Development and validation of novel data science tools for nationwide prescribing.

关键词：药物流行病学，药物暴露，药学数据库，电子处方摘要：行政卫生数据库越来越多地被用作药物流行病学研究的关键数据源，因为它们提供了在提供医疗保健过程中收集的大量数据。例如，使用药房记录提供了一个机会，可以回答与依从性、上市后药物反应、安全性和大量人群的处方模式有关的研究问题，而不必通过通过患者访谈等其他方法收集信息的昂贵和耗时的过程。已经进行了一些研究，通过显示药房记录、患者访谈、医疗记录和家庭药物清单之间高度一致，证实了药房记录作为确定患者可获得哪些药物的一种方法的有效性。在苏格兰，处方信息系统（PIS）对这类研究特别感兴趣，因为它包含了自1993年以来在全国社区环境中报销的16亿多张处方的信息，5.07亿份处方和3.44亿份自2009年以来分发的药物。此外，自2009年以来的记录与个别患者的社区健康指数（CHI）号码相关联，从而允许与苏格兰国家卫生服务机构内的其他健康记录相关联。这些系统为纵向药物流行病学研究提供了基础设施，这在英国其他地方只有部分可用，并且在这种类型的研究中使用苏格兰NHS内部的数据特别有趣，因为苏格兰拥有相对非流动人口，允许长期随访，以及许多疾病群体的高发病率，包括心血管疾病和精神健康状况。然而，数据集的复杂性意味着研究人员经常需要开发新的技能和工具，以了解在他们的研究中使用它的最佳方式，而且目前还没有标准化的方法来描述、操纵或报告处方数据分析的结果。此外，由于这些数据库最初是为报销目的而不是研究目的而设计的，原始数据本身对回答某些研究问题没有用处，必须首先转换为药物暴露期，目前必须手工完成。本研究的目的是开发一套通用工具，以获取个人处方记录，并在设定的时间段内为个体患者创建药物暴露期——首先对单个药物的暴露进行建模，然后调查在同一时间段内对几种药物进行建模的复杂性，以确定在什么时候数据变得过于复杂而无法用于统计和预后建模。然后，这些工具将通过使用它们来调查苏格兰精神病处方中与多药相关的问题来验证。

Studentship strategic priority area: E-Health Informatics ResearchKeywords: Pharmacoepidemiology, drug exposure, pharmacy databases, electronic prescribingAbstract:Administrative healthcare databases are increasingly being used as a key data source for pharmaco-epidemiological research, as they provide access to large amounts of data collected during the provision of healthcare. The use of pharmacy records, for example, provides an opportunity to answer research questions related to adherence, post-marketing drug responses and safety and prescribing patterns over a large population without having to go through the costly and time-consuming process of collecting information through other methods such as patient interviews. A number of studies have been performed which validate the use of pharmacy records as a method of determining which drugs a patient has access to, by showing a high level of agreement between pharmacy records, patient interviews, medical records and home medication inventories.In Scotland, the Prescribing Information System (PIS) is of particular interest for this type of research, as it contains information for over 1.6 billion prescriptions reimbursed in a community setting over the whole country from 1993 onwards, 507 million items prescribed and 344 million items dispensed from 2009 onwards. Additionally, records from 2009 on are linked to individual patients' Community Health Index (CHI) numbers, allowing for linkage to other health records within the Scottish National Health Service. These systems provide an infrastructure for longitudinal pharmaco-epidemiological research which is only partially available elsewhere in the UK, and the use of data from within the Scottish NHS in this type of research is of particular interest as Scotland has a relatively non-mobile population, allowing for long-term follow-up, and high incidences of a number of disease groups including cardiovascular disease and mental health conditions. The complexity of the dataset, however, means that researchers often need to develop new skills and tools to understand the best ways to use it within their research, and there are currently no standardised methods for describing, manipulating or reporting on findings from analysis of prescribing data. Additionally, as these databases were originally designed for reimbursement purposes rather than research, the raw data are not inherently useful for answering certain research questions, and must first be converted into periods of drug exposure, which must currently be done manually. The aim of this study is to develop a set of generic tools to take individual prescription records and create periods of exposure for medications over a set time period for individual patients - initially modelling exposure to individual drugs, and then investigating the complexity of modelling several drugs over the same period to determine at what point the data becomes too complex to be used within statistical and prognostic modelling. These tools will then be validated by using them to investigate issues relating to polypharmacy within psychiatric prescribing in Scotland.