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Partnership with the NHS and community sector has paid dividends for research

By David Wright

David Wright and colleagues describe how a new school of pharmacy has been able to attract over £2.5m in funding for research in medicines management

 

In May, the 2011 Health Services Research and Pharmacy Practice (HSRPP) conference is to be hosted by the School of Pharmacy at the University of East Anglia (UEA) with the theme of “Research in partnership”.

This is the first of the new schools of pharmacy to host this conference. The medicines management team at the UEA has, in the past three years, attracted over £2.5m in research funding in its own right and is a named collaborator on grants exceeding a further £1.5m.

A main factor in this achievement by a relatively new, small and inexperienced pharmacy practice research team is the ability to work in partnership with the NHS, the pharmaceutical industry and community pharmacy, and to collaborate with colleagues beyond the school.

In the first few years of the new school we focused on building the research team, developing external relationships and gaining experience in writing grant applications. The vision for the medicines management team was that of pharmacy practice researchers working alongside social scientists, medical statisticians and health economists. Due to the close proximity of a school of medicine we were successful in filling such posts.

The inclusion of other disciplines within research applications not only immeasurably improves their quality but also provides a better understanding of the subject areas for traditional pharmacy practice researchers.

Come to the conference

Attendance at the HSRPP conference 2011 will not only provide attendees with some insight into the quality of pharmacy practice research across the UK, it will also demonstrate the value of collaborative working and, it is hoped, provide a stimulus for greater partnership working between academia and practitioners.

The UEA experience to date has clearly shown that this approach can provide distinct benefits for all partners.

The conference will be held on 5 and 6 May 2011. Those interested in attending can visit www.hsrpp.org.uk for further details.

Develop grant writing skills

The good relationship between the schools of medicine and pharmacy at UEA provided the team with opportunities to join the local research governance committee and, more importantly, the National Institute for Health Research (NIHR) Research for Patient Benefit (RfPB; see Panel 1) committee.

The resulting experiences, together with a large number of initially unsuccessful grant applications, were pivotal to developing the team’s grant writing skills. Regular sight of research protocols and reviewers’ comments both on the local research governance committee and RfPB regional committees provided an invaluable opportunity to develop the skills to discern between good and poor quality research and possibly, more importantly, what funding bodies expect.

Panel 1: Research for Patient Benefit

Research for Patient Benefit (RfPB) is a nationally co-ordinated funding stream for regionally commissioned research. The RfPB scheme is a National Institute for Health Research programme and is ideal for researchers who want to test the feasibility of new services and undertake pilots.

With a maximum (and usual) grant award of £250,000 the money is not expected to be used to fund definitive trials of complex interventions unless feasibility and pilot studies have already been undertaken and a relatively small sample size provides sufficient power for the study to be performed.

The RfPB scheme accepts direct applications for membership of its regional grant awarding committees and we strongly recommend that all English schools of pharmacy with an interest in applied pharmacy practice research are encouraged to apply for membership on their local RfPB committee.

Each regional committee, including the committee within the East of England, is multidisciplinary and, due to the large number of research applications based on new uses for medicines or improving medicines use, pharmacists can offer significant input into the decision making process.

The UEA medicines management team has submitted 10 RfPB grant applications (the outcomes of seven are known) and has been successful in five of them although sometimes only after resubmission. The national success rate for RfPB applications is less than 20 per cent. Possible reasons for our success are listed in Panel 2.

Panel 2: possible reasons for successful applications to NIHR

  • Having an appreciation of the committee review process
  • Having good patient and public involvement from the outset
  • Demonstrating close working relationships with NHS organisations
  • Including a medical statistician, health economist and social scientist on applications where appropriate
  • Working with health service researchers with trials expertise where appropriate
  • Ensuring that recruitment goals are achievable
  • Developing ideas with clear patient benefit
  • Proposing projects that meet the government agenda of increased efficiency
  • Including novel solutions within research design to demonstrate careful planning
  • Selling the project and idea throughout the application
  • Providing clear aims and objectives that can be met and are appropriate for the proposal (ie, aims for a pilot study should not mirror those of a definitive study)
  • Ensuring that applications have a robust design and methodology (through partnership with the local research design service)

One of the unsuccessful RfPB applications was subsequently converted into a successful NIHR health technology assessment application for £440,000 to determine the feasibility of running a definitive trial with multi-compartment medication devices.

Within each region, there is a NIHR research design service that can be accessed for support in preparing research grant applications and even access to health economists and statisticians for delivering the grant if successful.

One of the workshops at the HSRPP conference in 2011 will be delivered by the research design service, providing insight on how to improve the preparation of grant applications.

Partner with the NHS

We would like to claim that the ideas for the successful grant applications have all come from the medicines management team but, in fact, three of the projects were initiated by NHS colleagues. First, due to our interest in medicines administration to patients with dysphagia, we were approached to collaborate on developing an evidence base for putting medicines down enteral feeding tubes. The RfPB committee within the South Central region awarded a grant to enable us to describe current practices and test these in a laboratory.

Secondly, a monthly research clinic provided to Addenbrooke’s Hospital’s pharmacy department to support the research infrastructure resulted in a successful grant application to undertake a pilot randomised controlled trial for medicines reconciliation to be provided to all patients by pharmacists within 24 hours.

Thirdly, an approach from a consultant pharmacist working within NHS Cambridgeshire resulted in another successful RfPB bid to perform a definitive trial on multidisciplinary medication reviews within care homes (CAREMED).

The two other successful grants, arising from a PhD project and educational research undertaken on behalf of the Royal Pharmaceutical Society, are based in Norfolk and Norwich University Hospital NHS Trust’s pharmacy department and NHS Norfolk, respectively.

More recently, we have submitted a grant application with NHS Suffolk. We see all of these grants as cementing our relationships with our NHS colleagues across our part of the east of England. Due to our external engagement with the NHS we were invited to submit applications to the strategic health authority to evaluate our community postgraduate diploma and to evaluate the local pharmacy education and workforce needs.

The latter project is now complete and is being disseminated via the region’s local practice forums. The former still has two years to go, but will provide some insight into the value of providing access to postgraduate diplomas to community pharmacists.

Due to the recognised importance of research collaborations with NHS partners and consultant pharmacists in particular, representatives from the consultant pharmacist group have been invited to attend the 2011 HSRPP conference, with one of them expected to join the organising committee in the future.

One of the aims of the conference is to provide opportunities for new researchers to present their work and to provide a showcase for aspiring health services researchers. Consequently, we are extending invitations to practising pharmacists who are interested in developing a research portfolio.

Involve patients and the public

The NIHR now regularly expects the involvement of patients both in the initial design of projects and their delivery. A regular failing within RfPB applications is the promise of patient involvement if successful but no involvement in the development of the application itself. Such omissions are particularly poorly received by patients who form a part of the external review network.

Working with the local Public and Patient Involvement in Research (PPIRES) Network in Norfolk has been a positive experience, with patients always willing to provide advice and views on study design. Every grant we have submitted has been significantly enhanced by PPIRES involvement and for this reason, members of the network have been invited to co-chair relevant HSRPP conference workshops in May 2011.

Collaborate

Collaborations with colleagues outside the university have also been pivotal to the team’s development. One piece of guidance given to us when setting up the school with a relatively inexperienced research team was to identify mentors as role models for our research activities. This mentorship has been provided by colleagues in the school of medicine and by the medicines management research team at the University of Aberdeen.

Working with teams familiar with applying for and managing large research projects, such as the Medical Research Council grant led by Christine Bond, professor of primary care: pharmacy at the University of Aberdeen, to evaluate the role of the independent pharmacist prescriber in chronic pain management, provides the experience necessary to apply for such grants of the same nature with confidence.

More recently the two groups, led by Aberdeen, have been successful in obtaining a significant Pharmacy Practice Research Trust grant to develop an evidence base for pharmacist involvement in minor ailments management.

Cross-school collaborations are vital for the multi-centre trials that are required to produce rigorous evidence to support the profession’s development. We would strongly recommend that new medicines management research teams look for senior partners to collaborate with because those senior partners will equally benefit from the collaboration.

The HSRPP conference will provide an opportunity to meet with senior researchers from schools of pharmacy and includes research based workshops for the first time this year to encourage interaction between individuals who may not have met or worked together before.

Partner with community pharmacy

The need to demonstrate the value of the community pharmacist resulted in a relatively recent approach by the Numark group to undertake some research through independent community pharmacies. Although this was a significant departure from the team’s research within hospital and primary care trusts, it has been a useful development.

The positive enthusiasm of the participating independent community pharmacists was one of the main learning points from the process, with the other being the need to employ a research assistant within each site to aid the recruitment process. Undertaking high quality randomised controlled trials within a number of community pharmacies is clearly going to be expensive.

There are a number of suitable research programmes within the NIHR portfolio for such evaluations and these are set firmly in our sights for future applications.

Partner with industry

Working with the pharmaceutical industry is, perhaps, the most contentious area in a field that is designed to improve pharmaceutical care while delivering service efficiency. Appropriately selected projects can, however, improve patient care, while providing benefits both for the industry and the school’s research team.

Representatives of the pharmaceutical industry will attend the 2011 HSRPP conference with all proceeds being used to enhance the quality of the experience for attendees.

 

David Wright, James Desborough, Debi Bhattacharya and John Wood, School of Pharmacy, University of East Anglia, Richard Holland, School of Medicine, University of East Anglia

Christine Bond and Margaret Watson, Centre of Academic Primary Care, University of Aberdeen

Citation: The Pharmaceutical Journal URI: 11072276

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