The case for medicinal cannabis

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General practitioners, paramedics and the primary care team; the potential for mutual benefit

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Management of bone fragility in primary care in Ireland

This study evaluated the prevention of bone fragility fractures in a representative sample of four Irish general practices. The clinical records of 243 patients potentially at risk of bone fragility were studied. One hundred and fourteen (47%) had a dual energy x-ray absorptiometry (DEXA) scan. Osteoporosis was established in 42 (17%) and osteopaenia in 28 (11%). One hundred and fifty-two (63%) were currently being prescribed bisphosphonates. Thirty-four (22%) of those on bisphosphonates did not have a baseline DEXA scan performed prior to commencing treatment and further analysis did not show a clear rationale for initiation of the treatment in this group of patients. Forty-six (30%) patients on bisphosphonates had been prescribed them for over 5 years without any apparent review to see if they were still indicated. There was no record of any of the practices having carried out a fracture risk score assessment prior to commencing bone fragility treatment. The implications are that bone fragility management warrants urgent review

Knowledge and attitudes of Irish GPs towards abortion following its legalisation: a cross-sectional study

Background: In May 2018, the Irish Constitution was changed following a referendum allowing termination of pregnancy by abortion. It is envisaged that the majority of terminations will be by medical abortion and will take place in general practice before 12 weeks gestation. Aim: To elicit attitudes and level of preparedness of Irish GPs to provide medical abortion services. Design & setting: Cross-sectional study of 222 GPs who were associated with the University of Limerick Graduate Entry Medical School (GEMS) and GP training programme. Method: An anonymous online questionnaire was distributed via email. Reminders were sent 2 and 4 weeks later. Results: The response rate was 57.2% (n = 127/222). Of the responders, 105 (82.7%) had no training in this area, with only 4 (3.1%) indicating that they had sufficient training. Nearly all responders (n = 119, 93.7%) were willing to share abortion information with patients. Just under half of responders (n = 61, 48.0%) would be willing to prescribe abortion pills, with 47 (37.0%) unwilling to do so. Only 53 (41.7%) responders believed that provision of abortion services should be part of general practice, with 52 (40.9%) saying that it should not. As to whether doctors should be entitled to a conscientious objection but should also be obliged to refer the patient, 92 (72.4%) responders agreed. Over two-thirds of responders (n = 89, 70.1%) felt that necessary patient support services are not currently available. Conclusion: There is a lack of training and a considerable level of unwillingness to participate in this process among Irish GPs. There is also a perceived lack of patient support services for women experiencing unwanted pregnancy. It is incumbent upon state and professional bodies to address these issues

Is there a role for paramedics in primary care in Ireland: an exploratory study

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An audit of discharge summaries from secondary to primary care

Background Health is information-intensive. Reliable health care depends on access to this information in a timely and accurate manner. A standardised data set for clinical discharge summaries is essential to optimise the care the patient receives, particularly at discharge. The Irish Health Information and Quality Authority (HIQA) have recently developed a national standard for patient discharge summaries. Aims Our aim was to assess the current quality of discharge summaries being received, determine the main areas of concern and establish the areas to improve patient safety. Methods We studied 60 discharge summaries received at 3 general practices in the Mid-West of Ireland. We used HIQA “National Standard for Patient Discharge Summary” 2013 as our audit standard. Results Mandatory fields including Surname, Forename and date of birth were present in 100%, missing in 0%. The patient’s address was missing in 7% (n = 4). Gender was missing in 82% (n = 50). Source of referral was missing in 52% (n = 32). No method of admission was documented in 70% (n = 43). Whilst principal diagnosis was documented in 100% (n = 60), no co-morbidities were documented in 28% (n = 17). No medication was documented in 30% (n = 18), and there was no documentation of medication changed in 39% (n = 24). Details of the person completing the discharge summary were incomplete as follows: 85% (n = 52) had no specialty documentation, 36% (n = 22) had no registration number and 38% (n = 23) had no contact number. Conclusions This audit shows deficits in adhering to HIQA standards. These must be addressed as a matter of urgency

Improving quality of referral letters from primary to secondary care: a literature review and discussion paper

Background: Referral letters sent from primary to secondary or tertiary care are a crucial element in the continuity of patient information transfer. Internationally, the need for improvement in this area has been recognised. This aim of this study is to review the current literature pertaining to interventions that are designed to improve referral letter quality. Methods: A search strategy designed following a Problem, Intervention, Comparator,Outcomemodelwas used to explore the PubMed and EMBASE databases for relevant literature. Inclusion and exclusion criteria were established and bibliographies were screened for relevant resources. Results: A total of 18 publications were included in this study. Four types of interventions were described: electronic referrals were shown to have several advantages over paper referrals but were also found to impose new barriers; peer feedback increases letter quality and can decrease ‘inappropriate referrals’ by up to 50%; templates increase documentation and awareness of risk factors;mixed interventions combining different intervention types provide tangible improvements in content and appropriateness. Conclusion: Several methodological considerations were identified in the studies reviewed but our analysis demonstrates that a combination of interventions, introduced as part of a joint package and involving peer feedback can improve

Medical management of acute upper respiratory infections in an urban primary care out-of-hours facility: crosssectional study of patient presentations and expectations

Objectives The purpose of this study was to examine the expectations of patients attending an urban primary care out-of-hours (OOH) facility with acute upper respiratory tract infection (acute URTI) regarding clinical examination, symptom management, information on their condition, reassurance, antibiotic treatment and other possible options including referral. Design Cross-sectional design. Setting One urban primary care OOH facility located in the midwest of Ireland. Participants 457 patients filled out a questionnaire while waiting in the OOH facility; 22 surveys were excluded as the patients did not present with symptoms of acute URTI resulting in 435 patients’ data being included in this study. There were 59.5% female participants and 40.5% male participants. Results 435 patients with acute URTI symptoms participated in the survey, representing 25.4% of those attending the single branch where the survey was conducted (n=1715). Of the study participants, 43% were aged under 6 years and 60% were women. The most common presenting symptoms were cough (72%), throat ache (46%) and common cold (26%). The most common expectations were for further examination (53%), reassurance (51%), information (49%) and medication for cough (47%), with 34% expecting an antibiotic. Conclusions Only one in three patients attending this primary care OOH facility with acute URTI symptoms had an expectation of antibiotics, with most seeking further assessment, information and reassurance. Recognition of such expectations may be important considerations for clinicians when deciding on management options for patients with acute URTI

The prevalence and treatment of mental health conditions documented in general practice in Ireland

Objectives. As prevalence of mental health disorders increases worldwide, recognition and treatment of these disorders falls increasingly into the remit of primary care. This study investigated the prevalence and management of adults presenting to their general practitioner (GP) in Ireland with a psychological condition. Methods. A random number function was used to select 100 patients with a consultation in the previous 2 years from 40 general practices around Ireland. The clinical records of these patients were examined using a standardised reporting tool to extract information on demographics, eligibility for free care, prevalence and treatment of psychological conditions. Results. From a sample of 3845 ‘active’ patients, 620 (16%, 95% confidence interval 15–17%) had a documented psychological condition in the previous 2 years. The most common diagnoses were depression (54%) followed by stress and anxiety (47%). The following patient characteristics were associated with having a documented mental health condition: female gender; higher GP consultation rate; a referral or attendance at secondary care and eligibility for free GP care. Of those with a psychological condition, 34% received a psychological intervention and 81% received a pharmacological intervention. Conclusions. The overall prevalence estimate of mental health disorders for this sample was lower than previously documented in primary care. Patients diagnosed with mental health disorders had higher utilisation of health services and pharmacological treatment was common

How do multi-morbidity and polypharmacy affect general practice attendance and referral rates? A retrospective analysis of consultations

Background As prevalence of multi morbidity and polypharmacy rise, health care systems must respond to these challenges. Data is needed from general practice regarding the impact of age, number of chronic illnesses and medications on specific metrics of healthcare Methods This was a retrospective study of general practices in a university-affiliated education and research network, consisting of 72 practices. Records from a random sample of 100 patients aged 50 years and over who attended each participating practice in the previous two years were analysed. Through manual record searching, data were collected on patient demo graphics, number of chronic illnesses and medications, numbers of attendances to the general practitioner (GP), practice nurse, home visits and referrals to a hospital doctor. Attendance and referral rates were expressed per person-years for each demographic variable and the ratio of attendance to referral rate was also calculat