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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.
Research by Community and Health Research Unit (CaHRU) broadly impacted on healthcare provision and care received by patients from ambulance services. The research directly informed policy and was a key factor in improving prehospital care for emergencies by directly influencing care systems, regulators, ambulance services, paramedics, and service users, initially in the East Midlands and subsequently throughout England from 2008 onwards.
The research which aimed to improve quality of ambulance care led to: development of new clinical quality indicators for ambulance services in England; benchmarking of service quality; initiatives to address gaps in care; measurable improvements in managing pain, heart attack, stroke, asthma and diabetes across all English ambulance services. Regulators now use these quality indicators to assess ambulance trusts in England.
Research on telehealthcare at the University of Stirling has guided the delivery of telehealthcare at home in West Lothian Scotland in the first instance, subsequently influencing decisions to adopt and implement telehealthcare in communities in Norway, Greenland, the Faroe Islands, Sweden, the Western Isles and Shetland. Research was translated into the MAST (Methodology for the ASessment of Telemedicine) manual, a practical tool which has been used across Europe by decision makers considering telehealthcare implementation. Through the DSDC (Dementia Services Development Centre) at the University, telehealthcare information and guidance has been provided to thousands of service providers and family care givers.
The Personal Social Services Research Unit (PSSRU) at the University of Manchester (UoM) has run a programme of research examining community care of older people since 1996. The findings have informed key government decision-making around two important national policy initiatives between 2008 and 2013: (1) the development and implementation of Personal Budgets in Social and Health Care and (2) National Strategies to improve Dementia Services. This has affected the national provision of social care for older people and other adult social care users. In 2011-12, there were over 1.2 million people in England receiving social care affected by these policy changes (over 800,000 aged 65+), with a cost of £6,600m spent on their care (NHS and Social Care Information Centre).
Research into participative practice and well-being with older people has contributed directly to the development and application of an ethic of care in policy and service delivery, as well as to practices in older people's participation, locally, nationally and internationally. The research has directly impacted on practitioners and practice developments in services for older people, with learning resources (co-designed with practitioners and older people) being used in professional education and training across the UK and in New Zealand. An innovative participatory methodology has both enhanced older people's participation locally and been adopted more widely by university community research collaborators working to enhance older people's citizenship and well-being (eg in Netherlands). Research has directly informed policy concerning older people's needs assessments by recognising the centrality of relationships to well-being in older age. The well-being research involving collaboration with service users and providers has been described as `exemplary' by the leading national charity Age UK.
Primary research with people with multiple sclerosis and their carers, led by Brunel, has had positive impacts on service user and government organisations internationally; research has improved practice in relation to the nature and effect of self-management strategies of people with Multiple Sclerosis, as well as enhancing therapy for the condition and raising awareness of the needs of carers. The research has shaped evidence-based guidelines, consensus papers, reports and policies, which have in turn enhanced the effectiveness of professional practice and service delivery. Through developing the evidence base and sharing best practice the research has resulted in improved health and welfare benefits for people with multiple sclerosis and their carers.
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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.
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.
Research at Newcastle has made a significant contribution to the public services modernisation agenda in the areas of inter-agency working and information-sharing. The research showed that effective information-sharing required not just that different information systems are made compatible with each other, but also that people from different professional cultures are enabled to work together through a common understanding of information governance issues. In active collaboration with a range of service providers, a number of processes and tools were developed for the significant benefit of service users. They have been implemented in a variety of policy settings, including children's services and adult social care, and have informed current programmes funded by the UK government.