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Between 1996 and 2013 researchers at Swansea University evaluated service initiatives and changing professional roles associated with the management of patients with debilitating gastrointestinal disorders. This work showed the clinical and cost effectiveness of two main innovations: open access to hospital services for patients with inflammatory bowel disease; and increased responsibility for nurses, particularly as endoscopists. Our evidence has had a broad, significant impact on: national policy through incorporation in NHS strategies, professional service standards and commissioning guides; service delivery through the provision of increasing numbers of nurse endoscopists and the wide introduction of nurse-led open access to follow-up; and patient care, as documented in sequential national audits in 2006, 2008 and 2010.
A decade of research at the University of Southampton has given thousands of people around the world suffering from dizziness and balance disorders access to a self-management resource that can alleviate their symptoms. Professor Lucy Yardley has pioneered the use of a Balance Retraining (BR) booklet to transform the means of delivering cost-effective, life-changing treatment previously offered to less than one in ten UK patients. The booklet, translated into several languages, has been distributed to patients and practitioners as far afield as China and Japan. Yardley's findings have contributed the bulk of good quality evidence to the Cochrane Review on vestibular rehabilitation.
This multicentre research study, led by Sullivan (University of Dundee), demonstrated that in patients with Bell's Palsy (where no best treatment had been defined), early treatment with prednisolone significantly improved the chances of complete recovery at three and nine months. Furthermore, this complex randomised controlled trial, recruiting 551 incident cases from primary care, demonstrated no evidence of benefit from aciclovir alone, or in combination with prednisolone. The findings led to revisions in the Cochrane reviews on the subject and have been incorporated into national and international guidelines. Substantial changes in prescribing practice for Bell's Palsy and reduced hospital referrals in the UK have been demonstrated as a direct result of publication of this study.
The findings of an innovative ethnographic study of Health Care Assistants (HCAs) who care for dementia patients were used to create a stage play, Inside out of Mind,which was performed to audiences of HCAs, NHS managers and the general public.
The performances raised awareness with NHS managers and healthcare policy makers, of the role and importance of HCAs; their working environment, the skills they need and the difficulties they encounter. It enabled HCAs to reflect upon their practice and to identify specific areas upon which they would focus to improve care.
The Counterweight Programme (CW) is a structured model for obesity management in primary care settings. CW has made substantial changes to clinical and public health guidelines and to practice nationally and internationally: the Programme has since been adopted in Primary Care Galway, Ireland and for a government funded trial in Ontario, Canada. The creation of a spin out company, Counterweight Ltd, in 2011 resulted in concomitant job creation and significant commercial activity, with CW now being used in private healthcare, pharmacies, fitness clubs, and by freelance healthcare professionals. Moreover, the programme has significantly benefited the health and welfare of obese patients and improved care practice by increasing quality, accessibility and cost effectiveness of weight management services in the UK.
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.
York research showing that a) screening for depression in primary care is ineffective and b) collaborative and stepped care improves outcomes for depression in primary care, has changed national and international policy. The National Institute for Health and Care Excellence (NICE) revised its guidelines, the National Screening Committee altered its recommendations, and money has been saved by no longer paying GPs to screen for depression under the Quality and Outcomes Framework. US advisory bodies have also shifted away from recommending routine screening for depression. Treatment guidelines/programmes in the USA, Europe and Australia now recommend collaborative care for the management of depression. Our research has also resulted in an expansion of the NHS Improving Access to Psychological Therapies programme, with many patients benefitting from improved care. The computer support system (PC-MIS©) we developed to record treatments and to track patient progress over time is the most widely used in the NHS. The clinical performance benchmarks we derived from this form the basis of metrics used for NHS-wide performance management of depression services.
Care provided to patients by emergency ambulance services is changing nationally and internationally. For example the proportion of 999 calls in England resulting in conveyance to hospital fell from 68% in 2007-8 to 55% in 2012-3. Professor Snooks of Swansea University and colleagues have collaborated with clinicians, policy makers and academics to identify approaches more cost-effective than routine conveyance to Emergency Departments (EDs) for many patients. International application of Snooks's evidence that telephone advice, decision support and referral pathways are safe and effective has reduced unnecessary attendance at EDs and costs without compromising patient experience, safety or quality of care.
Heart failure affects more than 22 million people worldwide, including 6 million in Europe and 5 million in the United States, with approximately 500,000 new patients diagnosed each year.
The cardiac resynchronisation in heart failure trial (CARE-HF) demonstrated that, in patients with heart failure and cardiac dyssynchrony, use of an implantable pacemaker to improve heart contraction led to a 37% reduction in the risk of death and hospitalisations and significant improvements in patient quality of life. The benefits are in addition to those of standard pharmacologic therapy. As a result of the CARE-HF trial, international and NICE guidelines have recommended the use of cardiac resynchronization therapy in patients with heart failure and dyssynchrony resulting in an increased use of cardiac resynchronisation throughout the world and significant improvements in quality of life and survival for heart failure patients.
Every year in the UK, 150,000 heart attacks are caused by coronary artery occlusion (blockage); worldwide, the figure is 17 million, according to the World Health Organization (WHO). Since 1993, the Leicester Interventional Cardiology group has been at the forefront of research to determine how best to manage such patients. Its findings have been incorporated into official UK (2008), European (2008, 2012) and US (2008) guidelines and have helped to change the way coronary heart disease and heart attacks are treated, with the number of patients treated with primary angioplasty doubling between 2008 and 2011. By guiding service provision, supporting industrial innovation and informing clinical practice, the Unit has contributed to improved healthcare and outcomes for thousands of heart patients. Overall, one-month mortality according to European figures has fallen from 15% to 4% between 2008 and 2013.