Clinical Research Office. A partnership between Sheffield Teaching Hospitals NHS Foundation Trust and the University of Sheffield

Research findings lead to professional doctorate for Hep C specialist

Research conducted by a specialist in viral hepatitis could help reduce the number of vital appointments missed by vulnerable patients.

Ray Poll, Nurse Consultant for Viral Hepatitis at the Royal Hallamshire Hospital, has spent five years researching a Professional Doctorate looking into the reasons that drug users miss appointments at hepatitis C outreach clinics.

He interviewed service users who missed appointments and based on the findings compiled a survey which was sent to staff providing similar outreach clinics in drug services across the country.

His findings will help to shape how services are delivered to minimise the number of missed appointments, which are crucial for offering treatment and support. The research could benefit patients not only in Sheffield but across the UK.

Ray said: “Many of the service users are generally described as ‘chaotic’ and ‘hard to reach,’ but I wanted to dig a bit deeper under these surface reasons and find the underlying reasons for missed appointments.

“I found that there are many underlying reasons apart from needing to ‘score’ to avoid the effects of withdrawal. Invariably these are people on a low income, who are largely not working or in low paid jobs and on benefits and so the cost of travel is an issue.

“Transport is also an issue – often it takes two bus journeys to get to clinic. Some people have a number of appointments with other agencies and struggle to make them all. Others are worried about giving blood for blood tests.”

At outreach clinics between 50-60% of appointments are missed. At the hospital clinic approximately 37% of newly referred patients miss appointments.

Mr Poll said his findings were informing the development of services to try and make them as accessible and user-friendly as possible, and avoid the need for multiple appointments.

One stop appointments are being arranged to include any blood tests, scans or other tests where needed, rather than having to make separate appointments. People who are entitled to it can have travel costs reimbursed.

A training pack has been developed to enable blood to be taken from the neck for patients with poor venous access.

Ray said: “We run a hepatitis clinic at the Hallamshire, as they do at other centres in other cities, so the work could help improve services elsewhere in the country as well.Hepatitis C is a silent disease with the majority of chronically infected people not showing any symptoms, so it is crucial that people in high risk groups get tested and access care and treatment promptly.”

As well as treatment and support patients have an assessment of their liver and may be given advice on reducing their alcohol intake and how to avoid passing on the infection to others.

Mr Poll spent five years working on the Professional Doctorate at Sheffield Hallam University and had to balance the studying with his job.

The final stage was passing his viva (oral exam), which involved answering questions about his work from a panel of two academics.

Ray said: “The main feeling was one of relief because so much work had gone into it.”

He is due to receive his doctorate in November.