Medicines in Acute and Chronic Care

This research will create a map of patient symptoms, diseases, patient care and use of medicines and outcomes in GPs and hospitals, with particular attention to people with multiple long-term conditions. This map will researchers, doctors and policy makers to understand and improve how medicines are used, aiming to maximise the benefit for patients while reducing any harms from those medicines.

Results from this research will be used to improve guidelines for patient care and to customise medicines to individual patients to improve their treatment. The programme will have a major focus on health and race inequalities, where multiple long-term conditions and care involving multiple medications are more common. This will pioneer new ways to improve patient care across the UK and internationally.

This work is funded by the UKRI Medical Research Council, UKRI Engineering and Physical Sciences Research Council, UKRI Economic and Social Research Council, Department of Health and Social Care, National Institute for Health Research (England), Chief Scientist Office (Scottish Government), Health and Care Research Wales, Public Health Agency HSC (Northern Ireland), British Heart Foundation and Cancer Research UK

This programme will curate the most complete map of medicine indication, use and outcome across the health ecosystem globally, and using this to transform medicines use for patients of all ages, especially those with complex care needs and multiple long-term conditions, through responsive algorithms which support personalised clinical decision making in real time.

This aims to understand and transform the use of medicines for patients of all ages, especially those with complex care needs caused by multiple long-term conditions (MLTCs). Consequently, the programme will have a major focus on health and race inequalities, where MLTCs and polypharmacy are more prevalent. The programme will maximise patient benefit and reduce medicines-associated harm. It will innovate guidelines and their deployment, to enable responsive medicines stratification and personalisation in real-time, informed by mature digital systems and individually linked health data, with the ultimate aim of improving patient outcomes.

Objectives
This programme will tackle the most critical health challenges associated with medicines.
1. To understand the longitudinal determinants and consequences of appropriate and inappropriate polypharmacy.
2. To reduce medicines-related harm and enable de-prescribing.
3. To build treatment guidelines which are fit for purpose for our changing demography and care needs, informed by real-world patient complexity in real time.
4. To share methodologies, guidelines, and recommendations with teams across the globe.

Impact and legacy
This programme will create a unique and highly valuable medicines data foundation: an ever-green map of medicines prescribing, dispensing and adverse effects across the UK and global healthcare ecosystem. Building on the successes of the leadership team and Hubs, the team will map and link primary, 154 community, and secondary care medicines data at an individual patient level, creating longitudinal records of medicines use and clinical conditions and pathways. For primary care, this will include highly granular data of acute and repeat prescriptions, indications, and adverse effects. For secondary care data, this will not only include a record of admissions due to medicines-related harm, but highly granular data on outpatient and inpatient prescribing, including the indication, administration and timings of medicines use, linked to laboratory, physiology, imaging, and outcome data, including medicines errors. This will include assessments of the representativeness of datasets and their quality, using nationally agreed frameworks for data equality and quality within the metadata catalogue.