Primary Care In Ireland Research Articles

Private equity involvement in primary care: the case of Ireland.

Private equity (PE) firms play an increasingly important role in healthcare. Yet, existing research remains uneven, mostly focused on the United States and on certain sectors such as nursing homes. Some geographical areas and health specialties remain under-explored. This brief paper outlines a research agenda focusing on three key issues: (1) PE's significance and (2) business strategies in healthcare, and (3) PE's impacts on health and healthcare. The paper uses primary care in Ireland as an example. The proposed research agenda should improve our understanding of the nature of PE in healthcare and serve as a basis for policy-makers to explore appropriate and effective regulation of PE to reduce its negative impacts if and when they exist.

Survey of GP registrars' training experience and confidence in managing children and adolescents with mental health conditions in primary care.

The aim of thisstudy is to assess General Practitioner (GP) trainees' training experience, and confidence in assessing and managing children and adolescents with common mental health conditions in primary care in Ireland. An online anonymous questionnaire was distributed to third and fourth year GP registrars enrolled in the Irish College of General Practitioners training schemes. The online questionnaire evaluated participants' training experiences and confidence levels in key areas of child and adolescent mental health in primary care. Sixty participants completed the survey out of 406, yielding a response rate of 14.8%. The majority (88%) reported no formal training or experience working in Child and Adolescent Mental Healthcare Services (CAMHS) during their GP training scheme. Responses indicated that many participants rated their competency, skills, and knowledge in essential areas of Child and Adolescent Mental Health as needing improvement. Similarly, their awareness of referral pathways and specialty services was below expectations, with poor perceived access to services. A large proportion (91.7%) expressed a definite need for further training in child and adolescent mental health disorders. The results highlight the need for enhanced training and support for GP trainees in the field of Child and Adolescent Mental Health, ensuring their ability to effectively and confidently address these common issues in primary care.

Estimating the prevalence of potential and actionable drug-gene interactions in Irish primary care: A cross-sectional study.

Pharmacogenetics (PGx) is increasingly recognized as a strategy for medicines optimisation and prevention of adverse drug reactions. According to guidelines produced by the Clinical Pharmacogenetics Implementation Consortium (CPIC) and the Dutch Pharmacogenetic Working Group (DPWG), most medicines with drug-gene interactions (DGIs) are prescribed in primary care. This study aimed to estimate the prevalence of potential and actionable DGIs involving all medicines dispensed in Irish primary care. Dispensings of 46 drugs to General Medical Services (GMS) patients in the Health Service Executive Primary Care Reimbursement Service Irish pharmacy claims database from 01 January 2021 to 31 December 2021 were analysed to estimate the national prevalence of total dispensings and incidence of first-time dispensings of drugs with potential DGIs according to the CPIC and/or DPWG guidelines. Phenotype frequency data from the UK Biobank and the CPIC were used to estimate the incidence of actionable DGIs. One in five dispensings (12 443 637 of 62 754 498, 19.8%) were medicines with potential DGIs, 1878 255 of these dispensed for the first time. On application of phenotype frequencies and linked guideline based therapeutic recommendations, 2349 055 potential DGIs (18.9%) required action, such as monitoring and guarding against maximum dose, drug or dose change. One in five (369 700, 19.7%) first-time dispensings required action, with 139 169 (7.4%) requiring a change in prescribing. Antidepressants, weak opioids and statins were most commonly identified as having actionable DGIs. This study estimated a high prevalence of DGIs in primary care in Ireland, identifying the need and opportunity to optimize drug therapy through PGx testing.

Opportunistic atrial fibrillation screening in primary care in Ireland: results of a pilot screening programme

BackgroundAtrial fibrillation (AF), a common, frequently asymptomatic cardiac arrhythmia, is a major risk factor for stroke. Identification of AF enables effective preventive treatment to be offered, potentially reducing stroke risk...

Trends in medication use after the onset of the COVID-19 pandemic in the Republic of Ireland: an interrupted time series study

Abstract Introduction The COVID-19 pandemic had a substantial impact on a range of health services, particularly in primary care. Research from Ireland suggests while community pharmacies remained open, restrictions for in-person healthcare appointments impacted patients.[1] Although there is evidence that the onset of the pandemic affected medicines utilisation internationally,[2] it is unclear how prescribing in Ireland changed following March 2020. Aim To evaluate how dispensing of medications in primary care in Ireland changed following the onset of the COVID-19 pandemic compared to expected trends. Methods This was an interrupted time series study, and the protocol was pre-registered (doi.org/10.17605/OSF.IO/WNQHR). It used publicly available data from the Health Service Executive Primary Care Reimbursement Services for each month between January 2016 and July 2022. Data covered dispensing on the General Medical Services (i.e. medical card) scheme for all medication therapeutic subgroups and commonly dispensed medications (based on the top 100 individual medications per month). Pre-pandemic data (January 2016-November 2019) was used to forecast expected trends from December 2019 onwards for each subgroup and medication with 99% prediction intervals. The Holt-Winters method was used, which decomposes time series data into seasonal, trend, and irregular components. Three months of observed data unaffected by the pandemic (December 2019-February 2020, validation period) were compared to the forecast to validate accuracy of predictions. Observed data were compared to forecasts in March 2020 (as the first month of pandemic restrictions in Ireland) and over the remainder of the study period from April 2020-July 2022. Statistical significance was defined as observed data outside the 99% prediction interval (p<0.01). Results The overall number of dispensings was 7.6% (99%CI 2.5% to 13.2%) higher than forecast in March 2020. Many (31/77) therapeutic subgroups had dispensing significantly different from forecast in March 2020. Drugs for obstructive airway disease had the largest difference, with dispensing 26.2% (99%CI 19.5%-33.6%) higher than forecasted. Other subgroups with dispensing significantly higher than forecasted included minerals, analgesics, thyroid therapy, serum lipid-reducing agents and diuretics. Dispensing was significantly lower than forecasted for other gynaecologicals (17.7% lower, 99%CI 6.3%-26.6%) and dressings (11.6%, 99%CI 9.4%-41.6%). Similarly, many individual medications had significantly higher dispensing in March 2020. Notably, dispensing of amoxicillin (with/without clavulanic acid) and oral prednisolone were lower than forecasted in the months following the onset of the pandemic, particularly during winter 2020/2021. Conclusion There was a peak in dispensing for many long-term medications in March 2020 suggesting patients obtained additional supplies of their regular medicines as pandemic restrictions were introduced. Exceptions were dispensing of two therapeutic subgroups (dressings/intrauterine devices) linked to in-person healthcare consultations, illustrating the disruption to service delivery. Lower than expected dispensing of antimicrobials and reduced seasonal peaks may be partly due to reduced infection transmission generally. Although we were limited by lacking data on the number of people dispensed each medication, this is the first study to examine changes in medication use during the COVID-19 pandemic in Ireland, considering all therapeutic areas. This study provides evidence to inform planning for medication demand and supply for future major health events.

Trends in medication use at the onset of and during the COVID-19 pandemic in the Republic of Ireland: An interrupted time series study.

The COVID-19 pandemic had a substantial impact on healthcare delivery, particularly in general practice. This study aimed to evaluate how dispensing of medications in primary care in Ireland changed following the COVID-19 pandemic's onset compared to expected trends. This interrupted time series study used data on medications prescribed in general practice 2016-2022 to patient eligible for state health cover, approximately one third of the population. Dispensing volumes for all therapeutic subgroups (ATC2 codes) and commonly dispensed medications were summarized. Pre-pandemic data were used to forecast expected trends (with 99% prediction intervals) using the Holt-Winters method, and these were compared to observed dispensing from March 2020 onwards. Many (31/77) therapeutic subgroups had dispensing significantly different from forecast in March 2020. Drugs for obstructive airway disease had the largest difference, with dispensing 26.2% (99%CI 19.5%-33.6%) higher than forecasted. Only two subgroups were significantly lower than forecasted, other gynaecologicals (17.7% lower, 99%CI 6.3%-26.6%) and dressings (11.6%, 99%CI 9.4%-41.6%). Dispensing of amoxicillin products and oral prednisolone were lower than forecasted in the months following the pandemic's onset, particularly during winter 2020/2021. There was a spike in dispensing for many long-term medications in March 2020, while pandemic restrictions likely contributed to reductions for other medications.

Prescribing differences among older adults with differing health cover and socioeconomic status: a cohort study

IntroductionAs health reforms move Ireland from a mixed public-private system toward universal healthcare, it is important to understand variations in prescribing practice for patients with differing health cover and socioeconomic status. This study aims to determine how prescribing patterns for patients aged ≥ 65 years in primary care in Ireland differ between patients with public and private health cover.MethodsThis was an observational study using anonymised data collected as part of a larger study from 44 general practices in Ireland (2011–2018). Data were extracted from electronic records relating to demographics and prescribing for patients aged ≥ 65 years. The cohort was divided between those with public health cover (via the General Medical Services (GMS) scheme) and those without. Standardised rates of prescribing were calculated for pre-specified drug classes. We also analysed the number of medications, polypharmacy, and trends over time between groups, using multilevel linear regression adjusting for age and sex, and hospitalisations.ResultsOverall, 42,456 individuals were included (56% female). Most were covered by the GMS scheme (62%, n = 26,490). The rate of prescribing in all drug classes was higher for GMS patients compared to non-GMS patients, with the greatest difference in benzodiazepine anxiolytics. The mean number of unique medications prescribed to GMS patients was 10.9 (SD 5.9), and 8.1 (SD 5.8) for non-GMS patients. The number of unique medications prescribed to both GMS and non-GMS cohorts increased over time. The increase was steeper in the GMS group where the mean number of medications prescribed increased by 0.67 medications/year. The rate of increase was 0.13 (95%CI 0.13, 0.14) medications/year lower for non-GMS patients, a statistically significant difference.ConclusionOur study found a significantly larger number of medications were prescribed to patients with public health cover, compared to those without. Increasing medication burden and polypharmacy among older adults may be accelerated for those of lower socioeconomic status. These findings may inform planning for moves towards universal health care, and this would provide an opportunity to evaluate the effect of expanding entitlement on prescribing and medications use.

Early cancer detection in primary care in Ireland: a protocol for a research prioritisation exercise

Background: Cancer is a significant cause of morbidity, mortality, and economic loss in Ireland. It is important that cancer research funding is directed in accordance with the values of a wide variety of stakeholders, so as to ultimately deliver tangible benefits to cancer patients. The aim of this study is to achieve consensus among key stakeholders (including patients, caregivers, healthcare professionals, policymakers and academics) regarding research priorities in the area of early detection of cancer in primary care in Ireland. Methods: A research prioritisation exercise adapted from the James Lind Alliance (JLA) consensus framework will be used to enable all key stakeholders to identify and prioritise research questions. This involves the following stages: (1) setting up a steering group and priority setting partnership, (2) gathering potential research questions via an online survey, (3) processing, categorising, and summarising these research questions, (4) identifying the unanswered research questions, (5) determining the top 10 research priorities via a consensus workshop. Results: The following outcomes will be reported: (1) a “Top 10” list of the most important research questions in early cancer detection in primary care; (2) a list of unanswered research questions which ranked outside of the Top 10; (3) a list of research questions which were proposed but considered to be already answered by a panel of academics working in the field. Conclusions: The co-production of consensus derived research questions in early cancer detection will provide a platform for both funders and researchers to concentrate on the most significant issues to stakeholders, especially patients and their doctors.

Point prevalence audit surveys of respiratory tract infection consultations and antibiotic prescribing in primary care before and during the COVID-19 pandemic in Ireland.

Respiratory tract infections (RTIs) are the most common reason for prescribing antibiotics in general practice. The COVID-19 pandemic has impacted on antibiotic prescribing and delivery of primary care in Ireland. To assess the quality of antibiotic prescribing, the impact of the COVID-19 pandemic and identify opportunities for antimicrobial stewardship (AMS) in Ireland. Point prevalence audit surveys for RTI consultations were conducted as part of a European study at three time periods: January-February 2020, March-May 2020 and March-May 2021. Antibiotic prescribing was assessed and comparisons made between the three time periods. In total, 765 consultations were recorded, which were mainly face to face before the pandemic, but changed to predominantly remote consultations during the pandemic surveys in 2020 and 2021 (82% and 75%). Antibiotics were prescribed in 54% of RTI consultations before the pandemic. During pandemic surveys, this dropped to 23% in 2020 and 21% in 2021. There was a decrease in prescribing of Red (reserve) agents in 2021. Assessment against indication-specific quality indicators showed a high proportion of consultations for bronchitis and tonsillitis resulting in an antibiotic prescription (67% and 85%). Point-of-care testing (POCT) to aid diagnosis of RTIs were utilized in less than 1% of consultations. During the COVID-19 pandemic, there was a reduction in antibiotic prescribing. Opportunities identified to support AMS in primary care in Ireland are targeted initiatives to reduce antibiotic prescribing for bronchitis and tonsillitis and introducing POCT to support appropriate antibiotic prescribing.

An audit of antibiotic prescribing in primary care 2019-2020 in Dunmanway Primary Care Centre.

Antibiotics are often the most common medication prescribed by general practitioners (GPs) and are often expected by patients despite campaigns such as Under the Weather. Antibiotic resistance is increasing in the community. The Health Service Executive (HSE) has issued 'Guidelines for Antimicrobial Prescribing in Primary Care in Ireland' aiming to optimise safe prescribing. This audit aims to analyse change in quality of prescribing after educational intervention. GP prescribing patterns were analysed over a week in October 2019 and re-audited in February 2020. Anonymous questionnaires detailed demographics, condition and antibiotic details. Educational intervention included texts, information and review of current guidelines. Data were analysed on a password protected spreadsheet. The HSE Guidelines for Antimicrobial Prescribing in Primary Care were taken as reference standard. A standard of 90% compliance for choice of antibiotic and 70% compliance for dose and course was agreed. FindingsAuditRe-AuditNumber prescriptions4024Number delayed scripts4/40=10%1/24=4.2%Adult37/40=92.5%19/24=79.2%Child3/40=7.5%5/24=20.8%IndicationURTI22.50%25%LRTI10%4%Other RTI37.50%42%UTI20%29%Skin12.50%0%Gynaecological2.50%0%2+ Infections 5%0%Co-amoxiclav17.50%12.50%AdherenceChoice37/40=92.5%22/24=91.7%Dose28/39=71.8%17/24=70.8%Course28/40=70%12/24=50%Discussion: Excellent antibiotic choice and dose concordance with guidelines was noted, with both phases meeting the set standards. Suboptimal course compliance with guidelines occurred in the re-audit. Potential causes include concerns regarding resistance and patient factors not included. This audit included unequal number of prescriptions in each phase but are still of significance and addresses a clinically relevant topic.

Reflections on recruiting healthcare professionals as research participants: Learning from the ONSPres Study.

The involvement of healthcare professionals (HCPs) as research participants is essential to generate high quality evidence for enhancing health services and practice. Research teams face many challenges in recruiting HCPs for research, and barriers and enablers for interdisciplinary research are not well described in the literature. The Oral Nutritional Supplement Prescribing Malnutrition Research Study (ONSPres Study) examined malnutrition identification, management, and appropriate oral nutritional supplement prescribing in primary care in Ireland. The ONSPres Study offers a unique view of recruiting HCPs for research because a range of disciplines were sought for participation in a mixed methods study. The purpose of this open letter is to describe the experiences of recruitment and participation. Sixteen general practitioners (GPs) were recruited to participate in one-to-one interviews, eighty health and social care professionals working in community care (including nurses, pharmacists, dietitians, physiotherapists, speech and language therapists, and occupational therapists) were recruited to take part in 12 focus groups, and 31 GPs and trainee GPs were recruited to participate in an education programme developed by the study team. Strategies required to gain access and reach HCPs differed between disciplines. Professional networks enhanced access to HCPs working in practice and recruitment was slower and more tailored when those networks were less available to the team. An interest in malnutrition, to assist in research, to advance patient care, and the opportunity for learning were incentives for the participating HCPs. Limitations in the diversity of the sample arose, with a bias towards female participants and GPs motivated by an interest in the topic. It is recommended that study teams collaborate early with relevant HCP disciplines so they can contribute to recruitment planning at project concept and design stages. To enhance and incentivise HCP participation in research, dedicated time and acknowledgement of participation as continuous professional development is proposed.

Changes to primary care delivery during the COVID-19 pandemic and perceived impact on medication safety: A survey study

IntroductionThe COVID-19 pandemic has had a profound impact on the delivery of primary care around the world. In Ireland, the use of technologies such as virtual consultations and the electronic transfer of prescriptions became widespread in order to deliver care to patients while minimising infection risk. The impact of these changes on medication safety is not yet known. ObjectivesThe aims of this survey study were to investigate 1) the changes that have occurred in Irish primary care since the start of the COVID-19 pandemic and 2) the impact of these changes on medication safety. MethodsAnonymous, online surveys were distributed to general practitioners (GPs) and pharmacists from August–September 2021. Surveys contained quantitative (multiple-choice, Likert scale) and qualitative (free-text) questions concerning workflow changes, medication safety incidents and near misses, and GP/pharmacist perspectives on medication safety and COVID-19. Reported medication safety incidents and near misses were categorised according to the WHO Conceptual Framework for the International Classification for Patient Safety. ResultsIn total, there were 251 responses to the survey, comprising of 211 pharmacists and 40 GPs. The most significant workflow changes during the pandemic were the widespread use of a secure clinical email service (Healthmail) that facilitates electronic prescription transfer and communication (75.3% of respondents) and the increased use of telephone consultations (49%). Overall, Healthmail was widely perceived to have had a positive impact on medication safety. Most GPs did not perceive a change in the frequency of medication safety incidents during the pandemic, while most pharmacists reported a slight increase in incidents. Survey participants highlighted pressure, patient expectations, and patient monitoring as significant challenges encountered during the pandemic. ConclusionsDuring the pandemic, a number of significant changes occurred in primary care in Ireland, particularly involving communication of healthcare information, with varying impacts on workflow and medication safety. Future research should focus on the optimisation of electronic prescribing and telemedicine services in Ireland, patient perspectives on the changes in primary care, and interventions to improve medication safety in primary care.

Diagnostic Pathway of Head & Neck Cancer Patients in Ireland: Audit of patterns of first attendance 1983-2019.

##Objectives: This audit explores patterns of HNC patient presentation in primary care in Ireland over four decades and reflects on the possible impact of a 10-year national HNC awareness campaign. ##Materials and Methods: Trends in patient presentation and diagnosis are presented for 920 HNC patients across three time periods: 1983-1990, 2010 and 2018-2019. Descriptive analysis was undertaken using SPSS-v27 on basic demographic details, tumour-related details and primary care referral patterns. ##Results: Patients were generally male (71%), aged 54+ (71%), and 84% were diagnosed with squamous cell carcinoma (SCC). Larynx, tongue and tonsil were the most common sub-sites. General Medical Practitioners (GPs) were the first healthcare contact for 75% cases, with only13% referred by General Dental Practitioners (GDPs). This pattern remained consistent across four decades. GDP role was higher for tongue, floor of mouth and intra-oral tumours (30-47%), with some increase seen in recent years. While symptomology varied by site, symptom burden remained high across the decades with 99.9% exhibiting 1+ NICE ‘red flag signs’ of HNC, suggesting considerable diagnostic delay, despite a 10-year national campaign to raise public and professional awareness. ##Conclusions: This audit highlights the role of GPs in HNC diagnosis, but reveals sub-optimal use of the dental pathway. The high symptom burden reported suggests considerable diagnostic delay. Increased and sustained efforts are required to raise public and professional awareness, encourage regular dental attendance, upskill HCP in opportunistic screening and ensure appropriate responses to symptomatic patients.

Prescribing differences among older adults with differing health cover and socioeconomic status: a cohort study

Abstract Introduction Ireland currently has a mixed public-private health system, where about 40% of individuals are entitled to free or low-cost public care based on their income and age (1). As health reforms move Ireland toward universal healthcare, it is important to understand divergent prescribing practice to patients with differing health cover and socioeconomic status. Aim To determine how prescribing patterns for patients aged ≥65 years in primary care in Ireland differ between public and private patients. Methods Data were collected during a larger study from 44 general practices in Ireland (2). Data were extracted from the patient management system relating to demographics and prescribing. Patients were included in the present analysis if they had prescriptions issued on at least two dates during the study period (2011-2018), and had demographics (age and sex) and prescription dates recorded. The cohort was divided between those with public health cover (via the GMS scheme, which over-represents socioeconomically deprived people) and those without. We calculated the standardised rate of prescribing for drug classes separately for GMS and non-GMS (private) patients. We pre-specified 12 drug classes of specific interest, due to their prevalence, inclusion in Ireland’s Preferred Drugs Initiative, or potential for sub-optimal prescribing. We also analysed the number of medications, polypharmacy, and trends over time between groups, using multilevel linear regression adjusting for age and sex. Results The study included 42,456 individuals, 62% with GMS cover. The rate of prescribing for all pre-specified drug classes was higher for GMS patients compared to non-GMS patients. In all cases, the rate of prescribing was at least 1.6 times higher in the public group, with this being the minimum difference between groups in the rate of antibacterials for systemic use. We saw the greatest disparity in inhaled adrenergics combined with corticosteroids and/or anticholinergics where the rate of public prescribing was 2.25 times higher. The mean number of unique medications prescribed to GMS patients was 10.9 (SD 5.9), and 8.1 (SD 5.8) for non-GMS patients. Among GMS patients, 85% had polypharmacy (being on ≥5 medications) compared to 77% among the non-GMS patients, while 51% and 43% respectively had major polypharmacy (≥10 medications). The mean number of medications prescribed per person increased in both groups over time. The increase was steeper and more sustained in the public health cover group where the mean number of medications prescribed increased by 0.67 medications/year for GMS patients. The rate of increase was 0.13 (95%CI 0.13, 0.14) medications/year lower for non-GMS patients, a statistically significant difference. Conclusion Our study found a significantly larger number of unique medicines were prescribed to patients with public health cover, compared to those without. This disparity increased over time and was consistent within all drug classes analysed. This may be driven by socioeconomic deprivation rather than health cover, although a limitation is that we were unable to examine or adjust for these potential contributors separately. Our study provides new evidence that the growth in medication burden and polypharmacy among older adults is accelerated for those of lower socioeconomic status. References (1) Thomson S, Jowett M, Mladovsky P. The editors Observatory Studies Series No. 33 33 Observatory Studies Series Health system responses to financial pressures in Ireland. (2) Pérez T, Moriarty F, Wallace E, McDowell R, Redmond P, Fahey T. Prevalence of potentially inappropriate prescribing in older people in primary care and its association with hospital admission: Longitudinal study. BMJ. 2018;363.

Atrial fibrillation (AF) pilot screening programme in primary care in Ireland: an implementation study protocol

IntroductionAtrial fibrillation (AF) is a major risk factor for stroke. There is a fivefold increase in stroke risk in the presence of AF. The irregular beating of the heart enables...

Quality care metrics for nurses working in general practice, mapping the evidence: a scoping review protocol

Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands over the past three decades. However, as nursing care in general practice advances at pace, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to carefully assess the role and facilitate development of services are required. Nursing quality care metrics (QCM) are an established mechanism which measure nursing care process, evaluate quality, and impact of care, and inform service development. The use of nursing QCM has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development of QCM within Irish GPN settings. Aim: To explore and map the literature regarding the use, application, and impact of nursing quality care metrics within a general practice, primary care setting. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O’Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCM which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about QCM, their use in general practice or primary care settings, and enrich understanding of their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary care in Ireland.

Disparities in Oral Nutritional Supplement Usage and Dispensing Patterns across Primary Care in Ireland: ONSPres Project.

When treating malnutrition, oral nutritional supplements (ONSs) are advised when optimising the diet is insufficient; however, ONS usage and user characteristics have not been previously analysed. A retrospective secondary analysis was performed on dispensed pharmacy claim data for 14,282 anonymised adult patients in primary care in Ireland in 2018. Patient sex, age, residential status, ONS volume (units) and ONS cost (EUR) were analysed. The categories of ‘Moderate’ (<75th centile), ‘High’ (75th–89th centile) and ‘Very High’ ONS users (≥90th centile) were created. The analyses among groups utilised t-tests, Mann–Whitney U tests and chi-squared tests. This cohort was 58.2% female, median age was 76 years, with 18.7% in residential care. The most frequently dispensed ONS type was very-high-energy sip feeds (45% of cohort). Younger males were dispensed more ONSs than females (<65 years: median units, 136 vs. 90; p < 0.01). Patients living independently were dispensed half the volume of those in residential care (112 vs. 240 units; p < 0.01). ‘Moderate’ ONS users were dispensed a yearly median of 84 ONS units (median cost, EUR 153), ‘High’ users were dispensed 420 units (EUR 806) and ‘Very High’ users 892 yearly units (EUR 2402; p < 0.01). Further analyses should focus on elucidating the reasons for high ONS usage in residential care patients and younger males.

Analysis of dispensing patterns and non-disease specific oral nutritional supplement usage in primary care: the onspres project

Rationale: Oral nutritional supplements (ONS) are recommended for malnutrition when dietary optimisation is insufficient. Multi-disciplinary support to manage malnutrition is limited, and the characteristics of ONS users and patterns of usage are unclear. This analysis describes the characteristics of ONS users and dispensing patterns of ONS in primary care in Ireland.

64 MANAGING FRAILTY IN AN IRISH PRIMARY CARE SETTING: A QUALITATIVE STUDY

Abstract Background Frailty is a complex, age-related condition which confers a risk of adverse outcomes. Evidence supports the effectiveness of screening and Comprehensive Geriatric Assessment (CGA) to meet the needs of frail older people. Little is known about the views of key stakeholders on frailty in a Primary Care context. This study explored the views of healthcare professionals and patients on frailty management in Primary Care in Ireland. Methods A qualitative descriptive study using semi-structured interviews was conducted. Healthcare professionals and patients were recruited using purposive sampling. Patients were recruited through the Frailty Intervention Team at the local acute hospital. Patients with cognitive impairment were excluded. Written informed consent was provided. Data were audio-recorded, transcribed and analysed using thematic analysis. The research was approved by the local Ethics Committee. Results Three patients and 17 healthcare professionals from general practice, public health nursing, physiotherapy, occupational therapy and social work participated. Three themes emerged. (i) Perceptions of Frailty (ii) Current Management of Frailty and (iii) CGA in Primary Care. Results demonstrated variability of perspectives on the concept of frailty, with limited knowledge of screening and CGA. Healthcare professionals described a fragmented service with sub-standard care for frail older patients. Critical weaknesses were: absence of essential services, uni-disciplinary working, inadequate IT systems and integration. Support for screening and CGA in Primary Care was evident. The general consensus was that frailty management required an adequately resourced Primary Care and the suitability of the current pathway for patients requiring CGA should be reviewed. Conclusion This study highlights an absence of a complete understanding of frailty among healthcare professionals. Inter-professional training and education is advocated. Further development of a frailty pathway and investment in Primary Care is required to improve care for frail older people. An intermediate interface service with a dedicated frailty management team is suggested.

Patients’ attitudes to and experience of the use of technology in mental health in Ireland

Abstract Mental health issues represent a significant proportion visits to GPs. It is estimated that 90% of mental health issues in Ireland are addressed in general practice, with an international trend towards making mental health services available in primary care. However, at present the mental health services, both locally in Ireland and internationally, are unable to meet the growing needs of those suffering mental ill health. Healthcare services internationally have examined novel and innovative ways of bridging with gap between patient needs and the available mental health services including e-mental health - “the use of information and communication technology to support and improve mental health”. The aim of this research was to explore patients' attitudes towards and experience of the use of technology and online resources with regard to mental health. Data was gathered by means of a patient survey. 8 point questionnaires were distributed and completed anonymously by 61 patients at the Carlton Clinic in Bray, Co. Wicklow. The objectives of the questionnaire were to ascertain patients' levels of awareness of the technology based resources available; whether they were using them; what patients' experience of using this technology was. The research showed low levels of awareness and usage with 39% of respondents aware of technology based resources and only 11% having ever used them. 15% of respondents reported that a GP had recommended digital resources to them. 72% of those surveyed reported they would find it useful if a GP recommended digital resources to them with regard to mental health issues. Conclusions Awareness and usage of digital resources in primary care population is low. However, the majority of patients were positive towards the option of digital resources and are willing to discuss them in mental health consultations. Key messages Readinzess of patients to embrace technology as means of delivering care and treatment for mental health problems in primary care in Ireland. Need for improved awareness of e-health options.