pharmacy service fees were considered appropriate for payment (42.2%, n  = 94). The primary challenge identified was high outpatient workload (30.9%, n  = 69).

Conclusions

Although primary healthcare practitioners held positive attitudes towards pharmacist clinics, limited knowledge, low confidence, and high workload contributed to the scarcity of their implementation. Practitioners with diverse sociodemographic characteristics, such as education, age, and institution, showed varying perceptions and practices regarding pharmacist clinics.

Peer Review reports

Pharmacist clinics are specialized healthcare facilities that offer professional pharmaceutical services, such as medication therapy management, medication reconciliation, lifestyle counseling, and immunizations, for patients with chronic diseases or managing multiple drugs [ 1 ]. Through the provision of these services, pharmacist clinics aim to improve patient access to healthcare, optimize medication use, and improve overall public health outcomes.

Pharmacist clinics originated in the 1960s in the United States and have spread globally in recent decades [ 2 ], with a growing number of countries adopting this model of care. The World Health Organization (WHO) has recognized the importance of pharmacists in primary healthcare and encouraged the integration of pharmaceutical services into broader healthcare systems [ 3 ]. This integration facilitates the rational use of medication, thereby minimizing adverse drug events and medication errors, ultimately leading to better therapeutic outcomes. Moreover, pharmacist clinics offer medication guidance and education, which adjusts optimal medication dosage [ 4 ], enhances patient adherence [ 1 , 5 ], expands access to health care [ 6 ], and reduces treatment costs [ 7 ]. These clinics effectively bridge the communication gap between physicians and pharmacists [ 8 ], fostering interdisciplinary collaboration and integrated patient care [ 1 , 9 ].

The development of pharmacist clinics in China was initiated in the late 20th century, coinciding with the introduction of healthcare reforms by the Chinese government in the early 2000s. The release of “Opinions on Deepening the Reform of the Medical and Health System” [ 10 ] in 2009 highlighted the importance of pharmacist clinics and the crucial role of pharmacists in improving the quality and accessibility of healthcare services in primary settings. In 2020, the Chinese government released a guidance document titled “Opinions on Strengthening the Pharmaceutical Management of Medical Institutions and Promoting Rational Drug Use,” encouraging provinces to actively establish pharmacist clinics [ 11 ]. However, it wasn’t until 2021 that the General Office of the National Health Commission developed the “Guidelines for Pharmaceutical Outpatient Services in Medical Institutions” to standardize these pharmacist clinics [ 12 ]. Despite the progress made, primary medical staff in both developed and developing countries face various challenges, especially in developing countries [ 13 ], including a shortage of qualified pharmacists [ 14 , 15 ], limited recognition of pharmacists’ roles among healthcare professionals and the public [ 16 , 17 ], and the need for a more standardized approach to pharmaceutical care [ 18 ]. Additionally, these clinics are predominantly located in large general hospitals or specialized medical facilities, limiting their coverage to specific areas, such as antibiotics [ 19 ] and anticoagulants [ 20 ]. In rural areas, there is scarce awareness and discussion regarding the promotion of pharmacist clinics.

To date, most research on pharmacist clinics comes from countries like the United States, the UK, Canada, and Australia, focusing primarily on the outcomes of pharmacist interventions rather than the implementation challenges [ 1 , 4 , 21 , 22 , 23 , 24 ]. In China, only a few studies have assessed the current state of pharmacist clinics. Cai et al. [ 25 ], for instance, conducted a national survey revealing that just 10.03% of hospitals had pharmacist clinics. Wu et al. [ 26 ] investigated the establishment and operational details of pharmacist-managed clinics in Taiwan. However, there is no published research exploring optimal practices for setting up pharmacist clinics in China or identifying the barriers to establishing these clinics in primary healthcare settings. In this study, we aim to assess the awareness and understanding of pharmacist clinics among primary healthcare providers. We conducted a cross-sectional survey based on the Knowledge-Attitude-Practice (KAP) model to identify knowledge gaps and develop interventions to encourage interprofessional collaboration and enhance practice efficiency. The findings may also improve patient outcomes, healthcare delivery by streamlining the implementation process, and utilization of high-quality pharmaceutical services. Our ultimate goal was to overcome barriers to advancing pharmacist clinics within China’s healthcare system and offer insights for policymakers and healthcare authorities to integrate these clinics into primary healthcare settings, not only in China but potentially in other countries as well.

Survey instrument & selection criteria

Our study employed a structural equation model based on the Knowledge, Attitude, and Practice (KAP) theory [ 27 ] and relevant literature [ 28 , 29 , 30 , 31 ] to explore the relationships between various factors. Following the KAP principles, we developed a questionnaire consisting of 21 questions across three domains: (A) knowledge of pharmacist clinics, (B) attitudes towards pharmacist clinics, and (C) practices related to pharmacist clinics. Demographic information such as gender, age, education, occupation, position, seniority, department, and institution was collected through self-reporting.

The inclusion and exclusion criteria for the sampled respondents were as follows. Inclusion criteria: (1) Full-time primary healthcare practitioners attending a continuing education course at Minhang Hospital in Shanghai, China. This included physicians, pharmacists, nurses, and other primary healthcare practitioners. (2) Willingness to participate in the study and provide informed consent. Exclusion criteria: (1) Part-time employees or interns. (2) Non-medical staff. (3) Individuals who declined to sign the informed consent form.

Study population and data source

This study used data from a cross-sectional survey conducted in May, 2023, involving primary healthcare practitioners from 10 community health centers (CHCs) and 38 private hospitals in Shanghai, China. After excluding participants from secondary or tertiary hospitals ( n  = 9), nursing homes ( n  = 6), and other facilities such as welfare homes and school clinics ( n  = 9), a total of 223 eligible subjects were included.

Data collection

The sample size was optimized to range between 105 and 210, based on the recommended ratio of 5 to 10 respondents per item [ 32 , 33 ]. We also performed a pilot study in April, 2023 to ensure linguistic clarity and readability of the questionnaire. Twenty-six student volunteers from the School of Pharmacy at Fudan University were recruited to refine the questionnaire. Additionally, face-to-face interviews were conducted to further assess their understanding of the content. The final version was electronically distributed to participants during a continuing education course using a voluntary sampling approach. The full questionnaire is available in Supplementary Table 1 , and all data were anonymized.

Statistical analysis

Categorical variables were summarized using frequency counts (weighted percentage, %). The Chi-square test and Fisher’s exact test were used to assess differences in knowledge, attitude, and practice regarding pharmacist clinics across various sociodemographic characteristics. Descriptive analytics and the Pareto principle were applied to multiple-answer questions. In case of rejection of the null hypothesis, multiple pairwise comparisons would be conducted as confirmatory post hoc analysis using Bonferroni correction. Based on the univariate analysis results, we constructed binary logistic regression models to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI) to reveal factors associated with perceived goals, service scope, and target recipients of pharmacist clinics.

All statistical analyses were performed using IBM SPSS Statistics for Windows, Version 20.0 (IBM Corp., Armonk, NY, USA). A two-sided p -value < 0.05 was considered statistically significant.

Demographics

As presented in Table  1 , a total of 223 primary healthcare practitioners participated in the survey, with 41.3% ( n  = 92) being male and 76.2% ( n  = 170) under 45 years old. The majority (84.3%, n  = 188) were physicians, while the remaining were pharmacists. Regarding educational qualifications, 82.5% ( n  = 184) of respondents held a bachelor’s degree or below. Furthermore, 91.9% ( n  = 205) held mid-level or lower positions, and 56.1% ( n  = 125) reported professional tenures of less than 10 years. Of these 223 practitioners, 36.8% ( n  = 82) were from public institutions (community health centers), and 63.2% ( n  = 141) were from private hospitals.

Knowledge of pharmacist clinics

Of primary care practitioners, 84.8% ( n  = 189) recognized pharmacist clinics, with 24.7% ( n  = 55) having strong familiarity. Figure  1 a-c showed practitioners’ views on the goals, services, and target recipients of these clinics. The primary goal was to provide comprehensive medication guidance (31.5%, n  = 200), with medication education (26.3%, n  = 202) being the primary service, and special populations (24.5%, n  = 153) identified as key recipients. Logistic regression results revealed several significant influential factors (Table  2 ).

Pareto chart demonstrating respondents’ knowledge of pharmacist clinics

( a ) Perceived goals: A prescription reviews, B medication guidance, C time-saving, D conflict alleviation, E patient empowerment, F cost reduction, G role enhancement, H research, I training, and J no perceived value

( b ) Perceived service scope: A drug regimen adjustments, B medication reconciliation, C medication education on dosage, side effects, and interactions, D adherence interventions, E health promotion, F patient follow-ups

( c ) Perceived target recipients: A isolated/empty-nest patients, B special populations (e.g. elderly, children, pregnant, and liver/kidney-impaired), C economically disadvantaged patients, D patients suffering from adverse reactions, E patients needing test report interpretations, F frequent drug collectors (> 20 times/year), G patients with ≥ 2 chronic diseases, H patients with any chronic diseases, I patients on ≥ 5 medications, J high-risk drug users (e.g. psychotropic drugs, hormones, injections, and inhalants), K patients under contract with family physicians, and L all patients

Compared to those with less education, practitioners with bachelor’s degrees were more likely to see the role of pharmacist clinics in medication guidance (aOR: 7.130, 95%CI: 1.809–28.099, p -value = 0.005), prescription reviews (aOR: 4.675, 95% CI: 1.548–14.112, p -value = 0.006), and serving patients on high-risk drugs (aOR: 2.824, 95% CI: 1.090–7.316, p -value = 0.033).

Besides medication guidance (aOR: 7.303, 95%CI: 1.343–39.720, p -value = 0.021), practitioners with master’s or higher degrees preferred adherence interventions (aOR: 4.221, 95%CI: 1.339–13.300, p -value = 0.014), follow-up services (aOR: 3.125, 95%CI: 1.095–8.915, p -value = 0.033), and catering to patients with ≥ 2 chronic diseases (aOR: 6.401, 95%CI: 1.233–33.223, p -value = 0.027) or ≥ 5 medications (aOR: 3.987, 95%CI: 1.250-12.717, p -value = 0.019). Higher education was also inversely associated with emphasizing patients needing test report interpretations (aOR < 1, p -value < 0.05).

Younger practitioners, aged 18 to 30, considered pharmacist clinics as tools to mitigate physician-patient conflicts through improved communication compared to those aged ≥ 46 (aOR: 0.165, 95%CI: 0.028–0.988, p -value = 0.048).

Compared to physicians, pharmacists typically addressed all patients as recipients (aOR: 3.322, 95%CI: 1.031–10.703, p -value = 0.044), but were less likely to offer drug regimen adjustments (aOR: 0.210, 95%CI: 0.088-0.500, p -value < 0.001).

Junior and intermediate-level practitioners demonstrated a greater likelihood for follow-up services (aOR 1 : 5.832, 95%CI: 1.308–25.998, p -value = 0.021; aOR 2 : 3.99, 95%CI: 1.087–14.646, p -value = 0.037), and were less likely to target patients in need of test report interpretations (aOR 1 : 0.172, 95%CI: 0.038–0.781, p -value = 0.023; aOR 2 : 0.287, 95%CI: 0.082–0.997, p -value = 0.049) than their senior counterparts.

Work seniority

Practitioners with 10–19 years of work experience were significantly more likely to consider isolated/empty-nest patients as suitable recipients compared to those with < 5 years of experience (aOR: 3.328, 95%CI: 1.021–10.849, p -value = 0.046).

Institution

Practitioners from CHCs were more likely to view frequent drug collectors as suitable recipients compared to those from private hospitals (aOR: 0.359, 95%CI: 0.134–0.966, p -value = 0.043).

Attitude of pharmacist clinics

Necessity and confidence in implementing pharmacist clinics.

Table  3 showed that 82.9% ( n  = 185) of practitioners recognized the necessity of pharmacist clinics, but only 33.3% ( n  = 75) felt confident in their implementation. Male practitioners exhibited significantly higher confidence levels compared to female practitioners ( p  = 0.037), and practitioners from community health centers (CHCs) showed greater confidence relative to those practicing in private hospitals ( p  = 0.008).

Preferred mode of pharmacist clinics

As shown in Table  4 , the favored modality was found to be joint physician-pharmacist clinics (36.8%, n  = 82), through collaboration with medical institutions (52.0%, n  = 116). Daily sessions emerged as the preferred frequency ( n  = 86, 38.5%), with both registration and pharmacy service fees considered appropriate for payment (42.2%, n  = 94).

Furthermore, we explored the influence of different sociodemographic variables. Practitioners holding a master’s degree or higher demonstrated a preference for a clinic frequency of 2–4 times per week ( p -value = 0.015), along with acceptance of both registration and pharmacy service fees ( p -value < 0.001), compared to those with lower levels of education. Conversely, those with a junior college education or below were more willing to seek free services. Practitioners from CHCs exhibited a preference for weekly or 2–4 times per week clinics, whereas those from private hospitals favored daily or monthly sessions ( p -value < 0.001).

Practice of pharmacist clinics

As shown in Table  5 , there was a limited prevalence of pharmacist clinics within primary care institutions. Only 17.0% ( n  = 38) of practitioners reported the implementation of pharmacy clinics, mostly scheduled once a week (47.4%, n  = 18), with the primary challenge being a high outpatient workload (30.9%, n  = 69). Practitioners from CHCs demonstrated a significantly higher implementation frequency compared to those from private hospitals ( p -value < 0.001).

We further explored sociodemographic factors associated with challenges. Practitioners aged over 45 years ( P  = 0.020) and occupying senior/deputy senior positions ( p -value = 0.018) were more likely to consider the absence of fee collection mechanisms as the principal difficulty, as opposed to their younger counterparts and those in lower positions.

Our study aims to evaluate the perceptions, attitudes, and practices of primary healthcare practitioners regarding pharmacist clinics and to identify necessary changes. The findings unveiled a lack of knowledge and confidence among primary care providers, who are faced with barriers including high outpatient workloads and concerns related to professionalism. Collaborative models are preferred as they align with the current emphasis on multidisciplinary approaches in modern healthcare, which aim to achieve optimal population health [ 34 ]. Additionally, our findings highlight the impact of institution and gender on the perceptions of primary care providers.

In this study, more practitioners preferred joint physician-pharmacist clinics over traditional physician-led clinics (36.8%, n  = 82 vs. 24.2%, n  = 54), which is in line with a global focus on integrating pharmacists into the provision of patient-centered, coordinated, and comprehensive care [ 1 , 35 , 36 ]. Primary care physicians are in short supply, and studies unveiled that the shortage of primary care physicians has led to increased workloads and a greater demand for medication guidance services, especially among vulnerable patients aged 65 and above [ 37 , 38 , 39 , 40 ]. Our study showed the primary goals of pharmacist clinics were found to be prescription reviews (28.9%, n  = 183) and medication guidance (31.5%, n  = 200), which are critical in addressing concerns regarding poorly managed or duplicate prescriptions [ 41 , 42 ]. Integrating pharmaceutical services into primary care offers expedited access and convenience for patients, thereby releasing physicians to focus on more complex cases and reducing their workload [ 43 , 44 ]. These services also contribute to overall savings in healthcare and medication costs, as well as reduced general physician appointments, emergency department visits, and inappropriate drug use [ 45 , 46 ]. Our findings support the potential of pharmacist-led prescription reviews in reducing duplicate prescriptions [ 47 ], drug-related problems [ 48 ], and medication costs, without increasing physicians’ workload [ 49 ]. Moreover, pharmacist-led medication guidance provided to other professionals has been shown to reduce medication errors and inappropriate prescriptions compared to standard care [ 50 , 51 ]. The development of joint physician-pharmacist clinics may be an advantageous choice for the development of pharmacist clinics in the future.

Current evidence highlights the suboptimal quality of primary care in China [ 52 ], with previous research suggesting that inadequate education and training pose significant challenges in enhancing care quality [ 53 ]. Primary healthcare providers in China have reported being too busy for continued education, dissatisfaction with course content, and having unqualified supervisors [ 54 ]. This issue seems to be consistent in the United States [ 55 ], Canada [ 56 ], and Belgium [ 57 ]. Moreover, our study has identified high workload (30.9%, n  = 69) and insufficient professionalism (25.1%, n  = 56) as the top two challenges faced by pharmacist clinics. On the other hand, insufficient knowledge may contribute to negative attitudes [ 39 ].

In this study, a minority of practitioners (24.7%, n  = 55) demonstrated strong familiarity, and only 33.3% ( n  = 75) felt confident. While some global studies did not find a significant difference in clinical competence confidence between public and private practitioners [ 58 , 59 ], our study revealed that pharmacists from CHCs exhibited greater confidence in conducting pharmacist clinics compared to those from private hospitals, partially due to their greater exposure to training. Studies have also shown that community pharmacists, through enhanced training, can acquire expanded expertise and knowledge [ 60 , 61 ], leading to improved service quality in primary care [ 62 , 63 ]. Future efforts should focus on establishing a more efficient learning and continued education system for community practitioners in China [ 52 ].

Several impediments were identified by respondents, including limited patient volume (22.0%, n  = 49) and low staff motivation (6.3%, n  = 14). Despite the positive impact of pharmacists in outpatient settings on patient outcomes, the adoption of these services remains low [ 1 ]. Recent literature has highlighted public uncertainty about primary care specialties and skepticism regarding their capacity to deliver comprehensive care [ 64 ]. Evidence suggests a lack of awareness, demand, and utilization of community pharmacy services among patients [ 65 , 66 ]. Another barrier is the prevailing focus on quantity rather than quality of care, with job content and bonuses linked more to quantity than the quality of care delivered [ 52 , 67 ]. Financial conflicts over funding and the absence of fee collection may also hinder collaboration between pharmacists and other healthcare providers [ 43 , 68 ]. Additionally, the implementation of the zero-mark-up drug policy in China in 2011 caused a substantial decrease of about 40% in drug-related incomes [ 69 ]. Institutions responded by scaling back clinical care services to offset this profit loss [ 70 ], leading to an uptick in hospital visits for minor ailments and further burdening the healthcare system [ 53 ]. It is important to expand community pharmacy services by establishing reimbursement mechanisms to relieve the burden on general practice [ 71 ]. Countries like Australia, the UK, New Zealand, and Canada have established systems for pharmacist remuneration [ 72 ]. Payment models for pharmaceutical services typically include fee-for-service, where providers are compensated based on the services delivered (as seen in Australia, Canada, Belgium, and Japan), capitation, where providers receive a fixed amount per patient (as in the US, Thailand, and Denmark), and blended funding, which combines government and private payments (as in China, Australia, New Zealand, and Canada) [ 73 ]. Despite the existence of various payment models for pharmaceutical services, there is no standardized pricing for pharmacist clinics. Among 465 hospitals with pharmacist clinics, only 98 (21.08%) owned charging mechanisms [ 25 ]. Various studies have explored the willingness to pay (WTP) for pharmaceutical services in different countries. For instance, Porteous et al. [ 74 ] found a WTP of $69.19 for community practices in the UK. Tsao et al. [ 75 ] reported a WTP of $21.26 for medication therapy management in Canada, and in Brazil, the estimated WTP for comprehensive medication management was $17.75 [ 76 ].

Our findings also revealed gender-based disparities in the perceptions and implementation of pharmacist clinics. Female practitioners exhibited lower levels of confidence in conducting the clinics compared to males, consistent with previous research indicating that women in healthcare often perceive deficiencies in their abilities despite no differences in clinical performance between genders [ 77 ]. Additionally, female medical students reported higher levels of anxiety, stress, and self-doubt about their knowledge and performance [ 78 ]. However, in Australia and Ireland, females rated themselves higher than males in self-assessment tests [ 79 , 80 ]. Further investigations to explore potential confounding factors, such as cultural influences, may contribute to understanding these variations and better address the need to tailor pharmacist-managed clinic services based on institutional needs [ 81 ].

This research is geographically confined to Shanghai and solely captures the perspectives of practitioners, potentially limiting generalizability. Future studies should broaden their scope to encompass diverse practices and include patients’ perceptions. The cross-sectional design used in this study restricts the evaluation of cause-effect relationships, emphasizing the need for longitudinal investigations. Despite these limitations, to the best of the authors’ knowledge, this is the first quantitative study that has examined the knowledge, attitudes, and practice of practitioners regarding pharmacist clinics in primary settings based on real-world data in China. The identified challenges in conducting these clinics provide valuable insights for policymakers, researchers, and institutions in this field.

Although primary healthcare practitioners generally hold positive attitudes towards pharmacist clinics, limited knowledge and confidence, high workload, and other factors lead to the scarcity of such clinics. Practitioners with diverse sociodemographic backgrounds, especially those from different institutions and genders, exhibit varying perceptions of the forms of pharmacist clinics. Further exploration with lager samples from different regions and service recipients is necessary.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

We thank all the participants in this research.

This study received funding from the Shanghai Committee of Science and Technology (Grant No. 22YF1439800) and the Shanghai Municipal Health Commission (Grant No. 20194Y0234).

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Xinyue Zhang, Zhijia Tang and Yanxia Zhang contributed equally to this work.

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Minhang Hospital & Department of Clinical Pharmacy, School of Pharmacy, Fudan University, 170 Xinsong Road, Shanghai, 201199, P.R. China

Xinyue Zhang, Zhijia Tang, Yanxia Zhang, Wai Kei Tong, Qian Xia, Bing Han & Nan Guo

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ZT and YZ designed the research, developed the questionnaire; WT and QX collected the data; XZ and ZT performed the statistical analysis and wrote the manuscript; BH and NG critically reviewed the statistical analysis, work, and this report. All authors read and approved the final manuscript.

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Correspondence to Bing Han or Nan Guo .

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Zhang, X., Tang, Z., Zhang, Y. et al. Knowledge, attitudes, and practices of primary healthcare practitioners regarding pharmacist clinics: a cross-sectional study in Shanghai. BMC Health Serv Res 24 , 677 (2024). https://doi.org/10.1186/s12913-024-11136-3

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DOI : https://doi.org/10.1186/s12913-024-11136-3

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Causes and Effects of Climate Change

Fossil fuels – coal, oil and gas – are by far the largest contributor to global climate change, accounting for over 75 per cent of global greenhouse gas emissions and nearly 90 per cent of all carbon dioxide emissions.

As greenhouse gas emissions blanket the Earth, they trap the sun’s heat. This leads to global warming and climate change. The world is now warming faster than at any point in recorded history. Warmer temperatures over time are changing weather patterns and disrupting the usual balance of nature. This poses many risks to human beings and all other forms of life on Earth.

Causes of Climate Change

Generating power

Generating electricity and heat by burning fossil fuels causes a large chunk of global emissions. Most electricity is still generated by burning coal, oil, or gas, which produces carbon dioxide and nitrous oxide – powerful greenhouse gases that blanket the Earth and trap the sun’s heat. Globally, a bit more than a quarter of electricity comes from wind, solar and other renewable sources which, as opposed to fossil fuels, emit little to no greenhouse gases or pollutants into the air.

Manufacturing goods

Manufacturing and industry produce emissions, mostly from burning fossil fuels to produce energy for making things like cement, iron, steel, electronics, plastics, clothes, and other goods. Mining and other industrial processes also release gases, as does the construction industry. Machines used in the manufacturing process often run on coal, oil, or gas; and some materials, like plastics, are made from chemicals sourced from fossil fuels. The manufacturing industry is one of the largest contributors to greenhouse gas emissions worldwide.

Cutting down forests

Cutting down forests to create farms or pastures, or for other reasons, causes emissions, since trees, when they are cut, release the carbon they have been storing. Each year approximately 12 million hectares of forest are destroyed. Since forests absorb carbon dioxide, destroying them also limits nature’s ability to keep emissions out of the atmosphere. Deforestation, together with agriculture and other land use changes, is responsible for roughly a quarter of global greenhouse gas emissions.

Using transportation

Most cars, trucks, ships, and planes run on fossil fuels. That makes transportation a major contributor of greenhouse gases, especially carbon-dioxide emissions. Road vehicles account for the largest part, due to the combustion of petroleum-based products, like gasoline, in internal combustion engines. But emissions from ships and planes continue to grow. Transport accounts for nearly one quarter of global energy-related carbon-dioxide emissions. And trends point to a significant increase in energy use for transport over the coming years.

Producing food

Producing food causes emissions of carbon dioxide, methane, and other greenhouse gases in various ways, including through deforestation and clearing of land for agriculture and grazing, digestion by cows and sheep, the production and use of fertilizers and manure for growing crops, and the use of energy to run farm equipment or fishing boats, usually with fossil fuels. All this makes food production a major contributor to climate change. And greenhouse gas emissions also come from packaging and distributing food.

Powering buildings

Globally, residential and commercial buildings consume over half of all electricity. As they continue to draw on coal, oil, and natural gas for heating and cooling, they emit significant quantities of greenhouse gas emissions. Growing energy demand for heating and cooling, with rising air-conditioner ownership, as well as increased electricity consumption for lighting, appliances, and connected devices, has contributed to a rise in energy-related carbon-dioxide emissions from buildings in recent years.

Consuming too much

Your home and use of power, how you move around, what you eat and how much you throw away all contribute to greenhouse gas emissions. So does the consumption of goods such as clothing, electronics, and plastics. A large chunk of global greenhouse gas emissions are linked to private households. Our lifestyles have a profound impact on our planet. The wealthiest bear the greatest responsibility: the richest 1 per cent of the global population combined account for more greenhouse gas emissions than the poorest 50 per cent.

Based on various UN sources

Effects of Climate Change

Hotter temperatures

As greenhouse gas concentrations rise, so does the global surface temperature. The last decade, 2011-2020, is the warmest on record. Since the 1980s, each decade has been warmer than the previous one. Nearly all land areas are seeing more hot days and heat waves. Higher temperatures increase heat-related illnesses and make working outdoors more difficult. Wildfires start more easily and spread more rapidly when conditions are hotter. Temperatures in the Arctic have warmed at least twice as fast as the global average.

More severe storms

Destructive storms have become more intense and more frequent in many regions. As temperatures rise, more moisture evaporates, which exacerbates extreme rainfall and flooding, causing more destructive storms. The frequency and extent of tropical storms is also affected by the warming ocean. Cyclones, hurricanes, and typhoons feed on warm waters at the ocean surface. Such storms often destroy homes and communities, causing deaths and huge economic losses.

Increased drought

Climate change is changing water availability, making it scarcer in more regions. Global warming exacerbates water shortages in already water-stressed regions and is leading to an increased risk of agricultural droughts affecting crops, and ecological droughts increasing the vulnerability of ecosystems. Droughts can also stir destructive sand and dust storms that can move billions of tons of sand across continents. Deserts are expanding, reducing land for growing food. Many people now face the threat of not having enough water on a regular basis.

A warming, rising ocean

The ocean soaks up most of the heat from global warming. The rate at which the ocean is warming strongly increased over the past two decades, across all depths of the ocean. As the ocean warms, its volume increases since water expands as it gets warmer. Melting ice sheets also cause sea levels to rise, threatening coastal and island communities. In addition, the ocean absorbs carbon dioxide, keeping it from the atmosphere. But more carbon dioxide makes the ocean more acidic, which endangers marine life and coral reefs.

Loss of species

Climate change poses risks to the survival of species on land and in the ocean. These risks increase as temperatures climb. Exacerbated by climate change, the world is losing species at a rate 1,000 times greater than at any other time in recorded human history. One million species are at risk of becoming extinct within the next few decades. Forest fires, extreme weather, and invasive pests and diseases are among many threats related to climate change. Some species will be able to relocate and survive, but others will not.

Not enough food

Changes in the climate and increases in extreme weather events are among the reasons behind a global rise in hunger and poor nutrition. Fisheries, crops, and livestock may be destroyed or become less productive. With the ocean becoming more acidic, marine resources that feed billions of people are at risk. Changes in snow and ice cover in many Arctic regions have disrupted food supplies from herding, hunting, and fishing. Heat stress can diminish water and grasslands for grazing, causing declining crop yields and affecting livestock.

More health risks

Climate change is the single biggest health threat facing humanity. Climate impacts are already harming health, through air pollution, disease, extreme weather events, forced displacement, pressures on mental health, and increased hunger and poor nutrition in places where people cannot grow or find sufficient food. Every year, environmental factors take the lives of around 13 million people. Changing weather patterns are expanding diseases, and extreme weather events increase deaths and make it difficult for health care systems to keep up.

Poverty and displacement

Climate change increases the factors that put and keep people in poverty. Floods may sweep away urban slums, destroying homes and livelihoods. Heat can make it difficult to work in outdoor jobs. Water scarcity may affect crops. Over the past decade (2010–2019), weather-related events displaced an estimated 23.1 million people on average each year, leaving many more vulnerable to poverty. Most refugees come from countries that are most vulnerable and least ready to adapt to the impacts of climate change.

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