Dear Editor

Milne and Hill suggest the 'Getting Research into Practice' programme may have contributed to the decline in surgery for glue ear that we have reported. We cannot, however provide any evidence to support this suggestion. The rate of decline in surgery throughout England was similar to that observed in 13 former health districts in the Oxford/Anglia region. The ratio of change in rates after 1992 over the change in rates beforehand was 0.88 (95%CI 0.86 to 0.90) in the 13 districts and 0.88 (95%CI 0.84 to 0.92) in England. When we consider Berkshire alone (West and East Berkshire districts combined) where GRiP was initially implemented, the ratio was 0.87 (95%CI 0.84 to 0.90).

Dear Editor

Black and Hutchings present an intriguing account of the rise and fall of glue ear surgery in two English regions.[1] They speculate that the acceleration of the decline from 1992 may have been due to the Effective Health Care bulletin on glue ear, helped by five "contextual features". One of these was the concurrent structural change to the NHS, arising from the introduction of health care commissioning.

We write to suggest another possible contextual feature, a project entitled "Getting Research into Practice (GRiP). GRiP was a project that started in 1992, initially within the Oxford region, that aimed to help the new purchasing health authorities find and apply evidence of effectiveness in their work.[2,3] One of the four topics chosen for GRiP was surgery for children with suspected glue ear. This was first taken forward in Berkshire and later in the other three counties of the region. From 1995 GRiP (and successor programmes) was generalised to the whole of the Anglia and Oxford regions. GRiP took a multifaceted approach to implementing change. There is evidence that multi-faceted interventions targeting different barriers to change are more likely to be effective than single interventions.[4] In addition surgery for glue ear became a topic for performance management in the Anglia and Oxford Region before other regions.

There would be several ways of exploring the specific contribution of GRiP to the decline of glue ear surgery. One would be to see if the decline was faster in Berkshire, or in the rest of the Oxford region, or in the Anglia and Oxford regions, than elsewhere. Another would be to compare the rate of decline of topics of low appropriateness covered in Effective Health Care bulletins but not in the GRiP project with those that were.

We are not aware of any quantitative evaluation of GRiP, although there has been a qualitative analysis of the process.[5]

Ruairidh Milne

Senior Lecturer in Public Health Medicine
Wessex Institute for Health Research and Development
Mailpoint 728
Boldrewood
University of Southampton
Southampton SO16 7PX

Alison Hill
Director
Public Health Resource Unit
Institute of Health Sciences
Old Road
Headington
Oxford OX3 7LF

References

(1) Black N, Hutchings A. Reduction in the use of surgery for glue ear: did national guidelines have an impact? Qual Saf Health Care 2002;11(2):121-4.

(2) Needham G. A GRiPPing yarn-getting research into practice: a case study. Health Libraries Review 1994;11:269-77.

(3) Dunning M, McQuay H, Milne R. Getting a GRiP. Health Service Journal 1994;April:24-6.

(4) NHS Centre for Reviews and Dissemination. Getting Evidence into Practice. Effective Health Care Bulletin . 1999;5(1) York: University of York.

(5) Dopson SE, Gabbay J. Getting research into practice and purchasing: issues and lessons from the four counties. Winchester: Wessex Institute of Public Health Medicine 1996.