Lecturer wins prestigious primary care research prize

Thursday 6 July 2023

On 23 June, the Society for Academic Primary Care (SAPC) announced Lecturer in Academic General Practice Dr Sarah Mills as the winner of the prestigious 2023 SAPC Doctoral Prize. The prize is awarded to health service researchers and clinical academics who have completed their doctorate within the last 18 months. It recognises work that has a substantial impact on primary care and significant implications for future research.

Dr Mills completed her PhD at the University of Dundee in 2021 after graduating with her BSc (Hons) in Medicine from the University of St Andrews. Her doctoral study, entitled “Use of unscheduled care by people who die from cancer,” was a retrospective cohort analysis of 2,443 cancer decedents in Tayside, Scotland, from March 2013 to June 2015. Funded by the Chief Scientist Office, Dr Mills’ work produced the first unscheduled care dataset in the UK that combined information from both General Practice Out-of-Hours (GPOOH) and Accident & Emergency (A&E) departments. By linking this data with information in national demography, Cancer Registry, community prescribing, and General Registry Office Death data, she was able to explore the frequency, patterns, and outcomes of unscheduled care use among cancer decedents.

Dr Mills’ most striking finding was a substantially higher rate of unscheduled care attendance by cancer decedents than previously reported. Notably, this rate also increased markedly in the final 12 weeks of life, with 60% of contacts analysed occurring during this period. Although these patients most frequently presented for pain and palliative care, a substantial proportion were not prescribed strong opioids, breakthrough medication, or other medication to alleviate common palliative care symptoms.

Dr Mills also identified associations between age, cancer type, accessibility, and prognosis with both the type of unscheduled care such patients used (GPOOH or A&E) and the frequency of their unscheduled care attendance. This has her helped identify potentially modifiable factors contributing to higher rates of unscheduled care use.

The implications of Dr Mills’ research for primary care practice are far reaching. Her findings have challenged existing beliefs about unscheduled care use among individuals with cancer and highlighted the need for improved pain management and palliative-care services. These results have informed the work of NHS and government policymakers, contributing to the design and redevelopment of unscheduled community palliative care services.

Dr Mills’ uniquely comprehensive dataset and the results of her analyses have also prompted new research aimed at predicting and proactively addressing individuals’ risk of frequent unscheduled care use. This includes work on a personalised Clinical Risk Prediction Tool to identify patients in need of social care reviews, prescribing interventions, or other anticipatory care measures that would reduce their need for unscheduled care. In recognition of her expertise, she has been invited to join the Scottish Government’s advisory group on Unscheduled Care Research.

Responding to news of the award, Dr Mills said, “Unscheduled Care is a vital part of providing good quality care to people in their last year of life.  I am honoured to have received the SAPC Doctoral Prize, in recognition of the impact that my work has had in this field, and delighted to be continuing my research in unscheduled care with the amazing team at the University of St Andrews.”

The School is thrilled for Dr Mills and looks forward to witnessing her future contributions to this essential field of medical research.

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