How the study works

Our primary data source for the statistical analyses in EMERALD is the Clinical Practice Research Datalink (CPRD), the world’s largest computerised database of anonymized longitudinal medical records from primary care. For further information on CPRD see www.cprd.com.

The qualitative workstream of the study is supported by seven secondary care sites, ten GP practices and the local Clinical Research Network, who assist in the identification and recruitment of three groups of participants: people living with severe mental illness and diabetes, relatives or friends who provide support, and healthcare professionals who provide or commission services for this patient group.

How the study works?

This study is a mixed methods study which integrates statistical analysis of patient health care records with interviews with people with severe mental illness and diabetes, family members who support them, and healthcare staff who commission or provide services for this population. The study is supported by several GP practices and Mental Health Trusts in the north of England who will identify suitable interviewees and will invite them to participate in the study. Please click to view our Privacy Statement (PDF , 190kb)

Who has advised on the study?

EMERALD is supported by the broader DIAMONDS research programme, and draws on expertise from the Patient and Public Involvement Panel DIAMONDS VOICE, the University of York, the University of Leeds, the University of Southampton, and Bradford District Care NHS Foundation Trust.

The study has a multi-disciplinary project team with representation from health economics, endocrinology, epidemiology, DIAMONDS VOICE, psychiatry, research methodology, health policy, general practice and statistics. In addition the study has an independent Study Steering Group that supervises the study team on behalf of the funder (National Institute for Health Research) and the sponsoring institution, the University of York.

What research questions does the study address?

Our key research questions in this study are:

What are the socio-demographic and illness-related risk factors associated with a) developing diabetes in people with severe mental illness (SMI)? b) variation in diabetes and mental health outcomes in people with SMI and diabetes?
How do physical and mental health outcomes differ between people with SMI and diabetes, a) compared to people with SMI without diabetes? b) compared to people with diabetes but no SMI?
What factors influence access to, and receipt of, diabetes care for people with SMI, and how are diabetes healthcare interventions experienced by people with SMI?
How and at what cost is diabetes monitored and managed in people with SMI compared to those without SMI?
What healthcare interventions (eg medication, referrals and care pathways) are associated with better diabetes outcomes for people with SMI and diabetes?

How is the study designed?

EMERALD is a mixed methods study which combines the analysis of primary care patient records with interviews with people affected by severe mental illness and diabetes, relatives or friends who provide support, and healthcare staff who provide or commission care for this population.

Findings will be merged from these two investigations to allow for a more in-depth exploration of the relationship with severe mental illness, diabetes, service use and outcomes.

What type of patient record data is being analysed?

The study involves the analysis of over 40,000 anonymised patient primary care medical records drawn from GP practices in England, containing information on diagnoses, referrals, lifestyle information (eg smoking and alcohol consumption), investigations, treatments and other forms of care administered within general practice. The records cover a time period fromm 2000-2016, so that changes over time can be analysed.

The patient record data is also linked to mortality data, hospital episode statistics, and deprivation data to enble a more comprehensive analysis of the health risks and outcomes for people with severe mental illness and diabetes.

Who is participating in the interview workstream of the study?

Three groups of people are being interviewed for EMERALD: around 30 people with severe mental illness and diabetes, 15-20 relatives or friends who provide support, and 15-20 healthcare staff who provide or commission services for this population.

Several NHS Mental Health Trusts and GP practices are collaborating in the study by identifying suitable people to be interviewed.

What will happen with the findings?

Findings will be translated into recommendations for healthcare in two multi-stakeholder workshops. To ensure that our study makes a difference, findings will be made available and acessible to people with serere mental illness (SMI), their friends and family members, and people who work and make decisions in the NHS. A dissemination event will be held to share results and discuss implications for diabetes care for people with SMI. We will also publicise findings via research publications, on our project website and across our mental health and diabetes networks.