Diverse projects supported in recent funding round

3 February 2009

Eight diverse projects supported in recent DHBRF funding rounds

Funding has been announced for a variety of projects addressing health research needs of District Health Boards, in the areas of mental health and diabetes, obesity and cardiovascular disease.

The eight District Health Board Research Fund projects are outlined below, in the words of the applicants:

District Health Board Research Fund: Mental Health

Funding results:

Integration of mental health care within a primary health care setting

Dr Sunny Collings, University of Otago

Mr Philip Gandar, Synergia Ltd

Professor Tony Dowell, University of Otago

Mr David Rees, Synergia Ltd

18 months, $999,632

The recently funded DHBRF project in the area of mental health care, “Toolkit for Primary Mental Health Care Development”, is led by Dr Sunny Collings, co-Director of the Social Psychiatry and Population Mental Health Research Unit, based at the University of Otago, Wellington, and Mr Philip Gandar, of Synergia Ltd.  The other investigators are Professor Tony Dowell, Department of Primary Healthcare and General Practice at the University of Otago, Wellington, and Mr David Rees of Synergia Ltd.

The aim of the project is to use a translational approach to research and develop an evidence based, sustainable system framework for primary mental health care. This will build on and strengthen existing capacities and capabilities. The overall aim is to support Primary Mental Health Care implementation in a range of New Zealand settings by producing a series of best practice toolkits.

The research will take 18 months and will look at what DHBs, PHOs, NGOs and other organisations need to do to provide mental heath care, ranging from mental health promotion to treatment of disorders in the primary care setting.  The process will engage a range of key stakeholders in the participative development of the framework, based on the principles of Participatory Action Research.

District Health Board Research Fund: Translational Research in Cardiovascular disease, Diabetes and Obesity

Funding results:

Preventing diabetes in people with acute coronary syndrome and hyperglycaemia.

Dr Jeremy Krebs, Department of Endocrinology, Capital & Coast District Health Board

12 months, $102,855

This project is a prospective intervention study involving individuals at-risk of having further cardiovascular events or developing Type 2 Diabetes Mellitus.  Those people with acute coronary syndrome and hyperglycaemia are identified as at-risk individuals. 

The proposed study will involve two groups.  Group A is the control and the subjects will receive primary and secondary healthcare as per normal.  Group B is the intervention and participants will receive normal secondary care but a more structured and focused link with primary healthcare. 

The intervention will involve regular check-ups over a 9 month period and a comprehensive package of education, diet and exercise from the primary health care services. 

The aim of this study is to optimise and co-ordinate the resources that are already present in the healthcare sector to provide a more strategic focus on the at-risk groups and to ultimately reduce the incidence of further cardiac events and development of type 2 diabetes.

New Zealand group-based self-management education for patients/whanau with Type 2 Diabetes.

Dr Jeremy Krebs, Department of Endocrinology, Capital & Coast District Health Board

12 months, $133,772

Type 2 diabetes affects 200 000 New Zealanders. Maori and Pacific populations have higher rates and related complications.  Tight control of glucose and blood pressure reduces the rates of complications and underpins the management of diabetes.  International evidence demonstrates that group-based self-management education facilitates improved glucose control, better understanding of disease and quality of life. 

These programmes have been developed in particular population, cultural and social contexts.  New Zealand must develop an efficacious and cost-effective education programme that meets the specific needs of our population.  This must be deliverable in primary care, meet the needs of Maori and Pacific and be developed in partnership with them. 

In this proposal a broad partnership between Secondary care, PHOs, Maori and Pacific stakeholders and University, reviews existing evidence-based programmes and develops a NZ equivalent including distinct Maori and Pacific components.  The programme will be piloted and revised accordingly.  It will then be tested in primary care environments in Wellington and Dunedin, including Maori and Pacific providers.

A trial program for reducing the impact of diabetes related foot disease through Māori whanau contexts

Dr Lisa Ferguson, Taupua Waiora, Centre for Māori Health Research, AUT University

12 months, $98,355

Decreasing diabetes foot and limb complications among Māori is a priority.  Prior research found that informed supportive whanau contexts are essential for ensuring and maintaining change.  This research will translate those findings into an appropriate programme. 

This programme will work with people who have diabetes and their whanau, using a multi-method design, within a Māori theoretical framework.  In collaboration with a facilitator from the Taranaki PHO, six Māori with diabetes and their whanau (N= approx 60) will develop their own plans for supporting preventive foot health.  Evaluation will assess the effectiveness of the program in reducing the impact and incidence of diabetes related foot pathology in the participants with diabetes and ensuring a supportive family context. 

This will inform policy at a national level about the effectiveness of a program designed by and with whanau rather than for an individual.  It will inform national strategies about processes that work in the regional DHB delivery of preventive health.

Optimal management of morbidly obese diabetes patients undergoing bariatric surgery

Dr Brandon Orr-Walker, Middlemore Hospital, Counties Manukau District Health Board.

12 months, $76,509

Bariatric surgery is a safe and effective method of delivering marked long-term weight reduction and a dramatic improvement in diabetes control.  However, it is not without its own side-effects and recipients may still regain the lost-weight if a commitment to lifestyle changes is not maintained. 

The aim of the current study is to investigate whether intensive pre- and post-operative counselling and support of morbidly-obese diabetic subjects will provide a better outcome than standard care.  A cohort of patients with type 2 diabetes and morbid obesity (BMI≥35) will be randomised to receive a “wrap around” regimen comprising intensive psychological assessment/counselling, cultural support , intensive dietetic assessment/counselling and an exercise programme or standard guideline-based based care in a 1:1 ratio. 

All participants will undergo a bariatric surgery procedure 6-months after randomisation.  The total duration of follow-up is 18 months (i.e. 6-months pre-surgery and 12-months post-surgery).  Principle outcome measures include change in BMI, HbA1c, blood pressure, fasting lipid levels, resting pulmonary function and quality of life.  If the study is successful, this could lead to a new health strategy where the very obese diabetic patient is offered an effective weight reduction treatment and the possibility of avoiding the worst scourges of long-term diabetes.

Does a Virtual Specialist Diabetes Clinic improve linkages with primary care and reduce the demand on secondary care diabetes specialist services?

Associate Professor Patrick Manning, Endocrinology, Otago District Health Board

12 months, $11,500

Specialist diabetes services are currently delivered by diabetologists through the conventional outpatient clinic.  Because of the demand on this service waiting times for people with diabetes referred by their GP can be considerable.  The aim of this study is to examine the impact of providing a virtual (telephone) clinic for general practitioners and practise nurses.  All referrals made to the diabetes service will be answered by way of direct telephone contact with the referrer by one of the four diabetes specialists at Dunedin Hospital. 

The aim will be to provide the advice that the primary care worker requires to care for the patient in the community without the patient having to come to the diabetes outpatient clinic.  We will also be able to provide advice for primary care workers who telephone the service at this time.  We will determine the effectiveness of this service by comparing the number of patients seen in the outpatient clinic in the 6 months prior to and after the virtual clinic is established.
Whole of System Approach to CVD Interventions in Counties Manukau

Dr Allan Moffitt, Primary Care Development, Counties Manukau District Health Board.

12 months, $104,462

This research will build on a national CVD dynamic simulation model to explore how it can be translated to the specific local context of Counties Manukau. 

We will partner with local DHB and PHO experts to identify: local priority questions that might be addressed by the model; where local data is available to apply within the national model; to quantify local changes in service during the time of the study and determine whether the model accurately reflects the effects of these changes on the system of cardiovascular services in Counties Manukau.

By involving local experts we expect to transfer knowledge of how to use these tools, and assess whether these experts consider this modelling process will help refine local decision making and therefore improve delivery of services within the available resources.

Factors affecting effective implementation of the National Diabetes Retinal Screening Grading System and Referral Guidelines: A multi centre analysis.

Dr Edward Hutchins, Ophthalmology Section, University of Otago Dunedin School of Medicine.

8 months, $103,030

Blindness as a result of diabetes when managed appropriately is almost entirely preventable. We plan to take an in depth look at those with diabetic eye disease referred to and seen in hospital eye departments across the country, in an effort to identify what practices make an efficient referral service (measured by meeting the national guidelines), so that these practices might be adopted by other services to improve efficiency and health outcomes for patients. 

This will take the form of a cross-sectional analysis or audit.  We anticipate that this will take six months to do; and that we will need to look at quite a number of the different eye clinics around the country in order to identify trends that are applicable to our different target populations (Māori, Non Māori, Pacific Islanders as well as younger and older populations).

ENDS

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