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What clinician and consultation factors predict patient compliance with long term medications?

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  • Full or part time
    Prof Tom Marshall
  • Application Deadline
    Applications accepted all year round

Project Description

Medication Possession Ratio (MPR) is the proportion of days which are covered by the patient’s prescriptions. It is a measure of patient compliance determined. A high MPR correlates with better blood pressure control, , and changes in MPR correlate with changes in blood pressure.

A number of factors have been proposed or found to influence compliance or persistence with long term medication although their significance in UK primary care is unclear. These include:
Frequency of follow up
Frequency that prescriptions are issued (90 day versus 30 day)
Whether medication is changed within the first month after initiation
Reporting of side-effects/intolerance
Continuity of follow up (whether follow up is predominantly by the same health professional)
Other factors may influence medication compliance but have not been investigated:
Length of consultation at first prescription
Profession of prescriber (nurse or doctor or other professional)
Whether the practice is a high or low prescriber of medications
Day of week and time of day (morning or afternoon) of initial prescription
Some of these factors are potentially easily modifiable.

Data source
THIN is a large dataset of electronic primary care records it includes patient details and also information recorded at each consultation such as prescriptions issued, diagnoses, symptoms and laboratory results. It also includes important metadata such as duration of consultation, the profession and gender of the person entering the data, date and time of day.

Aim
To investigate the extent and size of the above factors on MPR in patients prescribed statins and antihypertensive treatment.

Method
Retrospective cohort study of patients started on statins / antihypertensives


Applicants should hold or realistically expect to obtain at least an Upper Second Class Honours Degree in a relevant health or social science subject and have skills in data analysis.

Alternatively applicants may hold or realistically expect to obtain at least an Upper Second Class Honours Degree in a relevant subject that includes substantial analytic skills such as statistics, mathematics or computing science, but have a demonstrable interest in health and health care.

Funding Notes

Self-funded students

References

Schmitt KE. Edie CF. Laflam P. Simbartl LA. Thakar CV. Adherence to antihypertensive agents and blood pressure control in chronic kidney disease. American Journal of Nephrology. 32(6):541-8, 2010.
Warren J. Kennelly J. Warren D. Elley CR. Wai KC. Manukia M. Davy J. Mabotuwana T. Robinson E. Using the general practice EMR for improving blood pressure medication adherence. Studies in Health Technology & Informatics. 178:228-34, 2012.
Lemstra M, Blackburn D. Nonadherence to statin therapy: discontinuation after a single fill. Can J Cardiol. 2012 Sep-Oct;28(5):567-73. doi: 10.1016/j.cjca.2012.03.018. Epub 2012 May 31.
Taitel M, Fensterheim L, Kirkham H, Sekula R, Duncan I. Medication days' supply, adherence, wastage, and cost among chronic patients in Medicaid. Medicare and Medicaid Research Review. 2012;2(3):E1-E13.
Daugherty SL, Ho PM, Spertus JA, Jones PG, Bach RG, Krumholz HM, Peterson ED, Rumsfeld JS, Masoudi FA. Association of early follow-up after acute myocardial infarction with higher rates of medication use. Arch Intern Med. 2008 Mar 10;168(5):485-91; discussion 492. doi: 10.1001/archinte.168.5.485.

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