Primary care management and early intervention in people with severe mental illness and physical health co-morbidities: an application of population based approaches to risk stratification and secondary care pathway mapping

This studentship will be hosted at UCL’s Division of Psychiatry and also at Public Health England. This is an exciting opportunity to work and build links across two institutions committed to world-leading science, knowledge development, dissemination and implementation.

Background
In England, people with severe mental illness (SMI), such as schizophrenia and bipolar disorder die on average 15 to 20 years earlier than the general population and the gap in death rates is increasing. Poor physical health is common in people with SMI. Many people with SMI experience at least one physical health condition at the same time as their mental illness (co-morbidity). People with SMI experience inequalities in access to and outcomes from health and care services.

This studentship will focus on people with SMI with physical health co-morbidities in England. Using a large sample of primary care data, it will examine how well their conditions are managed. The project will involve analysing risk factors for unplanned hospital attendances and admissions, will map events leading to hospital contact and will determine how contacts affect care outcomes. The work will compare risk factors and unplanned care journeys in people with SMI with the general population. It will also examine planned hospital care, which is known to have better outcomes than unplanned activity but is reported to occur at lower rates in people with SMI.

This work will provide information to support the design, planning and commissioning of preventive initiatives and services for people with SMI and physical health co-morbidities. It will provide patients with information to help them to better understand and self-manage their conditions. This in turn will lead to improved health outcomes and a reduction in premature mortality in people with SMI.

The supervisory team will work with the successful candidate to develop a series of specific research objectives in relation to the overarching aim of understanding physical co-morbidity and care in SMI. These objectives will be tailored to the candidate’s own interests but could include determining rates of unplanned admissions, predictors of these, and potentially effective and non-effective pathways and interventions.

Approach
This project will use data from two sources:

1. The Clinical Practice Research Datalink (CPRD)
This links information from primary care, general hospitals, psychiatric hospitals and Office for National Statistics on 35 million of the United Kingdom population.

2. The Health Improvement Network (THIN)
This links information from primary care and general hospitals on over 12 million of the United Kingdom population.

In both cases, a cohort of individuals with mental health diagnoses will be identified, along with a general population comparison group. Analyses will include multivariable regression methods for binary, count and time to event data. Comparative effectiveness approaches may include within-individual study designs, propensity scores and instrumental variables.

All candidates should hold a Master’s qualification (or complete their Master’s by September 2019) in an appropriate discipline and have a minimum of a 2:1 or equivalent in their first degree. Applicants should preferably have knowledge of the UK health and care system. All applicants are required to have excellent written and verbal communication skills. They should also be willing to work collaboratively in multi-disciplinary and multi-professional teams.

Project-specific skills and experience required
Essential:
Some understanding of how to design and analyses cohort studies and the basics of comparative epidemiology
Experience using Stata, R or a similar data analysis software package

Applications
For the application we are asking for a CV, short (1 page max) personal statement on why this PhD and two references – please send all this info Noorjaben Monowari [Email Address Removed]

Application deadline: 29/05/2019
Interviews: the morning of 04/06/2019

If candidates have any questions in regards to the advert, please contact either David Osborn, [Email Address Removed], or Joe Hayes, [Email Address Removed].