Background
History
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consultations with the NHS, its users, and the research community, and with the non-health sector.
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research overviews (health and non-health).
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reports from four specially convened working groups on the role of consumers, the media, changing clinical practice, the impact of policy and financial levers.
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expert papers, commissioned from outside experts and advisory group members.
Ist Commissioning Round | |
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IMP 1 Influence of source and presentation of evidence on its uptake by health care professionals and others (20 applications, 1 funded) | |
IMP 1–11 Study of GP reasons for changing/not changing prescribing behaviour | Qualitative |
IMP 2 The principal sources of information on health care effectiveness used by clinicians (11 applications, 1 funded) | |
IMP 2–11 Nurses' use of research evidence in decision-making | Qualitative |
IMP 3 The management of uncertainty and communication of risk by clinicians (21 applications, 4 funded) | |
IMP 3–5 Communicating risk reduction to patients and clinicians in the secondary prevention of ischaemic heart disease | Qualitative & RCT |
IMP 3–10 Investigation of Doctors' ability to understand and use clinical prognostic models when different metrics are used to describe model performance | Qualitative |
IMP 3–12 Self-medication and the communication of risk: The case of deregulated medicines | Qualitative |
IMP 3–16 Systematic review of risk communication – improving effective clinical practice and research in primary care | SR |
IMP 4 Roles for health service users in implementing research (26 applications, 3 funded) | |
IMP 4–13 Availability of information material to promote evidence-based patient choice | Qualitative |
IMP 4–16 Evaluating improvements in the ability of health information services to provide information on clinical effectiveness | Qualitative |
IMP 4–21 Effective communication – an evaluation of touchscreen displays providing information on prenatal diagnosis | RCT |
IMP 5 Why some clinicians but not others change their practice in response to research findings (45 applications, 3 funded) | |
IMP 5–23 Understanding the reasons for change, or not, in clinical practice – the case for dilatation and curettage | Qualitative |
IMP 5–40 Uptake of effective practices in maternity units | Qualitative |
IMP 5–41 Social networks and the use of research in clinical practice | Qualitative |
IMP 6 The role of commissioning in securing change in clinical practice (16 applications, 0 funded) | |
IMP 7 Professional, managerial, organisational and commercial factors associated with securing change in clinical practice, with a particular focus on trusts and primary care providers (35 applications, 0 funded) | |
IMP 8 Interventions directed at clinical and medical directors and directors of nursing in trusts to promote evidence-based care (9 applications, 0 funded) | |
IMP 9 Local research implementation and development projects (such as GRiPP) (17 applications, 0 funded) | |
IMP 10 Effectiveness and cost-effectiveness of audit and feedback to promote implementation of research findings (16 applications, 2 funded) | |
IMP 10–11 Evidence based secondary prevention of heart disease in primary care: an RCT of three methods of implementation | RCT |
IMP 10–16 Effectiveness and costs of guidelines, prioritised audit criteria, and feedback in implementing change | RCT |
IMP 11 Educational strategies for continuing professional development to promote the implementation of research findings (34 applications, 3 funded) | |
IMP 11–10 Effectiveness of education & implementation strategies and the adoption of evidence based developments in primary care | RCT |
IMP 11–26 Using informal learning in the implementation of research findings | Qualitative |
IMP 11–29 Effectiveness of contin. education conferences and workshops to improve practice of health professionals | SR |
IMP 12 Effectiveness and cost-effectiveness of teaching critical appraisal skills to clinicians, patients/users, purchasers and providers to promote uptake of research findings (18 applications, 2 funded) | |
IMP 12-8 Systematic review of studies of effectiveness of teaching critical appraisal | SR |
IMP 12-9 RCT of the effectiveness of critical appraisal skill workshops on health service decision makers in SW region | RCT |
IMP 13 The role of undergraduate (pre-qualification) training in promoting the uptake of research findings (19 applications, 0 funded) | |
IMP 14 The impact of clinical practice guidelines in disciplines other than medicine (33 applications, 1 funded) | |
IMP 14–32 Review of the effectiveness of guidelines in professions allied to medicine | SR |
IMP 15 Effectiveness and cost-effectiveness of reminder and decision support systems to implement research findings (22 applications, 7 funded) | |
IMP 15-4 RCT of a simple prompting system re appropriate management of iron deficiency anaemia and its influence on clinical outcome | RCT |
IMP 15-8 Effectiveness of computerised advice on drug dosage in improving prescribing practice | SR |
IMP 15-9 Evaluation of computerised guidelines for the management of two chronic conditions | RCT |
IMP 15-11 Cochrane SR of effects of paper & computer-based reminders and decision support on clinical practices & patient outcomes | SR |
IMP 15-12 Comparing patient held prompt & reminder card to a doctor held prompt & reminder card to improve epilepsy care in the community | RCT |
IMP 15–19 Maternity Guidelines Implemented on Computer (MaGIC) | Pilot study |
IMP 15–21 Review of economic studies of reminders and decision support systems | SR |
IMP 16 The role of the media in promoting uptake of research findings (20 applications, 2 funded) | |
IMP 16–18 Systematic review of the impact of mass media campaigns on health services utilisation and health care outcomes. | SR |
IMP 16–19 The role of the media in public and professional understandings of breast cancer | Qualitative |
IMP 17 Impact of professional and managerial change agents (including educational outreach visits and local opinion leaders) in implementing research findings (16 applications, 2 funded) | |
IMP 17-12 Is the involvement of opinion leaders in the implementation of research findings a feasible strategy? | Qualitative |
IMP 17-13 Prevention of deep vein thrombosis: A feasibility study for a randomised trial of three different strategies to implement evidence based guidelines | Pilot study |
IMP 18 Effect on evidence – based practice of general health policy measures (3 applications, 0 funded) | |
IMP 19 The impact of national guidance to promote clinical effectiveness (16 applications, 1 funded) | |
IMP 19-15 The injecting drug taker and the community pharmacist: impact of new department of health guidelines and obstacles to a broader service-providing base | Qualitative |
IMP 20 Analysis of use of research-based evidence by policy makers (7 applications, 0 funded) | |
Joint DoH funded project (under IMP 4)
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Evaluation of informed choice leaflets in maternity care | RCT |
2nd Commissioning Round
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Evaluation of the effectiveness of interventions to improve the uptake of research findings in practice
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IMP R2-25 Evaluation of effectiveness and cost-effectiveness of audit, feedback and educational outreach in improving nursing practice and health care outcomes | RCT |
IMP R2-34 Development and preliminary evaluation of decision interventions decision | Pilot study |
IMP R2-64 RCT of dissemination & implementation strategies for guidelines for extraction of third molar teeth | RCT |
Methods
Documentary analysis
Questionnaire to the thirty-six lead applicants of IMP-funded projects
Questionnaires to potential users on the dissemination and use of research findings
Desk analysis
Interviews
Results
Quantitative assessment of outputs and dissemination
Publications
Type of publication | Number |
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Peer reviewed journal article | 59 |
Journal editorial | 3 |
Journal letter | 2 |
Published abstract | 15 |
Book | 2 |
Chapter | 11 |
Non-peer reviewed article | 2 |
Published conference proceedings | 6 |
Publicly available full report | 6 |
Other | 14 |
TOTAL
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120
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Further research
Considerable importance | Moderate importance | Small importance | Contribution not recorded | Combined totals | |
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Number of projects where funding known | 3 | 4 | 3 | 10 | |
Total amount awarded in each category | £678K | £576K | £60K | £1,314K | |
Number of projects where amount of further grant not stated | 2 | 2 | 1 | 5 | |
Total number of projects | 5 | 6 | 3 | 1 | 15 |
Research training
Qualification | Obtained | Expected | Contribution of the IMP project to the qualification | ||
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Considerable | Moderate | Small | |||
MSc | 1 | 1 | |||
MPhil | 1 | 1 | |||
MD | 3 | 2 | 1 | ||
PhD | 4 | 2 | 2 |
Impact on research, teaching and clinical practice: views of potential users
Number | % of those returned | |
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Questionnaires distributed | 227 | |
Questionnaires returned | 100 | |
Knew about IMP | 35 | 35% |
Heard of at least one project | 80 | 80% |
Read an article from at least one project | 68 | 68% |
Findings from at least one project already influenced: | ||
a) clinical practice | 54 | 54% |
b) research | 8 | 8% |
c) teaching | 20 | 20% |
Findings from at least one project will influence: | ||
a) clinical practice | 73 | 73% |
b) research | 14 | 14% |
c) teaching | 24 | 24% |
Findings from at least one project have/will have influenced others | 73 | 73% |
Impact on teaching, and on health policy and practice: views of IMP researchers
Type of impact | Number of projects making an impact | |||
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Yes | No | Don't know | Blank | |
Already impacted on policy | 9 | 15 | 2 | 4 |
Expect to impact on policy | 16 | 11 | 0 | 3 |
Already impacted on practice | 8 | 12 | 5 | 5 |
Expect to impact on practice | 17 | 5 | 1 | 7 |
Dissemination
Qualitative findings from interviews with advisory and commissioning group members
An innovative programme – understanding implementation
Setting and developing priority areas for research
Commissioning research – composition of the commissioning group
Commissioning research – interaction with applicants
Commissioning research – avoiding bias and conflicts of interest
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the poor quality of many of the qualitative applications.
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concerns about generalisability.
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a related "failure to embrace complexity", a tendency to go for known and more mechanistic approaches, and not to pursue complex questions in unfamiliar territory.
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the need for research teams working in this field to have good links with the NHS, and existing clinical trial teams already had these links.
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the fact that, as one interviewee put it, "medics tend to favour RCTs".
Probity
Need for a communication strategy
Examples of important studies
Case study 1: Availability of information to provide evidence-based patient choice [IMP 4–13]
Case study 2: Nurses' use of research evidence in decision-making [IMP 2–11]
Discussion
Outputs of the programme
Developing and commissioning a research programme – lessons learnt
Setting and developing priority areas for research
The role of the commissioning group
Support for research applicants
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to develop a precise, easily understood research brief prior to commissioning. As was attempted in the IMP, an iterative process to commissioning may also be required, building on detailed analysis of previous rounds of commissioning.
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to support the development of applications during commissioning. This was vigorously pursued in the IMP and thought by some interviewees to have been helpful, although views differed about the form and timing of this interaction.
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to assist project monitoring after commissioning. In the IMP, attempts were made to provide ongoing support for project development in relation to some funded studies. But, in the absence of an ongoing overall programme, these attempts were project-specific; no overall picture of these approaches and their impact has emerged.