Precision medicine and improving future health care to an ageing population.

Abstract

Developed countries show a change in population demographics as increasing life expectancy leads to a proportionally older population and a greater incidence of chronic disease and comorbidities. Those future capability and capacity demands on healthcare providers are a major societal and economic challenge requiring new models of health and care delivery for sustainability.1,2 Innovate UK Health and Care have invested through their Stratified Medicine and Assisted Living Innovation Platforms to improve patient care and treatment provision, ensuring patients receive the right treatment at the right time and are provided for appropriately, whether in primary or secondary care.3,4In an ageing population, the development of chronic disease and comorbidities such as cardiovascular and respiratory disease, cancer, dementia and diabetes can be attributed to a certain extent by lifestyle choices such as smoking, obesity, alcohol use and lack of exercise in earlier life. However, the impact of each or all of these choices on an individual's health status is complex and dependent upon that person's genetic and physiological predisposition.Although family history is still a good indicator of health risk, the development of new technologies that allow earlier and more accurate measurement and detection of disease such as proteomics, characterisation of the human genome, diagnostic tests and clinical imaging has led to a greater understanding of the underlying molecular causes of disease. Differences in an individual's ability to metabolise drugs can also have major implications for side effects, especially in the older patient with comorbidities who will be subject to several treatment regimes. This molecular understanding causes stratification of patients into specific subgroups, allowing the application of precision medicine to ensure that patients benefit from a more personalised approach of targeted treatments and therapeutic interventions, improving patient outcomes and decreasing risk of adverse events.5The United Kingdom has a leading capability in the understanding and implementation of precision (or personalised) medicine as a consequence of its academic, industrial and clinical science base; however, in relation to implementing improvements in citizen health for the future, it is imperative that patients are actively involved.6 The Academy of Medical Sciences has recently proposed extending precision medicine to enable greater prediction and prevention of disease through increasing patient participation (P4 medicine).7One way to drive this P4 approach is through the use of digital technologies. Increasingly large quantities of data relevant to health are becoming available. UK investments in infrastructure such as the 100,000 Genome Project, UK Biobank, the MRC Farr Institute and Clinical Practice Research Datalink (CPRD) and Health and Social Care Information Centre (HSCIC) clinical and care databases are allowing the United Kingdom to lead the way in predictive and precision medicine. This linkage of molecular information - genetic mutations related to rare disease or cancer - to electronic health records will lead to better diagnosis and prediction of health risk and will inform future treatment pathways within the National Health Service (NHS). The development of mobile health and wearable technologies such as mobile health apps, fitness monitors, glucose, heart rate and movement monitors allows longitudinal studies and more accurate monitoring to occur in real life, with patients better able to monitor and self-manage their own illness. One example is a mobile phone app where patients track and monitor their symptoms of psychosis, obtaining early intervention and support to improve their own disease management with a potential saving to each NHS trust of £1 million per year.8The use of patient data in the NHS is of key public interest, and there is considerable effort to guarantee the governance, security and privacy of patient data. …