Bridging the gap between the university and the NHS : health services research in psychiatry

Health services research is vital in any medical specialty. In psychiatry, it has become more high-profile with the reconfiguration of different approaches to delivering care to patients. Research in this area often appeals to clinicians, who feel that the findings may be applicable to ‘real life’ clinical experience. However, many become disillusioned when faced with unexpected problems, not only with regulatory bodies such as ethics committees and funding organisations, but also by the practicalities of recruiting patients and involving fellow clinicians in their studies. The Developing Evidence-Based Implementation Trials (DEBIT) project (Thompson et al, 2007) was run in four mental healthcare trusts in the south west of England, between February and July 2004. Its aim was to find a better way of changing clinical practice than the usual method of disseminating evidence-based guidelines, as there is wide appreciation that this is not successful (Bero et al, 1998). The research team developed a complex intervention consisting of a workbook, an educational visit to senior doctors and a reminder. The study targeted the prescription of antipsychotic polypharmacy on general adult psychiatric wards. A cluster randomised controlled trial design was employed and psychiatric units (clusters) were randomly allocated to the dissemination of guidelines alone, or the guideline plus the complex intervention. The primary outcome was a cross-sectional audit of antipsychotic prescribing taken from medication charts. The secondary outcome was a self-report questionnaire, designed to assess a change in beliefs about polypharmacy. The objective of this paper is to highlight some of the problems that were experienced during the trial and suggested solutions. Although our study was a relatively large cluster randomised controlled trial and used a reasonably sophisticated methodology, many of the problems encountered were generic and are also common to smaller, simpler and more local research. Each stage of the study has unique problems and issues and we try to reflect this