General Practice - Journal Articles

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    Supporting medical students towards future careers in general practice: A quantitative study of Irish medical schools
    (Irish Medical Organisation, 2022-10) Murphy, A. W.; Moran, D.; Smith, S. M.; Wallace, Emma; Glynn, L. G.; Hanley, K.; Kelly, M. E.
    Aim: In Ireland there is a significant, and increasing, shortage of general practitioners. By 2025, thisshortfall could be as high as 1,380, from a current workforce of 3,923. We aimed to determine the proportions of EU medical graduates from each of the six Irish medical schools who applied to the national GP Training Program for 2017-21 inclusive. Methods: The Spearman rank correlation was used to examine the correlations between the proportions of graduate entrants, the number of weeks spent directly on GP placement teaching at each medical school and the proportions of applicants, to GP training, from each medical school. Results: Between 2017-2021 inclusive, the average annual percentage of EU graduates applying to the national GP Training Program (n=1,302) ranged from 25-55% for each of the six Irish medical schools- a 2.2 fold difference. There was a strong correlation between the average annual percentage of EU graduates applying to the ICGP Training Program with the proportions of graduate entrants, but this did not reach statistical significance, (r=0.81; p=0.20) and no association with the number of GP placement weeks (r=0.2; p>0.50). Conclusion: We found a marked difference in the proportions of EU graduates, from the six medical schools, opting for a career in general practice. Further work is required to inform how best medical schools can support the generation of tomorrows general practitioners.
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    The impact of Covid-19 on medical professionals' benzodiazepine prescribing practices
    (Irish Medical Organisation, 2021-10) Coleman, A.; Lambert, Sharon; Bradley, Colin; Horan, A.
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    COVID-19 community assessment hubs in Ireland - the experience of clinicians
    (Springer Nature Switzerland AG, 2020-09-26) Bury, Gerard; Smith, Susan; Kelly, Maureen; Bradley, Colin; Howard, William; Egan, Mairead
    Background COVID-19 required rapid innovation in health systems, in the context of an infection which placed healthcare professionals at high risk; general practice has been a key component of that innovative response. In Ireland, GPs were asked to work in a network of community assessment hubs. A focused training programme in infection control procedures/clinical use of personal protective equipment (PPE) was rapidly developed in advance. University departments of general practice were asked to develop and deliver that training. Aim The aim of this article is to describe infection control procedure training in Ireland, the uptake by GPs and the initial experience of GPs working in this unusual environment. Design and setting Two anonymous cross-sectional online surveys are sent to participants in training courses. Method Survey 1 followed completion of training; survey 2 followed establishment of the hubs. Results Six hundred seventy-five participants (including 439 GPs, 156 GP registrars) took part in the training. Two hundred thirty-nine (50.3%) out of four hundred seventy-five responded to Survey 1-over 95% reported an increase in confidence in the use of PPE. Two hundred ten (44.2%) out of four hundred seventy-five participants responded to Survey 2; 195 had completed hub shifts. Younger, female GPs predominated. Very high levels of infection control procedures were reported. Participants commented positively on teamworking, environment and systems. However, 'real-time' ambulance service data suggest the peak of the surge may have passed by the time the hubs were established. Conclusion Academic departments, GPs and the Irish health system collaborated effectively to respond to the need for community assessment of COVID-19 patients.
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    Brief interventions targeting long-term benzodiazepine and Z-drug use in primary care: a systematic review and meta-analysis
    (John Wiley & Sons, Inc., 2020-01-27) Lynch, Tom; Ryan, Cristí­n; Hughes, Carmel M.; Presseau, Justin; van Allen, Zachary M.; Bradley, Colin P.; Cadogan, Cathal A.; Royal College of Surgeons in Ireland
    Aims: To assess the effectiveness of brief interventions in primary care aimed at reducing or discontinuing long‐term benzodiazepine/Z‐drug (BZRA) use. Method: Systematic review of randomised controlled trials of brief interventions in primary care settings aimed at reducing or discontinuing long‐term BZRA use in adults taking BZRAs for ≥3 months. Four electronic databases were searched: PubMed, EMBASE, PsycINFO, CENTRAL. The primary outcome was BZRA use, classified as discontinuation or reduction by ≥25%. The Theoretical Domains Framework (TDF) was used to retrospectively code behavioural determinants targeted by the interventions. The Behaviour Change Technique (BCT) Taxonomy was used to identify interventions’ active components. Study‐specific estimates were pooled, where appropriate, to yield summary risk ratios (RRs) and 95% confidence intervals (CIs). Pearson correlations were used to determine the relationship between intervention effect size and the results of both the TDF and BCT coding. Results: Eight studies were included (n=2071 patients). Compared with usual care, intervention patients were more likely to have discontinued BZRA use at 6 months (8 studies, RR 2.73, 95% CI 1.84‐4.06) and 12 months post‐intervention (2 studies, RR 3.41, 95% CI 2.22‐5.25). TDF domains ‘Knowledge’, ‘Memory, attention and decision processes’, ‘Environmental context and resources’ and ‘Social influences’ were identified as having been included in every intervention. Commonly identified BCTs included ‘Information about health consequences’, ‘Credible source’ and ‘Adding objects to the environment’. There was no detectable relationship between effect size and the results of either the TDF or BCT coding. Conclusion: Brief interventions delivered in primary care are more effective than usual care in reducing and discontinuing long‐term benzodiazepine/Z‐drug use.
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    General practitioners' knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia: A mixed-methods systematic review
    (John Wiley and Sons Ltd, 2018-06-13) Jennings, Aisling A.; Foley, Tony; Walsh, Kieran A.; Coffey, Alice; Browne, John P.; Bradley, Colin P.; Health Service Executive, Ireland; Irish College of General Practitioners; Atlantic Philanthropies
    Objectives: To synthesise the existing published literature on general practitioners (GP)'s knowledge, attitudes, and experiences of managing behavioural and psychological symptoms of dementia (BPSD) with a view to informing future interventions. Methods: We conducted a systematic review and synthesis of quantitative and qualitative studies that explored GPs' experiences of managing BPSD (PROSPERO protocol registration CRD42017054916). Seven electronic databases were searched from inception to October 2017. Each stage of the review process involved at least 2 authors working independently. The meta-ethnographic approach was used to synthesise the findings of the included studies while preserving the context of the primary data. The Confidence in the Evidence from Reviews of Qualitative research (CERQual) was used to assess the confidence in our individual review findings. Results: Of the 1638 articles identified, 76 full texts were reviewed and 11 were included. Three main concepts specific to GPs' experiences of managing BPSD emerged: unmet primary care resource needs, justification of antipsychotic prescribing, and the pivotal role of families. A “line of argument” was drawn, which described how in the context of resource limitations a therapeutic void was created. This resulted in GPs being over reliant on antipsychotics and family caregivers. These factors appeared to culminate in a reactive response to BPSD whereby behaviours and symptoms could escalate until a crisis point was reached. Conclusion: This systematic review offers new insights into GPs' perspectives on the management of BPSD and will help to inform the design and development of interventions to support GPs managing BPSD.