We need to think about treatment journeys when evaluating complex interventions

By Dr Katrina Turner
Senior Lecturer
Centre for Academic Primary Care

Most clinical trials are pragmatic in nature and aim to assess the effectiveness of a new treatment against ‘treatment as usual’. When interpreting trial results, researchers tend to focus primarily on what treatment participants in different trial arms received. This may be difficult in the usual care arm, as this arm is often poorly defined, whereas the intervention arm is often clearly defined prior to the trial starting. In addition, this focus is very narrow. Treatment is a process and patients’ experiences of accessing and receiving care could also influence their treatment outcomes, and thus the trial’s results.

A paper recently published in Trials  highlights that differences do exist between the experiences of participants randomised to usual care and intervention arms. These differences relate not only to what treatment participants receive, but also how they access and engage with … Read more

Measuring outcomes in primary care

by Dr Mairead MurphyDr Mairead Murphy
Senior Research Associate
Centre for Academic Primary Care

With ninety percent of patient interaction with health services going through primary care, it’s not surprising that primary care clinicians and researchers try to figure out ways to improve primary care services. Interventions are many and varied, and result in important questions about their effectiveness. Do electronic consultations offer a good service to patients? If GPs introduce advice on healthy lifestyles into the consultation, does it make patients healthier? What about increasing the duration of GP appointments to ten minutes – does this improve outcomes for patients? Or ensuring that patients always see the same named doctor? Or painting the waiting room green?

Questions like these are normally answered by administration of a generic patient-reported questionnaire. By comparing the responses of groups of patients (say those with eight minute consultations and those with ten minute consultations), researchers can … Read more

What is the ‘3D approach’ for managing multiple long-term conditions?

by Dr Mei-See Man
Trial Manager
Centre for Academic Primary Care

The 3D study, led by researchers from the Centre for Academic Primary Care (CAPC), is examining a new approach for GP practices to manage patients with multiple long-term health problems.

Meeting a need

Existing treatment is based on guidelines for each separate condition meaning that patients often attend multiple appointments for each disease which can be repetitive, inconvenient and inefficient. They see different nurses and doctors who may give conflicting advice. These patients frequently get depressed and they also sometimes complain that no-one treats them as a ‘whole person’ or takes their views into account.

The 3D approach was developed by patients and GPs together to address these issues. Based around patient-centred care, the approach focuses on three ‘D’s: Depression, Drugs and the patient’s Dimensions of health, such as their quality of life, priorities and … Read more

Listening to the child’s voice in research on domestic violence and abuse

LisaArai071015By Lisa Arai
Senior Research Associate
Centre for Academic Primary Care

Anybody who has worked on a systematic review will know you spend a lot of time thinking about the type of research papers to include in your review and those you will exclude. Tightly defined inclusion criteria, as well as critical appraisal, an explicit synthesis stage and measures to reduce reviewer bias (such as inter-rater checks), are what distinguish systematic from traditional reviews (a point usefully made by Mark Petticrew more than a decade ago, when he sought – among other things – to debunk the notion that systematic reviews are simply larger versions of traditional reviews).

Over many years teaching research methods, I’ve noticed students often regard this early stage of the review process as troublesome. It’s often approached with an uncertainty that, if not properly resolved, can render the review unwieldy. Or its significance might be underestimated; … Read more