Health services research
Health service research (HSR) encompasses many disciplines concerned with the development, implementation and evaluation of most aspects of clinical practice. Several major projects have recently secured funding and these focus on four key areas:
- Patient participation in clinical decision-making and management of chronic GI disease
- Development and implementation of clinical management guidelines into clinical practice
- Evaluation of new technologies/procedures in GI disease
- Evaluation of potential new pharmacological and psychological treatments for GI disease
Population-based GI research
This is a new area of development for GI Science, which will be developed further under the leadership of Sarah O’Brien who took up her chair in Health Sciences and Epidemiology at Hope Hospital in April 2004. We have already successfully secured funding for several major projects and these focus on the key themes:
- Using epidemiology to understand the aetiology of functional GI disorders, in particular the relationship between acute infection and chronic symptoms
- Patient participation in clinical decision-making and management of functional GI disorders
Research areas
- The redevelopment of Healthcare Services in Manchester and Salford provides access to large numbers of patients in primary care and further prospective studies on GI disease will follow. Health Technology Assessment and Primary Care are priority areas for government funding, which the group will seek to exploit.
- The development of a district-wide, integrated primary/secondary care database of patients will provide a valuable tool for epidemiological studies of GI disease. Incident capture of patients presenting with new diagnoses will allow early assessment and hypothesis testing particularly for patients with functional disease. Classification of symptoms with robust phenotypic data collection will underpin future genomic studies and allow the development of structured management pathways that will allow evaluation of novel interventions.
Furthermore, access to a defined population of patients across primary and secondary care will facilitate the evaluation of interventions arising from the epithelial physiology and neuroenterological research and provide a continuum from laboratory to society. Ongoing investment in information technology as part of the Salford Royal Hospitals Trust service redevelopment will provide the infrastructure for this database and our challenge is to ensure that research opportunities are fully represented. - Another opportunity to link the Population-based GI Research Group and the Epithelial Molecular Physiology Group is in the gastrointestinal infection arena, particularly campylobacter infection. In its first business plan the Food Standards Agency set a target of reducing the incidence of foodborne illness by 20% in 5 years. In 2000, the baseline year, there were over 1.3 million cases of acute foodborne disease in England and Wales, which led to over 368,000 GP consultations, nearly 21,000 hospital admissions (accounting for over 88,000 bed days) and nearly 500 deaths.
If campylobacter infection, which was responsible for most of the morbidity due to identifiable pathogens, is not controlled the Food Standards Agency will not meet its target. Furthermore, in his strategy for Health Protection the role of infection in chronic disease aetiology featured as one of the Chief Medical Officer’s priorities. The Advisory Committee on the Microbiological Safety of Food will be publishing a major report on campylobacter infection early in 2004 and the Group needs to be ready to respond to the research opportunities that will arise from it.