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SAFER 2 (Support and Assessment for Fall Emergency Referrals) trial protocol published

The SAFER 2 study is a randomised controlled trial of the clinical and cost effectiveness of new protocols for emergency ambulance personnel to assess and refer older people who fall to appropriate community based care.  The protocol for the study, led by Prof Helen Snooks at Swansea University and including Prof. Niro Siriwardena of the CaHRU and East Midlands Ambulance Service NHS Trust as a collaborator, has recently been published in BMJ Open:

Snooks H, Anthony R, Chatters R, Cheung WY, Dale J, Donohoe R, Gaze S, Halter M, Koniotou M, Logan L, Lyons R, Mason S,  Nicholl J, Phillips C, Phillips J, Russell I, Siriwardena AN, Wani M, Watkins A, Whitfield R, Wilson L. Support and assessment for fall emergency referrals (SAFER 2) research protocol: cluster randomised trial of the clinical and cost effectiveness of new protocols for emergency ambulance paramedics to assess and refer to appropriate community-based care. BMJ Open 2012;2: e002169. doi:10.1136/bmjopen-2012-002169

The study measured the costs and benefits of a novel protocol implemented by emergency ambulance paramedics caring for older people who had fallen, allowing the paramedic to assess and refer appropriate patients to a community based falls service. The study involved ambulance services in London,Wales,East Midlands. Stations were randomly allocated to implement the new protocol (intervention) or continue to provide care according to their standard practice (control).

Paramedics based at the stations selected for the intervention group received additional training, protocols and clinical support to enable them to assess older people and decide whether they need to be taken to the Emergency Department (ED) immediately, or whether they could benefit from being left at home, with a referral to a community falls service. The study compared costs, processes and outcomes of care (particularly subsequent 999 calls and ED attendances for falls) at 1 and 6 months for patients aged 65 or over who had fallen together with other quantitative and qualitative data.

The study was recently been completed and, currently in the final data collection phase, is due to be published next year.

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Improvement science and methods seminar series: experimental methods in health research

The latest seminar in the ‘improvement science and methods’ seminar series covered non-randomised experimental designs and was given by director of CaHRU, Niro Siriwardena.

The seminar included discussion of pre-experimental (uncontrolled before-and-after) designs and quasi-experimental designs such as time series, interrupted time series and non-randomised control group designs, including the advantages and disadvantages of these methods for quality improvement and complex interventions.

Presentation: ‘Experimental methods in health research’

A chapter on ‘Experimental methods in health research’ by Professor Siriwardena is also included in the recently published second edition of ‘Researching Health’, a textbook for health researchers.  The book includes qualitative and quantitative methods employed in researching health, contemporary issues such as research ethics, comparative research and the use of mixed methods, and how to disseminate health research.

 

 

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Online communities and social networking platforms for computerised therapies

A new study investigating how computerised cognitive behavioural therapy (CCBT) can be enhanced through the use of social networking platforms was published in the British Journal of General Practice in December 2012.  This qualitative study, funded by the EPSRC and conducted by members of the CaHRU team, Jo Middlemass, Dr Zowie Davy and Professor Niroshan Siriwardena, explored patient and practitioner perspectives on CCBT programmes for insomnia (CCBT-I) which would included social networking.

The objectives of the interview study were:

  • To explore patient and professional perspectives, attitudes, expectations and beliefs towards online health care programmes;
  • To identify participants’ preferences for content, style and information disclosure to health professionals or fellow sufferers;
  • To investigate barriers and facilitators of access, use and adherence to CCBT with a focus on sleep problems and insomnia.

Two meta-themes emerged as key to enhancing uptake and adherence to a potential new CCBT-I package: the need for trust (in the programme, in the patient-professional relationship and in online peer support) and the functionality of the CCBT-I package, with potential users expressing a preference for it to be interactive, individualised and easily navigable.

The findings from the interview study have been incorporated into a novel online CCBT-I package which is currently undergoing testing, designed by a team led by Professor Shaun Lawson who leads the Lincoln Institute of Social Computing (LiSC) with co-investigator Dr Conor Linehan, both based in the School of Computer Science, University of Lincoln.

The study was published in the Br J Gen Pract December 2012; 62 (605): 642-643 with the full-length article available through open access: Middlemass J, Davy Z, Cavanagh K, Linehan C, Morgan K, Lawson S, Siriwardena AN. Integrating online communities and social networks with computerised treatment for insomnia: a qualitative study of service user and primary health care professional perspectives. Br J Gen Pract 2012; 62:e840-e850 doi: 10.3399/bjgp12X659321.

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New study published investigating patient experiences of using the ambulance service for suspected stroke and heart attack

A study by members of the CaHRU team, Fiona Togher, Dr Zowie Davy and Professor Niroshan Siriwardena, to better understand the elements of care that are most important to patients with stroke and heart attack accessing the ambulance service, has been published in the Emergency Medicine Journal http://emj.bmj.com/cgi/content/full/emermed-2012-201507.

The qualitative study involved interviewing both patients and clinicians about their experiences of either receiving or providing care prehospital care for stroke or heart attack. Four main themes emerged:

  • communication
  • professionalism
  • treatment of condition
  • transition from home to hospital.

The technical knowledge and relational skills of clinicians’ together contributed to patients’ perceptions of professionalism in ambulance personnel. We found that the patient experience was enhanced when physical, emotional and social needs were attended to. Effective clinician–patient communication was also found to be a key component of high quality patient care.

Fiona Togher, who was lead author for the study, has recently been awarded a PhD studentship at Lincoln. The findings will be used to inform her doctoral research, which will examine the potential for developing a generic patient reported experience measure (PREM) for routine use in ambulance services in the UK

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University of Lincoln/NHS Health Research Forum

The latest Research Forum took place today on 7th November in the Board Room in Bridge House. The Research Forum takes place three times a year and is an opportunity for colleagues to present studies conducted in Lincolnshire or undertaken by the county’s researchers. The meeting  began with a light lunch and included NHS staff, university staff and students, and colleagues interested in health and social care research.

The presentations were:
• Programs to promote physical activity among children and adolescents: A case study of the Team Bath Tribe
Project presented by Dr Harriet Koorts, LCHS NHS Trust.
• An exploration of how a multi-disciplinary team (MDT) approach can support decision making in advanced
heart failure; an action research methodology presented by Rachel Gavin, Heart Failure Complex Case Manager, LCHS
NHS Trust.
• Achieving change in older people’s services: Effective prevention?’ presented by Karen Windle, Reader in Health, CaHRU, University of Lincoln.

The three studies were excellently presented and well received by attendees. There were some excellent questions generated and ably responded to by our speakers.

If you wish to attend future meetings, please contact Victoria Hill at Victoria.Hill@lincs-chs.nhs.uk