The Cluster Randomised Trial and beyond: achievements and future research
The final meeting of the RSS Primary Health Care Special Interest Group.
Sandra Eldridge (Centre for Primary Care & Public Health, Queen Mary University of London)
Early cluster randomised trials in health were undertaken in the middle of the twentieth century. From the 1980s onwards there was a significant increase in the number of these trials. Alongside this statistical papers on methodological aspects of these trials appeared, and then, around the turn of the century more papers in non-statistical journals. More recently there have been developments in analysis, in design, and in conduct, for example the handling of missing values, stepped wedge designs, the understanding of specific issues of bias in these trials, and the Ottawa statement on the ethics of these trials. These trials are particularly common in primary care. This talk will give an overview of the progress made in CRTs, particularly recent developments, and including those areas where work is currently ongoing, with particular reference to primary care .
Toby Prevost (Imperial College, London)
I will present some of the process and results from undertaking a meta-analysis in collaboration with behavioural psychology colleagues at the Cambridge Primary Care Unit. The example, which contained several interesting statistical issues, was later taken up by NICE as part of public health guidance on smoking in pregnancy, and was developed into a short course for students and researchers. It was a systematic review and meta-analysis of self-help smoking cessation interventions in pregnancy. This is an area where there is sparse data, arising from a low proportion meeting the binary endpoint of quitting smoking, and where there is considerable effect heterogeneity. The use of sensitivity analysis was shown to be beneficial in partly understanding this. We opted for a DerSimonian and Laird random effects model approach. In more recent general work with statistical colleagues we have begun developing methods for handling missing statistics in multiple Cochrane reviews, where the relationship between these two approaches will be important to exploit.
Tim J Peters (School of Clinical Sciences, University of Bristol)
While we should continue to appreciate fully the relatively healthy UK research funding environment for applied health services research in general and primary care research in particular, undoubtedly it will continue to become ever more competitive to obtain and difficult to deliver. It is also probably fair to say that in many ways research funding committees are inclined to be scientifically and financially conservative in their approach, while at the same time we face increasing challenges in terms of the context of our research, the costs and logistical hurdles we face as well as the study designs that we consider applying.
Kerry Hood (College of Biomedical & Life Sciences, University of Cardiff)
RCTs have become more expensive and challenging to undertake and there are concerns about the co-intervention effects of proactive data collection processes and challenges of loss to follow up. The pursuit in the NHS of single electronic records has been paired with the promise of capturing large amounts of data on participants in trials from what is collected during their usual contacts with the health service. Parallel centralised approaches to records have also been developed in other sectors. This talk will use examples from major trials over the last 10 years, including STAR and the Building Blocks trial of the Family Nurse Partnership in England, to explore the practical and scientific challenges of using routine data and consider what might become more possible in the future.
To be followed by Group Discussion.
Free to attend but pre-registration is required.
Followed by a closing reception
Organiser Name Maurice Marchant
Organising Group(s) RSS Primary Health Care Special Interest Group