General Practice - Journal Articles
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Item Monitoring of atrial fibrillation in primary care patients prescribed direct oral anticoagulants for stroke prevention(Springer, 2020-01-03) Murphy, Aileen; Kirby, Ann; Bradley, ColinBackground: Direct oral anticoagulants (DOACs) are widely marketed as medicines that do not require routine laboratory monitoring. However, they do have complex pharmacological properties and side effects; hence prescribing and monitoring guidelines, such as the European Heart Rhythm Association (EHRA) guidelines, have emerged. These advocate monitoring for renal and hepatic impairment; bleeding episodes; liver function; co-medication; circulation, and occurrence of side effects. Though 3 to 6 month follow-up is advocated, this is currently not routine, and its implementation creates a potential obligation for general practitioners (GPs) managing atrial fibrillation (AF) patients in the community. Aims: This study investigates the frequency, the type of follow-up, and the factors that influenced follow-up among Irish GPs, who prescribed DOACs to patients with AF, to prevent strokes in 2015. Methods: The frequency and type of follow-up care is estimated, and a count model regression analysis is applied to determine the GP and practice characteristics that are associated with the implementation of follow-up. Results: The EHRA guidelines most frequently followed were those pertaining to renal function (82%), bleeding episodes (71%), liver function (69%), circulation (54%), and side effects (55%). The regression analysis revealed that female GPs (P = 0.05) and GPs who follow all seven guidelines (P = 0.06) practice more frequent follow-up while those in training practices (P = 0.09) provide less frequent follow-up. Conclusions: Results show that there was incomplete adherence to the 2013 EHRA prescribing guidelines with only 24% adhering to all seven guidelines, and patient follow-up was less frequent than has been suggested.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 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.Item The impact of Covid-19 on medical professionals' benzodiazepine prescribing practices(Irish Medical Organisation, 2021-10) Coleman, A.; Lambert, Sharon; Bradley, Colin; Horan, A.Item 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, MaireadBackground 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.