Dr Jenny Eachus: Launching the PRINCIPLE study in Primary Care
The PRINCIPLE study is the first clinical trial in UK COVID-19 patients taking place in primary care. As COVID-19 disproportionately affects people aged over 65 years old or over 50 years old with comorbidities, the study aims to test a range of treatments for this population.
Dr Jenny Eachus tells us about COVID-19 research at Westbury-on-Trym Primary Care Centre in Bristol, and about their experience of setting up and launching the PRINCIPLE trial during the early days of the pandemic.
"Westbury-on-Trym Surgery has been involved in research for many years, however when I joined six and a half years ago, the practice wasn’t really research active. I revived research at the practice and we went through the process of becoming research ready. Over the years, I’ve had a great research team around me including research administrators and research nurses, so we’ve really been quite lucky.
"About four years ago I saw the opportunity to start a collaboration, called the Affinity Research Collaboration, with neighbouring practices. We became a collaboration of four practices initially (Greenway, Monks Park, Fallodon Way and Westbury); two were already involved in research and two were new to it. Now we’re in the process of getting the remaining two practices in our Primary Care Network (PCN) to be research active as well. Although Westbury is my main focus, I’m always thinking about the other five practices too. The joy of our research collaboration is the combined energy from the research teams in each practice and also it is a great area for research as the population of the six practices covers the full socioeconomic range.
"When the COVID-19 pandemic came along and everyone saw the horrors of the virus, there was a feeling that we could, and should, use our skills as a research practice to help. It was energising to see how the wider staff, including the receptionists, nurses and managers, were really keen to throw their weight behind research as that way we could contribute. Although we were doing a lot of research before and the staff at the practice were supportive, it had a new impetus and refreshed the attitude towards research at Westbury.
"Some of our other studies had to be paused while we prioritised the PRINCIPLE study, which is an urgent public health study. It was being put together at the University of Oxford pretty quickly and a lot of amendments were being sent to us. It was really busy, but with phone calls and emails between the study team, Royal College of General Practitioners (RCGP) and the practice, we got the ball rolling quite quickly, which meant that we caught that early wave of COVID-19 patients.
"When we were running the trial in March, being able to offer a test was a real positive for patients, as testing wasn’t available more widely yet. They were really keen to be part of the trial, particularly as they wanted the swab test and they wanted to try anything that might work. At that point, the jury was out about hydroxychloroquine, which the PRINCIPLE trial was initially testing, so again, that was seen as a benefit to offer to patients. It’s getting harder to recruit as time goes on as we’re not seeing people with the symptoms as often, and are seeing mostly negative test results. We’re really glad this population is having reduced cases of COVID-19, but it’s harder to recruit for research.
"Being involved in the national effort against COVID-19 has been really good. I think it’s been a boost for the practice and for the population to know that we’re trying to do our bit. Personally, before I did Medicine, I was working in Epidemiology, so I’m familiar with some of the requirements of research set-up and it has been great to be involved. There’s been a lot of change in primary care over the last few months - a massive cultural shift and you look back and think ‘how on earth did that happen in such a short time?’
"I think that the COVID-19 pandemic will have an impact on how people see research, as suddenly they can see the relevance. People are thinking ‘how are we going to get out of this situation’ and are realising that we’re going to have to research COVID-19 to understand the virus and identify the best treatment. For example with the PRINCIPLE trial, we can see that hydroxychloroquine has been and gone, and now we’re onto trialing the other treatments. It’s better to know that these drugs aren’t useful than to keep on using them with no evidence either way.
"We’re hoping to continue COVID-19 research at Westbury, as there’s quite an appetite for it. Initially when we were setting up PRINCIPLE, we were lucky enough to have two local teenagers volunteer to get involved and help deliver swab tests. It was wonderful to feel a real local effort towards research to benefit the NHS and find out more about COVID-19.
"There’s so much related to COVID-19 still to research, including the best treatments, the impact on people’s mental health, and any long-term implications of COVID-19. We’d also love to get involved with vaccine trials if they become available to primary care in Bristol."
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The views and opinions expressed in this blog are those of the authors and do not necessarily reflect those of the NIHR or the Department of Health and Social Care.