Royal%20College%20of%20Surgeons%20in%20Ireland%20Col

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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
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Overview

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

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Overview

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

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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)

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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

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Overview

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

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GP Electronic Health Record (EHR)
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EHR

• UK
• Ireland

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Trial data query system
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Recruitment RCT
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Visualisation- patient recruitment
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Diagnostic code recoded- type 1 NIDDM
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Overview

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

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TRANSFoRm- WP4 patient safety
WP4 Evidence Repository
Research Study Designer
WT 5.2 GP EHRs With CDSS
Study Criteria Design
Clinical Evidence Service
Evidence Management Tools
Find Eligible Patient
Research Study Management
WT 4.5 Evidence Mining and Analysis
Recruit Eligible Patient
Evidence Analysis Extraction Tool
Study Data Management
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Overview

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

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Potentially Inappropriate Prescribing (PIP)

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

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The prevalence of the most common STOPP/START PIP
indicators across three regions
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OPTI-SCRIPT study development
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Study overview
PCRS National Contemporaneous Control -
Observational comparison to national prescribing
data (376,858 patients, 2,000 practices)
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OPTI-SCRIPT website
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OPTI-SCRIPT RCT results

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

Intervention Control
11 practices 99 patients 10 practices 97 patients
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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

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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
P0.004) adjusted for gender, age, baseline
PIP, number repeat medications, GP practice size
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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
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Overview

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

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Overview

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

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Discussion

• Collaboration
• Joint funding
• HRB Centre renewal
• Horizon 2020
• Training of graduates