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Bruce Guthrie

2006-07 Harkness Fellow Health Foundation/Scottish Executive Chief Scientist Office postdoctoral research fellow University of Dundee Medical Research Council Health Services research training fellow University of Edinburgh

Harkness Project Title: Financial Incentives and the Implementation of Systematic Chronic Disease and Preventive Care in California Medicaid

Mentor: Andrew Bindman, M.D.

Placement: Division of General Internal Medicine, University of California, San Francisco

Biography at time of Harkness Fellowship: Bruce Guthrie, a 2006–07 Commonwealth Fund Harkness Fellow in Health Care Policy, was previously a Health Foundation/Scottish Executive Chief Scientist Office postdoctoral research fellow at the University of Dundee, and a Medical Research Council Health Services research training fellow at the University of Edinburgh. His research interests are in the definition and measurement of quality of care, and the effectiveness and equity of organization of health care for chronic disease including the place of personal continuity. He has training in quantitative and qualitative methods in epidemiology and social research, and combines his research work with clinical general/family practice.


Project: Guthrie’s project examined the impact of auto-enrolling those covered by Medi-Cal into managed care plans based upon those plans’ performance.  He used HEDIS measures to develop a care quality score for patients, which he used to compare quality in counties where this auto-enrolling procedure had been implemented to counties where it had not.  He also conducted individual and group interviews with people from the health plans participating in the auto-enrollment program.

Career Activity Since Fellowship


  • Member, National Institute for Health and Clinical Excellence QOF Indicators Committee, 2009
  • Member, NHS Quality Improvement Scotland National Clinical Data for Quality Improvement Advisory Group, 2009
  • Professor of Primary Care Medicine, University of Dundee, 2006

Current Position: (updated 10/2017)

  • Head, Population Health Sciences Division and Professor of Primary Care Medicine, University of Dundee

E-mail: [email protected]

Selected Publications


Gallacher KI, Batty G, McLean G, Mercer SW, Guthrie B, May CR, Langhorne P, Mair FS. Stroke, multimorbidity and polypharmacy in a nationally representative sample of 1,424,378 patients in Scotland: implications for treatment burden. BMC  Med. 2014 Oct 3;12(1):151.


McLean G, Gunn J, Wyke S, Guthrie B, Watt GC, Blane DN, Mercer SW. The influence of socioeconomic deprivation on multimorbidity at different ages: a cross-sectional study. Br J Gen Pract. 2014 Jul;64(624):e440-7.


Simpson RJ, McLean G, Guthrie B, Mair F, Mercer SW. Physical and mental health comorbidity is common in people with multiple sclerosis: nationally representative cross-sectional population database analysis. BMC Neurol. 2014 Jun 13;14:128.


McMurdo ME, Witham MD, Johnston D, Struthers AD, Guthrie B, Matthews K. Identifying older heart failure patients with major depression in primary care: a feasibility study. Int J Geriatr Psychiatry. 2014 May;29(5):547-9.


Guthrie B, Morales DR. What happens when pay for performance stops? BMJ. 2014Feb 10;348:g1413.


Grant AM, Guthrie B, Dreischulte T. Developing a complex intervention to improve prescribing safety in primary care: mixed methods feasibility and optimisation pilot study. BMJ Open. 2014 Jan 21;4(1):e004153. 


van Leijen-Zeelenberg JE, van Raak AJ, Duimel-Peeters IG, Kroese ME, Brink PR,Ruwaard D, Vrijhoef HJ. Barriers to implementation of a redesign of information transfer and feedback in acute care: results from a multiple case study. BMC Health Serv Res. 2014 Apr 3;14:149.


De Bruijn-Geraets DP, Van Eijk-Hustings YJ, Vrijhoef HJ. Evaluating newly acquired authority of nurse practitioners and physician assistants for reserved medical procedures in the Netherlands: a study protocol. J Adv Nurs. 2014 Mar 31.

Sumakadas D, McMurdo MET, ET, Mangoni AA, Guthrie B. Temporal trends in anticholinergic medication prescription in older people: repeated cross-sectional analysis of population prescribing data. Age and Ageing 2013 .

Dreischulte T, Madhok V, Barnett K, Guthrie B. Oral anticoagulation and antiplatelet treatment in relation to stroke risk in patients with atrial fibrillation: a population database analysis. European Journal of General Practice 2013

Marwick C, Guthrie B, Pringle J, Evans J, Nathwani D, Donnan P, Davey P. A multifaceted intervention to improve sepsis management in general hospital wards with evaluation using segmented regression of interrupted time series. BMJ Qual Saf 2013

Grant S, Guthrie B, Entwistle VA, Williams B. Dimensions of culture in primary care medical practices: insights from a systematic literature search and meta-ethnography of qualitative research from the UK, US, Canada, Australia and New Zealand. Journal of Health Organisation and Management 2013

Morales D, Jackson C, Lipworth B, Donnan P, Guthrie B. Adverse respiratory effect of acute beta-blocker exposure in asthma: a systematic review and meta-analysis of randomized controlled trials. Chest 2013

Lawson K, Mercer S, Wyke S, Grieve E, Guthrie B, Watt G, Fenwick E: 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 2013, 12(1):67.

Guthrie B, Clark SA, Reynish EL, Morales DR, McCowan C. Differential impact of two risk communications on antipsychotic prescribing to people with dementia in Scotland: segmented regression time series analysis 2001-2011. PLoS One 2013;8(7): e6897.

Mathieson L, Severn A, Guthrie B. 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 2013;58, 69-76.

Smith, DJ, Langan J, McLean M, Guthrie B, Mercer SW. Schizophrenia is associated with excess multiple physical-health comorbidities but low levels of recorded cardiovascular disease in primary care: cross-sectional study. BMJ Open 2013;3(4).

Duffy MA, Hernandez Santiago V, Orange G, Davey PG, Guthrie B. Prior trimethoprim prescription and trimethoprim resistance in childhood urinary tract infections: multilevel modelling of population data 2004-2009. British Journal of General Practice 2013; 623: e238-e243

Payne RA, Abel GA, Guthrie B, Mercer SW. The impact of physical multimorbidity, mental health conditions and socioeconomic deprivation on unplanned hospital admissions: a retrospective cohort study. Canadian Medical Association Journal 185:E221-E228.

Saunders, C, Byrne CD, Guthrie B, Lindsay R, McKnight J, Philip S, Sattar N, Walker JJ, Wild SH on behalf of the Scottish Diabetes Research Network Epidemiology Group. External validity of randomised controlled trials in glycaemic control and the influence on vascular disease: how representative are participants? Diabetic Medicine 2013;30(3);300-308

Morales DR, Jackson C, Fielding S, Guthrie B. Long acting β-agonist prescribing in people with asthma in primary care. Thorax 2013;68:192-194

McCowan C, Magin P, Clark S, Guthrie B. An observational study of psychotropic drug use in older patients resident in their own home or in care. Age and Ageing 2013; 42(1):51-56

Hughes L, McMurdo MET, Guthrie B. Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity. Age and Ageing 2013; 42(1): 62-69.

Guthrie B, Payne K, Alderson P, McMurdo ME, Mercer SW. “Adapting clinical guidelines to take account of multimorbidity.” BMJ. 2012 Oct 4;345:e6341.

McCowan C, Magin P, Anne Clark S, Guthrie B. “An observational study of psychotropic drug use and initiation in older patients resident in their own home or in care.” Age Ageing. 2012 Sep 13.

Mercer SW, Gunn J, Bower P, Wyke S, Guthrie B. “Managing patients with mental and physical multimorbidity.” BMJ. 2012 Sep 3;345:e5559.

Hughes LD, McMurdo ME, Guthrie B. “Guidelines for people not for diseases: the challenges of applying UK clinical guidelines to people with multimorbidity.” Age Ageing. 2012 Aug 21.

Mercer SW, Guthrie B, Furler J, Watt GC, Hart JT. “Multimorbidity and the inverse care law in primary care.” BMJ. 2012 Jun 19;344:e4152.

Murphy DJ, Guthrie B, Sullivan FM, Mercer SW, Russell A, Bruce DA. “Insightful practice: a reliable measure for medical revalidation.” BMJ Qual Saf. 2012 Aug;21(8):649-56.

Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. “Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study.” Lancet. 2012 Jul 7;380(9836):37-43.

Dreischulte T, Grant A, Donnan P, McCowan C, Davey P, Petrie D, Treweek S, Guthrie B. “A cluster randomised stepped wedge trial to evaluate the effectiveness of a multifaceted information technology-based intervention in reducing high-risk prescribing of non-steroidal anti-inflammatory drugs and antiplatelets in primary medical care: the DQIP study protocol.” Implement Sci. 2012 Mar 23;7:24.

Roland M, Guthrie B, Thomé DC. “Primary medical care in the United Kingdom.” J Am Board Fam Med. 2012 Mar;25 Suppl 1:S6-11.

Dreischulte T, Grant AM, McCowan C, McAnaw JJ, Guthrie B. “Quality and safety of medication use in primary care: consensus validation of a new set of explicit medication assessment criteria and prioritisation of topics for improvement.” BMC Clin Pharmacol. 2012 Feb 8;12:5.

Lockhart P, Guthrie B. “Trends in primary care antidepressant prescribing 1995-2007: a longitudinal population database analysis.” Br J Gen Pract. 2011 Sep;61(590):e565-72.

Norbury M, Fawkes N, Guthrie B. “Impact of the GP contract on inequalities associated with influenza immunisation: a retrospective population-database analysis.” Br J Gen Pract. 2011 Jul;61(588):e379-85.

Guthrie B, McCowan C, Davey P, Simpson CR, Dreischulte T, Barnett K. “High risk prescribing in primary care patients particularly vulnerable to adverse drug events: cross sectional population database analysis in Scottish general practice.” BMJ. 2011 Jun 21;342:d3514.

Roland M, Rao SR, Sibbald B, Hann M, Harrison S, Walter A, Guthrie B, Desroches C, Ferris TG, Campbell EG. “Professional values and reported behaviours of doctors in the USA and UK: quantitative survey.” BMJ Qual Saf. 2011 Jun;20(6):515-21.

O'Brien R, Wyke S, Guthrie B, Watt G, Mercer S. “An 'endless struggle': a qualitative study of general practitioners' and practice nurses' experiences of managing multimorbidity in socio-economically deprived areas of Scotland.” Chronic Illn. 2011 Mar;7(1):45-59.

Guthrie B. “Auto-Assigning New Enrollees To Top-Performing California Medicaid Plans Does Not Appear To Improve Quality” Health Affairs, 2010; 29(8).

Guthrie B, Saultz JW, Freeman GK, and Haggerty JL. “Continuity of care matters.” BMJ, 2008; 337:a867.

Campbell N, Murray E, Darbyshire J, Emery J, Farmer A, Griffiths F,  Guthrie B, Lester N, Wilson P, Kinmonth A. Designing and evaluating complex interventions to improve health care. BMJ 2007;334:455 – 459.