What can the primary care research network offer practices

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Primary Care Research Network - East of England. . One of 8 PCRNs across EnglandPart of the National Institute for Health Research (NIHR) family of networksCore team based in NHS CambridgeshireLocality teams across EoE100 studies About 45% of practices in EoE are involved in one of our studie

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What can the primary care research network offer practices

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1. What can the primary care research network offer practices?

2. Primary Care Research Network - East of England One of 8 PCRNs across England Part of the National Institute for Health Research (NIHR) family of networks Core team based in NHS Cambridgeshire Locality teams across EoE 100+ studies About 45% of practices in EoE are involved in one of our studies

3. PCRN: - Our aim To support clinical research and to facilitate the conduct of, and trials and other well-designed studies within the NHS. To increase the number of patients recruited

4. Why is it important ? Each month, 23 million people (more than three times the population of London) visit their GP surgery or practice nurse Full-time GPs treat an average of 255 patients a week. In a typical week, 1.4 million people will receive help in their home from the NHS. About 35% of all patients involved in NIHR portfolio research have been recruited in primary care

5. Research Agenda for Primary Care The natural history, diagnosis, treatment, and prevention of health conditions seen in primary care settings, including the management of undifferentiated clinical problems as well as long term conditions. The nature, characteristics, and organization of primary care practice. Health care decision-making and the relationship between the clinician and the patient in the context of the family and community. The continuity and coordination of primary care services, including referrals and the interface of primary and specialty care. (US Agency for Healthcare Research and Quality)

6. NHS Operating Framework 2009/10 ‘High Quality Care for All’ made it clear that innovation must be central to the NHS if we are to improve constantly the quality of care. To achieve this, the NHS must play its full part in supporting health research. All providers of NHS care will need to increase their participation in research. The national ambition is to double the number of patients taking part in clinical trials and other well-designed research studies within five years.

7. Evidence and practice

8. Evidence and practice

9. Are we ready for research?

10. 3 key concerns Quality of the studies and fit with clinical practice Support and facilitation to help practices or services – one Funding and capacity – need to be realistic

11. Quality: NIHR Portfolio Co-ordinated nationally Studies with competitive national funding Peer review Local prioritisation for our work Essential for NIHR support funding Local feasibility work Ensuring ethics and NHS permissions are in place

12. Entry level self-accreditation scheme Is there support within the practice for research activity? Does the practice have space and facilities to host research? Can searches of the practice database be carried out? Do you know what is required of your practice with reference to research governance?  Are you aware of your responsibilities to patients and staff if they are participating in research? --- PCRN can assist with this

13. PCRN support and facilitation for practices Co-ordinated approach Study summary sheets – RISP forms One port-of-call for troubleshooting Flexible ways of being involved This service can lead to high levels of practice participation in research

14. PCRN support and facilitation – flexible ways of being involved. Recruitment & follow-up visits by practice team: network facilitates study set up, provides guidance documents and support Network nurse support where there are workload pressures in the practice team eg EDS study, past bp Secondary care studies that need to find patients in primary care: network finds sites locally and supports practices undertaking site feasibility, and referring patients to research clinics in hospital recruitment Outreach work from universities – direct university research team support for recruitment: network links the practice with the research team who will support activity in your practice eg FAST study

15. Funding for practices and clinical teams involved in portfolio research The LES for Research - funded by E&H CLRN - Carol and Jacki have described this scheme Study specific funding: consistent funding packages to reimburse practice for work involved.

16. Your questions answered: The scientific content Interest & relevance quality The support available funding training & facilitation Fit with practice who will lead this? identifying participants workload randomisation & impact on care Conflicting priorities in practice

17. Benefits for research-active organisations Patients in trials have better outcomes than those who do not enter studies. Patients can access new treatments early. Many patients want to contribute to the development of better care for all. Professionals can benefit from training and development opportunities. Research brings additional funds to clinical services. Research involvement is seen as a proxy indicator of high standards and can help recruit and retain staff.

18. New participants recruited 08-09

19. This is what we offer but we need your help. We are looking for more practices and clinical teams who would like to get involved at a level that’s right for them.

20. Secondment to PCRN-EoE - opportunity for Allied Health Professional One day per week for one year. Become a member of PCRN-EoE team Promoting research in your organisation Introducing a portfolio study into your team Opportunity for training Possibility of further funding

21. Treatment alternatives for Acute Sore Throat in Everyday practice 460 participants needed – 3-5 per practice Present with acute sore throat Age over 16 years Must be able to self medicate with gum or probiotics Minimal exclusion criteria Set up, database search, mail shot Opportunistic recruitment, pack handouts GP/Practice nurse time, admin time funded £152/patient Training for intervention/informed consent required

22. EDS: 5659 EDS trial – erectile dysfunction and simvastatin: a randomised controlled trial Men, age over 40 with previously untreated ED Objectives: demonstrate if Simvastatin improves ED If improvement correlates with reduced cholesterol and/or improved endothelial function cost effective ED treatment which could prevent future CVD Randomised, placebo controlled, double blind, parallel group 10 sites - at each site:1,188 contacted, 43 screened, 24 run in, 17 randomised

24. Past bp: A randomised controlled trial of different blood pressure targets for people with a history of stroke or transient ischaemic attack (TIA) in primary care: 5987 Can more intensive BP targets for people who have had a stroke or transient ischaemic attack be achieved in a primary care setting, and whether more intensive therapy is associated with adverse effects on quality of life. Identify and invite patients from practice database. One GP and one nurse to attend half day training] on study procedures and NICE guidelines for measurement and treatment of hypertension Provide a room for PCRN nurse to see patients for clinics GP to see patient and determine whether alteration is needed to anti-hypertensive medication using the study specific treatment protocol Practice nurse to carry out patient follow-up at 1-3 monthly intervals depending on BP and treatment allocation.

25. TOMAS: A multi-centre randomised controlled trial of rehabilitation aimed at improving outdoor mobility for people after stroke: 6696 The health care objective is to improve the quality of people’s lives after a stroke by enabling them to get out of the house more often The research objective is to test the effectiveness and cost effectiveness of treating people with a stroke with mobility intervention. A novel rehabilitation technique (intervention) group will be compared to a usual care (control) group. Intervention group participants will receive up to 12 rehabilitation outdoor mobility sessions of about an hour each over up to 4 months. Control Group participants will receive what is considered clinically to be routine intervention for outdoor mobility limitations.

26. VENUS IV: Venous leg Ulcer Study IV: A randomised controlled trial of compression hosiery versus compression bandaging in the treatment of venous leg ulcers: 7994 To assess the clinical and cost effectiveness of compression hosiery compared with 4 – layer compression bandaging in terms of ulcer healing; quality of life and patient concordance.

27. RAPSID: randomized controlled trial of the efficacy of peer support delivered through a buddy (1:1) approach, a group approach or combined 1:1 and group approach. 8010. recruit 1550 patients with Type 2 diabetes via through general practice and through the community Local areas (clusters) will be randomised to have either: Individual 1:1 support, Group support, Combined 1:1 & group support or no peer support (control) All participants will receive an educational package Participants who are selected and are willing to act as Peer Supporter will be given training by the research team. GPs to provide a reference for potential peer supporter facilitators Baseline visit to be undertaken by PCRN/ network nurses including consent Practice Nurses /HCA/Phlebotomist to obtain blood samples at 6/12 visit Outcome measures are metabolic control, quality of life and self-care practice

29. EUDRAGENE: 4412 Objective - establish a collection of DNA samples as a resource for studying genes which influence serious or adverse drug reactions (ADRs) 5 approx recruited per practice £295/practice plus £43/patient recruited 10,000 plus size practices Method Data base search and manual note review blood test, consent & questionnaire Patients can consent through post or attend surgery for appointment with blood test

30. Why is the UK a terrible place to do clinical research? Workload increasingly tightly defined: Too busy to be involved “amateur” research no longer viable Expensive compared to other countries Unbelievable bureaucracy: MRECs, LRECs, RM&G etc Restrictions on access to data Honorary contracts +++

31. PCRN-EoE STRUCTURE (2009) NOTE: STRUCTURE DOES NOT DESCRIBE THE LINE MANAGEMENT & ACCOUNTABILITY ARRANGEMENTS.

32. Studies in 2008

33. Types of research

34. Why is the UK a great place to do clinical research? Comprehensive healthcare for population Excellent clinical facilities Outstanding science base Commitment to evidence-based medicine We need evidence that’s relevant for everyday practice Many patients are positive about research

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