Quality and Outcomes in Primary Healthcare (QOPH)

Please find below our current and recent projects on quality and outcomes in primary healthcare:

Active projects

Recently completed projects

Clinical Trials for Elderly Patients with Multiple Diseases (CHROMED) 2012-2014
Funded by the European Commission, awarding €2,563,530.75. Key contact: Dr Jo Middlemass.
This a three year study led by TESAN (Italy) and involving eight academic and third sector partners in seven European countries. The hypothesis of the study is that integrated home care electronic monitoring will improve the quality of life for the patient and reduce healthcare management and service use costs for co-morbidities such as chronic obstructive pulmonary disease (COPD) and Congestive Heart Failure (CHF). The team from CaHRU are working with Lincolnshire Community Health Services NHS Trust and general practices in Lincolnshire to develop and evaluate clinical protocols and organisational models based on the new technologies. The programme consists of an initial feasibility study which was completed in April to June 2013 and the full randomised controlled trial running from September 2013–April 2016.

Improving prescribing safety in general practices in the East Midlands through the PINCER intervention (Scaling up PINCER) 2014-15
The Health Foundation awarding £500,000. Key contact: Professor Niro Siriwardena.
To scale up a proven pharmacist-led information technology intervention for reducing clinically important errors in medication management (PINCER) in general practices using a regional quality improvement collaborative and to evaluate its effects.

Higher Education Institution Challenge for Patient Supported Quality Improvement and Education in Healthcare (HEI Challenge) 2015-16
East Midlands Academic Health Science Network awarding £250,000. Key contact: Rachel Hawley.
To bring HEIs providing health and social care education together to share, develop,showcase and spread work around the unifying topic of education for healthcare quality improvement.

Digital Insomnia therapy to Assist Your Life as well as your Sleep (DIALS) Trial 2015-16
Big Health (Sleepio) ltd. Key contact: Professor Niro Siriwardena.
To investigate the impact of dCBT for insomnia on functional health, quality of life, psychological wellbeing and sleep-related changes as mediating factors by conducting a randomised controlled trial of fully automated digital Cognitive Behavioural Therapy for Insomnia versus sleep hygiene education led by Prof Colin Espie at Oxford University.

Resources for Effective Sleep Treatment – Utilising Community Pharmacists (REST-UP) 2014-15
University Strategic Research Investment Fund (RIF) 14/SC/0156 awarding £39,688. Key contact: Prof Niro Siriwardena.
To explore how community pharmacists can improve the quality of their support to adult service users with sleep problems through the development of a community pharmacy based complex intervention, based on problem-focused therapy.

Investigating Potential for Influenza and/or Pneumococcal Vaccination to Prevent Against Stroke and Transient Ischaemic Attack (IPVASTIA) 2009-12
Funded by the National Institute for Health Research (NIHR) – Research for Patient Benefit Programme, awarding £82,534. Key contact: Dr Zahid Asghar.
IPVASTIA aimed to investigate the association between influenza vaccination (within the last vaccination season), pneumococcal vaccination (ever) or influenza and pneumococcal vaccination combined, with stroke or transient ischaemic attack (TIA) and whether this association was independent of other major cardiovascular risk factors. The usual risk factors such as age, gender, smoking, diabetes, high BMI and total cholesterol only account for approximately two-thirds of morbidity and mortality. We found that influenza but not pneumococcal vaccination was associated with a reduction in risk of stroke and our results were published in Vaccine: Siriwardena AN, Asghar Z, Coupland C. Influenza and pneumococcal vaccination and risk of stroke or transient ischaemic attack – matched case control study. Vaccine 2014;32(12): 1354-1361. doi: 10.1016/j.vaccine.2014.01.029.

Quality and Costs of Primary Care in Europe (QUALICOPC) 2011-14
Funded by the European Commission, awarding €62,000. Key contact: Dr Coral Sirdifield.
This study, which involves over 30 countries in Europe, North America and Australasia, aims to investigate which aspects of the structure and organisation of primary care are the most important in promoting service quality and equity while minimising costs. A team from CaHRU, led by Professor Niro Siriwardena, are running the UK section of this study, which involves recruiting 220 practices from across the East Midlands and South Yorkshire region. Each practice will be asked to complete a fieldworker questionnaire, a GP questionnaire, and questionnaires on patient values and experiences. Through this we hope to increase understanding of the variety of ways in which primary care is structured and organised in these regions, and to increase understanding of patients’ experiences of accessing primary care services and which aspects of care they particularly value.

Proactive Assessment of Obesity Risk during Infancy 2014-15
Funded by the Medical Research Council, awarding £149,995. Key contact: Professor Niro Siriwardena
This project, led by Prof Sarah Redsell at Anglia Ruskin University, aims to develop a and test the feasibility of a complex intervention comprising an interactive, educational programme (ProAsk) for health practitioners to guide and enhance communication with parents of infants about obesity risk identification and prevention strategies.

Early Prediction and Prevention of Obesity During Childhood (EPPOC) 2007-9
Funded by the Burdett Trust, awarding £49,966. Key contact: Professor Niro Siriwardena
This project, led by Prof Sarah Redsell at Anglia Ruskin University,  aims to develop a clinical guideline for health visitors to support the management of infants identified as at risk of developing childhood obesity. It has four objectives: to assemble a Guideline Development Group (GDG) that will include all stakeholders (healthcare professionals, parents and the academic team); undertake a systematic review of behavioural interventions to reduce the risk of childhood obesity that are delivered during infancy; assemble the evidence and to prepare the guideline for health visitors; and pilot the guideline in practice. It is envisaged the guideline will initially be adopted locally, but CaHRU’s dissemination policy will ensure that other localities will explore its adoption. Furthermore, CaHRU will use its different external professional linkages to make sure that the guideline is scrutinised by national policy and strategic bodies (e.g., Department of Health) and fed into national guidance.

Exploring Social Networks to Augment Cognitive Behavioural Therapy (ENACT) 2010-13
Funded by the Engineering and Physical Sciences Research Council (EPSRC) Healthcare Partnerships, awarding £463,840. Key contact: Dr Jo Middlemass.
The ENACT study investigated the possible improvement and greater acceptability of a computerised cognitive behavioural therapy through the use of social media. The interview study (an integral part of the overarching research) explored patient and health professional perspectives to inform the development of a computerised cognitive behavioural therapy programme for insomnia (CCBT-I) that includes social networking. The research identified that any programme should be integrated within clinical treatment and highlighted that the programme’s functionality should be individualised and easily navigable. A team from the School of Computing at the University of Lincoln (Professor Shaun Lawson) are now working on an innovative platform that can integrate social media with CCBT-I: Middlemass, Jo and Davy, Zowie and Cavanagh, Kate and Linehan, Conor and Morgan, Kevin and Lawson, Shaun and Siriwardena, A. Niroshan (2012)Integrating online communities and social networks with computerised treatment for insomnia: a qualitative study. British Journal of General Practice, 62 (605). e840-e850. ISSN 0960-1643 Item availability may be restricted.

Objective Impact on Sleep and Daytime Functioning of Sleep Restriction Therapy 2010-12
Funded by the Chief Scientist Office of the Scottish Government Health Directorates, awarding £49,505. Key contact: Professor Niro Siriwardena.
This study aimed to: rigorously test sleep restriction (SR), and so to provide an objective evidence base for its impact on sleep and daytime functioning; and evaluate the relationship between subjective and objective sleep and establish the optimal regime for adherence and the minimisation of adverse side-effects when advising on its use. The study seeks to test the following hypotheses: sleep restriction therapy leads to objective improvements in sleep parameters; sleep restriction modifies homeostatic pressure as measured by delta power during NREM sleep; sleep restriction impairs vigilance levels and higher cognitive abilities during acute implementation. A within subjects repeated measures design with major in-lab sleep evaluations, including neuro-cognitive testing, conducted at baseline, and at three points during SR treatment. Primary outcomes related to: changes to objectively defined sleep continuity and architecture and objective daytime functioning.  Secondary outcomes related to subjective sleep and daytime functioning/quality of life variables.  This work has been published and will help elucidate understanding behind the therapeutic action of SR, and how to deliver treatment in a safe and effective manner: Kyle, Simon D. and Miller, Christopher B. and Rogers, Zoe and Siriwardena, A. Niroshan and MacMahon, Kenneth M. and Espie, Colin A. (2014) Sleep Restriction Therapy for Insomnia is associated with reduced objective total sleep time, increased daytime somnolence, and objectively-impaired vigilance: implications for the clinical management of Insomnia Disorder. Sleep, 37 (2). pp. 229-237.

Improving Primary Care Resources for Effective Sleep (IPCREST) 2011-12
Funded by the East Midlands Health Innovation and Education Cluster (EM HIEC), awarding £39,833. Key contact: Viet-Hai Phung.
The overall aim of IPCREST was to further develop, pilot and implement a novel learning approach for delivery of education to primary care nurses and general practitioners to provide sleep assessment and Cognitive Behavioural Therapy for Insomnia (CBT-I) to patients in general practice. IPCREST aimed to encourage GPs to shift away from prescribing hypnotic drugs for treating insomnia in favour of CBT-I and envisaged that patients would be more involved in the management of their condition. The evaluation used a mixed methods approach including: pre- and post-learning surveys; e-learning usage; analysis of prescription and prescription cost data; practitioner interviews. Overall, during the period of IPCREST (April 2011 to March 2012), hypnotic and anxiolytic prescribing costs across the East Midlands counties involved fell over ten per cent from £4.34 million in 2010/11 to £3.89 million.

Experiences and Perceptions of Benzodiazepine Prescribing in Primary Care 2011-12
Funded by the College of Social Science, awarding £1,500. Key contact: Dr Coral Sirdifield.
This project used a thematic synthesis approach to combine and develop findings from qualitative papers investigating the influence of clinicians’ experiences and perceptions of benzodiazepine prescribing on their prescribing practice. We used this to build an explanatory framework to inform future research, and to improve the consistency of prescribing. Our findings were published and have been in BMC Family Practice, in paper which has been highly accessed: Sirdifield, Coral and Anthierens, Sibyl and Creupelandt, Hanne and Chipchase, Susan andChristiaens, Thierry and Siriwardena, A. Niroshan (2013) General practitioners’ experiences and perceptions of benzodiazepine prescribing: systematic review and meta-synthesis. BMC Family Practice (14). p. 191.

Effectiveness of Z-drug Hypnotics in the Treatment of Adult Insomnia Compared with Placebo using Data from the US Food and Drug Administration (FDA) 2011-12
Funded by the College of Social Science, awarding £1,500. Key contact: Professor Niro Siriwardena.
Hypnotic drug therapy is widely used despite limited evidence of effectiveness and adverse effects including residual sedation, cognitive impairment, anxiety, tolerance, dependence, road traffic accidents, falls and fractures. McCall et al undertook a meta-analysis of sleep changes associated with placebo in hypnotic clinical trials and found a confirmed placebo effect. Kirsch undertook a meta-analysis of antidepressants using unpublished data obtained from the FDA website and found that drug-placebo differences for antidepressants increase with baseline severity, but are relatively small even for severely depressed patients. We conducted a meta-analysis for hypnotics using US FDA data comparing drug-placebo differences. We found that Z drugs produced slight improvements in subjective and polysomnographic sleep latency compared with placebo, especially with larger doses and regardless of type of drug. Although the drug effect and the placebo response were rather small and of questionable clinical importance, the two together produced to a reasonably large clinical response. The study was published in the BMJ: Huedo-Medina T, Kirsch I, Middlemass J, Klonizakis M, Siriwardena ANEffectiveness of non-benzodiazepine hypnotics in treatment of adult insomnia: meta-analysis of data submitted to the Food and Drug Administration. British Medical Journal 2012; 345: e8343doi: 10.1136/bmj.e8343.