Author Archives: Niroshan Siriwardena

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CaHRU attends College of Paramedics National Conference at Warwick University, October 2014

ASCQI poster at WarwickViet-Hai Phung, researcher at CaHRU, recently attended the College of Paramedics national conference at Warwick University on 6-7th October 2014. This organisation, formerly the British Paramedic Association, represents the professional interests of prehospital clinicians in the UK. Viet-Hai was one of the few health researchers attending the conference, albeit one with an interest in prehospital care. He presented a poster entitled, ‘Leadership, innovation and engagement in quality improvement in the Ambulance Services Cardiovascular Quality Initiative: cross sectional survey’ which showcased the team’s work exploring leadership and innovation through the Ambulance Service Cardiovascular Quality Initiative (ASCQI). Delegates were interested in the collaboration between the University of Lincoln and East Midlands Ambulance Service (EMAS), so from that point of view, CaHRU did indeed raise its profile.

 

 

EMAS - A&E 5_750The College’s Chair, Andy Newton, opened the proceedings on both days. There were a number of enlightening presentations from the UK, including the problems the ambulance service faces in delivering an effective response to mental health issues and how it deals with end-of-life care. Professor Keith Willett, who is leading the review into urgent and emergency care in England, outlined the future challenges for prehospital care in the UK.

EMAS - A&E 6_750As well as the domestic picture, delegates learned more about how ambulance services operate in countries as diverse as the USA, South Africa, Australia, Austria and Switzerland. Professor Jerry Overton highlighted that the USA, like the UK, is focusing too much on outputs rather than outcomes. Kai Kranz, from the Swiss Paramedic Association, emphasised the fragmented nature of their ambulance service, arising from regional and linguistic differences. It was a well-organised, informative conference, giving all delegates much to think about. Looking forward to the next one in 2015!

Viet-Hai Phung

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CaHRU student wins Graduate Student Award to present at international Aging and Society conference

JV1Jolien Vos, Graduate Research Assistant and doctoral student at CaHRU, won a prestigious Graduate Scholar Award to present at this year’s Aging and Society conference in Manchester on the 7th and 8th November 2014. This fourth international interdisciplinary event will bring together experts from different disciplines with a common interest focused on the theme of ‘diversity and aging’.

Aging and Society gives a small number of Graduate Scholar Awards to students with an active academic interest in the field made through a competitive application and review process. Graduate Scholars get the opportunity to chair sessions, participate in Talking Circles, meet experts in the field, and interact and network with colleagues. Recipients are entitled to free registration for the conference, given recognition during the conference proceedings and cited on the conference website. Jolien will be trained the day before the conference to make the most of this exciting opportunity. A wonderful opportunity at this early stage in their career!

Manchester1Jolien and Dr Karen Windle will both attend the Manchester conference in November, presenting work on the research stream of “Older People and Wellbeing” at CaHRU. Jolien will present ‘Cast Adrift in the Care System? A Systematic Scoping Review of Care Navigation for Older People with Multimorbidity‘ which forms part of her doctoral studies aiming to gain an understanding of how older people with multimorbidity navigate the complex health and social care system.

 

By Jolien Vos

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Identifying barriers and facilitators to ambulance service assessment and treatment of acute asthma: a focus group study

d-shawResearchers in CaHRU and East Midlands Ambulance Service NHS Trust (EMAS) have published a new study: “Identifying barriers and facilitators to ambulance service assessment and treatment of acute asthma: a focus group study” in BMC Emergency Medicine. The study’s lead author was Deborah Shaw of the Clinical Audit and Research Department at EMAS and visiting fellow at CaHRU. She was supported in the work by Prof Niro Siriwardena, director of CaHRU and associate clinical director at EMAS.

EMAS - A&E 9_750The authors aimed to explore paramedics’ attitudes, perceptions and beliefs about prehospital management of asthma, to identify barriers and facilitators to guideline adherence, acknowledging variations in prehospital care for asthma. The investigators interviewed paramedics and managers and their analysis identified that guidelines should be made more relevant to ambulance service care; barriers to assessment; conflicts between clinicians’ and patients’ expectations; complex ambulance service processes and equipment; and opportunities for improved prehospital education, information, communication, support and care pathways for asthma.

EMAS - PTS 2_750The service has already used these findings to improve prehospital care for people with asthma and other chronic respiratory conditions.

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Improvement Science and Research Methods seminar: A journey through health economics with Prof Dr Darrin Baines

brayford_arc1In the latest in our series of Improvement Science and Methods seminars hosted by CaHRU on Tuesday 24th of June Prof Darrin Baines guided us on a ‘Journey through Health Economics’. Prof Baines was previously Associate Professor in Health Economics at the University of Nottingham and was recently appointed as Professor of health Economics at Coventry University. In his talk Dr Baines showed the different economic measures available and how we should interpret them.

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2014/08/A-journey-through-health-economics.pdf” width=”300″ height=”300″ responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

index_5The first stop of this journey was the cost benefit ratio. We were asked to consider what the ratio expresses: the price of a unit of benefits, or something we are not sure about? Most of the audience were surprised when they realised there was not a clear answer. The second stop was a comparison between two ratios of costs and benefits. Are we comparing efficiency? Are we sure about what it really means? The answer again was not certain. The comparison of ratios sometimes also gives us strange results. The next stop on our journey was Incremental Cost Effectiveness Ratios or ICERs. As was pointed out, although this measure solves some of the problems of previous measures, it also presents other problems, for example, in that it uses effects instead of benefits (money). And that is health economics: it is primarily about effects, rather than about money. Health economics is the study of decisions in an imperfect world where there is uncertainty and heterogeneity.

Nevertheless, our speaker indicated we cannot stop there, and we cannot just measure ICERs. If we want to analyse and solve a problem, if we want to understand the problem in front of us, then, we need to model it. Dr Baines finished his talk indicating the current measures we should be using: net monetary benefit (where we turn health into money) or net health benefit (where we turn money into health).

This was a very interesting talk and those present were very engaged with the topic – there was a general feeling of enjoyment and curiosity to know more about this field.

Ana Godoy Caballero

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CaHRU researchers attend HSRN Symposium 2014

Togher PhOEBE qualitative HSRN 2014 [Poster]On 19th and 20th June, Fiona Togher and Viet-Hai Phung from CaHRU attended the annual Health Services Research Network Symposium (HSRN). Together, they presented three posters during the conference poster sessions entitled, ‘What do users value about the emergency ambulance service?‘, ‘Investigating the understanding, use and experiences of older people in Lincolnshire accessing emergency and urgent services via 999 and NHS 111: A scoping study‘ and ‘Systematic review: barriers and facilitators for people from minority ethnic groups accessing urgent and prehospital care‘. Another poster presented by Rachel O’Hara and Maxine Johnson entitled ‘A qualitative study of system influences on paramedic decision making and patient safety’ which included Prof Niro Siriwardena as a study collaborator won the prize for best overall poster. The posters described and explained the findings of streams of work that had been encompassed within CaHRU’s Pre-hospital Emergency Quality and Outcomes programme of research.

photo3The multi-disciplinary conference programme consisted of several plenary talks as well as parallel sessions during which presenters talked about their research. There was a wide range of NHS and academic institutions represented at the event plus numerous influential leaders in healthcare research. The parallel session streams to choose from included; Urgent Care, Patient Experience, Systems/Organisational Change, Patient Data and Improvement Science amongst many others.

The Urgent Care session on the first day was attended by Fiona Togher. This consisted of four presentations entitled, ‘Explaining variation in avoidable emergency admissions’, ‘Features of primary care and their effect on unscheduled secondary care: a systematic review’, ‘Factors that influence patient choices about where to access care in an emergency: a qualitative enquiry, ‘Why Frail Older People end up in A&E: The Patient Journey as told by Older People’.

Viet-Hai_posterKey learning points included: variation in emergency admissions within different hospitals and trusts is not ‘real’ but due to differing coding processes; if patients do not have a ‘regular’ GP this can increase accident & emergency (A&E) department use; communities need more visible information about alternatives to A&E – access details, location & opening hours; and 99% of frail older people that were taken to hospital during the course of a study were English speaking which contradicts the notion of migrant pressure.

The Patient Experience session on day one was attended by Viet-Hai Phung. The four presentations were entitled: ‘Does the availability of a South Asian language in GP practices improve reports of doctor-patient communication from South Asian patients?’, ‘Treatment outcomes in Schizophrenia: the views of patients and carers’, ‘An evaluation of interventions to support the emotional and psychological needs of patients with end-stage renal disease’, and ‘One size fits all? Acute hospital inpatient experiences of multi-bed and single room accommodation’.

Some of these themes will inform CaHRU’s work on ethnicity and patient experiences. On the second day, there was a very informative plenary presentation from Simon Denegri from INVOLVE about the extent to which the public should be involved in health service research. This presentation was very timely, given our work on patient-public involvement in PhOEBE and other studies. Attendance at the conference was informative, interesting and a good opportunity to inform colleagues from other academic institutions and health care organisations about the research that is being undertaken in the Community & Health Research Unit at the University of Lincoln.

Fiona Togher and Viet-Hai Phung