‘Improving health
and wellbeing
through
Research’
Preston Football Club
17th October 2014
Improving health and wellbeing through research – October 2014
#LCFTresearch
@Lancashirecare
Medical Directors’ Office
Professor
Heather
Tierney-Moore
Chief Executive
Event Welcome
Improving health and wellbeing through research – October 2014
Dr Heather
Iles-Smith
Research & Innovation Lead
“Improving health and
wellbeing through
research – LCFT
strategy refresh”
Improving health and wellbeing through research – October 2014
Theme:
Research
Successes
Overview
• National picture
• Local picture
• Research strategy
 Objectives
• Current research
• Challenges
Medical Directors’ Office
Why we do research
NHS Constitution
- To develop new medicines, medical devices,
therapies and clinical services
- To facilitate access to new medicines/devices
/therapies for LCFT Service Users
- To add to the evidence base
- To embed evidence based practice within
LCFT services
Medical Directors’ Office
National Picture
• Transformations of NIHR Research Networks- 25 to 15
nationally
 Clinical Specialities 6 Divisions
Division 1- Cancer
Division 2- Diabetes, stroke, cardiovascular disease
Division 3- Children, reproductive health and childbirth
Division 4- Dementias and neurodegeneration (DeNDRoN), mental health
Division 5- Primary care, Ageing, Health services research, dental health, Public
health, Muscoskeletal disorders
Division 6- Anaesthesia and pain management, critical care
•
NW Coast Clinical Research Network (NWC CRN)
 includes Liverpool, Merseyside, Lancashire & South Cumbria
Medical Directors’ Office
Local Picture
• Overall LCFT has a balanced research portfolio- grant based
and NIHR portfolio research
• Lack of equilibrium between mental health and community
services and between professions
• Clinical academic researchers
 6 in mental health (all medical)
 0 in community services
 0 joint appointments for Nurses, Allied Healthcare Professionals,
Pharmacists or Psychologists
•
Contribution to the NIHR portfolio (2012/13)


24% mental health
76% community services
Medical Directors’ Office
Local Picture- Performance
Medical Directors’ Office
Research strategy
Vision
To improve the health and
wellbeing of patients and service
users within Lancashire Care
Foundation Trust (LCFT) through
embedding research and evidence
based practice in clinical services
Medical Directors’ Office
Research Strategy Objectives
Main objectives:Objective 1: Increase access to research for our patients and service users
Objective 2: Increase research capacity building within the Trust particularly
within the Community Services
Objective 3: Increase research culture of the organisation and embed research
within each of LCFT Clinical Networks
Objective 4: Increase service user/carer involvement in the research process
Global enabler
Establish financial security for LCFT research activity
Medical Directors’ Office
Current Research
• TechCare-
Dr Husain, Consultant Psychiatrist, Senior Lecturer
 A mobile assessment / therapy for Psychosis
 An intervention for clients within the early Intervention
service.
• Randomized, double-blind Placebo-Controlled, Trial of
Gantenerumab in Patients with Mild Alzheimer’s
Disease- Dr S Karim, Consultant Psychiatrist Older adults
 To reduce or slow down amyloid plaque build up (one cause
of Alzheimers)
 May improve cognition and function in early Alzheimers
Medical Directors’ Office
Current Research
• Clinical outcomes of Joint Crisis Plans to reduce
compulsory treatment for people with psychosis: a
randomised controlled trial- Professor Max Marshall,
Medical Director
 The Lancet, May 2013 (381:9878:1634-1641)
• C-GLOVES. An evaluation of the effectiveness of
compression gloves in arthritis: a feasibility studyJenny Welsby, Specialist OT, Rheumatology Department
 Occupational therapy study investigating the use of
pressure gloves in rheumatoid arthritis.
Medical Directors’ Office
Challenges
• Development fit for purpose
Clinical Research Facility
• Financial stability
Maintaining/growing grant income
Increasing industry studies
• Capacity building
focussing on nurses, AHP’s,
pharmacists and psychologists
Fellowship applications
Medical Directors’ Office
Thank You for listening…..
Web page:http://www.lancashirecare.nhs.uk/aboutus/Research-Innovation.php
Please contact us at:Heather.iles-smith@lancashirecare.nhs.uk
R&I@lancashirecare.nhs.uk
Medical Directors’ Office
Professor
Jenny Shaw
Clinical Director for Specialist
Services & R&D Director
Mental Health
Screening in Police
Custody In England:
Developing a screening
tool and referral pathway
Improving health and wellbeing through research – October 2014
Theme:
Research
Successes
Mental Health Screening in
Police Custody in England:
developing a screening tool
and referral pathway
From the inside out: Healthcare in custody and the criminal
justice system
www.ohrn.nhs.uk
Detecting mental illness in
Police Custody
• Higher rates of mental health problems amongst
people in contact with the criminal justice system
• Prevalence amongst police detainees
– estimates vary
– 2%-20% of police detainees have mental health issues (Bradley 2009)
• Early identification of mental ill health is a current UK
Government priority
www.ohrn.nhs.uk
Policy Priority
• Early intervention
• Liaison and Diversion
• Increasing access
www.ohrn.nhs.uk
The Problem
• Mental health screening procedure is not
sufficiently robust
– identifying the ‘known knowns’
• Non mental health trained personnel
– Whose job?
• Inconsistent mental healthcare services in
custody
– Lack of 24 hour cover
www.ohrn.nhs.uk
Research Team
Dr. Jane Senior
Miss. Heather Noga
Prof. Jenny Shaw
Miss. Susan Tighe
Dr. Elizabeth Walsh
University of Manchester
Lancashire Care NHS Foundation Trust
Lancashire Care NHS Foundation Trust /
University of Manchester
Lancashire Care NHS Foundation Trust
University of Leeds
This presentation outlines independent research funded by the National Institute for
Health Research (NIHR) under its Research for Patient Benefit (RfPB) Programme
(PB-PG-0808-17154). The views expressed are those of the author(s) and not
necessarily those of the NHS, the NIHR or the Department of Health.
www.ohrn.nhs.uk
Aims/Objectives
• Oct 2010 – Sept 2013
• Aims
– Improve current practices in police custody
– Develop a referral decision tool
• Objectives
– Identify and critique current procedures
– Develop a mental health referral tool
– Develop accompanying training and implementation package
www.ohrn.nhs.uk
Method
• Participants
– Mental Health Professionals
– Police Officers
– Service Users
www.ohrn.nhs.uk
•Understand
•Review of
current
Method
existing
•Service
Leads
practices
Intervie screening tools
from
Mental
ws (n •Views
on
•Consensus
on
Health,
Social
Consult
58)
requirements
scoring
Care,
Police,
ations
of
screening
Action
(routine/urgent
Private
(n
58)
referral
tool
Learning )Healthcare, City
Groups •Creation
of
Council, Service
(n 8)
www.ohrn.nhs.uk
Results
• Agreement that a screening tool should be;
–
–
–
–
–
–
short, simple language
questions mixed with free text observations
current issues
mental health, risk of suicide / self-harm
sensitive
facilitate dialogue
www.ohrn.nhs.uk
CMHS
“In a custody environment it
would need to be shorter and
simplified- detention officers
would have difficulties”
“Not relevant for custody,
too complicated and vague”
“The questions don’t really get to the
core of the problems and would miss
people with severe mental health issues”
www.ohrn.nhs.uk
PriSnQuest
“Simple and straight forward”
“It is brief, therefore quick to
complete and less likely to
be overlooked or cut short”
“Questions are clear,
specific, easy to
understand and likely
to get the answers that
they are looking for”
www.ohrn.nhs.uk
Police Custody
Risk Assessment
PriSnQuest
-
Historical issues
-
-Depression
Historical issues
-Self Harm
- Serious Mental Ill
Health
-Medication
PolQuest
www.ohrn.nhs.uk
PolQuest
• 14 Item Screening Questionnaire
• Administer in 5 minutes
• All Adult Detainees
• Corresponds to a referral pathway
www.ohrn.nhs.uk
•High Risk
Scoring
•Current
symptoms/sig
ns
of
Urgent
psychosis,
Referra
depression,
l
self harm,
Eg. ‘Have you recently found yourself wishing you were dead and
suicide
away
from it all?’
•Highly
www.ohrn.nhs.uk
•Low
Risk
Scoring
•Historical
Routi
issues
ne
•Known
Referr to/currently
al
engaged with
Eg: ‘Are you currently in contact
with mental health services?’
services
www.ohrn.nhs.uk
Referral Pathway
www.ohrn.nhs.uk
Training and
Implementation
• Implementation Manual
• ‘How to’ practical guidance
www.ohrn.nhs.uk
Impact
• Screens everyone in custody
• Clear referral process
• Early identification
• Economic use of services
• Provides standardisation of care
www.ohrn.nhs.uk
Future Directions
Feasibility Study
•Implement in real life-one custody suite
•Identify issues in application
•Design full scale trial
www.ohrn.nhs.uk
Thank you
Jenny.shaw@lancashirecare.nhs.uk
www.ohrn.nhs.uk
Dr Waquas
Waheed
Consultant Psychiatrist
“Partners 2”
Improving health and wellbeing through research – October 2014
Theme:
Research
Successes
PARTNERS 2
Development and Pilot Trial of Primary Care
Based Collaborative Care for People with
Serious Mental Illness
Overview of the Purpose of the PARTNERS2
Programme Grant
We aim to help primary care and community based
mental health services work more closely
together.
• Develop a system of collaborative care based in
GP surgeries where service users are seen
regularly by a mental health worker who acts
both as overall co-ordinator (supporting
individuals to access other services and activities)
and therapist.
• At the end of the 5 year Programme, we will
know if collaborative care for people with
Work stream 1:
Assessment
of
local
Work stream 2:
care
pathwaysof
and
Development
a
Work
stream
3:
current
services
for
core outcome set for
Development
of
the
people
with
severe
use in mental health
system of
Developing the grant application
1: Reilly S, Planner C, Hann M, Reeves D, Nazareth I, Lester H. The role
of primary care in service provision for people with severe mental
illness in the United Kingdom. PLoS One. 2012;7(5):e36468.
2: Reilly S, Planner C, Gask L, Hann M, Knowles S, Druss B, Lester H.
Collaborative care approaches for people with severe mental illness.
Cochrane Database Syst Rev. 2013 Nov 4;11:CD009531.
Building the team
Experts in
1.
2.
3.
4.
5.
6.
7.
8.
9.
Collaborative care
Primary care
Schizophrenia and Bipolar disorder
Qualitative researchers
Trial Methodologists
Health economics
Biostatistics
Service users
International partners
Contact details:
Dr. Waquas Waheed, Consultant adult psychiatrist at Lancashire Care NHS Foundation Trust and
North West Hub Lead. 01772 773 515, waquas.waheed@lancashirecare.nhs.uk
Maria Cox, PARTNERS 2 Research Assistant at Lancashire Care NHS Foundation Trust, Lantern Centre,
Vicarage Lane, Fulwood, Preston, PR2 8DW. 07943 092217, maria.cox@lancashirecare.nhs.uk
Jill Barlow, Research Studies Officer, Liverpool Science Park, Innovation Centre 1, 131 Mount
Pleasant, Liverpool, L3 5TF. 07818 521 738, jill.barlow@nihr.ac.uk
Or Visit:
www.birmingham.ac.uk/partners2
Dr Lizzy
MacPhie
Consultant
Rheumatologist
“Finding Time for
Research in a Busy
Rheumatology
Department”
Improving health and wellbeing through research – October 2014
Theme:
Developing
Clinical
Research
Finding Time for
Research in a Busy
Rheumatology
Department
Lizzy MacPhie
Rheumatology
Department
Minerva Health Centre
Preston
Overview
• The Rheumatology Service
• The challenges & solutions
• PPI
• Portfolios studies
Rheumatology Service
• Transferred to community in Sep 2010
• Based at the Minerva Health Centre
• Complete service redesign
– 0.6 WTE consultant at transfer
– 3 WTE consultants now in post
Service Developments
• Weekly MDT &
lunchtime educational
meetings
• Pathway days to inform
service development
• Regular patient support
group meetings
• Launch of website
Challenge 1
Limited Research Experience
• Historically patients considered for clinical
trials all sent to Wrightington
• No engagement with portfolio studies
• No engagement with CLRN
• Consultants little academic experience
Solution
• Networking
– Met with CLRN (Prof Goodacre)
– Introduced to CLRN nurses
– Spoke to Rheumatology colleagues
“The Alliance”
Challenge 2
Lack of dedicated research resources
• No dedicated research time in job plans
– Consultants or nurses
– Team too busy in clinic to recruit patients
• Managers very worried about impact on
activity
• Limited room availability
• No storage/processing facilities for bloods
Solutions
• CLRN Support
– All the team have to do is identify pts
• Simplifying recruitment process
– Email: study, pt name, contact no to CLRN nurse
• Met with managers
• Careful selection of Portfolio Studies
– Simple, observational eg registers, genetics
– Not requiring lots of clinician input
• Room Availability
– Discussion with lead clinic nurse
Challenge 3
Raising Awareness
• Research not seen as a priority
• CLRN nurses not part of the team
Solution
• Consultant Meetings
– Fixed item on agenda
• Lunchtime meetings
– Research update every 6 months, no’s recruited
• Posters in clinic rooms
• Leaflets in clinic rooms about all the studies
• CLRN nurses attend MDT
Think Research!
RAMS
Rheumatoid arthritis or undifferentiated IA
starting MTX
(1st/2nd line, mono or combination therapy)
Need to recruit
before starting MTX
DELAY
Rheumatoid arthritis or undifferentiated IA
Within 6 months of
diagnosis
BSRBR
Rheumatoid arthritis
- starting certolizumab or tocilizumab
(1st/2nd line)
-biologic naïve & starting etanercept, adalumimab or
infliximab
Within 6 months of
starting biologic
BSRBR-AS
Ankylosing spondylitis
-biologic naïve & starting etanercept or
adalumimab
Within 6 months of
starting biologic
Myositis
Genetics study
Diagnosis of inflammatory myositis
Any time following
diagnosis
SLE Genetics
study
Meets ACR criteria for SLE
Any time following
diagnosis
If you have any potential patients please provide them with a patient information leaflet
about the relevant study and email details (Name, MIN No & Contact No) to Sue or Gill
Sue.Cotterell@lthtr.nhs.uk or Gillian.Welch@lthtr.nhs.uk
Challenge 4
Keeping up the Momentum
Solution
• Recruitment figures recording on TIB
• Recognition
– Invited to Present to Network Research Meeting
– Invited to Present today
• Regular review of portfolio for new studies
• Clinical trials……..
• Dedicated research PA…….
PPI
• Posters & leaflets in waiting area
• Research stand in foyer
• Patient support group meetings
– Research stand
• Pathway days
– CLRN nurse attended
• NASS research engagement event
Timeline
BSRBR
16 patients
Delay
19 patients
RAMS
37 patients
SLE Genetics
11 patients
MTX
pneumonitis
0 patient
2010
2011
Myositis
genetics
4 patients
2011
2012
Noisy Knees
1 patient
BSRBR-AS
6 patient
Genetics in
AS
6 patients
2012
2013
2013
2014
BSRBR
“BSR Biologics Register”
• Long term hazards of biologic therapy in rheumatoid
arthritis
• Observational study: baseline & FU questionnaires
• Certolizumab or tocilizumab (1st/2nd line)
• Comparison cohort: etanercept, adalumimab,
Recruitment
– 51 historical patients still actively collecting data
– Recruited 16 patients
BSRBR-AS
“BSR Biologics Register”
• Long term hazards of biologic therapy in
ankylosing spondylitis
• Observational study: baseline & FU
questionnaires
• Recruitment
– Started Sep 2013
– Recruited 6 patients
RAMS
“Rheumatoid Arthritis Medication Study”
• Predicting response to MTX
• Observational study: bloods & questionnaires
• Recruitment
– Started April 2012
– Recruited 37 patients to date
SLE Genetics Study
• Investigation of genetics of SLE
• Observational study: bloods & CRF
• Consultant completes CRF
• Recruitment
– Rare condition
– Recruited 11 patients
Myositis Genetics Study
• Investigation of genetics of myositis
• Observational study: bloods & CRF
• Consultant completes CRF
• Recruitment
– Rare condition
– Recruited 4 patients
AS Genetics Study
• Investigation of genetics of ankylosing
spondylitis
• Invite letter, postal consent
• Recruitment
– 6 patients
Drug Induced Pneumonitis
in RA Patients
• Investigation of factors influencing drug
induced pneumonitis
• Observational study
• Recruitment
– Very rare complication
– Possible 1-2 pts during study period
“Noisy” Knees
• Acoustic Emission in Knee Arthritis
– AE as a non-invasive biomarker for OA
• Observational study: questionnaires & clinical
assessment
• Recruitment
– Target: 3 patients in a year
Thank-you for listening
Any Questions