Download - ‘Improving health and wellbeing through Research’ Preston Football Club 17 th October 2014
‘Improving health and wellbeing
through Research’
Preston Football Club17th October 2014
Improving health and wellbeing through research – October 2014
Medical Directors’ Office
#LCFTresearch@Lancashirecare
Professor Heather Tierney-MooreChief Executive
Event Welcome
Improving health and wellbeing through research – October 2014
Dr Heather Iles-SmithResearch & Innovation Lead
“Improving health and wellbeing through research – LCFT strategy refresh”
Theme:Research
Successes
Improving health and wellbeing through research – October 2014
Medical Directors’ Office
Overview• National picture• Local picture • Research strategy
Objectives
• Current research• Challenges
Medical Directors’ Office
Why we do research
- To develop new medicines, medical devices, therapies and clinical services- To facilitate access to new medicines/devices /therapies for LCFT Service Users
- To add to the evidence base - To embed evidence based practice within LCFT services
NHS Constitution
Medical Directors’ Office
National Picture• Transformations of NIHR Research Networks- 25 to 15
nationally Clinical Specialities 6 Divisions
• NW Coast Clinical Research Network (NWC CRN) includes Liverpool, Merseyside, Lancashire & South Cumbria
Division 1- CancerDivision 2- Diabetes, stroke, cardiovascular diseaseDivision 3- Children, reproductive health and childbirthDivision 4- Dementias and neurodegeneration (DeNDRoN), mental healthDivision 5- Primary care, Ageing, Health services research, dental health, Public health, Muscoskeletal disordersDivision 6- Anaesthesia and pain management, critical care
Medical Directors’ Office
Local Picture• Overall LCFT has a balanced research portfolio- grant based
and NIHR portfolio research• Lack of equilibrium between mental health and community
services and between professions• Clinical academic researchers
6 in mental health (all medical) 0 in community services 0 joint appointments for Nurses, Allied Healthcare Professionals,
Pharmacists or Psychologists• Contribution to the NIHR portfolio (2012/13)
24% mental health 76% community services
Medical Directors’ Office
Local Picture- Performance
Medical Directors’ Office
Research strategy
VisionTo improve the health and
wellbeing of patients and service users within Lancashire Care
Foundation Trust (LCFT) through embedding research and evidence based practice in clinical services
Medical Directors’ Office
Research Strategy Objectives
Main objectives:-Objective 1: Increase access to research for our patients and service users
Objective 2: Increase research capacity building within the Trust particularly within the Community Services
Objective 3: Increase research culture of the organisation and embed research within each of LCFT Clinical Networks
Objective 4: Increase service user/carer involvement in the research process
Global enabler
Establish financial security for LCFT research activity
Medical Directors’ Office
Current Research• TechCare- Dr Husain, Consultant Psychiatrist, Senior Lecturer
A mobile assessment / therapy for PsychosisAn intervention for clients within the early Intervention
service.
• Randomized, double-blind Placebo-Controlled, Trial of Gantenerumab in Patients with Mild Alzheimer’s Disease- Dr S Karim, Consultant Psychiatrist Older adults To reduce or slow down amyloid plaque build up (one cause
of Alzheimers)May improve cognition and function in early Alzheimers
Medical Directors’ Office
Current Research• Clinical outcomes of Joint Crisis Plans to reduce
compulsory treatment for people with psychosis: a randomised controlled trial- Professor Max Marshall, Medical DirectorThe Lancet, May 2013 (381:9878:1634-1641)
• C-GLOVES. An evaluation of the effectiveness of compression gloves in arthritis: a feasibility study- Jenny Welsby, Specialist OT, Rheumatology DepartmentOccupational therapy study investigating the use of
pressure gloves in rheumatoid arthritis.
Medical Directors’ Office
Challenges• Development fit for purpose
Clinical Research Facility • Financial stability
Maintaining/growing grant incomeIncreasing industry studies
• Capacity buildingfocussing on nurses, AHP’s,
pharmacists and psychologists Fellowship applications
Medical Directors’ Office
Thank You for listening…..Web page:-http://www.lancashirecare.nhs.uk/about-us/Research-Innovation.phpPlease contact us at:[email protected]&[email protected]
Professor Jenny ShawClinical Director for Specialist Services & R&D Director
Mental Health Screening in Police Custody In England: Developing a screening tool and referral pathway
Theme:Research
Successes
Improving health and wellbeing through research – October 2014
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Mental Health Screening in Police Custody in England:
developing a screening tool and referral pathway
From the inside out: Healthcare in custody and the criminal justice system
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Detecting mental illness in Police Custody
• Higher rates of mental health problems amongst people in contact with the criminal justice system
• Prevalence amongst police detainees– estimates vary– 2%-20% of police detainees have mental health issues (Bradley 2009)
• Early identification of mental ill health is a current UK Government priority
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Policy Priority
• Early intervention• Liaison and Diversion• Increasing access
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The Problem
• Mental health screening procedure is not sufficiently robust– identifying the ‘known knowns’
• Non mental health trained personnel– Whose job?
• Inconsistent mental healthcare services in custody– Lack of 24 hour cover
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Research Team
Dr. Jane Senior University of ManchesterMiss. Heather Noga Lancashire Care NHS Foundation TrustProf. Jenny Shaw Lancashire Care NHS Foundation
Trust / University of Manchester
Miss. Susan Tighe Lancashire Care NHS Foundation TrustDr. Elizabeth Walsh University of Leeds
This presentation outlines independent research funded by the National Institute for Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme
(PB-PG-0808-17154). The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.
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Aims/Objectives
• Oct 2010 – Sept 2013
• Aims– Improve current practices in police custody– Develop a referral decision tool
• Objectives– Identify and critique current procedures– Develop a mental health referral tool– Develop accompanying training and implementation package
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Method
• Participants– Mental Health Professionals – Police Officers– Service Users
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Method
•Understand current practices
•Views on requirements of screening referral tool
Interviews (n 58)
•Review of existing screening tools
•Consensus on scoring (routine/urgent)
•Creation of referral pathway
Consultations (n
58)
•Service Leads from Mental Health, Social Care, Police, Private Healthcare, City Council, Service Users
•Implementation and training package
Action Learning Groups
(n 8)
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Results
• Agreement that a screening tool should be;– short, simple language– questions mixed with free text observations– current issues– mental health, risk of suicide / self-harm– sensitive – facilitate dialogue
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CMHS
“In a custody environment it would need to be shorter and simplified- detention officers
would have difficulties”
“Not relevant for custody, too complicated and vague”
“The questions don’t really get to the core of the problems and would miss
people with severe mental health issues”
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PriSnQuest
“Simple and straight forward”
“It is brief, therefore quick to complete and less likely to
be overlooked or cut short”
“Questions are clear, specific, easy to
understand and likely to get the answers that
they are looking for”
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PolQuest
PriSnQuest
- Historical issues
-Depression- Serious Mental Ill
Health
Police Custody Risk Assessment
- Historical issues
-Self Harm-Medication
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PolQuest
• 14 Item Screening Questionnaire
• Administer in 5 minutes
• All Adult Detainees
• Corresponds to a referral pathway
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Scoring•High Risk•Current symptoms/signs of psychosis, depression, self harm, suicide
•Highly distressed
Urgent Referra
l
Eg. ‘Have you recently found yourself wishing you were dead and away from it all?’
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Scoring•Low Risk•Historical issues
•Known to/currently engaged with services
Routine
Referral
Eg: ‘Are you currently in contact with mental health services?’
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Referral Pathway
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Training and Implementation
• Implementation Manual
• ‘How to’ practical guidance
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Impact
• Screens everyone in custody
• Clear referral process
• Early identification
• Economic use of services
• Provides standardisation of care
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Future Directions
Feasibility Study
•Implement in real life-one custody suite
•Identify issues in application
•Design full scale trial
Dr Waquas WaheedConsultant Psychiatrist
“Partners 2”
Theme:Research
Successes
Improving health and wellbeing through research – October 2014
PARTNERS 2
Development and Pilot Trial of Primary Care Based Collaborative Care for People with
Serious Mental Illness
Overview of the Purpose of the PARTNERS2 Programme Grant
We aim to help primary care and community based mental health services work more closely together.
• Develop a system of collaborative care based in GP surgeries where service users are seen regularly by a mental health worker who acts both as overall co-ordinator (supporting individuals to access other services and activities) and therapist.
• At the end of the 5 year Programme, we will know if collaborative care for people with schizophrenia and bipolar disorder in England is likely to work.
Work stream 1: Assessment of local care pathways and current services for people with severe mental illness
Work stream 2: Development of a core outcome set for use in mental health trials involving people with schizophrenia or bipolar disorder in a community based setting.
Work stream 3: Development of the system of collaborative care.
1: Reilly S, Planner C, Hann M, Reeves D, Nazareth I, Lester H. The role of primary care in service provision for people with severe mental illness in the United Kingdom. PLoS One. 2012;7(5):e36468.
2: Reilly S, Planner C, Gask L, Hann M, Knowles S, Druss B, Lester H.Collaborative care approaches for people with severe mental illness. Cochrane Database Syst Rev. 2013 Nov 4;11:CD009531.
Developing the grant application
Building the team
Experts in
1. Collaborative care2. Primary care3. Schizophrenia and Bipolar disorder4. Qualitative researchers5. Trial Methodologists6. Health economics7. Biostatistics8. Service users9. International partners
Contact details:
Dr. Waquas Waheed, Consultant adult psychiatrist at Lancashire Care NHS Foundation Trust and North West Hub Lead. 01772 773 515, [email protected]
Maria Cox, PARTNERS 2 Research Assistant at Lancashire Care NHS Foundation Trust, Lantern
Centre, Vicarage Lane, Fulwood, Preston, PR2 8DW. 07943 092217, [email protected]
Jill Barlow, Research Studies Officer, Liverpool Science Park, Innovation Centre 1, 131 Mount
Pleasant, Liverpool, L3 5TF. 07818 521 738, [email protected]
Or Visit:
www.birmingham.ac.uk/partners2
Dr Lizzy MacPhieConsultant Rheumatologist
“Finding Time for Research in a Busy Rheumatology Department”
Theme:Developing
Clinical Research
Improving health and wellbeing through research – October 2014
Finding Time for Research in a Busy
Rheumatology Department
Lizzy MacPhie
Rheumatology Department
Minerva Health CentrePreston
Overview
• The Rheumatology Service
• The challenges & solutions
• PPI
• Portfolios studies
Rheumatology Service
• Transferred to community in Sep 2010
• Based at the Minerva Health Centre
• Complete service redesign– 0.6 WTE consultant at transfer– 3 WTE consultants now in post
Service Developments
• Weekly MDT & lunchtime educational meetings
• Pathway days to inform service development
• Regular patient support group meetings
• Launch of website
Challenge 1Limited Research Experience
• Historically patients considered for clinical trials all sent to Wrightington
• No engagement with portfolio studies
• No engagement with CLRN
• Consultants little academic experience
Solution
• Networking– Met with CLRN (Prof Goodacre)
– Introduced to CLRN nurses
– Spoke to Rheumatology colleagues“The Alliance”
Challenge 2Lack of dedicated research resources
• No dedicated research time in job plans – Consultants or nurses– Team too busy in clinic to recruit patients
• Managers very worried about impact on activity
• Limited room availability
• No storage/processing facilities for bloods
Solutions
• CLRN Support– All the team have to do is identify pts
• Simplifying recruitment process– Email: study, pt name, contact no to CLRN nurse
• Met with managers
• Careful selection of Portfolio Studies– Simple, observational eg registers, genetics– Not requiring lots of clinician input
• Room Availability– Discussion with lead clinic nurse
Challenge 3Raising Awareness
• Research not seen as a priority
• CLRN nurses not part of the team
Solution
• Consultant Meetings – Fixed item on agenda
• Lunchtime meetings – Research update every 6 months, no’s recruited
• Posters in clinic rooms
• Leaflets in clinic rooms about all the studies
• CLRN nurses attend MDT
RAMS Rheumatoid arthritis or undifferentiated IAstarting MTX(1st/2nd line, mono or combination therapy)
Need to recruit before starting MTX
DELAY Rheumatoid arthritis or undifferentiated IA Within 6 months of diagnosis
BSRBR Rheumatoid arthritis - starting certolizumab or tocilizumab (1st/2nd line)-biologic naïve & starting etanercept, adalumimab or infliximab
Within 6 months of starting biologic
BSRBR-AS Ankylosing spondylitis-biologic naïve & starting etanercept or adalumimab
Within 6 months of starting biologic
Myositis Genetics study
Diagnosis of inflammatory myositis Any time following diagnosis
SLE Genetics study
Meets ACR criteria for SLE Any time following diagnosis
Think Research!
If you have any potential patients please provide them with a patient information leaflet about the relevant study and email details (Name, MIN No & Contact No) to Sue or Gill
Challenge 4Keeping up the Momentum
Solution
• Recruitment figures recording on TIB
• Recognition– Invited to Present to Network Research Meeting– Invited to Present today
• Regular review of portfolio for new studies
• Clinical trials……..
• Dedicated research PA…….
PPI
• Posters & leaflets in waiting area
• Research stand in foyer
• Patient support group meetings– Research stand
• Pathway days– CLRN nurse attended
• NASS research engagement event
Timeline
2010 2011 2012 2013
BSRBR16 patients
201420122011 2013
RAMS37 patients
MTX pneumonitis
0 patientMyositis genetics
4 patients
SLE Genetics11 patients
BSRBR-AS6 patient
Genetics in AS
6 patients
Noisy Knees1 patient
Delay19 patients
BSRBR“BSR Biologics Register”
• Long term hazards of biologic therapy in rheumatoid arthritis
• Observational study: baseline & FU questionnaires
• Certolizumab or tocilizumab (1st/2nd line)
• Comparison cohort: etanercept, adalumimab, Recruitment
– 51 historical patients still actively collecting data– Recruited 16 patients
BSRBR-AS“BSR Biologics Register”
• Long term hazards of biologic therapy in ankylosing spondylitis
• Observational study: baseline & FU questionnaires
• Recruitment– Started Sep 2013– Recruited 6 patients
RAMS“Rheumatoid Arthritis Medication Study”
• Predicting response to MTX
• Observational study: bloods & questionnaires
• Recruitment– Started April 2012– Recruited 37 patients to date
SLE Genetics Study
• Investigation of genetics of SLE
• Observational study: bloods & CRF
• Consultant completes CRF
• Recruitment– Rare condition– Recruited 11 patients
Myositis Genetics Study
• Investigation of genetics of myositis
• Observational study: bloods & CRF
• Consultant completes CRF
• Recruitment– Rare condition– Recruited 4 patients
AS Genetics Study
• Investigation of genetics of ankylosing spondylitis
• Invite letter, postal consent
• Recruitment– 6 patients
Drug Induced Pneumonitis in RA Patients
• Investigation of factors influencing drug induced pneumonitis
• Observational study
• Recruitment– Very rare complication – Possible 1-2 pts during study period
“Noisy” Knees
• Acoustic Emission in Knee Arthritis– AE as a non-invasive biomarker for OA
• Observational study: questionnaires & clinical assessment
• Recruitment– Target: 3 patients in a year
Thank-you for listeningAny Questions