Understanding and Managing Polypharmacy - to explore how precision medicine might afford opportunities to refine the approach advocated in the guideline and incorporate this into decision support for e-prescribing

Background
“Medication is by far the most common form of medical intervention for many acute and chronic conditions. Drug therapy can be highly effective in preventing disease or slowing disease progression, with guidelines for single diseases recommending the use of a variety of evidence based drug treatments. However, there is often a mismatch between prescribing guidelines for specific medical conditions and the range of clinical complexity found in individual adults.” [3]

Polypharmacy is the term used to describe drug treatment for multiple conditions result in the patient taking several drugs simultaneously. In many circumstances this is appropriate but there is the potential for a number of patients to experience inappropriate polypharmacy where one or more of the following hold: no evidence-based indication for the drug; indication has expired; drugs fail to achieve the desired therapeutic outcome; one or more of the drugs in combination cause unacceptable Adverse Drug Reactions (ADR) (or expose the patient to an unacceptably high risk of ADRs); or the patient is not willing or able to take one or more of the drugs as prescribed.

Scotland has comprehensive polypharmacy guidelines and is leading the EU SIMPATHY project that is mapping and exploring the transfer of best practice in polypharmacy management across EUROPE.
Currently the guideline targets around 40,000 in the 75 and over population many of whom are high resource users. The main mechanism proposed in the guideline is a polypharmacy review process aimed at uncovering and correcting inappropriate polypharmacy. The goal of this project is to explore how precision medicine might afford opportunities to refine the approach advocated in the guideline and incorporate this into decision support for e-prescribing [1,2].

Aims
1. Currently the polypharmacy reviews are targeted using fairly crude stratification techniques. One goal is to explore the extent to which that can be improved using the current data sets.
2. Explore the extent to with a richer dataset could be used to support the application of the polypharmacy approach. Including the feasibility of gathering that data with appropriate quality.
3. Explore the extent to which improved understanding of the occurrence of polypharmacy could be used to improve decision support in e-prescribing systems and incorporate some aspects of the guidelines into e-prescribing systems and practice.

Training Outcomes
1 Statistical and mathematical skills in developing more sophisticated risk stratification for polypharmacy.
2 Development of skills in infrastructure to gather and manage data on a particular target group of users.
3 Interdisciplinary skills drawing on public health, sociology and informatics to develop effective means to support decision taking in e-presecibing.

This MRC DTP programme is joint between the Universities of Edinburgh and Glasgow. You will be registered at the host institution of the primary supervisor detailed in your project selection.

All applications should be made via the University of Edinburgh, irrespective of project location:

http://www.ed.ac.uk/studying/postgraduate/degrees/index.php?r=site/view&id=919

Please note you must apply to one of the available projects, and include details of the project you are applying to in Section 4 of your application. Additional information on the application process if available from the link above.

For more information about Precision Medicine visit:

http://www.ed.ac.uk/usher/precision-medicine