Community and Health Research Unit

The latest CaHRU/LIH Implementation Science and Research Methods seminar was given on December 6th 2016 by Professor Chris Bridle, Director of the Lincoln Institute for Health on the topic of “Accumulative evidence synthesis: Fast track through the implementation pipeline”. Before taking up his current post in January 2015, Chris was Professor of Human Behavioural Science and Director of Research at Aberystwyth University (2012-14) and prior to this Associate Professor (Reader) of Behavioural Interventions (2008-12) in the Clinical Trials Unit at Warwick Medical School.

The seminar focussed on the bottleneck of translating research findings and on an innovative idea for how to deal with this. After discussing some commonly encountered issues affecting the implementation process, from forming an initial research idea to translation of study findings, Chris introduced to attendees a new and improved method for progressing through the pipeline in a more time and cost-efficient manner involving adding results of small scale trials to the meta-analysis of existing studies. He then considered some key pre-conditions, before asking attendees to discuss potential issues relating to the adoption of his proposed method by researchers, funders and healthcare commissioners.

The seminar and Chris’ proposed method were very well-received and were the starting point for many thought-provoking discussions on the advantages, potential disadvantages, and prerequisites for such an approach. January’s Improvement Science and Research Methods seminar will be presented by Paul Leighton, Deputy Director at NIHR Research Design Service for the East Midlands, on January 21st 2017. His topic will be “The Delphi technique and other methods of consensus development in applied health settings”.

By Despina Laparidou

A new study ‘What evidence is there on the effectiveness of different models of delivering urgent care? A rapid review‘ was published this month, and included CaHRU’s Viet-Hai Phung as one of the report co-authors. Over the last 15 years, The NHS has undertaken many reviews of urgent care. It has also recommended service delivery changes to improve access to, and the quality of, urgent care. Despite this, rising demand continues to strain the emergency and urgent care system.

In response, the National Institute for Health Research’s (NIHR) Health Services and Delivery Research (HSDR) programme commissioned this report from the University of Sheffield’s ScHARR as part of a wider series of evidence syntheses. The report contains five separate reviews linked to themes in the NHS England review – demand for urgent and emergency care; telephone triage and advice; ambulance clinicians managing patients with urgent conditions; delivering Emergency Department (ED) services; and emergency and urgent care networks. Alongside this, the team conducted systematic reviews and quality assessed additional primary research papers.

The key findings for each review were:

There is little empirical evidence to explain increases in demand for urgent care;
Telephone triage services provide appropriate and safe decision making with high patient satisfaction but the required clinical skill mix and effectiveness in a system is unclear;
Extended paramedic roles have been implemented in various health settings and appear to be successful at reducing transport to hospital;
There is potential for GP services co-located within the ED to improve care;
No empirical evidence exists to support the design and development of urgent care networks.

The rapid review assessed the existing evidence base on delivering emergency and urgent care services. The research also identified two major gaps that further research needs to investigate. Firstly, we need to assess the current state of the urgent care. Secondly, we need to have a better understanding of the nature of demand, which can then be used to inform service delivery improvements.

Viet-Hai Phung