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3020cd35-d002-4b24-bc53-5ac051771722 Adopted Project: Paramedic delivery of end-of-life care: a mixed methods evaluation of service provision and professional practice (PARAID) Chief Investigator: Dr Natasha Campling, University of Southampton Funder: Marie Curie Research Grants Scheme Start Date: 1st March 2023 End Date: 7th October 2025 Partners: Research & Development Department, South East Coast Ambulance Service, University of the West of England, University of Southampton Summary Paramedics are often important to patients in the last year of their life (end-of-life). We know that 999 calls are increasing for individuals and their families at end-of-life, which may be because services in the community are under pressure e.g. those provided by family doctors and community nurses. Little wide scale research has been carried out to understand the contribution played by paramedics in these situations and how this might be improved. From practice it is known that paramedics attending patients at end-of-life face complex issues such as: not knowing the patient or their family, lack of availability of patient history, fear of doing wrong, issues with family conflict and a lack of healthcare professionals to hand over to out-of-hours if the patient is to remain at home. These issues can mean people are admitted to hospital when circumstances mean they could be cared for at home. The purpose of the study is to evaluate services and care provided by paramedics to people in the last year of life. We will survey paramedics throughout England to understand their professional practice and what factors influence this and conduct in-depth case studies (collecting information from patients, carers and healthcare professionals) to examine different ways of delivering services and how these shape paramedic decision-making and management of risk. It is important to evaluate service delivery and understand how the best service features can be incorporated into other services to improve the quality of care and support provided to patients and their families. This may prevent unnecessary hospital admissions at end-of-life, which often leads to people dying in hospital when most people state they would prefer to be cared for, and die, at home. The research will describe, characterise and evaluate paramedic delivered end-of-life service provision to answer the research question: how do different models of service provision shape paramedic practice and influence experiences and outcomes for individuals at end-of-life? The evaluation will enable service delivery models, their features, and effective risk management by paramedics to be distinguished to facilitate sharing of best practice and improve the quality of care and support for people at end-of-life.

c1df1831-b7ba-4277-88cf-bcbed05e91b7 Pharmacological And Non-Pharmacological treatment of ADHD in Pre-schoolers: a systematic review and network meta-analysis: the PANPAP study Lead applicant: Professor Samuele Cortese Co-applicants: Andrea Cipriani, Corentin Gosling, Luis Farhat, Cinzia Del Giovane Background: Children with Attention-Deficit/Hyperactivity Disorder (ADHD) have problems with attention and need to move more than most children. About 5% of school-aged children and 2% of pre-schoolers have ADHD, respectively. This translates into almost 10,000 pre-schoolers with ADHD in the South West England area. Interventions for ADHD include pharmacological and non-pharmacological treatments. When not treated, ADHD entails a significant burden to society, estimated at more than £20,000 per year. Therefore, it is important to detect and treat ADHD in the early years to prevent the negative consequences of ADHD later in life. Experts and ADHD support groups agree that the NHS does not meet the needs of pre-schoolers with ADHD. Currently, there are either long waiting lists or no services for pre-schoolers with ADHD in the NHS. To provide the best care for pre-schoolers with ADHD, we need to make sure that the NHS offers treatments that work well and are safe. In 2018, the National Institute for Health and Care Excellence (NICE) recommended mainly non-pharmacological interventions (behavioral interventions) for the treatment of pre-schoolers with ADHD. Back then, there was a paucity of studies on other non-pharamcological interventions and on medications for ADHD in pre-schoolers. Since 2018, there has been an increasing number of studies on other types of interventions (e.g., family-based interventions and diet) and on medications. There has also been an increasing trend in some countries (e.g., USA) to use medications for pre-schoolers with ADHD. Therefore, we need to understand which is the best intervention for pre-schoolers with ADHD. Aim: To compare the efficacy and safety of pharmacological and non-pharmacological interventions for ADHD in pre-schoolers. Methods: We will not do a new study, which would be very expensive. Rather, we will use a new type of research, called “network meta-analysis”. This approach uses data from available studies to compare different types of treatments even when they have not been compared directly in the individual available studies. Therefore, we will first systematically search for published and unpublished studies of any pharmacological or non-pharmacological treatment for pre-schoolers with ADHD. We will then combine the information from these studies with a state-of-the-art statistical approach. We will finally assess the quality of the studies included in the analysis and the strength of the evidence that we will generate. We are well known experts in this type of research. The study will be conducted at the University of Southampton, in collaboration with international researchers, including a statistician with renowned expertise in this type of analysis. Impact: The findings of our research are expected to inform future regional, national and international guidelines on the treatment of ADHD in pre-schoolers. As such, our results will be disseminated to local commissioners and policy makers, NICE, and international guidelines groups such as the European ADHD Guidelines Group. We will also disseminate our findings to associations of families with children with ADHD in the Wessex area, at the national (for example, National Attention Deficit Disorder Information and Support Service, ADDISS), and international level (ADHD Europe).

b22b148b-6fb0-4962-840d-74569bd42e48 ADOPTED: SORT-IT (Salisbury Operational Research Track – Improving Together) SORT-IT is an exciting programme of collaborative research exploring how operational research can drive improvements in peri-operative management at a time of significant challenges for the NHS. These include limited resources, increasing demand and workforce fatigue, and urgently require us to think creatively and collaboratively. The wider SORT-IT programme is a joint endeavour led equally by Professor Christine Currie (CC: UoS) and Dr Alexandra Hogan (AH) BA(Hons), PhD, MBBS, FRCA, Consultant Anaesthetist at SHFT / Academic affiliation – UCL Great Ormond Street Institute of Child Health. It is a novel programme of collaborative research with potential for clinical implementation under the SHFT strategic aim of ‘Improving Together’. In this proposal, working with SHFT, we are seeking funding for a seed project to develop the understanding and documentation needed to apply for external funding for the wider programme (target - NIHR RfPB). We will investigate two specific steps along the peri-operative pathway. 1. ‘Booking’ of a patient (processing of the patient’s referral for surgery and setting the course of their perioperative care). 2. Recovery (optimising patient preparation for their step-down from Theatres). SHFT serves approximately 270,000 people, of whom 12,500 underwent elective surgical procedures in 2019/20. Similar to many Trusts post-pandemic, only 70.2% of patients met the referral-to-treatment waiting time target of 18-weeks. The NHS is challenged by rising waiting lists, a trajectory established pre-pandemic (2012-2019) that is now accelerating. Consequently, the Government’s target of 92% of patients achieving ≤ 18-weeks to starting consultant-led treatment has not been met since 2016 (NHS Key Statistics, July 2023).

Clare Phillips - Hepatology Nurse Specialist, MSc Global Health < Back My journey into research My interest in research came as a bit of a surprise. Clare Phillips - Hepatology Nurse Specialist, MSc Global Health My interest in research came as a bit of a surprise. In 2016, I started an MSc in Global Health part-time at BSMS. I had previously completed the Diploma of Tropical Nursing at London School of Health and Tropical Medicine and was working as a clinical nurse specialist in viral hepatitis at the time. I started the MSc thinking I’d be more interested in the policy side of the course or, where it might take me from a clinical perspective. But, it was working with Prof Gail Davey’s research group, for my MSc dissertation, that was the game changer. Prof Davey’s work in Ethiopia had shed light on the neglected tropical disease, podoconiosis , in quite a remarkable way - improving care for those living with the condition, giving a voice to the seldom heard, influencing national policy, challenging stigmatising attitudes and building research capacity (across disciplines) within Ethiopia. It was hugely inspiring and a clear example of how research had enormous scope to influence change. Having completed my MSc, I began voluntarily joining various research projects that were going on at work – collecting data for some, writing manuscripts for others. This helped me build my CV and confirmed that a career in research was right for me. I moved back to Southampton in summer 2019 and began working for the Alcohol Care Team at University Hospital Southampton. Inadvertently, I stepped into a research-focused team, who wanted to use research to make a difference to our patient group. And it made all the difference. In 2021, with my manger, Anya Farmbrough, and Richard Darch from Adult Safeguarding, I wrote a paper challenging perceptions of self-neglect in patients with alcohol use disorder ( More than a ‘lifestyle’ choice? Does a patient's use of alcohol affect professionals' perceptions of harm and safeguarding responsibilities when it comes to self-neglect? A case study in alcohol-related liver disease | Gastrointestinal Nursing ( magonlinelibrary.com ) ). With support from Anya and our medical lead, Prof Julia Sinclair, I applied for the ARC Wessex Mental Health (Alcohol) Internship in 2022. My internship focused on older adults with alcohol use disorder (AUD), analysing some pre-collected service evaluation data and working on a systematic review of AUD interventions in this cohort. The internship gave me the time (and funds) to focus on developing gaps in my skillset e.g. I took an online statistics course and had the opportunity to work 1:1 with the ARC statistician to refresh my statistics skills. I am not sure how or when I would have been able to do this without the internship. The internship also provided opportunities to present my work, from academic conferences to departmental meetings and PPI groups. This allowed me to get familiar with answering direct questions about my research, and how to deal with the trickier ones! As a result of the ARC Wessex Internship, I had 2 abstracts accepted at national conferences this year ( 1586 OLDER AGE IS AN IMPORTANT PREDICTOR OF NON-REFERRAL TO COMMUNITY ALCOHOL SERVICES FOLLOWING AN INPATIENT EPISODE: FINDINGS FROM | Age and Ageing | Oxford Academic ( oup.com ) , P28 Mortality and cause of death in patients aged 50–59, 12 months after review by an alcohol care team | Gut ( bmj.com ) ). The internship also got me thinking about my next steps and enabled some key conversations to take place. I am certain my future career is a research-focused one and am currently working on my application for Round 11 of the NIHR Doctoral Fellowship programme. I have an important research question that needs answering, and so its full steam ahead! More about Clare Previous Next

1ab7e5e6-86e2-4f8e-a9c6-1bc46e56207d ADOPTED: Personalised social and self-management support for better living with multiple long-term conditions in the community (CO-ACTION) Chief Investigators : Dr Dorit Kunkell, School of Health Sciences, University of Southampton and Professor Mari Carmen Portillo, School of Health Sciences, University of Southampton. Team: Dr Hannah Wheat, Professor Victoria Allgar and Professor Richard Byng from the University of Plymouth. Miss Francesca White, Hampshire and Isle of Wight Integrated Care Board (ICB). Dr Tom Blakeman and Professor Peter Bower from the University of Manchester. Professor Daniel Prieto-Alhambra, Associate Professor Rafael Pinedo-Villanueva, Dr Annika Jödicke and Miss Maria T Sanchez-Santos from the University of Oxford. Dr Lindsey Cherry and Dr Kate Lippiett from the University of Southampton. Mr Eric Compton, Patient and Public Contributor, Southampton. Start: 1 June 2024 End: 30 November 2028 The CO-ACTION programme aims to improve wellbeing for people with multiple health problems. Living with Multiple Long-Term Conditions often called ‘Multimorbidity’ (MLTC-M) involves multiple appointments and care plans. Patient priorities are often overlooked. Common issues include pain, mobility problems and fewer interactions with friends and family. This can lead to loneliness and poorer mental health. The research team will work with fellow researchers, health, social care and VCSE sector workers to co-design and test a health and wellbeing intervention with and for people living with MLTC-M . To evaluate the CO-ACTION intervention: We will run a trial involving 500 people living with MLTC-M and carers. Half will receive the intervention. The other half will continue with usual care. We will recruit participants (with Patient and Public Involvement support) in health and community settings in Manchester, Leeds, Plymouth, and Southampton. Wellbeing, quality of life, unplanned hospital admissions, and costs will be assessed at the beginning, 6 and 12 months later. Researchers will test how this intervention can be adopted in the NHS in six case study sites. Public and patient (PPIE) contributors will help us design materials, consider challenges and provide feedback on findings.

c5ca53e9-5f1d-4394-8679-3abfad5e1fe1 WHELD: Training care home staff to improve well-being and mental health of dementia residents led by NIHR ARC Peninsula and working with NIHR ARC South London, NIHR ARC East Midlands, NIHR ARC East of England, NIHR ARC North East North Cumbria, NIHR ARC North West Coast and NIHR ARC Yorkshire and Humber Implementation of evidence-based cost-effective training for care home staff to improve Wellbeing and mental HEaLth for care home residents with Dementia and reduce unnecessary sedative medications (WHELD into Practice) Principle Investigator: Professor Clive Ballard Team members: Joanne McDermid, Jane Fossey, Barbara Woodward Carlton, John-Paul Taylor, Louise Robinson, Martin Orrell, Clare Hulme, Sube Banerjee, Esme Moniz-Cook, Dag Aarsland, Annette Boaz, Clarissa Giebel, Caroline Watkins, Jo Day Partners: NIHR ARC South West Peninsula ARC, University of Exeter, NIHR ARC Yorkshire and Humber, NIHR ARC East Midlands, NIHR ARC East of England, NIHR ACR South London, NIHR ARC North West Coast , NIHR ARC North East and North Cumbria, University of Plymouth, University of Newcastle, University of Hull, King’s College London, University of Nottingham, South West AHSN, Pendennis Care Home, Devon Partnership NHS trust, Alzheimer’s Society. Research sites: University of Exeter, University of Newcastle, University of Hull, King’s College London, University of Nottingham, University of Liverpool Starts: 1/09/2021 Ends: 31/03/2023 Lay Summary WHELD is an evidence-based person-centred training programme which, in 4 clinical trials involving 2349 care home residents with dementia, demonstrated benefits in well-being and mental health and a reduction in sedative medications across London and Buckinghamshire. No similar programme has been successfully implemented in the UK or elsewhere. Nationwide implementation would have a major impact on well-being among the most vulnerable people with dementia. Lead ARC South West Peninsula with implementation sites also in East Midlands, East of England, North East and North Cumbria, North West, and Yorkshire and Humber ARCs WHELD intervention resources have been optimized for implementation, based on the results of our recent COVID WHELD programme. WHELD will now be implemented in 75 care homes in ARC regions where WHELD has not previously been delivered. Implementation evaluation will identify implementation enablers and barriers, fidelity, reach and buy-in, and provide illustrative case studies. Engagement of PPI representatives and stakeholders to Develop Real World Implementation Plan will be integrated throughout the programme. Key stakeholder groups for this work will include commissioners, senior representatives from Integrated care system organizations, representatives from the AHSNs in the different ARC regions and care home owners/senior managers. A series of dissemination activities, including stakeholder workshops, will enable the development of a plan for scaling up the implementation to national level and any required adaptations to WHELD resources. Progress by October 2022: The digital materials for the programme have been optimized. The programme has IRAS approval and CRN adoption. We currently have 19 participating care homes, with a goal of completing recruitment by the end of March 2023. The first PPI and stakeholder workshops have been completed, with further workshops through the autumn and in the New Year.

About us At the NIHR Applied Research Collaboration (ARC) Wessex, we conduct applied health research with our partners and others in the health and care sector, alongside patients and members of the public. Applied health research aims to address the immediate issues facing the health and social care system. We also help bring research evidence into practice and provide training for the local workforce. NIHR Applied Research Collaborations (ARCs) support applied health and care research that responds to, and meets, the needs of local populations and local health and care systems. The NIHR ARC Wessex is one of 15 ARCs across England, part of a £135 million investment by the NIHR to improve the health and care of patients and the public. Before 1 October 2019 we were known as NIHR CLAHRC Wessex . The ARC Wessex programme of research addresses four areas related to the health and social care needs of our community. We are hosted by the School of Health Sciences at the University of Southampton and University Hospital Southampton NHS Foundation Trust. NIHR ARC Wessex is acting as the national lead on research for Ageing, dementia and Frailty. Want to get in touch? - jump to our contact details below About us Our mission to improve outcomes for patients and public; improve quality, delivery and efficiency of health and care services; increase the sustainability of health and care systems locally and nationally. National Institute for Health and Care Research Our mission Our collaboration Our collaboration Each NIHR ARC is made up of local providers of NHS services, local providers of care services, NHS commissioners, local authorities, universities, private companies and charities. These collaborations work together to conduct high quality, generalisable, applied health and care research that addresses the specific health or care issues in their region. NIHR ARCs act to increase the rate at which research findings are implemented into practice. The 15 ARCs work collaboratively to address national research priorities, with individual ARCs providing national leadership in their areas of expertise. Our partners At NIHR ARC Wessex we are a collaboration of organisations working together to carry out the most relevant and best quality health and care research with real-life impact. Read more About NIHR The mission of the National Institute for Health and Care Research (NIHR) is to improve the health and wealth of the nation through research. Read more Contact Southampton Science Park, Innovation Centre, 2 Venture Road, Chilworth, Southampton SO16 7NP 023 8059 7983 arcwessex@soton.ac.uk First Name Last Name Email Message Thanks for getting in touch Send

Get Involved We value all the help and support we get from our public contributors. Your input is important to us and helps us to design better research, address the health and care issues that matter in our communities and provide valuable support to our research teams. You can get involved with as little or as much as you would like either as a member of the public, a patient or carer for someone, or maybe you are supported in social care (sometimes called being a service user) The NHS, Universities and Councils often use jargon and short-hand as a way of describing things. Having people with different experience can help break down barriers in language. Working with us you will have all the support and encouragement you need in what can sometimes feel like an unfamiliar environment. We also cover costs of your time in many cases so that you are able to take part. If you would like to know more please get in touch with us at PublicInvolvement@uhs.nhs.uk or call us on 023 8120 4989. Or you can fill out the form below to let us know what particular things you're interested in. Introduction Frequently asked questions ! Widget Didn’t Load Check your internet and refresh this page. If that doesn’t work, contact us. Frequently askd questions Our commitments and strategy Our new Public and Patient Involvement and Engagement team is growing and adapting to the needs of our community. As a result we are in the process of updating and redesigning our strat egy and summary documents listed below. Our commitments still stand as listed: We will use a variety of ways to seek the views and insights of patients and the public, and work to ensure that the diversity of people giving their views reflects the diversity of the local population. We will provide information that is clear, jargon free and accessible. We will ensure people are adequately supported in their involvement role. We will make sure there are no financial implications for people’s involvement. We will involve people in a way that is open, honest and meaningful, being clear about what decisions they can and cannot influence. We will act on the views we have sought, and feedback to those who gave them on what we did, working in partnership with patients and the public to improve the quality and relevance of our research. Public and Patient Involvement and Engage ment (PPI/E) strategy Download PPI/E Strategy 2021-2024 summary report Download PPI/E Strategy 2021 - 2024 full report PPI resources Public and Patient Involvement resources Learn more about Public and Patient Involvement Learn more about Public and Patient Invo... Play Video Play Video 00:51 Public and patient support in research Hazel and Phillip have just been taking part in the research design workshop looking at how people manage with a long term illness

42074b03-6b8a-4374-ab92-19ec23c313f3 ADOPTED PROJECT: Happier Feet ADOPTED PROJECT: Happier Feet Disrupting the vicious cycle of healthcare decline in Diabetic Foot Ulceration through active prevention: The future of self-managed care Chief Investigator: Dr Andrew Weightman – University of Manchester Project Team Members: Dr Katherine Bradbury – University of Southampton, Professor Helen Dawes – University of Exeter, Mr Andrew Eccles – University of Strathclyde, Dr Safak Dogan – Loughborough University, Dr Glen Cooper – University of Manchester, Professor Frank Bowling – University of Manchester, Dr Xiyu Shi, Loughborough University, Professor Ahmeet Kondoz– Loughborough University Organisations Involved: Diabetes UK Background: There is a significant unmet clinical need for an adaptable, acceptable and adoptable technology to identify and prevent diabetic foot ulcer (DFU) formation, to enable self-management and timely clinical intervention to improve outcomes and reduce the economic burden of healthcare provision. Our primary purpose is to develop and implement an adaptable, acceptable, and cost- effective smart sensing insole technology which can detect when a DFU is likely to occur and can adapt plantar tissue loading to prevent formation, thus enabling self-management. This project proposes to build and expand on current smart insole technologies for the detection of DFUs, utilising a sensor fusion approach for their identification. A smart insole with integrated pressure (normal, shear), temperature, gait (IMU) and mechanomyography (acoustic) sensors will identify early indicators of ulceration and when movement is appropriate/inappropriate. The smart insole will respond to these inputs and adjust the foot (and gait), through an array of artificial muscles, to support better (safe/ comfortable) movement. This project aims to co-develop this new smart sensing insole with people living with diabetic foot ulcers. We hope to establish: What patients think of the idea of a smart sensing insole for early detection of DFUs which includes the provision to adjust the foot to reduce pressure on areas of likely ulceration. A prototype insole and optimised this with patient feedback. Early safety testing of this device. Security protocols to enable secure storage and sharing of data from this insole (e.g., between patient and clinicians). Publications Journal of Participatory Medicine - Developing a Smart Sensing Sock to Prevent Diabetic Foot Ulcers: Qualitative Focus Group and Interview Study In-shoe plantar temperature, normal and shear stress relationships during gait and rest periods for people living with and without diabetes | Scientific Reports

Vikki Tweedy is an Advanced Nurse Practitioner (Dementia/Frailty) Dorset County Hospital NHS Foundation Trust - and is about to begin a PhD at Bournemouth University < Back Caring for the person with dementia in hospital Veterans and Dementia - why routines can matter Vikki Tweedy is an Advanced Nurse Practitioner (Dementia/Frailty) Dorset County Hospital NHS Foundation Trust - and is about to begin a PhD at Bournemouth University Dementia is a progressive condition affecting cognition, memory, and behaviour, with significant implications for individuals, families, and healthcare providers. Patients with dementia are highly vulnerable in hospital environments due to unfamiliar surroundings, disrupted routines, and communication difficulties. This can lead to increased anxiety, agitation, and a decline in physical and cognitive function. The traditional hospital model, which prioritises medical interventions over psychological and emotional well-being, often fails to meet their holistic needs. Therapeutic engagement involves structured, person-centred interactions that promote communication, emotional well-being, and cognitive stimulation. Rather than focusing solely on physical care, it aims to build trust, reduce distress, and enhance the overall hospital experience. While medical management is essential, therapeutic engagement and meaningful activity play a crucial role in improving patient well-being and hospital experience and here Dorset County Hospital NHS Foundation Trust the Dementia team have taken a proactive approach to try to address the personalised need for activity. Meaningful activity refers to engagement that holds personal significance to an individual. For people with dementia, maintaining a sense of routine and purpose through tailored activities can significantly enhance well-being. Through engagement with veterans with dementia in acute hospital setting, I have observed first hand how their military backgrounds influence their hospital experiences, responses to stress, and engagement with care teams. Meaningful activity is particularly relevant for veterans with dementia, whose unique life experiences, military backgrounds, and potential trauma histories require a tailored approach to care. Understanding their needs and providing structured engagement can help mitigate distress, improve outcomes, and foster a sense of purpose during hospitalisation. For veterans with dementia, the challenge of the hospital environment can be further compounded by their past experiences. Military training emphasises structure, discipline, and resilience, which may shape how veterans respond to hospitalisation. Additionally, some veterans may have underlying post-traumatic stress disorder (PTSD) or other service-related mental health conditions that can influence their reactions to stress, noise, and certain interactions. Without appropriate engagement strategies, they may experience heightened distress, mistrust, or withdrawal. Having completed an NIHR internship (research initiation award), this gave me confidence and knowledge to want to pursue a clinical academic pathway and my work in this area has now led me to progress a proposal for a PhD, focusing on the lived experience of veterans with dementia in the acute hospital setting, further highlighting the importance of personalised, meaningful interventions in acute care settings. It is hoped that this research will contribute to improving care pathways for veterans with dementia, ensuring they receive hospital care that recognises and respects their unique needs. Therapeutic engagement and meaningful activity are essential components of high-quality dementia care in NHS acute hospitals. For veterans with dementia, recognising and integrating military-specific approaches can further enhance their hospital experience, reduce distress, and promote better outcomes. Embedding these principles into routine practice requires staff training, investment in resources, and collaboration with military support organisations. Here at Dorset County Hospital we have also been extremely fortunate to have been supported by the Royal British Legion who have provided us with some care packages to give to veterans in the hospital. The giving of the care packages by the dementia team was an excellent way to engage with patients about their military history but also to give the recognition to those who have served. Previous Next

862768fa-36ea-4f23-802a-07ca10e5572b Social Prescribing Link Workers framework: supporting complex needs of adults living with physical and mental health long term conditions Chief Investigators: Dr Leire Ambrosio. Lecturer. School of Health Sciences, University of Southampton and Mari Carmen Portillo. Professor of Long-term Conditions. School of Health Sciences, University of Southampto. Team: Skaiste Linceviciute. Research Fellow. Faculty of Medicine, University of Southampton, David Baldwin. Professor of Psychiatry and Section Head, Clinical Neuroscience, Faculty of Medicine, University of Southampton Joseph Jenness. Senior Manager at Southampton Voluntary Services. SO:Linked Jade Topham. Social Prescribing Link Worker, Southampton North PCN William Barnaby Jones. NIHR ARC Wessex PPIE, University of Southampton Traci Carroll. PPIE Representative as part of the NIHR ARC Wessex PPIE group, University of Southampton Siân Brand. Chair of Social Prescribing Network, Social Prescribing Network Partners: Hampshire and Isle of Wight Integrated Care Board, Hampshire and Isle of Wight NHS Foundation Trust, University Hospital Southampton NHS Foundation Trust, University of Southampton, Anxiety UK, Social Prescribing Network, SO: Linked. Start: 1 October 2024 End: 31 March 2026 Background to the research As part of the NHS Long Term Plan in rolling out an integrated approach built around personalised care, NHS England has initiated the Social Prescribing Link Workers (SPLW) model to offer personalised support for patients in primary care facing continued pressures with long-term conditions, and to bridge fragmented healthcare systems with key community stakeholders through joined-up approaches (NHS, 2019). Our recent SPLW project demonstrated that despite Link Workers’ positive and multifaceted impact, the current efforts lack standardised approach and robust guidance that delay and complicate the work of SPLWs in delivering coordinated support for addressing the needs of adults with long-term physical and mental health conditions. Key challenges related to the lack of collaborative planning, expectations management, and limited communication with multidisciplinary teams. This leaves SPLWs managing complex cases with overstretched workload and with patients struggling to achieve sustainable, long-term support for the management of their physical and mental health LTCs. Aims of the research Informed by the findings of our previous SPLW project, a need has emerged to develop a consistent SPLW framework that sets out sustainable and integrated pathway that can optimise social prescribing services in the community, standardise guidance for training support and is equipped to support the long-term management of complex needs of adults with physical and mental health LTCs. Publications Understanding the potential role of Social Prescribing Link Workers in supporting identified needs of people with physical and mental long-term conditions: a qualitative study | BMC Primary Care | Full Text

f5c7ef05-9a58-48a5-9c06-02ebd55d89cd COMPLETED: Medicines optimisation Principal Investigator: Dr Simon Fraser Team members: Dr Simon Fraser (Associate Professor of Public Health. School of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital), Professor Chris Edwards (Professor of Rheumatology, Southampton and Associate Director of the NIHR Clinical Research Facility) Dr Chris Holroyd (Consultant Rheumatologist, University Hospital Southampton NHS Foundation Trust), Dr Kinda Ibrahim (Senior Research Fellow, Faculty of Medicine, University Hospital Southampton NHS Foundation Trust), Dr Ravina Barrett (Pharmacist, University of Portsmouth), Dr Clare Howard (Chief Pharmacist, Medicines Optimisation, Wessex AHSN), Dr Mary O’Brien (NHS England, NHS Rightcare), Dr David Culliford (Senior Medical Statistician, Health Sciences, University of Southampton), Professor Paul Roderick (Professor of Public Health, Primary Care and Population Sciences, University of Southampton), Professor James Batchelor (Director Clinical Informatics Research Unit, Faculty of Medicine, University of Southampton), Dr Matthew Stammers (Senior Endoscopy Fellow, University Hospital Southampton and Clinical Informatics Research Fellow at Clinical Informatics Research Unit) Start: 1 October 2019 Ends: 30 September 2024 Project Partners: University Hospital Southampton NHS Foundation Trust, NHS England (NHS Rightcare), University of Portsmouth, University of Southampton, Academic Health Sciences Network (AHSN) Wessex. Lay summary Painful conditions associated with age (such as arthritis) are common in the UK and safe pain relief options for older people are limited. Anti-inflammatory drugs such as ibuprofen are widely used – both bought from the pharmacy and prescribed by doctors, but they have significant risks, such as bleeding from the stomach and kidney damage. Older people and those with certain long-term medical conditions are at higher risk of experiencing bad effects from these drugs. Another issue concerns people who are taking one of a group of medications call ‘disease-modifying anti-rheumatic drugs’ (DMARDs). These drugs are often used for rheumatoid arthritis and work by slowing its progression, reducing the likelihood of severe joint damage and other related health problems. They are also used for inflammatory bowel diseases, such as Crohn’s disease. Methotrexate is one of the most commonly used DMARD in arthritis and azathioprine is one of the most commonly used in inflammatory bowel disease. Anti-TNF drugs are an important group of so called ‘biological agents’ – another type of DMARD. DMARDs are powerful drugs that require regular blood tests to check for adverse effects, such as liver problems, and guidelines advise how often these tests should be done. However, for most people, these blood tests are almost never abnormal, and could potentially be safely done less frequently. In addition, some people with inflammatory arthritis have an excellent response to DMARDs. Stopping DMARDs can lead to flare ups of disease, but the amount of therapy used may be tapered successfully to reduce dose-dependent adverse events and costs. This project involved two studies The first study showed that non-steroidal anti-inflammatory drugs (NSAIDs) are still sometimes prescribed for high-risk patients, such as older adults and those with chronic kidney disease. NSAIDs can cause acute kidney injury (AKI), leading to serious complications. This study developed a risk tool for practices to identify those who should not be prescribed NSAIDs. The second explored the frequency of blood testing for patients on Disease-Modifying Anti-Rheumatic Drugs (DMARDs) like methotrexate, commonly used for rheumatoid arthritis. Guidelines recommend 3-monthly blood tests due to potential liver issues. The research found that many tests were seldom abnormal, suggesting that low-risk patients might safely have less frequent tests if further research is done on the safety of risk-stratifying people. What did we learn? In the two different parts of the project we found that: About half of people taking the ‘disease modifying’ drugs (‘ DMARDs ’) methotrexate for rheumatoid arthritis or azathioprine for inflammatory bowel disease experienced no blood test abnormality over two years despite having to have blood tests every three months. Reducing testing frequency may therefore be safe for younger people and those without other long-term conditions. Among people taking non-steroidal anti-inflammatory drugs (‘ NSAIDs ’ like ibuprofen) the risk of kidney damage was highest among older people with combinations of long-term conditions including chronic kidney disease, diabetes, heart disease and heart failure, and high blood pressure. These people should avoid taking NSAIDs and we provided a way for GPs to identify them in their databases. What difference will this new knowledge make? DMARDs: Further investigation is needed on the safety and acceptability of reduced blood testing frequency testing for some people taking DMARDs but this could potentially result in reduced unnecessary patient anxiety and burden, fewer referrals to hospital and reduce resource use for the NHS. If testing could be reduced this would mean reduced treatment burden for patients and reduced cost and admin work for the NHS NSAIDs: GP practices can be provided with a search tool that helps identify those at highest risk of kidney damage from NSAIDs. Using this information they can review and stop NSAIDs to reduce the risk. If prescribing was stopped for some people at risk, this would reduce risk of acute kidney injury which can have lasting consequences or even be fatal What was the impact? Non-steroidal anti-inflammatory drugs (NSAIDs) As part of the medicines optimisation project we explored the risks of acute kidney injury (AKI) associated with taking non-steroidal anti-inflammatory drugs like ibuprofen and naproxen. There was a news article here about it: https://www.arc-wx.nihr.ac.uk/post/southampton-led-study-shows-need-for-painkiller-caution-to-prevent-kidney-damage and a publication here: https://bjgpopen.org/content/6/1/BJGPO.2021.0208 We developed a risk score that can help GP practices identify those patients at highest risk of NSAID-associated kidney injury. We have run this risk tool in the Dorset Intelligence and Insight Service (a database covering over 70 Dorset GP practices - more than 800,000 people) and along with colleagues from the AHSN we are running a masterclass with many of the GP practices involved to present the findings and to promote best practice in NSAID prescribing. The aim is to reduce NSAID prescribing in those at high risk of adverse outcomes like AKI. Rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) are prevalent inflammatory conditions, affecting 0.8% and 0.7% of the population, respectively. Disease-modifying anti-rheumatic drugs (DMARDs), such as methotrexate for RA and azathioprine for IBD, are commonly used to control disease activity. These drugs require regular safety blood-test monitoring for liver function abnormalities, kidney function, and bone marrow toxicity. Monitoring is frequent at initiation and less frequent once a maintenance dose is established. In the UK, initiation usually occurs in secondary care, with ongoing monitoring in primary care as recommended by NICE. Regular blood-test monitoring has been linked with anxiety and depression for some patients, incurs substantial costs for healthcare providers, and increases the workload for clinicians and laboratory staff. Despite guidelines, the optimal monitoring frequency has not been established, and the extent to which patients experience prolonged periods with no abnormal tests is unclear. This study aimed to assess the extent of persistently normal blood-test results among people with RA and IBD, and to describe the frequency of blood testing to indicate health-service and patient workload. Targeted monitoring of higher-risk individuals and reduced monitoring for lower-risk patients may improve efficiency and reduce patient workload. Our large, 2-year retrospective cohort study (over 700,000 people) assessed persistently normal blood tests among people with rheumatoid arthritis (RA) taking methotrexate and those with inflammatory bowel disease (IBD) taking azathioprine. Approximately half of the patients experienced no blood-test abnormalities using NICE-recommended tests. In the RA/methotrexate cohort, abnormalities were more common in older people with reduced renal function. For the IBD/azathioprine cohort, abnormalities were less common and mainly involved reduced renal function in older people with comorbidities. The absolute risk of persistently normal blood tests was lowest among older people and those with comorbidities. Since the study, a piece of work led by Nottingham cited our work ( https://www.bmj.com/content/381/bmj-2022-074678 ) and created a model to risk stratify patients taking methotrexate. This is quite likely to change clinical practice when NICE reviews its guidance on DMARDs in due course. This work was supported by representatives of the ‘Getting It Right First Time’ programme, who also linked this issue to sustainability: ‘Saving the planet with reduced routine DMARD blood monitoring frequency BMJ 2023; 382 doi: https://doi.org/10.1136/bmj.p1645’ https://www.youtube.com/watch?v=uSriKPqdbvA&t=6s