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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.
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.
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.
Research by the University of Southampton has contributed significantly to reducing the global threat of antibiotic resistance. A series of both conventional placebo-controlled and novel open design trials has influenced a number of important national clinical guidelines for Respiratory Tract Infections (RTIs) and the implementation of novel prescribing strategies that discourage unnecessary antibiotic prescription. As a direct result of the research, delayed prescribing for all acute respiratory infections is a tool in the everyday practice of the UK's GPs. Southampton's work in this field has informed international guidelines currently in place in the United States, Israel and the European Union.
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.
Research by Cardiff University is contributing to initiatives within the NHS and across Europe to safely reduce unnecessary antibiotic prescribing and thus help contain antimicrobial resistant bacteria. Our researchers conducted observational studies of prescribing patterns linked to local resistance data and qualitative research with GPs and patients on their perceptions of acute respiratory tract infections and antibiotic use and resistance. This enabled the Cardiff team to develop clinician training and patient education resources (covering issues such as communication skills, point of care testing, and typical duration of infections) to reduce unnecessary prescribing. Our trials proved these interventions were effective, at times cutting prescribing by as much as two-thirds. Our research has provided the basis for new clinical guidelines, antibiotic stewardship initiatives and policies, and educational tools for clinicians and patients that are being used in the UK and internationally.
Patient safety research from Manchester Pharmacy School at the University of Manchester (UoM) has reduced prescription errors in primary and secondary care. Pharmacists using our indicators with patients' electronic health records (aimed at preventing drug-related morbidity in general practices) reduced the odds of prescribing and monitoring problems by at least 22%. These indicators are now incorporated into `medicines optimisation' software for general practice computer systems. The EQUIP study led changes in the recommended design of hospital prescription charts, an annual national assessment of prescribing competence of medical students and the employment of extra hospital pharmacists to prevent the 9% of prescriptions with errors from harming patients.
Research conducted at the University of Aberdeen into the treatment of depressive disorder in primary care has directly led to the revision of health care policy by the Scottish Government Health Department. The work initiated debate over the validity of tools for the assessment of depression, contributing to revision of the Quality and Outcomes Framework (QOF), a system for the performance management and payment of GPs in the NHS in the UK. The findings are now being discussed in commentaries on the development of forthcoming disease classification systems for depression in the US (Diagnostic and Statistical Manual DSM-revision V) and Europe (International Classification of Disease — ICD revision 11).
Therefore the claimed impact is on: health and welfare; changes to public policy and on impact on practitioners and services.
This work has formed the basis for a new pharmacy service that has now been commissioned for nursing homes in N. Ireland. It has been recognised that prescribing of medications for older people in nursing homes has been inappropriate, with overuse of medicines that are not clinically indicated. In collaboration with colleagues in the USA, the development and implementation of the Fleetwood Model, a pharmacy intervention service, has led to a reduction in the inappropriate prescribing of psychoactive medications (anti-psychotics, hypnotics and anxiolytics) which can cause sedation and other side-effects, and was shown to be cost-effective.
Imperial College researchers have developed methods and indicators for highlighting potential variations in healthcare performance and safety using routinely collected health data. Analytical tools based on our methodological research are used by managers and clinicians in over two thirds of NHS hospital trusts, and hospitals throughout the world. The results of our analyses helped detect problems at Mid Staffordshire NHS Foundation Trust and triggered the initial investigation and subsequent public inquiry with wide ranging recommendations based on the recognition of their value and their use in enhancing the safety of healthcare.