A Realist Evaluation of Paramedics Working in General Practice: An assessment of clinical and cost-effectiveness (READY Paramedics) 

General Practices are currently under increasing amounts of pressure, there is a shortage of doctors to meet demands, so general practices are using other health professionals to undertake some tasks. Paramedics who are trained professionals to give emergency care outside of the hospital are one of the professions being used alongside doctors in general practice. The paramedic's role will vary in different practices across England, for example in some practices paramedics are employed to carry out home visits and in others, they are employed for same-day clinics or telephone appointments, and some can only see specific patients. The approach this study is taking an approach called 'Realist Evaluation' to look at what will work best in different circumstances. 

Different General Practices have various problems to solve and one way of using a paramedic might work for one but not the other, therefore the study will be looking at the effect this variation has on factors such as patient care, safety and experience, staff workload and costs to the NHS. 

While using previous research, we will investigate issues that might be important in understanding what works for patients and staff and how it affects resources like time and money. While speaking to key people such as practice managers, funding staff, doctors, paramedics and patients to ensure that we can fully understand the issues. This information will be used to guide a detailed investigation of general practices. 24 different practices will take part across England, these practices will represent the use of paramedics in different ways, and those practices that do not use paramedics will also be included, all will vary in size, location and many other characteristics. 

In all practices, a sample of patients who have and haven't seen a paramedic will be invited to participate in the study to provide additional detail about their appointment, how they felt about it and what happened after. The findings will be communicated to academics and will then help to provide a better understanding of how and why paramedics are best used in general practice under different circumstances, and the costs involved. This research will have the potential to improve patient safety and experience and inform local and national funding decisions about NHS services. 

Around 10-15% of people over the age of 65 living at home are at risk of malnutrition. Poor appetite is an important risk factor for malnutrition and for weight loss, and a risk factor for the development of infections, hospital admisions and even longer term mortality. This may be  down to the fact that they are not getting enough to eat or because they are not eating enough of the right foods. 

The study team have therefore developed an approach ('intervention') to help out the doctors and nurses in general practice to check if older adults who live at home are at risk of malnutrition, they are then able to offer support to those who need it. The study teams intervention, named 'Eat Well, Feel Well, Stay Well',  includes booklets and other meterials for older adults and support for health professionals. The support that will be offered to health professionals includes guidence about when to see patients, and for those more severely at risk when to use oral nutritional supplements. This intervention was improved after feedback from people aged over 65 years, patients and healthcare professionals. 

The team will aim to assess the effectiveness of the above intervention. All patients get a brief intervention with patient bookelts and follow-up, but individuals who are at much greater risk will have accesss to the brief intervention plus oral nutritional supplements (ONS) for short spells when they are unwell. The team will assess the outcomes including the number of infections people get, change in eating patterns, weight and quality of life, they will aslo compare patients and health professionals' experiences of being in these different groups. 

Here at Townsend House, we are taking part in the study of Acitve Brains, this study's objective is to help adults look after their brain and body health, these patients will be recruited from specific searches. The study aims is to help prevent problems with things like remembering, concentrating or reasoning (known cognitive decline).

The website will help guide older adults to make simple changes such as getting more active, playing brain training games and finding ways to eat more healthily and the research results will test how well the website works. The findings of this study will mean that the team can tell whether the Active Brains website helps the people who use it to avoid or delay cognitive decline. 

The team will be testing the website in two groups of people, the first group will consist of older adults with signs of cognitive decline and the second group consisiting of older adults without any cognitive decline. Members from both groups will be placed randomly into one of three study groups:

1 - Care as they usually would from their GP practice.

2 - The Active Brains website.

3 - The Active Brains website plus a bit of support from a trained person (Over the phone or by Email).

The study will last for five years and at the end of the first year, the study team will compare people's thinking (cognitive) skills in each of the three groups. Then after five years, they will compare the three study groups again and also check how many of the people in each study group went on to be diagnosed with dementia.