Medication and self-harm in primary care patients: understanding incidence, GP prescribing patterns, and risk of subsequent adverse outcome.

Professor Darren Ashcroft and Dr Roger Webb

The National Institute for Health Research (NIHR) Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC) invites applications for the following 3-year PhD studentship. The studentship would commence in April 2014, providing an annual tax-free stipend of £18,181, full coverage of tuition fees and conference/travel allowance. Applicants must be UK/EU nationals due to the nature of the funding.

The focus of the study is to use the a large electronic healthcare database to gain an understanding of the frequency of self-harm among UK primary care patients and examine short and longer-term adverse outcomes amongst these patients. The PhD research will undertake this investigation from a patient safety perspective, specifically by examining medication prescribed by GPs to patients who have harmed themselves, with a view to informing national evidence-based guidelines. Our ultimate intention is to lower the overall incidence of self-harm, and reduce the risks of self-harm repetition and premature death in these patients.

The latest NICE guidelines on longer-term management of self-harm (CG133) includes a specific section on primary care but contains only 3 recommendations, amounting to just 5% of the 57 recommendations in CG133. This low figure illustrates the lack of evidence for this topic. Updated and robust epidemiological evidence is now needed. The study will utilise the Clinical Practice Research Datalink (CPRD) - the largest routinely collected primary care dataset internationally.

The dataset includes clinical events (i.e. symptoms, diagnostic tests and confirmed diagnoses), referrals to secondary care and to specialist services, and lifestyle information (smoking and alcohol consumption).

The project will address the following questions:

1. What is the incidence of self-harm among U.K. primary care patients, and how do these rates differ by age, gender and area-level socioeconomic status?
2. What proportion of patients with history of self-harm was prescribed with a psychotropic drug, or another medication type, that is potentially harmful or lethal in overdose?
3. What are the determinants of adverse outcome in people who have harmed themselves: i.e. risks of self-harm repetition, and of natural vs. unnatural premature death?

We expect the project to achieve important impact in reducing risk of self-harm in high-risk patients treated in primary care with depression and psychological distress.

Training will be provided in relevant pharmacoepidemiological and statistical methods, and skills in using the CPRD, supporting progression into a variety of academic or clinical healthcare career positions in the NHS or pharmaceutical industry.

Candidates are expected to hold a minimum upper-second (or equivalent) undergraduate degree in a relevant area such as epidemiology, statistics or pharmacy. A Masters qualification in an associated area and/or relevant professional experience in pharmacy would be a distinct advantage.

Please direct applications in the following format to Professor Darren Ashcroft by clicking the 'Apply' button:                  

• Academic CV
• Official academic transcripts
• Contact details for two suitable referees
• A personal statement (750 words maximum) outlining your suitability for the study, what you hope to achieve from the PhD and your research experience to date.

Any enquiries relating to the project and/or suitability should be directed to Professor Ashcroft at the address above. Deadline for applications: Monday 18 November 2013.

http://www.pharmacy.manchester.ac.uk/staff/DarrenAshcroft

http://www.bbmh.manchester.ac.uk/staff/RogerWebb

http://www.population-health.manchester.ac.uk/primary-care-patient-safety/

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