18 research outputs found
Additional file 1: of Intramuscular oxytocin versus intravenous oxytocin to prevent postpartum haemorrhage at vaginal delivery (LabOR trial): study protocol for a randomised controlled trial
SPIRIT 2013 checklist. (DOC 122 kb
What Is the impact of physical activity and physical function on the development of multimorbidity in older adults over time? A population-based cohort study
Background: Multimorbidity is recognized internationally as having a serious impact on health outcomes. It is associated with reduced quality
of life, increased health care utilization, and future functional decline. Physical activity is associated with good health and psychological
well-being. The aim of this study was to identify the impact of physical activity and physical function on the development and worsening of
multimorbidity over time.
Methods: Using The Irish Longitudinal Study on Ageing (TILDA), we analyzed 4,823 participants ≥50 years with and without multimorbidity.
Multimorbidity was defined as the presence of ≥2 chronic conditions. Development of multimorbidity was measured as the accrual of additional
conditions over a 2-year period. Physical activity and physical function were measured using the International Physical Activity Questionnaire
(IPAQ), gait speed (m/sec), and grip strength (kg).
Results: Sixteen groups of chronic conditions were included in analyses. 53.7% of included participants had multimorbidity at baseline and
71.7% at follow-up. Six hundred and thirty-eight of 2,092 (30.4%) participants without multimorbidity and 1,005 of 2,415 (41.6%) with
existing multimorbidity developed new condition/s. Gait speed (relative risk [RR] = 0.67, confidence interval [CI]: 0.49–0.90), grip strength
(RR = 0.98, CI: 0.97–0.99), and age (compared to 50–59 years, 60–69: RR = 1.30, CI: 1.11–1.52; ≥70: RR = 1.35, CI: 1.03–1.77) were
significantly associated with the development of multimorbidity and accrual of additional conditions.
Conclusion: These results show that physical function is associated with the development and worsening of multimorbidity over time. They
support the recent National Institute for Health & Care Excellence (NICE) Guidance on multimorbidity that suggests that patients with
multimorbidity and reduced gait speed should be identified and targeted for interventions to improve health outcomes
Prescribing patterns of glucosamine in an older population: a national cohort study
Background: Glucosamine is commonly prescribed as a disease modulating agent in osteoarthritis. However, the
evidence to date suggests that it has a limited impact on the clinical symptoms of the disease including joint pain,
radiological progression, function and quality of life. The aim of this study was to examine the prescribing patterns
of glucosamine from 2002–2011 in an elderly Irish national population cohort using data from the Health Service
Executive Primary Care Reimbursement (HSE-PCRS) General medical services (GMS) Scheme.
Methods: Patients aged ≥ 70 years on the HSE-PCRS pharmacy claims database between January 2002 and December
2011 were included. ATC code M01AX05 (glucosamine) was extracted. Prevalence rates per 1000 eligible population
with 95% confidence intervals were calculated for all years and age groups (70–74 years, ≥75 years). A negative
binomial regression analysis was used to determine longitudinal usage trends and compare prevalence rates
across years, sex and age groups.
Results: The annual patient rate of glucosamine prescribing increased significantly from 13.0/1000 eligible
population (95% CI 12.6-13.4) in 2002 to 68.7/1000 population (95% CI 67.8-69.5) in 2009 before decreasing to
62.4/1000 population (95% CI 61.6-63.2) in 2011. The rate of prescribing of glucosamine varied with sex, with
women receiving significantly more prescriptions than men. The cost of glucosamine also increased from 2002–2008.
In 2008 total expenditure reached a high of €4.6 million before decreasing to €2.6 million in 2011.
Conclusion: The national trend in prescribing of glucosamine increased significantly from 2002 to 2009 before
decreasing in 2010 and 2011, in keeping with current international guidelines. There is a need for awareness among
healthcare professionals and patients alike of the best available evidence to inform decision making relating to the
prescription and consumption of such supplements
Development and validation of a clinical prediction rule to identify suspected breast cancer: a prospective cohort study
Background: The number of primary care referrals of women with breast symptoms to symptomatic breast units
(SBUs) has increased exponentially in the past decade in Ireland. The aim of this study is to develop and validate a
clinical prediction rule (CPR) to identify women with breast cancer so that a more evidence based approach to
referral from primary care to these SBUs can be developed.
Methods: We analysed routine data from a prospective cohort of consecutive women reviewed at a SBU with
breast symptoms. The dataset was split into a derivation and validation cohort. Regression analysis was used to
derive a CPR from the patient’s history and clinical findings. Validation of the CPR consisted of estimating the
number of breast cancers predicted to occur compared with the actual number of observed breast cancers across
deciles of risk.
Results: A total of 6,590 patients were included in the derivation study and 4.9% were diagnosed with breast cancer.
Independent clinical predictors for breast cancer were: increasing age by year (adjusted odds ratio 1.08, 95% CI 1.07-1.09);
presence of a lump (5.63, 95% CI 4.2-7.56); nipple change (2.77, 95% CI 1.68-4.58) and nipple discharge (2.09, 95% CI 1.
1-3.97). Validation of the rule (n = 911) demonstrated that the probability of breast cancer was higher with an increasing
number of these independent variables. The Hosmer-Lemeshow goodness of fit showed no overall significant difference
between the expected and the observed numbers of breast cancer (χ2
HL: 6.74, p-value: 0.56).
Conclusions: This study derived and validated a CPR for breast cancer in women attending an Irish national SBU. We
found that increasing age, presence of a lump, nipple discharge and nipple change are all associated with increased risk
of breast cancer. Further validation of the rule is necessary as well as an assessment of its impact on referral practice
Supplementary_file_1 – Supplemental material for Life Course Transitions and Changes in Alcohol Consumption Among Older Irish Adults: Results From The Irish Longitudinal Study on Ageing (TILDA)
<p>Supplemental material, Supplementary_file_1 for Life Course Transitions and Changes in Alcohol Consumption Among Older Irish Adults: Results From The Irish Longitudinal Study on Ageing (TILDA) by Alice Holton, Fiona Boland, Paul Gallagher, Tom Fahey, Roseanne Kenny and Gráinne Cousins in Journal of Aging and Health</p
Improving risk factor management for patients with poorly controlled type 2 diabetes: a systematic review of healthcare interventions in primary care and community settings
Objectives Poorly controlled type 2 diabetes mellitus
(T2DM) is a major international health problem. Our
aim was to assess the effectiveness of healthcare
interventions, specifically targeting patients with poorly
controlled T2DM, which seek to improve glycaemic control
and cardiovascular risk in primary care settings.
Design Systematic review.
Setting Primary care and community settings.
Included studies Randomised controlled trials (RCTs)
targeting patients with poor glycaemic control were
identified from Pubmed, Embase, Web of Science,
Cochrane Library and SCOPUS. Poor glycaemic control was
defined as HbA1c over 59 mmol/mol (7.5%).
Interventions Interventions were classified as
organisational, patient-oriented, professional, financial or
regulatory.
Outcomes Primary outcomes were HbA1c, blood pressure
and lipid control. Two reviewers independently assessed
studies for eligibility, extracted data and assessed study
quality. Meta-analyses were undertaken where appropriate
using random-effects models. Subgroup analysis explored
the effects of intervention type, baseline HbA1c, study
quality and study duration. Meta-regression analyses were
undertaken to investigate identified heterogeneity.
Results Forty-two RCTs were identified, including 11 250
patients, with most undertaken in USA. In general, studies
had low risk of bias. The main intervention types were
patient-directed (48%) and organisational (48%). Overall,
interventions reduced HbA1c by −0.34% (95% CI −0.46%
to −0.22%), but meta-analyses had high statistical
heterogeneity. Subgroup analyses suggested that
organisational interventions and interventions on those
with baseline HbA1c over 9.5% had better improvements
in HbA1c. Meta-regression analyses suggested that
only interventions on those with population HbA1c over
9.5% were more effective. Interventions had a modest
improvement of blood pressure and lipids, although
baseline levels of control were generally good.
Conclusions This review suggests that interventions for
T2DM, in primary care, are better targeted at individuals
with very poor glycaemic control and that organisational
interventions may be more effective
Psychostimulant prescribing trends in a paediatric population in Ireland: a national cohort study
Background: Psychotropic paediatric prescribing trends are increasing internationally. The aim of this study is to examine
the prevalence and secular trends in psychotropic prescribing in Irish children and adolescents between 2002 and 2011.
Methods: Data was obtained from the Irish General Medical Services (GMS) scheme pharmacy claims database
from the Health Service Executive Primary Care Reimbursement Services (HSE-PCRS). Prescribing rates per 1000
eligible population and associated 95 % confidence intervals (CIs) were calculated across years (2002–2011), age
groups (0–4, 5–11, 12–15 years) and gender. Rates of concomitant prescriptions for psycholeptics and
antidepressants were also examined. The total expenditure costs were calculated and expressed as a percentage of
the cost of all prescriptions for this age group (≤15 years).
Results: In 2002, 3.77/1000 GMS population (95 % CI: 3.53–4.01) received at least one psychostimulant prescription and this
rate increased to 8.63/1000 GMS population (95 % CI: 8.34–8.92) in 2011. Methylphenidate was the most frequently prescribed
psychostimulant. For both males and females the prevalence of medication use was highest among the 12–15 year old
group. On average, a psycholeptic medication was prescribed to 8 % of all psychostimulant users and an antidepressant was
concomitantly prescribed on average to 2 %. Total expenditure rose from €89,254 in 2002 to €1,532,016 in 2011.
Conclusions: The rate and cost of psychostimulant prescribing among GMS children and adolescents in Ireland increased
significantly between 2002 and 2011. Further research is necessary to assess the safety, efficacy and economic impact of
concomitant psychotropic prescribing in this population
Link workers providing social prescribing and health and social care coordination for people with multimorbidity in socially deprived areas (the LinkMM trial): protocol for a pragmatic randomised controlled trial
Introduction Link workers are non-health or social care professionals based in primary care who support people to develop and achieve a personalised set of health and social goals by engaging with community resources. Link workers have been piloted in areas of deprivation, but there remains insufficient evidence to support their effectiveness. Multimorbidity is increasing in prevalence, but there are limited evidence-based interventions. This paper presents the protocol for a randomised controlled trial (RCT) that will test the effectiveness of link workers based in general practices in deprived
areas in improving health outcomes for people with multimorbidity
GPs' and community pharmacists' opinions on medication management at transitions of care in Ireland
OBJECTIVE: The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care. METHODS: A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken. RESULTS: There was an overall response rate of 17.7% (897 respondents-554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by >90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors. CONCLUSIONS: While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it.OBJECTIVE: The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care. METHODS: A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken. RESULTS: There was an overall response rate of 17.7% (897 respondents-554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by >90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors. CONCLUSIONS: While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it
Stakeholders’ perspectives on models of care in the emergency department and the introduction of health and social care professional teams: A qualitative analysis using world cafés and interviews
Background: There is some evidence that health and social care professional (HSCP) teams contribute to enhanced patient and process outcomes in increasingly crowded emergency departments (EDs), but the views of service users and providers on this model of care need investigation to optimize implementation. Objective: This qualitative study investigated the perspectives of key ED stakeholders about HSCP teams working in the ED. Methods: Using a participatory design, we conducted World Café focus groups and individual interviews in two Irish hospital sites with 65 participants (purposive sampling) including ED patients and carers/relatives, ED doctors and nurses, HSCPs and pre-hospital staff. Data were thematically analysed using NVivo software. Results: Participants reported that ED-based HSCP teams could improve quality and integration of care and staff experience (Theme 1) and would be appropriate for older adults with complex needs and non-urgent complaints (Theme 2). Concerns were raised about operational and relational barriers to implementation (Theme 3), and changes in processes and culture were considered necessary for HSCPs to work successfully in the ED (Theme 4). In contrast to service providers, service users’ concerns centred on the importance of positive communication and relations (Theme 5). Conclusions: Our study indicates potential acceptability of HSCP teams working, in the ED, especially to care for older adults; however, operational and relational aspects particularly developing interdisciplinary and integrated care, need addressing to ensure successful implementation. Differences in priorities between service users and providers (relational vs operational) highlighted the usefulness of gathering views from multiple stakeholders to understand ED processes