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Depression is a major public health problem producing substantial decrements in health and well-being, with 15% lifetime prevalence, affecting 350 million people worldwide. The Mood Disorders Centre (MDC) has improved treatment for depression by (i) understanding psychological mechanisms underpinning depression; (ii) translating this into innovative treatments and prevention interventions, evaluated in clinical trials; (iii) improving dissemination, delivery, and access to treatments. This research has improved patient care and quality of life, influenced national policy (NICE Depression Guidelines), informed national service and training provision (Improving Access to Psychological Therapies IAPT programme, with 680,000 people completing treatment 2008-2011) and achieved international impact on clinical practice.
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.
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.
In order to reduce morbidity and mortality from HIV/AIDS, tuberculosis and other chronic diseases, effective and cost-effective interventions to strengthen primary care through in-service nurse training were put in place as standard practice throughout South Africa (population 50 million), based on our research. This programme has so far trained 1500 trainers in all 8 provinces, who in turn have trained 18,000 primary care professionals in 1900 of all 3500 clinics nationally. South Africa, with 5.8 million HIV+ people, and 500,000 newly infected with tuberculosis each year, based its Nurse Initiation and Monitoring of Antiretroviral Treatment policy on our training package and trials. These were landmark changes in primary health policy and provision in South Africa. The training methods and materials are also being used in Gambia, Malawi, Brazil and Portugal.
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.
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.
There is strong evidence that Mindfulness-Based Cognitive Therapy (MBCT) plays a major role not only in preventing the recurrence of depression, but also in enhancing well-being more broadly. Much of this research was carried out at Bangor University's Centre for Mindfulness Research and Practice, with a focus on non-academic impact from the outset. Between 2008-2013, the Centre has delivered MBCT courses to over 1500 members of the public. We have also trained over 1300 professionals to deliver MBCT within the NHS and other contexts, leading to several successful spin-off businesses. Finally, Centre researchers lead in the creation of UK good practice standards.
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.
Improving patient experience of health services is a policy priority worldwide. The University of Manchester (UoM) has conducted research on patient experience since 1995, leading to the development of a series of validated measures for assessing patient experience of quality of care in primary care, including access to care and the degree to which services are patient-centred. Our measures have been in routine use in the NHS since 2004, sent to samples of several million patients. The data have been used to provide incentives for the highest quality practices, and to inform policy makers about current care throughout the UK.
Newcastle research into practical methods to reduce alcohol-related risk and harm has underpinned national policy, including the Government's Alcohol Strategy and a National Audit Office report. This has shaped public health practice concerning alcohol across England. A UK-specific screening and brief intervention (SBI) programme was developed by Newcastle University for use by GPs and nurses in primary care. This programme, which was designed to reduce alcohol-related problems, has been widely recommended and adopted. An evidence review commissioned by the National Institute for Health and Care Excellence (NICE) found that the use of SBI reduces alcohol consumption, mortality, morbidity and alcohol-related injuries. Department of Health figures show that SBI provides an estimated annual healthcare saving of around £100 million.