Evolving training plan

Evolving training plan (3 years at 30% protected research time)*

Year 1

1. If DynAIRx grant awarded: contribute to antipsychotic multimorbidity data extraction and analysis, and focus-group interview design and delivery with clinicians (this is co-incidental experiential training). Writing publications on DynAIRx as a co-applicant. If the application is unsuccessful (it was invited to resubmit worthy of funding but to reduce initial submission costing) then I will be supporting resubmissions for funding.
2. Training on quantitative database analysis to undertake cross-sectional survey of antipsychotic use and co-morbidity prevalence by main locus of care status (primary or secondary care) using Secure Anonymised Information Linkage (SAIL) database. I have held scoping/costing meetings with the SAIL team at University of Swansea to discuss Structured Query Language (SQL) design and data extraction; SAIL (Sarah Rees, Senior Data Scientist) and RDCS NWORTH (Dr Andrew Brand) independently confirm the methodological design is robust, and can delineate which patients on antipsychotics remain under secondary care and who have been discharged; this is crucial for the cross-sectional survey and longitudinal studies.
3. Training on qualitative methods (questionnaire and thematic analysis) via interview of patients, staff and commissioners. Pilot questionnaire and qualitative thematic analysis with stakeholders; engagement with key patient groups to understand and refine future study analysis to best serve their interests. Stakeholder-led engagement to obtain ethical approval for interview and testing of questionnaire tools (e.g., quality of life surveys, antipsychotic side effect questionnaire use (e.g., LUNSERS2) for patient surveys.

Year 2

1. Achieve publications for DynAIRx (1), cross-sectional survey (2) and pilot interviews (2). Present findings at national conferences, to health boards, patient groups and charities. Refine research hypotheses and focus efforts from results obtained and continue training on research skills as per year 1.
2. Commence 3-arm retrospective cohort study (10-year follow-up) of patient outcomes taking antipsychotics dependent on main locus of care (primary or secondary care) against age-sex matched controls not on antipsychotics from SAIL database.
3. Commence pilot-tested thematic interview and questionnaire surveys of care providers and patients on antipsychotics delineated by locus of care to identify common themes that may act as barriers to effective care and patient perception of care. Identify key influences of mental health policy development and conduct policy analysis and review: engage with strategic health policy leaders to influence care pathways.

Year 3

1. Complete longitudinal study analysis, publications and present at conferences (5). Engage with key stakeholders (patients, mental health charities, clinicians and commissioners) on outcomes and to iterate/refine future work to investigate the interventional health needs of this patient group/service redesign.
2. Complete qualitative analysis from interviews and questionnaires. Publish findings identifying key barriers to effective care of patient cohorts and present to stakeholders. Use findings from (5) and (8) to influence service redesign to improve patient outcomes and influence at a strategic level.
3. Submit a competitive research grant as a co-investigator on minimisation strategies of adverse outcomes from long-term antipsychotic care and on service redesign, to establish myself as an independent research clinician.

*This is an ambitious but adaptive training programme: early broad flexible exploration in the first 18 months will lead to increasing focus on research of greatest impact to concentrate on, and collaborate/oversee in a secondary role the other areas, or in future grant applications. However, all these studies are equally important to improve lived experience of Welsh patients with serious mental illness, which is a key Welsh Government target in ‘A Healthier Wales3’ and a priority area in ‘Programme for Government (2021-26)’4 and whose situation is only worsening with the collateral effects of the COVID-19 pandemic on mental health.