Collaborative Research using Hub and Spoke practices
The Peninsula Practice
The CORDIA study is a different approach to diabetes education whereby patients are encouraged to influence each other to make lifestyle improvements rather than rely solely on the didactic, paternalistic, consultations often experienced. It is very challenging to recruit "well" diabetes patients who may work to commit to group discussion sessions.
We were approached by the Cordia Team March 2013 and met for an initial study meeting together with other interested surgery teams.
This session was very enlightening. We were relatively ‘new kids on the block’ and felt very much part of the ‘seeds of design’ stage being involved with feasibility practicalities and understanding how the theory (design) could be put into practice. We helped brain storm the logistics of implementing the study
This was both liberating and inspiring – realising how us in a little surgery in rural Suffolk can engage and help shape studies that are so relevant to Primary Care and subsequently important in shaping service provision. It showed us how the process of studies evolves and how everyone no matter how experienced or not in research can contribute to the optimisation of a good and robust study.
A further meeting was arranged a few months later where we went through a ‘virtual test’ of the trial. This led to the realisation that the Cordia study lent itself perfectly to a hub and spoke model and we at The Peninsula Practice had the team and confidence to be the hub for the first time.
As we are very proactive with research at the Peninsula Practice we felt we could achieve a high intake and we had the internal structures to manage this successfully. Enthusiasm, energy and drive to be part of the process is pivotal to success in research and we are fortunate to have such a passionate team.
Furthermore we were the hub for surgeries within the Deben Health Group - a collaborative group of local practices with whom we meet regularly to brain storm ideas and collaborative working to enhance the delivery of excellent patient care. So with this positive and supportive relationship between surgeries there was already a good working relationship between us.
Our research nurse Ruth visited all the sites and worked with all staff involved. Dr Crockett was the Principle Investigator and performed all the record reviews and took overall responsibility for the clinical aspect. Our excellent practice manager worked hard behind the scenes with regular liaison and support of the CRN and in overseeing payments received for study support costs.
Ruth felt it enabled her to liaise with practices more effectively, which enabled surgeries to jointly recruit to different cohorts. The study did involve a lot of unsociable hours due to the delivery of the patient sessions however the Research team supported our nurse in this.
Once the delivery sessions were completed it then involved data capture work for the nurse.
Ruth felt supported by the Research team, and was given a lot of positive feedback from the Study team. She found that the 6 month data capture showed some interesting results. Ruth felt she gained confidence in dealing with diabetic patients and gained very much in personal development.
By the end of the study the 6 Practices that collaborated recruited 63 out of the total 180 recruits onto this study, and that would undoubtedly have failed without this flexible approach to working the study.
Since the study we have realised the importance of patient education and how perceptions that diabetic patients may have can determine their overall care.
An example is how our tick box culture risks medicalising diabetes (and other chronic conditions) and it is easy to forget that patient’s knowledge of their illness is paramount to optimal management. Diabetes is clearly not just about medicating their HbA1c. So now we take a more holistic approach, our nurses are developing their skills for diabetic reviews with an emphasis on lifestyle, education and understanding what the patient’s concerns and needs are. This results in a happier and healthier patient as well as clinicians!
Quote from the Cordia Study Team
Peninsula Practice played a key role in achieving recruitment targets for the Cordia study within Suffolk. The practice acted as the hub for multiple sites in the area; they were highly effective in recruiting spoke sites, and feeding participants into the study, such that they recruited the most participants to the study of all of our primary sites. Linda, Lindsay and Ruth showed great enthusiasm and commitment to the study, and were a pleasure to work with.