General Practice - Journal Articles
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Item The impact of drug palatability on prescribing and dispensing of antibiotic formulations for paediatric patients: A cross-sectional survey of general practitioners and pharmacists.(Oxford University Press, 2023-07-06T00:00:00Z) Elgammal, Ayat; Ryan, Joseph; Bradley, Colin; Crean, Abina M.; Bermingham, Margaret; Science Foundation Ireland; European Regional Development FundBackground: Palatability is a key element of paediatric acceptability for medicines. Many patient and drug factors are considered when choosing an antibiotic for a child. Pharmacists report that they receive questions about the palatability of oral liquid antibiotics for children. This study aimed to explore the experiences of GPs and pharmacists concerning palatability of oral liquid antibiotics for children. Methods: A questionnaire about the impact of palatability on the choice of antibiotic formulation for children was emailed to all community pharmacists in Ireland and to GPs and trainee GPs in the Cork region and posted on social media. Survey items were not compulsory; therefore, percentage responses were calculated based on the number of responses to that item. GP and pharmacist responses were analysed independently. Results: Responses were received from 244 participants (59 GPs, 185 pharmacists). Clinical guidelines and availability of supply were the most important factors considered when choosing an oral liquid antibiotic formulation for children by GP (79.7%) and pharmacist (66.5%) respondents respectively. Forty GP respondents (76.9%) reported ensuring adherence was the most common palatability-related reason leading to deviation from guidelines. Pharmacist respondents (52%) reported advising a parent/caregiver to manipulate the required antibiotic dose to improve acceptability. The least palatable oral liquid antibiotics reported were flucloxacillin (16% GPs, 18% pharmacists) and clarithromycin (17% of each profession). Conclusion: This study identified palatability issues associated with oral liquid antibiotics for children reported by GPs and pharmacists. Pharmaceutical approaches to adapting oral liquid antibiotic formulations must be developed to improve palatability and thus paediatric acceptability.Item 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 IrelandAims: 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.Item 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 PhilanthropiesObjectives: 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.Item Psychosocial, psychiatric and work-related risk factors associated with suicide in Ireland: Optimised methodological approach of a case-control psychological autopsy study(BioMed Central Ltd., 2019-09-06) Arensman, Ella; Larkin, C.; McCarthy, J.; Leitao, Sara; Corcoran, Paul; Williamson, Eileen; McAuliffe, C.; Perry, Ivan J.; Griffin, Eve; Cassidy, E. M.; Bradley, Colin; Kapur, N.; Kinahan, J.; Cleary, A.; Foster, T.; Gallagher, Jonathan; Malone, K.; Ramos Costa, Ana Paula; Greiner, Birgit A.; Health Research Board; National Office for Suicide PreventionBackground: Suicide has profound effects on families and communities, but is a statistically rare event. Psychological autopsies using a case-control design allow researchers to examine risk factors for suicide, using a variety of sources to detail the psychological and social characteristics of decedents and to compare them to controls. The Suicide Support and Information System Case Control study (SSIS-ACE) aimed to compare psychosocial, psychiatric and work-related risk factors across three groups of subjects: suicide decedents, patients presenting to hospital with a high-risk self-harm episode, and general practice controls. Methods: The study design includes two inter-related studies; one main case-control study: comparing suicide cases to general practice (GP) controls, and one comparative study: comparing suicide cases to patients presenting with high-risk self-harm. Consecutive cases of suicide and probable suicide are identified through coroners’ registration of deaths in the defined region (Cork City and County, Ireland) and are frequency-matched for age group and gender with GP patient controls recruited from the same GP practice as the deceased. Data sources for suicide cases include coroners’ records, interviews with health care professionals and proxy informants; data sources for GP controls and for high-risk self-harm controls include interviews with control, with proxy informants and with health care professionals. Interviews are semi-structured and consist of quantitative and qualitative parts. The quantitative parts include a range of validated questionnaires addressing psychiatric, psychosocial and occupational factors. The study adopts several methodological innovations, including accessing multiple data sources for suicide cases and controls simultaneously, recruiting proxy informants to examine consistency across sources. Conclusions: The study allows for the investigation of consistency across different data sources and contributes to the methodological advancement of psychological autopsy research. The study will also inform clinical and public health practice. The comparison between suicide cases and controls will allow investigation of risk and protective factors for suicide more generally, while the comparison with high-risk self-harm patients will help to identify the factors associated specifically with a fatal outcome to a self-harm episode. A further enhancement is the particular focus on specific work-related risk factors for suicideItem A qualitative study of the dementia-care experiences and educational needs of physiotherapists in the Republic of Ireland(Elsevier, 2019-08-09) Foley, Tony; Sheehan, Cormac; Jennings, Aisling A.; O'Sullivan, Trish; Health Service Executive; Atlantic PhilanthropiesObjectives: Gait disturbance and impaired balance lead to a greater risk of falls and hip fractures for people with dementia. Physiotherapists play an important role in multidisciplinary dementia care. This study aimed to explore physiotherapists’ experiences of dementia care and sought to identify their dementia-specific educational needs. Design: Qualitative design, using focus group interviews. Setting: Primary care and secondary care physiotherapy services in the Republic of Ireland. Participants: Six focus groups with thirty-two physiotherapists, working in community care and hospital settings. Results: Physiotherapists described a significant dementia-related workload. Challenges to care included absence of a formal diagnosis, clinical uncertainty, scarcity of resources, physical working environment and the assessment of rehabilitation potential. Dementia care was enhanced by the involvement of family members and by collaboration with other allied healthcare professionals. Participants expressed a wish to receive further dementia training and clear evidence-based physiotherapy guidelines. Identified areas of educational need included enhanced communication techniques, use and interpretation of cognitive screening tools, sub-typing of dementia, and ethical issues in dementia care. Conclusions: Our findings indicate that physiotherapists remain challenged by complex aspects of dementia care. Tailored dementia training for physiotherapists should be developed, focusing on their educational needs. Delivery of training should incorporate interactive case-based activities and interprofessional education with other allied healthcare professionals.