Collaboration for Academic Primary Care (APEx) Blog
Collaboration for Academic Primary Care (APEx) Blog
Posted by ma403
24 September 2024As colleagues in Exeter will know a large part of my Deputy Medical Director role within the National Institute of Health and Care Research (NIHR) Clinical Research Network (CRN) was spent in leading pandemic primary care studies. As the dust settles on COVID-19, now is an appropriate time to reflect on the delivery of the studies and reflect on what it can teach us about primary care research both in and out of a pandemic.
As soon as the pandemic began a number of platform studies was set up urgently by the NIHR These platform studies included the secondary care RECOVERY study and the PRINCIPLE study of re-purpose drugs for COVID-19 in the community led by Professor Chris Butler from Oxford. The PRINCIPLE study investigated seven re-purposed drugs, in an adaptive platform design, none of which had a beneficial effect on COVID-19 mortality or hospitalisation in patients at higher risk of adverse complications in a predominantly vaccinated primary care population.
It was a privilege to lead the CRN engagement across primary care, working closely with colleagues across England and the four nations, to deliver this study which was a decentralised study with potential participants signposted to the study website and participating in a remotely delivered trial. Over 11,000 patients participated in this trial which finished in 2023.
Back in 2021 there was increasing evidence of the beneficial effect of the newer anti-viral drugs in COVID-19 and again it was a pleasure to lead the CRN engagement in England and liaise with our equivalent networks in the other three devolved administrations to deliver the PANORAMIC (Platform Adaptive trial of NOvel antiviRals for eArly treatMent of COVID-19 In the Community) Trial. This NIHR trial was also awarded to Chris Butler and colleagues in the University of Oxford.
PANORAMIC broke new ground in the delivery of a trial in primary care recruiting just under 30,000 participants before it finished in March 2024. Two anti-viral drugs were studied. molnupiravir and Paxlovid were compared with usual care in primary care in a pragmatic randomised trial. The trial itself commenced at the height of the omicron pandemic wave in Christmas 2021. Patients were recruited through the trial website by signposting or through around 60 GP hubs and associated spokes across the country. Patients with positive COVID-19 tests recorded on their GP clinical system were then approached and invited to participate. 25% of the recruitment came through GP practices.
I have recently co-authored an extensive report of our reflections on the delivery of the study and our summary of stakeholder feedback on the NIHR Open Research website if you wish to read more detail. There is also an NIHR news piece which outlines the key points.
This report makes 30 recommendations about future pandemic research including the need to prioritise primary care research in the pandemic to prevent infected individuals reaching hospital. There are also recommendations about improving the inclusivity of research and EDI engagement; the use of GP data in identification of individuals; the innovative delivery of the trial through GP hubs and spokes; delivery of medication to patients’ homes in a decentralised trial and the importance of an adaptive platform design in a pandemic.
Pleasingly, these two trials, were recently recognised as groundbreaking and the University of Oxford was awarded the UK Prix Galien UK 2024 award for Best Public Sector Innovation. It was a pleasure to receive this award with the team at the Natural History Museum in May.
Professor Phil Evans
13/9/24
