COLLEGE OF MEDICINE AND HEALTH
Medicine, Nursing and Allied Health Professions

Primary Care Focused Health Service Research

Organisation and Delivery of Care

 

We have designed and managed large, pragmatic clinical trials and used other robust methods to develop and evaluate alternatives to face-to-face GP consultations including telephone triage by GP or practice nurse and video consulting. This work has expanded to include a study of digital facilitation for online primary care services. We are considered one of the leading groups in the country for research on primary care workforce examining the changing GP workforce, primary care teams and the role of multispecialty community providers.

 

Current Projects

  • STOPP START - Understanding the use of the tools 'Screening Tool of Older Persons’ Prescriptions (STOPP)', and 'Screening Tool to Alert to Right Treatment (START)' to reduce complications of medications, need for GP appointments, the time people spend in hospital and medication costs
  • VOLITION - Development and feasibility testing of an intervention (VOLITION): To support older patients with multiple health problems in joint decision-making about their healthcare with a GP.

     

Past Projects 

  • COCOA - Care for Offenders: Continuity of Access

  • DAQOL AGE - the Devon Ageing and Quality of Life Study

  • ERS - The effectiveness and cost-effectiveness of exercise referral schemes: a systematic review and economic evaluation
  • ESTEEM - an NIHR-funded cluster trial of triage for patients seeking same day appointments in primary care
  • GETuP study - The effect of targeted exerise on falls and function for people with Parkinson's disease
  • MESH - Managing Illness by Empowerment of Self-Care and Harmonisation of Patient-Practitioner Agendas Asthma Self-Care Pilot Study
  • ReGROUP – NIHR-funded (Health Services & Delivery Research) project which aims to inform and support the NHS in addressing current GP workforce issues in the UK
  • Pain Clinic Practitioners' Beliefs About the Causality of, and Expectations for Treatment of Chronic Musculosketal Pain
  • Sickness Absence Project - early interventions for reducing the length of sickness absence
  • Special Messages in Primary Care - Development of a special message system to improve informational continuity in the out-of-hours care of patients with palliative care needs.

Measuring Experience and Outcomes

 

We have 20 years’ experience developing valid and reliable measures of primary care performance, focussing on the accessibility and patient experience of care. In collaboration with Roland (Cambridge) we have led the design/ evaluation of the English General Practice Patient Survey (GPPS), widely accepted as the most relevant barometer for informing commissioning policy and practice within primary care, resulting in >35 major publications (Campbell, Abel).

We have conducted world-leading research on the appraisal, development, implementation and evaluation of Patient Reported Outcome Measures (PROMs) in Clinical Practice (PROMETHEUS, Valderas). We are leading a Cochrane reviews of the impact of using PROMS in Clinical Practice in collaboration with Gibbons (MD Anderson, US) (Valderas).

We have led the development of the Patient Reported Experiences and Outcomes of Safety in Primary Care (PREOS-PC) as part of the collaboration with the NIHR National School for Primary Care Research, which has being translated and implemented in Spain and Brazil (Valderas). We are also leading the development of a survey of experiences and outcomes of Primary Care for patients with chronic conditions as part of the Patient-Reported Indicator Surveys (PaRIS) initiative for the Organization for Economic Development and Co-operation (Valderas).

 

Patient Reported Indicator Survey (PaRIS) Projects

  • International survey on outcomes and experiences of patients with chronic conditions. (OECD), €3,036,097, 15/01/2019-14/10/2023. Prof Jose Valderas
  • Development work in Norway as basis for an application to Horizon Europe on comparative health system analysis and research. Norwegian Institute for Public Health, £146,419, 01/06/2020-30/05/2021. Prof Jose Valderas

 

Patient-Reported Outcome Scores (PROMs) Projects

  • Time-dependent variation of patient-reported outcome scores in patients with chronic health conditions. University of Exeter, £50,000, 36 months Prof Jose Valderas

 

Past Projects

Identification/ Management of Vulnerable Groups

 

A considerable body of research focuses on patients with mental health problems, especially treatment-resistant depression, and patients who are depressed after an acute cardiac event. Other studies include a process evaluation of the ARRISA trial which aims to reduce hospitalisation and death of patients with asthma by identifying, flagging and prioritising care for those at-risk in primary care. Additional trials of community based weight loss interventions to prevent diabetes, and vascular risk assessment for patients unable to have upper arm measurement are also being conducted. 

 

Current Projects

Asthma

 

Blood Pressure

  • Clinical relevance of double-arm blood pressure measurement; prevalence of clinically important inter-arm blood pressure differences and associated patient characteristics, based on a cohort of 72,669 Indian primary care subjects using standardized automated simultaneous blood pressure measurement. 
  • Cochrane reviews: 
    • Allied health professional-led interventions for improving control of blood pressure in patients with hypertension
    • Home-based vs centre-based cardiac rehabilitation update
    • Involving older people with multimorbidity in decision-making about their primary healthcare: A Cochrane systematic review of intervention
  • EuroPAD
    • Diagnosis of peripheral arterial disease in primary care; a survey of general practitioners in England
  • Exploring the aetiology of clinic blood pressure changes during a single clinic visit: A cross-sectional study
    • Protocol for evaluation of the implementation of a home-based cardiac rehabilitation programme for patients with heart failure
    • Improving access to cardiac rehabilitation for people with heart failure: Implementation of a home-based service in the NHS 
    • Developing and evaluating a network of practice for the implementation of home-based heart failure rehabilitation across the UK
    • Improving the provision and access of cardiac rehabilitation services. REF Impact Case Study, University of Exeter

 

Older Patients

  • VOLITION: Development of an intervention (VOLITION): To support older patients with multiple health problems in joint decision-making about their healthcare with a GP

 

Women

Cross cutting with new modes of consulting and primary care:

  • Digital self-help focussed interventions for depression or anxiety in people with heart disease: systematic review and meta-analysis
  • D REACH-HF: Digital Rehabilitation Enablement in Chronic Heart Failure
  • Group-based interventions to improve control of blood pressure in hypertension: systematic review and meta-analysis
  • imPulse: Sensitivity and Specificity of a mobile lead-one ECG like device for the detection of Atrial Fibrillation (AF) 

 

Past Projects

  • Designing, evaluating and implementing novel interventions to promote and maintain weight loss. UEMS PhD studentship, £60,228, PI: Jane Smith, Sep 2013 - Mar 2018
  • Investigating the use of smartphone and Web 2.0 technologies used in behavioural interventions for weight management (post-doc mobility fellowship). Swiss National Science Foundation, £58,000, PI: Marco Bardus, May 2014 - Oct 2015
  • DESCARTE - Decision rule for severe symptoms and complications of acute red throat in everyday practice (DESCARTE)
  • Financial Assessment and Benefits (FAB) advice service: impact on older people and their carers in Torbay
  • SoSAA - run by Universities of Bristol and Exeter with the specialist team working for the charity Survivors of Sexual Abuse Anonymous (SoSAA) about the support that is available for people who have experienced sexual abuse, rape or sexual assault
  • Pain Clinic Practitioners' Beliefs About the Causality of, and Expectations for Treatment of Chronic Musculosketal Pain
  • Upstream Healthy Living Centre - community based intervention to address social isolation in the elderly

New Modes of Consulting and Accessing Primary Care

 

Whether face-to-face, telephone, video, or web based interactions, the consultation and related communication remains at the heart of the interaction between primary care professionals and their patients. Facilitating access to such interactions (and providing an evidence base for their use) and to other online services provided by the NHS requires an evidence base – we can’t just ‘assume’ that these alternatives are ‘a good thing’. On this page are some projects where we’re trying to support the NHS in providing evidence round alternative means and routes to accessing care.

 

Current Projects

  • Di-Facto - Facilitating access to online NHS primary care services - current experience and future potential
  • PRP - Current and potential impact of online consultations in general practice on socio-economic inequalities 

 

Past Projects

COVID-19 Related Health Service Research

 

COVID-19 came in to global healthcare like a hurricane in November 2019. By March 2020, the UK was in lockdown. The University of Exeter has delivered many high-quality projects round the COVID-19 research agenda. In primary care, we are leading BRACE: the UK’s largest trial, funded by the Bill and Melinda Gates Foundation and the Peter Sowerby Foundation, examining the potential for BCG in mitigating the effects of COVID-19 – working in collaboration with a major international consortium of resercahers. We’re also involved in other major studies listed below.

 

Current Projects