The Primary Care Epidemiology Group includes clinicians, statisticians, epidemiologists, and patient representatives. The group undertakes large scale research into:
- The epidemiology of diseases (such as heart disease, stroke, diabetes, cancer, thrombosis, osteoporosis, mental health, motor neurone disease and dementia).
- Safety of commonly prescribed drugs (including antidepressants, antipsychotics, statins, anticoagulants, anticholinergics, NSAID pain killers, Cox-2 inhibitors, oral contraceptive pill, hormone replacement therapy, and drugs used in the treatment of type 2 diabetes).
- Group members are also involved with the development, validation and implementation of risk prediction tools in collaboration with ClinRisk Ltd and EMIS Health.
We make extensive use of a number of databases including QResearch. Set up in 2002 by Professor Julia Hippisley-Cox with EMIS Health (leading supplier of NHS Health Computer Systems), QResearch is the largest database of its kind worldwide, containing a wealth of longitudinal data from over 35 million people in over 1,500 UK practices using linked to secondary care data for hospital admissions, mortality and cancer registration.
Whilst clinical trials are undertaken during the development and testing phases for new and commonly used drugs, these trials tend to be in small numbers of selected participants for limited periods of time. Once a drug is licensed, it tends to be used in large numbers of unselected individuals over long periods of time. It is therefore important to have independent systematic research into the risk and benefits of new and commonly used drugs to identify and quantify both intended and unintended effects on patients. This is to help ensure that we can target the right medication towards the right patients. We use QResearch and other databases to undertake such studies which are of national and international importance.
Much of clinical practice involves assessing the probability that a patient either has a particular disease or may develop it at some point in the future and also what the risks and benefits of various treatments or interventions are. Doctors need better information to inform discussions with patients and decisions to investigate, refer and treat individuals. Both doctors and patients need better information to ensure patients are fully informed about the risks and benefits of clinical decisions, so they can give consent. New approaches to risk estimation were needed to take account of the characteristics of the population to which the tool should be applied and which can be updated over time as the population changes and national guidelines for prevention evolve.
A suite of innovative risk prediction models has been developed by the group using the QResearch database including:
- QRisk tool is a tool for predicting an individual’s 10-year risk of cardiovascular disease. In 2014, it replaced Framingham as the risk engine of choice in the NICE lipid modification guideline and is central to policy guidance such as NHS Health Checks.
- QStroke tool. QStroke predicts 10-year risk of ischaemic stroke to identify patients for whom stroke prevention measures (such as anticoagulation) are likely to be beneficial.
- QBleed tool. QBleed predicts the risk of upper gastrointestinal bleeding and intracranial bleeding with anticoagulation. It is designed to be used with QStroke to help patients weigh up the risks and benefits of anticoagulation.
- QCancer tool. This estimates the risk of a patient having an existing but as yet undiagnosed cancer based on the pattern of symptoms and risk factors for 12 different types of cancer. The research underpinning the QCancer tool was widely cited in the 2015 NICE guidance on referral for suspected cancer.
- QCancer-10 tool estimates the 10-year risk of developing cancer. The colorectal cancer tool had the best performance of any colorectal cancer risk assessment tool in an independent external validation by Cambridge University using the UK-Biobank cohort.
- QFracture tool predicts 10-year risk of fragility fracture of hip, spine, wrist and shoulder so that high risk patients can have interventions to lower this risk. It is recommended by SIGN in Scotland.