Evidence-Based/Knowledge Management Librarian, KnowledgeShare, The Library, Audrey Emerton Building, Royal Sussex County Hospital, Brighton, UK
Quality improvements in primary care rely on evidence of effectiveness, but for evidence to exist, goodquality research has to be done. Ideally this research would be based in primary care and conducted by primary care clinicians, but until recently the quantity,and in many cases the quality, of such research has been lacking.
Quality improvements in primary care rely on evi-dence of effectiveness, but for evidence to exist, good-quality research has to be done. Ideally this research would be based in primary care and conducted by primary care clinicians, but until recently the quantity, and in many cases the quality, of such research has been lacking. A study published in the British Journal of General Practice found that although a reasonably large proportion of general practitioners (GPs) were involved in research, this was mainly limited to recruiting participants for studies initiated by others.1 Only 11% had achieved publication of a research paper themselves.
Commonly cited reasons for a lack of research activity include shortcomings in training and support, bureaucratic disincentives and lack of protected time. A survey of primary care staff in 2002 found that all groups had ideas for research (the most popular interests were prescribing, cardiovascular disease and the primary/secondary care interface) but ‘lacked information on how to take these forward’.2 GPs were looking for training and advice on originating and finding funding for research, whereas practice nurses wanted support with data collection and IT skills. Improving the clarity of governance frameworks has also been identified as a key factor for facilitating innovation in the NHS;3 a Reference to the notoriously complex research and ethics requirements that can easily put off potential researchers.
In 2006, in order to address some of these issues, the Department of Health published Best Research for Best Health, a strategy document with the goal of ensuring ‘a vibrant, world-class environment for conducting and using NHS health research’.4 The emphasis here is on funding patient-based, practice-based research, and providing a comprehensive support structure to encourage clinicians to get involved. There are initiat-ives to reduce bureaucracy and increase transparency, and proposals for extended networking opportunities that will allow researchers to share and combine their work. With many of these developments already under way, now is an excellent time to expand your role by becoming involved in a multicentre study or devel-oping a research project of your own. The following websites offer a range of advice and support for clinicians involved in, or interested in, research.
National Institute for Health Research: www.nihr.ac.uk
The National Institute for Health Research (NIHR) was established by the Department of Health to co-ordinate the implementation of Best Research for Best Health. In addition to news on the progress of the strategy and its implementation plans, the website provides information on the four main aspects of the institute: the NIHR Faculty; funding programmes; infrastructure; and information systems.
The NIHR Faculty will be launched in April 2007 and will be aimed at supporting the careers of NHS researchers. NHS staff who undertake research proj-ects will be eligible to apply for membership of the faculty at one of three levels, depending on their experience. The faculty will endeavour to enhance the professional status of members and to develop skills and career pathways for researchers. The ‘Programmes’ area of the site details the various governmental funding streams that are available, including infor-mation on who is eligible and how grants are awarded. The existing UK research programmes are listed here, such as the Health Technology Assessment programme and the UK Cochrane Centre, as well as newer schemes, for instance the ‘Research for Patient Benefit’ pro-gramme, which has been set up to fund applied research that will have a clear focus on day-to-day practice within the NHS.
The section on ‘Infrastructure’ refers primarily to the clinical research networks that have been set up to link researchers working in similar fields across the country, and to aid in the recruitment of participants. More information about these is available at the website of the UK Clinical Research Network Co-ordinating Centre, discussed below. The final major work stream within the NIHR is its development of information systems that, it hopes, will simplify re-search processes and save time. The ‘Systems’ pages detail these initiatives to reduce red tape through better integration of IT, reducing multiple entry of information and bringing information on trials together in one place.
UK Clinical Research Collaboration: www.ukcrc.org
Working closely with the NIHR is the UK Clinical Research Collaboration (UKCRC), a partnership of funding bodies, academic institutions, industry, patients and the NHS. This website provides details on all aspects of their work including the development of clear and flexible career structures for those interested in clinical research, increasing both the individual and institutional incentives for research involvement and co-ordinating the many different organisations that fund healthcare research. Of particular interest in the ‘Research Funding’ section is a report, published in 2006, which provides an overview of health research in the UK. The report analyses the spread of health research investment both geographically and across all areas of health and disease.
Perhaps the most important arm of the UKCRC is the UK Clinical Research Network (UKCRN; www.ukcrn.org.uk), the network of networks tasked by the NIHR to provide the fundamental infrastructure for national clinical research. The UKCRN consists of six topic-specific research networks (the National Cancer Research Network, the Diabetes Research Network, and so on), a Primary Care Research Network and a soon to be launched Comprehensive Research Net-work that will ‘plug the gaps’ left by the other net-works. Each of these networks is subdivided into smaller local networks that encourage collaboration between researchers in the NHS and academia, and connect potential participants with researchers. This site provides details of the different networks, maps of their geographical coverage and information on get-ting involved in an existing project or applying to run a project of your own.
National Network of Research and Development Support Units: www.national-rdsu.org.uk
While the clinical research networks have been set up to enable collaboration and recruit patients, researchers themselves, especially those who are new to research, may feel the need for additional support. Research and Development Support Units (RDSUs) can pro-vide help and advice in a wide range of areas through training and seminars as well as putting you in touch with local experts in different fields of research. Usually based in universities, but serving NHS staff from across the disciplines, RDSU courses range from statistics, to gaining ethical approval, to qualitative research methods and beyond. The National Network website allows you to locate the RDSU in your area and find out what training is available, as well as to find information on their national conferences, meetings and mailing list.
Unfortunately RDSUs are not available throughout the UK; however, there is one web-based service that offers a similar level of research support to the whole country: RDInfo.
Funded by the Department of Health, the RDInfo unit provides three interlinked services through its website. The first is RDLearning, which maintains a compre-hensive database of educational opportunities for healthcare researchers across the UK. This resource can be used to locate health-related degrees, short courses and individual workshops dealing with research skills and methods that are run by universities, NHS organ-isations, RDSUs, and other institutes, colleges and so-cieties. Information is held on the content, objectives, qualification gained, entry requirements, costs and venues of each course, as well as full contact details.
The second section of the site is RDFunding, which can be used to find information on thousands of research funding opportunities, plus help on how to cost a proposal and apply for grants. Their database can be searched by research area, amount needed, duration of the study and various subject-specific keywords. Notably, the funding bodies covered range beyond the UK to international organisations, pro-viding that these are willing to support British research projects. Users of the site can sign up to receive notifications of new funding opportunities in specific areas of interest.
Finally, RDInfo runs an advice service called RDDirect, a telephone and email helpline that answers questions on health research. Answers to their most frequently asked questions are available on the site, as well as a useful research process flowchart with ideas and contact information to help with everything from formulating a research question to disseminating your findings.
Medical Research Council: www.mrc.ac.uk
The Medical Research Council (MRC) is a publicly funded organisation that works closely with the NHS to encourage medical research and support researchers. They do this by providing grants to NHS and univer-sity researchers, by funding research centres in part-nership with academia, and through developing their own research facilities. You can check the website for news and events relating to medical research, find details of the MRC’s research portfolio and priorities, and read about available grants. The site has infor-mation on how to apply for research funding and explains how proposals are assessed.
Foundation of Nursing Studies: www.fons.org
The UK-based Foundation of Nursing Studies (FoNS) is committed to supporting quality in nursing and midwifery through a range of practice development initiatives. They provide funding and support for nurse-led teams who want to systematically develop and change practice through research. As well as being able to apply for grants, nurses using the site can get help in making contacts with local researchers and encouragement in publishing and disseminating work. Details of completed projects are also available on the site, which may prompt ideas for a study in your own area. The coverage is very wide-ranging, examples include: breaking bad news, patient-initiated review in rheumatoid arthritis, and supplying women with evidence-based information. FoNS also provides awards for nurses and midwives who have developed good-practice initiatives to improve patient care.
Royal College of Nursing Research & Development Coordinating Centre: www.man.ac.uk/rcn
This website collects together the resources available for nursing research and development (R&D). It aims to provide a one-stop-shop for nurses interested in R&D. There are articles on career pathways for nurse researchers as well as new job opportunities relating to nursing research. The section on research networks contains links to dozens of organisations covering a wide range of research interests, going far beyond the clinical research networks mentioned above. The site also allows users to subscribe to a short weekly bulletin of the latest news in nursing research and develop-ment. Additional collections of links include training opportunities, governance and policy, how to dis-seminate your research and where to go to find completed research reports.
Current Controlled Trials: https://controlled-trials.com
In order to find information about ongoing trials, or to register your own trial to be viewed by others, you can visit Current Controlled Trials. This site was launched in response to the idea that there should be a central collection of in-progress randomised con-trolled trials (RCTs) from around the world as well as a set of unique identifiers assigned to these trials. In addition to the database of unique identifiers, there is also a searchable metaRegister of Clinical Trials, which has been built up from the registers held by the sponsors of trials. While this is not a complete collec-tion of all trials being conducted worldwide, it does contain information from various Department of Health funding bodies as well as the MRC, the Wellcome Trust and the US National Institutes of Health.
The user is able to search individual registers from the site, or to search all registers simultaneously. Results are brief, but include information about where the research is being undertaken, who has funded it and who can be contacted for more detail. In many cases it is also possible to see what groups of patients were included in the study, what intervention was being investigated and what the main outcome measures were. This database can be used by those wanting to see whether their research question is already being investigated, as well as those interested in participating in an existing project. The search function is not very sophisticated here, you cannot browse by disease area or search within particular fields, but referring to the ‘tips on searching’ does allow you to refine your search somewhat.
The results of completed trials are not available on this site. For results of Department of Health-funded trials that have been completed but not yet published try the Research Findings Register (www.refer.nhs.uk), and for abstracts of published research there are of course numerous online databases. See my Knowledge-Share article in the December 2006 issue of Quality in Primary Care.5
Research and Development Forum: www.rdforum.nhs.uk/home.htm
If you are involved in planning or managing research in health or social care then you may find the Research and Development Forum to be a useful resource. The aim of the forum is to create a network of contacts in R&D management in order to encourage the sharing of best practice. Members of the Forum can join working groups on topics such as ethics, training for R&D managers, and working with industry. The site contains news items, details of forthcoming events, jobs, training courses, and guidance on key issues such as the Human Tissues Act. There is also a fledgling discussion list that will allow research managers to ask questions and share ideas with one another.
Central Office for Research Ethics Committees: www.corec.org.uk
This site contains news from the Central Office for Research Ethics Committees (COREC) and guidance on various aspects of an ethics application. There are fact sheets on informed consent, differentiating audit and research, and submitting progress reports to your research ethics committee. You can also use the site to submit your ethics application online and there is a section for patients and members of the public who are interested in ethics in healthcare research.
Funded by the NIHR, Involve has been set up to promote public involvement in NHS, public health and social care research. They hope to make research more relevant to people’s concerns and more likely to be used in practice. Publications are available for researchers (for example on how to correctly reim-burse members of the public), for commissioners (such as getting public involvement in research grant applications), and for consumers wanting to get in-volved in the process. There is a database of research projects that intend to actively involve members of the public, and a list of questions and answers, including: ‘why involve the public?’, ‘who can represent the public?’, and ‘how should I involve the public?’. Involve also provides a database of training opportunities on these topics, runs conferences on public involvement in research, and allows users to sign up to share their knowledge of public involvement with other inter-ested parties.
There are many benefits that come with involvement in research alongside one’s clinical practice, including increased professional enthusiasm, improved critical thinking and a greater use of evidence in practice.6 Research is an important part of professional practice, backed by professional bodies such as the Royal College of Nursing which believes that ‘research is every nurse’s business’.7 Support for staff interested in research is plentiful, as demonstrated above, but sufficient protected time and a supportive environ-ment within departments is also vital. The recent developments in UK health research policy should raise the profile and increase the incentives for clinical research involvement, but this needs to be backed up at a local level. The evidence base is still skewed towards studies conducted in secondary care; the only way to rectify this is for primary care staff to come to view research involvement as feasible, per-sonally valuable and important to the healthcare economy as a whole.
Thanks to Judy Lehmann, Head of Library Services at Brighton and Sussex University Hospitals NHS Trust for her contributions.