This is an repository of previous Cambridge-led research projects
funded by the NIHR School for Primary Care Research.
Patterns of medication use and polypharmacy at the end of life
(1/10/2015- 30/09/2017)
Dr Rupert Payne (now at University of Bristol)
Medicines are among the commonest treatments used by doctors. Doctors are looking after an ageing population, who increasingly have several conditions and complicated medical needs. This is leading to the growing issue of “polypharmacy”, a term that describes the use of multiple medicines. As the end of life approaches, the benefits of taking many medicines are unclear; such patients often welcome reducing the number of medications they receive. However, little is known about how many and what types of medicines patients are prescribed towards the end of life, both medicines for long-term conditions and those aimed at symptom control in the final period of life. Understanding these issues is important if we are to develop successful ways of improving the quality of patient care and medicines use in such patients. Read more
Systematic reviews of literature to inform development of a primary care intervention to improve uptake and completion of exercise/activity programmes in people with peripheral arterial disease
(01/10/2015 – 30/09/2016)
Dr Ricky Mullis
This project aims to inform development of a PC intervention to improve uptake and adherence to supervised exercise programmes in patients with peripheral arterial disease and intermittent claudication. Research more
Assessing the potential of a data sharing and communication facility within a cessation smartphone app (Q Sense) for patients and NHS smoking cessation advisors
(01/10/2015 – 31/03/2017)
Felix Naughton (now at University of East Anglia)
Mobile phone-based support programs for quitting smoking have potential to improve the effectiveness of NHS smoking cessation support, particularly in primary care where most smokers are seen compared to other settings. We have developed a smartphone app called Q Sense which invites smokers to provide real-time information about their smoking. This includes where they are, who they are with and how they are feeling before they smoke. The app also asks smokers about their cravings and quitting confidence at the end of each day. If the smoking cessation advisors of patients using Q Sense had access to the detailed information it collects it could help them deliver more timely and tailored support. In addition, if smokers could interact with advisors through the app this might also improve outcomes and support access rates which would in turn improve the chance of Q Sense users quitting successfully. Read more
Validation of existing risk prediction models for colorectal cancer
(01/10/2015 – 31/12/2017)
Dr Juliet Usher-Smith
This project will assess the performance of a range of existing risk scores developed to identify individuals at high risk of developing colorectal cancer in a large UK cohort, in order to inform future risk stratified screening approaches in the UK. Read more
Developing and evaluating a measure of inappropriate polypharmacy in primary care
(01/10/2015 – 31/03/2018)
Dr Rupert Payne (now at University of Bristol)
Medicines are among the commonest treatments used by doctors to improve the health and well-being of patients. Being admitted to hospital can result in considerable changes to a patient’s usual medicines. This can be confusing and worrying for patients, and can sometimes result in mistakes being made in the prescription. However, little is known in the UK about the nature of these medication changes, such as which patients and what types of medicines are affected most. Understanding these issues would help us improve the quality of patient care and medicines use in patients who have recently been discharged from hospital. Read more
Systematic review of prostate cancer risk prediction models for use in the general population
(01/10/2015 – 22/02/2017)
Dr Greg Irving
In the UK, prostate cancer is the most common cancer in men with over 40,000 new cases diagnosed each year and approximately 10,000 dying as a direct result of the disease. It is a highly variable disease with some men at risk of serious illness that will harm them, whilst in others the disease is relatively harmless. At present, we don’t know how to get the balance right between 1) the early identification of those with serious disease to prevent the disease from causing harm and 2) minimising the detection of disease which is harmless, for which some may receive unnecessary treatment. Patient and clinician groups have identified this issue as research priority for the National Health Service. Read more
Using national administrative data to evaluate new models of primary care
(01/01/2016 – 31/12/2018)
Professor Martin Roland
Primary care remains at the centre of NHS plans to meet current demographic challenges. Yet primary care is poorly prepared. Not only are the structures unsuitable (e.g. small practices, limited premises), but recruitment to and morale in general practice are poor with many practices struggling to meet the expectations placed on them. Read more
Toward person-centred care: development of a patient support needs tool for patients with advanced Chronic Obstructive Pulmonary Disease (COPD) in primary care
(01/02/2016 – 31/03/2017)
Dr Morag Farquhar (now at University of East Anglia)
Chronic Obstructive Pulmonary Disease (COPD) is a long-term lung condition that shortens people’s lives. People with advanced COPD have severe breathlessness and face difficulties in daily living. COPD also affects family members and friends who provide care and support. We know that patients have unmet care and support needs in advanced COPD. We also know some of the reasons why these needs are unmet. Read more
Validation of existing risk prediction models for prostate cancer using data from UK BioBank and EPIC-Norfolk
(01/03/2016 – 28/02/2017)
Dr Greg Irving
In the UK, prostate cancer is the most common cancer in men with over 40,000 new cases diagnosed each year and approximately 10,000 dying as a direct result of the disease. It is a highly variable disease with some men at risk of serious illness that will harm them, whilst in others the disease is relatively harmless. At present, we don’t know how to get the balance right between 1) the early identification of those with serious disease to prevent the disease from causing harm and 2) minimising the detection of disease which is harmless, for which some may receive unnecessary treatment. Read more
The Tip of the Iceberg: Identifying Patients with Heart Failure and Preserved Ejection Fraction (HFpEF) in Primary Care
(02/03/2016 – 30/06/2016)
Professor Christi Deaton
Heart failure (HF) is a condition in which the heart is not working effectively as a pump, resulting in breathlessness and fatigue. In about half of the people with HF this occurs because the heart has become stiff and does not relax and easily fill with returning blood from the body. This is known as HF with a preserved ejection fraction (HFpEF). HFpEF is difficult to diagnose even with an echocardiogram, and experts disagree about diagnosing it. Read more
Identifying patients at raised risk of stroke due to paroxysmal or persistent atrial fibrillation in primary care populations
(01/04/2016 – 31/10/2018)
Dr Duncan Edwards
One in four strokes may be caused by an irregular heart beat known as atrial fibrillation (AF). Having AF means you are five times as likely to have a stroke. Often, AF is diagnosed only after a stroke has occurred. AF is commoner in older people, so it is getting commoner in the UK due to the ageing population.” Read more
Impact of hospital admission upon patterns of primary care prescribing
(01/07/2016 – 30/06/2018)
Dr Rupert Payne (now at University of Bristol)
Medicines are the commonest treatment used by doctors to improve health. Doctors are looking after an ageing population with increasingly complicated medical needs. This is leading to a growing problem of “polypharmacy” – the use of multiple medicines in a single patient. Read more
Developing and pre-testing a tailored interactive voice response (IVR) intervention to support adherence to anti-hypertensive medications
(01/09/2016 – 31/08/2017)
Dr Katerina Kassavou
In England, there are 8 million people with hypertension (high blood pressure). Treatment for high blood pressure usually consists of one or more blood pressure lowering medicines, known as antihypertensives. Taking medication as prescribed can significantly reduce risks, complications and early deaths associated with these conditions. However, many people with hypertension do not take their medication as prescribed. Read more
Optimising Treatment for Mild Systolic Hypertension in the Elderly
(01/10/2016 – 31/05/2019)
Dr Jenni Burt
The OPTiMISE trial is a multi-disciplinary and multi-institution programme of work on optimising treatment for mild systolic hypertension in the elderly. Due to an ageing population and consequent increase in the number of people living with multiple chronic conditions, the proportion of the population taking multiple medications is on the rise. Hypertension is the number one co-morbid condition in older patients, and up to half of those aged 80 years or over are prescribed two or more antihypertensive medications. Read more
‘I’m fine’: exploring patient and carer assertions of status in advanced COPD and clinical implications for primary care
(01/04/2017 – 31/03/2018)
Dr Robbie Duschinsky
Patients can be reluctant to say they need help and support, telling clinicians they are “fine” despite having unmet needs. Research with patients in mental health settings suggests that when patients do this they are less likely to follow their treatment plans, and that their informal carers may be at risk of depression. However we don’t know whether this is also true for patients with physical health problems. In this study we will explore this in patients with advanced chronic lung disease (COPD) and their carers: we know some of these patients and carers report being “fine” despite having needs, but we don’t know the impact of this – for example, are these patients less likely to follow treatment plans or are these carers at greater risk of depression? Read more
What are the barriers and facilitators when conducting CTIMPs in a primary care setting: experiences and lessons from the PROPS trial
(01/04/2017 – 31/03/2018)
Dr Ricky Mullis
Research to improve primary care services should be performed in primary care settings. Too often, such studies are carried out in specialist settings such as hospitals, particularly when they involve a drug trial. In part, this reflects the difficulties of carrying out such studies in a primary care setting, especially at a time when resources are in short supply and the primary care workforce is in crisis. The PROPS trial is an on-going drug trial based in general practices, and has struggled to recruit patients. PROPS is investigating the use of a capsule containing three different types of medication (a ‘polypill’) for people who have suffered a stroke. The aim of these treatments is to reduce the chance of having another stroke. Read more
Development of simple risk models incorporating modifiable risk factors for the most common preventable cancers using EPIC-Norfolk
(01/04/2017 – 31/03/2018)
Dr Juliet Usher-Smith
Cancer is one of the leading causes of death in the UK and the number of people getting cancer is increasing every year. Research has shown that lifestyle choices, such as smoking, alcohol consumption, diet, physical activity and weight, play a part in four out of every ten cases of cancer and nearly 600,000 cancer cases could have been prevented in the past five years if people had healthier lifestyles. However, research has also shown that many people are unaware of this. The aim of this research is to develop simple risk calculators that include lifestyle choices for the five most common cancers for men and women. Read more
Association of vascular risk factors and corresponding pharmacological modification treatments with post-stroke dementia: cohort studies using Clinical Practice Research Datalink and Cognitive Function and Ageing
(01/04/2017 – 30/09/2018)
Zhirong Yang
More people are surviving having a stroke, with a result that the long term sequelae are growing in importance. One such issue is problems with thinking and memory which may progress to dementia. Dementia after stroke is thought to be related to blood cholesterol that increases risk of heart attacks and strokes, despite the association not having been well demonstrated. This suggests that lipid-lowering treatments may help prevent dementia after stroke. In this study, we want to explore whether being on lipid-lowering medications is associated with lower risk of dementia after stroke. Read more
Improving the diagnostic process for patients with bladder and kidney cancer: variations in pre-diagnostic clinical activities and events
(01/05/2017 – 30/04/2018)
Dr Yin Zhou
Early diagnosis of cancer is crucial for better survival and patient experience. However, diagnosis can be difficult as benign non-cancerous conditions are common and cancer is quite rare. The use of tests forms a very important part in diagnosis, but what and when tests are done can vary for different patients with the same cancer. Our study will highlight differences in diagnostic timeliness in patients with kidney and bladder cancer that may be related to use of tests. Read more
Management of Patients with Heart Failure with Preserved Ejection Fraction: What do Patients and Providers Need and Want?
(01/05/2017 – 31/03/2018)
Professor Christi Deaton
Heart failure (HF) is a condition in which the heart does not work well as a pump. About half of patients with HF have a type of HF in which the heart is very stiff, which is more common in older people with a history of high blood pressure, obesity and diabetes. It is harder to diagnose and is less well recognised and understood. Read more
Identifying effective ways to increase the uptake of cessation support among smokers: systematic review and meta-analysis
(01/07/2017 – 31/12/2018)
Dr Joanne Emery (Now at University of East Anglia)
Reducing the proportion of smokers is a public health goal but rates have reduced very slowly in the last decade, standing at around 18% of adults in England. Effective quitting support has been available, free-of-charge, in England since 2000 through NHS Stop Smoking Services (SSS), delivered in general practice / primary care and other settings. Little is currently clear about what methods work best for increasing smokers’ uptake of support due to wide variation in the quality of research evidence, and it is unknown if different methods work better for different support types (e.g. face-to-face versus distance support). A systematic review is therefore needed to collate the evidence on ways that smokers’ uptake of SSS, and alternative quitting support, could be increased. Read more
The association between continuity of primary care and mortality and emergency hospitalisation for older patients with complex multimorbidity
(01/11/2017 – 31/07/2018)
Professor Simon Griffin
Older patients who suffer with many long-term diseases (like heart disease, diabetes and dementia) are an important group. Their health problems are usually more complex than other patients’ and they often need more care from GPs. They are also more likely to be admitted to hospital as emergency cases. This can be distressing for these patients and costly for the NHS.
As the number of older patients with long-term diseases rises, finding ways to provide better care for them in general practice becomes more important. Research in other countries suggests that older patients with many long-term conditions who mainly see a GP who knows them well have lower levels of emergency hospital admission. In this study we will use data from a research database of anonymised GP records to find out whether this is also true in England. Read more
Experience, impact and management of cancer-related fatigue (CRF) in teenagers and young adults (TYA): grant development and dissemination project
01/09/2018 – 31/07/2019
Dr Stephen Barclay, Dr Anna Spathis
Fatigue, a severe tiredness that interferes with a person’s usual ability to function, is the most common symptom suffered by teenagers and young adults (TYA) with cancer. It is a particularly distressing symptom for young people as it makes it harder to be independent or to be in education or work. Fatigue often continues for years after the end of cancer treatment. Relief of fatigue would greatly improve young patients’ quality of life and, particularly for this young group, could have long-term health and economic benefits. Read more
Exploring patients’ values and preferences for colorectal cancer screening
(01/01/2019 – 30/06/2019)
Dr Juliet Usher-Smith
Bowel cancer is one of the most common causes of cancer-related death. Many countries have screening programmes to try and pick up people with early signs of cancer. However, all screening tests require time and effort from participants and can have side effects. For example, having a colonoscopy (a camera examination of the bowel), requires time away from home and medication to be taken before the test. Read more
Effectiveness of Acceptance and Commitment Therapy (ACT) interventions for promoting physical activity: Systematic review and meta-analysis
(01/04/2019 – 31/08/2019)
Dr Sally Pears
Physical inactivity increases the risk of many diseases, and there is a need for low-cost ways to help individuals to increase their physical activity. Interventions that are based on a model called Acceptance and Commitment Therapy (ACT) may be an effective way of supporting people to become more active. We want to find out whether interventions that are based on ACT are effective in helping people to increase their physical activity, and if they are, we would like to look at what particular aspects of the ACT interventions are most helpful. Read more