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Page 1: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Royal College of Surgeons in IrelandColáiste Ríoga na Máinleá in Éirinn

Connected health: collaborative opportunities for ICON and academia

Tom Fahey

Professor of General Practice, RCSI Medical School & Principal Investigator, HRB Centre for Primary Care Research

Page 2: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Overview

• Background

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

Page 3: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Overview

• Background

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

Page 4: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

My own background

• Professor of General Practice, RCSI 2006 onwards

• Medical graduate UCD, trained epidemiology & Public Health (TCD & Oxford)

• Previously (UK 14 years)– Professor (University Dundee)– SL (University of Bristol)– L (University of Oxford)

Page 5: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Roles

• Professor & Head of Department

• Principal investigator HRB Centre for Primary Care Research

• Chair of Research, Irish College of General Practitioners

• Other roles– Academic collaborator EU FP7 TRANSFoRm– Medical advisory group Irish Medicines Board

Page 6: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Page 7: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Overview

• Background

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

Page 8: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

GP Electronic Health Record (EHR)

Page 9: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

EHR

• UK

• Ireland

Page 10: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Page 11: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Page 12: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Page 13: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Page 14: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Page 15: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Page 16: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Trial data query system

Page 17: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Recruitment RCT

Page 18: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Visualisation- patient recruitment

Page 19: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Diagnostic code recoded- type 1 NIDDM

Page 20: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Overview

• Background

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

Page 21: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

TRANSFoRm- WP4 patient safety

WP4 Evidence Repository

Clinical Evidence Service

WT 4.5 Evidence Mining and Analysis

Research Study Designer WT 5.2GP EHRs

With CDSS

Evidence Analysis & Extraction Tool

Evidence Management

Tools

Study Criteria Design

Find Eligible Patient

Research Study Management

Recruit Eligible Patient

Study Data Management

Page 22: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Overview

• Background

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

Page 23: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Potentially Inappropriate Prescribing (PIP)

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

Page 24: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

The prevalence of the most common STOPP/START PIP indicators across three regions

Page 25: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

OPTI-SCRIPT study development

Page 26: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Study overview

PCRS – National Contemporaneous Control

- Observational comparison to national prescribing data (376,858 patients, 2,000+ practices)

Page 27: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

OPTI-SCRIPT website

Page 28: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Page 29: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

OPTI-SCRIPT RCT results

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

• Minimisation

Intervention Control11 practices99 patients

10 practices97 patients

Page 30: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Study design & methodology – cluster RCT

• Primary outcome measure: • Proportion of patients with no PIP• Mean PIP per group

• Data collection baseline & immediate post intervention • Between group differences:

• Random effects logistic regression • Cluster mean • Random effects poisson regression

• Process evaluation

Page 31: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Outcome – Proportion with no PIP

Group N Number of patients with no PIP

% of patients with no PIP

Intervention 99 47 47.5

Control 97 22 22.7

Adjusted odds ratio = 3.06 (95% CI 1.4,6.5; P=0.004)*

*adjusted for gender, age, baseline PIP, number repeat medications, GP practice size

Page 32: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

National contemporaneous control – PCRS

• Intervention period, Sep 2012 – August 2013 prevalence of 38%

• Odds of having no PIP in OPTI-SCRIPT intervention compared to odds of having no PIP in the national PCRS cohort

Odds Ratio 95% CI

2.49 1.68, 3.69

Page 33: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Overview

• Background

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

Page 34: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Overview

• Background

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

Page 35: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Page 36: Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Division of Population Health Sciences

Discussion

• Collaboration

• Joint funding– HRB Centre renewal– Horizon 20:20

• Training of graduates


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