Bruce Guthrie

• MB BChir MSc PhD
• Professor at University of Edinburgh

Social attributes of neighborhoods, like heritage, and low-level social disorder, are not reflected in official metrics such as deprivation indices. However, research suggests these attributes are important for understanding spatial variations in health and social outcomes. This exploratory study investigated whether recurring themes in local newsp...

Background Physical health checks in primary care for people with severe mental illness ((SMI) defined as schizophrenia, bipolar disorders and non-organic psychosis) aim to reduce health inequalities. Patients who decline or are deemed unsuitable for screening are removed from the denominator used to calculate incentivisation, termed exception repo...

Background: Most people with any long-term condition have multiple long-term conditions, but our understanding of how conditions cluster is limited. Many clustering studies identify clusters in the whole population, but the clusters that occur in people of different ages may be distinct. The aim of this paper was to explore similarities and differe...

Background Multimorbidity, the co-occurrence of two or more conditions within an individual, is a growing challenge for health and care delivery as well as for research. Combinations of physical and mental health conditions are highlighted as particularly important. Here, we investigated associations between physical multimorbidity and subsequent d...

Multiple Long-Term Conditions (MLTC) is a key global challenge for health and social care systems owing to its association with greater use of health services, adverse healthcare events and poorer health outcomes. Yet little is known about its contextual drivers and whether this varies by how MLTC is defined/measured. This poster showcases the infl...

Clustering multimorbidity has been a global research priority in recent years. Existing studies usually identify these clusters using one of several popular clustering methods and then explore various characteristics of these clusters, e.g., their genetic underpinning or their sociodemographic drivers, as downstream analysis. These studies make sev...

Background The Scottish Government introduced the first phase of a new General Practice (GP) contract in 2018, aiming to transform primary care and address health inequalities. However, the impact of these changes on patient satisfaction is unclear. Aim To assess temporal changes in overall patient satisfaction, and satisfaction with access and co...

Background Coronavirus disease-2019 was associated with significant mortality and morbidity in care homes in 2020–1. Repurposed antiviral drugs might reduce morbidity and mortality through reducing viral transmission, infection, replication and inflammation. We aimed to compare the safety and efficacy of potential antiviral drugs in care home resid...

Aims Delirium is common in hip fracture patients, but large-scale routine data studies examining the prevalence and associations of delirium at the time of initial presentation with a hip fracture are rare. This study aimed to describe the prevalence and outcomes of delirium on initial presentation with a hip fracture in a large national population...

BACKGROUND Assistive technologies (AT) are used increasingly in community settings for the management of older adults’ health and care. Despite a rapid increase in the capabilities and uptake of these technologies, gaps remain in understanding main barriers to their usage. OBJECTIVE This systematic review investigated the barriers and facilitators...

As the prevalence of multimorbidity grows, provision of effective healthcare is more challenging. Both multimorbidity and complexity in healthcare delivery may be associated with worse outcomes. We studied consecutive, unique emergency non-surgical hospitalisations for patients over 50 years old to three hospitals in Scotland, UK between 2016 and 2...

Background Atrial fibrillation (AF) prevalence is rising due to population ageing and comorbidity is an increasing problem. The aim of this study was to examine the prevalence and association of coexisting health conditions among adults with AF in the general population. Methods Cross-sectional analysis of Clinical Practice Research Datalink (CPRD...

The ability to manage ill health and care needs might be affected by who a person lives with. This study examined how the risk of unplanned hospitalisation and transition to living in a care home varied according to household size and co-resident multimorbidity. Here we show results from a cohort study using Welsh nationwide linked healthcare and c...

Background Depression is associated with a range of adverse physical health outcomes. We aimed to quantify the association between depression and the subsequent rate of accrual of long-term physical health conditions in middle and older age. Methods and findings We included 172,556 participants from the UK Biobank (UKB) cohort study, aged 40–71 ye...

Studies of how multiple long-term conditions (MLTC) cluster together in individuals vary in the populations studied, and whether they age and/or sex stratify, which limits comparison between studies and reproducibility. This study uses a large, UK primary-care dataset to examine how pairwise strength of association between 74 conditions varies by a...

Introduction Recording dementia diagnoses is essential to ensure appropriate post-diagnostic support and care. We examined the prevalence of recorded dementia in different routine datasets and associations with emergency hospitalisation and mortality. Methods This retrospective longitudinal cohort study included all adults ≥65 years registered wit...

Purpose: Frailty, a state of increased vulnerability to adverse health outcomes, impacts individuals and healthcare systems. The cumulative deficit model provides a flexible frailty measure but its application across diverse data remains underexplored. This study compares frailty indices derived from survey and routine data. Methods: Frailty indice...

Background Trials conducted in highly selected populations have shown that type 2 diabetes (T2D) remission is possible, but the feasibility and acceptability of supporting remission in routine clinical practice remain uncertain. Aim We explored primary care professionals' perceptions and understandings of T2D remission and their views about suppor...

Background Depression is associated with multiple physical health conditions, and inflammation is a mechanism commonly proposed to explain this association. We aimed to investigate the association between depression and the incidence of physical health conditions thought to have an inflammatory etiological component, including coronary heart diseas...

Background: The number of adults with multiple long-term conditions (MLTC) who experience frequent care transitions is rising. Improving care transitions for adults MLTC is important because transitions between and within care settings commonly lead to preventable adverse events. We explored multidisciplinary professional perspectives and experienc...

Background People with severe mental illness (SMI) are at increased risk of cardiovascular disease (CVD), and initiatives for CVD risk factor screening in the UK have not reduced disparities. Objectives To describe the annual screening prevalence for CVD risk factors in people with SMI from April 2000 to March 2018, and to identify factors associa...

Background There is wide variation in antibiotic prescribing across care-homes for older people, with implications for resident outcomes and antimicrobial resistance. Objective To quantify variation in antibiotic prescribing and associations with resident, care-home and general practice characteristics. Design Population-based analyses using admi...

Background The 2018 Scottish GP contract established GP clusters and multidisciplinary team (MDT) expansion. Qualitative studies have suggested suboptimal progress with these initiatives. Aim To quantify progress since the introduction of the new contract. Design and setting A cross-sectional postal survey of all qualified GPs was undertaken in S...

Benzodiazepines and z-drugs are often prescribed to critical care survivors due to high prevalence of mental health problems and insomnia. However, their safety has not been studied in this population. Retrospective cohort study of 28,678 adult critical care survivors hospitalised in 2010 and 2018: 4844 prescribed benzodiazepines or z-drugs, matche...

Background Blood pressure (BP) control following stroke is important but currently sub-optimal. This trial aimed to determine whether self-monitoring of hypertension with telemonitoring and a treatment escalation protocol, results in lower BP than usual care in people with previous stroke or transient ischaemic attack (TIA). Methods Unblinded rand...

Background Detecting Adverse Drug Events (ADEs) is an emerging research area, attracting great interest in the research community. Better anticipatory management of predisposing factors has considerable potential to improve outcomes. Automatic extraction of ADEs using Natural Language Processing (NLP) has a great potential to significantly facilita...

The co-occurrence of multiple long-term conditions (MLTC), or multimorbidity, in an individual can reduce their lifespan and severely impact their quality of life. Exploring the longitudinal patterns, e.g. clusters, of disease accrual can help better understand the genetic and environmental drivers of multimorbidity, and potentially identify indivi...

Background Care home residents are a highly vulnerable group, but identifying care home residents in routine data is challenging. This study aimed to develop and validate Natural Language Processing (NLP) methods to identify care home residents from primary care address records. Methods The proposed system applies an NLP sequential filtering and p...

Background Hip fracture is common in older people and has significant health and care implications. This study aimed to examine the impact of household characteristics (living alone or living with someone who is themselves ill) on adverse outcomes following hip fracture. Methods A cohort study of hip fracture patients aged ≥ 50 years living alone...

Purpose Survivors of critical illness are often affected by new or worsened mental health conditions and sleep disorders. We examined the incidence, practice variation and factors associated with new benzodiazepine and z‐drug community prescriptions among critical illness survivors. Methods A retrospective cohort study using the UK Clinical Practi...

Background Antibiotic resistance is a public health priority and antibiotic use in humans is a major contributing factor to its development. Interventions to improve antibiotic prescribing in the community, where most antibiotics are prescribed, are widely implemented with varying effect. The aim was to systematically review and meta-analyse eviden...

Background As the prevalence of multimorbidity grows, provision of effective healthcare is more challenging. Both multimorbidity and complexity in delivery of healthcare may be associated with worse outcomes. Methods We studied consecutive, unique emergency non-surgical hospitalisations for patients over 50 years old to three hospitals in Scotland,...

Background Multimorbidity has become a global public health challenge. Increasing work has identified different individual- and household-level determinants of multimorbidity; however, our understanding of how characteristics of place affect multimorbidity remains limited. This scoping review aims to identify the place-based risk factors of multimo...

Background: People with severe mental illness (SMI) are at increased risk of cardiovascular disease (CVD), and initiatives for CVD risk factor screening in the UK have not reduced disparities. Objectives: To describe the annual screening prevalence for CVD risk factors in people with SMI from April 2000 to March 2018, and to identify factors associ...

Existing models for the safe, timely and effective delivery of health and social care are challenged by an ageing population. Services and care pathways are often optimised for single-disease management, while many older people are presenting with multiple long-term conditions and frailty. Systems engineering describes a holistic, interdisciplinary...

Background Antidepressants have a pivotal role in the treatment of many psychiatric disorders, but there are concerns about long-term use and adverse effects. The objectives of this study were (1) to examine time trends in antidepressant use, (2) to estimate the prevalence of long-term and potential high-risk antidepressant use, and (3) to examine...

The adverse effects of Multiple Long-Term Conditions (MLTCs) are well known, including reductions in quality of life, increased healthcare costs, and excess mortality. This underscores the importance of researching MLTCs and understanding their hotspots. In addition to informing the location of public interventions, hotspots can provide clues to po...

Objectives To describe the effect of multimorbidity on adverse patient centred outcomes in people attending emergency department. Design Population based cohort study. Setting Emergency departments in NHS Lothian in Scotland, from 1 January 2012 to 31 December 2019. Participants Adults (≥18 years) attending emergency departments. Data sources L...

This briefing paper reports on the findings from a stakeholder engagementworkshop undertaken in collaboration with the Digital Health & Care Innovation Centre (DHI). This work is part of the Systems Engineering and Thinking to Transform Transitions (SET4) of Health and Social Care study. The stakeholder engagement workshop included a diverse group...

Background Detecting Adverse Drug Events (ADEs) is an emerging research area, attracting great interest in the research community. Better anticipatory management of predisposing factors has considerable potential to improve outcomes. Automatic extraction of ADEs using Natural Language Processing (NLP) has a great potential to significantly facilita...

Objectives To quantify prevalence, harms, and NHS costs in England of problematic oral non-steroidal anti-inflammatory drug (NSAID) prescribing in high risk groups. Design Population based cohort and economic modelling study. Setting Economic models estimating patient harm associated with NSAID specific hazardous prescribing events, and cost to t...

Background Frailty, a state of increased vulnerability to adverse health outcomes, has garnered significant attention in research and clinical practice. Existing constructs aggregate clinical features or health deficits into a single score. While simple and interpretable, this approach may overlook the complexity of frailty and not capture the full...

Background Innovation for reforming health and social care is high on the policy agenda in the United Kingdom in response to the growing needs of an ageing population. However, information about new innovations of care being implemented is sparse. Methods We mapped innovations for people in later life in two regions, North East England and South E...

Background Multimorbidity, the co-occurrence of two or more conditions within an individual, is a growing challenge for health and care delivery as well as for research. Combinations of physical and mental health conditions are highlighted as particularly important. The aim of this study was to investigate associations between physical multimorbidi...

Background There has been significant investment in pharmacists working in UK general practice to improve the effective and safe use of medicines. However, evidence of how to optimise collaboration between GPs and pharmacists in the context of polypharmacy (multiple medication) is lacking. Aim To explore GP and pharmacist views and experiences of...

This study introduces a novel knowledge enhanced tokenisation mechanism, K-Tokeniser, for clinical text processing. Technically, at initialisation stage, K-Tokeniser populates global representations of tokens based on semantic types of domain concepts (such as drugs or diseases) from either a domain ontology like Unified Medical Language System or...

Introduction Predicting risk of care home admission could identify older adults for early intervention to support independent living but require external validation in a different dataset before clinical use. We systematically reviewed external validations of care home admission risk prediction models in older adults. Methods We searched Medline,...

Objectives To assess whether age, sex, comorbidity count, and race and ethnic group are associated with the likelihood of trial participants not being enrolled in a trial for any reason (ie, screen failure). Design Bayesian meta-analysis of individual participant level data. Setting Industry funded phase 3/4 trials of chronic medical conditions....

Background Expanding primary care multi-disciplinary teams (MDTs) was a key component of the 2018 Scottish GP contract, with over 4,700 MDT staff appointed since then. Aim To explore patients’ views on primary care MDT expansion in Scotland. Design and methods (1) Survey of patients recently consulting a GP in deprived-urban, affluent-urban and r...

Objective: To investigate risks of multiple adverse outcomes associated with use of antipsychotics in people with dementia. Design: Population based matched cohort study. Setting: Linked primary care, hospital and mortality data from Clinical Practice Research Datalink (CPRD), England. Population: Adults (≥50 years) with a diagnosis of demen...

Background Robustly examining associations between long-term conditions may be important in identifying opportunities for intervention in multimorbidity but is challenging when evidence is limited. We have developed a Bayesian inference framework that is robust to sparse data and used it to quantify morbidity associations in the oldest old, a popul...

Background Frailty is characterised by a reduced resilience to adversity. In this analysis we examined changes in frailty in people aged 50+ before and during a period of austere public spending in England. Methods Data from the English Longitudinal Study of Ageing 2002–2018 were analysed. Associations between austerity and frailty were examined u...

Background The impact of the COVID-19 pandemic on long-term care residents remains of wide interest, but most analyses focus on the initial wave of infections. Objective To examine change over time in: (i) The size, duration, classification and pattern of care-home outbreaks of COVID-19 and associated mortality and (ii) characteristics associated...

Background Clinical guidelines commonly recommend preventative treatments for people above a risk threshold. Therefore, decision-makers must have faith in risk prediction tools and model-based cost-effectiveness analyses for people at different levels of risk. Two problems that arise are inadequate handling of competing risks of death and failing t...

Background: The new Scottish GP contract commenced in April 2018 with a stated aim of mitigating health inequalities. Aim: To determine the health characteristics and experiences of patients consulting GPs in deprived urban (DU), affluent urban (AU), and remote and rural (RR) areas of Scotland. Design and setting: In 2022, a postal survey of a ra...

This paper captures trajectories of income in later-life and considers how membership of particular income trajectories is patterned by social class, sex and precarity in housing, pensions relationships, care and retirement. Using the English Longitudinal Study of Ageing (2002-19) for over-50s, latent class analysis identifies 10 income trajectory...

Background Multiple short delirium detection tools have been validated in research studies and implemented in routine care, but there has been little study of these tools in real‐world conditions. This systematic review synthesized literature reporting completion rates and/or delirium positive score rates of detection tools in large clinical popula...

Video-Reflexive Ethnography (VRE) is an innovative and participatory research and improvement methodology that involves videoing in-situ work practices and collaboratively analysing this footage with participants during reflexive sessions. This involves participants ‘slowing down’, engaging reflexively with their everyday working practices, and tak...

Background Many people survive critical illness with the burden of new or worsened mental health issues and sleep disturbances. We examined the frequency of psychotropic prescribing after critical illness, comparing critical care to non-critical care hospitalised survivors, and whether this varied in important subgroups. Methods This retrospective...

Background The new Scottish GP contract introduced in April 2018 aims to improve quality of care through expansion of the multidisciplinary team (MDT) to enable GPs to spend more time as expert medical generalists with patients with complex needs. Aim To explore patients’ views on the changes in general practice in Scotland since the inception of...

Purpose Evaluating interventions for cardiovascular disease (CVD) requires estimates of its effect on utility. We aimed to 1) systematically review utility estimates for CVDs published since 2013 and 2) critically appraise UK-relevant estimates and calculate corresponding baseline utility multipliers. Methods We searched MEDLINE and Embase (April...

Background: The Scottish Government's vision to transform primary care includes expansion of the primary care multidisciplinary team (MDT), formalised in the new GP contract in April 2018. Aim: To explore practitioners' views on the expansion of MDT working in Scotland. Design and setting: Qualitative study with GPs and a range of MDT staff worki...

Background Multiple long-term conditions (MLTC), also known as multimorbidity, has been identified as a priority research topic globally. Research priorities from the perspectives of patients and research funders have been described. Although most care for MLTC is delivered in primary care, the priorities of academic primary care have not been iden...

Background Detecting Adverse Drug Events (ADEs) is an emerging research area, attracting great interest in the research community. Better anticipatory management of predisposing factors has considerable potential to improve outcomes. Automatic extraction of ADEs using Natural Language Processing (NLP) has a great potential to significantly facilita...

Objectives The aim of this study was to understand how patients experienced hypertension management, with or without blood pressure (BP) telemonitoring, during the COVID-19 pandemic. Design, methods, participants and setting This qualitative study conducted between April and November 2022 consisted of 43 semistructured telephone interviews (23 men...

There is still limited understanding of how chronic conditions co-occur in patients with multimorbidity and what are the consequences for patients and the health care system. Most reported clusters of conditions have not considered the demographic characteristics of these patients during the clustering process. The study used data for all registere...

Introduction Linking free-text addresses to unique identifiers in a structural address database [the Ordnance Survey unique property reference number (UPRN) in the United Kingdom (UK)] is a necessary step for downstream geospatial analysis in many digital health systems, e.g., for identification of care home residents, understanding housing transit...

Background People with comorbidities are under-represented in randomised controlled trials, and it is unknown whether patterns of comorbidity are similar in trials and the community. Methods Individual-level participant data were obtained for 83 clinical trials (54,688 participants) for 16 index conditions from two trial repositories: Yale Univers...

Holistic assessment-based interventions (HABIs) are effective in older people admitted to hospital, but it is unclear whether similar interventions are effective in adults with multiple long-term conditions or frailty in the community. We conducted an umbrella review to comprehensively evaluate the literature on HABIs for adults (aged ≥18 years) wi...

Background Multimorbidity is one of the greatest challenges facing health and social care systems globally. It is associated with high rates of health service use, adverse healthcare events, and premature death. Despite its importance, little is known about the effects of contextual determinants such as household and area characteristics on health...

Background Direct treatment disutility (DTD) represents an individual’s disutility associated with the inconvenience of taking medicine over a long period of time. Objectives The main aim of this study was to elicit DTD values for taking a statin or a bisphosphonate for primary prevention. A secondary aim was to understand factors which influence...

BACKGROUND Clinical guideline development preferentially relies on evidence from randomised controlled trials (RCTs). RCTs are the gold-standard method to evaluate the efficacy of treatments with the highest internal validity but limited external validity, in the sense that their findings may not always be applicable to, or generalisable to clinica...

Background Clinical guideline development preferentially relies on evidence from randomized controlled trials (RCTs). RCTs are gold-standard methods to evaluate the efficacy of treatments with the highest internal validity but limited external validity, in the sense that their findings may not always be applicable to or generalizable to clinical po...

Purpose To address the care needs of older adults, it is important to identify and understand the forms of care support older adults received. This systematic review aims to examine the social networks of older adults receiving informal or formal care and the factors that influenced their networks. Methods A systematic review was conducted by sear...

Background Depression is associated with a range of adverse health outcomes, including reduced life expectancy and increased incidence of physical health conditions. The aim of this study was to quantify the association between depression and the subsequent accrual of 69 long term physical health conditions in middle age. Methods We used data from...

Background Multimorbidity, the co-existence of two or more long-term health conditions, is a public health concern due to its association with adverse health outcomes. Recent research has shown that people with multimorbidity including depression have particularly high service use and premature mortality. However, since existing research is largely...

Background Many countries have introduced reforms with the aim of primary care transformation (PCT). Common objectives include meeting service delivery challenges associated with ageing populations and health inequalities. To date, there has been little research comparing PCT internationally. Our aim was to examine PCT and new models of primary car...

Background: Measurement of multimorbidity in research is variable, including the choice of the data source used to ascertain conditions. We compared the estimated prevalence of multimorbidity and associations with mortality using different data sources. Methods: A cross-sectional study of SAIL Databank data including 2,340,027 individuals of all...

Background Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortality...

Background: Understanding and quantifying the differences in disease development in different socioeconomic groups of people across the lifespan is important for planning healthcare and preventive services. The study aimed to measure chronic disease accrual, and examine the differences in time to individual morbidities, multimorbidity, and mortali...