A partnership between the Universities of Brighton and Sussex with the NHS

 

elderly care and community medicine

Name: Professor Helen Smith BM BS MSc DM MRCGP FFPHM

Academic position: Chair of Primary Care

Research: Evaluation of new technologies in Primary Care

Contact details:

Room 319
Mayfield House
Brighton and Sussex Medical School
University of Brighton
Brighton BN1 9PH
UK

Fax: +44 (0)1273 644440

Personal Assistant to Chair of Primary Care:

vacancy
01273 644143

Biography:

• Graduate University of Nottingham 1981
• Accreditation in Public Health Medicine 1991
• Research Fellow, University of British Columbia 1990-92
• Accreditation in General Practice 1993
• Senior Research Fellow, Primary Medical Care, University of Southampton 1994-96
• Director Wessex Primary Care Research Network 1994-2003
• Senior Lecturer (1996-2000) and Reader (2000-03) in Primary Care, University of Southampton
• Chair of Primary Care and Director of Division of Primary Care and Public Health Medicine, Brighton and Sussex Medical School, 2003 onwards

Teaching focus:

Undergraduate teaching of Public Health and General Practice. Post graduate teaching of health service research methods. In addition I have a particular interest in developing the capacity of practitioners to use and do research through membership of a primary care research network.

 

Research focus:

Multi-method evaluative studies of new technologies in the primary care setting.

Current research:

The evaluation of new technologies in a primary care setting is of increasing importance as the scope and nature of General Practice changes in response to health policy and work load. My work focuses on both specific clinical conditions (allergy, musculoskeletal disorders and heart failure) and the evaluation of alternative methods of service delivery to cope with an increasing work load.

 

Musculoskeletal disorders

Hip fractures in the elderly are a major source of morbidity and mortality. To date preventive measures have focused only on those individuals with known osteoporosis. In collaboration with colleagues in Southampton (Dr Fraser Anderson (Elderly Care), and Prof Cyrus Cooper (MRC Rheumatology)) I am leading a randomised evaluation of a cheap and practical primary intervention (annual vitamin D injections).

Vitamin D deficiency is thought to be a major contributor to fractures in the elderly. This study involves 10,000 patients and assesses the clinical effectiveness of an annual Vitamin D injection that is given in the autumn at the same time as the pre-existing and accepted primary care intervention of influenza vaccination. Allied with this project we are investigating the bioavailability of intramuscular vitamin D, the relationship between fear of falling and immobility, men’s attitudes towards osteoporosis and the impact of vitamin D on knee pain. A recent successful trial of vestibular rehabilitation for dizzy patients in the community will be developed into a falls intervention and trialled in the elderly.

 

Allergy and atopic disease
Atopic disorders are increasing in prevalence. Many patients with hay fever do not experience symptom relief with conventional drug therapy. Injection immunotherapy is now confined to use in tertiary referral centres, but oral immunotherapy (sublingual tablets) is a safe alternative that may be effective in a primary care setting where the majority of patients with rhinitis are managed. I have recently led a large pragmatic trial of sublingual immunotherapy for grass pollen allergy in General Practice which demonstrated improvement in nasal but not ocular symptoms. There is a need now to trial other dosing regimes to explore if the therapeutic benefits can be maximised. In parallel with these trials I am exploring in qualitative and quantitative studies patients’ understanding of hay fever and beliefs about medication, as this is a clinical condition where adherence is particularly poor.

Further projects relating to atopic disorders include an evaluation of writing about emotional events in the management of patients with asthma (with Prof R Horne, Centre for Healthcare Research, PGMS, University of Brighton) and a trial of yogic breathing exercises in the management of children with asthma (with Dr G Lewith, Complementary Medicine, University of Southampton).

Cardiac failure
Cardiac failure is poorly diagnosed in primary care, clinical criteria are inaccurate and the value of simple investigations such as chest x-ray or ECG is limited. Echocardiography is currently considered to be the most appropriate diagnostic tool. I established a multidisciplinary research team to assess the prevalence of left ventricular-dysfunction in a community and compared the cost and predictive value of echocardiography with a biochemical marker of heart failure (B type natriuretic peptide). The trial also included an assessment of the impact of echocardiographic screening on the psychological well being, clinical management and resultant quality of life of the patient.

Leading on from this work I am conducting a study of elderly patients’ adherence to heart failure medication using electronic compliance monitors and correlating compliance with standardised measures of illness perception and beliefs about medicines. This work on adherence, together with our data on prevalence, performance characteristics of screening instruments, economics and uptake rates, will support the development of a pragmatic intervention for a RCT of a screening programme for heart failure in the elderly

 

Evaluation of new ways of delivering health care in a primary care setting
This program of work is built on national collaborations which began with a randomised-controlled trial of Telephone Triage Service for out-of-hours calls to GPs. Out-of-hours calls to GPs had quadrupled in the last 20 years and now less than one third of calls are for emergencies. This study was an evaluation of alternative ways of dealing with the increased workload. A centralised telephone help line service staffed by a nurse receives patients’ out-of-hours calls to their GPs. The nurse assessed the patient’s problem using computerised protocols and the patient was given either advice, referred on to a GP or a ‘999 call’ activated as appropriate. Outcome measures included avoidable deaths, hospital admissions, complaints and patient satisfaction and generated six major publications and has been developed nationally in the form of “NHS Direct”.

More recent evaluations include cardiac liaison nurses in the management of patients post myocardial infarction, a direct access nurse led sigmoidoscopy service, the out of hours exemplar program, minor surgery and Advanced Access.

Key/recent publications:

 

Books:

SMITH H, FREW AJ. Allergy – your questions answered. Churchill Livingstone, London (2003)

 

Editorials:

STOCKS N, SMITH H Primary Care Research networks for Australia (2002) Australian Family Physician 31:195-196

 

Full papers:

YARDLEY L, SMITH H (2002) A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. Gerontologist 42: 17-23

WRIGLEY H, GEORGE S, SMITH H, SNOOKS H, GLASPER A, THOMAS E (2002) Trends in demand for ambulance services in Wiltshire over nine years: observational study. BMJ 324: 646-7

SMITH H, WRIGHT D, MORGAN S, DUNLEAVEY J, MOORE M. (2002) The ‘research spider’: a simple method of assessing research experience. Primary Health Care Research & Development 3 :139-40
EXWORTHY M, WILKINSON E, McCOLL A, MOORE M, RODERICK P, SMITH H, GABBAY J. (2003) The role of performance indicators in changing the autonomy of the general practice profession in the UK. Social Science & Medicine 56: 1493-1504

SMITH H, WRIGHT D, WHITE P, MOORE M. (2003) To collaborate, or not to collaborate? ; The WReN Rapid Guide to assessing research requests. Primary Health Care Research and Development 4: 5-7

LATTIMER V, BRAILSFORFD S, TURNBULL J, TARNARAS P, SMITH H, GEORGE S, GERARD K, MASLIN-PROTHERO S. Reviewing emergency care systems 1: insights from systems dynamics modelling. Emergency Medicine Journal (in press)

GERARD K, LATTIMER V, TURNBULL J, SMITH H, GEORGE S, BRAILSFORD S, MASLIN-PROTHERO S. Reviewing emergency care systems 2: measuring patient preference using a discrete choice experiment. Emergency Medicine Journal (in press)

JORDAN K, SAWYER S, COAKLEY P, POOLE J, SMITH H, COOPER C, ARDEN N. (2004) The use of conventional and complementary treatment in patients with knee osteoarthritis in the community. Rheumatology 43; 381-4

HOWE A, CAMPION P, SEARLE J, SMITH H. (2004) New perspectives - approaches to medical education at four new UK Medical Schools. BMJ 329:327-331

SMITH H, WHITE P, WEBLEY F, FREW A. A survey of hay fever leaflets available in the community and a review of their quality. Clinical and Experimental Allergy (in press)

SMITH H, WHITE P, ANNILA I, POOLE J, FREW A. A randomised controlled trial of sublingual immunotherapy for hay fever in UK. Journal of Allergy and Clinical Immunology (in press)

POCKNEY P, GEORGE S, PRIMROSE J, SMITH H, KINLEY H, LITTLE P, LATTIMER V, LOWY A, KNEEBONE R. Impact of the introduction of fee for service payments on types of minor surgical procedures undertaken by General Practitioners: observational study. Journal of Public Health Medicine (in press)

YARDLEY L, DONOVAN-HALL M, SMITH H, WALSH B, BRONSTEIN A. Effectiveness of nurse-delivered vestibular rehabilitation for dizziness in primary care: a randomised controlled trial. Annals of Internal Medicine (in press)

PAYNE S, KERR S, HAWKER S, SHELDON F, SEAMARK D, DAVIS C, ROBERTS H, JARRETT N, RODERICK P, SMITH H. A survey of the provision of palliative care in community hospitals: an unrecognised resource. Journal of the Royal Society of Medicine Sept 2004 97:428-431

 

Current/recent laboratory funding:

• National Osteoporosis Society
• MRC
• NHS R&D
• Department of Health

 

Active collaborations:

National:

• Dr Val Lattimer (University of Southampton) - Evaluation of exemplar sights for out of hours care
• Dr Chris Salisbury (University of Bristol) - Evaluation of Advanced Access
• Prof Cyrus Cooper (MRC, University of Southampton) - Prevention of osteoporotic fracture
• Prof Sheila Payne (University of Sheffield) - Palliative care in community hospitals
• Prof David Cogan (MRC, University of Southampton) - Management of upper limb pain
• Dr Steve George & Prof John Primrose (University of Southampton) - Evaluation of Primary Care minor surgery.

Research fellows and assistants:

• Dr David Crook
• Dr Tim Chiari
• Dr Sarah Edwards
• Anna Tissandier

Other information:

• Member of Society of Academic Primary Care
• Member of North American Primary Care Research Group
• Member of the European Academy of Allergology and Clinical Immunology
• Member of the American Academy of Allergy, Asthma & Immunology
• Editorial Board Member Primary Health Care Research & Development
• Examiner Part 1 Membership Faculty of Public Health