In the large community-based SCOOP trial, systematic fracture risk screening using FRAX® led to greater use of AOM and greater adherence, in women at high fracture risk, compared with usual care. In the SCreening of Older wOmen for Prevention of fracture (SCOOP) trial, we investigated the effect of the screening intervention on subsequent long-term self-reported adherence to anti-osteoporosis medications (AOM). SCOOP was a primary care–based UK multicentre trial of screening for fracture risk. A total of 12,483 women (70–85 years) were randomised to either usual NHS care, or assessment using the FRAX® tool ± dual-energy X-ray absorptiometry (DXA), with medication recommended for those found to be at high risk of hip fracture. Self-reported AOM use was obtained by postal questionnaires at 6, 12, 24, 36, 48 and 60 months. Analysis was limited to those who initiated AOM during follow-up. Logistic regression was used to explore baseline determinants of adherence (good ≥ 80%; poor < 80%). The mean (SD) age of participants was 75.6 (4.2) years, with 6233 randomised to screening and 6250 to the control group. Of those participants identified at high fracture risk in the screening group, 38.2% of those on treatment at 6 months were still treated at 60 months, whereas the corresponding figure for the control group was 21.6%. Older age was associated with poorer adherence (OR per year increase in age 0.96 [95% CI 0.93, 0.99], p = 0.01), whereas history of parental hip fracture was associated with greater rate adherence (OR 1.67 [95% CI 1.23, 2.26], p < 0.01). Systematic fracture risk screening using FRAX® leads to greater use of AOM and greater adherence, in women at high fracture risk, compared with usual care.

A reduction in hip fracture incidence following population screening might reflect the effectiveness of anti-osteoporosis therapy, behaviour change to reduce falls, or both. This post hoc analysis demonstrates that identifying high hip fracture risk by FRAX was not associated with any alteration in falls risk. To investigate whether effectiveness of an osteoporosis screening programme to reduce hip fractures was mediated by modification of falls risk in the screening arm. The SCOOP study recruited 12,483 women aged 70–85 years, individually randomised to a control (n = 6250) or screening (n = 6233) arm; in the latter, osteoporosis treatment was recommended to women at high risk of hip fracture, while the control arm received usual care. Falls were captured by self-reported questionnaire. We determined the influence of baseline risk factors on future falls, and then examined for differences in falls risk between the randomisation groups, particularly in those at high fracture risk. Women sustaining one or more falls were slightly older at baseline than those remaining falls free during follow-up (mean difference 0.70 years, 95%CI 0.55–0.85, p < 0.001). A higher FRAX 10-year probability of hip fracture was associated with increased likelihood of falling, with fall risk increasing by 1–2% for every 1% increase in hip fracture probability. However, falls risk factors were well balanced between the study arms and, importantly, there was no evidence of a difference in falls occurrence. In particular, there was no evidence of interaction (p = 0.18) between baseline FRAX hip fracture probabilities and falls risk in the two arms, consistent with no impact of screening on falls in women informed to be at high risk of hip fracture. Effectiveness of screening for high FRAX hip fracture probability to reduce hip fracture risk was not mediated by a reduction in falls.

Summary Community-based screening and treatment of women age 70 – 85 years at high fracture risk reduced fractures; moreover, the screening programme of fracture risk in older women had an effect that was cost-saving. The results support a case for a screening programme of fracture risk in older women in the UK. Purpose The SCOOP (screening for prevention of fractures in older women) randomised controlled trial investigated whether community-based screening could reduce fractures in women age 70 – 85 years. The objective of this study was to estimate the long-term cost-effectiveness of screening for fracture risk in a UK primary care setting compared with usual management, based on the SCOOP study. Methods A health economic Markov model was used to predict the life-time consequences in terms of costs and quality of life of the screening programme compared with the control arm. The model was populated with costs related to drugs, administration and screening intervention derived from the SCOOP study. Fracture risk reduction in the screening arm compared with the usual management arm was derived from SCOOP. Modelled fracture risk corresponded to the risk observed in SCOOP. Results Screening saved 9 hip fractures and 20 non-hip fractures over the remaining lifetime (mean 14 years) of 1,000 patients compared with usual management. In total, the screening arm saved costs (£286) and gained 0.015 QALYs/patient in comparison with usual management arm. Conclusions This analysis suggests that a screening programme of fracture risk in older women in the UK would gain quality of life and life years, and reduce fracture costs to more than offset the cost of running the programme.

Community-based screening and treatment of women aged 70–85 years at high fracture risk reduced fractures; moreover, the screening programme was cost-saving. The results support a case for a screening programme of fracture risk in older women in the UK. The SCOOP (screening for prevention of fractures in older women) randomized controlled trial investigated whether community-based screening could reduce fractures in women aged 70–85 years. The objective of this study was to estimate the long-term cost-effectiveness of screening for fracture risk in a UK primary care setting compared with usual management, based on the SCOOP study. A health economic Markov model was used to predict the life-time consequences in terms of costs and quality of life of the screening programme compared with the control arm. The model was populated with costs related to drugs, administration and screening intervention derived from the SCOOP study. Fracture risk reduction in the screening arm compared with the usual management arm was derived from SCOOP. Modelled fracture risk corresponded to the risk observed in SCOOP. Screening of 1000 patients saved 9 hip fractures and 20 non-hip fractures over the remaining lifetime (mean 14 years) compared with usual management. In total, the screening arm saved costs (£286) and gained 0.015 QALYs/patient in comparison with usual management arm. This analysis suggests that a screening programme of fracture risk in older women in the UK would gain quality of life and life years, and reduce fracture costs to more than offset the cost of running the programme.

AimLittle is known about the challenges of transitioning from school to university for young people with Type 1 diabetes. In a national survey, we investigated the impact of entering and attending university on diabetes self-care in students with Type 1 diabetes in all UK universities. MethodsSome 1865 current UK university students aged 18-24 years with Type 1 diabetes, were invited to complete a structured questionnaire. The association between demographic variables and diabetes variables was assessed using logistic regression models. ResultsIn total, 584 (31%) students from 64 hospitals and 37 university medical practices completed the questionnaire. Some 62% had maintained routine diabetes care with their home team, whereas 32% moved to the university provider. Since starting university, 63% reported harder diabetes management and 44% reported higher HbA(1c) levels than before university. At university, 52% had frequent hypoglycaemia, 9.6% reported one or more episodes of severe hypoglycaemia and 26% experienced diabetes-related hospital admissions. Female students and those who changed healthcare provider were approximately twice as likely to report poor glycaemic control, emergency hospital admissions and frequent hypoglycaemia. Females were more likely than males to report stress [odds ratio (OR) 4.78, 95% confidence interval (CI) 3.19-7.16], illness (OR 3.48, 95% CI 2.06-5.87) and weight management issues (OR 3.19, 95% CI 1.99-5.11) as barriers to self-care. Despite these difficulties, 91% of respondents never or rarely contacted university support services about their diabetes. ConclusionThe study quantifies the high level of risk experienced by students with Type 1 diabetes during the transition to university, in particular, female students and those moving to a new university healthcare provider.

Patient and public involvement (PPI) in research is very important, and funders and the NHS all expect this to happen. What this means in practice, and how to make it really successful, is therefore an important research question. This article analyses the experience of a research team using PPI, and makes recommendations on strengthening PPI in research.

Within current mainstream understandings of patient and public involvement (PPI) in health research, a clear distinction is made between what ‘involvement’ in research is: ‘research being carried out ‘with’ or ‘by’ members of the public rather than ‘to’, ‘about’ or ‘for’ them91 and what it is not: namely ‘engagement with’ and ‘participation in’ research. Research evidence describes problems than can arise when such distinctions are unclear or misunderstood (often by those new or unfamiliar with PPI); or when distinctions are intentionally blurred e.g. by ‘dual roles’ being created within some projects, where research participants also advise on the conduct of projects. What is less widely examined, however, is the blurring of boundaries between the object of enquiry which is the business of PPI for that project, the data which is the object of qualitative collection involving discussion with participants and the purposeful research activities which are best progressed through engagement with stakeholders. This poster draws upon case study findings from two recent, similar National Institute for Health Research (NIHR)-funded evaluations of PPI in health research: RAPPORT (England-wide) and IMPRESS (regional research programme-specific), pertaining to how researchers (from various disciplines, using various research designs) within different case study research projects can blur the boundaries between qualitative research, stakeholder events and PPI. We pose questions pertaining to the consequences of blurred research design boundaries for the success of outcomes of public-research collaborations. We query why, and to what extent, such distinctions matter in co-producing knowledge and in measuring the impact of various investments in collaborative research activities.

Method: Students, actors (patients) and assessors received written and verbal briefings prior to SCEs within a busy clinical trials unit. Students collected actors from waiting areas, undertook MR in consultation rooms and then presented the results to a real GP. Assessors, actors and the GP provided feedback on student performance. Post-completion an on-line survey, using 5 point Likert scales and free text, was used to elicit students’ opinions including overall experience, location, logistics, use of actors, and feedback.

Background National clinical guideline developers, such as the UK’s National Institute for Health and Clinical Excellence (NICE), produce high quality guidelines, yet primary care practitioners (PCPs) may question the relevance of the evidence and recommendations to a primary care (PC) population. Objectives To evaluate PCPs’ views about the relevance of NICE clinical guidelines to PC. Methods An online Delphi panel of 28 PCPs, recruited regionally and nationally, reviewed 14 guideline recommendations: 8 supported by PC relevant evidence and 6 by evidence from elsewhere. Panellists scored recommendations twice, on a scale of 1–9 (9 = highly relevant for PC), before and then again after reading a summary of the evidence, including study setting and population. They also commented on factors influencing guideline validity and PC implementability. Results 25 PCPs (89%) completed the Delphi. Overall mean scores were 7.4 (range 6.2–8.2) before reading the evidence summary, and 6.6 (4.6–8.3) after. Mean scores for the 8 recommendations supported by PC evidence were 7.4 before and 7.2 after (change -0.2). Mean scores for the 6 with evidence from elsewhere were 7.4 before and 5.8 after (change -1.6). Factors perceived to influence implementation included clarity, brevity, and relevance to PC. Discussion PCPs’ ratings of PC guideline validity dropped when they became aware that substantial supporting evidence for the guidelines had come from non PC settings. The relevance of the evidence to PC patients was important. Implications for Guideline Developers/Users Developers should explicitly describe the relevance of available evidence for PCPs and their patients.

SCOOP is a UK seven-centre, pragmatic, randomised controlled trial with 5-year follow-up, including 11,580 women aged 70 to 85 years, to assess the effectiveness and cost-effectiveness of a community-based screening programme to reduce fractures. It utilises the FRAX algorithm and DXA to assess the 10-year probability of fracture.

IntroductionThe Social Distance Scale (SDS) is an established tool in the measurement of discriminatory attitudes towards those with mental illness.ObjectivesTo send an electronic questionnaire incorporating the SDS to both healthcare and nonhealthcare undergraduates.AimsTo compare attitudes using the SDS of both student groups towards vignettes describing active and medically resolved cases of mental illness.Methods567 first year healthcare and 501 non-healthcare (law and english) university students were sent a questionnaire randomly containing one of six possible vignettes (describing either active or medically resolved depression, schizophrenia or asthma). The SDS as used by Nordt (2006), was then completed, indicating what level of social closeness would be accepted with the person described.Results180 responses were received for the healthcare group (31.7% response rate) and 125 for the non-healthcare group (25% response rate). Very good reliability of the Social Distance Scale (Cronbach's a=0.91) was observed in the sample. Statistical analysis was performed using SPSS. A linear regression model was applied which explained 20% of the variance. A significant difference was observed in attitudes between healthcare and non-healthcare students towards both the active and resolved schizophrenia, with the Non-healthcare group expressing higher social distance towards these vignettes (+0.31; P=0.043) compared to the healthcare group. The two groups did not differ significantly in social distance towards the depression and asthma vignettes.ConclusionsThe non-healthcare students were significantly more socially distant towards both active and resolved schizophrenia vignettes. The findings for the remaining vignettes were similar between the two groups.

Objectives To evaluate the effectiveness of using electronic registers to identify and improve management of high-risk asthma patients in primary care. Design Cluster-randomised controlled trial with stratification by high/low deprivation scores and 1-year follow-up. Participants 29 GP practices in Norfolk, UK with suitable software systems used electronic searches and clinical knowledge to identify 911 patients aged 5+ years at high risk from their asthma as defined by British asthma guidelines (severe asthma plus adverse psychosocial characteristics, including poor adherence). Intervention Intervention practices established registers of high-risk asthma patients and used an electronic alert to identify these patients at all practice encounters. This allowed reception staff to prioritise appointments and facilitate patient access to clinicians and clinical staff to review patients9 asthma at all opportunities. Practice staff received a 1-h tailored training session on the use of alerts and actions to be taken from a GP (MN) and nurse (JW). Control practices continued with routine care. Outcomes A composite measure of moderate–severe exacerbations (primary outcome, see Abstract S137 Table 1 for definition), disaggregated exacerbation-related events, consultations and medications (secondary outcomes) were derived from anonymous clinical data extracted from practice-based patient records for the year before and after implementation of registers. Results See Abstract S137 Table 1 for results of unadjusted analyses. After adjustment for relevant covariates at baseline similar effects were observed but only the effect on nebulised β-agonists prescriptions remained significant. Conclusions Use of at-risk registers had no significant effect on the overall rate of moderate–severe exacerbations. However, they were associated with increases in prescriptions of oral steroids, inhaled steroids and long-acting β-agonists, coupled with reductions in asthma hospitalisations, prescriptions of nebulised short-acting β-agonists and in failures to attend primary care appointments. Together these are suggestive of improved asthma management in the intervention group.

IntroductionThe Social Distance Scale (SDS) has been widely used as a proxy to explore stigmatising attitudes towards mental illness.ObjectivesTo administer a vignette-based questionnaire incorporating the SDS to first year healthcare undergraduates.AimsTo compare the attitudes of participants towards active and resolved cases of mental illness.Methods567 students were sent an electronic questionnaire containing one vignette selected at random from a possibility of six (describing either active or medically resolved depression, schizophrenia or asthma). Participants then completed the SDS as used by Nordt (2006), to indicate what level of social closeness they would accept with such a person described in the vignette.Results180 responses were received (31.7% response rate). Good levels of reliability for the Social Distance Scale were demonstrated (Cronbach's alpha = 0.90). Statistical analysis was performed using SPSS. A linear regression model was applied which explained 18% of the variance. Respondents showed significantly more social distance towards the vignettes describing active cases of depression, schizophrenia and asthma compared to the vignettes describing medically resolved cases (+0.21; p=0.045). Social distance towards the schizophrenia vignette was significantly higher (+0.28; P=0.031) compared to the depression vignette, and social distance towards the asthma vignette was significant lower (-0.413; p=0.001) compared to the depression vignetteConclusionsStudents were more socially distant towards the active cases of mental and physical illness compared to the resolved cases. A hierarchy of social distance existed, with most distance shown towards schizophrenia, followed by depression, with asthma receiving the least social distance.