Protocol for the development of an intervention to improve the use of Point-of-caRE DiagnostICs in the management of respiraTOry tRact infectionS in primary care (the PREDICTORS study).

Background: Antimicrobial resistance is a significant global health challenge, exacerbated by inappropriate antibiotic prescribing, particularly in primary care where up to 50% of antibiotic prescriptions prescribed by general practitioners (GPs) and dispensed by community pharmacists (CPs) are deemed inappropriate. Respiratory tract infections (RTIs) are among the most common conditions leading to GP consultations and subsequent antibiotic prescribing, much of which is inappropriate as most RTIs are viral in nature or self-limiting bacterial infections. Point-of-care tests (POCTs) have emerged as tools to improve the diagnosis and appropriate treatment of RTIs.

Shortcomings in reporting country-level participation in multi-centre randomised controlled trials involving Ireland as a collaborating partner: A meta-research study.

Background And Objective: Multi-centre randomised controlled trials (RCTs) provide vital information about healthcare interventions. Reporting on country-level participation is important for understanding the context of multi-centre RCTs. This study aimed to examine multi-centre RCT reporting of country-level participation, using Ireland as a case study.

Out-of-pocket prescription medicine expenditure amongst community-dwelling adults: Findings from the Irish longitudinal study on ageing (TILDA) in 2016.

Background: The number of prescription medicines prescribed to older adults is increasing in Ireland and other countries. This is leading to higher out-of-pocket prescription medicine expenditure for older adults, which has several negative consequences including cost-related non-adherence. This study aimed to characterise out-of-pocket prescription medicine payments, and examine their relationship with entitlements, multimorbidity and adherence.

Prevalence and predictors of sub-optimal laboratory monitoring of selected higher risk medicines in Irish general practice: a 5-year retrospective cohort study of community-dwelling older adults.

Objectives: To describe the prevalence of sub-optimal monitoring for selected higher-risk medicines in older community-dwelling adults and to evaluate patient characteristics and outcomes associated with sub-optimal monitoring.

Study Design: Retrospective observational study (2011-2015) using historical general practice-based cohort data and linked dispensing data from a national pharmacy claims database.

Setting: Irish primary care.

Commercial influences on patient and public involvement: a renewed call for research and action.

Patient and public involvement is increasingly advocated in health policy, research and practice. Patients and people with lived experience, carers and the general public should have a say in how policy is generated, how services are delivered and how research is conducted. Through this perspective article, we hope to stimulate discussion and debate around industry influence in patient and public involvement, specifically pertaining to patient organizations, which often play a key role in patient and public involvement activities.

Core medication use in general practice prescriptions: A pilot study evaluating the Drug Utilization 90% Index in Irish general practice.

Aims: The Drug Utilization 90% Index (DU90%), the number of medicines making up 90% of a doctor's prescribing, is a simple tool that can be used to describe core prescribing patterns. This research aimed to pilot the application of the DU90% in the Irish context, to investigate the relationship between the DU90% and prescriber and practice characteristics and prescribing quality.

Methods: Retrospective observational study using anonymous prescription data from a sample of Irish general practitioners (GPs).

Stakeholder perceptions of and attitudes towards problematic polypharmacy and prescribing cascades: a qualitative study.

Introduction: Problematic polypharmacy is the prescribing of five or more medications potentially inappropriately. Unintentional prescribing cascades represent an under-researched aspect of problematic polypharmacy and occur when an adverse drug reaction (ADR) is misinterpreted as a new symptom resulting in the initiation of a new medication. The aim of this study was to elicit key stakeholders' perceptions of and attitudes towards problematic polypharmacy, with a focus on prescribing cascades.

Evidence for using point-of-care diagnostics in the management of respiratory tract infections in primary care: a scoping review protocol.

  Antimicrobial resistance (AmR) is widely considered a global health threat and is associated with significant morbidity, mortality and costs. Inappropriate antimicrobial use is the most important modifiable risk factor for AmR. Most human antimicrobial medicines use occurs in primary care [prescribed by general practitioners (GPs), dispensed by community pharmacists (CPs)].

Prescribing differences among older adults with differing health cover and socioeconomic status: a cohort study.

Introduction: As health reforms move Ireland from a mixed public-private system toward universal healthcare, it is important to understand variations in prescribing practice for patients with differing health cover and socioeconomic status. This study aims to determine how prescribing patterns for patients aged ≥ 65 years in primary care in Ireland differ between patients with public and private health cover.

Methods: This was an observational study using anonymised data collected as part of a larger study from 44 general practices in Ireland (2011-2018).

Clinical study reports published by the European Medicines Agency 2016-2018: a cross-sectional analysis.

Objectives: To describe the characteristics of clinical study report (CSR) documents published by the European Medicines Agency (EMA), and for included pivotal trials, to quantify the timeliness of access to trial results from CSRs compared with conventional published sources.

Design: Cross-sectional analysis of CSR documents published by the EMA from 2016 to 2018.

Methods: CSR files and medication summary information were downloaded from the EMA.

The impact of lidocaine plaster prescribing reduction strategies: A comparison of two national health services in Europe.

Aims: In 2017, two distinct interventions were implemented in Ireland and England to reduce prescribing of lidocaine medicated plasters. In Ireland, restrictions on reimbursement were introduced through implementation of an application system for reimbursement. In England, updated guidance on items which should not be routinely prescribed in primary care, including lidocaine plasters, was published.

Derivation and validation of clinical prediction rules for diagnosis of infectious mononucleosis: a prospective cohort study.

Objectives: Infectious mononucleosis (IM) is a clinical syndrome that is characterised by lymphadenopathy, fever and sore throat. Although generally not considered a serious illness, IM can lead to significant loss of time from school or work due to profound fatigue, or the development of chronic illness. This study aimed to derive and externally validate clinical prediction rules (CPRs) for IM caused by Epstein-Barr virus (EBV).

Adverse drug reactions and associated patient characteristics in older community-dwelling adults: a 6-year prospective cohort study.

Background: To date, research on adverse drug reactions (ADRs) has focused on secondary care, and there is a paucity of studies that have prospectively examined ADRs affecting older adults in general practice.

Aim: To examine the cumulative incidence and severity of ADRs and associated patient characteristics in a sample of community-dwelling older adults.

Design And Setting: Prospective cohort study of older adults (aged ≥70 years, = 592) recruited from 15 general practices in the Republic of Ireland.

Self-monitoring for improving control of blood pressure in patients with hypertension: a Cochrane intervention review.

Background: Hypertension is a major risk factor for cardiovascular events with only a minority of people treated to satisfactory levels. There is an increasing body of literature pertaining to the beneficial effect of self-blood pressure monitoring (SBPM) on blood pressure control in hypertensive patients. It is cost-effective, well tolerated, and has been shown to be a better predictor of end organ damage than traditional office blood pressure monitoring (OBPM).

Prescribing cascades in community-dwelling adults: A systematic review.

The misattribution of an adverse drug reaction (ADR) as a symptom or illness can lead to the prescribing of additional medication, referred to as a prescribing cascade. The aim of this systematic review is to identify published prescribing cascades in community-dwelling adults. A systematic review was reported in line with the PRISMA guidelines and pre-registered with PROSPERO.

An external pilot cluster randomised controlled trial of a theory-based intervention to improve appropriate polypharmacy in older people in primary care (PolyPrime).

Background: For older populations with multimorbidity, polypharmacy (use of multiple medications) is a standard practice. PolyPrime is a theory-based intervention developed to improve appropriate polypharmacy in older people in primary care. This pilot study aims to assess the feasibility of the PolyPrime intervention in primary care in Northern Ireland (NI) and the Republic of Ireland (ROI).

Anticipatory care planning for community-dwelling older adults at risk of functional decline: a feasibility cluster randomized controlled trial.

Objectives: To determine the feasibility, implementation and outcomes of an Anticipatory Care Planning (ACP) intervention in primary care to assist older adults at risk of functional decline by developing a personalized support plan.

Design: Feasibility cluster randomized control trial.

Setting And Participants: Eight primary care practices (four in Northern Ireland, United Kingdom and four in the Republic of Ireland) were randomly assigned to either intervention or control arm.

Overuse and underuse of cardiovascular diagnostic and therapeutic procedures for community-dwelling adults: a protocol for a systematic review.

Potentially inappropriate care can result from overuse or underuse of treatments, tests, or procedures. Overuse is defined as the use of health services with no clear benefit to the recipient or where harms outweigh benefits and/or costs of care. Underuse is defined as failure to deliver an effective and cost-effective healthcare intervention.

Evaluation of policies and practices to support safe and appropriate analgesic and sedative prescribing: The CDRx (controlled drug prescribing) protocol.

Medications provide many therapeutic benefits; however, these must be balanced against the potential for patient harm. Two high-risk medications are benzodiazepine receptor agonists or BZRAs (including benzodiazepines and Z-drugs hypnotics) and opioid analgesics, which carry a risk of dependence, misuse, and abuse. Use of these medications has been growing internationally, along with associated morbidity and mortality.

Opioid and analgesic utilization in Ireland in 2000 and 2015: A repeated cross-sectional study.

In recent decades, opioid use has increased internationally and is a major public health concern. This study aims to characterize changes in opioid and other analgesic prescribing in Ireland over a 15-year period (2000-2015). This is a repeated cross-sectional study of administrative pharmacy claims data in 2000 and 2015.

Prescribing cascades in community-dwelling adults: protocol for a systematic review.

Internationally, health systems face the challenge of managing a growing ageing population living with multimorbidity and polypharmacy. Potentially inappropriate prescribing is common among patients with polypharmacy, increasing the risk for adverse drug reactions (ADRs). Several prescribing indicator sets exist to improve prescribing and reduce potentially inappropriate prescribing, but do not address prescribing cascades.

Successful implementation of a trans-jurisdictional, primary care, anticipatory care planning intervention for older adults at risk of functional decline: interviews with key health professionals.

Background: Aging populations present a challenge to health systems internationally, due to the increasing complexity of care for older adults living with functional decline. This study aimed to elicit expert views of key health professionals on effective and sustainable implementation of a nurse-led, person-centred anticipatory care planning (ACP) intervention for older adults at risk of functional decline in a primary care setting.

Methods: We examined the feasibility of an ACP intervention in a trans-jurisdictional feasibility cluster randomized controlled trial consisting of home visits by research nurses who assessed participants' health, discussed their health goals and devised an anticipatory care plan following consultation with participants' GPs and adjunct clinical pharmacist.

Payments reported by the pharmaceutical industry in Ireland from 2015 to 2019: An observational study.

Background: The pharmaceutical industry makes large numbers of payments to healthcare organisations (HCOs) and healthcare professionals (HCPs). Ireland has a large pharmaceutical industry presence and national debate on legislating for greater industry payment transparency. This study characterises payments in Ireland to HCPs and HCOs during 2015-2019, and the content, consistency and methodology of the data source.

Protocol for a process evaluation of an external pilot cluster randomised controlled trial of a theory-based intervention to improve appropriate polypharmacy in older people in primary care: the PolyPrime study.

Background: The PolyPrime intervention is a theory-based intervention aimed at improving appropriate polypharmacy in older people (aged ≥65 years) in primary care. The intervention consists of an online video which demonstrates how general practitioners (GPs) can prescribe appropriate polypharmacy during a consultation with an older patient and a patient recall process, whereby patients are invited to scheduled medication review consultations with GPs. The aim of the process evaluation is to further examine the implementation of the PolyPrime intervention in primary care.