PRIME Centre Wales Long Term Conditions Consensus Meeting Tuesday 10th November 2015, St Mary's Priory, Abergavenny, NP7 5ND http://www.primecentre.wales/ltc-consensus-meeting.php

1. PRIME Centre Wales
Methodologies for Research
in Primary Care
Dr Nefyn H Williams
North Wales Centre for Primary Care
Research
Bangor University

2. Work Packages
1. Long term conditions & co-morbidity
2.Patient centred &
prudent health care
3.Infections &
antimicrobial
resistance
4.Screening, prevention,
& diagnosis in primary
care
5.Unscheduled and

3. Primary and Emergency Care
• First contact
• Person-centred
• Comprehensive
• Co-ordinated
• Family centred
• Community orientated
• Complex
• Multi-morbidity
• Ageing
• Health and social care provision
• Multi-disciplinary
• Primary care
• Community care
• Social care
• Emergency care

4. Challenges
• Health needs and inequalities in Wales
• Prudent health care delivery
• Reconfiguring health services
• 90% of care outside of hospital
• <8% of resources
• Re-thinking
• More prevention
• Increased care in the community
• Reducing burden of frailty & chronic disease
• Switch focus from disease to functional impairment?
• Rehabilitation for all?
• More evidence…

5. Systematic Review methods
• Treatment sequencing PhD
• Reviews of treatment sequencing
• Identify methodological challenge
• Identify data needed to parameterise decision analytic models
• MRC skills development fellowship
• Compare discrete Markov cohort versus discrete event simulation for
modelling treatment sequences for advanced prostate cancer
• Assess impact of using simplifying assumptions for developing sequence
effects on structural uncertainty
• Network meta-analysis sciatica treatments
• Results used to justify RCT of a biological agent to treat sciatica
• Realist review to develop complex intervention
• Development of a community based rehabilitation intervention following
proximal femoral fracture

6. Co-production
• Research priority setting in residential care homes
• Wide range of topics requiring further investigation
• Involve stakeholders in decisions regarding prioritisation of topics for
future research
• Obtain consensus using participatory research techniques (Delphi)
• Early cancer diagnosis
• Utilise social and community networks to co-produce, evaluate and
implement interventions to facilitate early cancer diagnosis

7. Routinely collected data
• Patient safety and healthcare improvement
• Collection of routine healthcare data such as safety incident reports and
combining with existing research and improvement activity, expert
consensus and empirical data
• Screening for colorectal cancer
• NIHR themed call on multi-morbidity
• Data linkage via SAIL to link screening and primary care data
• Concurrent economic evaluations
• Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR) feasibility
study
• Collection of routinely collected health service activity data compared
with that obtained from patient completed questionnaires

8. Randomised Controlled Trials
• Adaptive trial design
• Adaptive trial design of anti-virals for seasonal influenza
• Routinely collected data
• Concurrent economic evaluation
• e-trials
• Outcome measures
• FEMuR feasibility study comparing 3 different types of self-efficacy
questionnaire, comparison of ICECAP with EQ-5D
• Evaluate new quality of life tool for children with eczema
• Palliative care settings
• NoBLE comparing hyoscine versus placebo for death rattle
• Cariad comparing different types of carer administered opioid analgesia

9. Development of Complex Interventions
• Wearable technology
• Wearable devices (iWatch, fitbits etc.) linked by blue-tooth technology to
mobile phone apps
• Multiple methods for intervention development
• Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)
• Intervention developed using:
• Realist review
• Survey of current practice
• Focus groups of participants, carers and rehabilitation professionals

10. Development of Complex Interventions
• Wearable technology
• Wearable devices (iWatch, fitbits etc.) linked by blue-tooth technology to
mobile phone apps
• Multiple methods for intervention development
• Fracture in the Elderly Multidisciplinary Rehabilitation (FEMuR)
• Intervention developed using:
• Realist review
• Survey of current practice
• Focus groups of participants, carers and rehabilitation professionals