Author Archives: Niroshan Siriwardena

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CaHRU study on CFRs presented to National Ambulance Forum

vhp2Viet-Hai Phung presented the findings of a University of Lincoln study on Community First Responders at a meeting of the National Ambulance Service First Responder Managers Forum at East Midlands Ambulance Service NHS Trust at Beechdale, Nottingham on 25th April 2017. The presentation set out the aims and objectives of the research, which were to explore the role of CFRs in a rural location, using a systematic scoping review followed up by qualitative interviews.

This study team of Viet-Hai Phung, Fiona Togher, Ian Trueman, Prof Roderick Ørner and Prof Niro Siriwardena, began the research in April 2016 with a systematic scoping review of CFR schemes in the UK which was published recently. CFRWordItOut-word-cloud-2426149Then followed a qualitative study involving 16 interviews of CFRs, conducted from June-July 2016. After describing the progress of the study, Viet-Hai Phung outlined the key findings of the scoping review. These included that: volunteers became CFRs mainly for altruistic reasons; they wanted more training and feedback on incidents they had attended; there were concerns about the possible emotional impact on CFRs responding to incidents; there was low public recognition of CFR schemes and sometimes confusion with ambulance staff; relationships with the ambulance staff were sometimes affected by confusion over roles; CFRs wanted local autonomy for CFR schemes but with greater sharing of best practice. Some of the findings from the scoping review were reinforced by the interview study. These findings, alongside others, were reinforced by the interview study.

The broad consensus among the regional ambulance managers was that further research was needed on CFRs and CFR schemes building on the work so far, and CaHRU is committed to working with ambulance trusts to further develop the work on CFRs. Professor Niro Siriwardena, who was also present at the event, said there were plans to discuss this further with ambulance service research leads at the next meeting of the National Ambulance Research Steering Group.

By Viet-Hai Phung

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New CaHRU publication on biosimilars in British local formularies

murraysmith1A new article entitled ‘Biosimilar uptake by British local formularies: a cross sectional study‘, authored by CaHRU member Dr Murray Smith together with colleagues at the universities of Nottingham and Manchester, was published online on September 5, 2017, in the International Journal of Clinical Pharmacy – the link to the open access article is here. The article reported research examining the uptake throughout Britain of biosimilar medicines, where these are inexact copies of biological medicines no longer protected by legal patent from copying.

medication_pillsIncreasing numbers of biosimilars are being manufactured, licensed and becoming available for use in healthcare in Britain predominantly because the biologics they seek to replace are themselves generally quite expensive for the NHS to buy. By interrogating the prescribing recommendations made in 146 local pharmaceutical formularies from NHS trusts and health boards across Britain we were able to contrast the willingness of clinicians towards prescribing a patient to a biosimilar versus that of remaining with the original biologic.

The main finding of this work is that the uptake of biosimilar medicines in Britain is generally less than would be expected especially given that its market for pharmaceuticals has typically had such a strong focus on the use of generics.

By Dr Murray Smith

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CaHRU Newsletter (Spring 2017)

CaHRU_logotypeThe latest edition of the CaHRU Newsletter (Spring 2017) was published in June 2017. The newsletter presents the work of the research centre over the previous three months and includes articles from the CaHRU blog covering publications, conferences and funding. The newsletter is written by members of the CaHRU team and produced by Sue Bowler, CaHRU administrator.

[su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2017/07/CaHRU-Newsletter-Spring-2017.pdf” responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]

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Qualitative study of perceptions of older people with COPD and chronic heart disease on home telemonitoring in long term conditions published

chromedThe latest study from researchers at CaHRU was published this month (July 2017) in BMC Medical Infromatics and Decision Making. Entitled ‘Perceptions on use of home telemonitoring in patients with long term conditions – concordance with the Health Information Technology Acceptance Model: a qualitative collective case study‘, and co-authored by Dr Jo Middlemass (visiting fellow), Jolien Vos (doctoral student) and Prof Niro Siriwardena (director), the study formed part of the process evaluation of a large multicentre, multinational trial funded through the European Framework 7 programme, Clinical tRials fOr elderly patients with MultiplE Disease (CHROMED: clinicalTrials.gov Identifier: NCT01960907).

Figure 2This was a qualitative interview study of patients aged between 60 years and over together with their partners or relatives where applicable on implementation of a telemonitoring system in their homes for chronic obstructive pulmonary disease (COPD) combined with heart disease. Patients and their relatives were largely positive about telemonitoring but they expressed concerns regarding health professional access and attachment; heightened illness anxiety and desire to avoid continuation of the ‘sick-role’; the need for good organisational processes and informal support. Ease of use was connected to equipment design being suitable for older people. Participants felt it was important to establish trends in health status, to enable detection of early signs of infection and increase the potential for patients to self-manage.

CaHRU_logotypeThe main trial results have been previously presented at the European Respiratory Society conference and these are currently being prepared for publication. The overall conclusion of this sub-study was that to increase home telemonitoring acceptance among older people, consideration of equipment design and organisational factors was important.

By Niro Siriwardena

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Dr Julie Pattinson presents at International Medical Graduates (IMG) Conference 2017 in Boston, UK

PHOTOJulie Pattinson of CaHRU presented her work on reasons for variations in performance in the MRCGP Applied Knowledge Test at the recent International Medical Graduates’ conference at the Conference Hall, Centre for Medical & Dental Education, Pilgrim Hospital. Speakers included Dr Bijoy Sinha (GP Speciality Training Programme Director, Lincolnshire), Dr Nick Humphry (GP Speciality Training Programme Director, Lincolnshire), Dr Bevis Heap (Programme Director HEE, East Midlands) and Dr Sathya Naidoo (Associate Postgraduate Dean and ARCP Lead for the East Midlands).

The purpose of the meeting was to identify needs of IMGs to help support them in GP training with a specific focus on the trainers’ roles. There were around 50 attendees in total, with the majority of the audience being GP speciality programme directors, vocational training managers, GP trainers and General Practitioner Speciality Training Registrars (GPSTRs). Dr Humphry opened the conference talking about the challenges and opportunities for IMGs in primary care training. This was followed by a talk from Dr Heap, who spoke about the challenges identified for IMGs that are different from those of indigenous graduates. Dr Naidoo spoke about identifying ‘at risk’ GPSTRs and the RCGP iMAP.

CaHRU_logotypeDr Julie Pattinson gave a presentation on ‘Understanding reasons for variation by ethnicity in performance of general practice specialty trainees in the Membership of the Royal College of General Practitioners’ Applied Knowledge Test: cognitive interview study’. Her talk was about the differences that exist in candidate performance in high stakes medical licensing examinations, specifically the Membership of the Royal College of General Practitioners (MRCGP), between black and minority ethnic (BME) compared to white British doctors. The grounded theory analysis generated insights into reasons for difficulty in answering AKT questions in all participants, but it emerged that overseas trained (OST) participants do face additional difficulties answering AKT questions compared to UKGs and this could provide the basis for developing interventions to reduce differential attainment in UK specialty training for general practice. Feedback from Dr Humphrey following her talk stated ‘There was quite a buzz about it after and it stimulated a lot of conversation. I think our trainers and GPRs will find it useful when considering how to improve success in the AKT.’

bostonDuring the afternoon session Dr Sinha delivered a talk about IMG in practice and the GPSTRs’ experience. Emphasis was placed on supporting IMGs in speciality training. There was a talk from a scheme graduate how to get the best out of training, understanding examinations and how they may be challenging. Overall the conference was very interactive and group discussions followed each presentation. In the afternoon there were workshops exploring problems and solutions for IMGs.

By Dr Julie Pattinson