Category: Themes

Dr Elena Pizzo

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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.

Capturing the views of patients in emergency care

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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

Requests for emergency contraception could be an important sign of abuse

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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

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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.