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CaHRU wins new grant to investigate prehospital pain management

zahidAn international team of researchers led by Prof Niro Siriwardena with statistician Dr Zahid Asghar from CaHRU has been awarded funding from the Falck Foundation to study prehospital pain management. The study involves collaboration between CaHRU at the University of Lincoln, with East Midlands, East of England and South Central Ambulance Service NHS Trusts, together with the Universities of Swansea, Hertfordshire and the Sunshine Coast (Australia).

EMAS - A&E 9The study, ‘Exploring factors increasing Paramedics’ likelihood of administering Analgesia in pre-hospital pain: cross sectional study (ExPLAIN)’ aims to identify how patient factors such as age, gender, ethnicity and the cause of pain together with clinician factors such as sex or role seniority affect pain assessment and use of analgesic drugs by ambulance staff. The study builds on previous research conducted by members of the team in the area of prehospital pain management and the findings will be used to inform recommendations to improve the rate and quality of acute pain relief provided by ambulance staff and to reduce unintended variations in care.

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The study is part of CaHRU’s ongoing research as part of its Prehospital and Emergency Quality and Outcomes (PEQO) workstream which involves collaboration with other ambulance services in England and which has already led to new measures and improvements in the quality of ambulance service care provision.

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New study by Jolien Vos from CaHRU on recording sexual health information in primary care

BPrevention through identifying risk factors and health promotion to address these is becoming standard practice, for example in programs supporting patients to stop smoking. However, some risk factors such as sexual behaviour, cannot be easily assessed, are more difficult to measure and less likely to be recorded. Potentially risky sexual behaviour is sensitive information which is more difficult to classify as present or absent, but is still important in assessing a person’s overall health risk. Previous research indicates that although patients prefer to discuss sexual health issues with GPs compared to other healthcare workers, patients often wait for a sign from their GPs before discussing this intimate subject whereas GPs usually wait for a sign from the patient.

Jolien VosThis was confirmed in a recently study, ‘Collecting and registering sexual health information in the context of HIV risk in the electronic medical record of general practitioners: a qualitative exploration of the preference of general practitioners in urban communities in Flanders (Belgium)‘, published in Primary Care Research and Development, with lead author Jolien Vos, who is a graduate research assistant at CaHRU. The study team interviewed 13 GPs in Flanders (Belgium) who had experience with HIV patients. The interviews explored what GPs considered to be ‘risk factors’ in terms of sexually risky behaviour as well as how they collected, discussed and registered this information.

CaHRU_logotypeThe study revealed that although participating GPs said that they felt comfortable discussing sexual health with patients, they assumed that patients would not feel at ease with this. GPs felt that waiting for the patient to initiate the discussion would mean that it would only take place when a problem had already occurred. Sexual orientation was often seen as an indicator for GPs to be cautious when enquiring about sexual risk behaviour. The GPs emphasised the importance of discussing sexual health and the need for guidance on recording information sexual risky behaviour more systematically, to support continuity of care while maintaining privacy of sensitive patient data in a country where patients are free to move GP and general practices are becoming more multidisciplinary.

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New book chapter from Rachel Hawley, CaHRU, on coaching patients

coachingA new book, Coaching in Professional Contexts, edited by Christian van Niewerburgh, features a chapter on coaching patients authored by Rachel Hawley who is Project Manager for the HEI Challenge for Patient Supported Quality Improvement at the Community and Health Research Unit (CHRU), School of Health and Social Care.

RachelThe chapter, ‘Coaching Patients’, aims to encourage readers to reflect on their own experiences of health and health care and engage in a critical dialogue with the dominant discourses of coaching theory and practice. The idea of “making every conversation count” is a philosophy that underpins this chapter. In her coaching teaching and practice Rachel is committed to the view that through open and creative dialogue, coaching patients can open new opportunities for achieving improved health and wellbeing. In turn, this supports wider engagement in health care practice and learning.

For further information see: van Niewerburgh, C. (ed), Coaching in Professional Contexts. London: Sage (2015).

Rachel Hawley

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Rapid review published on effectiveness of different models of delivering urgent care

TEMAS - A&E 5he NIHR commissioned rapid evidence review to assess the nature and quality of the existing evidence on delivery of emergency and urgent care services and to identify gaps for future research was published last week: Phung V-H (2015) Chapter 6 – Delivery of emergency department services in Turner J, Coster J, Chambers D, Cantrell A, Phung V-H, Knowles E, Bradbury D, Goyder (eds.). What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review. Health Serv Deliv Res 2015;3(43). The team, from the School of Health And Related Research (ScHARR) at the University of Sheffield with Viet-Hai Phung, research assistant and doctoral researcher at CaHRU, undertook five separate literature reviews linked to themes in the NHS England review in 2013, which latter drove the need for this rapid evidence review. The review, which took six months to complete, incorporated findings from 45 systematic reviews and 102 primary research studies across all five reviews

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Viet-Hai Phung wrote the review in Chapter 6 on the Delivery of Emergency Department (ED) services. This review included literature from 2009 to 2015. Nine papers were included in the review: two systematic reviews, which included 28 individual papers, and seven additional papers. Of the 35 included studies, there were only five randomised control trials and many uncontrolled before-and-after studies, which cannot control for other system effects.

NThere were three themes to this part of the review: Managing ED flow; Workforce; and managing the frail and the elderly in EDs. In the first review, interventions that aimed to increase access to primary care and ED cost-sharing were found to be effective in reducing ED use. For the Workforce review, the evidence suggested that supplementing existing ED staff with NPs can help to manage demand more effectively, especially in high-volume EDs. For the final review, there was mixed evidence about the effectiveness of Comprehensive Geriatric Assessment (CGA): CGA did not have a significant impact on outcomes nor mortality, while other studies suggested that use of CGA to inform interventions could reduce functional decline.

Viet-Hai Phung

 

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CaHRU hosts second East Midlands Research into Ageing Network regional seminar at University of Lincoln

Emran-png-250The Community and Health Research Unit, as part of the work of the centre’s Healthier Aging programme of research, recently hosted the second East Midlands Research into Ageing Network (EMRAN) seminar that took place at the University of Lincoln on 25 November 2015 and which focused on the care of older people in the community. The seminar started with a brief presentation by Professor John Gladman and Chris Craig on EMRAN’s purpose to facilitate collaborative applied research into ageing and older people research across the East Midlands and a brief update on EMRAN’s progress, including recent publications and projects which are being developed thanks to EMRAN’s intervention.

jo1The first part of the seminar included four ‘Elevator Pitches’. Dr Carlos Rodriguez Pascual (University of Lincoln; Lincoln County Hospital) presented his project on frailty and cardiovascular disease, exploring how a combination of a comprehensive geriatric assessment (CGA) score and frailty is a predictor of cardiovascular disease in an older person. The second pitch, presented by Dr Jo Middlemass (CaHRU, University of Lincoln), outlined findings from the ‘CArers of people with Dementia: Empowerment and Efficacy via Education’ (CAD: E3) project that aims to improve carer and patient well-being by offering carers of people with dementia a multicomponent intervention (focusing on education and skill-building). The third pitch, presented by Dr Fiona Marshall (University of Nottingham), looked at a project aimed at creating more dementia friendly areas, by gathering local information (through geo-spatial mapping) of what health, social, religious groups, community and voluntary services (amongst others) there are for older people living in the Peak District of Derbyshire. Finally, Dr Gill Garden (United Lincolnshire Hospitals NHS Trust) presented the very successful Bromhead Care Home service, which involved training care home staff so they can more confidently and effectively deliver care in care homes and reduce admissions to hospitals.

EMAS - PTS 7Professor Niro Siriwardena (Director of CaHRU, University of Lincoln) delivered the second part of the seminar, presenting the work of CaHRU and ideas for developing new projects involving ambulance services: ‘Pathways for Older People from Ambulance Services to Safe Community Care’. The aim of the presentation was to show that paramedics, apart from safely transporting patients, can also offer important treatment and refer patients who don’t require hospitalisation to community services that are often more adequately equipped to care or support them. After the successful SAFER-2 trial (Support and Assessment for Fall and Emergency Referrals), exploring how ambulance staff could assess and divert older people who had suffered a fall to appropriate community-based services, Prof Siriwardena and his colleagues at the East Midlands Ambulance Service (EMAS) are currently interested in exploring other conditions, such as hypoglycaemia, epilepsy and COPD (chronic obstructive pulmonary disease) which may also be amenable to community pathways.

After a quick recess for some much needed tea and coffee, the attendees split into small groups to discuss the projects presented earlier, focusing on possible challenges and solutions to the design and conduct of each study, and consider ideas for further research and exciting collaborations. The seminar came to a close with Chris Craig and Prof John Gladman thanking everyone for their participation and with a promise for more similar events and innovative seminars.

Despina Laparidou