Sexual health clinics should ask about abuse

Training clinicians to proactively ask patients about domestic violence and abuse (DVA) is feasible for sexual health clinics to implement and could increase referrals to specialist services, according to a joint CLAHRC North Thames/CLAHRC West study led by researchers at Queen Mary University of London (QMUL) and the University of Bristol involving over 4,300 women.

The risk of gynaecological and sexual health problems (including sexually transmitted infections, painful sex, vaginal bleeding and recurrent urinary tract infections) is three-fold higher in women who have suffered DVA. Meanwhile, 47 per cent of women attending sexual health services will have experienced DVA at some point in their lives.

Sexual health services can be the first point of contact for women who have experienced DVA, and were listed by the National Institute for Health and Care Excellence (NICE) as a setting in which all patients should be asked about DVA. However, most sexual health professionals have had minimal training in identifying and responding to DVA.

The study looked at the feasibility of sexual health clinics adopting a programme called IRIS (Identification and Referral to Improve Safety) – a DVA training and referral programme endorsed by NICE, the Royal College of GPs and Department of Health, originally aimed at encouraging GPs to ask patients whether they are experiencing DVA and to make referrals to specialist domestic violence services.

The team tested the intervention in two female walk-in sexual health services; an east London clinic serving an inner-city multi-ethnic population, and a Bristol clinic serving an urban population.

In the east London clinic over seven weeks, 267 out of 2,568 women attending were asked about DVA, with 16 of those (4 per cent) saying that they were affected by abuse. Overall, eight of the women affected by abuse (50 per cent) were referred to specialist services.

In the Bristol clinic over twelve weeks, 1,090 out of 1,775 women attending were asked about DVA, with 79 of those (7 per cent) saying they were affected by abuse. Overall, eight of the women affected by abuse (10 per cent), were referred to the specialist services.

Lead CLAHRC North Thames researcher Dr Alex Sohal (pictured left) said:

Women attend sexual health clinics for care of their sexual health but little thought is given to whether the relationship with the person that a woman has sex with directly harms her health. Without training, system level changes and senior managerial support, clinicians end up ignoring DVA in consultations or have an arbitrary approach that fails many women affected by DVA.

Not only is this a feasible intervention for a sexual health clinic setting, but we also found that clinical leads and busy local DVA service providers were incredibly supportive, with many people understanding the importance of making this work.”

 

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Read the full paper:
Improving the healthcare response to domestic violence and abuse in sexual health clinics: feasibility study of a training, support and referral intervention
Sohal AH, Pathak N, Blake S, et al. Sex Transm Infect Published Online First: doi:10.1136/ sextrans-2016-052866

 

Helping the NHS visualise complex referral data

The NHS generates huge amounts of data but using it to track patient flow and pathways of care requires sophisticated mathematical modelling. CLAHRC PhD student, Ryan Palmer, is “embedded” within one of our partner organisations – North East London Foundation Trust (NELFT) – where part of his work involves offering support and guidance to managers and staff interested in getting the most out of the data they routinely collect.

An example of Ryan’s visualisation of referral patterns between hospital and community services in a busy NHS Trust.

Ryan ran a successful workshop hosted by our research partners NELFT training healthcare professionals how to use network mapping methods for understanding referral data in community healthcare. Care leads who attended came from a range of healthcare disciplines and services, including paediatrics, adult physical health, mental health services and social care.

The two-hour session involved: how to prepare data, how to create network diagrams and the beginnings of discussions as to how these methods may be used to inform service planning. Interest was generated during the session, with many realising the benefits of these methods.

Visualising referral data helps researchers and care managers to work together and understand otherwise overwhelming and hard to interpret data for complex systems. These network maps highlight important characteristics of referral activity and can help identify services that exhibit interesting dynamics. Sharing this work with healthcare professionals, they helped to stimulate further conversations around the analysis and organisation of referrals in community healthcare services.

Our collaborators are currently seeking to implement a single point access (SPA) for older adult community services. This session formed part of the ongoing work with our collaborators to help inform their thinking in designing this SPA.

Memory study poster is award winning!

Research Assistant Moïse Roche enjoyed success at the recent prestigious Health Services Research UK conference in Nottingham.

A poster outlining Moise’s work, as part of our Improving care of people with memory problems in Black African and Caribbean groups study won the People’s Poster Prize at the event – as voted by attendees.

Congratulations to Moïse!

Podcast – A call for increased paediatric palliative care research: Identifying barriers

Palliative care for children and young people with life-limiting conditions and life-threatening illnesses is a relatively new discipline, and one where current practice in services has developed beyond the evidence base available. Barriers to conducting research in this area are numerous, and span the entire length of the research process.

CLAHRC researchers from the BRAVES project, based at the Louis Dundas Centre, are working to identify these barriers to recruiting children with life-limiting conditions to research, and to develop solutions.

“Establishing robust evidence is going to require concerted effort on everyone’s part: clinicians, parents, patients, and researchers.”

Professor Myra Bluebond-Langner, principal investigator on the BRAVES project, has recently recorded a podcast with the journal Palliative Medicine, discussing the need for an increased understanding of barriers to research in paediatric palliative care, findings from the project so far, and outlining the future research planned by the team. 

Initial findings from the study, and previous work at the Louis Dundas Centre, have suggested that fundamental barriers exist at both the individual level, e.g. clinicians’ attitudes to involving young people in research, as well as at the institutional level, e.g. ethics committees and resource constraints, even though children and young people want to participate in research.

 “So, why, if we no longer accept paternalism in clinical practice, are we willing to accept it, indeed demur to it, in research practice?

The overall goal of the BRAVES project is to develop guidance based on the experience of all stakeholders, which in turn will help to develop the evidence base in the field of paediatric palliative care.

Based on the findings outlined in the podcast, the research team has since conducted a study investigating the experiences and difficulties of chief investigators recruiting children and young people with life-limiting conditions and life-threatening illnesses to research. The findings from this study are expected to be published soon. The next step for the CLAHRC researchers is to analyse data collected from a nationwide research groups’ applications to Research Ethics Committees, and to interview members of these committees to develop further insights.

Click here to read the journal article on which this podcast is based.

New short course for 2017! Becoming Research Active

Our CLAHRC Academy is running a new short course in 2017, in collaboration with the Research Design Service London (east London arm) and Clinical Research Network North Thames.

Held on Thursday 12 October 2017, Becoming Research Active – what does it involve and where do I start? is an introductory level course for nurses, allied health professionals, public health and local government members of staff who are interested in research.

As a first step towards becoming “research active”, by the end of the course attendees will be able to understand the research process and will have produced an action plan for taking their research idea forward.

For more details on the workshop, including how to apply,

please visit our events page.

 

New King’s Fund report on the GIRFT programme

A new report from healthcare think tank the King’s Fund sets out progress in delivering the Getting It Right First Time (GIRFT) programme deliver improvements in quality and reductions in the cost of orthopaedic care in England.

Tackling variations in clinical care Assessing the Getting It Right First Time (GIRFT) programme gives an overview of the programme, how clinicians have responded and what it has already highlighted in terms of variations of care across the NHS.

 

 

 

 

 

The CLAHRC is carrying out an evaluation of the planned changes to orthopaedics, to identify lessons to inform future efforts to improve the organisation and delivery of services.

Registration now open! Introduction to Demand, Capacity and Flow

Registration for our next CLAHRC North Thames Academy short course, Introduction to Demand, Capacity and Flow, is now open!

Aimed at staff from NHS Trusts, CCGs and Local Authorities, this hands-on, one-day workshop may be for you if you are interested in learning more about:

  • What we mean by demand, capacity and flow

  • The role of variability in demand forecasting and capacity planning

  • How these concepts relate to flow within and between organisations

  • Common pitfalls including the role and limitations of using historical data

  • Some useful rules of thumb from ‘queueing theory’

  • Practical skills and tips for applying these concepts within your own organisations

Date: Tuesday 26 September 2017

Time: 10:00 – 16:00

Venue: Woburn House, 20-24 Tavistock Place, Central London

For more details on the workshop, including how to apply, please see the event page here.