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Identifying and quantifying the relative importance that patients attach to the outcomes of safe prescribing in primary care


Project Description

There are over 1.8 million serious prescribing errors in English general practices each year and hazardous prescribing is associated with substantial healthcare costs, reduced quality of life and increased risk of mortality.

This PhD is part of a research programme focusing on quantifying the economic impact of interventions to reduce hazardous prescribing in primary care, quantified by cost to achieve changes in quality-adjusted life-years (QALYs). Focussing on health status alone is likely to underestimate the value of interventions to patients and decision-makers.

Recent qualitative work suggests that what people consider important in safety extended beyond health status and included preventability and trust. Similarly, factors such as improving public trust and confidence influence local and national decision-makers when implementing services. Another component that may be important to patients is the concept of process utility, such as how the information about potential harms is communicated.

The aim of this PhD is to explore the relative importance to patients of safe prescribing, capturing health status, non-health benefits and process utility. This PhD will use stated preference methods (discrete choice experiments (DCEs) or best-worst scaling experiments (BWS)) to quantify the stated preferences of patients for the relative order of importance of different consequences possible when a medicine is prescribed more safely as a result of a general practice based intervention.

This PhD will be based in the Manchester Centre for Health Economics (MCHE), School of Health Sciences. The supervisory team will include Rachel Elliott and Katherine Payne, who are both Professors of Health Economics, MCHE. Professor Elliott is an expert in the economics of safety and Professor Payne has expertise in in stated preference methodology.

The PhD student will be expected to:
• Carry out a literature review and critique of the published evidence
• Complete a qualitative interview-based study to develop the preference experiment.
• Design, execute and present analysis of a preference experiment.

Specialised training in the design and analysis of stated preference surveys including the methods needed to take account of scale and preference heterogeneity will be provided will be provided. The supervisors have conducted many preference-based studies and their teams of postdoctoral researchers and PhD students will provide additional ad hoc advice and support. The successful candidate would also attend relevant economic/statistical/qualitative methods courses at the University, including modules from the online Masters in Public Health, as well as short courses in the Faculty of Biology Medicine and Health and in the Faculty of Humanities (i.e. courses hosted by the Cathie Marsh Institute for Social Research). The successful candidate would be expected to regularly attend meetings of the Manchester Centre for Health Economics and PSTRC. Funding for attending external courses and/or presenting research findings at conferences will also be available.
Specific skills to be developed will include: Critical appraisal of published literature, Database handling and statistical analysis using STATA; Oral and written presentation skills.


For international students we also offer a unique 4 year PhD programme that gives you the opportunity to undertake an accredited Teaching Certificate whilst carrying out an independent research project across a range of biological, medical and health sciences. For more information please visit http://www.internationalphd.manchester.ac.uk.

Funding Notes

Applicants are expected to hold, or about to obtain, a minimum upper second class undergraduate degree (or equivalent) in economics, or a primarily quantitative or health-related discipline. A Masters degree in a relevant subject and/or experience in health economics or health services research is desirable.

This project has a Band 1 fee. Details of our different fee bands can be found on our website (View Website). For information on how to apply for this project, please visit the Faculty of Biology, Medicine and Health Doctoral Academy website (View Website).

Informal enquiries may be made directly to the primary supervisor.

References

1. Elliott RA, et al. Cost effectiveness of a pharmacist-led IT-based intervention with simple feedback in reducing rates of clinically important errors in medicines management in general practices (PINCER) Pharmacoeconomics 2014; 32:573-590. DOI: 10.1007/s40273-014-0148-8
2. Steuten, L. and M. Buxton, Economic evaluation of healthcare safety: which attributes of safety do healthcare professionals consider most important in resource allocation decisions? Quality and Safety in Health Care, 2010. 19(5): p. e6.
3. Rhodes, P., et al., Sensemaking and the co-production of safety: a qualitative study of primary medical care patients. Sociology of Health & Illness, 2016. 38(2): p. 270-285.
4. Daker-White, G., et al., Blame the Patient, Blame the Doctor or Blame the System? A Meta-Synthesis of Qualitative Studies of Patient Safety in Primary Care. PLoS One, 2015. 10(8): p. e0128329.
5. Vass C, Wright SJ, Burton M & Payne K. Scale Heterogeneity in Healthcare Discrete Choice Experiments: A Primer The Patient 2018 DOI: 10.1007/s40271-017-0282-4

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