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Our research has produced a paradigm shift in the primary care management for back pain, by expanding traditional diagnostic approaches to attending to physical and psychosocial factors shown to influence future outcome (`prognosis'). We have developed screening tools (freely available, widely accessed, translated and adopted), to distinguish groups at low or high risk of long-term disability, and developed primary care interventions tailored to these groups. Through improved clinical outcomes and cost-effectiveness, we have changed back care at national and international levels, evidenced by inclusion in official guidelines, into training of health professionals, adoption by spine and pain services, and active engagement of health care commissioners, clinicians and educators.
Methods for valuing quality of life developed by Professor Devlin at City University London are used internationally to help governments make healthcare decisions. Her research focuses on a widely-used questionnaire for measuring patient reported health, the European Quality of Life 5-Dimensions (EQ-5D). Government organisations routinely use the EQ-5D to judge whether new medicines work and are cost-effective. Over 15 countries are undertaking EQ-5D studies using Professor Devlin's methods to inform decisions on pricing and provision of new medicines. These developments have been achieved through active dissemination to the academic community and governments and through Professor Devlin's scientific leadership of the European Quality of Life (EuroQol) Group. The impact of this research is highly significant in improving health and health care decision-making and has had wide reach throughout the UK and in many other countries.
We have developed the first ever physiotherapy guidelines (2008-) for contracted (frozen) shoulder (CFS). CFS is painful and disabling, affects c.9% of the UK working-age population,1 and costs the NHS > £13.5 million annually.2 Appropriate physiotherapy could improve outcomes and reduce costs by up to £2,000 per case.b
Endorsed by the Chartered Society of Physiotherapy (CSP), the guidelines have generated great interest and already influenced practice and will improve the quality and cost-effectiveness of clinical management, as well as patients' experiences. They will also provide a better framework for research into the condition and, as a `live', electronic document, will evolve with future research.
Management science research that has evolved over two decades at Southampton Management School has provided the Sri Lankan government with the means to revolutionise its dental care system, and to devise new strategies for the more effective recruitment of health care professionals. A computer simulation model, based on Southampton's research, underpinned a government decision to limit dental student intake, create 400 new posts in under-resourced rural areas and grant access to dental care to an additional 1.5 million people. This in turn led to better use of taxpayers' money and improved career prospects for Sri Lankan dentists.
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.
The thesis of this case study is that a demonstration project, encompassing an organisational change, utilising the principles that underpinned a Department of Health (1993) policy for maternity care, has been influential in corroborating and establishing a philosophy for maternity services in industrialised countries within the 21st century.
The project provided an evidence-based approach to standards and quality of midwifery care. It demonstrates outcomes influencing national and international guidelines and policies for maternity practice. As a result, current midwifery guidelines for the UK and other countries, such as Australia, New Zealand, The Netherlands, Sweden and Canada, include elements of continuity of care/r (including one-to-one care and case loading) informed choice for women and evidence-based practice.
The research has led to the design of a new clinical pharmacy service model, centred on community pharmacies, to improve the care of patients with palliative care needs living in the community. This resulted in better provision of information for patients (and their carers) and new training resources and staff development opportunities for the multi-disciplinary palliative care team. Funding has been secured to rollout the new service across NHS Greater Glasgow and Clyde Health Board (NHS GGC - 1.2M population) in 2013. The research has also supported a successful bid to explore the service model in a remote and rural Health Board (NHS Highland) and has informed specific programmes of Macmillan Cancer Support UK, pharmacy workforce planning, and the Boots Macmillan Information Pharmacists initiative.
Beneficiaries of this research are patients in intensive care and healthcare staff. This research has had impacts in two distinct but related areas:
These advances are informed by our synthesis and application of rigorous, innovative methodologies relating to questionnaire development and real-time data collection.
A high quality clinical trial, systematic reviews and meta-analyses performed by a team at Brunel University have directly informed key international clinical practice guidelines, policies and on the management of low back pain and neuropathic pain and have been cited by users (NHS Trusts: Addenbrookes) in response to such guidelines. In this way our research is directly informing clinical practice.