NON-COMMUNICABLE DISEASE, MULTI-MORBIDITY, AND AGEING
Managing long-term illness is an important and increasingly costly element of health care, accounting for a high proportion of the work in primary care. The GP QOF contract reflects this activity, with the majority of clinical indicators relating to monitoring and management of long-term conditions. Despite recent improvements in quality of care, there are major unanswered questions about how long-term conditions should be monitored and managed, and some of these questions have substantial cost implications for the NHS. The SPCR has developed or tested potential technologies covering better monitoring and management in primary care to improve the quality of care which patients receive, such as BNP guided treatment in heart failure. A potential example for study is the safety and effectiveness of long-term drug therapy for control of symptoms such as chronic pain, a growing challenge to primary care which draws together research interests across the School.
The monitoring and management of long-term conditions have generally been neglected areas of applied research. There is considerable scope for improved practice and the development of specific clinical tools. While poor monitoring may be an expensive waste, good monitoring can improve patient outcomes. For example, effective self-monitoring of warfarin is associated in trials with a reduction in mortality of one third with no increase in haemorrhage rates. Self-management and support for self-management is a critical technology to investigate across a range of chronic diseases and the principles of psychosocial support in the management of chronic disease similarly crosses disease boundaries. There are major opportunities to develop methods to monitor management of chronic disease using GP morbidity and prescription databases, building on expertise and data resources across old and new School member departments. The SPCR will continue to invest in research into patient self-management options.