Is pay for performance promoting inverse inequality in Irish general practice?

Background: In 2020, the Chronic Disease Management (CDM) programme was introduced in Ireland. This programme resources GPs to review public (GMS) patients, diagnosed with eight named chronic diseases, twice yearly according to a structured protocol. This pay for performance initiative has been widely adopted by GPs.

Determinants of poor glycaemic control and proteinuria in patients with type 2 diabetes: a retrospective analysis of general practice records in Ireland.

Background: Analysis of general practice records can address the information gap on the epidemiology of type 2 diabetes (T2DM) in Ireland, informing practice and the development of interventions in primary care. The aim of this study was to identify patients with poor glycaemic control, risk factors for complications and evidence of end organ damage in a large multi-practice study and to profile their characteristics.

Methods: Patients with T2DM were identified using disease coding in Health One practice management software in 41 general practices.

'Dopesick'; why a critical view of the literature may save your patient's life.

Introduction: Teaching critical literature appraisal is challenging. Providing a compelling clinical context using 'cinemeduation' stimulates interest in the topic.

Methods: After watching the first episode of the mini-series 'Dopesick', where the scope, timeline and extent of the problem of opioid abuse are clearly seen, abstracts of the period literature strongly supporting the use of Oxycontin for use in chronic pain are shown.

How often do patients attend general practice, how often are they referred to hospital, and how do multi-morbidity and polypharmacy affect general practice attendance and referral rates?

Background: As prevalence of multimorbidity and polypharmacy rise, healthcare systems must respond to these challenges. Data are needed from general practice on specific metrics of healthcare utilisation. This research aims to establish the rates of attendance to general practice and referral to hospital; and how age, multi-morbidity and polypharmacy affect them.

Sustainable protocol-based management of hypertension in one institution in northern Malawi.

Introduction: Across all WHO regions, Africa has the highest prevalence of hypertension with 46% of the population >25 years estimated to be hypertensive. Blood pressure (BP) control is poor, with <40% of hypertensives diagnosed, <30% of those diagnosed receiving medical treatment, and <20% with adequate control. We report an intervention to improve BP control in a cohort of hypertensive patients attending a single hospital in Mzuzu Malawi, by introducing a limited protocol of four antihypertensive medications taken once-daily.

Towards a Whole Sample Imaging Approach Using Diffusion Tensor Imaging to Examine the Foreign Body Response to Explanted Medical Devices.

Analysing the composition and organisation of the fibrous capsule formed as a result of the Foreign Body Response (FBR) to medical devices, is imperative for medical device improvement and biocompatibility. Typically, analysis is performed using histological techniques which often involve random sampling strategies. This method is excellent for acquiring representative values but can miss the unique spatial distribution of features in 3D, especially when analysing devices used in large animal studies.

Dynamic actuation enhances transport and extends therapeutic lifespan in an implantable drug delivery platform.

Fibrous capsule (FC) formation, secondary to the foreign body response (FBR), impedes molecular transport and is detrimental to the long-term efficacy of implantable drug delivery devices, especially when tunable, temporal control is necessary. We report the development of an implantable mechanotherapeutic drug delivery platform to mitigate and overcome this host immune response using two distinct, yet synergistic soft robotic strategies. Firstly, daily intermittent actuation (cycling at 1 Hz for 5 minutes every 12 hours) preserves long-term, rapid delivery of a model drug (insulin) over 8 weeks of implantation, by mediating local immunomodulation of the cellular FBR and inducing multiphasic temporal FC changes.

Barriers to and motives for engagement in an exercise-based cardiac rehabilitation programme in Ireland: a qualitative study.

Background: Insufficient physical activity (PA) is a leading risk factor for premature death worldwide. Ireland's public healthcare system, the Health Service Executive (HSE), has supported the development of the National Exercise Referral Framework (NERF) to tackle low levels of PA amongst those with non-communicable diseases (NCDs). 'NERF centres' are medically supervised PA programmes across Ireland that have established referral pathways with local hospitals and general practitioners.

'Doctors can't be doctors all of the time': a qualitative study of how general practitioners and medical students negotiate public-professional and private-personal realms using social media.

Objective: The objective of this study is to explore the experiences and perspectives of general practitioners' and medical students' use of, and behaviour on, social media and to understand how they negotiate threats to professional and personal life on social media.

Design: A two-phase qualitative design was used, consisting of semistructured interviews and follow-up vignettes, where participants were asked to respond to vignettes that involved varying degrees of unprofessional behaviour. Data were analysed using template analysis.

The Foreign Body Response to an Implantable Therapeutic Reservoir in a Diabetic Rodent Model.

Advancements in type 1 diabetes mellitus treatments have vastly improved in recent years. The move toward a bioartificial pancreas and other fully implantable systems could help restore patient's glycemic control. However, the long-term success of implantable medical devices is often hindered by the foreign body response.

Development and sustainment of professional relationships within longitudinal integrated clerkships in general practice (LICs): a narrative review.

Background: Longitudinal integrated clerkships (LICs) are a relatively new model of clinical medical education, whereby students participate in patient care over time and develop relationships with those patients', their clinicians, and other health care staff involved in the care of those patients. It has been called 'relationship-based education' but, to date, no review has investigated the development and impact of these central relationships within this curricula model.

Aims: The aim of this study is to review the literature pertaining to relationships in LICs, specifically to understand how they come about and how they affect learning.

A snapshot of chronic obstructive pulmonary disease management in general practice in Ireland.

Background: Chronic obstructive pulmonary disease (COPD) is a leading cause of death and disability. Its diagnosis, classification and management are complex. There is a paucity of data on the standard of COPD management in Irish general practice.

Career destinations of graduates from a medical school with an 18-week longitudinal integrated clerkship in general practice: a survey of alumni 6 to 8 years after graduation.

Background: There is a worldwide recruitment and retention crisis in general practice. Workforce planning has identified the need to train more general practitioners as an urgent priority. Exposure of medical students to general practice as part of the formal and hidden curriculum, the use of longitudinal integrated clerkships, and positive experiences and role models in general practice are all thought to be contributing factors to doctors choosing careers in general practice.

The effect of 'paying for performance' on the management of type 2 diabetes mellitus: a cross-sectional observational study.

Background: The 'cycle of care' (COC) pay for performance (PFP) programme, introduced in 2015, has resourced Irish GPs to provide structured care to PCRS eligible patients with type 2 diabetes mellitus (T2DM).

Aim: To investigate the effect of COC on management processes.

Design &setting: Cross-sectional observational study undertaken with two points of comparison (2014 and 2017) in participating practices (Republic of Ireland general practices), with comparator data from the United Kingdom National Diabetes Audit (UKNDA) 2015-2016.

Knowledge and attitudes of Irish GPs towards abortion following its legalisation: a cross-sectional study.

Background: In May 2018, the Irish Constitution was changed following a referendum allowing termination of pregnancy by abortion. It is envisaged that the majority of terminations will be by medical abortion and will take place in general practice before 12 weeks gestation.

Aim: To elicit attitudes and level of preparedness of Irish GPs to provide medical abortion services.

Medical management of acute upper respiratory infections in an urban primary care out-of-hours facility: cross-sectional study of patient presentations and expectations.

Objectives: The purpose of this study was to examine the expectations of patients attending an urban primary care out-of-hours (OOH) facility with acute upper respiratory tract infection (acute URTI) regarding clinical examination, symptom management, information on their condition, reassurance, antibiotic treatment and other possible options including referral.

Design: Cross-sectional design.

Setting: One urban primary care OOH facility located in the midwest of Ireland.

Over prescribing of antibiotics for acute respiratory tract infections; a qualitative study to explore Irish general practitioners' perspectives.

Background: Anti-microbial resistance (AMR) is a global threat to public health and antibiotics are often unnecessarily prescribed for acute respiratory tract infections (ARTIs) in general practice. We aimed to investigate why general practitioners (GPs) continue to prescribe antibiotics for ARTIs despite increasing knowledge of their poor efficacy and worsening antimicrobial resistance.

Methods: We used an explorative qualitative study design.

The prevalence and treatment of mental health conditions documented in general practice in Ireland.

Objectives: As prevalence of mental health disorders increases worldwide, recognition and treatment of these disorders falls increasingly into the remit of primary care. This study investigated the prevalence and management of adults presenting to their general practitioner (GP) in Ireland with a psychological condition.

Methods: A random number function was used to select 100 patients with a consultation in the previous 2 years from 40 general practices around Ireland.

A snapshot of type two diabetes mellitus management in general practice prior to the introduction of diabetes Cycle of Care.

Background: Diabetes is associated with complications, including coronary heart disease, stroke, kidney failure, blindness and amputation, and ultimately is a major cause of disability and death worldwide. Adherence to best practice guidelines is limited in unstructured diabetes management in primary care settings.

Aims: This study aims to establish what data was being collected in general practice prior to the introduction of the Cycle of Care, which is a proactive model of diabetes management introduced in Ireland.

Assessment of waist-worn tri-axial accelerometer based fall-detection algorithms using continuous unsupervised activities.

This study aims to evaluate a variety of existing and novel fall detection algorithms, for a waist mounted accelerometer based system. Algorithms were tested against a comprehensive data-set recorded from 10 young healthy subjects performing 240 falls and 120 activities of daily living and 10 elderly healthy subjects performing 240 scripted and 52.4 hours of continuous unscripted normal activities.

Morphometric analysis of pollen grains for paleoecological studies: classification of Picea from eastern North America.

Little is known about the paleoecological histories of the three spruce species (white spruce, Picea glauca; black spruce, P. mariana; and red spruce P. rubens) in eastern North America, largely because of the difficulty of separating the three species in the pollen record.