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Drug Utilisation Research Group (Euro DURG)

1 Feb

Euro DURG logo
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

ISQua 1_CROPPED_Becci Morris

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.

Ukraine and China delegation visits to learn about patient safety

1 Feb

At the end of November, PSTRC staff met with delegations from Ukraine and China to talk about the quality and safety of care.

The Ukraine delegation consisted of senior healthcare managers and clinicians from the region of Poltava, who were visiting to learn about quality and safety interventions in the Greater Manchester healthcare system, especially around cardiovascular disease. They met at The University of Manchester with Stephen Campbell, Darren Ashcroft and Niels Peek from the PSTRC and Ben Squires, Head of Primary Care Operations at the Greater Manchester Health and Social Care Partnership. 

Stephen Campbell met with a delegation from the China National Health Development Research Center and the Health Family Planning commission, as part of visit organised by the Institute of Global Health Innovation at Imperial College London, St Mary’s Campus. Stephen spoke about quality and safety measurement and incentivisation in Primary Care.

Want to get involved?

4 Jan

People speech bubble_small

We are looking for a Non-Executive lay member to join the Executive Management Board for the NIHR Greater Manchester Patient Safety Translational Research Centre (Greater Manchester PSTRC).

Could that person be you?

Closing date: Monday 22nd January 2018 at 5pm

Time commitment:  Regular meetings over a 2 year period

We are looking for someone who can :

  • lead and represent the patient/public voice of the Greater Manchester PSTRC by membership of the Executive Management Board and theme/project review meetings
  • represent the Greater Manchester PSTRC to outside bodies as required and provide  a patient/public perspective to the Greater Manchester PSTRC strategic plan.

You will have:

  • An understanding of executive committee processes.
  • An understanding of governance processes at an executive level.
  • An understanding of NHS healthcare structures and issues in Greater Manchester and the UK.
  • Responsibility to ensure that the Greater Manchester PSTRC Executive Management Board is kept appropriately informed of involvement and engagement progress, impact and concerns within the Greater Manchester PSTRC.
  • the skills and knowledge to contribute to a range of involvement and engagement meetings.

Full copy of the role description and person specification.

Appointment for the Non- Exec lay member position will be made by shortlisting and a face-to-face formal interview.

If you have any questions about the role, please contact Dr Sally Giles, PPI Lead by email sally.giles@manchester.ac.uk or phone 0161 306 8020.

If you would like to apply, please fill out the following forms:

  • Application form
  • Equality monitoring form

which can be downloaded in the application pack and return by email to Dr Sally Giles at sally.giles@manchester.ac.uk

FOR INFORMATION   – Payments policy

Putting patient safety first

4 Dec

by Maria Panagioti, Senior Research Fellow

GP & Patient pulse_square

Delivering safe healthcare to patients and preventing patient harm is an international priority. Despite this, patient safety incidents are not uncommon. Around 10 per cent of patients experience a harmful patient safety incident whilst being treated. Such harmful incidents could be due to actions of healthcare professionals, healthcare system failures or a combination of both. Medication errors, misdiagnosis, wrong-site surgery, hospital-acquired infections and in-hospital falls are all examples of serious patient safety incidents which can result in patient harm.

While eliminating patient harm is a desirable goal, in practice it may not always be possible. A certain level of harm is considered inevitable because harm cannot always be predicted. For example, some adverse drug reactions occur in the absence of any error in the medication process and without the possibility of early detection.

Focusing on prevention

This understanding has recently led researchers and policymakers to focus on reducing preventable harm. Although full consensus about the nature of preventable harm has not yet been reached, most working definitions include the idea that preventable harm is identifiable, in that it can be attributed to medical care and modifiable in that it’s possible to avoid by adapting a process or adhering to guidelines. The focus on preventable harm could help policy makers and healthcare practitioners to devise more efficient and reliable plans to predict and prevent patient harm.

There has been a lack of clarity in the literature about the prevalence and main types of preventable harm – and how often severe harm such as death and severe injuries are likely to occur. In response to the need to better understand preventable harm, the General Medical Council commissioned our team to undertake a large systematic review and meta-analysis to understand the nature of preventable patient harm across healthcare settings including hospitals, primary care and specialty settings. The aim of this review is to help the GMC and stakeholders get a better understanding of types, causes and patterns of harm – with a view to identifying ways of mitigating them.

Letting numbers do the talking

We reviewed 149 published studies through this work and our findings in relation to the importance and impact of preventable patient harm were striking:

  • Six in 100 patients experience preventable harm and 13% of this preventable harm leads to permanent disability or patient death.
  • Medication incidents such as errors in ordering, prescribing and administering medication, and misdiagnoses are the main causes of preventable patient harm.
  • Preventable patient harm might also be higher in certain medical specialities such as surgery.

These findings provide useful direction on areas where regulators, the NHS and Government should invest to reduce preventable patient harm. For example, investment in interventions to reduce medication errors (particularly at the stages of prescribing and administration of medication) and preventing misdiagnoses would be encouraged by our findings.

In line with our findings, the importance of improving medication safety is fully recognised by the World Health Organisation who have recently identified Medication Without Harm as the theme for their third Global Safety Challenge. Given the large number of studies we reviewed, the quality and depth of data on preventable patient harm is relatively low. We need to invest in better research and reporting practices to understand which types of patient harm clinicians and healthcare systems can prevent.

In recognition of the importance of patient safety research, and following on from previous research undertaken in Manchester and London already having an impact on NHS frontline services, the NIHR announced funding of three new NIHR PSTRCs. Work began in August at the Centres – located in London, Manchester and Leeds – and their aim is to turn patient safety discoveries into practice.

By understanding the nature of preventable patient harm we can work towards eliminating it – saving lives and reducing unnecessary medical interventions. Investing in reducing key sources of preventable harm and improving reporting standards of future research studies on preventability of patient harm could be a major contribution to the safe care of patients.

The Foundations Framework for Developing and Reporting New Models of Care for Multimorbidity

15 Nov

by Jonathan Stokes, Research Associate in the Manchester Centre for Health Economics

J Stokes_Foundations Framework diagram

With colleagues at the Universities of Bristol, Glasgow and Dundee, we have published a framework aimed at improving care for patients with multimorbidity (two or more long-term conditions).

Long-term conditions and multimorbidity are a global health priority. Patients with multimorbidity receive more fragmented care and have worse health outcomes, and health systems struggle to address their needs. We need new ways of delivering care to address this.

To date, there has been limited success at delivering care that improves outcomes for these patients. One major problem is that there is no agreement on how to describe care for patients with multimorbidity. This makes it difficult for researchers to talk about their work, and to explain these new ways of delivering care to patients and policy makers. Our framework offers a starting point for addressing this issue.

Our framework describes care for multimorbidity in terms of the foundations:

  •  the theory on which it is based
  • ·         the target population (‘multimorbidity’ is a vague term, so we need to define the group carefully, e.g. a patient with diabetes and hypertension might have very different care needs than a patient with dementia and depression)
  • the elements of care implemented to deliver the model.

We categorised 3 elements of care: (1) the clinical focus (e.g. a focus on mental health), (2) how care was organised (e.g. offering extended appointment times for those who have multimorbidity), and (3) what was needed to support care (e.g. changing the IT system to better share electronic records between primary and secondary care).

We used our framework to look at current approaches to care for multimorbid patients. We found:

  • Care for multimorbidity is mostly based on the well-known Chronic Care Model (CCM). This was designed for people with single diseases, and may not be fit for purpose for patients with multimorbidity.
  • Much care is focussed on elderly or high-risk patients, although there are actually more people aged under 65 with multimorbidity. We need to make sure that models don’t neglect the needs of younger patients, or those who are at lower risk, who might have most to gain in preventing future health problems.
  • We need to look more at the needs of low-income populations (where multimorbidity is known to be more common), and those with mental health problems (multimorbid patients with a mental health issue are at increased risk for worse health outcomes).
  • There is an emphasis on self-management, but patients with multimorbidity frequently have barriers to self-managing their diseases.
  • The emphasis on case management (intensive individual management of high-risk patients) should take into account the evidence that while patient satisfaction can be improved, cost and self-assessed health are not significantly affected.

Health systems have only recently begun to implement new models of care for multimorbidity, with limited evidence of success. Careful design and reporting can help develop evidence more rapidly in this important area. We hope our framework can encourage better research which is urgently needed to improve care for those who use it most.

This free to read article can be found at the following link: http://www.annfammed.org/content/15/6/570.full

Stokes J, Man M-S, Guthrie B, Mercer SW, Salisbury C, Bower P. The Foundations Framework for Developing and Reporting New Models of Care for Multimorbidity. The Annals of Family Medicine. 2017;15(6):570-7.

Diagnostic Error in Medicine: key topics

2 Nov

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

DEM 10th conference_cropped

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.