Roland+ by ajizai

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									                                                                                             School for Primary Care Research




School for
 Primary                NIHR School for Primary
  Care
Research                    Care Research
 Increasing the
evidence base for
  primary care
     practice
                                  Martin Roland, Director
                                  University of Cambridge


                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research




                                                                         r
School for
 Primary
  Care
Research

 Increasing the
evidence base for
  primary care
     practice




                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research




                            Health Services Research: to inform
School for
 Primary                    NHS policy (National Primary Care
  Care                      Research and Development Centre,
Research
                            established 1996)
 Increasing the
evidence base for
  primary care
     practice

                            Clinical research: to inform NHS
                            practice (NIHR School for Primary
                            Care Research established 2006)

                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research



                         NIHR School for Primary Care
School for
                                 Research
 Primary
  Care                  • 5 or 5* departments in 2001 RAE
Research

 Increasing the
                        • Birmingham, Bristol, Cambridge,
evidence base for
  primary care            Manchester, Oxford
     practice

                        • £3m per annum to carry out
                          research “to increase the evidence
                          base for primary care practice”

                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research




                     Five programmes of research
School for
 Primary             • Prevention & Early Diagnosis
  Care
Research             • Monitoring and Management of long
 Increasing the
                       term conditions
evidence base for
  primary care
     practice        • Comorbidity
                     • Patient practitioner interface
                     • Research methods


                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research




School for
 Primary                     Prevention & Early Diagnosis
  Care
Research

 Increasing the               Lead: Professor David Mant
evidence base for
  primary care
     practice
                              (Oxford)




                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                                School for Primary Care Research



                    Antibiotic resistance and GP prescribing

School for                                       18
 Primary
                                                 16
  Care
                      Pooled point estimate of




Research                                         14
                                                 12
                           (OR, 95%CI)




 Increasing the
                            Resistance




evidence base for                                10
  primary care
     practice
                                                  8
                                                  6
                                                  4
                                                  2
                                                  0
                                                      1 w eek   2 w eeks   1 month   2 months   3-4 months   6 months   12 months

                                                                Time between exposure and outcome

                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research




                       How do GPs recognise sick children?
School for
 Primary
  Care
Research                Pulse oximeter can
 Increasing the         be used to measure
evidence base for
  primary care          respiratory rate
     practice

                        - important sign,
                        not often measured




                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                              School for Primary Care Research




                    • UK cancer survival
                      is worse than in
School for            most European
 Primary
  Care                countries
Research            • Could earlier
 Increasing the       diagnosis in
evidence base for
  primary care        general practice
     practice
                      help?
                    • CAPER series of
                      studies


                     The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                 Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                                                       School for Primary Care Research


                    Diagnosis of ovarian cancer: time before
                    diagnosis when symptoms presented
School for
                        15




                                                                                 2.5
 Primary                                Abdominal pain                                            Abdominal bloating




                                                                                       2
  Care
                        10




                                                                                 1.5
Research




                                                                                       1
                         5




                                                                                 .5
                         0




                                                                                       0
 Increasing the
                                     -400    -300      -200           -100   0             -400       -300      -200       -100     0
evidence base for
  primary care                                 Days before diagnosis                                   Days before diagnosis
     practice




                                                                                       5
                        10




                                                                                                  Loss of appetite

                                                                                       4
                                        Abdominal distension
                         0 2 4 6 8




                                                                                       3
                                                                                       2
                                                                                       1
                                                                                       0



                                     -400    -300      -200           -100   0             -400       -300      -200       -100     0
                                               Days before diagnosis                                    Days before diagnosis

                                                Reports in controls                                              Reports in cases



                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research


                        Positive predictive value of symptoms and
                                 signs for ovarian cancer
School for            Bloating        Abdominal         Appetite         Distension
 Primary                              pain              loss
  Care
Research                  0.3              0.3               0.6               2.5           Positive predictive value as a
                                                                                             single symptom
 Increasing the
evidence base for                          0.8               3.3               3.0           Abdominal bloating
  primary care
     practice

                                                             1.0               3.1           Abdominal pain


                                                                               >5            Loss of appetite




                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research




School for              Monitoring and Management of
 Primary                    long term conditions
  Care
Research

 Increasing the
evidence base for            Lead: Professor Paul Glasziou,
  primary care
     practice                Oxford




                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research


                         Self-monitoring of blood pressure

School for                      Self monitoring of blood pressure is
 Primary
  Care
                                useful in the diagnosis and management
Research                        of hypertension
 Increasing the
evidence base for
  primary care
                                Multiple measurements of blood
     practice
                                pressure allow a better estimation of
                                "true" blood pressure

                                Self monitored blood pressure
                                correlates better with risk of stroke than
                                office readings
                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research




School for                                         Co-morbidity
 Primary
  Care
Research
                          Lead: Professor Chris Salisbury
 Increasing the
evidence base for         (Bristol)
  primary care
     practice




                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research


                                               Co-morbidity
                     •    How common are co-morbidities and which patterns of
School for                co-morbidity are most common in different population
 Primary                  groups?
  Care
                     •    What are the mechanisms through which co-morbid
Research
                          conditions interact?
 Increasing the      •    How should co-morbidity influence the way in which
evidence base for
  primary care
                          primary health care is organised and quality of care
     practice             assessed?
                     •    What are the implications of co-morbidities for the
                          design of interventions for patients with more than one
                          condition?
                     •    How can we measure the outcomes of health care in
                          ways which both take account of the presence of co-
                          morbidity and reflect how patients value health and
                          illness?
                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research




School for                    Patient Practitioner Interface
 Primary
  Care
Research
                               Professor Stephen Sutton,
 Increasing the
evidence base for
  primary care
                               (Cambridge)
     practice




                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research




School for                  Patient Practitioner Interface
 Primary
  Care
Research

 Increasing the         Using graphics to support risk
evidence base for
  primary care
     practice
                               communication




                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research




School for
 Primary
  Care
Research

 Increasing the
evidence base for
  primary care
     practice




                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research




School for
 Primary
  Care
Research

 Increasing the
evidence base for
  primary care
     practice




                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research


                        Using graphics to support risk
                               communication
School for
 Primary
                       • People who are good with numbers are
  Care                   also good with graphs
Research

 Increasing the
evidence base for      • Low numeracy people get no extra benefit
  primary care
     practice            from graphs

                       • Are there types of graphical representation
                         that would better support people with low
                         numeracy?
                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research




School for
                            New Methods for Primary Care
 Primary                             Research
  Care
Research

 Increasing the
evidence base for                 Professor Brendan Delaney,
  primary care
     practice                     Birmingham




                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research



                                     Aims of the programme
School for
 Primary
                    1. Informatics: To develop methods
  Care                 for the integration of research and
Research
                       clinical data
 Increasing the
evidence base for
  primary care
                    2. Patient Safety: To develop methods
     practice
                       for studying diagnostic error
                    3. Recruitment and retention: To
                       develop a programme of work.
                       (NSPCR-PCRN)
                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research




                                                    Other roles
School for
 Primary             • Leadership
  Care
Research
                     • Partnership
 Increasing the
evidence base for
  primary care       • Research training
     practice




                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research




                                           Peer learning sets
School for
 Primary
  Care               • Exploring the relationships between
Research
                       research, policy and practice (Helen
 Increasing the
evidence base for
                       Lester and Martin Roland)
  primary care
     practice

                     • “Normalisation Process Model” in
                       developing and evaluating complex
                       interventions (Carl May and
                       Elizabeth Murray)

                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research




                                    Future of the School
School for
 Primary
  Care                        • New members (2009)
Research
                              • Expanded remit to include
 Increasing the
evidence base for               research training
  primary care
     practice
                              • Expanded funding




                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.
                                                                                             School for Primary Care Research

                    Website: www.nspcr.ac.uk


School for
 Primary
  Care
Research                                               www.nspcr.ac.uk
 Increasing the
evidence base for
  primary care
     practice




                    The School for Primary Care Research is a partnership between the Universities of Birmingham, Bristol, Cambridge,
                                Manchester and Oxford and is part of the National Institute for Health Research.

								
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