NIHR Newcastle Patient Safety Research Collaborative

Over 14 million people in England live with two or more long-term illnesses– experiencing what is called multiple long-term conditions (MLTCs). MLTCs become more frequent as we age and disproportionately affect the most disadvantaged in society. Managing and supporting patients with MLTCs is complicated because they need several treatments.

This can include numerous medicines as well as minor invasive and non-invasive procedures to support their treatment.

It is a sad fact, however, that unless care is taken, the complexity of treatment required by people with MLTCs can result in harm from: the impact of receiving multiple medicines at the same time for different conditions (something called polypharmacy) with side-effects, drug interactions and harmful impacts of a drug given for one condition on another. the real increased risk of adverse outcomes because of delays in accessing appropriate and timely care. failings in join-up within the system, with ineffective communication between the different care settings, which patients with MLTCs frequently rely on.

In each case, the impacts are greater in disadvantaged communities: MLTCs are more common; there is a tendency to use quick win therapies resulting in polypharmacy; the health and social care delivery systems are most stretched because of greatest demand with least investment and disadvantaged communities lack the voice to demand better.

This creates a vicious circle of increasing risk. Our vision is to break that circle. Our proposal will deliver real and meaningful changes in patient safety for those with MLTCs.

We propose four research themes, each led by two experts: Artificial intelligence and data science in MLTCs Safer management of polypharmacy in MLTCs Safer integrated health and social care environments Safer management of MLTCs in disadvantaged communities We will draw upon expertise and existing NIHR infrastructure within Newcastle University (NU), Newcastle upon Tyne Hospitals NHS Foundation Trust (NUTH) and our partners, to examine how polypharmacy can be safely managed and how we can identify patients most at risk with MLTCs, using artificial intelligence (AI) and data science.

We will evaluate how we reduce risk around patients moving between care environments and how newer approaches to online consultation and computerised diagnosis can potentially speed up access to appropriate care, but also be safely used and be accessible for all patients with MLTCs.

Throughout, we will design, implement and evaluate the effectiveness and value for money of solutions to help minimise or remove risks and build capacity and capability to continue this research using front line health professionals, through an innovative and extensive capacity building programme. Our work will be supported by a patient and public involvement, engagement and participation (PPIE) programme.

So far this has identified MLTCs and their complex interactions with, for example, polypharmacy as a key area requiring further research to enhance patient safety.

PPIE will be the bedrock of identifying problems and solutions, suggesting ways that these can work in daily life and identifying which solutions are acceptable to the patients that our healthcare systems serve, specifically including those from disadvantaged backgrounds.