Wales Centre for Primary & Emergency Care Research:

PRIME Centre Wales

Professor Adrian Edwards Centre Lead

Background

• NISCHR infrastructure call for new research Centres & Units - 2014

• Wales School for Primary Care Research (WSPCR) 2008-14: Universities of Cardiff, Bangor, South Wales.

• Thematic Research Network for emergency, UnScheduled, and Trauma care (TRUST) 2008-14: University of Swansea

• Collaborative bid: Wales Centre for Primary & Emergency Care Research – PRIME Centre Wales

All Wales Centre

Bangor University

Swansea University

Cardiff University

University of South Wales

Wrexham

Leadership Team

• Director: Adrian Edwards, Cardiff University

• Partner University Leads:

–Professor Richard Neal, Bangor University

–Professor Helen Snooks, Swansea University

–Professor Joyce Kenkre, University of South Wales

Aims

• PRIME Centre Wales aims to improve the health and well being of people in Wales and internationally through:

– undertaking high quality research on topics of national policy priority which contributes to the evidence base in primary and emergency care

– ensuring that research findings are translated into policy and practice.

Objectives: growth, collaboration

1. Increase the quantity of large scale high quality research- carried out or led from Wales

• attracting prestige funding into Wales• leading prestige research• collaborating across our participating universities

– funding applications, projects– PhD studentships and fellowships

– collaborating in studies led from elsewhere

– encouraging recruitment of patients in Wales into high quality studies– embedding Patient and Public Involvement in all research stages

– increasing the number of research leaders in primary and emergency care research in Wales

– demonstrating collaboration with other NISCHR Centres and Units– working with industry and the third sector in the prioritisation, design and

conduct of research– promoting collaboration in multi-disciplinary research that includes the

contributions of relevant stakeholders.

Objectives: impact

2. Achieve high and demonstrable research impact by:– publishing research findings

• high quality scientific and practitioner journals• popular media

– working with policy-makers, public and practitioners to ensure that findings are implemented and transferred to all relevant settings

– presenting at academic, public and practitioner conferences• nationally and internationally

– tracking evidence of impact across domains including health, social care, wellbeing, economy and professional development

– raising the profile of research in primary and emergency care in Wales on the national and international stages

– working with industry and the third sector in the reporting and dissemination of research findings.

Objectives: PPI, capacity

3. Undertake research and dissemination activities of key importance to patients and the public– involve service users, carers and wider public in

prioritisation, design, conduct, interpretation and dissemination of research.

4. Build capacity for research in primary and emergency care in Wales, across disciplines, sectors, professional groups and levels of seniority.

PRIME Centre Wales: Work Packages

1. Long term conditions

2. Patient centred & prudent health care

3. Infections & antimicrobial resistance

4. Prevention, screening & diagnosis

5. Emergency & unscheduled (includes pre-hospital) care

6. Patient safety & health care improvement

7. Oral health

8. Methodological innovation

Who will we work with?Public and patients

• Strategy Leads: Bridie Evans & Alison Porter, Swansea University

• Service users involved in developing proposals– named co-applicants

• Building on ‘SUCCESS’– award-winning service user group - a network of service users

and carers across Wales– developed expertise and understanding of the research process– provide rich, wide-ranging contributions to TRUST-linked

research.

• Represented in PRIME Centre Organisational Structure:– Executive Management Board – 3 members– Faculty – Infrastructure link with Involving People

Who will we work with?Social Care Services

• Strategy Leads: Professor Joyce Kenkre & Dr Carolyn Wallace, University of South Wales

• Represented in PRIME Centre Organisational Structure:– Executive Management Board – Gideon Calder, social care representative– Faculty – 4 members.

• Examples of engaging with social care services include:– YMCA drop-in centre for young parents to help establish healthy, independent and happy

lives.– Care home staff identifying and prioritising 23 research topics.

• Emergent themes: improving communication between hospital and care home staff;• care home staff development; • diagnosing UTIs in elderly women.

• Examples of Future work:– Partnership with City and County of Swansea on the Social Care and Health of Older

People• study of use of social care and unscheduled hospital admissions using routine anonymised data.

– Nursing and Care Homes, working closely with partners in the social care sector in conducting research, • e.g. the HTA PAAD and EME PRINCESS studies (Francis).

Who will we work with?Third Sector

• Strategy Lead: Professor Richard Neal, Bangor University

• Represented in PRIME Centre Organisational Structure:– Executive Management Board – Chris Mulholland,

British Lung Foundation– Faculty links – Age Cymru, BLF, Home-Start UK.

• Future plans:– Build on our experience and relationships with third

sector organisations– Consensus building event inviting people from the

third sector to prioritise research issues and establish how we can deliver these collectively.

Who will we work with?Industry

• Strategy Lead: Professor Richard Neal, Bangor University

• Represented in PRIME Centre Organisational Structure:– Executive Management Board – Strategy Lead: Richard

Neal– Faculty links – Industrial & commercial partners.

• Future plans:– Linking with Health Research Wales & SEWAHSP

(South East Wales Academic Health Science Partnership)

– Build upon existing industrial & commercial links• All Themes continuing to identify and collaborate with

commercial partners for primary, community and emergency and social care settings

NISCHR Infrastructure Links

• Trials Units: NWORTH, SEWTU, SCTU (formerly WWORTH), WCTU• NISCHR CRC Research Professional Network• Other units/centres: •Wales Cancer Research Centre•Centre for Ageing & Dementia Research •Diabetes, Cardiovascular & Stroke Rehabilitation Centre, Cymru•Wales Centre Population Health Res•Centre for Mental Health•Wales Brain Research Unit

• Health Information Research Unit (HIRU)• Involving People• NISCHR Faculty & AHSC• Health Economics (WHESS)• Wales School of Social Care• PICRiS research ready practices

PRIME Centre Wales - Faculty

• All WCPECR Collaborators

• PPI: all previous / current PPI collaborators

• Health care professionals: Welsh RCGP, RCN, Paramedic

• Social care professionals via:

•Care Forum Wales

•Public Services Support Unit, Torfaen

• Government representatives

• Third sector links (Age Cymru; BLF; Home-Start UK)

• Industrial & commercial partners

• Et al.

• What will PRIME Centre Wales do?

PRIME Centre Wales: Work Packages

1. Long term conditions

2. Patient centred & prudent health care

3. Infections & antimicrobial resistance

4. Prevention, screening & diagnosis

5. Emergency & unscheduled (includes pre-hospital) care

6. Patient safety & health care improvement

7. Oral health

8. Methodological innovation

WP1 – Long Term Conditions

– Leads: Professor Joyce Kenkre, Dr Carolyn Wallace, University of South Wales

– Focus: Develop research in practice that is needs led for LTCs

– Link professional groups, organisations, and users across sectors, integrating with Social Care.

– Project: The Functional Recovery from stroke during rehabilitation in the Cardiff Stroke unit and home environment (Robert van Deursen, Alan Preece, Allison Cooper).

• WP2: Patient Centred & Prudent Health Care– Leads: Dr Fiona Wood & Professor Adrian Edwards,

Cardiff University

– Focus: • Patient empowerment and co-production in engaging

patients and members of the public in health and health care.

• (i) Shared Decision Making & Decision Aids

• (ii) Self-management support & health literacy

• (iii) Behaviour change.

• Innovation, implementation and evaluation of interventions.

– Project: MAking Good decisions In Collaboration with patients (MAGIC) (Adrian Edwards)

• WP3: Infections & Antimicrobial Resistance

– Lead: Dr Nick Francis, Cardiff University

– Focus:

• Maximise the understanding of infectious disease epidemiology and mechanisms

• Develop and evaluate interventions to improve management of common infections

• Enhance antimicrobial stewardship in primary care.

– Project: POETIC – point of care testing for urinary tract infections in primary care.

• WP4: Prevention, Diagnosis & Screening– Leads: Professor Richard Neal, Bangor University & Dr Kate

Brain, Cardiff University– Focus:

• Public health problems and inequalities in Wales (smoking, obesity, inactivity)

• Continuing strong work in cancer (2015-17; linking with NISCHR Cancer Centre)

• Addressing other priority health areas (e.g. heart disease, rheumatoid arthritis; 2017-18)

– Examples of work:• Awareness and Beliefs about Cancer Care (ABACus programme) -

cancer Research UK and Tenovus• ‘WICKED’ – Wales Interventions and Cancer Knowledge about

Early Diagnosis – programme to Cancer Research Wales• Diagnostic Journeys in Sarcoma – PhD studentship to Sarcoma UK• WG – Lung Cancer Awareness Campaign

• WP5: Emergency & Unscheduled Care (includes pre-hospital) – Lead: Professor Helen Snooks, Swansea University– Focus:

• Appropriate (‘Prudent’) emergency and unscheduled care, avoiding unnecessary contacts and streamlining the emergency care system.

• Collaborations with UK-wide ambulance services to develop and test alternative care models, linking closely to the e-trials methodological theme

• Close connection with the 999 EMS Research Forum to disseminate research and transfer knowledge to practice.

– Project: SAFER2 Trial - Evaluation of the clinical and cost-effectiveness of assessment and referral of older people who fall by emergency ambulance paramedics to appropriate community care (RCT).

(Helen Snooks)

• WP6: Patient Safety & Healthcare Improvement– Lead: Dr Andrew Carson-Stevens, Cardiff University

– Focus: • epidemiology of care quality in terms of the frequency,

burden and preventability of harm

• Development, testing and implementation of interventions in priority areas

• Development / refinement of methods to learn from routine health care data (e.g. safety incident reports), existing research and improvement activity, expert consensus, and empirical data.

– Project: Characterising the nature of primary care patient safety incident reports in England and Wales: mixed methods study (PISA study) (Andrew Carson-Stevens)

• WP7: Oral Health

– Lead: Professor Ivor Chestnutt, Cardiff University

– Focus:

• Quality research in Primary Dental Care– preventive technologies, antibiotics, HSR / prudent dental care

• Collaborate where there is currently expertise in Primary Medical Care research that could be applied to Primary Dental Care / where oral health can reasonably be incorporated into another study

– Project: Seal or Varnish? A randomised trial to determine the relative cost and effectiveness of pit and fissure

sealants and flouride varnish in preventing dental decay.

• WP8: Methodological Innovation– Leads: Dr Nefyn Williams, Bangor University &

Professor Kerry Hood, Cardiff University

– Focus: Cross-cutting work package that will promote, identify and develop methodological innovation in the 7 other work packages within:• systematic reviews and evidence synthesis

• randomised controlled trials

• qualitative research.

– Project: FP7 funded PREPARE study. Platform for European Preparedness Against (Re-)Emerging Epidemics. • Work Package 1 (EARL): Rapid review & qualitative analysis of

focus groups to identify Ethical, Administrative, Regulatory & Administrative solutions to conducting ‘live’ research during an epidemic / pandemic.

Early successes• New grant awards…

– RHiNO Respiratory Health in Preterm Neonatal Outcomes.• MRC £1.7 million; Dr Edgar Williams (USW, co-app) with Kotecha, Henderson, Doull,

Marchesi (CU), Wild (Sheffield) and Dr Z Hoare (NWORTH),

– Epidemiology of Patient Safety in 1Care• DH England, £350k, Nottingham (Avery – with Carson-Stevens, Edwards

– Patient choices for prostate cancer treatment • Tenovus, £60K, Wilkinson C, Neal RD.

– Evaluating cancer services across the NHS in Scotland, Wales and Northern Ireland. • Cancer Research-UK, £73K, Morrison, Black, Donnelly, Gavin, Hubbard, Jones,

MacDonald, McNeish, Neal RD (Bangor).

– Data linkage across ambulance services and acute trusts: assessing the potential for improving patient care• Health Foundation, £475,696. Lead: Clark S, London Ambulance Service. Co-applicants:

Porter A, Snooks H et al

– Using record linkage analysis to inform the development of an improved care pathway(s) for psychiatric and self-harm emergencies currently transferred by ambulance to Emergency Departments• £30,000, Chief Scientific Office. Lead: Duncan E, University of Stirling. Co-applicant:

Snooks H et al

First Annual Event: Tuesday 22nd

September

• Confirmed speakers:– Mark Drakeford AM, Health Minister

– Ruth Hussey, CMO Wales

– Jean White, CNO Wales

– Simon Denegri, PPI Lead, NIHR

– Niro Siriwardena, Lincoln University

– Fiona Godlee, BMJ Editor

• Venue: Wales Millennium Centre, Cardiff Bay