‘Improving health and wellbeing

through Research’

Preston Football Club17th October 2014

Improving health and wellbeing through research – October 2014

Medical Directors’ Office

#LCFTresearch@Lancashirecare

Professor Heather Tierney-MooreChief Executive

Event Welcome

Improving health and wellbeing through research – October 2014

Dr Heather Iles-SmithResearch & Innovation Lead

“Improving health and wellbeing through research – LCFT strategy refresh”

Theme:Research

Successes

Improving health and wellbeing through research – October 2014

Medical Directors’ Office

Overview• National picture• Local picture • Research strategy

Objectives

• Current research• Challenges

Medical Directors’ Office

Why we do research

- 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

NHS Constitution

Medical Directors’ Office

National Picture• Transformations of NIHR Research Networks- 25 to 15

nationally Clinical Specialities 6 Divisions

• NW Coast Clinical Research Network (NWC CRN) includes Liverpool, Merseyside, Lancashire & South Cumbria

Division 1- CancerDivision 2- Diabetes, stroke, cardiovascular diseaseDivision 3- Children, reproductive health and childbirthDivision 4- Dementias and neurodegeneration (DeNDRoN), mental healthDivision 5- Primary care, Ageing, Health services research, dental health, Public health, Muscoskeletal disordersDivision 6- Anaesthesia and pain management, critical care

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

VisionTo 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 PsychosisAn 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 DirectorThe Lancet, May 2013 (381:9878:1634-1641)

• C-GLOVES. An evaluation of the effectiveness of compression gloves in arthritis: a feasibility study- Jenny Welsby, Specialist OT, Rheumatology DepartmentOccupational 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 incomeIncreasing industry studies

• Capacity buildingfocussing on nurses, AHP’s,

pharmacists and psychologists Fellowship applications

Medical Directors’ Office

Thank You for listening…..Web page:-http://www.lancashirecare.nhs.uk/about-us/Research-Innovation.phpPlease contact us at:-Heather.iles-smith@lancashirecare.nhs.ukR&I@lancashirecare.nhs.uk

Professor Jenny ShawClinical Director for Specialist Services & R&D Director

Mental Health Screening in Police Custody In England: Developing a screening tool and referral pathway

Theme:Research

Successes

Improving health and wellbeing through research – October 2014

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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

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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

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Policy Priority

• Early intervention• Liaison and Diversion• Increasing access

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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

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Research Team

Dr. Jane Senior University of ManchesterMiss. Heather Noga Lancashire Care NHS Foundation TrustProf. Jenny Shaw Lancashire Care NHS Foundation

Trust / University of Manchester

Miss. Susan Tighe Lancashire Care NHS Foundation TrustDr. Elizabeth Walsh 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.

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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

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Method

• Participants– Mental Health Professionals – Police Officers– Service Users

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Method

•Understand current practices

•Views on requirements of screening referral tool

Interviews (n 58)

•Review of existing screening tools

•Consensus on scoring (routine/urgent)

•Creation of referral pathway

Consultations (n

58)

•Service Leads from Mental Health, Social Care, Police, Private Healthcare, City Council, Service Users

•Implementation and training package

Action Learning Groups

(n 8)

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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

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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”

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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”

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PolQuest

PriSnQuest

- Historical issues

-Depression- Serious Mental Ill

Health

Police Custody Risk Assessment

- Historical issues

-Self Harm-Medication

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PolQuest

• 14 Item Screening Questionnaire

• Administer in 5 minutes

• All Adult Detainees

• Corresponds to a referral pathway

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Scoring•High Risk•Current symptoms/signs of psychosis, depression, self harm, suicide

•Highly distressed

Urgent Referra

l

Eg. ‘Have you recently found yourself wishing you were dead and away from it all?’

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Scoring•Low Risk•Historical issues

•Known to/currently engaged with services

Routine

Referral

Eg: ‘Are you currently in contact with mental health services?’

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Referral Pathway

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Training and Implementation

• Implementation Manual

• ‘How to’ practical guidance

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Impact

• Screens everyone in custody

• Clear referral process

• Early identification

• Economic use of services

• Provides standardisation of care

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Future Directions

Feasibility Study

•Implement in real life-one custody suite

•Identify issues in application

•Design full scale trial

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Thank you

Jenny.shaw@lancashirecare.nhs.uk

Dr Waquas WaheedConsultant Psychiatrist

“Partners 2”

Theme:Research

Successes

Improving health and wellbeing through research – October 2014

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 schizophrenia and bipolar disorder in England is likely to work.

Work stream 1: Assessment of local care pathways and current services for people with severe mental illness

Work stream 2: Development of a core outcome set for use in mental health trials involving people with schizophrenia or bipolar disorder in a community based setting.

Work stream 3: Development of the system of collaborative care.

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.

Developing the grant application

Building the team

Experts in

1. Collaborative care2. Primary care3. Schizophrenia and Bipolar disorder4. Qualitative researchers5. Trial Methodologists6. Health economics7. Biostatistics8. Service users9. 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 MacPhieConsultant Rheumatologist

“Finding Time for Research in a Busy Rheumatology Department”

Theme:Developing

Clinical Research

Improving health and wellbeing through research – October 2014

Finding Time for Research in a Busy

Rheumatology Department

Lizzy MacPhie

Rheumatology Department

Minerva Health CentrePreston

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 1Limited 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 2Lack 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 3Raising 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

RAMS Rheumatoid arthritis or undifferentiated IAstarting 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

Think Research!

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 4Keeping 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

2010 2011 2012 2013

BSRBR16 patients

201420122011 2013

RAMS37 patients

MTX pneumonitis

0 patientMyositis genetics

4 patients

SLE Genetics11 patients

BSRBR-AS6 patient

Genetics in AS

6 patients

Noisy Knees1 patient

Delay19 patients

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 listeningAny Questions