Congratulations to our Safer management of polypharmacy in multile long-term conditions research Co-theme leads Professor Adam Todd and Professor Barbara Hanratty on getting their commontary; “Beyond polypharmacy to the brave new world of minimum datasets and artificial intelligence: thumbing a nose to Henry” published in the BMJ Quality and Safety Journal.
Professor Barbara Hanratty, Professor Adam Todd
Newcastle NIHR Patient Safety Research Collaborative (PSRC) – SafetyNet
The Newcastle National Institute for Health and Care Research (NIHR) Patient Safety Research Collaboration (PSRC)is focused on creating research into patient safety for those people affected by multiple long-term conditions (MLTCs). This occurs when patients are affected by two or more long-term illnesses and is associated with poor health outcomes. MLTCs are becoming increasingly common in our population and the age at which patients acquire multiple illnesses is falling, meaning people affected in this way are losing years of healthy living. In addition, we know that people who come from deprived areas of our country or those from minority ethnic communities are disproportionately affected by MLTCs and the poor health outcomes that accompany this problem. Our research is designed to try and understand how this population are exposed to greater safety risks than might otherwise be the case. Patients who experience MLTCs have greater exposure to healthcare interventions, are generally treated with more medicines and are managed by multiple healthcare providers for the various issues they have. Altogether, this has the potential to increase risk for this group and our PSRC is designed to identify those risks and develop approaches to treatment that may improve patient safety.
We have four areas of focus within the Newcastle NIHR PSRC – around the risks of taking multiple medicines, otherwise known as polypharmacy, how we use artificial intelligence to understand risk in care pathways, how we safely transfer care from one provider to another and how social and financial disadvantage have the potential to worsen the risk that people are exposed to within health and social care. In addition to this, we have PSRC resources to train new researchers in patient safety so that we can build a group that is sustainable in the long-term who can continue research into this area. We are funding numerous programmes of further study for healthcare professionals within our PSRC.
SafetyNet has been created as a way for the funded PSRCs in England to work together. This is an excellent opportunity for us to share our experience and expertise to maximise the outputs of the funding provided by NIHR. As a new PSRC in Newcastle, we must establish a brand-new collaborative, bringing together various academic leaders in patient safety research across our partner Universities and hospital trusts. The formation of SafetyNet allows us to learn from the previously funded PSTRCs to benefit from their experience. This has been invaluable for us during the initial stages of our award, providing peer support and outlining different ways of approaching some of the challenges of setting up our unit.
SafetyNet provides the platform to share expertise and create synergies across our research areas. We have created links across PSRCs between colleagues with methodological expertise, for example health economics or artificial intelligence. We will establish meetings of these groups, which in turn will develop collaborations, with a view to developing larger collaborative grant applications, addressing patient safety challenges on a much greater scale than would otherwise be the case.
A key aspect of all PSRCs is the development of research capacity through the training and development of research staff who will eventually go on to be leaders in the patient safety research field. SafetyNet is providing opportunities for our trainees to network and socialise their research at an early stage in its development. We have the opportunity for our researchers to create meetings to formally share their work and early results or to focus on an individual discipline or research methodology, which has relevance for the PSRCs.
We are enthusiastic about the creation of SafetyNet and we look forward to it helping us to achieve out aims and objectives for the Newcastle NIHR PSRC moving forward over the next four years.
Hello, and welcome to my first blog post for the Newcastle PSRC. My name is Chris Lovegrove, and I am delighted to join the PSRC in June this year as a Clinical Research Fellow in Patient Safety. In this post, I will share a little about myself, my career, and my research.
Since becoming an occupational therapist in 2007, I’ve had the privilege of working in various specialities, from supporting vulnerably-housed young people to community mental health rehabilitation and trauma and orthopaedics. These roles have taken me across different settings, including the third sector and NHS. During a rotation at Frimley Park Hospital, I discovered my passion for neurology and decided to specialise in this area. In 2011, I took up a post at the Royal Devon & Exeter Hospital, where I worked in stroke, acute neuromedical, and inpatient neurorehabilitation services.
I have supported clinical service delivery in a range of leadership roles, supporting clinicians at various stages of their careers. A particularly foundational leadership experience for me was helping to lead a coastal community rehabilitation team during the start of the COVID-19 pandemic. Providing leadership during a once-in-a-lifetime global health crisis in a setting that I was utterly fresh to certainly presented challenges, but it was an overall enjoyable (albeit stressful) experience that strengthened my skills.
In 2013, I encountered a clinical challenge that led to the start of my clinical academic career. I was working with increasing numbers of people with Parkinson’s who experienced profound anxiety to the extent that it amplified their other Parkinson’s symptoms and stopped them from living their lives the way that they wanted to. After spending some time looking into this problem, it became apparent that there wasn’t an effective treatment for people with Parkinson’s with anxiety. My journey to address this problem had begun! I was awarded a place on an NIHR-funded Masters in Clinical Research degree course at the University of Plymouth. This was the start of my early research career and my first steps as a clinical academic. I was awarded an NIHR Clinical Doctoral Research Fellowship (now the Doctoral Clinical and Academic Fellowship, or DCAF) in 2021 to co-produce and feasibility-test a new occupation-based complex intervention to help people with Parkinson’s live well with anxiety. I am now at the end of my fellowship and analysing our final dataset. I’m excited to report our findings in the future and to continue this work as part of the Newcastle PSRC. I am passionate about developing future clinical academic leaders, and I look forward to sharing what I have learned with the next generation as part of the ACD theme.
I eagerly anticipate meeting, working, and collaborating with you to improve patient safety and public health for all, regardless of background. Finally, I have relocated to Newcastle upon Tyne from Devon in the Southwest of England. If you see me looking lost, I probably am! So please feel free to say hello. It would be great to meet you.
The Tilly Hale Awards are run by the Faculty of Medical Sciences in honour of Tilly who was a dedicated and passionate public and patient contributor and advocate for research inclusivity. They are awarded to applications with an innovate approach to including members of the public and patients in research.
Dr Charlotte Richardson, Dr Laura Lindsay, Professor Hamde Nazar, Dr Matt Cooper.
For 2024, Matt Cooper, Hamde Nazar, Charlotte Richardson, and Laura Lindsay have been granted on of these awards for their approach to involving informal (unpaid) carers in driving their research agenda. The team is part of the Newcastle Patient Safety Research Collaborative and School of Pharmacy and will be using the award to develop a carer group to support across research avenues and develop ideas and approaches to improving understanding about the impact of caregiving on the carer and the person they support.
The group will meet multiple times across the year and be involved in supporting current projects, priority setting, designing research goals, and providing support on how to make research more accessible. Matt and the team will be holding showcase events across the award (in the early part of 2025) so if you are interested in hearing or attending these events please sign up to the SafetyNet newsletter or follow us on X/twitter.
– M Cooper
Supporting Care Transitions for Older Adults with Multiple Long-term Conditions Including Dementia: The Digital Solution
For my PhD within the Newcastle PSRC, I am investigating how we can use digital technologies to support older adults with multiple, complex health and social care needs, to ensure they remain safe as they move between different care environments.
The landscape of healthcare for older adults is evolving, and with it, the challenges of managing complex conditions like dementia. Characterised by a progressive impairment in cognition, symptoms of dementia can affect memory, problem-solving, language and behaviour, which worsens the ability to perform everyday activities over time. As the population ages, the number of older adults (aged 65 years and above) living with dementia is rising. However, dementia rarely travels alone. On average, older adults with dementia live with four additional long-term health conditions, resulting in complex care needs. Currently, our healthcare system uses a single-disease approach, focused on treating one condition at a time, which doesn’t adequately address the needs of those living with multiple health issues.
In order to access services to support and manage their care needs, older adults with multiple long-term conditions including dementia experience frequent transitions between healthcare settings, and between healthcare professionals. This includes transitions between hospital, home, and residential care, as well as receiving care from outpatient services.
What does this mean for patient safety?
Care transitions between several providers can further exacerbate the complexities of managing dementia alongside multiple long-term conditions. Suboptimal transitions of care, through multiple different services, can expose this group to lapses in patient safety which could include:
- Delays in receiving appropriate treatment and support due to breakdowns in communication,
- Test results being lost in the transfer of information between services,
- Preventable admissions and readmissions to hospital.
As well as the risk they present to patient safety, suboptimal care transitions can also impact well-being. Informal caregivers, often family members, or friends, play a pivotal role in supporting older adults with dementia with their care needs as the condition progresses. Combined with providing care to a loved one, having to navigate transitions through multiple health systems can contribute to increased stress, depression, and anxiety.
Going digital
Digital technologies have been widely advocated as an approach to support the way healthcare is delivered. Electronic health records, patient portals, and other digital tools offer the promise of enhanced communication and information sharing between healthcare providers, presenting a more patient-centred approach to care. By providing access to comprehensive health information and facilitating communication between care providers, digital solutions have the potential to mitigate the challenges associated with care transitions.
However, the success of using digital technologies hinges on whether they are suitable and inclusive. Digital solutions to support older adults with multiple long-term conditions including dementia to make safer, integrated transitions of care must be tailored to meet their specific care needs. Importantly, we must also ensure that they don’t exacerbate existing health inequalities, which is a key emphasis within the Newcastle PSRC. This is a crucial step towards creating a healthcare system that truly works for everyone.
So, what are we going to do?
Through my PhD, I am investigating how digital solutions can be used to support transitions from hospital to home for older adults with multiple long-term conditions including dementia. This work is aligned with the Newcastle PSRC’s theme ‘Safer integrated health and social care environments,’ which aims to understand how we can safely transfer care from one provider to another.
By exploring how digital solutions can be used to facilitate integrated transitions of care, this work aims to understand what needs to be done to support older adults with multiple long-term conditions including dementia to manage their complex healthcare needs.
Across multiple independently-funded projects Professor Linda Sharp and Dr Laura Woods are seeking to develop a more comprehensive understanding of what underpins social differences in the proportion of patients whose cancers are diagnosed too late to be treated effectively, and what specific impactful routes exist to reduce these inequalities. Each of the three research projects make use of existing, routinely collected data on cancer patients, their diagnoses, their treatment and healthcare, as well as other, widely available data on the nature of different communities, geographies and localities.
The first project seeks to identify areas with particularly low take up of cancer screening, going on to use new statistical techniques to find out if there are similarities between such places. The results from this project will offer a different perspective on the challenges associated with screening attendance, as well as enable screening services to be more appropriately designed to reach communities where fewer people are screened.
A second project will develop a better understanding of patterns in head and neck cancer incidence (who has cancer?) and survival of these patients (how long do they live?) across England, with a focus on the pre- and peri-pandemic periods. The will examine how patterns in head and neck cancer vary by stage, age, deprivation and region, and whether these have changed (or not) over time. The planned analyses will provide crucial data to head and neck cancer clinicians and policy makers on current needs and priorities in head and neck cancer care, information which has not been unavailable for many years, and will help them better identify the current challenges in this very lethal cancer.
The third project will examine adherence to endocrine therapy (tamoxifen and similar drugs) amongst women in England who have been diagnosed with breast cancer, in order to better understand whether this is a factor in explaining inequalities in long-term survival between different deprivation groups and amongst different ethnicities. They will utilise primary care data to determine the proportions of women who take endocrine therapy as recommended, for how long, and whether patterns of therapy adherence explain inequalities in breast cancer outcomes.