Primary Care Stratified Medicine (PRISM)
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Primary Care Stratified Medicine (PRISM) research group

Aims

Many major health problems, such as heart disease and cancers, are still not effectively prevented and managed. This can be improved by ‘stratifying’ people in ways that better identify their risk, or likely benefit from an intervention or treatment.

Our research develops and translates new stratified approaches into primary care – where over 90% of health care is delivered.

Professor Nadeem Qureshi and Professor Joe Kai

Co-leads of the Primary Care Stratified Medicine Research Group

PRISM

 

Research issues

  • Medicine and health care often use a ‘one size fits all’ approach to treatment or care. This means many treatments are only effective in 30-60% of people receiving them, while others may not benefit at all. 

  • Better and more equitable healthcare can be achieved by improved understanding of people’s diversity – such as genetic, social or ethnic variation. 

What do we do?

  • Our ‘stratified medicine’ research aims to better identify people, or groups of people at risk of disease, and their response to an intervention or treatment.  

  • We do this by developing and using emerging techniques – such as applying advances in genomics or data science.  

  • We also research how to use these techniques in ‘real life’ health care practice with patients, their GPs and other community healthcare settings. This is ‘translational research'.

  • We evaluate these approaches in diverse communities to help achieve more equitable (fairer) benefit from advances in care.

  • Both stratification and translation are required for patients and health services to benefit from better-targeted and effective interventions in prevention and management of common conditions. 

  • This enables selection of the ‘right treatment at the right time’ for individuals. 

  • Having a ‘stratified’ approach can also help earlier diagnosis, screening and treatment, or smarter monitoring, in more cost-effective ways. 

Our focus so far

Our focus is on major health problems we can address in primary care - such as cardiovascular disease, cancers and common inherited disorders.

An example:

Patients identified with raised cholesterol provides an exemplar of our primary care stratified medicine research: interrogating primary care databases has enabled us to stratify patients into those with inherited lipid disorders and multifactorial risk factors for cardiovascular disease, whilst genomic testing enables us to confirm those with severe familial hypercholesterolaemia and milder polygenic conditions.

Also, the database research combined with further sequencing of genome, will stratify patients by response to different lipid lowering therapies. We have also translated these techniques into actual primary care clinical practice using mixed method research.

Data Science Research

Cardiovascular Disease

  • Pharmacogenomics stratifying drug response to statins using the Clinical Practice Research Datalink (CPRD). 

  • Machine-learning using neural networks, deep learning, ensemble learning, random forests, gradient boosting for improving diagnosis of cardiovascular disease using the Clinical Practice Research Datalink (CPRD). 

 Related publication:

 

Cancer

  • Argumentation from patients stratified for familial breast cancer data derived from general practice IT systems and research databases.

 

Common Inherited Disorders

  • First study using primary care electronic health records to investigate the association between Sickle Cell Trait and thrombotic risk.

  • Risk stratification of familial hypercholesterolaemia using the Clinical Practice Research Datalink.  

  • External validation of the familial hypercholesterolaemia case finding stratification tool using UK General Practice databases.

Related publications:

 

Mixed Methods Translational Research

Cardiovascular Disease

The first randomised control trial (ADDFAM) which showed that simple family history assessment collection by GPs can improve risk stratification of future risk of heart disease in primary care. 

Related publications:

The first mixed methods study (ADDGEN) assessing acceptability of cardiovascular genetic testing in primary care.  

Related publications:

 

Cancer

  • The first exploratory trial (FBC) of systematically stratifying risk of familial breast cancer using decision support software in primary care.

  • Genetic educational outreach project to improve identification of familial cancer in primary care.
  • Systematic reviews on clinical utility of  the cancer family history and accessing cancer genetic services. 

Related publications:

 

 

Common Inherited Disorders

  • The first observational intervention study (FAMCHOL) of systematically identifying familial hypercholesterolaemia in primary care.
  • The first clinical utility study (FAMCAT) of using a novel informatics-based risk stratification algorithm, developed from routine GP databases, to diagnose and manage patients with familial hypercholesterolaemia in primary care. 
  • Systematic reviews on implementing preconception screening in primary care, and identification of familial hypercholesterolaemia in non-specialist settings. 
  • The first national genetic antenatal screening programme.
  • National genetics and genomics surveys of primary health care practitioners' attitudes, knowledge and skills.
  • Evaluate the national neonatal screening programme for cystic fibrosis and sickle cell disorder.

Related publications:

 

Therapeutics

  • The first and largest randomised control trial (ECLIPSE) that found that the levonorgestrel intrauterine system (LNG-IUS) was more effective than usual care to reduce menorrhagia in primary care.
  • Evaluating pharmacogenomics test for adverse effects to carbamazepine and allopurinol.

Related Publications:

 

Impact

Our research impacts health policy internationally, including:

  • NICE guidelines on familial hypercholesterolaemia, breast cancer and lipid modification.

  • Antenatal and newborn genetic screening programmes.

  • Related training in the UK NHS.

  • Use of family history in health care (NIH consensus statement in US).

  • Research on diversity and genetics is helping reduce disparities in the Genome England 100,000 project.

Publications

Our research has been published in leading peer-reviewed journals. See our individual staff profiles to find out more.  See a list of our recent publications.  

 

 

 

 

Primary Care Stratified Medicine (PRISM)

The University of Nottingham
School of Medicine


telephone: +44 (0)115 846 6903
email:nadeem.qureshi@nottingham.ac.uk