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CLAHRC2 East Midlands (Collaboration for Leadership in Applied Health Research and Care) Richard Morriss and John Gladman CLAHRC’s NDL, LNR and EM AIMS: 1. Conduct high quality applied health research (public health, community focus, high primary health services research esteem); 2. Implement the findings from research into clinical practice (using AHSN approaches); and 3. Increase the capacity of NHS organisations to engage with and apply research Track record: high quality research, NHS capacity • Delivered over 100 research and implementation projects • Recruited 33,000 people as research participants • Attracted around £17.5m in external research grant funding, including from industry partners • Published over 300 papers in peer reviewed journals • Supported 30 PhDs • Supported 40 diffusion fellow/knowledge broker posts for clinicians and 30 research into practice placements Implementation • Specialised mood disorder service in 3 NHS Trusts • CBT + IPS intervention helped over 50% people with serious mental illness into work (previously 12%) • Identified barriers and drivers to engaging people with personality disorder in psychological treatment and training package • 3,000 patients in EIP received simple intervention to improve dental care • CLAHRC BITES adopted nationally as a means of brief summaries of useful research findings • SDO report (Warwick University) – iteration between services, clinicians and research led to implementation of high quality intervention New CLAHRC EM • Host Trust : Nottinghamshire Healthcare Trust • Director: Professor Kamlesh Khunti, Professor of Diabetes and Primary Care, University of Leicester • 55 NHS, local authority, university, third sector and industry partners in East Midlands CLAHRC EM Themes Theme Theme Leader Preventing chronic disease Professor Kamlesh Khunti (U of Lei) Managing chronic disease Professor Sally Singh (U of Lei) Caring for older people and stroke survivors Professor John Gladman (U of Nott) Enhancing mental health Professor Richard Morriss (U of Nott) Implementing evidence and improvement Professor Justin Waring (U of Nott) Overall vision • Take health problems with highest prevalence, greatest disability and mortality, priority of CCGs and HWBs in East Midlands • Research into cost effectiveness and implementation of national or local policy interventions e.g. NICE, IAPT • Evaluate technology (NIHR/AHSN/HTC) • Address BME and all ages- adapt practice • Evaluate implementation strategies used by CLAHRC/AHSN e.g. network/brokerage, education, technology QOF data. Source: NHS Commissioning Board CCG Information Packs 2013-14. East Midlands England 2011/ 2012* Coronary Heart Disease 3.8 (2.7 - 4.6) 3.4 Stroke/TIA 1.8 (1.2 - 2.3) 1.7 14.3 (10.5 - 16.7) 13.6 COPD 1.8 (1.3 - 2.3) 1.7 Mental Health 0.7 (0.5 - 0.9) 0.8 Asthma 6.2 (5.1 - 7.1) 5.9 Dementia 0.5 (0.4 - 0.7) 0.5 Diabetes Mellitus 5.7 (4.4 - 7.0) 5.8 11.5 (7.4 -15.8) 11.7 5.5 (3.0 - 9.1) 4.3 11.4 (8.5 - 14.8) 10.7 Hypertension Depression Chronic Kidney Disease Obesity The CLAHRC will provide useful interventions • Information and evaluated tools on how to diagnose, prevent and manage in high risk patients for GPs, community services and with some adaptation mental health services: diabetes, tobacco control, obesity, chronic kidney disease, chronic obstructive airways disease, cardiac disease • Interventions for children in schools, pregnant women, people from South Asian background – obesity, exercise, tobacco control Enhancing Mental Health • Our commissioners, service providers and service users told us they wanted: NICE Guidelines, particularly depression*, selfharm*, bipolar disorder (revision), schizophrenia (revision) • Psychological treatments and crisis work • Complexity, transition across primary care/general hospital/mental health and reduce emergency/urgent contacts. • Older and younger age as well as adults Depression pathway (WHO survey Lancet 2012worldwide, 2nd leading cause of disability): Depression and self-harm – best predictors of suicide, suicidality & depression. 70% calls for to Nottingham city crisis team. In adolescents, adult, PD/forensic (NICE self-harm recommendation 10 session psychological treatment by front line staff) 5 year follow up of 187 patients treated by specialist mood disorder team – mean duration of 7 years Economic modelling study of specialist mood disorder team as part of depression pathway (NICE depression guideline) Technology: RCT of results from QBTest (objective measure of attention and hyperactivity) versus treatment as usual in ADHD (8-18 yrs) Emergency use & anxiety (1st & 7th world disability) IAPT services have to start managing medically unexplained symptoms (NHS £3 billion additional cost/yr). RCT of teaching IAPT teams to manage health anxiety in people who repeatedly present as emergency in primary & secondary care v usual care Prevalence & service needs of dementia & elderly people with cognitive impairment in forensic settings Proposed implementation • Additional research projects in mental health and older people chosen in 2015 to start 2016 (not drugs, high quality design) • Implementation of mental health theme projects to be led by NHS staff (networking leads) working as “knowledge brokers” with other network practitioners, research team, service users, Trust staff, AHSN, LET-B, professions, clinical strategic networks, commissioners