Requests for emergency contraception could be an important sign of abuse

Women who experience domestic violence and abuse (DVA) are more than twice as likely to seek emergency contraception as other women, according to a study by National Institute for Health Research (NIHR)-funded researchers at the University of Bristol and Queen Mary University of London, suggesting that requests for emergency contraception could be an important sign of abuse.

In the study, published in the British Journal of General Practice today, the researchers analysed medical records of over 200,000 women of reproductive age registered with a GP and found that those who had a record of DVA were 2.06 times more likely to have a consultation for emergency contraception compared to other women, rising to 2.8 times for women aged 25-39.

The researchers also found some evidence that abused women are more likely to seek emergency contraception repeatedly.

DVA is a major public health problem, with devastating consequences for the women who experience it and great financial cost to the NHS. It is known to have a significant impact on women’s reproductive health, including an increased risk of unintended pregnancy and abortion, as abusive and controlling partners coerce women to have unprotected sex or rape them.

Although emergency hormonal contraceptive, also known as the morning-after pill, is available from pharmacies, women can also get it from their GP. Up to a third of all emergency contraceptives are prescribed by GPs.

The researchers are calling for this new evidence to be included in existing DVA training programmes for GPs and sexual health practitioners, and for the training to be extended to community pharmacists, to help them identify and refer women who have experienced DVA on to specialist support services. Such programmes are recommended by the National Institute for Health and Care Excellence (NICE) and the World Health Organization (WHO) as part of a multi-sector response to DVA.

Joni Jackson, Research Associate from the NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) West and co-lead author of the study, said:

We found a strong positive association between exposure to domestic violence and abuse and requests for emergency contraception. Our findings are in line with evidence from studies in other countries suggesting that women experiencing DVA use more emergency contraception than other women. GPs, pharmacists and sexual health practitioners are at the frontline responding to these requests, with community pharmacists dispensing 50% of all emergency contraceptive pills. This presents an important opportunity to identify women experiencing DVA, signpost them to appropriate support services, and potentially save lives.”

Dr Natalia Lewis, from the Centre for Academic Primary Care at the University of Bristol and co-lead author, said:

The negative impact of domestic violence and abuse on health results in higher use of healthcare services by abused women compared to the general population. This means that healthcare services are an important point of contact for DVA victims and survivors. We have already seen improvements in GPs’ ability to identify and refer women experiencing DVA through the success of the IRIS (Identification and Referral to Improve Safety) programme. IRIS has recently been adapted for sexual and reproductive health services. Our findings support the case for adapting the IRIS intervention to the community pharmacy setting, although more research is needed to explore if and how this could be done.”

The research was supported by NIHR CLAHRC West and CLAHRC North Thames.

Papers:

Exposure to domestic violence and abuse and consultations for emergency contraception: nested case-control study in a UK primary care dataset. Joni Jackson, Natalia V Lewis, Gene S Feder, Penny Whiting, Timothy Jones, John Macleod, Maria Theresa Redaniel. British Journal of General Practice. 4 December 2018.

Use of emergency contraception among women with experience of domestic violence and abuse: a systematic review. Natalia V Lewis, Theresa HM Moore, Gene S Feder, John Macleod, Penny Whiting. BMC Family Practice. 26 September 2018.

CLAHRC research has Europe-wide impact

Dr Werner Leber, an East London GP with a passion for driving earlier identification and diagnosis of HIV, has seen his work recognised by the European agency responsible for the continent’s defences against infectious disease – the European Centre for Disease Prevention and Control (ECDC).

Dr Leber (above) is a practising GP in Tower Hamlets as well as being an NIHR Clinical Lecturer in Primary Care. His work with the CLAHRC, based at the Queen Mary University of London, aims to improve the identification and management of people with HIV.

Werner’s research among East London’s GP practices will now have a Europe-wide impact after being highlighted as good practice by the ECDC in its first integrated European hepatitis B virus (HBV) hepatitis C virus (HCV) and HIV testing guidance. The trial is summarised on page 71 of the guidance.

“The results support the hypothesis that an education programme promoting rapid HIV testing in general practice leads to increased and earlier HIV diagnosis.”

Public health guidance on HIV, hepatitis B and C testing in the EU/EEA;
An integrated approach
European Centre for Disease Prevention and Control, 2018

The project consortium and a panel of experts highlighted work published by Dr Leber and his team – Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trial as a case study to support the published evidence and advice for implementation for the new guidance.

Read the RHIVA2 case study as a stand-alone document.

In this trial in Hackney, general practices were randomly assigned to offer either opt-out rapid HIV testing to newly registering adults or continuing usual care. The study found that promotion of opt-out rapid testing in general practice led to an increased rate of diagnosis, and might increase early detection, of HIV.

In developing the guidance the ECDC looked for excellent examples of HBV, HCV and HIV testing services across EU/EEA Member States, reviewing the latest evidence and putting out two published calls for submissions of good practice.

Promotion of rapid testing for HIV in primary care (RHIVA2): a cluster-randomised controlled trial
Lancet HIV. 2015 Jun;2(6):e229-35. doi: 10.1016/S2352-3018(15)00059-4. Epub 2015 Apr 28.
Leber W, McMullen H, Anderson J, Marlin N, Santos AC, Bremner S, Boomla K, Kerry S, Millett D, Mguni S, Creighton S, Figueroa J, Ashcroft R, Hart G, Delpech V, Brown A,
Rooney G, Sampson M, Martineau A, Terris-Prestholt F, Griffiths C

What do hospitals need for a board-level quality improvement intervention to work?

Healthcare systems around the world are becoming more concerned with strengthening board level governance of quality. In England, national healthcare regulators are developing approaches, resources and interventions aimed at supporting senior hospital leaders in their role in the governance of quality.

New CLAHRC research investigates the organisational response to an improvement intervention in six hospital boards across England. The research, published in a new BMJ paper and BITE-sized summary shows the results a 30-month period of fieldwork, involving interviewing NHS board members, observing board meetings and analysing relevant documentation.

The findings will be relevant to NHS Boards, the staff and clinicians they lead and all those in the NHS working to improve the quality and safety of care.

As well as researchers, the results will be of interest to policymakers, regulators, knowledge mobilisation organisations and thinkers on boards and leadership across all sectors..

Read the paper

Jones L, Pomeroy L, Robert G, et al
Explaining organisational responses to a board-level quality improvement intervention: findings from an evaluation in six providers in the English National Health Service
BMJ Qual Saf Published Online First: 31 October 2018. doi: 10.1136/bmjqs-2018-008291

Read our “need to know” summary

What do hospitals need for a board-level quality improvement
intervention to work?

Clinicians and research leaders’ views on barriers to involving children and families in research

Within the UK, 32 out of every 10,000 children are living with a life-limiting condition or life-threatening illness (LLC/ LTI).

Research, from genetic studies to drug trials is vital to improving care for these children and their families, but the inclusion of this vulnerable population into research studies has been difficult.

Barriers to Research Access: Voices, Experiences, and Solutions (BRAVES) is a CLAHRC study focusing on improving access and participation in research for children and young people with LLC/LTI and their families.

A new BITE – a postcard “need to know” summary of our published research – shares the perceptions of clinicians and research leaders on their perceptions of the barriers preventing children and their families becoming involved in research.

The BRAVES team surveyed palliative care clinicians, often “gatekeepers” to children and their families getting involved in research asking them

‘In your experience, what have you found to be the biggest barriers to palliative care research with children?’

We also consulted Chief Investigators (CIs) – leaders of NIHR research studies involving CYP with LLC/LTI and their families. CI’s were invited to complete an anonymous, web-based questionnaire and three key barriers to research were emerged, alongside four potential solutions.

 

Supporting our partners in Becoming Research Active

Local research bodies join forces with patient partners to deliver an introduction to research

We ran our Becoming Research Active course on November 14th offering our partners in front-line care a primer in research and the research process.

CLAHRC North Thames Academy collaborated with other NIHR funded research organisations in the region – the Clinical Research Network and Research Design Service – to deliver the training, with vital contributions from patients and members of the public.

The day-long course is structured to reflect the research cycle – from defining a problem, through securing funding to dissemination and evaluation. Attendees, who came from across the NHS and local authorities were encouraged to bring a research idea they could develop over the course of the day.

“The course has provided me with lots of resources and a clearer sense of direction, which is what I hoped for.”

We joined forces with NIHR infrastructure across the North Thames region – the Research Design Service which provides support to those preparing research proposals for submission to peer-reviewed funding competitions for applied health or social care research; and the local Clinical Research Network which makes it possible for patients and health professionals across England to participate in clinical research studies.

The training aimed to highlight the processes involved in planning and carrying out successful research, in partnership with patients and the public, and signpost attendees to the support available to them.

We were also very fortunate to have some patients and members of the public bringing their unique lived experience – of working with researchers, leading research and being a clinical trial participant respectively to offer tips to attendees.

CLAHRC Research Advisory Panel member Ayath Ullah (below left) joined the CLAHRC’s involvement officer Steven Towndrow to offer a lay perspective on how researchers can make patient/public advisers welcome and valued.

One of the CRN’s Patient Research Ambassadors (PRAs) Phillip Wingfield spoke about his experience of taking part in two clinical trials, offering a perspective from a participants point of view. 

We were also joined by community researchers Sultana and Farzana from the NEON project, where they have led research into improving nutrition practices among the Bangladeshi community in East London.

“Useful to have a range of speakers with varied experience. Great place to come prior to starting research.”

Researchers, staff and health professionals delivered a range of presentations with small group work and regular exercises to reinforce learning, and were on hand to facilitate each part of the day.

Feedback from attendees was overwhelmingly positive;

“Very useful and informative.”

“Lots of information to move forward my idea. Thank you very much.”

“A good overview of processes. Helpful to know all the help/support available.”

“Very well designed and delivered. It kept my attention throughout. The content/sessions were well balanced and provided me with the basis to build on”

We are offering follow up sessions with attendees to support the development of research ideas into action, and we plan to run the course again in summer 2019. Get in touch to join our mailing list to find out when courses are planned – clahrc.academy@ucl.ac.uk.

CLAHRC researcher’s run half-term residential training event for second cohort of young commissioners

Young Commissioners residential training for Dudley Council Integrated Commissioning hub, 2-4 November 2019

The “Young Commissioner” model – which sees children and young people work with funders and planners of local services to ensure they meet the needs of those in their age group  – is gaining traction among local authorities and the NHS.

CLAHRC North Thames child and adolescent researchers are training and supporting staff and young people based at Dudley Council, West Midlands to establish and embed the Young Commissioner model in their Integrated Commissioning Hub. This follows our work with a previous cohort of young people in East London to improve diabetes services.

Over the weekend of 2-4 November this residential event kicked-off the training programme for the young people using the principles of ‘learning by doing’. This has involved blending training with real-time commissioning activities.

The Young Commissioners worked with graphic facilitator Penny Mendonca on public speaking and presentation skills, and the different communication channels they could use.

Adult learners have also accessed project-specific eCPDs developed by the team to help them better align Council systems, structures and processes to optimise the impact and sustainability of this initiative. The adoption of the Young Commissioners model marks an area of innovation in how they work together with the public to commission children and young people’s services.

There is a strong commitment in Dudley Children’s Services to the active involvement of children and young people – the initiative forms part of Dudley Children’s Services Active Involvement strategy 2017, and the Children and Young People Market Position Statement 2018-2022.

“Dudley is a Borough where co-production with children and young people’s their rights are realised, and their views shape decisions made about their lives and those of their families.”

Dudley Children’s Services Active Involvement strategy 2017

Introduction to Economic Evaluation

February 27, 2019 @ 9:00 am – 5:00 pm

Do you need to demonstrate the economic impact of projects in your organisation?

Do you want to assess the outcomes and sustainability of a new service?

Are you tasked with carrying out an economic evaluation, but don’t know where to start?

This one day, hands-on workshop aims to provide an introduction to addressing these challenges.  It is run by the NIHR CLAHRC North Thames Academy.  The course is aimed at staff in frontline services in the NHS and local government, who have limited experience of conducting evaluations and decision making analysis.

After attending this course, you will have the skills and knowledge to undertake your own simple economic evaluation of a local intervention or service, and be able to appraise other evaluations.

The course will cover:

  • introduce the basic principles of economic evaluation methods
  • explain how to assess the costs of an intervention/service
  • explain how to measure and value outcomes of an intervention/service
  • give practical examples of economic evaluation analysis
  • help to understand how to use economic evaluation in decision making
  • offer the opportunity to discuss in small groups the economic evaluation you are doing or thinking of doing.  A facilitator will help scope your economci evaluation, draft its core elements, identify the data you will need to use, think how you could overcome information or data gaps.

This workshop is suitable for staff from NHS Trusts, Local Authorities and CCGs who need to evaluate local programmes or services from an economic perspective as part of their work. It is not aimed at academics and/or researchers.

In order to be most beneficial for the participants, we invite applications from individuals who are carrying out or soon will need to carry out an economic evaluation of a service/intervention. In the selection process, we will give priority to applications providing a detailed description of such projects. Groups of people working on the same project are encouraged to apply.

No previous knowledge of economics is required (or experience of study design and statistics), however an interest in economics and being comfortable with numbers is desirable.

All participants will receive a certificate of attendance.

Cost – This course is free for staff working in NIHR CLAHRC North Thames partner organisations (please click here to see a list of our partners). There is a delegate fee of £250 for other attendees.

Registration – Please complete the registration form and email it to clahrc.academy@ucl.ac.uk by 5pm, Wednesday 19th December 2018.  

Please note, a cancellation fee of £100 will be charged to both partner and non-partner delegates in the event of non-attendance without notice after 5pm, Wednesday 20th February 2019

 

 

 

Evaluating a digitally-enabled care pathway for Acute Kidney Injury

A new publication highlights our work in evaluating a new patient pathway with the potential to provide clinicians with real-time data on inpatients at risk of Acute Kidney Injury.

AKI is common (affecting up to 20% of UK acute hospital admissions);  associated with significant morbidity and mortality, and expensive – excess costs to the NHS in England alone may exceed £1 billion per year.

Researchers at the Royal Free Hospital (RFH), part of London’s Royal Free London NHS Foundation Trust (RFLFT) have developed a digitally-enabled care pathway for inpatients, incorporating  a mobile software application – the “Streams-AKI” app – that “reads” routinely collected serum creatinine data in hospital inpatients and alerts health professionals where a patient is at risk of AKI.

We have published our protocol for this evaluation, and a postcard-style “need to know” summary – or BITE – of our research plans. We’ll measure its success for patients (in terms of speed and effectiveness of their diagnosis and care), NHS staff and clinicians (to find out what they think of the pathway) and for the NHS in terms of patients’ length of stay and costs to the service.

The protocol and BITE will interest NHS staff and clinicians working in renal care, as well as those interested in the potential of technology to improve detection and diagnosis via routinely collected data

Co-producing a ‘perfect’ care pathway for diabetes with young people

We’ve been working with young people to transform how local health diabetes services are designed and delivered for their age group.

CLAHRC researchers based at the University of East London worked with local young people to understand the options and barriers they face when given a diagnosis of diabetes and using NHS services.

We recruited a mixed young research team – in terms of age, ethnicity, faith-identities and backgrounds – who worked together over one year to help commissioners and providers better understand and address the options and barriers of delivering a ‘perfect’ care pathway.

You can see the results of this work in our latest BITE – a postcard summary of a CLAHRC research paper.

This is part of our wider work to co-design community-based diabetic services responsive to the needs of children and young people

How do older people’s social connections influence their use of preventive health care services?

Most of us have experienced the benefits of having strong and positive social relationships. We also know that a lack of these can lead to social isolation and loneliness – which are connected to illness and early death.

We know less about how social connections can influence our use of preventive health care services, such as screening, flu immunisation or health checks. Is it the quality of our relationships that matters, or how wide our networks are, or how often we are in contact with other people?

Our latest BITE – a postcard “need to know” summary of our published research – presents the findings of our investigation into whether and how social connections affect the use of recommended preventive health service programmes amongst people in their late 60s.

While it is common to target public health initiatives based on where people live or their economic and physical health circumstances, our work suggests using social connectedness indicators may also improve targeting of initiatives to increase preventive healthcare participation.

In addition, our results highlight the value of public health initiatives to increase social networks – itself a benefit beyond improving the uptake of services.