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Alastair Hay Consultant Senior Lecturer in Primary Health Care

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I am always learning new skills: research methods, critical appraisal, ... I'm ambitious and easily bored and was always looking for the 'next thing' to do. ... – PowerPoint PPT presentation

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Title: Alastair Hay Consultant Senior Lecturer in Primary Health Care


1
Alastair HayConsultant Senior Lecturer in
Primary Health Care
  • Research ideas and outcomes Does primary care
    research matter?

2
Structure 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

3
Can 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.

4
Can research make a difference? (2)
Sharland et al BMJ 2005
5
Can 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?

6
Can 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.

7
Can 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

8
Can 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.

9
Can 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.

10
Can 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.

11
Can 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).

12
Can 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.

13
Qu(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

14
Qu(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)?

15
Qu(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.

16
3. 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

17
Qu(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

18
Why 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!

19
Why 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.

20
Why 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.

21
Why 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!

22
Why 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!

23
Why 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!

24
Why 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.

25
Why 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

26
Why 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

27
Who 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.

28
Who 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

29
How 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

30
Summary
  • 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.
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