Primary Care Epidemiology
  • Print
   
   

Primary Care Epidemiology research group

Overview

This group studies the epidemiology of diseases (eg heart disease, diabetes, cancer, thrombosis, osteoporosis, depression and dementia) and drug safety of commonly prescribed drugs (including antidepressants, statins, novel anticoagulants, anticholinergics, NSAIDs, Cox-2 inhibitors and drugs used in the treatment of type 2 diabetes). Group members are also involved with the development, validation and implementation of risk prediction tools in collaboration with ClinRisk Ltd.

We make extensive use of a number of databases including QResearch (www.qresearch.org), the largest database of its kind worldwide, containing a wealth of longitudinal data from patients in over 1,300 UK practices linked to secondary care data for hospital admissions, mortality and cancer registration. 

qresearch

 

Research issues

1. Drug Safety

Whilst clinical trials are undertaken during the development and testing phases for new and commonly used drugs, this tends to be in small selected populations for limited periods of time. Once a drug is licensed, it tends to be used in large numbers of unselected individuals over long periods of time.

read more

It is therefore important to have independent systematic research into the effects of new and commonly used drugs to identify and quantify both intended and unintended effects on patients. We use the QResearch and other databases to undertake such studies which are of national and international importance.

 

2. Risk Prediction

Doctors and patients need both better information to inform decisions to investigate, refer and treat individuals. Both doctors and patients need better information to ensure patient are fully informed about the risks and benefits of clinical decisions and so can give consent.

read more

New approaches to cardiovascular risk estimation were needed to take account of the characteristics of the population to which the tool should be applied and which can be updated over time as the population changes and national guidelines for prevention evolve.

QRISK was therefore developed as a new approach to cardiovascular risk estimation. The algorithm was developed using the QResearch database which is a large anonymised repository of electronic health records for medical research created as part of a not-for-profit partnership between the University of Nottingham and EMIS – a leading supplier of GP clinical computer systems in the UK (www.qresearch.org). 

 

Outcomes

Our work on safety of NSAIDs published in the BMJ in 2005, led to a European review of NSAID safety which then confirmed our findings. Guidelines have since been amended to take account of our original research.

QRISK software, which is now embedded in > 99% of UK GP clinical computer systems, runs calculations every night which generate a rank-ordered list of those at high risk of heart disease or stroke. Similar tools which estimate risk of other conditions such as osteporotic fracture and diabetes are also now recommended in national guidelines and tools embedded in clinical computer systems. The tools help identify those patients at high risk of developing a disease for whom preventative measures can be considered.

read more about how QRISK is used in practice

The QRISK software is used daily by clinicians during consultations with patients and as a risk stratification tool to identify patients for recall for further assessment. Patients at high risk of cardiovascular disease can therefore be identified and given interventions to lower risk where appropriate. Interventions include weight reduction, smoking cessation, blood pressure lowering treatment and cholesterol lowering treatment.

The NHS Health Checks Programme offers a cardiovascular risk assessment to adults aged 40-74 years in England. The Department of Health endorsed QRISK on publication and used it to develop the economic modelling underpinning the NHS Checks programme in 2008, recommending its use for the start of the programme in 2009.

Use of QRISK was endorsed by NICE guidance in 2010 and is now recommended instead of Framingham for use in England. Use of QRISK is also an integral part of the UK GP contract since vascular screening is one of the quality indicators for which GPs are paid. The new indicator for primary prevention of cardiovascular disease was introduced in 2010/11.

 

Current projects

  • Safety and harms of antidepressant medication
  • Risk of cancer in patients with diabetes
  • Risk of dementia among patients prescribed anticholinergic drugs
  • Cross validation of QScores on QResearch and CPRD
  • Safety and effectiveness of novel anticoagulants
  • Risk of venous thromboembolism with the oral contraceptive pill

 

 

 

Primary Care Epidemiology

The University of Nottingham
School of Medicine, Tower Building
Nottingham, NG7 2RD


telephone: +44 (0) 115 846 6915
email:julia.hippisley-cox@nottingham.ac.uk