Irish College of General Practitioners (ICGP)http://hdl.handle.net/10147/1354202024-03-26T15:25:15Z2024-03-26T15:25:15ZIrish general practitioner (GP) perspectives on impact of direct access radiology on patient care in the community: results from a mixed-methods study.O'Callaghan, Michael EdmundFawsitt, RonanGao, JiaranBroughan, JohnMcCombe, GeoffPhelan, AmyQuinlan, DiarmuidCollins, ClaireStanley, FintanCullen, Walterhttp://hdl.handle.net/10147/6380272023-10-05T02:10:26Z2023-06-24T00:00:00ZIrish general practitioner (GP) perspectives on impact of direct access radiology on patient care in the community: results from a mixed-methods study.
O'Callaghan, Michael Edmund; Fawsitt, Ronan; Gao, Jiaran; Broughan, John; McCombe, Geoff; Phelan, Amy; Quinlan, Diarmuid; Collins, Claire; Stanley, Fintan; Cullen, Walter
Background: Since winter 2020/21, general practitioners (GPs) in the Republic of Ireland (RoI) have been granted access to diagnostic imaging studies on a new publicly funded pathway, expediting access to services previously obtained via hospital-based doctors.
Aims: Outline GP perspectives on imaging studies obtained via the new "GP Access to Community Diagnostics" initiative.
Methods: A mixed-methods design was employed. Referrals over the first six months of 2019 and 2021 were collated by a private imaging provider, and a randomly selected subset of 2021 studies (maximum 30 referrals per GP) was returned to participating GPs to provide detail on the impact on each patient's care. In-depth qualitative interviews were also conducted with participating GPs.
Results: Eleven GPs supplied detailed information on 81 studies organized through the new initiative. GPs reported that the initiative had led to a large proportion of cases being managed solely in general practice, with an 81% reduction in referrals to acute hospital settings and a 58% reduction in referrals to secondary care clinics. GPs felt imaging studies improved patient care in 86% of cases and increased GP workload in 58% of cases. GP qualitative interviews revealed four key themes: improved patient care, increased GP workload, reduction in hospital referrals, and opinions on ongoing management of such initiatives, including guidelines.
Conclusions: GPs felt enhancing access to diagnostics improved patient care by expediting diagnosis, decision-making, and treatment and by reducing hospital referrals. GPs were generally positive about the initiative and made some suggestions on future management of the initiative.
2023-06-24T00:00:00ZPromoting physical health among people with enduring mental illness: a qualitative study of healthcare providers' perspectives.Collins, ClaireFinegan, PearseO'Shea, MarieLarkin, JamesPericin, IvanaOsborne, Brianhttp://hdl.handle.net/10147/6311502022-01-27T01:49:06Z2021-04-21T00:00:00ZPromoting physical health among people with enduring mental illness: a qualitative study of healthcare providers' perspectives.
Collins, Claire; Finegan, Pearse; O'Shea, Marie; Larkin, James; Pericin, Ivana; Osborne, Brian
Background: People with enduring mental illness (EMI) have higher morbidity and mortality from chronic diseases than the general population, and this results in a significantly reduced relative life expectancy-accounted for primarily by physical illness. This gap may be partly influenced by the reduced likelihood of access to and uptake of regular physical health screening.
Aim: To establish Irish service providers' perspectives regarding the care of the physical health of people with EMI in an effort to inform future service developments aimed at improving the physical health of people with EMI.
Design and setting: Qualitative study of healthcare providers-general practitioners (GPs) and members of the community mental health teams-in Ireland.
Participants: GPs and mental health service providers.
Methods: Qualitative semi-structured interviews were conducted with 34 service providers. Thematic analysis was undertaken.
Results: Participants considered that the physical health of people with EMI is not currently regularly addressed by the patient's GP or the mental health team. Factors associated with this include patient compliance with attendance, time constraints in consultations to adequately support patient self-management, communication difficulties with the patient and between primary and secondary care, and lack of clarity as to whose responsibility it is to ensure physical health is monitored. In participants' view, a barrier to improvement is the present funding approach.
Conclusion: The evidence from this study has the potential to form the basis for innovation and change in service delivery for people with an EMI in Ireland and internationally, specifically in countries where it is not clear who has the overall responsibility to monitor the physical health of patients with EMI. This role requires time and regular contact, and both the organisation and the funding of the health system need to support it.
2021-04-21T00:00:00ZHow many general practice consultations occur in Ireland annually? Cross-sectional data from a survey of general practices.Collins, CHomeniuk, Rhttp://hdl.handle.net/10147/6311172022-01-26T01:57:01Z2021-02-20T00:00:00ZHow many general practice consultations occur in Ireland annually? Cross-sectional data from a survey of general practices.
Collins, C; Homeniuk, R
Background: General practice plays a central role in the Irish health system. This study aimed to determine a baseline estimate of the number of consultations completed in general practice in Ireland annually to facilitate evidence-based healthcare planning.
Methods: A survey was emailed to all 3378 individual members of the Irish College of General Practitioners in February 2020 asking each practice to report on consultations by general practitioners and practice nurses occurring on the previous day of practice.
Results: A total of 507 practices responded to the survey, reporting 34,594 general practitioner consultations and 13,161 nurse consultations on one day. Extrapolating this figure nationally, we estimate 21,353,731 GP consultations and 7,749,615 practice nurse consultations occur in Ireland annually. An Irish person visits their GP an estimated 4.34 times a year and the average consultation time is 13.7 min.
Conclusions: This study shows that over 29.1 million consultations take place in Irish general practice every year. Innovative interventions to increase the capacity of general practice are needed to ensure high-quality care continues to be accessible in Ireland.
2021-02-20T00:00:00ZThe association between cervical cancer screening participation and the deprivation index of the location of the family doctor's office.Serman, FannyFavre, JonathanDeken, ValérieGuittet, LydiaCollins, ClaireRochoy, MichaëlMessaadi, NassirDuhamel, AlainLaunay, LudivineBerkhout, ChristopheRaginel, Thibauthttp://hdl.handle.net/10147/6296062021-06-05T01:53:42Z2020-05-15T00:00:00ZThe association between cervical cancer screening participation and the deprivation index of the location of the family doctor's office.
Serman, Fanny; Favre, Jonathan; Deken, Valérie; Guittet, Lydia; Collins, Claire; Rochoy, Michaël; Messaadi, Nassir; Duhamel, Alain; Launay, Ludivine; Berkhout, Christophe; Raginel, Thibaut
Background: Cervical cancer screening rates are known to be strongly associated with socioeconomic status. Our objective was to assess whether the rate is also associated with an aggregated deprivation marker, defined by the location of family doctors' offices.
Methods: To access this association, we 1) collected data from the claim database of the French Health Insurance Fund about the registered family doctors and their enlisted female patients eligible for cervical screening; 2) carried out a telephone survey with all registered doctors to establish if they were carrying out Pap-smears in their practices; 3) geotracked all the doctors' offices in the smallest existing blocks of socioeconomic homogenous populations (IRIS census units) that were assigned a census derived marker of deprivation, the European Deprivation Index (EDI), and a binary variable of urbanization; and 4) we used a multivariable linear mixed model with IRIS as a random effect.
Results: Of 348 eligible doctors, 343 responded to the telephone survey (98.6%) and were included in the analysis, encompassing 88,152 female enlisted patients aged 25-65 years old. In the multivariable analysis (adjusted by the gender of the family doctor, the practice of Pap-smears by the doctor and the urbanization of the office location), the EDI of the doctor's office was strongly associated with the cervical cancer screening participation rate of eligible patients (p<0.001).
Conclusion: The EDI linked to the location of the family doctor's office seems to be a robust marker to predict female patients' participation in cervical cancer screening.
2020-05-15T00:00:00ZManaging hypertension in frail oldest-old-The role of guideline use by general practitioners from 29 countries.Roulet, CélineRozsnyai, ZsofiaJungo, Katharina TabeaA van der Ploeg, MillyFloriani, CarmenKurpas, DonataVinker, ShlomoKreitmayer Pestic, SandaPetrazzuoli, FerdinandoHoffmann, KathrynViegas, Rita P AMallen, ChristianTatsioni, AthinaMaisonneuve, HubertCollins, ClaireLingner, HeidrunTsopra, RosyMueller, YolandaPoortvliet, Rosalinde K EGussekloo, JacobijnStreit, Svenhttp://hdl.handle.net/10147/6295522021-06-01T01:38:26Z2020-07-10T00:00:00ZManaging hypertension in frail oldest-old-The role of guideline use by general practitioners from 29 countries.
Roulet, Céline; Rozsnyai, Zsofia; Jungo, Katharina Tabea; A van der Ploeg, Milly; Floriani, Carmen; Kurpas, Donata; Vinker, Shlomo; Kreitmayer Pestic, Sanda; Petrazzuoli, Ferdinando; Hoffmann, Kathryn; Viegas, Rita P A; Mallen, Christian; Tatsioni, Athina; Maisonneuve, Hubert; Collins, Claire; Lingner, Heidrun; Tsopra, Rosy; Mueller, Yolanda; Poortvliet, Rosalinde K E; Gussekloo, Jacobijn; Streit, Sven
Background: The best management of hypertension in frail oldest-old (≥80 years of age) remains unclear and we still lack guidelines that provide specific recommendations. Our study aims to investigate guideline use in general practitioners (GPs) and to examine if guideline use relates to different decisions when managing hypertension in frail oldest-old.
Design/setting: Cross-sectional study among currently active GPs from 29 countries using a case-vignettes survey.
Methods: GPs participated in a survey with case-vignettes of frail oldest-olds varying in systolic blood pressure (SBP) levels and cardiovascular disease (CVD). GPs from 26 European countries and from Brazil, Israel and New Zealand were invited. We compared the percentage of GPs reporting using guidelines per country and further stratified on the most frequently mentioned guidelines. To adjust for patient characteristics (SBP, CVD and GPs' sex, years of experience, prevalence of oldest-old and location of their practice), we used a mixed-effects regression model accounting for clustering within countries.
Results: Overall, 2,543 GPs from 29 countries were included. 59.4% of them reported to use guidelines. Higher guideline use was found in female (p = 0.031) and less-experienced GPs (p<0.001). Across countries, we found a large variation in self-reported guideline use, ranging from 25% to 90% of the GPs, but there was no difference in hypertension treatment decisions in frail oldest-old patients between GPs that did not use and GPs that used guidelines, irrespective of the guidelines they used.
Conclusion: Many GPs reported using guidelines to manage hypertension in frail oldest-old patients, however guideline users did not decide differently from non-users concerning hypertension treatment decisions. Instead of focusing on the fact if GPs use guidelines or not, we as a scientific community should put an emphasis on what guidelines suggest in frail and oldest-old patients.
2020-07-10T00:00:00ZA national model of remote care for assessing and providing opioid agonist treatment during the COVID-19 pandemic: a report.Crowley, DesDelargy, Idehttp://hdl.handle.net/10147/6283342020-09-25T03:21:40Z2020-07-17T00:00:00ZA national model of remote care for assessing and providing opioid agonist treatment during the COVID-19 pandemic: a report.
Crowley, Des; Delargy, Ide
Background: Health services globally are struggling to manage the impact of COVID-19. The existing global disease burden related to opioid use is significant. Particularly challenging groups include older drug users who are more vulnerable to the effects of COVID-19. Increasing access to safe and effective opioid agonist treatment (OAT) and other harm reduction services during this pandemic is critical to reduce risk. In response to COVID-19, healthcare is increasingly being delivered by telephone and video consultation, and this report describes the development of a national model of remote care to eliminate waiting lists and increase access to OAT in Ireland.
Purpose and findings: The purpose of this initiative is to provide easy access to OAT by developing a model of remote assessment and ongoing care and eliminate existing national waiting lists. The Irish College of General Practitioners in conjunction with the National Health Service Executive office for Social Inclusion agreed a set of protocols to enable a system of remote consultation but still delivering OAT locally to people who use drugs. This model was targeted at OAT services with existing waiting lists due to a shortage of specialist medical staff. The model involves an initial telephone assessment with COVID-risk triage, a single-patient visit to local services to provide a point of care drug screen and complete necessary documentation and remote video assessment and ongoing management by a GP addiction specialist. A secure national electronic health link system allows for the safe and timely delivery of scripts to a designated local community pharmacy.
Conclusion: The development of a remote model of healthcare delivery allows for the reduction in transmission risks associated with COVID-19, increases access to OAT, reduces waiting times and minimises barriers to services. An evaluation of this model is ongoing and will be reported once completed. Fast adaptation of OAT delivery is critical to ensure access to and continuity of service delivery and minimise risk to our staff, patients and community. Innovative models of remote healthcare delivery adapted during the COVID-19 crisis may inform and have important benefits to our health system into the future.
2020-07-17T00:00:00ZMinor surgery in general practice in Ireland- a report of workload and safety.Ní Riain, AilísMaguire, NiallCollins, Clairehttp://hdl.handle.net/10147/6282422020-09-09T01:29:49Z2020-06-23T00:00:00ZMinor surgery in general practice in Ireland- a report of workload and safety.
Ní Riain, Ailís; Maguire, Niall; Collins, Claire
Background: The provision of minor surgical services is an established part of the task profile of general practitioners (GPs) in many countries in Europe and elsewhere. This study aimed to collect data on the clinical process and outcomes for specified minor surgical procedures undertaken in Irish general practice by GPs experienced in minor surgery in order to document the scope and safety of minor surgery being undertaken.
Methods: Over a six-month period, 24 GPs in 20 practices recorded data on a pre-determined list of procedures undertaken in adults (aged 18 and older); procedures for ingrown toenails were also recorded for those aged 12-18 years. Clinical data were rendered fully anonymous by the participating GPs, entered onto the Excel database template and returned to the project team monthly.
Results: On average, each practice undertook 212 procedures in a six-month period. The four most frequent procedures include two relatively non-invasive procedures (cryosurgical ablation of skin lesions and aspiration and/or injection of joints) and two more invasive procedures (full thickness excision of skin lesion and shave, punch or incisional biopsy). Overall, 83.8% of relevant specimens were submitted for histology. Combining benign and malignant cases, there was an overall 87% clinical and histological concordance; 85% of malignancies were suspected clinically. A complication was recorded in 0.9% after 1 month.
Conclusions: Irish GPs with experience in minor surgery can provide a range of surgical services in the community safely.
2020-06-23T00:00:00ZHepatitis C virus infection in Irish drug users and prisoners - a scoping review.Crowley, DMurtagh, RCullen, WLambert, J SMcHugh, TVan Hout, M Chttp://hdl.handle.net/10147/6271452020-02-06T02:07:18Z2019-08-08T00:00:00ZHepatitis C virus infection in Irish drug users and prisoners - a scoping review.
Crowley, D; Murtagh, R; Cullen, W; Lambert, J S; McHugh, T; Van Hout, M C
Background: Hepatitis C infection is a major public health concern globally. In Ireland, like other European countries, people who use drugs (PWUD) and prisoners carry a larger HCV disease burden than the general population. Recent advances in HCV management have made HCV elimination across Europe a realistic goal. Engaging these two marginalised and underserved populations remains a challenge. The aim of this review was to map key findings and identify gaps in the literature (published and unpublished) on HCV infection in Irish PWUD and prisoners.
Methods: A scoping review guided by the methodological framework set out by Levac and colleagues (based on previous work by Arksey & O'Malley).
Results: A total of 58 studies were identified and divided into the following categories; Epidemiology, Guidelines and Policy, Treatment Outcomes, HCV-related Health Issues and qualitative research reporting on Patients' and Health Providers' Experiences. This review identified significantly higher rates of HCV infection among Irish prisoners and PWUD than the general population. There are high levels of undiagnosed and untreated HCV infection in both groups. There is poor engagement by Irish PWUD with HCV services and barriers have been identified. Prison hepatology nurse services have a positive impact on treatment uptake and outcomes. Identified gaps in the literature include; lack of accurate epidemiological data on incident infection, untreated chronic HCV infection particularly in PWUD living outside Dublin and those not engaged with OST.
Conclusion: Ireland like other European countries has high levels of undiagnosed and untreated HCV infection. Collecting, synthesising and identifying gaps in the available literature is timely and will inform national HCV screening, treatment and prevention strategies.
2019-08-08T00:00:00ZAn online survey of Irish general practitioner experience of and attitude toward managing problem alcohol use.Collins, ClaireFinegan, PearseO'Riordan, Margarethttp://hdl.handle.net/10147/6239902019-08-30T12:30:21Z2018-12-18T00:00:00ZAn online survey of Irish general practitioner experience of and attitude toward managing problem alcohol use.
Collins, Claire; Finegan, Pearse; O'Riordan, Margaret
In the general practice setting screening, brief intervention and counselling have been shown to be effective in the reduction of problem alcohol use. This study aimed to explore Irish general practitioners' (GPs) current practice of and attitudes towards the management of problem alcohol use. An online survey was emailed, with one email reminder, to 1750 general/family practitioners who were members of the Irish College of General Practitioners (ICGP) and for whom an active email address was available. Overall, 476 completed questionnaires were received representing a 27.2% response rate. Two-thirds of the respondents reported that they have managed patients for problem alcohol use and related issues in the past year. The majority, 96%, of respondents indicated that they initiate conversations around alcohol even when the patient does not do so. Almost two thirds of GPs stated that they use structured brief intervention when talking to patients about their alcohol intake and circa 85% reported that they provide some form of counselling in relation to reducing alcohol consumption. While more than two out of three GPs felt prepared when counselling patients in relation to alcohol consumption, almost half considered they are ineffective in helping patients to reduce alcohol consumption. One third of GPs advised that they did not have access to an addiction counsellor. GPs in this survey reported widespread experience of screening and intervention, however, many still felt ineffective. In order to maximise the potential impact of GPs, a clearer understanding is required of what interventions are effective in different scenarios. Furthermore, GPs are only part of the solution in terms of addressing alcohol consumption. The services available in the broader health care system and Government alcohol related policy needs to further support GPs and patients.
In the general practice setting screening, brief intervention and counselling have been shown to be effective in the reduction of problem alcohol use. This study aimed to explore Irish general practitioners' (GPs) current practice of and attitudes towards the management of problem alcohol use.
2018-12-18T00:00:00ZHealth system changes needed to support people consulting general practice out of hours services in Ireland.Collins, CO'Shea, M TCunniffe, JFinegan, Phttp://hdl.handle.net/10147/6239042019-08-30T11:52:15Z2018-01-01T00:00:00ZHealth system changes needed to support people consulting general practice out of hours services in Ireland.
Collins, C; O'Shea, M T; Cunniffe, J; Finegan, P
Mental illness acts as a barrier to accessing and obtaining effective medical care. It has been shown that out of hours services are an important first stop for emergency care for people experiencing mental health difficulties. However, little is in fact known about the use of out of hours general practice services by people experiencing mental health difficulties. To establish the number and range of consultations that have a primary or related mental health issue attending general practitioner (GP) out of hours and to document adherence to their follow-up care referral. Descriptive study in one large out of hours primary care service in the South East of Ireland (Caredoc). An anonymous extraction of retrospective data from 1 year of the out of hours' electronic database was undertaken. Patients who attended the out of hours with a possible mental health issue and were referred to the psychiatric services or back to their own GP, were tracked via phone follow-up with hospitals and GPs over 6 months to establish if they attended for the recommend follow-up care.
Mental illness acts as a barrier to accessing and obtaining effective medical care. It has been shown that out of hours services are an important first stop for emergency care for people experiencing mental health difficulties. However, little is in fact known about the use of out of hours general practice services by people experiencing mental health difficulties.
2018-01-01T00:00:00Z