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CLAHRC National Newsletter

Please see below for a directory of articles the CLAHRC West Midlands has published in the community e-newsletter for the National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRCs), which contains the latest news and interesting developments from across the 13 collaborations and the health service research community. Subscribe to the newsletter on the CLAHRC Partnership Programme website.

2016

August - Mental and physical wellbeing

July - Public health interventions

June - Patient safety

May - Patient and public involvement

April - Working with industry

March - Five Year Forward View

February - Managing long-term conditions

January - Prevention and detection

2015

December - Early years, children and young people

November - Diabetes

October - Self-care / management

September - Reducing admissions / care planning

July/August - End of life care / older people

June - Technologies

May - Mental health

April - Patient experience

March - Primary care


August 2016 - Mental and physical wellbeing

Integrating emotional and psychological support into the end-stage renal disease pathway: Use of mixed methods to identify patients’ lower-level support needs and how these can most effectively be addressed

As a result of difficulties related to their illness, diagnosis and treatment, patients with end-stage renal disease (ESRD) experience significant emotional and psychological problems, which, if untreated, can have considerable negative impact on their health and wellbeing. Despite evidence that patients desire improved support, management of their psychosocial problems, particularly at the lower level, remains poor. There is limited understanding of the specific support that patients need and want, from whom, and when, and also a lack of data on what helps and hinders renal staff in identifying and responding to their patients’ support needs, and how barriers to doing so might be overcome. Through this CLAHRC West Midlands project we seek to determine what, when, and how, support for patients with lower-level emotional and psychological problems should be integrated into the ESRD pathway.

The research involves two linked, multi-centre studies designed to identify and consider the perspectives of patients at five different stages of the ESRD pathway, and renal staff working with them. Use of a mixed methods design will generate a holistic patient and healthcare professional perspective that is more likely to identify viable solutions to enable implementation of timely and integrated care. Based on the research outputs, appropriate support interventions will be developed, implemented and evaluated in a linked follow-on study. For more information about this project, visit the project’s website or contact f.taylor@bham.ac.uk.

Intervention halves treatment delays for first-episode psychosis

Research by CLAHRC West Midlands Youth Mental Health Theme (2) was the first evidence-based approach to reduce the duration of untreated psychosis (DUP) in the UK. Long DUP has consistently been shown to predict poorer outcomes, with the first six months of treatment delay thought to be a critical period. However, no effective strategy to reduce DUP has been implemented in the UK. Theme 2 research revealed that the majority of DUP in Birmingham is accounted for by delays in mental health services and help-seeking delay. Targeting these sources of delay in two areas of Birmingham, the study team implemented a two-part intervention: a youth mental health care pathway involving a rapid assessment and referral to the Early Intervention Service (EIS) for young people aged 16-25; and a community engagement campaign using a youth-friendly website as the hub, which aimed to increase awareness of when, where and how to seek help for psychosis. The results revealed that DUP in the intervention area was more than halved (from 71 to 39 days), and both components of delay which the study targeted showed reduction in DUP. The authors recommended further research including evaluation of clinical outcomes in order to evaluate the impact of such interventions.

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July 2016 - Public health interventions

Evaluation of an SMS-based weight maintenance programme ‘Lighten Up PLUS’

A randomised controlled trial to evaluate the effectiveness of a text-based weight management programme was recently completed by Professor Kate Jolly at University of Birmingham (supported by pilot CLAHRC and CLAHRC West Midlands). Previous evidence produced by the same research group demonstrated that commercial sliming clubs, such as Weight Watchers and Slimming World, were more effective than ‘own grown’ programmes developed by General Practices and recommended that local practices disinvest in ‘own grown’ services in favour of commercially provided services [1]. The Lighten Up PLUS study [2] recruited 380 participants, randomly assigned to receive a brief telephone call and leaflet of weight loss maintenance strategies (usual care); or usual care plus text intervention that encourage regular self-weighing. The results showed no significant difference in weight change between the intervention and usual care groups: participants in both study groups maintained weight loss in the short term, but regained weight over the longer term. The authors recommended further research is needed into how tele-health can support behaviour change, and future research should focus on providing personalised information about diet and/or physical activity, and setting weekly weight-related goals.

1. Jolly K, Lewis A and Beach J et al. (2011) Comparison of range of commercial or primary care led weight reduction programmes with minimal intervention control for weight loss in obesity: Lighten Up randomised controlled trial. British Medical Journal. 3;343:d6500
2. Sidhu MS, Daley A, Jolly K. Evaluation of a text supported weight maintenance programme ‘ Lighten Up Plus’ following a weight reduction programme: randomised controlled trial. Int J Behav Nutr Phys Act. 2016. 13:19

Worcestershire County Council public health projects supported by CLAHRC WM research

Dr Gavin Rudge of the Research Methods theme is leading on a programme of work developed in partnership with Worcestershire County Council (WCC), in response to the specific health priorities of their local population. Projects include: Embedding public health in planning: Jenny Shepherd (a collaborator on this programme of work) drove the adoption of the Health Impact Assessment (HIA) process by facilitating workshops for WCC staff. Health and wellbeing is now considered in all policies at WCC to consider whether an HIA is required; Providing evidence for public health interventions: Researchers created a ‘Census Atlas’ to help target public health interventions and contribute to improved health and wellbeing outcomes in Worcestershire. The findings were presented to key groups at the local authority via two ‘health geography’ seminars; Domestic abuse needs assessment: researchers worked on a review, evaluation and assessment of domestic abuse services, systems and processes in WCC. This includes analysis of the extent of the problem in Worcestershire, impact on certain groups and the current service response. This evidence will help to inform the recommendations for future Worcestershire domestic abuse services.

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June 2016 - Patient safety

The use of control charts by hospitals boards

Every level of NHS provider organisations is bombarded with metrics and statistics on performance. This can range from ward level performance on infection control through to trust level performance against a national target, like the 62-day cancer wait standard. Being able to make effective use of the data available is a constant challenge for staff at all levels in organisations, regardless of their professional or educational background. One problem is separating out normal variation (chance) in performance from signals of poor performance. Control charts can be more sensitive to these changes than standard line charts or tables and are widely used in industry and manufacturing to detect issues of quality and safety.

A recent study funded by the West Midlands Academic Health Science Network and undertaken by NIHR CLAHRC West Midlands looked at the use of control charts by reviewing board papers from 30 hospital trusts over a one-year period. It found that of the 589 charts considered, only 72 included an element of control chart methodology to eliminate chance from their findings. Even in the examples where control chart methodology was used, it was often not made clear how the control limits had been set, which restricts how useful the charts are. It is difficult to ascertain whether the limited use of control charts is due to a lack of demand from boards, or because staff lack the expertise or tools to present data in this way. More information on NIHRC CLAHRC West Midlands is here.

Evaluation of a programme to improve safety in care homes

Most patient safety initiatives and research has focused on hospitals. Relatively little work has been undertaken in care homes, even though residents are an increasingly frail and elderly population for whom adverse safety events can quickly escalate into hospital attendance and admission. NIHR CLAHRC West Midlands is embarking on a two-year evaluation of a safety programme being funded by the West Midlands Patient Safety Collaborative. Thirty care homes in two CCG areas will be taking part in a programme designed to skill up staff in service improvement techniques with the aim of reducing the incidence of harm and improving the safety culture in the participating homes. Training and workshops will be combined with facilitation of groups of staff in individual care homes who will also be undertaking local improvement projects. The mixed methods evaluation will combine quantitative assessment of changes in safety culture and hospital admissions with qualitative staff interviews, focus groups and four case studies of Care Homes. The evaluation is due to begin in October 2016. Contact: s dot l dot damery at bham dot ac dot uk.

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May 2016 - Patient and public involvement

Researchers work with patients to co-produce Quality Indicators for use in Primary Care

The NIHR embraces principles of co-production. Characteristics of co-production encourage collaboration and underline the value of people’s expertise through experience. Researchers in CLAHRC West Midlands worked in partnership with patients of a Research User Group (RUG) at Keele University to co-produce a set of self-reported Quality Indicators (QIs) for osteoarthritis in primary care (appointments with the GP or practice nurse).

Patients with osteoarthritis should receive the best care and support and should be provided with the right information to help them manage their condition. Information about the quality of care patients with osteoarthritis receive is not routinely collected. QIs can benefit patients by measuring whether minimum standards of care are met and ensuring patients are offered best care.

The research had two stages: 1) co-development of QIs for use in primary care in the UK, and 2) comparing the UK QIs with QIs developed in Norway. RUG members and researchers produced 15 QIs and RUG members ensured the wording of a questionnaire to assess the QIs was appropriate.

The 15-item QI questionnaire has been used successfully in the MOSAICS study, which developed and evaluated a new model of supported self-management of OA to implement the NICE quality standards for OA. Having QIs helps to ensure that patients osteoarthritis receive high-quality care and includes elements of care that patients consider to be important.

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April 2016 - Working with industry

Researchers work with software companies to implement GP consultation tool

Researchers from Keele University, partners in the NIHR CLAHRC West Midlands leading the chronic disease programme, have developed the STarT Back tool, whereby patients are screened for risk of chronicity and matched pathways are put in place to target the right treatment to the right patient. In addition, Keele researchers have established the ENHANCE study, which aims to test the feasibility and acceptability of a Practice Nurse-led Long-Term Condition (LTC) review, for case-finding, assessing and initiating management and sign-posting of osteoarthritis-related joint pain, anxiety and/or depression in patients attending routine LTC reviews. Both studies help to structure what can be complex conversations for patients with multiple morbidity, making these as effective and streamlined as possible by providing prompts for General Practitioners to guide the consultation discussion.

Keele has already worked successfully with industry partners (EMIS and www.patient.co.uk) to integrate the STarT Back tool into the GP clinical system (EMIS). This allows automated completion of the tool and auto-referral to appropriate matched treatments, along with increased data collection to aid evaluation. More recently, the research team have been working with INPS who own the Vision GP information system to incorporate both the STarTBack and ENHANCE tools into their software. These two software companies cover a very high percentage of GP practices and so will allow other AHSNs across the country to adopt the implementation of these tools at scale and pace, as the West Midlands is currently doing. Learn more about the CLAHRC West Midlands at www.clahrc-wm.nihr.ac.uk.

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March 2016 - Five Year Forward View

Does Integrated Care Reduce Hospital Activity?

One of the key mantras of the Five Year Forward View was to break down the barriers between health care providers and between health and social care. With an ageing population and increasing prevalence of chronic health conditions, the policy advocated the creation of Multispecialty Community Providers to care for people in the community rather than in acute hospital settings.

NIHR CLAHRC West Midlands Theme 4 (Chronic Diseases) is working on an umbrella review of systematic reviews to try to determine the effectiveness of integrated care interventions for patients with one or more chronic diseases in reducing hospital activity. The study considers 75 different reviews and meta-analyses, and draws conclusions about the impact of integrated care on hospital admissions, hospital re-admissions, length of stay, Accident and Emergency use and costs. It also uses patient outcomes, patient satisfaction, care co-ordination and quality of life measures to determine patient experience of changes in service delivery. The role of Multi-Disciplinary Teams (MDTs) has already emerged as a key determinant in the success of integrated care schemes, but the most successful schemes often still involved the acute sector.

The study has significant implications for initiatives such as the Better Care Fund and for vanguard sites seeking to deliver integrated care, and for policy makers. It also highlights the need for further research on the theme of multi-morbidity and on the optimum service configuration for delivering integrated care.

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February 2016 - Managing long-term conditions

Improving care of people with long-term conditions in primary care

Osteoarthritis (OA) and anxiety/depression often coexist with other long-term conditions (LTCs), yet are frequently under-recognised and under-treated, which can lead to poorer quality of life and clinical outcomes, and increased healthcare costs. Primary care is increasingly seen as the optimal setting to deliver care for long-term conditions; however, clinical guidance for managing long-term conditions typically focuses on single disease management.
Researchers from NIHR CLAHRC West Midlands are undertaking the ENHANCE study to test the feasibility and acceptability of a practice nurse-led ‘ENHANCE LTC’ review consultation for identifying, assessing and managing OA-related joint pain and anxiety/depression.

The ENHANCE LTC review has been co-designed by researchers, patients, clinicians and other stakeholders and involves case-finding for anxiety, depression and OA-related joint pain; development of a management plan, comprising self-management and signposting/referral to other services; and a specially-designed ENHANCE EMIS template. The study will report on both process and research outcomes enabling the acceptability and feasibility of the practice nurse training, fidelity of delivery, and suitability for a larger randomized controlled trial to be fully assessed. For more information please visit www.clahrc-wm.nihr.ac.uk.

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January 2016 - Prevention and detection

Trial to assess a self-directed rehabilitation intervention for people with Chronic Heart Failure

Heart Failure (HF) is a progressive condition affecting around 900,000 people in the UK, and is a common cause of hospitalisation. Cardiac rehabilitation (CR) has been shown to significantly reduce the risk of hospitalisation and improve health-related quality of life. NICE recommends offering CR for patients with HF, but few UK centres have a specific rehabilitation programme for HF.

The Rehabilitation EnAblement in CHronic Heart Failure (REACH-HF) intervention is a home-based self-help CR manual to improve health-related quality of life. The manual includes an exercise programme; management of stress/anxiety; HF symptom monitoring; and understanding and taking medications. A study team including academics from three NIHR CLAHRCs: South West Peninsula (who are leading the study), West Midlands Theme 3 (Prevention and Detection) and East Midlands are conducting a trial to assess the clinical- and cost-effectiveness of the intervention in addition to usual care for patients with systolic HF. Outcomes after 12 months will be compared with a control group receiving usual care to measure disease specific health-related quality of life, as well as survival, hospitalisation, psychological well-being and patient safety. The findings will provide valuable information for clinicians, policy makers, patients and their caregivers about the role of self-directed rehabilitation.

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December 2015 - Early years, children and young people

High stress levels reduce teachers’ ability to provide support for their students’ wellbeing, study finds

At least 10 percent and up to 25 percent of school-age children have a mental health condition, with 50 percent of mental health problems occurring before the age of 14, and 75 percent before the age of 24. In spite of this, young people are often reluctant to seek help, leaving them vulnerable and untreated. Researchers from the NIHR CLAHRC West Midlands Theme 2 (Prevention and Early Intervention in Youth Mental Health), have conducted a study into how the mental health needs of teachers could affect their ability to provide early identification and intervention to support their students’ emotional wellbeing. The study involved an online survey which received 320 responses from teaching staff at 148 secondary schools in the Birmingham local authority area. The results revealed that 78.5 percent of teachers were currently experiencing moderate to high levels of stress due to overwhelming workloads, and fear of negative responses from senior management. The study concluded that high levels of work-related stress may have a negative impact on teachers’ ability to facilitate early identification and intervention strategies with regard to the mental health of their students. Recommendations included implementing a whole-school strategy taking into account the emotional wellbeing of both staff and students; integrating mental health training into teacher training programmes; and working with mental health service partners to provide ongoing training and support in order to improve mental health outcomes for children and young people.

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November 2015 - Diabetes

Walking away from gestational diabetes: a joint CLAHRC project

Women with gestational diabetes are seven times more likely to develop type 2 diabetes within ten years, and the number of cases is growing due to increasingly unhealthy lifestyles. Researchers from NIHR CLAHRC East Midlands and NIHR CLAHRC West Midlands are undertaking a joint project which aims to develop and implement lifestyle education programmes for women with a history of gestational diabetes. The project will identify women with a diagnosis of gestational diabetes between six and 36 months previously, and 250 participants will be randomly allocated to usual care or intervention groups for 12 months. The usual care group will receive usual care plus - an information leaflet about healthy lifestyle choices after childbirth; while the intervention group will receive usual care plus a referral to the face-to-face and online education programmes. Participants will wear a physical activity monitor for seven days before, during and after the study, and the education programmes will be deemed successful if physical activity increases by around 30 minutes per day. This level of activity is sufficient to reduce type 2 diabetes risk by 30-50 percent, as part of a healthy lifestyle. If successful, researchers will work with local stakeholders during the study to ensure it is widely implemented.

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October 2015 - Self-care / management

A qualitative evaluation of culturally-tailored self-management education

Migrant populations are at greater risk of developing long-term conditions, typically practice fewer self-management behaviours and make greater use of emergency healthcare services in comparison with the general population. NIHR CLAHRC West Midlands Theme 3 (Prevention and Detection of Diseases) researchers have undertaken a qualitative evaluation of the design and delivery of Chronic Disease Self-management Programmes (CDSMPs), used to address the growing demand for healthcare services. CDSMPs are weekly, group-based workshops delivered by lay people from the community, who generally have a greater understanding of the cultural beliefs and societal factors faced by their community. Theme 3 researchers interviewed lay educators and observed workshops, and analysed data in order to understand how elements such as lay workers, the group-based design, and culturally-appropriate educational material are intended to encourage behavioural change in culturally diverse communities. Their results revealed that lay educators face a number of challenges when addressing health beliefs and changing lifestyle practices. The educators’ cultural awareness aided communication and strengthened relationships with attendees, however, financial constraints at policy level inhibit the development and training required for this role. This work is published in this open access paper. See further information about the NIHR CLAHRC West Midlands.

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September 2015 - Reducing admissions / care planning

Collaboration with local NHS partners to reduce hospital readmissions in the West Midlands

Researchers in NIHR CLAHRC West Midlands Theme 4 (Chronic Diseases) are undertaking two projects aimed at reducing hospital readmission. The first involves collaboration with Sandwell and West Birmingham NHS Trust to identify effective ways to reduce high levels of 30-day emergency hospital readmissions following a hospital stay. The first stage of the work is to assess whether the 'LACE' risk prediction tool, which uses information on patient length of stay, admission type, other health conditions and previous emergency admissions, can predict accurately whether or not a patient is likely to be readmitted to hospital after being discharged. If the tool is successful, NIHR CLAHRC West Midlands will work with the Trust to design and test interventions to offer enhanced inpatient care and more intensive management after discharge to improve patient outcomes and reduce the number of emergency readmissions for high-risk patients. The second project is outlined below.

Project to evaluate a supported integrated discharge service in the West Midlands

NIHR CLAHRC West Midlands is also collaborating with the Heart of England NHS Foundation Trust (HEFT) on a project to evaluate a supported integrated discharge service to identify whether its objectives are being met, and to understand the impact it has on patients, carers, staff and costs. HEFT has implemented a system of supported integrated discharge for patients aged over 65, admitted to hospital as an emergency, with a length of stay of 14 days or more. This patient group often has multiple chronic conditions and needs intensive rehabilitation, reablement and longer-term social care services input after their hospital stay. The aim is to reduce the length of hospital stay by providing specialist, multidisciplinary rehabilitation and support services in the patient’s home, improve the co-ordination of care across settings and care providers, reduce readmissions to hospital, make resource savings for the Trust, and help patients to improve their quality of life and stay independent for as long as possible. The integrated discharge service offers up to 14 days of therapy from the hospital Trust in the patient’s home, up to six weeks reablement from the local authority, a full community social work assessment, and managed handover to community therapy services if needed.

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July/August 2015 - End of life care / older people

Improving Paediatric Palliative Care through NIHR CLAHRC West Midlands

NIHR CLAHRC West Midlands is supporting the evaluation of two initiatives designed to support families whose children have complex, life-limiting, or life-threatening conditions. The first project will examine the use of the Advanced Care Plan for a Child or Young Person (ACP) across the West Midlands. This is a tool that aims to support families and professionals to discuss, document and agree plans to manage (i) illnesses or declines in health that are expected to be reversible and (ii) emergency or end-of-life care. The second project will explore the early implementation and impact of Magnolia House, a new facility that will soon be built at Birmingham Children’s Hospital NHS Foundation Trust to provide support and care to families and staff who are coping with ‘bad news’ situations or bereavement. At the heart of both is an intention to improve outcomes that matter to both families and staff, by providing more supportive and co-ordinated care.

The teams (which include collaborators from Birmingham Children’s Hospital and the Universities of Birmingham, Warwick, and Aston), will use mixed methods to explore how individuals, groups and organisations attach meaning to the ACP and Magnolia House and how these meanings shape actions that come to define the initiatives. They will provide important insights into the extent to which the ACP and Magnolia House represent innovative models of care and how they might be developed, redesigned or even replaced to provide optimal benefit to families and staff. As such, the findings will not only have implications for local service development, but will have implications for potential scale-up and adaptation.

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June 2015 - Technologies

E-solution helps match patients with back pain to appropriate care pathways

Over 70% of the population will experience a significant episode of back pain at some point during their life. Back pain is the most common reason middle-aged people visit their GP and is the second most common reason for sickness absence from work. A review of current practice suggests that a significant majority of back pain patients are over-treated in the NHS; while a significant number go on to suffer long-term pain and disability. Researchers from Keele University, partners in the NIHR CLAHRC West Midlands leading the chronic disease programme, have developed the STarT Back tool, whereby patients are screened for risk of chronicity and matched pathways are put in place to target the right treatment to the right patient. STarT Back has been shown to be clinically and cost effective – reducing over-treatment of low-risk groups, by ensuring their management is maintained in primary care, with more effective matched and targeted treatment for medium- and high-risk groups provided by physiotherapists in community and secondary care settings. A linked study demonstrated that the application of the STarT Back approach provided a 40% reduction in referral of low-risk groups, while medium- and high-risk groups gained earlier access to therapy, with improved outcomes and significant reduction in time lost from work.

As part of NIHR CLAHRC West Midlands programme to support the NHS to take research into practice NIHR CLAHRC West Midlands colleagues from Keele University, with West Midlands Academic Heath Science Network (AHSN) funding in 2014, identified the barriers to implementing this approach in practice and have supported an extensive programme of training and pathway development . In addition, Keele have worked with industry partners (EMIS and www.patient.co.uk) to integrate the STarT Back tool into the GP clinical system (EMIS) allowing automated completion of the tool and access to high quality patient information and auto-referral to appropriate matched treatments. Piloted with five practices in North Staffordshire CCG in 2014, this system will be rolled out across the West Midlands as part of the ongoing implementation activities supported by the West Midlands AHSN during 2015.

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Prescribing systems could save hospitals money

Mistakes can be made in the prescribing and dispensing of medications in hospital. One solution to prevent many of these errors is an electronic prescribing system. This system computerises the process so that prescriptions are entered onto a computer, which transmits them to the pharmacy, which then prompts nurses when certain drugs should be given. Warnings also pop up to remind clinical staff if there is an opportunity for patient harm to arise. Electronic prescribing systems are expensive, however. The question NIHR CLAHRC West Midlands researchers are tackling is whether an electronic prescribing system is good value for money.

When patient experiences harm from a medication error, which may be anything from an allergic rash to a life-threatening complication, they suffer a loss of health and their period in hospital is extended. So preventing errors reduces both excess costs and improves patient health. To measure the benefits, NIH CLAHRC West Midlands Research Methods Theme (6) has therefore collected information on excess length of stay and patient harms and, using information on the effectiveness of electronic prescribing systems, estimated the resulting benefits. Health gains can be converted into a monetary value using the cost-effectiveness threshold the NHS specifies that all new technologies must meet.

Preliminary results suggest that the gains from an electronic prescribing system are greater than the costs of implementing it. So these systems may actually save hospitals money despite their high costs.

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May 2015 - Mental health

Early intervention service in Birmingham to offer mental health services for young people

Clinical evidence suggests that half of all lifetime mental health illnesses begin by the age of 14 and three quarters by age 25 (excluding dementia). This is reflected by increased referral rates to Child and Adolescent Mental Health Services (CAMHS) in recent years. However, research by the Youth Mental Health Theme (2) of NIHR CLAHRC West Midlands revealed that many young people with first-episode psychosis face long and damaging treatment delays in their care pathways. As a result of this research, CAMHS in Birmingham will now be offered for young people aged 0-25. The new service will be provided by Forward Thinking Birmingham, a partnership led by Birmingham Children’s Hospital. The evaluation will be led by NIHR CLAHRC West Midlands own Theme 2 at the Universities of Warwick and Birmingham. This will assess its mobilisation and impact including those outcome indicators in the NHS Outcomes Framework.

SchoolSpace network supports eating disorder research

Researchers in the Youth Mental Health Theme (2) of NIHR CLAHRC West Midlands have developed an excellent working relationship with teachers and pupils in local schools through the establishment of the ‘SchoolSpace’ network. This network of schools is committed to working with NIHR CLAHRC West Midlands on youth mental health research and has adopted the Theme’s website, as their key resource for providing general education and support about youth mental health. The Theme provides network schools with a range of bespoke training sessions, which include sessions on self-harm, eating disorders, anxiety and depression. SchoolSpace has been instrumental in supporting the success of a number of Theme 2 projects, including a longitudinal exploration of factors associated with the development of eating disorders.

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April 2015 - Patient experience

A pilot evaluation of interventions to support the emotional and psychological needs of patients with end-stage renal disease

The transition to dialysis can be frightening and traumatic for end-stage renal disease patients, and there are often many associated emotional and psychological challenges for them. However, renal consultants rarely address emotional problems due to worries about lengthening consultation times and not being able to deal with the issues raised. Researchers at NIHR CLAHRC West Midlands have piloted two simple interventions designed to encourage consultants to talk openly and explicitly with patients about emotional concerns. One intervention involved consultants using a question based on NICE evidence-based guidance during routine consultations with patients; the second involved patients using a Patient Issues sheet to identify two or three issues they would like to discuss, and taking the sheet into their consultation.

The study concluded that both pilot interventions had a positive impact on what was discussed in consultations. Patients appeared to like both interventions, but the researchers emphasised that the training of renal consultants is necessary prior to the use of these interventions to ensure the appropriate response to emotional concerns raised. Following the success of this work, NIHR CLAHRC West Midlands researchers are currently about to start implementing a four-year research programme using mixed-methods to evaluate the effectiveness of different interventions to support the low-level emotional and psychological needs of patients with end-stage renal disease. The work will be undertaken in four NHS Trusts in the West Midlands, and will be led by PI Dr Gill Combes supported by Francesca Taylor.

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March 2015 - Primary care

Identifying patients with mental health problems and joint pain in routine long-term condition reviews in primary care

Osteoarthritis (OA) and mental health problems are common, and often co-exist with other long term conditions (LTCs). However, they are seldom prioritised, which results in under-detection and suboptimal treatment in primary care. Researchers at the CLAHRC West Midlands have developed the ENHANCE study, which aims to test the feasibility and acceptability of a Practice Nurse-led LTC review, for case-finding, assessing and initiating management and sign-posting of OA-related joint pain, anxiety and/or depression in patients attending routine LTC reviews. Multiple methods for developing the new complex intervention included an evidence synthesis, three stakeholder workshops, a patient advisory group, a practice nurse advisory group and a focus group with practice nurses. In the focus group, barriers to implementation of the new intervention were identified and discussed. The study has enabled the production of an innovative complex intervention for integrating joint pain, anxiety and depression into routine LTC reviews in primary care, and facilitated the identification of training needs. A pilot stepped-wedge trial will test the acceptability and feasibility of the new intervention.

Keele University gains status as leading Primary Care Research centre

The Keele Research Institute for Primary Care & Health Sciences based at Keele University, a key collaborator in the CLAHRC West Midlands initiative, has established itself as a world leader in Primary Care Research. In November 2014, the NIHR announced that the Keele Research Institute secured re-designation of its membership to host one of the NIHR School for Primary Care Research (SPCR). The research team at Keele University have a strong track record in the area of musculoskeletal research working closely with respective health and social care partners, and are undertaking a variety of primary care research studies supported by CLAHRC WM, including the ENHANCE study. In addition, the group has secured the only NIHR Research Professorship in Primary Care Research in round four of the NIHR competition, awarded to Professor Christian Mallen, as well as recently celebrating an outstanding result from the 2014 Research Excellence Framework (REF). The REF results demonstrate that the Medical School is ranked sixth nationally among Schools undertaking primary care research and fifth in terms of best research publications. Watch this space for further successes emerging from our CLAHRC WM-funded primary care projects being carried out by this group.

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