Transcript CLAHRC East Midlands (Collaboration for Leadership in

CLAHRC2 East Midlands
(Collaboration for Leadership in
Applied Health Research and Care)
Richard Morriss and John Gladman
CLAHRC’s NDL, LNR and EM
AIMS:
1. Conduct high quality applied health research
(public health, community focus, high primary
health services research esteem);
2. Implement the findings from research into
clinical practice (using AHSN approaches); and
3. Increase the capacity of NHS organisations to
engage with and apply research
Track record: high quality research, NHS capacity
• Delivered over 100 research and implementation
projects
• Recruited 33,000 people as research participants
• Attracted around £17.5m in external research
grant funding, including from industry partners
• Published over 300 papers in peer reviewed
journals
• Supported 30 PhDs
• Supported 40 diffusion fellow/knowledge broker
posts for clinicians and 30 research into practice
placements
Implementation
• Specialised mood disorder service in 3 NHS Trusts
• CBT + IPS intervention helped over 50% people
with serious mental illness into work (previously
12%)
• Identified barriers and drivers to engaging people
with personality disorder in psychological
treatment and training package
• 3,000 patients in EIP received simple intervention
to improve dental care
• CLAHRC BITES adopted nationally as a means of
brief summaries of useful research findings
• SDO report (Warwick University) – iteration
between services, clinicians and research led to
implementation of high quality intervention
New CLAHRC EM
• Host Trust : Nottinghamshire Healthcare Trust
• Director: Professor Kamlesh Khunti, Professor
of Diabetes and Primary Care, University of
Leicester
• 55 NHS, local authority, university, third sector
and industry partners in East Midlands
CLAHRC EM Themes
Theme
Theme Leader
Preventing chronic disease
Professor Kamlesh Khunti (U of Lei)
Managing chronic disease
Professor Sally Singh (U of Lei)
Caring for older people
and stroke survivors
Professor John Gladman (U of Nott)
Enhancing mental health
Professor Richard Morriss (U of Nott)
Implementing evidence
and improvement
Professor Justin Waring (U of Nott)
Overall vision
• Take health problems with highest prevalence,
greatest disability and mortality, priority of CCGs and
HWBs in East Midlands
• Research into cost effectiveness and implementation
of national or local policy interventions e.g. NICE,
IAPT
• Evaluate technology (NIHR/AHSN/HTC)
• Address BME and all ages- adapt practice
• Evaluate implementation strategies used by
CLAHRC/AHSN e.g. network/brokerage, education,
technology
QOF data. Source: NHS Commissioning Board CCG Information Packs 2013-14.
East Midlands
England
2011/ 2012*
Coronary Heart Disease
3.8 (2.7 - 4.6)
3.4
Stroke/TIA
1.8 (1.2 - 2.3)
1.7
14.3 (10.5 - 16.7)
13.6
COPD
1.8 (1.3 - 2.3)
1.7
Mental Health
0.7 (0.5 - 0.9)
0.8
Asthma
6.2 (5.1 - 7.1)
5.9
Dementia
0.5 (0.4 - 0.7)
0.5
Diabetes Mellitus
5.7 (4.4 - 7.0)
5.8
11.5 (7.4 -15.8)
11.7
5.5 (3.0 - 9.1)
4.3
11.4 (8.5 - 14.8)
10.7
Hypertension
Depression
Chronic Kidney Disease
Obesity
The CLAHRC will provide useful
interventions
• Information and evaluated tools on how to
diagnose, prevent and manage in high risk
patients for GPs, community services and with
some adaptation mental health services:
diabetes, tobacco control, obesity, chronic
kidney disease, chronic obstructive airways
disease, cardiac disease
• Interventions for children in schools, pregnant
women, people from South Asian background
– obesity, exercise, tobacco control
Enhancing Mental Health
• Our commissioners, service providers and
service users told us they wanted:
NICE Guidelines, particularly depression*, selfharm*, bipolar disorder (revision),
schizophrenia (revision)
• Psychological treatments and crisis work
• Complexity, transition across primary
care/general hospital/mental health and
reduce emergency/urgent contacts.
• Older and younger age as well as adults
Depression pathway (WHO survey Lancet 2012worldwide, 2nd leading cause of disability):
Depression and self-harm – best predictors of suicide,
suicidality & depression. 70% calls for to Nottingham
city crisis team. In adolescents, adult, PD/forensic (NICE
self-harm recommendation 10 session psychological
treatment by front line staff)
5 year follow up of 187 patients treated by specialist
mood disorder team – mean duration of 7 years
Economic modelling study of specialist mood disorder
team as part of depression pathway (NICE depression
guideline)
Technology: RCT of results from QBTest (objective
measure of attention and hyperactivity) versus treatment
as usual in ADHD (8-18 yrs)
Emergency use & anxiety (1st & 7th world disability)
IAPT services have to start managing medically
unexplained symptoms (NHS £3 billion additional
cost/yr). RCT of teaching IAPT teams to manage health
anxiety in people who repeatedly present as emergency
in primary & secondary care v usual care
Prevalence & service needs of dementia & elderly
people with cognitive impairment in forensic settings
Proposed implementation
• Additional research projects in mental health
and older people chosen in 2015 to start 2016
(not drugs, high quality design)
• Implementation of mental health theme
projects to be led by NHS staff (networking
leads) working as “knowledge brokers” with
other network practitioners, research team,
service users, Trust staff, AHSN, LET-B,
professions, clinical strategic networks,
commissioners