The goal is to develop and evaluate approaches that can cost effectively improve the control and management of chronic conditions in primary care.
Our trial concluded that intervention to promote early intensive management of type 2 diabetes was not harmful and could yield moderate benefits (Lancet 2011).
Our trial in people with poorly controlled hypertension showed that a strategy of patient self-management of hypertension in combination with telemonitoring of blood pressure was superior in decreasing blood pressure than usual care (Lancet 2010).
Our meta-analysis has suggested that ambulatory monitoring of blood pressure before the start of lifelong drug treatment leads to more appropriate targeting of treatment than relying on clinic or home measurement of blood pressure (BMJ 2011).
Our comparative cohort study of older patients with atrial fibrillation showed that current risk stratification schemes have only limited ability to predict stroke, suggesting classification of all such patients over 75 years as “high risk” to avoid systematic under-treatment (BMJ 2011).
Our crosssectional study of primary care records showed that older people were disproportionately low users of statin medications, suggesting implications for clearer guidelines for people aged over 75 years (BMJ 2012).
Our long-term cohort study indicated that the estimated median survival for incident dementia is 4.5 years (BMJ 2008), suggesting implications for prognosis and planning for patients, carers, and health services.
Our Future Plans
We are conducting trials to evaluate “polypill” interventions in cardiovascular disease prevention and ways to improve outcome following stroke. We have commenced the feasibility phase for a trial of metformin for the prevention of cardiovascular disease in people at high risk of type 2 diabetes, with the full trial of 12,000 people expected to start in 2015.