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NAPCRG 45th annual meeting

1 Feb

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Sally Giles, Penny Lewis, Sarah Rodgers and Patient and Public Involvement (PPI) representative Antony Chuter presented a workshop at the recent Annual Meeting of the North American Primary Care Research Group (NAPCRG) in Montreal. The objectives of the workshop were to provide an overview of examples of current research into medication safety in primary care, discuss the challenges to medication safety and some of the tools that can be used in practice to improve medication safety.

Sarah highlighted the work of the ‘PINCER’ prescribing intervention and workshop participants worked through clinical scenarios using the PINCER indicators. Antony discussed his role as a PPI member in various medication safety research projects. This stimulated discussion around patient involvement in healthcare research, as this is a relatively new concept in North America.

Penny and Sally discussed patient involvement in medication safety and the development of the Manchester Patient Safety Framework (MaPSaF) with workshop participants engaging in discussions about how they currently involve patients in the prevention of safety incidents. The workshop was well attended by a mixture of primary care physicians, pharmacists and healthcare researchers and the topic fitted well with the patient-centred care theme of the conference.

Sally also presented her work on the primary care patient measure of safety (PC_PMOS) in a well-attended oral session. Sally’s work stimulated interest in the audience with US researchers hoping to carry out similar work in this area.

Drug Utilisation Research Group (Euro DURG)

1 Feb

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Stephen Campbell attended the European Drug Utilisation Research Group (Euro DURG) Conference 2017, in Glasgow in November 2017 to present at a workshop on the “Quality of quality indicators”. Healthcare and medication use are changing and the field of drug utilisation research is evolving in a digital world.

Drug utilisation is an eclectic scientific discipline that includes many methods for the “quantification, understanding and evaluation of the processes of prescribing, dispensing and consumption of medicines and for the testing of interventions to enhance the quality of these processes”.  It has overlap with the PSTRC focus on medication safety, transitional care for those with multimorbidity and safety informatics but is linked also to the broader field of pharmacoepidemiology (the study of the uses and effects of drugs in defined populations) and health outcomes research and health economics.

The overall aim is to improve the safe and efficient use of medicines in populations to shape health policy and clinical practice.  The economic and health consequences of inappropriate drug use are substantial and patients are the end users of medicines. Those in marginalised groups can experience more inconsistent outcomes due to medication. The conference emphasised the need for a partnership between researchers, policy-makers and patients.

ISQua 34th annual conference

1 Feb

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In October 2017, Sudeh Cheraghi-Sohi chaired a workshop at The International Society for Quality in Health Care (ISQua) 34th annual conference. The workshop was entitled “Developing and improving a systems approach to diagnostic safety in primary care” and was developed with collaborators Hardeep Singh from the Veterans Affairs organisation based in Houston, Texas and Ian Litchfield from the Institute of Applied Health Research, Birmingham University.

The workshop covered three major areas in diagnostic error and safety.  Firstly, Sudeh introduced the concept and various definitions of diagnostic error, along with the various causes of such errors and how to measure them. This was followed by Ian Litchfield presenting some work on a specific cause of diagnostic errors: poor or non-existent test results follow-up. Ian Litchfield described where these issues commonly occur e.g. clinicians being unaware that ordered tests had not come back from the lab. Finally, Hardeep Singh summarised the future research agenda in this area and highlighted how Information Technology will play an increasing role in diagnostic safety.

Many in the audience expressed surprise as to how little focus there had been on this area given its importance and expressed support of our current work and the future research agenda. Diagnostic error is still a niche area, but is gaining prominence due to America’s Institute of Medicine’s 2015 Improving Diagnosis report and The World Health Organization’s Technical Series on Safer Primary Care, which both prioritised errors in diagnosis as a global priority for patient safety.

Working together: the three PSTRCs

1 Feb

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There are three PSTRCs that have been funded for five years from August 2017: the Greater Manchester PSTRC, Yorkshire & Humber PSTRC and Imperial PSTRC. On 9 November 2017, the Directors of all three PSTRCs joined together in a panel session at the Imperial PSTRC annual Symposium on “research priorities in patient safety for the next five years and the central role of patients” held at the Royal Academy of Engineering in London.

The session showed that there is overlap in the programmes of the three PSTRCs but these are being approached through different, but complementary, lenses. For example, all three PSTRCs have a focus on stakeholder and patient involvement and engagement, transitions and safer systems across health and social care boundaries, the safer use of medications and the use of informatics and digital interventions.

All the PSTRCs are funded to develop and test interventions that can then become widely used  in health and social care practice to deliver safer care. There is an urgent need for high-quality evidence to make care safer, working in partnership with patients and healthcare providers and commissioners. The Greater Manchester PSTRC will work together with Yorkshire & Humber and Imperial PSTRCs on joint priorities to build research capacity and training.

Diagnostic Error in Medicine: key topics

2 Nov

by Sudeh Cheraghi-Sohi, Research Fellow in Safety in Marginalised Groups: Patients and Carers theme

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I recently attended the 10th International Conference on Diagnostic Error in Medicine (DEM) held in Boston and organised by the Society to Improve Diagnosis in Medicine (SIDM).  I was invited to attend the research summit as well as to display some of my work from the 2012-2017 NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (PSTRC).

The research summit was an excellent forum for discussing the key areas of interest in the field of DEM research.   This year’s topics of interest were around uncertainty and the role of the team and teamwork. For the first topic, I was really interested to participate in discussions as I have already done some work in the area of uncertainty in terms of a review[1] around the various aspects of uncertainty and the PSTRC has also developed a training package[2] to help peoples’ awareness of the issues and in managing their uncertainty.  The discussions were very lively and a keynote speech at the conference given by Dr Arabella Simpkin also resonated with the conference delegates.

The second topic is an area that the Institute of Medicine, in their 2015 report on Improving Diagnosis, placed a focus on. The role of team in making a diagnosis may not be obvious to many people, particularly in the context of UK general practice where patients probably think about the one-to-one consultation with their general practitioner, but even in general practice, there are often multiple people involved in making a diagnosis. For example, the phlebotomist and the practice nurse/nurse practitioner may have already seen a patient prior to the GP consultation and performed certain tasks and provided prior information for the GP to work with. Also, when GPs make referrals, they are seeking the expertise of others and then utilising all the gathered information to inform their diagnostic thinking and hopefully coming up with an accurate diagnosis. This is certainly an area that I would like to explore more. 

Finally, the main conference itself was fascinating. There was a superb talk given by Don Berwick, one the world’s leading patient safety experts, as well as many interesting workshops to attend. I am also happy to say people were very interested in the Greater Manchester PSTRC’s work around Missed Diagnostic Opportunities[3] and I will write another blog when we are able to share more of our findings from this project.

Learning from each other: the International Society for Quality in Healthcare (ISQua) Conference 2017

24 Oct

by Rebecca Morris, Research Fellow in the Safety in Marginalised Groups theme

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The International Society for Quality in Healthcare (ISQua) conference was held this year at the QEII conference centre in London next to Westminster Abbey and Palace of Westminster which was a prestigious backdrop to an interesting and diverse range of presentations.  This year’s conference focused on learning at the system level to improve healthcare quality and safety and was supported by the Health Foundation. It was great to see that the conference was awarded the Patients Included status which reflected the conference’s focus on incorporating the experience of patients whilst ensuring that they are not excluded or exploited. This was evident within presentations that I attended that included patients speaking alongside researchers and clinicians and I felt this was a welcome development from last year’s conference. Sharing and valuing different experiences and expertise is an important recognition of different types of expertise that need to be involved, particularly when we are looking at healthcare quality and safety.

There was a fantastic array of workshops, plenaries, oral and poster presentations. I wanted to be in more of the streams than I could attend in one day! I had both a 15 minute oral presentation and a poster presentation to discuss two of the projects in the NIHR Greater Manchester PSTRC. My oral presentation was part of the Quality in the community theme and it was great to hear about different community approaches to quality and safety across the world. I presented the James Lind Alliance Primary Care Patient Safety Priority Setting Partnership and the top 10 priorities for future research. This is important in shaping the direction of future work which prioritises the questions which patients, carers and healthcare professionals need answering. Also in-keeping with the theme of incorporating the experience of patients and turning that into action, I presented a poster on the co-development of the patient safety guide for primary care where we have co-produced the guide package with patients, carers, GPs and pharmacists. The poster was a great opportunity to discuss the patient safety guide, co-production and networking with people from a range of places, from Canada to India, about the work and sharing ideas and building links.

After last year’s conference where there was a limited discussion of primary care and the community, it was great that there were so many of us there to represent the work that we’ve been doing working with patients, carers and clinicians. Fellow Greater Manchester PSTRC researchers, Caroline Sanders and Sudeh-Cheraghi Sohi, were part of workshops discussing the use of patient experience data and diagnostic safety respectively, along with posters from Penny Lewis and Christian Thomas exploring safety in community pharmacy.

To finish off an interesting day I was invited to a Health Foundation reception at Westminster Abbey to carry on the conversations and it was great to meet and discuss how our work can lead to improvement in the system and experiences of people who use and deliver healthcare services. A great way to end the day and I’m looking forward to how we can build on this over the next year.