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Two major national studies, conducted by staff in the Unit and colleagues from a number of other institutions, provide the most comprehensive estimate to date of the prevalence of prescribing errors in general practice in England. These studies identified a number of strategies for reducing these prescribing errors that have been endorsed by the General Medical Council (GMC). Other impacts from these studies include increased public understanding and debate through media coverage, changes to GP education to be implemented by the Royal College of General Practitioners (RCGP), improvements to computerised prescribing decision support for general practitioners and increased awareness of the medication safety role of primary care pharmacists.
Research at the University of Manchester (UoM) has, and continues to have, a direct impact on pharmacy policy and practice. From 1993, our work on the contribution of pharmacists to primary health care has helped improve patients' access to medicines and pharmacies. Our `Care@TheChemist' trial led to changes in the national pharmaceutical contract and now almost 5,000 pharmacies offer the service to several million primary care patients. Our skill mix research is used to inform regulatory control of pharmacies and our wider workforce research continues to inform national governments about how to forecast future requirements for pharmacist numbers.
Leeds researchers first proposed and tested the concept of a pharmacist-led clinical medication review and showed its effectiveness in care homes. This led to a collaborative study on medicines' safety in care homes which showed seven out of ten residents, on any one day, had at least one medication error. As a direct result, there was a ministerial-led summit, and the Department of Health (DH) issued a `Health Alert' requiring NHS trusts to take immediate action, citing the study findings. This was followed by several national initiatives to take forward the recommendations of the study, including a DH commissioned initiative involving Royal Colleges, the National Care Forum, the Health Foundation and Age UK. Prototype tools developed on the basis of our research and with Leeds input were reported in 2012 and are now being evaluated for national roll out.
Our research has: i) increased public and professional knowledge and understanding of the prevalence, nature and causes of prescribing errors in general practices; ii) led the General Medical Council to recommend improvements to GP education and training; iii) led to the Royal College of General Practitioners to revise its curriculum to increase the emphasis on safe prescribing; iv) led one of the major GP computer system suppliers to make safety improvements; v) identified an IT-based intervention that is effective at reducing prescribing errors; vi) led to the roll-out of the intervention in over 800 general practices.
Our ground-breaking research has driven major changes in non-medical prescribing (NMP) legislation. As a result of our research, over 19,000 nurses and 2,000 pharmacists now independently prescribe medicines directly to patients across the most comprehensive range of medicines in the world. This amounts to four million prescriptions per year in England. NMP has improved the quality and efficiency of health care: patients can now access prescribed medicines faster and NMP has reduced the number of professionals required. Study results have also contributed significantly to a recent extension of independent prescribing powers to physiotherapists and podiatrists. Our research is widely cited in international NMP policy development, and our survey methods and evaluation measures are used to assess NMP quality and safety internationally.
Research at the University of Manchester (UoM) has changed the landscape of medical care and research in fungal infections internationally. The impacts include: the world's first commercialised molecular diagnostic products for aspergillosis and Pneumocystis pneumonia (£10m investment); pivotal contributions to the preclinical development (£35m investment), clinical developments and registrations of 3 new antifungals with combined market share of ~$2 billion; one (voriconazole, 2012 sales >$750m worldwide) now first line therapy for invasive aspergillosis with improved survival of 15-20%; and internationally validated methods to detect azole resistance in Aspergillus (an emerging problem partly related to environmental spraying of azole fungicides for crop protection).
15m people have a stroke each year worldwide. In England alone, stroke generates direct care costs of £3bn and a wider economic burden of £8bn. Service users report high levels of unmet need in relation to cognitive dysfunction (e.g. concentration). Improving cognition was the number one priority agreed by users and providers (James Lind Alliance, Lancet Neurology 2012). Research led by the University of Manchester (UoM) underpins recommendations in several recent clinical guidelines for stroke management and rehabilitation in the UK and internationally. Our 2012 aphasia trial and qualitative study made key contributions to the recommendations in the recent NICE (2013) and Intercollegiate Stroke Working Party (2012) guidelines. UoM-led Cochrane reviews (e.g., neglect, apraxia, perception) have directly influenced recommendations in guidelines produced by the Scottish Intercollegiate Guidelines Network, the European Stroke Organization and the Australian National Stroke Foundation.
Research conducted at the University of Manchester (UoM) has shaped the design of national systems of accreditation for general practice in the UK, Europe and beyond. Accreditation systems set standards that reflect key aspects of the organisational systems and processes in general practice that are needed to ensure delivery of good quality care. Accreditation systems also provide a kite mark of quality assurance and act as a platform for supporting continuous quality improvement. UoM developed indicators of quality in general practice structure and organisation and demonstrated how they could be used effectively to improve quality. Working in partnership with health professional organisations, governmental organisations and other universities, UoM used knowledge from the research to develop systems for general practice accreditation now used in the UK and across Europe.
Newcastle research into practical methods to reduce alcohol-related risk and harm has underpinned national policy, including the Government's Alcohol Strategy and a National Audit Office report. This has shaped public health practice concerning alcohol across England. A UK-specific screening and brief intervention (SBI) programme was developed by Newcastle University for use by GPs and nurses in primary care. This programme, which was designed to reduce alcohol-related problems, has been widely recommended and adopted. An evidence review commissioned by the National Institute for Health and Care Excellence (NICE) found that the use of SBI reduces alcohol consumption, mortality, morbidity and alcohol-related injuries. Department of Health figures show that SBI provides an estimated annual healthcare saving of around £100 million.
The emergency care team at Warwick Medical School has a strong track record of high-quality health sciences research encompassing evidence synthesis, health-services research and clinical trials. Our trials of a 03b2-agonist (salbutamol) in acute respiratory distress syndrome (ARDS) have influenced therapeutic recommendations in the International Sepsis Guidelines (2013), reducing the use of this potentially detrimental therapy. Our cardiac arrest research informed the 2010 international guidelines on cardiopulmonary resuscitation (CPR) led to the generation of new intellectual property, and prompted industrial collaborations to build new technologies, such as TrueCPRTM (2013). These have led to improved CPR practice and improved patient survival. Furthermore, our research has led to major policy changes and to a redesign of UK emergency healthcare, improving cost efficiency, the patient experience and clinical outcomes (e.g. 95% of patients were treated within 4 hours - up from 65%; and people leaving without been seen reduced to less than 5%).