Reviewing and optimising the use of electronic prescribing systems to improve medicine safety in integrated care systems

With a rapidly ageing population in the UK, there is an escalating demand for older care that requires therapeutic drug monitoring with the help of electronic prescribing and record systems (EPRS). However, the complex nature of these technologies, contributed by various factors (human v/s technical), impedes their sustained implementation [1]. The human and technical factors that contribute to the challenges associated with EPRS in primary care include prescriptions not being cancelled actively, drug handling errors, software programming errors, and system updates/upgrades. These challenges can lead to medication errors, patient safety risks, and inefficiencies in care delivery. [2]. This suggests the need for effective use of such technologies to better understand how to support such implementation and mitigate the risks to medicine safety.

The Department of Health and Social Care emphasises the necessity of Adult Social Care Reform to meet the needs of older adults through alternative forms of effective care coordination and technology-oriented new models of care [3]Therefore, the reform requires improvements in general medical practices and primary care networks to overcome the challenges related to EPRS and ensure safety, particularly in care, to benefit the wider society.

Research Questions

1.  How are electronic record systems used to manage medicines safety issues in primary care, with a focus on polypharmacy for older people and medicines that require therapeutic drug monitoring or have “shared care” protocols?
2.  How do human and technical factors contribute to those challenges associated with EPRS in primary care? What are the consequences of those challenges, and what actions are taken to mitigate the risks to medicine safety?
3. What strategies should be implemented by medical general practices and primary care networks to overcome the challenges related to EPRS and improve medicine safety?

Methods

The project will comprise three phases.

1.  Phase 1 (12 months): To address RQ1 & RQ2, we will conduct a mixed-methods online survey distributed through e-mail to primary care teams, supported by the Bradford Enablement Support Team. The quantitative data will be analysed using a logistic regression model, and the qualitative data will be analysed using both inductive (framework analysis) and deductive (existing literature and the NASSS framework) approaches. A systematic review of the challenges of EPRS will supplement this.
2. Phase 2 (15 months): To address RQ2 & RQ3, we will conduct interviews with primary care managers and health care professionals (15 participants) and with ethnically diverse patients of any age group (15 participants), including older adults (65 years or above). This will help gain insights about best care practices and understand the service users’ experience and attitudes toward medicine safety. We will report the study findings and then work with primary care staff through Focus Group Discussions (8 participants) to translate the findings into actionable guidance. We will work with key stakeholders, i.e., the NIHR Yorkshire and Humber Patient Safety Research Collaboration (YHPSRC), Bradford District Craven Health & Care Partnership, and NHS WY Integrated Care Board.
3. Phase 3 (9 months): The developed guidance will be validated using a regional online Delphi survey of expert opinions to test the relevance and acceptability of the guidance for progressive refining in collaboration with the above stakeholders. Upon analysing the findings, a consensus will be reached after the final round of questionnaires among the experts to view future (validated) guidance in alignment with English Healthcare (RQ3).

Key research output/ impact

• Generating valuable knowledge and insights into medicines safety and managing risk
• A clear, actionable guidance for better care coordination within the primary care team
• Better use of electronic systems to monitor medicines safety for high-risk medicines or individuals
• Evidence-based policy recommendations for primary care teams to improve medicines safety
• Dissemination of findings through academic journals and conference presentations

Eligibility criteria

Applicants should have a master’s degree or equivalent in a subject area relevant to the research topic, such as health informatics, digital health, pharmacy, or health technologies.

How to apply

Formal applications can be made through the University of Bradford web site. Applicants should register an account, and choose 'Full-time PhD in Public Health' as the course.

About the University of Bradford

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