Title: Alastair Hay Consultant Senior Lecturer in Primary Health Care
1Alastair HayConsultant Senior Lecturer in
Primary Health Care
- Research ideas and outcomes Does primary care
research matter?
2Structure of presentation
- Can research make a difference? Examples of
influential research. - Brain warm up the Qu(oF)iz
- Why get involved in research? The thoughts of a
range of practitioners - Who else thinks research is important?
- How to get involved
- Summary
3Can research make a difference? (1)
Paul Little et al, BMJ 1997
- Which prescribing strategy is best for patients
with sore throat? - Prescribing antibiotics for sore throat only
marginally affects the resolution of symptoms but
enhances belief in antibiotics and intention to
consult in future when compared with the
acceptable strategies of no prescription or
delayed prescription.
4Can research make a difference? (2)
Sharland et al BMJ 2005
5Can research make a difference? (3)
Charles Cornford, Family Practice 1993
- I wasnt sleepingI kept waking upevery hour,
every half hour just thinkingit was a constant
worryand you know you feel a bit foolish going
to the doctor and saying Oh, by the way hes got
a bit of a cough, is he all right? when
reallyIm thinking Is my child going to
live?is he going to survive this?
6Can research make a difference? (4)
Alan Montgomery et al, J Hum Hyperten 2005
- Do NSAIDs increase BP in patients with treated
hypertension? - No evidence of an association between NSAID use
and blood pressure control among a group of
treated hypertensive patients in primary care.
7Can research make a difference? (5)
Sandra Hollinghurst et al, BMJ 2005
- Between 1991 and 2002, prescriptions per head
for all antidepressants increased 2.8-fold and
the total cost increased by 310m. These costs
could have been used to employ 7700 cognitive
behavioural therapists. Resources associated with
higher levels of NHS antidepressant prescribing
in England in 2002 compared with 1991 could have
been used to deliver therapy more than a third of
adults with depression or mixed anxiety depression
8Can research make a difference? (6)
Knut Schroeder et al, J Clin Epi 2006
- When patients BP do not reach target is it due
to non-response or poor adherence? And how to
assess adherence? A simple questionnaire was able
to distinguish different levels of adherence when
compared with gold standard electronic
monitors.
9Can research make a difference? (7)
Peter Brindle et al, BMJ 2003
- Guidelines for the primary prevention of
coronary heart disease advocate offering
preventive measures to individuals at high risk.
Currently recommended risk scoring methods
derived from the Framingham study significantly
overestimate the absolute coronary risk assigned
to individuals in the United Kingdom.
10Can research make a difference? (8)
Jenny Ingram et al, Lancet 2001
- Mothers who experience breastfeeding
difficulties with their first babies are less
likely to breastfeed subsequent babies. A
longitudinal study measured milk output at 1 and
4 weeks after giving birth to their first and
second babies. More breast milk was produced at 1
week for the second lactation and the increase
was greatest for those with the lowest milk
output on the first occasion. Health
professionals should encourage women to
breastfeed all their children, whatever their
experience with their first child.
11Can research make a difference? (9)
Chris Salisbury et al, BMJ 2005
- What benefits do we hope to gain from
introducing GPSIs? Is it cutting waiting lists?
Reducing costs? Improving patient outcomes?How do
we know if these are achieved? - In an RCT we compared people sent to a GPSI led
service or outpatient care. We showed that the
GPSI service was more accessible, more
satisfactory, equivalent clinical outcomes, but
at greater cost to the NHS (but less cost to the
patient).
12Can research make a difference? (10)
Alastair Hay et al, J Antimicrob Chemo 2005
- What is the relationship between primary care
prescribed antibiotics and the development of
antibiotic resistance? - We found no evidence of an association between
resistance and patients' exposure to any
antibiotic prescribed in primary care in the
previous 12 months. However, secondary analyses
demonstrated greater resistance in patients
exposed to antibiotics within 2 months and a
doseresponse relationship to increasing
trimethoprim exposure.
13Qu(oF)iz points
- Total your points
- Compare with your neighbours over a pint
- Exception report any questions on which you did
not do well. - Hand in your final score card for RD points to
Peter
14Qu(oF)iz questions
- Can you define the term science? (2)
- What is the difference between audit and
research? (2) - What is the difference between qualitative and
quantitative research? (2) - What does the Latin Ars Longa Vita Brevis mean?
(1) (For 1 bonus point which medical school uses
this as its logo?) - Is medicine a science or an art? (? if you are
right) - Have you ever thought about doing research (2)?
15Qu(oF)iz answers (1)
- Science - the observation, identification,
description, experimental investigation, and
theoretical explanation of phenomena
(http//dictionary.reference.com) - Audit compares local practice against existing
knowledge (agreed standards). Research is the
systematic method used to acquire new,
generalisable knowledge.
163. Qualitative vs. quantitative
- Truth not separate from researcher
- Discovering truth involves exploring
investigators own perceptions and contributions
to the research - Subjective
- Inductive (hypothesis generation)
- Theoretical
- Asks why?
- Truth is a separate entity
- Can be discovered through observation,
experimentation and survey but the investigator
is divorced from process - Objective
- Deductive (tests hypotheses)
- Reliable
- Statistics
17Qu(oF)iz answers (3)
- 4. The art is long, life is short
- 5. Hmmmgood question. I cannot see a part of
medicine that cannot be subjected to some
scientific scrutiny therefore a science? - 6. More about this during the day
18Why get involved in research (1)?
- Christine Carroll (Practice Nurse helping with
studies) - I like to deliver evidence based care and
taking part in research projects that may
demonstrate that evidence is very stimulating and
worthwhile! It also makes our job more
interesting!
19Why get involved in research (2)?
- Joy Farrimond (Full Time Paediatric Research
Nurse) - I got involved in research because I am curious
about phenomena and people, especially people and
how they think, feel and behave during illness.
As a children's nurse with many years of working
for NHS behind me I wanted to be more involved in
developing research based practice. I was excited
by the challenge of research looking at the
issues of fever in children and hope that I may
in some way improve how this is treated in UK.
20Why get involved in research (3)?
- Sarah Owen (Academic GP Registrar)
- Looking for diversity to career, different
challenges/source of stimulation, investigate
options/choices for career, needed something else
to satisfy interests/way of thinking on top of
provision of clinical care.
21Why get involved in research (4)?
- Jonathan Cleary (Academic GP Registrar)
- I believe it develops skills which are often
underused in clinical medicine (especially GP)
such as long term planning and vision, working to
deadlines, the ability to present and justify
arguments to public scrutiny (usually done by
primary care clinicians in Court or in front of
the GMC!), enhanced critical appraisal skills and
even clinical knowledge. It is quite different to
clinical work in which we are usually presented
with a problem and are expected to react to it.
So I think it is healthy to try and use other
bits of our brains now and again. Even including
the statistical bit!
22Why get involved in research (5)?
- Matt Ridd (GP Research Training Fellow)
- 1. It's a completely different pace compared to
clinical work - you get chance to think! 2. You
have the opportunity to look at things in depth -
I enjoy the breadth of clinical practice, but
also enjoy the chance to scratch beneath the
surface. 3. It's interesting! 4. It challenges
and rewards in a very different way to clinical
work - the slowness sometimes can be a
frustration, for example, but the positives of
being involved in looking at something for the
first time, plus the stimulation of teaching, is
unique. 5. I enjoy working with some very bright
and pleasant people!
23Why get involved in research (5)?
- Matt Ridd (GP Research Training Fellow)
- 1. It's a completely different pace compared to
clinical work - you get chance to think! 2. You
have the opportunity to look at things in depth -
I enjoy the breadth of clinical practice, but
also enjoy the chance to scratch beneath the
surface. 3. It's interesting! 4. It challenges
and rewards in a very different way to clinical
work - the slowness sometimes can be a
frustration, for example, but the positives of
being involved in looking at something for the
first time, plus the stimulation of teaching, is
unique. 5. I enjoy working with some very bright
and pleasant people!
24Why get involved in research (6)?
- Alastair Hay (Senior Lecturer in Primary Health
Care) - No day is the same. I am always learning new
skills research methods, critical appraisal,
statistics, teaching, managing staff and budgets
and all of this with interested and interesting
members of a multidisciplinary team. I think the
most exciting bit is dreaming up the next project
or course then comes the hard work of
delivering your vision, but the pay offs at the
end are like nothing else you experience in your
professional life. And I think it keeps me fresh
for my clinical work too.
25Why get involved in research (7)?
- Chris Salisbury (Professor of Primary Health
Care) - I enjoy 'projects' i.e. defined, goal
orientated work with a defined 'product', and
always have done. I enjoy debate and can't resist
joining in, and feeling I'm contributing to
something. I'm ambitious and easily bored and was
always looking for the 'next thing' to do. I
enjoy teaching. Putting all this together I
realised an academic career of some sort might be
the way forward. So I did an MSc, found I was
quite good at research and writing, and so
pursued it
26Why get involved in research (8)?
- Paul Little (Professor of Primary Health Care,
Southampton) - I wanted to make a difference - to inform
primary care decision making, and to improve
care for patients. It was also really exiting to
be in a creative part of the profession with a
very good bunch of people
27Who else thinks research is important? (1)
- Gordon Brown budget speech, April 2006
- The Government is today announcing its
intention to ring fence the Department of
Healths RD budget and that the Secretaries of
State for Health and Trade and Industry will
create a single, jointly held health research
fund of at least 1 billion per year.
28Who else thinks research is important? (2)
- Best research for best health (more from Peter)
- National School for Primary Care Research
- UK Clinical Research Network (health and wealth)
- Primary Care
- Medicines for Children
- Mental Health
- Diabetes
- Dementia
- Cancer
29How to get involved
- Different levels of involvement/commitment
- Help with other peoples research
- PITCH
- DESCARTE
- GenPod
- IPCRESS
- Look for support with your own ideas
- Go for research training
- More of this later
30Summary
- As primary care professionals, we are engaged in
the practical appliance of science - Without research we would have no unbiased,
reliable system on which to diagnose, prognose,
treat or understand our patients - Engaging with research opens new, exciting
perspectives on our thinking and practice - Research is central to the government vision for
the future of the NHS.