Research

Ongoing projects

Incidence and Clinical Characteristics of Virologically Confirmed RSV: An Observational Study of Acute Respiratory Illness (ObservatARI)
Co-investigator, Health Economics work package
Funded by Moderna, £4 million, 2023-2025

Abstract

Respiratory syncytial virus (RSV) is a highly infectious seasonal respiratory virus. More precise contemporary data on RSV incidence in the community is needed to assist in planning any new RSV vaccination programme for the elderly. To deploy point-of-care-testing (POCT) in primary care to provide contemporary data about incidence, clinical presentation and disease burden of virologically confirmed RSV among adults presenting with acute respiratory infection (ARI). Between November 2023 and November 2024 we will recruit 21 geographically spread practices in England participating in the RCGP Research Surveillance Centre (RSC) based at the University of Oxford. Practices were selected if they were undertaking reference virology sampling for the RSC and had prior experience with undertaking respiratory illness studies. The staff at each study practice will receive training on the appropriate use of the POCT device from the manufacturer, which will be documented on a training log. We will estimate the incidence rate of RSV and use regression models to describe the characteristics of patients with RSV, investigate its clinical features and risk factors, and measure the economic burden of disease.

Waiting times in Emergency Departments: Inequalities and Impact on health outcomes
Co-investigator
Funded by the National Institute for Health Research (NIHR) and
Health and Social Care Delivery Research (HSDR), £609,000, 2023-2026

Abstract

Crowding and long waiting times in Emergency Departments (EDs) are a major challenge for healthcare systems worldwide. In England, ED attendances reached 25 million in 2019/20, a 17% increase since 2010/11, and in December 2022 over 35% of patients waited more than four hours to be seen. Although deprivation is strongly associated with poorer health and higher ED use, it is unclear whether patients from more deprived areas experience longer waits for unplanned emergency care, or whether longer ED waits are associated with worse health outcomes. Ensuring equitable access to ED care is a key NHS priority, particularly as plans are underway to replace the four-hour waiting time target with alternative performance measures. This study will provide robust evidence to inform fair and timely ED care. We will: (i) assess inequalities in ED waiting times by deprivation, age, gender, ethnicity and other characteristics; (ii) examine the impact of ED waiting times on patient health outcomes; and (iii) explore how differences in ED organisation influence patient prioritisation and treatment. Quantitative analyses will use anonymised NHS data from 2018–2022, accounting for the COVID-19 pandemic and focusing on both all conditions and deprivation-related conditions such as heart failure, COPD and asthma. Qualitative research will involve observations and interviews with patients, relatives and staff in four English EDs. Findings will be disseminated through patient-friendly summaries, policy briefs, academic publications and stakeholder workshops, supported by strong patient and public involvement throughout the project.

Multi-morbidity, Inequality, and Use of and Access to Health Care (MICA)
Co-investigator
Funded by National Institute for Health Research (NIHR) School for
Primary Care Research, £62,700, 2021-2024

Abstract

Multi-morbidity is a major challenge with substantial implications for NHS resources. The aims of this project are to improve understanding of the relationships between socioeconomic status and: • use of healthcare services by middle-aged and older people with multiple chronic conditions; • access to primary and secondary care by middle-aged and older people with multiple chronic conditions. We will focus on people aged 50 and over since multi-morbidity is more prevalent in later life. We define multi-morbidity as occurring when a patient has two or more of 37 health conditions identified in a study by the University of Cambridge. We will use electronic records from the Clinical Practice Research Datalink (CPRD) linked with Hospital Episode Statistics (HES) and Index of Multiple Deprivation (IMD) data to examine relationships between the number of health conditions, patients’ socioeconomic status and their use of and access to healthcare services. We will conduct multivariate analyses of the CPRD data sample and linked HES and IMD data to examine the relationship between the number of health conditions, patients’ socioeconomic status and use of healthcare services. As a proxy for primary care access, we will estimate, using a dynamic regression (time variant) analysis, the number of A&E attendances (consultant led 24-hour service) recorded in a specified time-period, for patients who self-refer to A&E and are discharged after their attendance. Using multivariate analysis and Poisson models, we will estimate the numbers of consultations and tests in primary care, visits to A&E departments, outpatient appointments and hospital admissions for groups of patients who suffered a postponed/cancelled appointment before and during the Covid-19 pandemic. This analysis will be useful to explore if the pandemic has exacerbated inequality between socioeconomic groups.

Real-world effectiveness of the Oxford/AstraZeneca COVID-19 vaccine in England
Co-investigator, Health Economics work package
Funded by AstraZeneca £5 million, 2022-2024

Abstract