Enquiry Service Proposal Workshop

Monday 10 October, Lister Institute, Edinburgh

Steve TurnerSenior ResearcherDental Health Service Research UnitUniversity of Dundee

s.turner@chs.dundee.ac.uk

Proposed pilot online enquiry network for primary care staff

Linked to e-library

Collaborative – sharing workload and expertise

Based on CHPs or sample of practicesService : enquiry answering and user education

Online – email? Web-based? Both?

£20K

A Pilot – implications?

Implementation research design

Implementation research

investigation into the efficiency and efficacy of different methods of promoting evidence-based practice (Walker et al, 2000).

selection of subjects

nature of the intervention

Outcome measures

unit of analysis (treatment-patient-practitioner-practice)

Why do research?

Enthusiasm for practice

Increase evidence base for practice

Improve patient care and outcomes

It’s stimulating and creative

It’s career-enhancing

Proposed pilot online enquiry network for primary care staff

Linked to e-library

Collaborative – sharing workload and expertise

Based on CHPs or sample of practicesService : enquiry answering and user education

Online – email? Web-based? Both?

£20K

Core components of research proposals

Make sure that these are meaningful, not mechanistic

Core components (part1)

• Abstract• Description of the research question

• An indication of why the problem is important

• Review of relevant literature

• Description of the proposed methodology (intervention and evaluation)

• Time frame (Gantt chart)

Defining the research question

• A broad research area is not a research question

• Formulate a number of possible questions, and weigh up the pros and cons

• The proposal must show that the issues have been thought through

Pinning things down

“How feasible and effective is an online enquiry service in Primary Care?”

Pinning things down

Pinning things down (cont.)

• Restrict to General Practice?

• Internet availability for all practice team

• Define effectiveness

• Define feasibility

• Limit to disease/client groups?

Pinning things down: the revised research question

“What is the impact of an online enquiry service for General Practice in terms of practitioner use, satisfaction and reported patient outcome, and how do these outcomes relate to costs?”

The literature review

• Provides a conceptual framework for the research

• Provides an integrated overview of the field of study

• Helps establish a need for the research• May help clarify the research problem• Helps to demonstrate researcher’s

familiarity with the area under consideration (theory and / or methods)

Methodology

Is any pilot work needed?Validation of toolsSample size calculation if

appropriateFeasibility study of proposed

recruitment strategies / processes

Methodology

Quantitative/qualitative/mixed?What are the outcomes of interest?Is it do-able?

Can outcomes be measured?Adequate access to samples?Resources likely to be available?

Methodology

• Cost analysis–Overall costs–Unit costs per completed enquiry–Implementation costs

• Recruitment of practices –Random Sample–Purposive Sample–S.P.I.R.R.e. (S.S.P.C.)

Scottish Practices and Professionals Involved in

Research (SPPIRe)

Aims to "increase the amount of research relevant to patient care undertaken in a primary care setting".

National primary care research framework operating in Scotland under the auspices of the Scottish School of Primary Care, with funding from the Chief Scientist Office in Scotland.

Helps link researchers with professionals in primary care who can host or otherwise support high quality research projects of relevance to primary care.

  

SPPIRe has three principle functions:

• to develop and maintain a dynamic register of research interested practices and professionals willing to participate in research, either as hosts or as more active participants;

• to 'translate' research requests and protocols into workable procedures for primary care professionals and ensure that commitment is maintained;

• To rationalise the number of requests to professionals and practices to undertake research through either national or regional systems.

Core elements 2• Budget• Description of how findings will be

disseminated• Outline of team members’ expertise

(CVs) and responsibilities• Capacity development• Ethical statement• Possible problems• Other information specified by

funders

What resources will be needed?

Detailed and accurate costingsRealistic timescaleWho will do the work?Who will be the sponsor for the

project?Will all legal requirements be

covered?Support for Science if appropriate

Collaboration

• Do we have the right skill mix to develop the project?

• Invite collaborators with complementary skills

• Decide on division of how responsibilities and roles

• Identify any gaps in expertise

Producing a successful proposal

CSO checklist for assessing outline applications (1)

IntroductionEstablishes the importance of the

topic?Clear account of what is already

known?Background information relevant and specific to the aims of the study?Clear what search strategy was used?

Aims and Research QuestionsClear?Relevant (to improving population

health or healthcare)?Answerable?Are they research questions?

CSO checklist for assessing outline applications (2)

Plan, Methods, Expertise Available Research design appropriate to the

research aims and questions?Methods clearly described?Size of the study well justified?Clear and realistic recruitment strategy?Analysis plan appropriate to the data?Necessary expertise and experience?Feasible with the resources requested?

Research Outcomes Suggestions for implementing the results

clear and realistic?

What do funders want to see?

•Clearly defined research question•Appropriate literature provides a background to the problem

•Use of other sources to identify/support the problem

•Objectives clearly specified•Conceptual framework and theoretical assumptions clearly stated

•Appropriate design and methodology•Promotes further research•Preliminary data/pilot study•Necessary resources available

What don’t funders want to see?

• Too long• Poor structure, language use• Inappropriate use of technical terms• Research too ambitious• Literature review inadequate or not original• No integration of theory in literature review• Budget not linked to methodology• Unrealistic costing• Methods not clear• Methods inappropriate• No references or bibliography

Check out these services

• Clinical Effectiveness Enquiry Service UCL

• ATTRACT PC enquiry service in Wales (BMJ 2001;322; 529-530)

• Relevant features• Service aims?• How evaluated?• How successful?

1.The ATTRACT Process• Clinician sends query to ATTRACT• Researcher receives question and seeks clarification if necessary• Analyses terms- looks for synonyms, general classifications and

MeSH terms- then devises a search strategy• Searches abstracts of evidence based literature in accordance

with the following hierarchy of sources:– Cochrane Library – Clinical Evidence (BMJ) – TRIP database including searching via clinical queries on

PubMed • If a recent (less than 2 yrs old) systematic review answers the

query, the search terminates.• If no recent evidence from the core sources then Medline (via

OVID or PubMed) and EMBASE searched.• The research literature is appraised according to the standard

EBM "Hierarchy of Evidence" and summarised.• A hardcopy of the summary and printouts of relevant research

abstracts sent to the clinician who asked the question. • The summary uploaded onto ATTRACT website as an answer to

the question, categorised by subject area, and strength indicated.

UCL Clinical Effectiveness Enquiry Service

– Literature searching on demand - with or on behalf of Royal Free staff

– Information or evidence sought to inform: • individual patient care

– general patient care (CPD)– guideline development– teaching and presentations– publication– research– audit– – Access - in-person, by telephone, e-mail, fax,

intranet

UCL Clinical Effectiveness Enquiry Service

Consultant telephones for literature search to find any evidence on the treatment of Lassa fever

→ search is carried out and references emailed to the consultant

→ he selects 7 articles

→2 provided from stock, 5 articles are ‘urgent action’ inter-library loaned from the BL

→ articles are hand delivered to the consultant the following morning = patient is discharged.

* Incomplete data

CEES - enqueries by information use

0

10

20

30

40

50

60

Individual patient care General patient care

Research Guideline development

Publication Present./Teach.

Audit Other

[ 2002 ] [ 2003 ]

How had they heard of CEES?PromotionalmaterialPresentation

Colleague

Accident

Other

Did they receive the information in time?

Yes

No

No answer

Had they recommended the service to colleagues?

Yes

No

Noanswer

How did they rate CEES?

Excellent

Good

Satisfactory

Poor

No answer

CEES time line

2002Clinical and Research

Governance Support

Librarian in post

CEES launch

Retrospective user survey

Intranet submission

2003

Peak in users (52 in Jan) TODAY

Launch of CIS@

RNTNEH

Clinical Librarian pilot

Library Newsletter

‘helping you achieve Clinical Governance’

CHI visit

Nurses and Midwifery Forum

Floor walk

Physiotherapy Dept.

Palliative Care Service Group

UCL Clinical Research Network

Information Fair

Clinical Audit and Effectiveness Committee

(CAEC)

Clinical Practice Group (CPG)

RNTNEH

Report on CEES

Clinical audit skills

CAEC

Cochlear Implant Group

Stroke prevention guidelines

RNTNE Service Group

CPG

NoCTeN Nuffield speech team

Managing life in the NHSLibrary Committee

11th June

25th July

CAEC

Clinical governance working group (CGWG)

J F M A M J J A S O N D

J F M A M J J A S O N D

Welcome (new doctors)

Occupational Therapy Dept.

Occupational Therapists (Musculoskeletal)

CGWG

CAEC Library Newsletter

Medical Library link on front page of Freenet (Trust intranet)

12 month pilot giving clinicians free full text of electronic resources available to CRGSL

Letter to all Clinical Heads of Service; presentation to coincide with NeLH Awareness week initiative

Resources used to problem solve

62-65 Dentists; 57-61 GPs (Taylor et al )

Never

Rarely

Occasionally

Often

Very often

Remember

All the evidence to support your application must be included on the form

Do not assume that the funder will know the worth of your area of research

Will be judged on the basis of the whole package

Be clear and concise

Your aim should be for:

Clarity

Value

Relevance

Ta-ra factor

Solid question

Robust proposal

Useful results

Resources

EASTREN websiteSSPC website and adviceUniversity of Michigan Proposal

Writer's Guide by Don Thackrey         

If you get the money…

Ethical approvalTrust Management R&D approvalIf Scotland-wide, register as SPPIRe

project

Thanks to Marie Pitkethly, EastRen Co-ordinator