Evidence Synthesis Working Group
CEBM members form one of the nine teams that make up the SPCR’s Evidence Synthesis Working Group, with Oxford acting as the lead institution. This cross-School collaboration was formed last year to deliver twenty high-impact systematic reviews to underpin effective care in important priority areas in the NHS.
Recognising the importance of systematic reviews to NHS primary care
One of the aims of the National Institute for Health Research is to ‘drive faster translation of scientific discoveries into
tangible benefits for patients’. One way of achieving this is through the greater use of systematic reviews, which have been described as the basic unit of knowledge translation. By systematically searching for the totality of available evidence, critically appraising, synthesizing and contextualising the evidence into a useable form, they remain powerful ‘tools’ used by clinicians, policy makers and patients.
The NIHR recognises the value of evidence synthesis to the NHS. Several major funding streams of the NIHR directly support the conduct of evidence synthesis. These range from individual systematic review fellowships which build capacity and capability in UK researchers to core funding for the UK Cochrane Review Groups.
The Evidence Synthesis Working Group (ESWG) is a collaboration of all nine primary care member departments of the SPCR and includes over 45 researchers, methodologists, information specialists and clinicians. The aims of the ESWG are to produce high quality reviews that not only evaluate what works, but also determine, through the use of novel evidence synthesis methods (such as realist reviews and complex reviews), what works, in what situations, and for whom. In addition, the Group will identify clinical and methodology gaps to inform future research, inform policy and develop robust practical interventions for primary care.
Generating new knowledge to support primary care
Increasing wait times, declining resources, an ageing population, multi-morbidity and rising demands are just some of the challenges facing general practice. Innovative strategies are needed to meet these challenges. These include keeping patients out of hospital and in the community, the optimal use of emerging technologies and identifying new pathways for delivering sustainable and transformative models of care. However, such innovations must have a robust evidence base to ensure limited resources are used fully while ensuring high quality patient care.
Our over twenty systematic reviews are divided into four themes.
Urgent Care: recognises that unplanned hospital admissions are a major burden on patients and for UK health services, costing an estimated £12.5 billion annually. The theme will answer critical questions such as: Which health and social care interventions help reduce unplanned hospital admissions in older patients? and Does advanced care planning (ACP) for older people help to reduce unplanned hospital admissions and improve quality of life?
End-of-Life Care and Bereavement: acknowledges that bereavement is an important cause of mortality and morbidity especially among older people and those who are socially isolated, influencing both physical and mental health, and the ability to function at work. This theme will use realist synthesis methods to answer the questions: What are the interventions and policies shown to reduce complicated grief in bereaved patients in Primary Care? and What are the initiatives that have been employed to improve end of life care in Primary Care?
New drugs and methodologies: provides important evaluative evidence on technologies to improve chronic disease management. The theme will produce a series of complex systematic reviews that include synthesis of regulatory documents and clinical study reports to evaluate new drugs and some technologies in widespread use where there is uncertainty about the benefit and harms profiles. An example being the drug Mysimba to treat overweight and obesity.
Service redesign in primary care: aims to answer key questions to support the redesign of future primary care, such as: In what ways and in what contexts does telephone triage impact on workload in primary care, for whom and why? and What is the role of care navigators in primary care?
Patient and public involvement
We made patient and public involvement and engagement key components of our work. We recognise that there are many potential benefits to patient and public involvement in systematic reviews including: the consideration and identification of the key outcomes to be assessed, involvement of members of the public have first-hand experience of the disease and treatment and the opportunity for researchers and members of the public to learn from each other to gain a full understanding of a review and its purpose.
Our patient and public involvement strategy involves four core elements: oversight of review conduct and procedure, appropriate involvement in each review, the reporting of involvement and the development of prioritisation partnerships. In addition to the involvement activities outlined above, the Group will undertake engagement activities to ensure widespread dissemination is carried out. These reviews have direct public relevance and will be disseminated widely in order to ensure their findings reach the public.
Building capacity for the next generation of researchers
In the first phase of this work, we have provided bursaries for early and mid-career researchers to attend Masters level
taught courses in evidence synthesis methods. We will also continue to organise short courses in evidence synthesis
methods. In addition, we are planning ‘Evidence Synthesis Virtual Clinics’ to provide a research design service for complex evidence synthesis protocols, particularly for early career researchers applying for further funding.