General Practices In Northern Ireland Research Articles

An exploration of Northern Ireland general practice pharmacists’ views on their role in general practice: a cross-sectional survey

BackgroundThere is limited research examining the views of general practice pharmacists (GPPs) on their role and their impact in general practice. The aim of this study was to explore GPPs’ views regarding this role and its potential impact within general practice in Northern Ireland (NI).MethodsA paper-based self-administered questionnaire was mailed to 319 general practices in NI in 2022, directed to the GPP who spent most time at the practice. A variety of closed and open questions were included in six sections. Responses to closed questions were analysed descriptively whilst open question responses were analysed using content analysis. To ascertain associations between variables (e.g. GPP prescribing status, working arrangements and aspects of collaboration with GPPs), Fisher’s exact test was employed with an a priori significance level of p < 0.05.Results155 responses were received equating to a response rate of 48.5%. Most participants (72.3%) were female, independent prescribers (71%), and 64.5% were currently using their independent prescriber qualification. Services that were provided by most GPPs were medication reconciliation (99.4%) and medication reviews (97.4%). The most common method of communication between GPPs and general practitioners (GPs) was face-to-face (89.0%). Telephone was the most common method of communication between GPPs, community pharmacists (97.4%) and patients (98.7%). Most GPPs (> 80%) showed positive attitudes towards collaboration with GPs and those who worked in multiple practices were more likely to agree with the Attitudes Towards Collaboration Instrument for pharmacists (ATCI-P) statements compared to those who worked in a single practice (p < 0.05). Less than 40% (36.8%) of GPPs agreed that patients were aware of the role they provided. The majority of GPPs (80.6%) expressed positive views on their impact on primary care. Analysis of the free-text comments revealed the need for more GPP patient-facing activities, GPP-specific training, and promotion of the GPP role.ConclusionThe findings indicated that GPPs had largely positive views about their role and their impact on primary care. The results may be helpful for practices and service commissioners. Further research is necessary to explore the perspectives of patients regarding the role of the GPP and to enhance patients’ awareness of the GPP.

Levelling up or left behind? Does increasing GP training numbers inadvertently widen health inequalities?

Increasing the GP workforce will not automatically level up healthcare provision; instead, increasing GP training numbers could worsen health inequity and inequalities. This is especially of concern if there are fewer opportunities to learn, train, and build confidence in under-served, socioeconomically deprived areas. To examine how representative of wider socioeconomic deprivation the postgraduate GP training practices are in Northern Ireland (NI). The deprivation indices and scores of GP postgraduate training practices were compared against general practice in NI. Representation of practices whose patients live in blanket deprivation, higher deprivation, and higher affluence was compared. Of 319 practices in NI, 171 (54%) were registered as postgraduate training practices and had a mean deprivation score of 3.02 (95% CI [confidence interval] = 2.91 to 3.12) compared with non-training practices' higher mean deprivation score of 3.2 (95% CI = 3.01 to 3.33), P-value <0.05. The proportion of training practices with blanket deprivation and higher levels of deprivation are marginally underrepresented and training practices had higher affluence scores. Postgraduate training practices had a statistically significant lower deprivation score and did not fully reflect the socioeconomic make-up of wider NI general practice. The results, however, are more favourable than the representation in other areas of the UK and better than undergraduate teaching opportunities in general practice. As GP recruitment is increased, representation of general practice in areas of high need and high socioeconomic deprivation is essential, otherwise it risks widening health inequalities.

Levelling up or left behind? are GP training opportunities in northern Ireland widening or closing the gap on health inequalities?

Increasing the GP workforce will not necessarily level up healthcare provision: instead increasing GP training numbers could worsen health inequity and inequalities. This is especially true if there are fewer opportunities to learn, train and build confidence in under-served, socioeconomically deprived areas. To investigate the representation of socioeconomic deprivation in postgraduate GP training practices in Northern Ireland (NI). Socioeconomic deprivation indices and scores of GP practices in Northern Ireland were calculated. We compared the socioeconomic deprivation indices and scores of GP postgraduate training practices against general practice in NI by examining the representation of practices whose patients live in areas of blanket deprivation, higher deprivation and higher affluence. Of 319 practices in NI, 171 (54%) were registered as postgraduate training practices with a mean deprivation score of 3.02 (95% CI 2.91-3.12) compared with non-training practices' higher mean deprivation score of 3.2 (95% CI 3.01-3.33), P-value <0.05. The proportion of training practices with blanket deprivation and higher levels of deprivation was underrepresented, with the current postgraduate GP training practices having more affluent populations. Postgraduate training practices had a statistically significant lower deprivation score and did not fully reflect the socioeconomic make-up of wider NI general practice. The results, however, are more favourable than in other areas of the UK and better than undergraduate teaching opportunities in general practice. Health inequalities will worsen if the representation of general practice training in areas of greater social economic deprivation is not increased.

Impact of social prescribing on general practice workload and polypharmacy

ObjectivesSocial prescribing has emerged as a useful tool for helping patients overcome some of the social and behavioural determinants of poor health. There has been little research on the impact of social prescribing on use of primary healthcare resources. This study sought to determine whether social prescribing activities influenced patient-general practitioner (GP) contacts and polypharmacy. Study designQuality-improvement design with social prescribing activity interventions from an urban general practice in Northern Ireland. MethodsPatients over 65 years of age with a chronic condition who attended their GP frequently or had multiple medications were offered a social prescribing activity. Participants' contacts with GP and the new repeat prescriptions before and during the social prescribing activity were measured. The total number of repeat prescriptions per patient was compared at the time of referral and 6–12 months later. Indications for referral, primary diagnoses and reasons for declining participation in a social prescribing activity after referral were prospectively recorded. ResultsSixty-eight patients agreed to participate but only 28 (41%) engaged in a prescribed social activity. There was no statistically significant difference in GP contacts (visits to GP, home visits or telephone calls) or number of new repeat prescriptions between referral and completion of 12 weeks of social prescribing activity. Similarly there was no statistically significant difference in the total number of repeat prescriptions between referral and 6–12 months after social prescribing activity in either intention to treat or per protocol analyses. Social prescribing participants had similar demographic factors. Mental health issues (anxiety and/or depression) were more common among participants than those who were referred but declined participation in a social prescribing activity (P = 0.022). ConclusionsWhile social prescribing may help patients' self-esteem and well-being, it may not decrease GP workload. Further research is required to optimise social prescribing benefits.

Molecular characterisation of the quinolone resistance-determining regions (QRDR) including gyrA, gyrB, parC and parE genes in Streptococcus pneumoniae

ABSTRACTStreptococcus pneumoniae is the leading cause of community-acquired pneumonia (CAP). Currently, empirical treatment with quinolones is being used due to the emergence of β-lactam and macrolide resistance in S. pneumonaie. Although the prevalence of quinolone-resistant S. pneumoniae remains low, increasing numbers of resistant isolates are being seen. Genetic mechanisms leading to fluoroquinolone resistance in pneumococci are complex. This study aims to use molecular methods to characterise all isolates through sequence analysis of their QRDR regions. Thirty-two S. pneumoniae isolates were obtained from nasal swabs from adult and paediatric patients attending local general practices in Northern Ireland. Phenotypic minimum inhibitory concentration (MIC) was determined for Clinical and Laboratory Standards Institute (CLSI) broth microdilution against ciprofloxacin, levofloxacin and norfloxacin. Simultaneously, the QRDR regions of gyrA, gyrB, parC and parE were analysed by sequence typing for all pneumococci obtained. Only one isolate (3.1%) showed reduced susceptibility to ciprofloxacin and levofloxacin. Two amino acid positions were discordant in the S. pneumoniae R6 strain and eight (25%) and 23 (71.9%) isolates contained the mutations Ile460Val in gyrA and Lys137Asn in parC (deposited in GenBank, accession numbers GQ999587–GQ999589), respectively. No mutations were found in either the gyrB or parE loci. In conclusion, the study demonstrated increased fluoroquinolone resistance which could not be accounted for simply through QRDR mutations, and, reciprocally, that mutations in the QRDR region do not necessarily result in overt phenotypic resistance.

The stroke offspring study: is parental stroke history of value in targeted risk factor screening?

This study aimed to compare the prevalence of stroke risk factors among people with a parental history of stroke to those in a control group of individuals, of similar age, gender and social class, with no parental stroke history. Parental stroke increases an individual's risk of stroke, but little is known of the potential value of using this information in targeted screening for primary prevention in general practice. We sent questionnaires to 300 randomly selected individuals aged 40-65 years, in each of 11 different general practices in Northern Ireland. Among 1061 responses received within six weeks, 332 reported a parental history of stroke (31.3%). We matched respondents with (cases) and without (controls) a parental history of stroke on characteristics of age, gender and socioeconomic status. Matched pairs were invited to attend a consultation at which their diet and exercise habits were assessed using validated questionnaires and height, weight, blood pressure and serum lipids and glucose were measured. Matched data were available for 199 case-control pairs (398 individuals). Mean systolic and diastolic blood pressures were significantly higher in cases than in paired controls (systolic 146.3 versus 140.6 mmHg (P < 0.01); diastolic 87.7 versus 85.0 mmHg (P = 0.014)). Cases consumed more alcohol than their paired controls (13.8 versus 10.1 U/week (P < 0.01)), but their measures of body mass index, lipids, diabetes, diet and exercise did not differ significantly. The results of this study suggest that screening offspring of patients with stroke in respect of blood pressure has potential value in identifying people likely to benefit from primary prevention, but do not support the adoption of a targeted screening strategy for other commonly cited stroke risk factors.

Thomas Gilliland Lowry

Thomas Gilliland Lowry was the second of five sons (all but one of whom became doctors). After qualifying he tried to get into general practice in Northern Ireland immediately, but...

Effect of tailored practice and patient care plans on secondary prevention of heart disease in general practice: cluster randomised controlled trial

Objective To test the effectiveness of a complex intervention designed, within a theoretical framework, to improve outcomes for patients with coronary heart disease.Design Cluster randomised controlled multicentre trial.Setting General practices...

Secondary prevention of cardiovascular disease in different primary healthcare systems with and without pay-for-performance

Objective:To compare baseline cardiovascular risk management between people from two different healthcare systems recruited to a research trial of an intervention to optimise secondary prevention.Design:Cross-sectional study.Setting:16 randomly selected general practices...

The journey to concordance for patients with hypertension: a qualitative study in primary care

We aimed to explore, using qualitative methods, the perspectives of patients with hypertension on issues relating to concordance in prescribing. This study took place in NHS general practices in Northern Ireland. A purposeful sample of patients who had been prescribed anti-hypertensive medication for at least one year were invited to participate in focus groups or semi-structured interviews; data were analysed using constant comparison. The perspectives of patients with hypertension on issues relating to concordance in prescribing. Twenty-five individuals participated in five focus groups; two participated in semi-structured interviews. Participants felt they could make valuable contributions to consultations regarding their management. They were prepared to negotiate with GPs regarding their medication, but most deferred to their doctor's advice, perceiving doctors' attitudes and time constraints as barriers to their greater involvement in concordant decision-making. They had concerns about taking anti-hypertensive drugs, were aware of lifestyle influences on hypertension and reported using personal strategies to facilitate adherence and reduce the need to take medication. Participants indicated a willingness to be involved in concordance in prescribing anti- hypertensive medication but needed health professionals to address their concerns and confusion about the nature of hypertension. These findings suggest that there is a need for doctors and other healthcare professionals with responsibility for prescribing to develop skills specifically to explore the beliefs and views underlying an individual's medication use. Such skills may need to be developed through specific training programmes at both undergraduate and postgraduate level.

Patient-Active Prevention in Primary Dental Care: A Characterisation of General Practices in Northern Ireland

To investigate the preventive orientation of general dental practices by examining their patient-active prevention activities, practice policies for prevention and employment strategies. All general dental practices located within the region of the Eastern Health and Social Services Board (EHSSB) in Northern Ireland were contacted and invited to participate. A questionnaire assessed practice characteristics, patient-active prevention, practice policies and employment strategies. The principal general dental practitioner (GDP) was invited to complete the questionnaire. Seventy-seven per cent of practices participated. Nearly all the practices provided patient-active prevention; however, lower proportions of dentists provided advice on diet for dental caries (3%), oral hygiene instruction, fluoride toothpaste use and interdental cleaning (7%) with each new course of dental treatment. 'Patient-active' prevention practices were 5.8 times more likely to employ a hygienist and 5.3 times more likely to have a practice policy to screen for oral cancer. These findings suggest that the employment of a hygienist is central to the reorientation of primary dental care. The Government must be encouraged to provide the financial means to allow primary care to shift from being disease-centred to health-focused.

Sterilization and disinfection in general practice in Northern Ireland

: In view of the recent trend towards more minor surgery being carried out in general practice we decided to conduct a postal survey to assess the level of knowledge of sterilization and disinfection and the use of benchtop sterilizers in general practice in Northern Ireland. The survey, of all 366 practices in the Province, was carried out in January/March 1998. One hundred and eleven (30%) completed questionnaires were returned. All practices performed at least one of a range of procedures requiring sterilization or disinfection, e.g., minor surgery 95%, cervical smear taking 98%, syringing of ears 98%. Only 76% of practices had a benchtop sterilizer and 39% did not have access to a sterile supply department (SSD); 32% of the latter had no desire to utilize such a service. Only 25% and 34% correctly identified the Medical Devices Agency (MDA) definitions of sterilization and disinfection respectively. The MDA Device Bulletin on benchtop sterilizers had been read by only 26% of respondents. There was an 86% interest in attending a workshop on sterilization and disinfection. The concepts and practice of sterilization and disinfection appear not to be clearly understood. We conclude that resources must be identified to provide appropriate education in this important area for primary care staff.

General practice data retrieval: the Northern Ireland project.

To develop an epidemiological database of morbidity in the community as presented to general practitioners and to support epidemiological research in general practice. The project is a sentinel network of 23 general practices in Northern Ireland that report the incidence of a list of selected diseases to a central unit for analysis. Results are presented for depression, diabetes, and myocardial infarction. The age--sex distributions of diabetes and myocardial infarction are comparable with other published data but the incidence of depression is under estimated. The importance of complete accuracy of data reported within sentinel networks depends on the purposes for which information is to be used. For some diagnoses, such as diabetes and acute myocardial infarction, the accuracy of the reported incidence is high while for other diseases, such as depression, where diagnostic behaviour varies more between doctors, the figures are much less reliable.

The relationship of fasting insulin levels to vascular risk factors in a general practice in Northern Ireland

To investigate the relationship between insulin and vascular risk factors in a healthy male population at high risk of ischaemic heart disease. Computer-generated random number selection of subjects. A suburban general practice population (total practice population 4500) in Northern Ireland. Four hundred male subjects, aged 35-65 years, were randomly selected with 273 responding. At interview, each subject completed a questionnaire, had blood pressure measured and a 12-lead ECG recorded. The next morning, fasting blood samples were taken and a timed overnight urine collection for the albumin excretion rate was returned. To exclude the confounding effects of other variables on insulin concentrations, a healthy nonobese, nondiabetic, normotensive group with no history of ischaemic heart disease, no family history of diabetes and not taking drugs was identified (n = 120). Within this group there was a significant correlation between insulin and triglyceride (r = 0.30; P < 0.05), high-density lipoprotein (HDL) cholesterol (r = 0.24; P < 0.05) and glucose (r = 0.30; P < 0.05). A group with higher insulin levels (n = 22) were compared to a group with lower insulin levels (n = 22). Serum triglyceride was higher (1.29 +/- 0.1 vs. 1.00 +/- 0.08 mmol L-1; P < 0.05), HDL cholesterol was lower (1.26 +/- 0.06 vs. 1.50 +/- 0.09 mmol L-1; P < 0.05) and plasma glucose higher (5.2 +/- 0.1 vs. 4.9 +/- 0.1 mmol L-1; P < 0.05) in the group with higher insulin levels. There is a relationship between insulin and triglyceride, HDL cholesterol and glucose but not blood pressure, cholesterol or low-density-lipoprotein (LDL) cholesterol in a healthy population at high risk of ischaemic heart disease.

Antibiotic prescribing: the need for a policy in general practice.

To see whether changes in prescribing of oral antibacterials in Northern Ireland show the need for a community antibiotics policy. Analysis of prescribing totals for several oral antibiotics obtained retrospectively from the prescription pricing bureau for the years 1983-7. Audit of anti-infective prescribing in general practice in Northern Ireland over five years. Respective usage of agents defined as "common" and "occasional" in 1983. There was a gradual decrease in the relative use of common agents from 82% of the total in 1983 to 77% in 1987 together with a complementary increase in the use of occasional agents from 5% to 10%. Pronounced changes were noted in the use of amoxycillin, ampicillin, erythromycin, minocycline, doxycycline, and amoxycillin-clavulanic acid. Though this survey found reasonably conservative prescribing, the trend towards increased use of occasional agents has both clinical and cost implications which could be addressed by the use of a prescribing formulary.

Pellagra in General Practice in Northern Ireland

Pellagra in General Practice in Northern Ireland