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Southampton's research into the management of depression highlighted deficits in the way GPs were assessing and treating depression, and demonstrated failure to improve their performance through education alone. The findings were included in guidelines drawn up by the National Institute for Health and Care Excellence (NICE) and led to incentives for questionnaire assessments of depression being introduced into the GP contract Quality Outcomes Framework (QOF). UK-wide QOF data from 2008-2013 demonstrated questionnaire assessments in 2.2 million cases of depression. Subsequent Southampton-led research showed that improved targeting of treatment resulted from questionnaire assessments, and trial evidence shows such assessments improve patient outcomes.
Research into primary care insomnia by the Community and Health Research Unit (CaHRU) has led to broad improvements in healthcare provision for insomnia, improved patient quality of life, informed national/international policy and practice in insomnia care and impacted directly on health professional practice and insomnia sufferers, initially in Lincolnshire spreading across the UK and internationally from 2008 to 2011. Direct effects on practice include changes in sleep management and reduced hypnotic prescribing through seminars, workshops, conferences and e-learning developed by the team; inclusion in UK policy, practitioner information, training materials and guidance on hypnotics has led to greater professional and public awareness of sleep management internationally.
In response to the gap between standards and the reality of preventive cardiovascular disease (CVD) health care delivered across Europe, Imperial College researchers developed an innovative nurse-led, multidisciplinary, family centred, CVD prevention programme (EUROACTION) and led its evaluation in hospital and general practice across 8 European countries. We showed that patients and their families in our programme can achieve healthier lifestyles and better risk factor management compared to usual care and these differences were sustained out to one year. We then adapted our learning from EUROACTION for the NHS, by integrating secondary and primary prevention into one community service (MYACTION), and managing cardiovascular disease as a family of diseases with common antecedents. To train doctors, nurses and allied professionals to deliver MYACTION we created an MSc in Preventive Cardiology which is now in its 6th year. EUROACTION is now recommended as an evidence based model of care in current European CVD prevention guidelines, and MYACTION is being commissioned by the NHS in London, and Galway, Republic of Ireland, and by the Western Isles Health Board. Our research has impacted directly on the development and delivery of high quality preventive care in both Europe, and the NHS, and on the training of doctors, nurses and allied health professionals in preventive cardiology.
King's College London (KCL) researchers have created, refined and validated the Palliative care Outcome Scale (POS), a tool that measures the physical, psychological, spiritual and information needs of patients at the end of their lives and their families. The POS has had an outstanding impact on clinical competencies and knowledge, and has underpinned an international collaboration to develop standards for palliative care outcomes. The POS is embedded increasingly in everyday clinical practice, improving the care of patients affected by advanced conditions and providing support for their families. The POS, widely used regionally and nationally in the UK to evaluate and improve the quality of care, has been culturally adapted for use in 20 European Union countries, and in Africa and other countries around the globe.
Work on better management and identification of Medically Unexplained Symptoms (MUS) has led to the introduction of new treatments in primary care in England through the Improving Access to Psychological Treatment (IAPT) programme as well as having an impact on service planning and commissioning. These approaches have also been implemented into the routine training and practice of General Practitioners (GPs) in parts of Europe. A clinical and economic evaluation of a psychosocial approach to chronic fatigue syndrome using general nurses and development of a cognitive behaviour therapy approach has changed general practice and enhanced the patient experience for those with MUS.
Depression is a major public health problem, producing substantial deterioration in health and well- being and costing the UK £billions annually. A programme of research at Exeter, led by Professor Richards, (trials and Phase IV implementation studies) has changed national policy on the treatment of depression (NICE guidelines). It has also underpinned the UK's Improving Access to Psychological Therapies (IAPT) programme which has been widely implemented, leading to new treatment for over 1 million people, with a recovery rate in excess of 45%, and over 45,000 people coming off sick pay and benefits. The research has also achieved International impact.
Lower Urinary Tract Symptoms (LUTS) in men is a chronic disease of ageing that causes significant quality of life impairment in one third of men over the age of 60. Traditional management comprises a step-up regimen of drugs and surgical interventions aimed at relieving symptoms. At UCL we conceived, developed, evaluated and implemented a self-management intervention that results in greater symptom reduction than that achieved by medication, reduction in the use of medication and of referrals to secondary care, and reduced costs. The intervention is now a global standard of care.
Osteoarthritis affects 8.5 million people in the United Kingdom, accounting for a third of all years lived with disability. Our research has provided commissioners and third-sector organisations with accurate estimates of the size of the problem, policy-makers with evidence on groups at particularly high-risk, and clinicians with original evidence on better approaches to assessing and managing osteoarthritis in patients presenting to primary care. These key insights have supported advances in public health and health care policy debate, changes in legislation, and improvements in the quality of patient care through training and new national, European, and global guidelines for health professionals.
Atrial fibrillation (AF) is the commonest heart rhythm abnormality, affecting around 8.8 million people in the European Union, and conferring a substantial risk of stroke and death. Up to 2% of the UK population, some 1.2 million individuals, take oral anticoagulation medication.
The University of Birmingham is an internationally-respected centre of excellence for research in AF, and has made crucial impacts in international clinical practice guidelines and improvements in patient care. Primary care research at the University of Birmingham has led to the transfer of oral anticoagulation services from secondary to primary care, and latterly patient self-management, resulting in improved clinical outcomes. In addition, the BAFTA trial has provided evidence to support the use of anticoagulation therapy (warfarin) for people aged over 75 who have atrial fibrillation, resulting in changes in clinical management of these patients.