New CLAHRC research looks at how comorbidities – multiple conditions experienced by patients – influence referrals to, and outcomes of hip and knee replacement surgery.
Taking a 360-degree view of the referral and treatment process our researchers, led by Bélène Podmore, investigated current evidence in this area for patients with multiple conditions undergoing surgery. We examined;
the short-term outcomes relating to the safety of the hip or knee replacement surgery
long-term outcomes relating to the benefits of undergoing hip and knee replacement surgery.
We found comorbidities predominantly impact the safety of hip and knee replacement surgery but have little impact on its effectiveness.
Bélène also interviewed a variety of health professionals and therapists for their take on referring and selecting patients with comorbidities for joint replacement surgery. We found some disagreement among professionals – ranging from GPs to surgeons – on roles and responsibilities in the management of these patients.
The two pieces of research are presented in handy new “BITE-sized” summaries with links to full papers and further reading –
Helen is a consultant in public health medicine and a health services researcher. She is a member of the CLAHRC research partnership team, and Deputy Director of the CLAHRC Academy. Her research uses qualitative and quantitative methods to evaluate health care and public health services.
The work of CLAHRC researcher Dr Bélène Podmore has been highlighted as “high quality” by the National Institute for Health Research. Bélène’s work, recently published in BMJ Open investigated how having a long-term condition impacts access to and benefit from hip and knee surgery. The research was promoted by NIHR via their “Signals” service. NIHR Signals summarise the latest important research on health care, public health and social care, along with implications for practice.
Why was this study needed? In the UK, over 210,000 hip and knee replacements were performed in 2017 at an average age of 68 for hips and 69 for knees. One in six of these people had an illness affecting their day to day life.
New knowledge generated by our research impacts commissioning and funding decisions on welfare advice
Our work to investigate the impact of locating welfare advisers in GP surgeries is bearing fruit as the new knowledge and evidence we have generated is influencing commissioning decisions for these services across London and beyond.
We know that a significant amount of General Practitioners workload is generated by patients approaching them with non-clinical issues such as debt, housing and immigration.
While these concerns undoubtedly impact health and wellbeing, doctors are not necessarily the best professionals to assist. Haringey Council trialled a scheme to locate welfare advice, and welfare advisers in GP surgeries to deal with these issues.
We evaluated the impact of this advice (provided by Citizen’s Advice Bureau staff) on both GP workloads and on the health, wellbeing and use of services by the patients affected.
Our evidence has been used to support the following decisions –
Haringey: our evidence was used to support retention of all except one primary care co-located welfare advice service in and to provide an additional more intensive service at a mental health hospital (St Ann’s Hospital);
Camden: although the CCG decided to cease funding for GP outreach two GP practices have used the study findings to support ongoing funding for services at their practices (including an application for Big Lottery funding)
Deryshire; Citizens Advice services in Derbyshire have requested study findings to support a business case for ongoing funding of GP outreach in the region
Sussex: our study has been used as a basis to develop an evaluation framework in Sussex
GPs are often faced with patients seeking help and advice on non-clinical issues such as debt, unemployment and housing. Though these issues undoubtedly impact patients’ health and wellbeing, health professionals are not always the best qualified people to tackle them.
We investigated the impact of putting welfare advice, and welfare advisers in GP surgeries on
the ability of low income groups to secure financial support they are entitled to
patients’ anxiety and stress associated with financial related social worries;
and, to GP time spent managing non-clinical issues
New CLAHRC BITEs offer a summary of two papers investigating the impact –
A qualitative study to identify the processes by which co-located services can improve outcomes for GP practices
Co-location of welfare services has many benefits to patients including:
Offering a signposting option for staff in contact with patients with ‘non-clinical’ social needs.
Helping to address underlying patient social issues.
Providing an alternative option for patients seeking help for such issues.
Reducing bureaucratic pressures and time demands on practice staff.
2. A quantitative study, using a controlled comparison, assessing the impact on mental health and service use of co-located welfare advice.
Key Findings – service users receiving welfare advice versus control group
Had the advice service not been at the practice, nearly half of the advice group would not have sought help or consulted their GP instead.
The majority of advice recipients reported improved circumstances after advice (e.g., stress, income, housing etc.)
Compared to those who did not get advice, after 3 months:
Those in the advice group whose circumstances improved experienced a bigger improvement in their well-being.
Those in the advice group experienced a bigger reduction in financial strain, reduced credit card and overdraft use.
Those in the advice group experienced a bigger reduction in symptoms of common mental disorder, especially among recipients who were female, those who identified as Black and those who reported that their circumstances improved as a result of advice.
There was, however no evidence for a reduced frequency of GP consultations.
For every £1 of investment by funders, those receiving co-located advice gained £15 in entitlements on average