Primary Care Reimbursement Service Research Articles

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.

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.

Utilization, Expenditure, and Treatment Patterns Associated With Calcitonin Gene-Related Peptide Monoclonal Antibodies Reimbursed Subject to a Managed Access Protocol in Ireland

ObjectivesCalcitonin gene-related peptide monoclonal antibodies (CGRP mAbs) are novel high-cost treatments for the prevention of migraine. This study presents data on utilization, expenditure, and treatment patterns with CGRP mAbs available under a managed access protocol in Ireland, to a cohort of treatment refractory patients (failed 3 or more previous treatments) with chronic migraine. MethodsData were extracted from the Primary Care Reimbursement Service High Tech claims database and special drug request online system and analyzed using Microsoft Excel and SAS. Treatment persistence was evaluated by refill patterns, and adherence was evaluated using the proportion of days covered method. Expenditure data were extracted directly from the database. ResultsBetween September 1, 2021 and April 30, 2023, 1517 applications for reimbursement approval for a CGRP mAb were received; 1458 (96.1%) were approved for reimbursement. Total expenditure on CGRP mAbs in year 1 (September 1, 2021 to August 31, 2022) was €3.2 million. The majority of patients initiated treatment with fremanezumab (60.8%) or erenumab (37.1%). Almost 90% of patients were considered adherent, and treatment persistence was high, with more than 75% of patients receiving more than 12 months of treatment in our 18-month study time frame. ConclusionsThis study demonstrates the importance of active health technology management, after reimbursement, in enabling cost-effective use of high-cost treatments while providing budget certainty for the healthcare payer. High levels of adherence and persistence suggest that treatment is successfully targeted in situations which unmet clinical need is greatest.

Eligibility rates and representativeness of the General Medical Services scheme population in Ireland 2016-2021: A methodological report

Background In Ireland, the means tested General Medical Services (GMS) scheme provides access to a range of healthcare services at no or low cost to approximately one third of the population. Individuals eligible for the GMS scheme are often a focus of research, as a population that account for a large proportion of healthcare services use. The aim of this study is to describe the eligibility rates and representativeness of the GMS scheme population over time, with respect to age group, sex, and geographical area in Ireland. Methods Population data was obtained from the Central Statistics Office (CSO), using 2016 Census figures and projected population figures for 2017-2021. GMS eligibility figures for 2016-2021 were obtained from the HSE Primary Care Reimbursement Service (PCRS). GMS eligibility rates and relative rates of eligibility were calculated for 2016-2021 by age group and sex. Additionally, 2016 eligibility rates were calculated by geographical area. Results The crude eligibility rate decreased from 36.4% in 2016 to 31.2% in 2020, with a slight increase to 31.6% in 2021. In the 75+ years age group, 78.2% of the total population were eligible for the GMS scheme in 2021. The age group with the lowest rate of eligible individuals was the 25–34 age group, with 19.5% eligible in 2021. The eligibility rate was higher among females compared to males throughout the study period. The highest eligibility rate was seen in Donegal, with a crude rate of 52.8%. Dublin had the lowest rate, with a crude rate of 29.3%. Conclusions GMS eligibility varies greatly depending on age, sex, and geographical area, and decreased between 2016 and 2021. This study uses the most up-to-date data available to provide age group, sex and area-based figures for GMS eligibility which may inform planning and conduct of research focusing on GMS-eligible individuals.

297 ADHERENCE TO DENOSUMAB PRESCRIPTION FOLLOWING DISCHARGE FROM A GERIATRIC REHABILITATION UNIT

Abstract Background Post-acute geriatric rehabilitation units are an ideal setting to address bone health following acute admission with a fracture. Longer lengths of stay allow for vitamin D replacement and comprehensive multidisciplinary input. However, persistence with osteoporosis medications is suboptimal amongst older Irish adults, and breaks in therapy reduce the medications effectiveness. This study aims to determine adherence rates to Denosumab six-months after discharge from geriatric rehabilitation in patients with fragility fracture who either commenced or continued treatment whilst an inpatient. Methods Patients admitted with fragility fracture between January and October 2021 were identified through review of an online database. The type of osteoporosis medication, and dates of treatment were documented. Adherence to denosumab prescription six months post-discharge was checked using the Primary Care Reimbursement Service (PCRS) database. Results 98 patients were admitted with fragility fractures, representing one third of total admissions. Patients were excluded for incomplete data (10), transfer back to acute facility (10) or death (4). Of the 74 included, the average age was 80 (range 65-94), and 53 (71%) female. One in five had a diagnosis of dementia. 52 Patients received first dose Denosumab as an inpatient, 4 were continuing on Denosumab, 11 were on bisphosphonates (4 changed from Denosumab on discharge) and 10 not on bone protection. The majority of patients (N=30, 57%) who had Denosumab administered in hospital did not have the second dose administered at six months. Conclusion In keeping with prior research, this study found that persistence with osteoporosis medications is low. Reasons are multifactorial and may include the infrequent timing of Denosumab and a lack of reminders to give the medication in primary care settings. New guidelines recommend enhanced screening for and treatment of osteoporosis in frail older adults including follow-up appointments to check adherence to treatment.

Eligibility rates and representativeness of the General Medical Services scheme population in Ireland 2016-2021: A methodological report.

In Ireland, the means tested General Medical Services (GMS) scheme provides access to a range of healthcare services at no or low cost to approximately one third of the population. Individuals eligible for the GMS scheme are often a focus of research, as a population that account for a large proportion of healthcare services use. The aim of this study is to describe the eligibility rates and representativeness of the GMS scheme population over time, with respect to age group, sex, and geographical area in Ireland. Population data was obtained from the Central Statistics Office (CSO), using 2016 Census figures and projected population figures for 2017-2021. GMS eligibility figures for 2016-2021 were obtained from the HSE Primary Care Reimbursement Service (PCRS). GMS eligibility rates and relative rates of eligibility were calculated for 2016-2021 by age group and sex. Additionally, 2016 eligibility rates were calculated by geographical area. The crude eligibility rate decreased from 36.4% in 2016 to 31.2% in 2020, with a slight increase to 31.6% in 2021. In the 75+ years age group, 78.2% of the total population were eligible for the GMS scheme in 2021. The age group with the lowest rate of eligible individuals was the 25-34 age group, with 19.5% eligible in 2021. The eligibility rate was higher among females compared to males throughout the study period. The highest eligibility rate was seen in Donegal, with a crude rate of 52.8%. Dublin had the lowest rate, with a crude rate of 29.3%. GMS eligibility varies greatly depending on age, sex, and geographical area, and decreased between 2016 and 2021. This study uses the most up-to-date data available to provide age group, sex and area-based figures for GMS eligibility which may inform planning and conduct of research focusing on GMS-eligible individuals.

The Study to Investigate COVID-19 Infection in People Living in Ireland (SCOPI): A seroprevalence study, June to July 2020.

BackgroundRobust data on SARS-CoV-2 population seroprevalence supplement surveillance data in providing evidence for public health action.AimTo conduct a SARS-CoV-2 population-based seroprevalence survey in Ireland.MethodsUsing a cross-sectional study design, we selected population samples from individuals aged 12–69 years in counties Dublin and Sligo using the Health Service Executive Primary Care Reimbursement Service database as a sampling frame. Samples were selected with probability proportional to the general population age–sex distribution, and by simple random sampling within age–sex strata. Antibodies to SARS-CoV-2 were detected using the Abbott Architect SARS-CoV-2 IgG Assay and confirmed using the Wantai Assay. We estimated the population SARS-CoV-2 seroprevalence weighted for age, sex and geographic area.ResultsParticipation rates were 30% (913/3,043) and 44% (820/1,863) in Dublin and Sligo. Thirty-three specimens had detectable SARS-CoV-2 antibodies (1.9%). We estimated weighted seroprevalences of 3.12% (95% confidence interval (CI): 2.05–4.53) and 0.58% (95% CI: 0.18–1.38) for Dublin and Sligo, and 1.69% (95% CI: 1.13–2.41) nationally. This equates to an estimated 59,482 (95% CI: 39,772–85,176) people aged 12–69 years nationally having had infection with SARS-CoV-2, 3.0 (95% CI: 2.0–4.3) times higher than confirmed notifications. Ten participants reported a previous laboratory-confirmed SARS-CoV-2 -infection; eight of these were antibody-positive. Twenty-five antibody-positive participants had not reported previous laboratory-confirmed infection.ConclusionThe majority of people in Ireland are unlikely to have been infected with SARS-CoV-2 by June–July 2020. Non-pharmaceutical public health measures remained key pending widespread availability of vaccination, and effective treatments.

Antipsychotic prescribing in GMS paediatric and young adult population in Ireland 2005-2015: repeated cross-sectional study.

To examine the rates of antipsychotic prescribing in the Irish paediatric and young adult population enrolled in the Irish General Medical Services Scheme pharmacy claims database from the Health Service Executive Primary Care Reimbursement Services database, with a focus on age and sex differences. To examine concomitant prescribing of certain other related medicines in this population. Data were obtained from the Irish General Medical Services (GMS) scheme pharmacy claims database from the Health Service Executive (HSE) - Primary Care Reimbursement Services (PCRS). Participants included children aged <16 years and youth aged 16-24 years availing of medicines under the HSE-PCRS GMS scheme between January 2005 and December 2015. Outcome measures included prescribing rates of antipsychotics from 2005 to 2015, differences in prescribing rates between different ages and sexes, and percentage of concomitant prescriptions for antidepressants, psychostimulants, anxiolytics and hypnosedatives. Overall the trend in prescribing rates of antipsychotic medications was stable at 3.94/1000 in 2005 compared with 3.97/1000 in 2015 for children <16 years, and 48.37/1000 eligible population in 2005 compared to 39.64/1000 in 2015 for those aged 16-24. There was a significant decrease in prescribing rates for males in the 16-24 age group. While rates of antipsychotic prescribing have decreased or remained stable over the timeframe of the study, we did find a significant proportion of this population were prescribed antipsychotics. This study also shows that co-prescribing of antidepressants increased and highlights the need for guidelines for antipsychotic prescribing in children and youth in terms of clinical indication, monitoring, co-prescribing and treatment duration.

Utilisation, expenditure and cost-effectiveness of cystic fibrosis drugs in Ireland: a retrospective analysis of a national pharmacy claims database

ObjectivesTo determine the use and expenditure associated with cystic fibrosis (CF) modulator therapies in Ireland since their reimbursement in 2013.DesignA retrospective analysis of a national drug claims database.SettingThe data included...

Sacubitril/valsartan (Entresto) utilisation and prescribing patterns in the context of a reimbursement application system.

Entresto (sacubitril/valsartan) is used to treat symptomatic chronic heart failure with reduced ejection fraction. Given its high potential budget impact, the Health Services Executive introduced a reimbursement application system (RAS) to ensure its appropriate use. The aim of this study was to evaluate the utilisation of Entresto in Ireland and compare patient characteristics to those of the pivotal PARADIGM-HF trial. We used dispensed claims data from the Primary Care Reimbursement Services, clinical data obtained from the RAS, and data from published studies of Entresto utilisation. Differences in the baseline characteristics in the study populations vs the Entresto arm of the PARADIGM-HF trial were analysed. We also investigated cardiovascular medication use in the 6 months pre- and post-Entresto initiation. In 2018, there were 1043 individuals receiving Entresto, corresponding to an expenditure of €1.2 million. Patients prescribed Entresto in Ireland were older, had lower left ventricular ejection fraction and were more symptomatic than those in the PARADIGM-HF trial. Irish patient characteristics were reflective of Entresto-treated populations in other real-world studies. More than 63% of patients were commenced on the lowest Entresto dose. Entresto initiation was associated with a reduction in the use of other medications for heart failure. The utilisation of Entresto has been steadily increasing in Ireland since its reimbursement approval. The expenditure in the first year was substantially lower than predicted, and the RAS is an example of how health technology management can facilitate appropriate and cost-effective use of medicines.

Effect of an Online Reimbursement Application System on Prescribing of Lidocaine 5% Medicated Plaster in the Republic of Ireland.

The lidocaine 5% medicated plaster, Versatis®, has one therapeutic indication listed on the Summary of Product Characteristics-symptomatic relief of post-herpetic neuralgia (PHN) in adults. Increased expenditure on Versatis® suggests that there is considerable off-label use. To support the appropriate use of Versatis®, the Health Service Executive's Primary Care Reimbursement Service (PCRS) introduced a reimbursement application system for Versatis® from 1 September 2017. The aim of this study was to investigate the effect of introducing a reimbursement application system on Versatis® prescribing under the General Medical Services (GMS) scheme. This study was carried out using prescription dispensing data from the PCRS pharmacy claims database. We carried out segmented linear regression to assess changes in the Versatis® prescribing rate per 1000 GMS eligible population, before and after the introduction of the online reimbursement application system. The results of the segmented regression analysis show that there was a statistically significant level (- 4.91, p < 0.001) and trend change (- 0.69, p < 0.001) in the rate of Versatis® prescribing post-introduction of the reimbursement application system. In the year prior to the introduction of the system, 2016, the annual GMS expenditure on Versatis® lidocaine 5% patches was over €27 million, whereas the GMS expenditure in 2018 was reduced to just over €2 million. In our study, a substantial decrease in the dispensing of Versatis® was seen after the implementation of a reimbursement application system. Prescribing of Versatis® should be restricted to patients with a diagnosis of PHN not only to reduce costs, but to ensure evidence-based use of this medication.

PCN284 PRESCRIBING TRENDS ACROSS EPIDERMAL GROWTH FACTOR RECEPTOR TYROSINE KINASE INHIBITORS IN NON-SMALL CELL LUNG CANCER IN IRELAND

Afatinib, erlotinib and gefitinib are epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs). They are indicated for the treatment of non-small cell lung cancer (NSCLC) with activating EGFR mutations. Erlotinib is also indicated for pancreatic cancer. Erlotinib, gefitinib and afatinib have been reimbursed in Ireland since 2006, 2011 and 2014 respectively. This work aims to describe prescribing trends across EGFR-TKIs in Ireland. It is anticipated that the patent for erlotinib will expire in 2020; the potential cost saving implications of this are examined. Anonymised prescription claims data obtained from the Primary Care Reimbursement Service (January 2006 to April 2019) were analysed using R. The following variables were examined: market share (MS), treatment sequencing and number of patients treated per year. Until 2011 erlotinib held 100%of the MS for EGFR-TKIs. Following the launch of gefitinib in 2011 the MS of erlotinib decreased to 91% by 2013. In 2014, afatinib reduced the MS held by erlotinib and gefitinib by 3% and 5% respectively. In 2017 the MS for erlotinib was 71% and the annual expenditure was reported to be €1,218,666. It was found that only 3% patients received sequential EGFR-TKIs, with afatinib followed by erlotinib the most common sequence (N=40).The lowest number of patients (N=150) were treated with an EGFR-TKI in 2018. Erlotinib was found to dominate the market share each year despite the subsequent launch of gefitinib and afatinib. A limitation of this study is that the MS reported included patients prescribed EGFR-TKIs for conditions other than NSCLC. The availability of generic erlotinib is likely to result in significant cost savings with the price expected to fall to 50% of the original ex-factory price. However, the upcoming availability of third generation EGFR inhibitors as first–line treatment in NSCLC may have substantial impact on the majority MS currently held by erlotinib.

1071-P: Uptake of Continuous Subcutaneous Insulin Infusion Therapy by Adults with Type 1 Diabetes

Introduction: Continuous Subcutaneous Insulin Infusion (CSII) treatment for people with type 1 diabetes (T1D) is fully funded in Ireland via the Long-Term Illness scheme (LTI) and, similarly as in some other developed countries such as Germany, Sweden or the UK, does not involve any out-of-pocket expenses for the person with T1D. Uptake of CSII in adults has been reported to vary from 6.7% (Wales, 2018), through 15.6% (England, 2018) up to &amp;gt;50% in the United States (in 2012). However, available evidence on the uptake of CSII, particularly in adults, is scarce. The aim of this study was to estimate the uptake of CSII in Ireland. Methods: A retrospective cross-sectional study was conducted utilizing the Irish Health Service Executive Primary Care Reimbursement Service (HSE-PCRS) national pharmacy claims database data from the years 2011-2016. Individuals with T1D were identified by co-prescription of insulin and glucometer test strips without any prolonged course (&amp;gt;12 months) of oral hypoglycemic agents prior to commencing insulin. Individuals using CSII were identified by a prescription of infusion sets. Results: Of all adults with T1D (&amp;gt;18 years of age) meeting our criteria (n=19,551), only 5.84% (n=1141) were claiming infusion sets (95% CI 5.51% - 6.16%). The uptake of CSII varied geographically across Ireland from as low as 1.68% to 8.35%. Conclusions: In comparison to other countries where CSII therapy is fully covered, uptake of CSII was low in Irish adults. The determinants of the uptake (barriers to and facilitators in accessing this diabetes-related technology) are under more in-depth investigation. Disclosure K.A. Gajewska: None. S. Sreenan: Advisory Panel; Self; Abbott, AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Novo Nordisk Inc. Other Relationship; Self; Eli Lilly and Company. R. Biesma: None. K. Bennett: None. Funding Health Research Board (SPHeRE/2013/1)

The PIPc Study—application of indicators of potentially inappropriate prescribing in children (PIPc) to a national prescribing database in Ireland: a cross-sectional prevalence study

ObjectivesEvidence is limited regarding the quality of prescribing to children. The objective of this study was to apply a set of explicit prescribing indicators to a national pharmacy claims database...

A Health Evaluation of Targeted Home Energy Efficiency Upgrades for Disadvantaged Residents in Dublin, Ireland.

Background: There are numerous pathways by which home energy efficiency improvements may affect health. We are evaluating the Dublin &amp;#8220;Warmth and Wellbeing&amp;#8221; pilot scheme which is aimed at improving health, wellbeing and social inclusion through home energy efficiency improvements for people aged 55 and over living in fuel poverty and suffering from chronic respiratory disease.Methods: The evaluation has a controlled &amp;#8216;stepped-wedge&amp;#8217; design in which homes of eligible participants receive energy efficiency upgrades at staggered intervals from April 2016 to March 2019. Participants are followed to the end of 2019. Principal outcome measures (measured before and after intervention) include: self-reported health and well-being scores (based on SF36, SGRQ, EQ-5D questionnaires); monitored changes in internal temperatures and indoor air pollutants; consultations and hospital admissions for exacerbations of respiratory illness; and prescription data for drugs used in the management of chronic airflow limitation (CAL) obtained from the Primary Care Reimbursement Service (PCRS).Results: To date (March 2018), 400 households of the target 1000 participants have been recruited, approximately half of whom have received energy efficiency upgrades based on healthcare worker assessment of their health and wellbeing needs. Initial analyses of baseline and post-intervention questionnaire data and month-by-month prescriptions data (for drugs under the Anatomical Classification System code R (CAL) and code J (antibiotics)) are in progress. Early indications suggest that required energy efficiency upgrades were much more substantial than originally expected.Conclusions: The Dublin Warmth and Wellbeing scheme is succeeding in implementing targeted home energy efficiency improvements for patients with chronic lung disease. The evaluation of this pilot will inform the possible expansion of the scheme in Ireland, and will be relevant to other similar settings.

An evaluation of prescribing trends and patterns of claims within the Preferred Drugs Initiative in Ireland (2011–2016): an interrupted time-series study

ObjectiveTo examine the impact of the Preferred Drugs Initiative (PDI), an Irish health policy aimed at enhancing evidence-based cost-effective prescribing, on prescribing trends and the cost of prescription medicines across...

Investigating the cost implications of including all respiratory medicines in PCRS schemes.

This study estimates the additional cost to the State to pay for all respiratory medicines through the Primary Care Reimbursement Service (PCRS) schemes, reducing cost barriers to medication as a complement to existing chronic disease management programmes. Previous literature found higher medication adherence rates amongst medical card patients than those that had to pay or co-pay themselves. A review of medication expenditure on the PCRS schemes from 2005 to 2015. Data on medicines sold into and out of pharmacies was used to estimate the proportion to PCRS schemes or private. Scenario analyses were conducted to estimate what the cost to the State would be to provide funding for all respiratory medicines. Trend analysis findings showed that respiratory medicines have been less than 10% of total PCRS medicine expenditure for the years reviewed. The largest portion of the respiratory medicine expenditure is allocated to 'drugs for obstructive pulmonary disorder' (OPD), ranging from 90% in 2005 to 69% in 2015. Eighty-seven per cent of drugs to treat OPD are dispensed publicly and 13% privately. A scenario analysis estimated that the extra cost to the State to be €20.2m. Respiratory disease is included in the Irish Government's chronic disease management programme. This aims to deliver optimal care in the most appropriate setting so as to improve health outcomes and quality of life. Medication adherence is imperative to achieving these aims. Reducing cost barriers as a complement to other initiatives may improve medicine adherence thereby improving the effectiveness of disease management and patient outcomes.

Donegal going against the flow: Irish differences in long-term urinary catheterisation (LTC) rates in men with Benign Prostatic Hypertrophy (BPH).

Donegal is a geographically removed county on the northwest coast of Ireland. It is known to have high levels of social deprivation¹.Feedback from both hospital and general practice (GP) colleagues indicate that there appears to be a high proportion of men in Donegal with long-term urinary catheters (LTCs). There is a perceived difficulty accessing Urology services for public (GMS) patients in Donegal.A retrospective analysis of Primary Care Reimbursement Service (PCRS) data (2013) was carried out which demonstrated:Total urinary catheter insertions in men over 65 years of age (2013): Donegal 907 ; Kerry 282; Dublin South 33; Dublin West 28; Waterford 1612.This gives a crude 2.55% rate for male GMS patients in Donegal greater than 65 years of age for urinary catheter insertions compared to Dublin South: 0.045% ;Waterford: 0.63 % ; NICE &gt; 75yrs: 0.5%3.For the patients sampled in Donegal, The average duration since 1st urinary catheter insertion was 53 months. 89% of the patients had been referred to Urology. The mean wait for Urology review was 43.75 months. The mean patient age was 80 years. (21%) were based in a nursing home and (79%) were in the community.Differences in LTC rates in the population sampled in Donegal (Rural), Leinster (Urban) and Waterford (Suburban) were significant 1.41% (95% CI 1.0203 – 1.7958) (P &lt; 0.0001) and 1.81% (95% CI 14840 – 2.1549) ( P &lt; 0.0001) respectively.For many reasons Donegal has struggled with service provision particularly in services like Urology. Could this anomaly in LTC rates be a useful parameter to measure the quality and provision of local health services?

Can demographic, clinical and treatment-related factors available at hormonal therapy initiation predict non-persistence in women with stage I-III breast cancer?

To investigate whether demographic, clinical and treatment-related risk factors known at treatment initiation can be used to reliably predict future hormonal therapy non-persistence in women with breast cancer, and to inform intervention development. Women with stage I-III breast cancer diagnosed 2000-2012 and prescribed hormonal therapy were identified from the National Cancer Registry Ireland (NCRI) and linked to pharmacy claims data from Ireland's Primary Care Reimbursement Services (PCRS). Non-persistence was defined as a treatment gap of ≥180 days within 5 years of initiation. Seventeen demographic, clinical and treatment-related risk factors, identified from a systematic review, were abstracted from the NCRI-PCRS dataset. Multivariate binomial models were used to estimate relative risks (RR) and risk differences (RD) for associations between risk factors and non-persistence. Calibration and discriminative performance of the models were assessed. The analysis was repeated for early non-persistence (<1year of initiation). Within 5 years of treatment initiation 680 women (19.9%) were non-persistent. Women aged <50 years (adjusted RR 1.41, 95% CI 1.16-1.70) and those prescribed antidepressants (RR 1.22, 95% CI 1.04-1.45) had increased risk of non-persistence. Married women (RR 0.82 95% CI 0.71-0.94) and those with prior medication use (RR 0.62 95% CI 0.51-0.75) had reduced risk of non-persistence. The area under the receiver-operating characteristic (ROC) curve for non-persistence was 0.61. Findings were similar for early non-persistence. The risk prediction model did not discriminate well between women at higher and lower risk of non-persistence at treatment initiation. Future studies should consider other factors, such as psychological characteristics and experience of side-effects.

Potentially inappropriate prescribing in two populations with differing socio-economic profiles: a cross-sectional database study using the PROMPT criteria.

PurposeThe purpose of this study is to establish the prevalence of potentially inappropriate prescribing (PIP) in middle-aged adults (45–64 years) in two populations with differing socio-economic profiles, and to investigate factors associated with PIP, using the PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) criteria.MethodsA retrospective cross-sectional study was conducted using 2012 data from the Enhanced Prescribing Database (EPD), covering the full population in Northern Ireland and the Health Services Executive Primary Care Reimbursement Service (HSE-PCRS) database, covering the most socio-economically deprived third of the population in this age group in the Republic of Ireland. The prevalence for each PROMPT criterion and overall prevalence of PIP were calculated. Logistic regression was used to investigate the association between PIP and gender, age group and polypharmacy.ResultsThis study included 441,925 patients from the EPD and 309,748 patients from the HSE-PCRS database. Polypharmacy was common in both datasets (46.7 % in the HSE-PCRS and 20.3 % in the EPD). The prevalence of PIP was 42.9 % (95%CI 42.7, 43.1) in the HSE-PCRS and 21.1 % (95%CI 21.0, 21.2) in the EPD. Age group, female gender and polypharmacy were significantly associated with PIP in both populations (p < 0.05) and polypharmacy had the strongest association.ConclusionsPIP is common amongst middle-aged people with the risk of PIP increasing with polypharmacy. Differences in the prevalence of polypharmacy and PIP between the two populations may relate to heterogeneity in healthcare services and different socio-economic profiles, with higher rates of multimorbidity and associated polypharmacy in more deprived groups.Electronic supplementary materialThe online version of this article (doi:10.1007/s00228-015-2003-z) contains supplementary material, which is available to authorized users.