An Evaluation of Rheumatology Practitioner Clinics held in Primary Care

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An Evaluation of Rheumatology Practitioner
Clinics held in Primary Care

• Dr Richard Watts
• Consultant Rheumatologist Ipswich Hospital NHS
  Trust
• Senior Lecturer University of East Anglia

Norfolk and Suffolk Comprehensive Local Research
Network
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Outline

• Overview of Relationship between CLRN and NIHR
• How CLRN supports NIHR projects

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Network
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What is the UKCRN?

• Managed set of Clinical Research Networks to
  facilitate the conduct of clinical trials
  (commercial and non-commercial) and other
  well-designed studies
• Covers 6 priority Topic-Specific Clinical
  Research Networks Cancer (2001), Mental Health
  (2003), Diabetes (2005), Stroke, Medicines for
  Children, Dementia Neurodegenerative diseases
  (2006)
• Primary Care Network (national coverage) (2007)
• Comprehensive Clinical Research Network (national
  coverage) (2007)

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Purpose of UKCRN

• To provide a world-class health service
  infrastructure to support NHS clinical research.
• To support and conduct randomised controlled
  trials of interventions (including prevention,
  diagnosis, treatment, and care) and other well
  designed studies for commercial and
  non-commercial sponsors.
• To play a key role in promoting the active
  involvement of patients and the public in
  research.
• To enable research to be conducted across the
  full spectrum of disease and clinical need
  through a managed set of research networks

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Comprehensive Clinical Research Network

• The purpose of the Comprehensive Clinical
  Research Network in England is
• To provide support for all studies that fall
  outside Topic Specific Clinical Research
  Networks (TCRNS)
• To provide the NHS infrastructure to support
  clinical research by funding NHS support costs
• To help streamline the research management
  governance function

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NIHR Portfolio the benefits

• Studies that are included in the NIHR portfolio
  can benefit from the support of UKCRN-funded
  staff working in Local Research Networks, e.g.
• Infrastructure support, e.g. research nurse
  support
• identification and recruitment of patients
• NHS service support costs
• help and advice with RD approval procedures
• covered publicising the study
• (will depend on the resources available at
  individual sites)

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Role NIHR

• Commissions and funds NHS and social care
  research essential for delivering NIHR
  responsibilities in public health and personal
  social services.
• Role is to develop the research evidence to
  support decision making by patients,
  professionals and policy makers, make this
  evidence available, and encourage its uptake and
  use.
• It is for other organisations to develop guidance
  and services.
• NIHR funds research, not implementation or
  service development.

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Norfolk and Suffolk Comprehensive Local Research
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Research for Patient Benefit (RfPB)

• National response-mode programme for high quality
  investigator-led research projects that address
  issues of importance to the NHS.
• Funds research into everyday practice in the
  health service.
• Proposals will be identified by health service
  staff, and developed by them with appropriate
  academic input.
• All proposals must show evidence from systematic
  reviews to ensure patient safety and value for
  money.

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Research for Patient Benefit (RfPB)

• The RfPB programme funds research that has a
  clear focus on day-to-day practice within the
  NHS.
• Funds available on a population basis.
• Applications assessed and processed by a regional
  committee.

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Network
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RfPB Application

• An Evaluation of Rheumatology Practitioner
  Clinics held in Primary Care

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Network
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Project Background

• Rheumatology practitioners (RP) have become an
  integral part of the multidisciplinary team.
• RP services in Norfolk have evolved uniquely to
  include clinics led by RPs in primary care
• There are also traditional consultant and RP
  clinics held at the Norfolk and Norwich
  University Hospital

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Project Background

• What is not known is the clinical and cost
  effectiveness of independent RP services in
  primary care compared with conventional hospital
  based services.
• Existing data suggests that consultant care in
  the community is associated with better access
  but at higher cost.

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Project Aim

• To evaluate the health benefits, costs, and
  processes of rheumatology services held in
  primary and secondary care.
• To evaluate the clinical and cost effectiveness
  of independent RP clinics in primary care in
  comparison with RP clinics held in the DGH and
  with traditional consultant clinics.
• To evaluate patient perceptions of the quality of
  care in these settings.

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Methods - Qualitative

• 3 year study
• First, qualitative part of study
• 2 focus groups with 8-10 pts to establish their
  views about the present service
• To ensure that all relevant aspects of the
  service from the patients perspective are
  included in the clinical a cost effectiveness
  analysis.
• Face-face interviews with staff will establish
  their attitudes to outreach clinics.

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Methods - Quantitative

• Second part, compare the clinical and cost
  effectiveness of the different models of service.
  
• A case-referent (comparator) study comparing the
  features of RP outreach clinics (these will be
  considered the cases) with clinics held by RPs in
  hospitals and Doctors in hospitals (these will be
  considered the controls).

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Recruitment

• Consecutive patients with established RA
  undergoing routine follow up.
• Fulfil the ACR criteria for RA and gt 18 years.
• Exclusion no new referrals, those with
  concomitant severe medical problems and those
  with life threatening disease
• 235 RP outreach (cases)
• 235 hospital clinics (controls)

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Data Collection

• Self-administered questionnaires will be used to
  evaluate clinic process, patient perception of
  service quality, personal costs and health
  status.
• Process details will include clinic size, waiting
  times, outcome, investigations and procedures
  performed.
• Health status will be assessed using EQ-5D,
  SF-36, HAQ and RA activity measures.
• Resource utilisation will be assessed using
  standard questionnaires including staff costs
  (salary, travel), overheads, patients treatment
  and personal costs.

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Project Team

• Team consists of co-applicants
• Dr Richard Watts (chief investigator)
• Dr Gary Barton (health economist)
• Professor Alex Macgregor (rheumatologist)
• Mrs Janice Mooney (research nurse)
• Professor David Price (primary care)
• Professor David Scott (rheumatologist)
• Professor Lee Shepstone (statistician)
• Plus
• Lay member
• Research associate (tba)

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Project Sites

• Norfolk and Norwich University Hospital
• Primary Care
• Attleborough
• Fakenham
• Holt
• North Walsham
• Sheringham
• Thorpewood (Norwich)
• Wymondham

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How will CLRN help

• Infrastructure support,
• NHS service support costs
• Help and advice with RD approval procedures
• Liaison with Primary Care RCN
• Accrual Tracking
• Publicity

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Thank You
Norfolk and Suffolk Comprehensive Local Research
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