Capturing the views of patients in emergency care

CLAHRC researchers highlight potential to use patient-reported outcomes for emergency admissions.

Patient-reported outcome measures or PROMs are a well-established method of capturing the views of NHS patients, allowing the service to assess the quality of care delivered, from the patient perspective.

PROMs use pre- and post-operative surveys completed by patients to calculate their health gains after surgical treatment.

While there is an extensive PROM programme across the English NHS, they have yet to be used in emergency admissions. These account for nearly 40% of all hospital admissions and are an area of increasing demand. However, this is also an area where the NHS knows least about;

  • the quality of patient outcomes,
  • whether resources are being used effectively,
  • and whether there are unexpected variation between different providers

CLAHRC researcher and PhD Dr Esther Kwong investigated how to use PROMs to evaluate the quality of acute and emergency hospital care in the NHS. Esther developed and tested PROMS with patients who underwent emergency admissions, establishing that it is feasible to use PROMS in this clinical area.

They are presented in four new CLAHRC BITEs – postcard summaries of Esther’s published academic papers.

Can Patient Reported Outcomes Measures (PROMs) be used in emergency admissions?

Feasibility of collecting retrospective patient reported outcome measures (PROMs) in emergency hospital admissions

Using patient-reported outcome measures (PROMs) for primary percutaneous coronary intervention

Assessing Patient Reported Outcomes (PROMS) for emergency admissions: laparotomy for gastrointestinal conditions

Introduction to Evaluation

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

Do you want to improve the design and implementation of your programme?

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

This one day, hands-on workshop, run by the NIHR CLAHRC NorthThames Academy, addresses these challenges.  It is aimed at staff from NHS Trusts, CCGs and Local Authorities, who have limited experience of conducting service evaluations.

After attending this workshop, you will have the skills and knowledge to undertake your own evaluation of a local programme or service.

The course covers:

  • Different types of evaluation, including their pros and cons
  • How to select suitable methods and approaches for evaluating a local programme or service
  • Practical skills and tips in using evaluation methods and approaches
  • Ways of sharing your evaluation findings to make an impact

This workshop is suitable for staff from NHS Trusts, Local Authorities and CCGs.  It is not aimed at academics and/or researchers.  Participants should attend the course with an evaluation in mind that they may need to carry out.  No previous experience of study design, statistics or evaluation is needed.

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 adelegate fee of £250 for other attendees.

Registration – Please complete the registration form and email to clahrc.academy@ucl.ac.uk by 5pm, Friday 1st March 2019.

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, Tuesday 26th March 2019

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.

Prof Peter Fonagy

Professor Fonagy is one of the key international figures in the evaluation of mental health interventions. He holds Chairs at UCL, Harvard, Yale and Baylor, and is a NIHR Senior Investigator. In the 1990’s, he co-led the NHS Review of Psychotherapies, evaluating all outcomes data which provided the basis for the radical policy change, Improved Access to evidence-based Psychological Therapies (IAPT), now an important part of the NHS mandate. The report ‘What Works for Whom’ has over 3,000 scholarly citations. Since 2010, he has led the Children and Young People’s Programme for IAPT and achieved a doubling of the Government’s financial commitment to this service transformation programme for CAMHS services to be restructured using evidence based, patient centred therapies. He is a key figure in developing NHS mental health strategy through NICE guidance and chaired the Depression in Children and Young People GDG and co-ordinated the prevention section of guidelines for Antisocial Personality Disorder and Conduct Disorder. He led the development of National Occupational Standards for Psychological Therapies and Chaired the Advisory Group leading to the introduction of routine outcomes assessment in mental health services (HoNOS). He served on several UK Government panels and on the Academic Advisory Board of the Presidential Commission on Violence Prevention, chaired panels at NIMH and the German Research Foundation, and was a UK representative on the Expert Psychological Panel of the European Science Foundation EIRH Programme. He is PI or co-PI on evaluation research programmes in excess of £15M, is Programme Director on the UCLP mental health programme and is leading the largest Clinical Psychology Department and training scheme in the UK, with 150 doctoral students.

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

Prof Kamaldeep Bhui

Professor Kamaldeep Bhui is Professor of Cultural Psychiatry & Epidemiology at Queen Mary University of London and an Honorary Consultant Psychiatrist in East London Foundation Trust.  He is an psychoanalytic psychotherapist.  He is Editor of the British Journal of Psychiatry and the International Journal of Culture and Mental Health.  Professor Bhui trained at University College London and at Guys and St Thomas’ qualifying in 1988.  He proceeded to train in London, completing his higher psychiatric training by 1992, secured a Wellcome Training Fellowship to progress research and secured a first consultant appointment in 1999 followed by a Senior Lecturer and Professorial post at Queen Mary University of London in 2000 & 2003 respectively.  His research and practice interests on health include social exclusion, work characteristics, cultural psychiatry, epidemiology, health services research and psychological therapies.  He has undertaken original research with communities to understand this complex process called radicalisation and provides evidence on how it works and who is vulnerable.

Professor Bhui heads the Centre for Psychiatry at Barts & the London Medical School.  He is also the Director of the Cultural Consultation Service (Culturalconsultation.org), Director of the QMUL MSc Programme, the co-founder of Careif (www.careif.org), an international mental health charity based in London that promotes work for young people and their health through culture, sport and arts and, more recently, the Director of the Synergi Collaborative Centre, a new initiative to transform ethnic inequalities in mental health services, (synergicollaborativecentre.co.uk).

In 2016 he received a CBE (Commander of the British Empire) in the Queen’s New Years’ Honours List for services to mental health care and research.