I am Professor of Primary Care Medicine at the University of Dundee Medical School where I carry out applied research to translate basic and clinical research into effective and reliable clinical practice. I am additionally an Honorary Consultant in NHS Fife and a General Practitioner in Cardenden in Fife. I was previously a Medical Research Council Health Services Research Fellow at University of Edinburgh, an National Institute for Health Research post-doctoral research fellow at University of Dundee, and a 2006/7 Commonwealth Fund Harkness Fellow in Healthcare Policy at University of California San Francisco where I was also a Visiting Professor in 2010. I regularly review for various grant-making bodies and journals, contribute to undergraduate and postgraduate medical teaching, and supervise and examine MSc and PhD students in Dundee and other universities. As well as conducting research, I serve or have served on a number of National Health Service advisory bodies, including the National Institute for Health and Clinical Excellence (NICE) Quality and Outcomes Framework Indicators Advisory Committee (which recommended which quality indicators should be included in the UK primary care pay for performance programme) where I chaired the Thresholds, Review and Retiral Sub-committee, and the Scottish Government Polypharmacy Working Group. I was the chair of the guideline development group of the NICE Multimorbidity Clinical Guideline published in late 2016.
My main research interests are the quality and safety of healthcare, particularly in primary care and currently focused on prescribing quality and safety, multimorbidity the organisation of healthcare. I am a mixed methods researcher and collaborate with researchers from a wide range of disciplines and institutions. The methods I use include quantitative analysis of large, routine datasets; cluster randomised trials with mixed methods parallel process evaluations; and qualitative analysis of interview and observational data. My recent and current work includes development and evaluation of interventions to improve polypharmacy, examination of the implications of competing mortality risk for single disease risk prediction, and examination of the applicability of trial evidence to clinical populations.
'Quality of Care in the United Kingdom after Removal of Financial Incentives' New England Journal of Medicine, vol. 379, no. 10, pp. 948-957.
'Understanding usual care for patients with multimorbidity: baseline data from a cluster-randomised trial of the 3D intervention in primary care' BMJ Open, vol. 8, no. 8, e019845.
'Identifying care-home residents in routine healthcare datasets: a diagnostic test accuracy study of five methods' Age and Ageing.
'Balancing measures or a balanced accounting of improvement impact: a qualitative analysis of individual and focus group interviews with improvement experts in Scotland' BMJ Quality & Safety, vol. 27, no. 7, pp. 547-556.
'A computer template to enhance patient-centredness in multimorbidity reviews: a qualitative evaluation in primary care' British Journal of General Practice, vol. 68, no. 672, pp. e495-e504.
'Management of multimorbidity using a patient-centred care model: a pragmatic cluster-randomised trial of the 3D approach' Lancet, vol. 392, no. 10141, pp. 41-50.
'The Research Data Management Platform (RDMP): A novel, process driven, open-source tool for the management of longitudinal cohorts of clinical data' Giga Science, vol. 7, no. 7, giy060.
'Identifying who lives in a care home-a challenge to be conquered' Age and Ageing, vol. 47, no. 3, pp. 322-323.
'Between demarcation and discretion: the medical-administrative boundary as a locus of safety in high-volume organisational routines' Social Science and Medicine, vol. 203, pp. 43-50.
'Efficiency and thoroughness trade-offs in high-volume organisational routines: an ethnographic study of prescribing safety in primary care' BMJ Quality & Safety, vol. 27, no. 3, pp. 199-206.
'Divided we fall: The commodification of primary medical care' BMJ, vol. 360, pp. 1-2.
'Chronic morbidity, deprivation and primary medical care spending in England in 2015-16: a cross-sectional spatial analysis' BMC Medicine, vol. 16, 19, pp. 1-13.
'Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: Quantitative examination of variation between practices in recruitment, implementation and effectiveness' BMJ Open, vol. 8, no. 1, e017133, pp. 1-12.
'A framework for ensuring a balanced accounting of the impact of antimicrobial stewardship interventions' Journal of Antimicrobial Chemotherapy, vol. 72, no. 12, pp. 3223-3231.
'The Foundations Framework for Developing and Reporting New Models of Care for Multimorbidity' Annals of Family Medicine, vol. 15, no. 6, pp. 570-577.
'Developing middle-ground research to support primary care transformation' British Journal of General Practice, vol. 67, no. 664, pp. 498-499.
'Hospital antimicrobial stewardship: the way forward' Lancet Infectious Diseases, vol. 17, no. 11, pp. 1119-1120.
'Has primary care antimicrobial use really been increasing? Comparison of changes in different prescribing measures for a complete geographic population 1995-2014' Journal of Antimicrobial Chemotherapy, vol. 72, no. 10, pp. 2921-2930.
'Using the Payoff Time in Decision-Analytic Models: A Case Study for Using Statins in Primary Prevention' Medical Decision Making, vol. 37, no. 7, pp. 735-746.
'Comorbidities in adults with asthma: population-based cross-sectional analysis of 1.4 million adults in Scotland' Clinical and Experimental Allergy, vol. 47, no. 10, pp. 1246-1252.
'Exploring the impact and use of patients' feedback about their care experiences in general practice settings-a realist synthesis' Family Practice, vol. 35, no. 1, pp. 13-21.
'Non-steroidal anti-inflammatory drug induced acute kidney injury in the community dwelling general population and people with chronic kidney disease: Systematic review and meta-analysis' BMC Nephrology, vol. 18, no. 1, 256.
'Epidemiology and outcomes of people with dementia, delirium and unspecified cognitive impairment in the general hospital: prospective cohort study of 10,014 admissions' BMC Medicine, vol. 15, 140, pp. 1-12.
'Co-morbidity and polypharmacy in Parkinson's Disease: insights from a large Scottish primary care database' BMC Neurology, vol. 17, no. 1, 126, pp. 1-8.
'Multimorbidity, dementia and health care in older people: a population-based cohort study' CMAJ Open , vol. 5, no. 3, pp. E623-E631.
'Evaluation of a complex intervention to improve primary care prescribing: a phase IV segmented regression interrupted time series analysis ' British Journal of General Practice, vol. 67, no. 658, pp. e352-e360.
'Comorbidity and polypharmacy in chronic heart failure: a large cross-sectional study in primary care' British Journal of General Practice, vol. 67, no. 658, pp. e314-e320.
'Chronic obstructive pulmonary disease and comorbidities: a large cross-sectional study in primary care' British Journal of General Practice, vol. 67, no. 658, pp. e321-e328.
'The role of informal dimensions of safety in high-volume organisational routines: an ethnographic study of test results handling in UK general practice' Implementation Science, vol. 12, no. 1, 56, pp. 1-12.
'Better guidelines for better care: accounting for multimorbidity in clinical guidelines – structured examination of exemplar guidelines and health economic modelling' Health Services and Delivery Research, vol. 5, no. 16, pp. 1-179.
'Process evaluation of the Data-driven Quality Improvement in Primary Care (DQIP) trial: case-study evaluation of adoption and maintenance of a complex intervention to reduce high-risk primary care prescribing' BMJ Open, vol. 7, no. 3, e015281, pp. 1-12.
'Off-label prescribing of antidepressants' BMJ, vol. 356, j849.
'Smoking cessation interventions for patients with coronary heart disease and comorbidities: an observational cross-sectional study in primary care' British Journal of General Practice, vol. 67, no. 655, pp. e118-e129.
'Physical and mental health comorbidities of epilepsy: population-based cross-sectional analysis of 1.5 million people in Scotland' Seizure, vol. 45, pp. 125-131.
'Respiratory effect of beta-blockers in people with asthma and cardiovascular disease: population-based nested case control study' BMC Medicine, vol. 15, 18.
'Comorbidity and polypharmacy in people with dementia: insights from a large, population-based cross-sectional analysis of primary care data' Age and Ageing, vol. 46, no. 1, pp. 33-39.
'Process evaluation of the data-driven quality improvement in primary care (DQIP) trial: active and less active ingredients of a multi-component complex intervention to reduce high-risk primary care prescribing' Implementation Science, vol. 12, 4, pp. 1-11.
'Clinical assessment and management of multimorbidity: summary of NICE guidance' BMJ, vol. 354, i4843.
'Associations between exemption and survival outcomes in the UK's primary care pay-for-performance programme: a retrospective cohort study' BMJ Quality & Safety, vol. 25, no. 9, pp. 657-670.
'The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation' Chronic Illness, vol. 12, no. 3, pp. 165-181.
'Data feedback and behavioural change intervention to improve primary care prescribing safety (EFIPPS): multicentre, three arm, cluster randomised controlled trial' BMJ, vol. 354, i4079, pp. 1-9.
'Respiratory effect of beta-blocker eye drops in asthma: population-based study and meta-analysis of clinical trials' British Journal of Clinical Pharmacology, vol. 82, no. 3, pp. 814-822.
'Quality and Outcomes Framework: what have we learnt?' BMJ, vol. 354, i4060, pp. 1-4.
'Accounting for multimorbidity in pay for performance: a modelling study using UK Quality and Outcomes Framework data' British Journal of General Practice, vol. 66, no. 649, pp. e561-e567.
'The care plus study - a whole system intervention to improve quality of life of primary care patients with multimorbidity in areas of high socioeconomic deprivation: exploratory cluster randomised controlled trial and cost-utility analysis' BMC Medicine, vol. 14, 88, pp. 1-10.
'Protocol for a process evaluation of a cluster randomised controlled trial to improve management of multimorbidity in general practice: the 3D study' BMJ Open, vol. 6, no. 5, e011260.
'Improving the management of multimorbidity in general practice: protocol of a cluster randomised controlled trial (The 3D Study)' BMJ Open, vol. 6, no. 4, e011261, pp. 1-11.
'Do Pills Have No Ills? Capturing the Impact of Direct Treatment Disutility' Pharmaco Economics, vol. 34, no. 4, pp. 333-336.
'How does sex influence multimorbidity? Secondary analysis of a large nationally representative dataset' International Journal of Environmental Research and Public Health, vol. 13, no. 4, 391.
'Safer Prescribing: A Trial of Education, Informatics, and Financial Incentives' New England Journal of Medicine, vol. 374, no. 11, pp. 1053-1064.
'Spatio-temporal elements of articulation work in the achievement of repeat prescribing safety in UK general practice' Sociology of Health & Illness, vol. 38, no. 2, pp. 306-324.
'Fair access to medicine? Retrospective analysis of UK medical schools application data 2009-2012 using three measures of socioeconomic status' BMC Medical Education, vol. 16, no. 1, 11.
'Psychoactive prescribing for older people-what difference does 15 years make?' International Journal of Geriatric Psychiatry, vol. 31, no. 1, pp. 49-57.
'General practice funding underpins the persistence of the inverse care law: cross-sectional study in Scotland' British Journal of General Practice, vol. 65, no. 641, pp. e799-e805.
'Bad apples or spoiled barrels? Multilevel modelling analysis of variation in high-risk prescribing in Scotland between general practitioners and between the practices they work in' BMJ Open, vol. 5, no. 11, e008270.
'Widening access to medicine may improve general practitioner recruitment in deprived and rural communities: survey of GP origins and current place of work' BMC Medical Education, vol. 15, 165.
'Comorbidity as a driver of adverse outcomes in people with chronic kidney disease' Kidney International, vol. 88, no. 4, pp. 859-866.
'Vascular comorbidities in younger people with dementia: a cross-sectional population-based study of 616 245 middle-aged people in Scotland' Journal of Neurology, Neurosurgery and Psychiatry, vol. 86, no. 9, pp. 959-964.
'Multiple physical and mental health comorbidity in adults with intellectual disabilities: population-based cross-sectional analysis' BMC Family Practice, vol. 16, 110.
'Combined use of nonsteroidal anti-inflammatory drugs with diuretics and/or renin-angiotensin system inhibitors in the community increases the risk of acute kidney injury' Kidney International, vol. 88, no. 2, pp. 396-403.
'Time series analysis of the impact of an intervention in Tayside, Scotland to reduce primary care broad-spectrum antimicrobial use' Journal of Antimicrobial Chemotherapy, vol. 70, no. 8, dkv095, pp. 2397-2404.
'NSAID exacerbated respiratory disease: a meta-analysis evaluating prevalence, mean provocative dose of aspirin and increased asthma morbidity' Allergy, vol. 70, no. 7, pp. 828-835.
'Methods for identifying 30 chronic conditions: application to administrative data' BMC Medical Informatics and Decision Making, vol. 15, no. 31, 31.
'The rising tide of polypharmacy and drug-drug interactions: population database analysis 1995-2010' BMC Medicine, vol. 13, 74.
'Drug-disease and drug-drug interactions: systematic examination of recommendations in 12 UK national clinical guidelines' BMJ, vol. 350, h949.
'Managing patients with multimorbidity in primary care' BMJ, vol. 350, h476.
'Changes in opioid and other analgesic use 1995-2010: repeated cross-sectional analysis of dispensed prescribing for a large geographical population in Scotland' European Journal of Pain, vol. 19, no. 1, pp. 59-66.
'Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams' Sociology of Health & Illness, vol. 37, no. 1, pp. 30-51.
'A multifaceted intervention to improve sepsis management in general hospital wards with evaluation using segmented regression of interrupted time series' BMJ Quality & Safety, vol. 23, no. 12, e2.
'Oral ketamine analgesia in chronic pain and problematic rise in blood pressure' BMJ Case Reports, vol. 2014, 207836.
'Quality in primary care: Individual doctors matter, and pay for performance may reduce hospital admissions' BMJ, vol. 349, g6485.
'Depression and multimorbidity: a cross-sectional study of 1,751,841 patients in primary care' Journal of Clinical Psychiatry, vol. 75, no. 11, pp. 1202-1208.
'Visual impairment is associated with physical and mental comorbidities in older adults: a cross-sectional study' BMC Medicine, vol. 12, 181.
'Effective Feedback to Improve Primary Care Prescribing Safety (EFIPPS) a pragmatic three-arm cluster randomised trial: designing the intervention (Clinical Trials.gov registration NCT01602705)' Implementation Science, vol. 9, 133.
'Stroke, multimorbidity and polypharmacy in a nationally representative sample of 1,424,378 patients in Scotland: implications for treatment burden' BMC Medicine, vol. 12, 151.
'Standard cardiovascular disease risk algorithms underestimate the risk of cardiovascular disease in schizophrenia: evidence from a national primary care database' Schizophrenia Research, vol. 159, no. 1, pp. 176-181.
'Use of oral anticoagulants in atrial fibrillation is highly variable and only weakly associated with estimated stroke risk: cross-sectional population database study' European Journal of General Practice, vol. 20, no. 3, pp. 181-189.
'The influence of socioeconomic deprivation on multimorbidity at different ages: a cross-sectional study' British Journal of General Practice, vol. 64, no. 624, pp. e440-e447.
'Temporal trends in anticholinergic medication prescription in older people: repeated cross-sectional analysis of population prescribing data' Age and Ageing, vol. 43, no. 4, pp. 515-521.
'Safety risks for patients with aspirin-exacerbated respiratory disease after acute exposure to selective nonsteroidal anti-inflammatory drugs and COX-2 inhibitors: meta-analysis of controlled clinical trials' Journal of Allergy and Clinical Immunology, vol. 134, no. 1, pp. 40-45.e10.
'Factors associated with statin treatment for the primary prevention of cardiovascular disease in people within 2 years following diagnosis of diabetes in Scotland, 2006-2008' Diabetic Medicine, vol. 31, no. 6, pp. 640-646.
'Identifying older heart failure patients with major depression in primary care: a feasibility study' International Journal of Geriatric Psychiatry, vol. 29, no. 5, pp. 547-549.
'Adverse respiratory effect of acute beta-blocker exposure in asthma: a systematic review and meta-analysis of randomized controlled trials' CHEST, vol. 145, no. 4, pp. 779-786.
'What happens when pay for performance stops? no evidence of serious harm so far, but future changes need evaluation' BMJ, vol. 348, g1413.
'Developing a complex intervention to improve prescribing safety in primary care: mixed methods feasibility and optimisation pilot study' BMJ Open, vol. 4, no. 1, e004153.
'Identifying which septic patients have increased mortality risk using severity scores: a cohort study' BMC Anesthesiology, vol. 14, no. 1, 1.
'Physical and mental health comorbidity is common in people with multiple sclerosis: nationally representative cross-sectional population database analysis' BMC Neurology, vol. 14, pp. 128.
'Multimorbidity in bipolar disorder and undertreatment of cardiovascular disease: a cross sectional study' BMC Medicine, vol. 11, 263.
'Differential impact of two risk communications on antipsychotic prescribing to people with dementia in Scotland: segmented regression time series analysis 2001-2011' PLo S ONE, vol. 8, no. 7, pp. e68976.
'Monitoring and adverse events in relation to ACE inhibitor/angiotensin receptor blocker initiation in people with diabetes in general practice: a population database study' Scottish Medical Journal, vol. 58, no. 2, pp. 69-76.
'Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study' BMJ Open, vol. 3, no. 4, e002808.
'Trimethoprim prescription and subsequent resistance in childhood urinary infection: multilevel modelling analysis' British Journal of General Practice, vol. 63, no. 609, pp. 238-43.
'The effect of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned admissions to hospital: a retrospective cohort study' CMAJ, vol. 185, no. 5, pp. E221-E228.
'Long-acting β-agonist prescribing in people with asthma in primary care' Thorax, vol. 68, no. 2, pp. 192-194.
'An observational study of psychotropic drug use and initiation in older patients resident in their own home or in care' Age and Ageing, vol. 42, no. 1, pp. 51-56.
'Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity' Age and Ageing, vol. 42, no. 1, pp. 62-69.
'Process evaluations for cluster-randomised trials of complex interventions: a proposed framework for design and reporting' Trials, vol. 14, 15.
'External validity of randomized controlled trials of glycaemic control and vascular disease: how representative are participants?' Diabetic Medicine, vol. 30, no. 3, pp. 300-308.
'Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study' BMJ Open, vol. 3, no. 4.
'Double trouble: the impact of multimorbidity and deprivation on preference-weighted health related quality of life a cross sectional analysis of the Scottish Health Survey' International Journal for Equity in Health, vol. 12, no. 1.