Involving the public in electronic health record research: Medication reviews and polypharmacy in primary care

What was your project about?   

Medication reviews in general practices are an important opportunity for people to discuss the medicines they are being prescribed. We wanted to find out how many people are having medication reviews, and whether these reviews have any impact on the number and types of medicines prescribed.

What did you do?

We studied two groups of people who often take several medicines: adults prescribed antidepressants, and adults aged 65 years and over. We used data from a research database called the Clinical Practice Research Datalink (CPRD). This contains anonymised electronic health records collected in general practices in the UK. We compared people who did and did not have a medication review in 2019. Then, for people who did have a review, we compared how many and which medicines a person was prescribed before and after the review.

What did you hope to achieve through your public involvement/engagement?

Projects using electronic health record databases sometimes have long periods where it is harder to involve patients and the public.  The data processing and analysis is complicated and often takes a long time.  We wanted to make sure that the public contributors still felt part of the project, and understood what we were doing and why.  We hoped the public contributors would gain a better understanding of database research, feel able to contribute their insights and have more confidence getting involved in future projects using large health record databases.

Who was involved and how they were involved across the project?

The original research question about medication reviews came from a discussion about taking more than one medicine with public contributors from a research involvement team with an interest in mental health.  We invited people from this group who were interested to get involved with the project, and three joined the team.  Two had experience of being prescribed multiple medicines and medication reviews, and all had experience of being prescribed mental health medicines.  They provided their thoughts and insights about the study design and aims, data preparation, and results, based on their own experiences of medication reviews and prescribing practices in primary care.

All of the public contributors were co-authors on a published journal article.  We also produced a short animated video describing the PPI contributors’ experiences working on the project.  Each contributor wrote text that was used in the script and two recorded their own voiceovers.

What impact did the Public Involvement and/or Engagement have on your project, those involved, and on yourself/research team?

Public involvement led to the research question for the study, and helped us interpret the study findings and their practical implications. Understanding the importance of the research question to the people it affects is one of the biggest benefits of public involvement.  Hearing about our public contributors’ lived experiences was incredibly helpful and reminds us why we are doing this research.

What advice about public involvement and/or engagement you would share with colleagues that you have learnt from carrying out this project

Although database research doesn’t have some of the opportunities for public involvement that other research methods do, such as designing patient information sheets, recruiting participants or interviewing people, there is still a real value from having public contributors involved.  By having regular PPIE-specific meetings, in addition to whole team meetings, we could explain the different parts of the analysis we were doing, ensure we were answering the questions asked, and increase the knowledge and confidence of the public contributors so that hopefully they, and others, will feel more able to join other similar projects.  It’s an important part of any research, and we would encourage everyone to make sure there’s good communication within the whole project team.

What you plan to do next?

Our research group is running more database studies, and we’re continuing to involve our public contributors wherever possible, including giving presentations about the work.  We really want people to see the opportunities and possibilities that meaningful PPIE can have in all research.

Acknowledgements & Further information:

This blog post was written by Ruth Jack (Senior Research Fellow, University of Nottingham) as part of our ‘PPIE in Practice’ Series.

To find out more about this project please contact Ruth via ruth.jack@nottingham.ac.uk

The project ‘medication reviews and polypharmacy in primary care’ was funded by the NIHR SPCR Grant 587.