Medicines in Acute and Chronic Care Driver Programme

Medicines in Acute and Chronic Care Driver Programme


The vision of this programme is 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, our programme will have a major focus on health and race inequalities, where MLTCs and polypharmacy are more prevalent. Our 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.
Medicines are fundamental in maintaining human health. Prescription costs are rising faster than any other component of health care. Adverse drug reactions and side effects are increasingly common, especially in our globally ageing, multimorbid population. There is an unacceptably high rate of medicines related errors, fuelled by the complexity of guidelines and the expanding array of potential therapies. Those with lower education and low income are most likely to experience medicines-related adverse events and errors, suggesting there are considerable health inequalities in medicines mismanagement.

These challenges are not unique to the UK. Connecting with global programmes working to gather data on drug safety and rational drug use, we will work with HDR Global and their partnership with The Global Health Network to share our methods and outputs, and learn from different approaches within the community of practice to advance knowledge and engagement in pharmacovigilance.

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

Medicines are fundamental to health care, with a global spend of approximately 1.3 trillion U.S dollars in 20204. In 2019/20 the overall drugs cost at list price in the NHS was £20.9 billion with hospital drug prescribing accounting for over half (55.9%) of the total drugs-spend, at £11.7 billion (2019/20)5. Medicines spending increased by 9.9% from 2019 to 2020, a substantially faster rate of growth than the overall NHS budget.

Challenge 1: Reducing avoidable drug-drug interactions and medicines-related adverse events through risk prediction and deprescribing.
Polypharmacy is increasingly common. In 2021, the Ridge report6 (“Good for you, good for us, good for everybody. A plan to reduce overprescribing to make patient care better and safer, support the NHS, and reduce carbon emissions”) highlighted that 15% of people in England are taking >5 medicines a day.

The most common reasons for polypharmacy include the management of multiple, long-term, non-communicable conditions7. There are known health and race inequalities with polypharmacy, with a higher medication burden in those experiencing social deprivation and in certain ethnic groups. Although some polypharmacy is appropriate, much is not. Each year there are approximately 7 million emergency admissions to hospital, with 6.5% of adult and 3% of paediatric hospital admissions due to adverse drug reactions and 1% of hospital admissions caused by drug-drug interactions. The risk of drug related adverse events is much greater in those taking 5 medicines or more8. Realising the widespread scale of harm arising from polypharmacy, The World Health Organisation identified Medication Without Harm as the third international Global Patient Safety Challenge9. This initiative, designed to raise global awareness about inappropriate and hazardous prescribing, aims to reduce avoidable medication harm by 50% globally over 5 years. Deprescribing potentially inappropriate medications can minimise drug-related harm, but a new approach is needed to medication management, to reach this ambitious goal.

Challenge 2: Ensuring guidelines used to treat disease are cognizant of multi-morbidity and responsive to dynamic changes in physiology and end-organ function.
Approximately 66% of clinically significant medicines errors occur in hospitals, contributing to >1700 deaths, >£98M of costs and requiring >181,500 bed-days10. Episodes of acute ill health are a particular challenge for medicines management. This is because treatment guidelines ubiquitously focus on single diseases despite multi-morbidity being highly prevalent and acute ill-health is associated with physiological instability and systems-wide end organ damage which can alter tolerance to medicines. These factors make adverse events and drug interactions more likely. Indeed, the incidence of drug related harm in this setting is high, thought to affect 15.4-41% of acute presentations. A systems approach to prescribing, (embedded in electronic health systems) has been shown to reduce simple errors of dose, diluent, and administration, for example, reducing drug errors from 25% of all complex prescription regimes to <1%11 but these systems have not advanced further than simple rules-based approaches.

To meet both challenges, we require a deep understanding of medicines use in different settings and decision support systems that can incorporate demographic, genomic, pathological and physiological data in real time, so that known drug synergisms, interactions or adverse events are identified and mitigated before drug administration. These systems would suggest treatment regimens for multimorbidity, identifying and managing polypharmacy and supporting personalised treatment pathways including de-prescribing.

This foundation programme will enable unparalleled advancements in prescribing practices. It will focus on:
• people at the highest risk of adverse outcomes from medications (patients of all ages with complex care needs, multiple long-term conditions and suffering health inequalities)
• those most underserved by medicines management
• healthcare environments with the highest error rates

These areas of focus map to HDR-UK’s cross cutting research themes, namely understanding and addressing inequalities across the life course and geographies, resilience against future health shocks and synergistic approaches to disease prevention and prognosis.

Our overall programme will result in a reduction in inappropriate polypharmacy, drug-related harm, and provide a catalyst for cross-sector collaboration. To achieve this, we will foster close relationships with NHS providers. Every work package will include a multi-disciplinary team of analysts, patients and public members, and healthcare providers, professionals and policymakers, as equal stakeholders, so implementation and end-user experience are considered from inception.

This Driver Programme requires interoperable, large-scale, granular medicines and patient phenotype data; infrastructure which enables federated analytics and established governance processes which support data access while providing needed public oversight, building public trust. These will form the infrastructure foundations of the programme. We will deliver this in partnership with the “technical infrastructure” and “useable data” themes within HDR UK, collaborating through regional HDR UK sites (North, Midlands, Southwest, Scotland, Wales and NI).

 

Project Team

Project Details

Start Date: 01/04/2023

End Date: 31/03/2028

Funder: Health Data Research UK

Funding amount: £5M

Predictive models in perioperative medicine

HDR Midlands Project

PATHWAY – UHB Health Data Research Hub

HDR Midlands Project

West Midlands Secure Data Environment

HDR Midlands Project