Members of Community and Health Research Unit (CaHRU), Jo Middlemass (research nurse) and Prof Niro Siriwardena travelled north to Tromsø, Norway, in the Arctic Circle, to discuss progress and the next phase of the European Commission Framework 7 funded study, Clinical tRials fOr elderly patients with MultiplE Disease (CHROMED).
CHROMED is an international multicentre randomised control trial in five European countries: United Kingdom, Sweden, Estonia, Spain and Slovenia, representing different social and organisational contexts in Europe. The study is seeking to investigate the effectiveness of health and lifestyle status management using telehealth to support elderly patients with multiple conditions including chronic obstructive lung disease and chronic heart disease or sleep apnoea. The Lincoln arm of the study, which involves a partnership between Lincoln Community Health Services NHS Trust and CaHRU at the University of Lincoln comprises a feasibility study of five patients followed by a full study involving 32 patients.
Tromsø in the summer has permanent daylight, which means that after a hard day’s work many local residents and visiting researchers can be seen climbing the local mountains to enjoy the view!
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.
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.
The Resources for Effective Sleep Treatment (REST) project, led by Prof Niro Siriwardena, was featured on “Tonight” the flagship ITV1 documentary programme, the highest rating current affairs series on UK television for the past decade. In the programme “Waking up to Insomnia” screened on 17 November at 7:30pm, Geraint Vincent revealed some results of the Great British Sleep Survey and found out from sufferers how it affected their lives. The programme discussed the problems of insomnia, why sleeping tablets were not a good solution and why Cognitive Behavioural Therapy for insomnia (CBTi) although effective is not widely available in the NHS. The REST project funded by the Health Foundation aimed to improve primary care for insomnia by developing primary care friendly sleep assessment and CBTi. A follow-on translational project, Improving Primary Care Resources for Effective Sleep Treatment (IPCREST) funded by East Midlands Health Innovation and Educational Cluster aims to spread the learning through seminars, workshops and an e-learning programme for healthcare practitioners. Further information is available on the University website and at the REST website. Niro is presenting on “How to provide better care for insomnia: Resources for effective sleep treatment in the general practice consultation” at the Sleep and Mental Health conference at the Royal Society of Medicine on 23 November 2011.
A book edited by Dr Stephen Gillam (University of Cambridge) and Prof Niroshan Siriwardena (University of Lincoln) and published by Radcliffe Publishing Ltd entitled “The Quality and Outcomes Framework: QOF – transforming general practice” was highly commended at the BMA Medical Book Awards 2011. Steve Gillam and Niro Siriwardena were present at the awards ceremony in BMA House in London.
Highly commended in this year's BMA Medical Book Awards 2011
Contributors to the book include the architects of the QOF, developers, researchers, practitioners and commentators. Work is currently proceeding on a systematic review of research into the QOF involving the Universities of Cambridge, Lincoln and East Anglia.