Researchers 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.
The 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.
The service has already used these findings to improve prehospital care for people with asthma and other chronic respiratory conditions.
The results of a national Quality Improvement Collaborative study, the Ambulance Services Cardiovascular Quality Initiative (ASCQI) were published this week in the international academic journal Implementation Science. The article entitled The effect of a national quality improvement collaborative on prehospital care for acute myocardial infaction and stroke in England showed large and significant improvements in the quality of care provided by 11 ambulance services (out of 12) in England for people with heart attack and stroke. Members of the CaHRU team involved in the study included Professor Siriwardena, Dr Zowie Davy and Fiona Togher together with visiting fellows at CaHRU who are members of the research team at EMAS including Anne Spaight, Debbie Shaw and Nadya Essam. Professor Michael Dewey, chair in epidemiological statistics in London was the statistician on the project.
The project has been part of a programme of work, Prehospital and Emergency Quality and Outcomes, developed through collaboration between academics from the Community and Health Research Unit and ambulance services across the United Kingdom, particularly East Midlands Ambulance Service NHS Trust (EMAS). This collaboration has enabled a strategic partnership between the University of Lincoln and EMAS to undertake research which is relevant to ambulance services, focusing on health issues of regional and national importance, and conducted with ambulance staff in order to increase the impact of the research by improving prehospital care for emergencies.
The study examined the period between January 2010 and February 2012. Across England overall, the percentage of emergency cases where care bundles (packages of essential care) were delivered in full increased from 43% to 79% for heart attack and from 83% to 96% for stroke. ASCQI supported frontline staff, and their management, to introduce improvements using checklists, aide memoires, individual and group feedback and sharing of information within and between different trusts to improve the reliability of care for people with heart attack and stroke. The project was shortlisted for an HSJ award in 2012.
A new study has been published on organisational factors associated with practice success in the annual seasonal influenza vaccination programme in BMJ Open, the new open access journal from the BMJ.
The study entitled ‘Strategies to increase influenza vaccination rates: outcomes of a nationwide cross-sectional survey of UK general practice‘ was led by Dr Laura Dexter, virologist, while based in Sheffield University under Prof Robert Read with collaboration from Niro Siriwardena at the University of Lincoln.
The study was funded by the NIHR Policy Research Programme to determine how to improve flu vaccination rates in at-risk groups in the UK. Flu vaccine uptake is below the national and international target of 75% particularly in the under 65-year-old age group. This study used an online survey to GPs, nurses and practice managers to identify which strategies and procedures reported were associated with higher rates of flu vaccine uptake. The recommendations have been summarised in annual guidance in the seasonal flu plan (Annex B – GP practice checklist p11-12) from the UK Chief Medical Officer, Dame Professor Sally Davies.
The study builds on previous work led by Niro Siriwardena on methods to improve influenza and pneumococcal vaccination rates in primary care and in general practice in Lincolnshire which led to a definitive cluster randomised controlled study of an educational intervention for general practice. The Community and Health Research Group are also working on the role of influenza vaccination in preventing cardiovascular disease. After studies showing a reduction in risk of heart attack linked to influenza vaccination (published in the Canadian Medical Association Journal and Vaccine) the team are now working on a case-control study to investigate potential role for influenza and/or pneumococcal vaccination in prevention against stroke and transient ischaemic attack (IPVASTIA), funded by the NIHR Research for Patient Benefit programme.
The new study in BMJ Open has identified seven key strategies that were significantly associated with the success of practices’ seasonal flu vaccination campaigns which include leadership (a named responsible flu lead), ordering sufficient vaccines, up-to-date registers of patients at risk, starting the programme early, robust call and recall arrangements, offering appointments and opportunistically vaccination, and working with community midwives for vaccination in pregnancy. If widely implemented by general practices, these strategies could improve vaccination rates by 7% to 8%. The learning has been publicised in professional magazines and translated into an online learning module for GPs which is having impact on professional practice.