Category: project-04
After the trial: how a programme to improve the health care response to domestic violence and abuse fares in the real-world NHS
How does an intervention developed and tested by researchers make its way to the front-line of health care?
This is the topic of a new blog by Dr Natalia Lewis, a Research Fellow at Centre for Academic Primary Care in the University of Bristol.
Natalia is part of the research team investigating the impact of IRIS (Identification and Referral to Improve Safety), a general-practice-based Domestic Violence and Abuse (DVA) training, support and referral programme.
Cost-effectiveness of a domestic violence and abuse training and support programme in primary care in the real world: updated modelling based on an MRC phase IV observational pragmatic implementation study
EMmY Trial Protocol
Bart’s Research Centre for Women’s Health is up and running with the EMmY study
We’re delighted to announce our latest research partnership – with the the Bart’s Research Centre for Women’s Health (BARC) .
BARC was launched in June 2017 and is led by Professors Shakila Thangaratinam and Khalid Khan.
The Centre is funded by Barts Charity and based within Queen Mary University of London at the Whitechapel campus.
The centre team (pictured above) will focus on improving the health of mothers and babies in East London, addressing healthcare challenges such as diabetes, obesity and heavy blood loss during childbirth.
The first BARC study is set to start in January 2018 – “EMmY: Effectiveness and acceptability of myo-inositol nutritional supplement in the prevention of gestational diabetes: a pilot placebo controlled double blind randomised trial”.
EmMY will aim to randomise 200 women who are at risk of developing gestational diabetes, across three sites (Barts Health, Guy’s and St Thomas’, and Central Manchester University NHS Trusts).
Participants will be randomised to receive either 4g of Myo-inositol – a naturally occurring substance produced in the human body that belongs to the vitamin B complex group – or placebo study supplement daily, from the end of the first trimester until delivery.
The pilot will examine rates of recruitment and randomisation to the trial, and rates of adherence to the intervention. Researchers will analyse reasons for participation, non-participation, and non-adherence to the trial protocol. Any preliminary estimates and insight into trial procedures from the EMmY study will then inform a future large-scale trial.
The CLAHRC is supporting the study by providing health economic analysis for the pilot and full trial and assisting with patient and public involvement..
Contact Doris Lanz, BARC Senior Trial Manager for more info at d.lanz@qmul.ac.uk
Dr Elena Pizzo
Elena is a Senior Health Economics. She holds a PhD in Economics and Management from Padua University, a Master degree in Economics and Management of Health Care Services from Ferrara University and a first degree in Economics from Padua University.
Prior to coming to UCL she was a Research Associate at the Imperial College Business School, working on the economic evaluation of the Collaborations for Leadership in Applied Health Research and Care (CLAHRC) for Northwest London.
She previously held a research post at the Department of Economics, Ferrara University, where she collaborated to a multi-year research project and undertook an economic evaluation of a Regional Colorectal Cancer Screening Program.
Prof Chris Griffiths
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.
How can we improve dementia care in UK black elders?
Black elders dismiss the warning signs of dementia until the condition becomes too severe to ignore or a crisis strikes. They are also less likely to receive a diagnosis of their condition, resulting in delayed treatment and
less time to plan for the future.
Our latest BITE – a summary of published CLAHRC research provides an overview of our work with black elders, their families and carers to;
- identify barriers and facilitators to seeking help for dementia.
- based on what we found, work with dementia patients and their carers, volunteers from the public, clinicians and experts in the treatment and research of dementia to develop an intervention – a leaflet entitled Getting help for forgetfulness (below)
- trial the intervention with GP registered patients, who were asked to rate it and evaluate its effect on their intention to seek help from their doctor.
