Tuesday February 6 th , 2007
Andrew W Murphy
Department of General Practice,
NUI, Galway
1

Time Topic
1100 Intro
1105 Cochrane Primary Hlth
Care Field
1120 Discussion
1200 Programme grants
1215 Discussion
1300 Lunch
1400 Research networks
1415 Discussion
1500 Finish
Discussant
AW Murphy
T Fahey
AW Murphy
TC O’Dowd
2

• To outline experience of SPHERE programme grant
• To stimulate discussion regarding 2007 programme grant applications
– potential topics
– potential partners
3

M Byrne,, M Cupples, AW Murphy, S Smith
4

RCT of a behavioural intervention for primary care, to improve secondary prevention of coronary heart disease
(CHD)
Baseline Irish data indicated room for improvement
(Byrne & Murphy, 2002)
Recent review of trials – optimal intervention still elusive
(McAlister, 2001)
5

• Primary
– To design, implement and evaluate a multifaceted intervention to improve both the process of care and objective clinical outcomes for patients with established ischaemic heart disease in general practice.
• Secondary
– To perform a qualitative analysis of the development and delivery of the intervention.
– To perform a health economic analysis of the intervention in the Republic of Ireland and Northern Ireland.
– To perform a policy analysis of the context within which the intervention is delivered in the Republic of Ireland and Northern
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Ireland.

Preclinical phase:
Theory
Phase I:
Modelling
Phase II:
Exploratory trial
Phase III:
Definitive
Randomised
Controlled
Trial
Phase IV:
Long-term
Implementation
Continuum of increasing evidence
Campbell et al . BMJ 2000; 321(7262):694-6.
7

Time
Perera BMJ 334:127
SPHERE Usual Care line intervention (control)
Baseline bac cba a a
Randomisation
(time 0)
During 18 months from randomisati on f de gh d e g h f b c b c
Measurement of outcomes
18 months
8

9

10

Date Position Name
01.09.04 -
01.03.03 -
01.01.07 -
15.01.07 -
01.12.06 -
01.09.06 -
01.10.04 -
Project Manager Mary Byrne
Principal Research
Nurse
Claire Leathem
Regional Research
Nurse
Regional Research
Nurse
Helen Grealish
Patricia Ryan
Qualitative Researcher
(50%)
Qualitative/Policy
Researcher
Maureen D’Eath
Joanne Wilson
Economics PhD student Paddy Gillespie
11

Date
Position
01.01.03 - 30.06.04
Project Manager
01.06.04 – 15.12.06
Regional Research
Nurse
Name
Molly Byrne
Mary O’Malley
01.01.06 – 05.01.07
Regional Research
Nurse
01.06.04 – 30.11.05
Regional Research
Nurse
Valerie Spillane
Ailish Houlihan
01.04.03 – 30.04.04
Qualitative
Researcher (40%)
Pauline Clerkin
01.01.03 – 28.02.05
Qualitative
Researcher (50%)

• Corrigan M, Cupples ME, Smith SM, Byrne M, Leathem C,
Clerkin P, Murphy AW. The contribution of qualitative research in designing a complex intervention for secondary prevention of coronary heart disease in two different healthcare systems.
BMC Health Services Research 2006; 6:90
• Byrne M, Cupples ME, Smith SM, Leathem C, Corrigan M,
Byrne MC, Murphy AW.
Development of a complex intervention for secondary prevention of coronary heart disease in primary care using the UK Medical Research Council
framework. Am Journal of Managed Care2006;12:261-266
• Murphy AW, Cupples ME, Smith S, Byrne M, Leathem C, Byrne
MC. The SPHERE Study. Secondary prevention of heart disease in general practice: protocol of a randomised controlled trial of tailored practice and patient care plans with parallel qualitative, economic and policy analyses.
[ISRCTN24081411].
Current Controlled Trials in
Cardiovascular Medicine 2005. Jul 29;6(1):11
• Byrne M, Corrigan M, Cupples ME, Smith SM, Leathem C,
Murphy AW. The SPHERE study: Using psychological theory to inform the development of behaviour change training for primary care staff to increase secondary prevention of
coronary heart disease. Irish Journal of Psychology 2005;
26(1-2):53-64.
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• Murphy AW, Esterman A, Pilotto L. Cluster randomised
controlled trials in primary care: an introduction. EJGP
12(2): 70-73, 2006.
• Pirkis JE, Blashki GA, Murphy AW, Richards JC, Hickie
IB, Ciechomski L. The contribution of general practice based research in the development of national policy:
case studies from Ireland and Australia. Australia and
New Zealand Health Policy 2006; 3:4.
• Byrne M, Murphy AW, Walsh J, Shryane E, McGroarty M,
Kelleher CC. A cross sectional study of secondary cardiac care in general practice: Impact of personal and
practice characteristics. Fam Prac 2006; 23: 295-302
• Ononeze V, Murphy AW, Byrne M, Bradley C, MacFarlane
A. Patients and health professionals' perspectives on the sociocultural influences on secondary cardiac behaviour: a qualitative study of the implications in policy and
practice. Fam Prac 23: 587 – 596, 2006
14

• Lancet protocol accepted
• Zero use of Masters/ PhD’s
• Probably the most rewarding and enjoyable collaborative academic exercise I have been involved in
• Explicit strategic ‘07 departmental goal
15

• To outline experience of SPHERE programme grant
• To stimulate discussion regarding 2007 programme grant applications
– potential topics
– potential partners
16

• Translational research
– € 1.5 million over five years
• Health services R&D
– € 1.25 million over five years
• Both:
– Call date August; Closing date 07 (EoI)
– To be confirmed
17

• Support research which is related to the day-to-day
practice of health service staff and is capable of showing a demonstrable impact on the health or
health care of users of the service.
• Funded research projects are likely to fall into the areas of health service and systems research and public
health research, although other areas are not excluded from the programme.
• Research proposals should use quantitative or qualitative methods to:
– study the provision and use of services;
– evaluate the effectiveness and cost effectiveness of interventions;
– examine the resource utilisation of alternative means for healthcare delivery;
– formally scrutinise innovations and
developments;
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• This programme will not fund:
– laboratory-based research or basic science research, including research based on animals
– proposals which are solely service developments: although the programme will fund research aimed at evaluating the effectiveness of a service or intervention it will not fund the costs of providing the service or intervention itself
– proposals which are solely: literature reviews, audit, surveys, needs assessment, technology development (although these elements may be part of an integrated research study) 19

• Susan Smith: Diabetes and peer support
• ?
20

• is defined as research that applies ideas, insights and discoveries generated through basic scientific inquiry to the treatment or prevention of human disease.
• The purpose of these awards is to
– support the development of clinical research
– improve outcomes for patients by establishing and supporting teams working full time on extensive research programmes with clear link to patients
– contribute to the creation of intellectual property and the development of bio-industry by using scientific or technical knowledge to produce new or substantially improved materials, devices, products or
21 services.

• Reducing hospital infections caused by methicillin-resistant aureus and
Staphylococcus vancomycin-resistant enterococci by effective environmental decontamination and effective hand hygiene
• Neurocardiovascular influences on cognitive functioning: basic and clinical mechanisms
22

• Potential topics
– What, if any, areas have you ambitions for in 2007 ?
– NUI, Galway: eGFR
• Potential partners
– Whom, if anybody, would you like to work with ? In and out of primary care ?
23

Kaplan-Meier risk of CVS composite end point according to baseline eGFR, Glynn07
Hazard Function
0.4
0.2
eGFR category
<30ml/min
>59ml/min
30-44ml/min
45-59ml/min
No serum creatinine data
<30ml/min-censored
>59ml/min-censored
30-44ml/mincensored
45-59ml/mincensored
No serum creatinine data-censored
0.0
0 500 1000
Time (days)
1500 2000
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