P0342 - Optimising Structured Medication Reviews for older people
Optimising Structured Medication Reviews for older people with severe frailty and care home residents to reduce overprescribing and associated inequalities.
Principal Investigator: Prof. Andrew Clegg, Leeds Institute of Health Sciences
About the study
Background: To try and reduce the prescribing of unnecessary medications, the NHS in England has introduced routine medication reviews for older people with severe frailty, care home residents and adults across all age groups prescribed high-risk medications. However, there are concerns that some people may not be getting these reviews, for example people from ethnic minority groups or people living in deprived areas. This can cause unfair differences in health outcomes-termed ‘health inequalities’.
Aim: To improve the access to medication reviews to ensure they meet the diverse need of people with severe frailty living in the community, care home residents and adults prescribed high-risk medications across different ethnic groups and in more deprived areas of England.
Methods: We will use anonymous data from the Clinical Practice Research Datalink (CPRD) and Connected Bradford. We will analyse the data to predict which people might be at risk of medication-related side effects. We will also find out if there are differences in how medication reviews are being provided for older people with severe frailty, care home residents and people prescribed high-risk medications e.g. opioid medications, sedatives, long-term steroids. We will also find out if there are differences in: the number of medicines that have been stopped, the dose of medications and the incidence of adverse outcomes (e.g. hospitalisations) for different ethnic groups and for people living in deprived areas following the introduction of medication reviews. For people on long-term steroids, we will identify those at high risk of adverse outcomes such as fractures and infections.
Privacy Notice
Where do we obtain data from?
This study uses anonymised data from the Clinical Practice Research Datalink (CPRD), Hospital Episode Statistics (HES) and Office for National Statistics (ONS). The CPRD contains details of offer and uptake of structured medication reviews, diagnoses, prescriptions and tests performed in primary care, collected from patient record systems in a large sample of GP practices. The HES data contains details of the diagnoses and treatments a patient receives during a hospital admission in England. The ONS provides data about the level of socioeconomic deprivation based on the postcode of where person lives. For patients that have died, the ONS also provide information about their date and cause(s) of death, based on death registration data.
We will also use a local anonymised data set called Connected Bradford, which links primary care data to secondary care data. This database contains similar data to that described above but will also contain more detailed information on the dose of medications following a structured medication review.
Data from these sources is linked, minimised and securely anonymised by CPRD, prior to being provided to researchers at the University of Leeds. More information about the data sources and linkage methods is available on the CPRD website (https://www.cprd.com/) and the Connected Bradford website (https://bradfordresearch.nhs.uk/connected-bradford/).
What data do we hold?
The data does not contain patients’ names, addresses, phone numbers, or NHS numbers. It contains the admissions, diagnoses, and treatments administered to individuals, along with information about their date of death, use of homecare services, and admission to a nursing home.
These data do include a unique identifier which, if combined with data held by the various data controllers, would allow identification of an individual and therefore these data are classed as ‘personal data’ under the General Data Protection Regulation (GDPR).
Who will process my personal information?
The data will only be accessed by university employees or those with university honorary contracts, and only used for the purpose of this project. Only summarised and aggregated data will be disseminated in the form of academic presentations, peer-reviewed journals and lay summaries. The data will not be used for commercial purposes, provided in record level form to any third party or used for any direct marketing. There will be no requirement or attempt to re-identify any individuals within the data.
There will be no transfers of the data to third countries or international organisations, and there will be no automated decision making or profiling in use with these data.
What is the purpose and legal basis of the processing?
Under the General Data Protection Regulation (GDPR), the University of Leeds has to identify a legal basis for processing personal data and, where appropriate, an additional legal basis for processing special category data.
As a publicly funded organisation, the University of Leeds processes personal data to undertake scientific research which is in the public interest (further details here: https://dataprotection.leeds.ac.uk/wp-content/uploads/sites/48/2019/02/Research-Privacy-Notice.pdf). The legal basis for processing data is under Article 6 (1) (e) of the GDPR: Processing is necessary for the performance of a task carried out in the public interest. Special category data is processed under Article 9 (2) (j): Processing is necessary for archiving purposes in the public interest, or scientific and historical research purposes or statistical purposes.
How will you keep my data secure?
The data controllers for this study are CPRD and Connected Bradford. For CPRD, the University has in place appropriate technical and organisational measures to protect your personal data and/or special category data. Connected Bradford offer only remote access to their datasets, and have appropriate security measures in place.
Information will be treated confidentially. The University is committed to the principle of data protection by design and default and uses the minimum amount of data necessary for the project.
How can I access my personal information?
Various rights under data protection legislation, including the right to access personal information that is held about you, are qualified or do not apply when personal information is processed solely in a research or archival contact. This is because fulfilling them might adversely affect the integrity of, and the public benefits arising from, the research study or project.
The full list of (qualified or inapplicable) rights is: the right to access the personal information that is held about you by the University, the right to ask us to correct any inaccurate personal information we hold about you, to delete personal information, or otherwise restrict our processing, or to object to processing (including the receipt of direct marketing) or to receive an electronic copy of the personal information you provided to us.
If you have any questions regarding your rights in this context, please use the contact details below. Please note as we do not hold names or addresses for this study we cannot remove participants from this study, correct any information we hold about you or provide you with an electronic copy of the personal information we hold about you.
How long is my information kept?
The datasets are kept for the length of the project, and are then archived for 3 years to ensure all work is complete and any corrections can be handled. After this, the data is securely and permanently deleted.
Who can I contact?
If you have any questions about this research study, please contact the principal investigator Prof. Andrew Clegg at A.P.Clegg@leeds.ac.uk
If you have any general questions about how your personal information is used by the University, or wish to exercise any of your rights, please consult the University’s data protection webpages. If you need further assistance, please contact the University’s Data Protection Officer (Rebecca Messenger-Clark dpo@leeds.ac.uk).
Our general postal address is University of Leeds, Leeds LS2 9JT, UK.
Our postal address for data protection issues is University of Leeds Secretariat, Room 11.72 EC Stoner Building, Leeds, LS2 9JT. Our telephone number is +44 (0)113 34 37641.
Our data controller registration number provided by the Information Commissioner’s Office is Z553814X.
How can I complain?
If you wish to raise a complaint on how we have handled your personal data, you can contact our Data Protection Officer who will investigate the matter. If you are not satisfied with our response or believe we are processing your personal data in a way that is not lawful you can complain to the Information Commissioner’s Office (ICO).