The latest edition of the CaHRU Newsletter (Autumn2015) was published in November. The newsletter presents the work of the research centre over the previous three months and includes articles from the CaHRU blog covering publications, conferences and funding. The newsletter is written by members of the CaHRU team and [su_document url=”https://communityandhealth.dev.lincoln.ac.uk/files/2016/01/CaHRU-Newsletter-Autumn-2015.pdf” responsive=”no”]Multi-morbidity, goal-oriented care, the community and equity[/su_document]produced by Sue Bowler, CaHRU administrator.
The Community and Health Research Unit were awarded the University of Lincoln team award for Achievement in Research at the awards ceremony in November 2015. Members of the team were Professor Niro Siriwardena (director), Dr Zahid Asghar, Dr Zowie Davy, Dr Jo Middlemass, Dr Coral Sirdifield, Ana Godoy Caballero, Fiona Togher, Viet-Hai Phung, Despina Laparidou, Rebecca Porter, Rachel Hawley and Sue Bowler. Ana Godoy has left the team to begin a new post in Spain and Rebecca Porter has started her medical studies at Durham.
Over the past year CaHRU achieved research centre status. The centre focussed its efforts on ‘making an impact on healthcare through international and world class research’ by: conducting research which is likely to make a difference to people’s health and well-being; promoting high quality care which enhances the experience, safety, effectiveness, efficiency and equity of healthcare by investigating how to transform the performance and function of health and social care practice, organisation and delivery; positively engaging with health care organisations regionally and nationally; strengthening its academic and health service collaborations regionally, nationally and internationally; supporting its researchers to achieve their potential through a research environment that encourages cooperation, collaboration and mutual support; and engaging with service users, carers, practitioners, health service managers, commissioners and policymakers in research activities to maximise the impact of its research by responding to service priorities, working with service users and care organisations to embed research into practice and disseminate findings.
The team’s efforts have led to an increase in the number and quality of successful research bids including funding from the National Institute for Health Research, Wellcome Trust and Falck Foundation, greater numbers of research outputs in high quality peer-reviewed journals, and continuing research impact extending regionally, nationally and internationally. Team members use a wide range of research designs and methods, but the centre is now undertaking more clinical trials which provide greater potential for future research impact.
Prevention 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.
This 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.
The 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.
The Resources for Effective Sleep Treatment (REST) project featured in the Health Foundation’s recent newsletter, ‘Stories of outstanding impact in primary care‘. The REST project is an ongoing area of research within the Quality and Outcomes in Primary Healthcare group at CaHRU led by Prof Niro Siriwardena and involving other members of the team including Fiona Togher, Viet-Hai Phung, Dr Coral Sirdifield, Dr Jo Middlemass and Dr Zowie Davy. The project was initially funded by the Health Foundation under their Engaging with Quality in Primary Care scheme to improve primary care for people with insomnia. Subsequent work has been funded by the Research Investment Fund at the University of Lincoln, the EPSRC and the East Midlands Health Innovation and Educational Cluster.
The research seeks to improve treatment for people suffering with sleep problems by promoting a range of treatment options beyond just sleeping tablets and has led to a series of peer-reviewed and highly cited publications in journals such as the British Journal of General Practice, Health Expectations, Sleep, Biomed Central Family Practice, and the British Medical Journal. Subsequent research has also been undertaken in collaboration with other institutions including Universities of Glasgow, Connecticut and Ghent and also Harvard and Oxford Universities.
The project led to its own REST project website (http://restproject.org.uk/) in 2011 and a REST e-learning programme for primary care professionals on how to manage insomnia using non-drug therapy which has been accessed almost 12,000 times by 10,000 users in over 150 countries with over 5,000 users in the UK alone. REST was showcased as one of three impact case studies submitted from CaHRU to REF2014.
Members of CaHRU, Dr Coral Sirdifield, Ana Godoy and Prof Niro Siriwardena attended the annual conference of the European Forum for Primary Care (EFPC), ‘Integrated primary care: research, policy and practice’, at the Tobacco Museum in Amsterdam from 30 August to 1 September 2015 to meet with colleagues and present an invited workshop on patient experience at the meeting. Niro Siriwardena is a member of the advisory board of the EFPC and attended a board meeting on the day before the conference.
The workshop, entitled ‘QUALICOPC in the UK, the patient perspective, took place on the first afternoon of the conference and was informed by work from CaHRU on the EU funded Quality and Costs of Primary Care in Europe (QUALICOPC) study. The session was well attended, enabling participants to discuss different approaches for measuring patient satisfaction with primary care and how satisfaction could be improved. Coral and Ana presented an innovative approach called Importance-Performance Analysis, using the QUALICOPC data from England, to demonstrate how the technique could help practitioners, researchers and policy makers to identify where one most needed to focus to improve patient satisfaction.
The conference included excellent keynotes from Prof Chris van Weel, Emeritus Professor of General Practice at Nijmegen (‘The history of Dutch General Practice or: how Primary Care saved the nation’), Dr Isabel Moulon from the European Medicine Agency (‘Bridging the gap between medicine development and clinical practice: is primary care out of the picture?’), Ellen Nolte from the European Observatory on Health Systems and Policies (‘Integrating care: what we know and what we do not know’), Prof John Øvretveit of the Karolinska Institute (‘Priorities for actionable research to speed and spread improvements in caring for chronic illnesses’), Dr Tonka Poplas Susič and Metka Žitnik Šircelj (‘Model practices in family medicine in Slovenia’) and a closing summary from Prof Marc Bruijnzeels of the Jan van Es Institute (‘Challenges for the future of integrated primary care’). A range of parallel research, debate and workshop sessions, lunch on a riverboat and an excellent conference dinner provided a full, interesting and enjoyable programme for delegates.