royal college of surgeons in ireland coláiste ríoga na máinleá in Éirinn

Division of Population Health Sciences

Royal College of Surgeons in IrelandColáiste Ríoga na Máinleá in Éirinn

Connected health: collaborative opportunities for ICON and academia

Tom Fahey

Professor of General Practice, RCSI Medical School & Principal Investigator, HRB Centre for Primary Care Research


Overview

• Background

• Collaborative opportunities– Exploring potential of large databases– Patient safety– Quality of care– Education and training of graduates


My own background

• Professor of General Practice, RCSI 2006 onwards

• Medical graduate UCD, trained epidemiology & Public Health (TCD & Oxford)

• Previously (UK 14 years)– Professor (University Dundee)– SL (University of Bristol)– L (University of Oxford)


Roles

• Professor & Head of Department

• Principal investigator HRB Centre for Primary Care Research

• Chair of Research, Irish College of General Practitioners

• Other roles– Academic collaborator EU FP7 TRANSFoRm– Medical advisory group Irish Medicines Board


Overview

• Background



GP Electronic Health Record (EHR)


EHR

• UK

• Ireland


Trial data query system


Recruitment RCT


Visualisation- patient recruitment


Diagnostic code recoded- type 1 NIDDM


Overview

• Background



TRANSFoRm- WP4 patient safety

WP4 Evidence Repository

Clinical Evidence Service

WT 4.5 Evidence Mining and Analysis

Research Study Designer WT 5.2GP EHRs

With CDSS

Evidence Analysis & Extraction Tool

Evidence Management

Tools

Study Criteria Design

Find Eligible Patient

Research Study Management

Recruit Eligible Patient

Study Data Management


Overview

• Background



Potentially Inappropriate Prescribing (PIP)

• PIP is prevalent in the older population (> 70 years)• Republic of Ireland 36%• Northern Ireland 34%• United Kingdom 29%


The prevalence of the most common STOPP/START PIP indicators across three regions


OPTI-SCRIPT study development


Study overview

PCRS – National Contemporaneous Control

- Observational comparison to national prescribing data (376,858 patients, 2,000+ practices)


OPTI-SCRIPT website


OPTI-SCRIPT RCT results

• Participants • 21 GP practices (32% cluster response rate)• 196 patients (37% response rate)

• Minimisation

Intervention Control11 practices99 patients

10 practices97 patients


Study design & methodology – cluster RCT

• Primary outcome measure: • Proportion of patients with no PIP• Mean PIP per group

• Data collection baseline & immediate post intervention • Between group differences:

• Random effects logistic regression • Cluster mean • Random effects poisson regression

• Process evaluation


Outcome – Proportion with no PIP

Group N Number of patients with no PIP

% of patients with no PIP

Intervention 99 47 47.5

Control 97 22 22.7

Adjusted odds ratio = 3.06 (95% CI 1.4,6.5; P=0.004)*

*adjusted for gender, age, baseline PIP, number repeat medications, GP practice size


National contemporaneous control – PCRS

• Intervention period, Sep 2012 – August 2013 prevalence of 38%

• Odds of having no PIP in OPTI-SCRIPT intervention compared to odds of having no PIP in the national PCRS cohort

Odds Ratio 95% CI

2.49 1.68, 3.69


Overview

• Background



Discussion

• Collaboration

• Joint funding– HRB Centre renewal– Horizon 20:20

• Training of graduates

royal college of surgeons in ireland coláiste ríoga na máinleá in Éirinn

Documents