Interventions for improving outcomes in patients with multimorbidity in primary care and community settings.

Background: Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. The term comorbidity is also used but this is now taken to mean that there is a defined index condition with other linked conditions, for example diabetes and cardiovascular disease. It is also used when there are combinations of defined conditions that commonly co-exist, for example diabetes and depression.

Antibiotic use in early childhood and risk of obesity: longitudinal analysis of a national cohort.

Background: Taking oral antibiotics during childhood has been linked with an increased risk of childhood obesity. This study assessed any potential association in number of courses of antibiotics taken between 2-3 and 4-5 years of age and body mass trajectory up to age 5.

Methods: The study was a secondary analysis of 8186 children and their parents from the infant cohort of the Irish National Longitudinal Study of Children.

Shared care across the interface between primary and specialty care in management of long term conditions.

Background: Shared care has been used in the management of many chronic conditions with the assumption that it delivers better care than primary or specialty care alone; however, little is known about the effectiveness of shared care.

Objectives: To determine the effectiveness of shared care health service interventions designed to improve the management of chronic disease across the primary/specialty care interface. This is an update of a previously published review.

An analytic observational study on complaints management in the general practice out of hours care setting: who complains, why, and what can we do about it?

Background: General Practice Co-Operatives provide most out of hours care in communities in Ireland. Limited data exists on patient complaints. This study reports on complaints at Kildare and West Wicklow Doctors on Call ('K Doc'), a GP Co-Operative in Ireland, examining the impact of a formal risk reduction strategy implemented (2010-2013).

Interventions for improving outcomes in patients with multimorbidity in primary care and community settings.

Background: Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. The term comorbidity is also used but this is now taken to mean that there is a defined index condition with other linked conditions, for example diabetes and cardiovascular disease. It is also used when there are combinations of defined conditions that commonly co-exist, for example diabetes and depression.

Weighing children; parents agree, but GPs conflicted.

Background: General practitioners (GPs) do not routinely check children's weight, partly due to concern regarding parental/child response. The aim of this study is to compare GP concerns regarding weighing with parental/child responses.

Objective: Compare GP insights on weighing children with the experience of parents whose children had been weighed.

Weight, body image and bullying in 9-year-old children.

Aim: To explore the association between weight and bullying; considering victims and perpetrators as two aspects of bullying, and subjective perception and objective measurement as two aspects of weight.

Methods: This study is based on the first wave of data collection from Growing Up in Ireland - the National Longitudinal Study of Children. The two-stage sample design included a sample of 910 primary schools in Ireland, from which a sample of 8568 nine-year-old children and their families was randomly selected.

Multimorbidity in a cohort of patients with type 2 diabetes.

Background: People with type 2 diabetes frequently have a variety of related and unrelated chronic conditions. These additional conditions have implications for patient education, treatment burden and disease management.

Objectives: The aim of this study was to examine the nature of multimorbidity, and its impact on GP visits, polypharmacy and glycaemic control as measured by HbA1c, in a cohort of patients with type 2 diabetes attending general practice in Ireland.

Managing patients with multimorbidity: systematic review of interventions in primary care and community settings.

Objective: To determine the effectiveness of interventions designed to improve outcomes in patients with multimorbidity in primary care and community settings.

Design: Systematic review.

Data Sources: Medline, Embase, CINAHL, CAB Health, Cochrane central register of controlled trials, the database of abstracts of reviews of effectiveness, and the Cochrane EPOC (effective practice and organisation of care) register (searches updated in April 2011).

Use of folic acid supplements and risk of cleft lip and palate in infants: a population-based cohort study.

Background: Orofacial clefts occur when the lips or the roof of the mouth do not fuse properly during the early weeks of pregnancy. There is strong evidence that periconceptional use of folic acid can prevent neural tube defects but its effect on oral clefts has generated debate.

Aim: To identify factors associated with suboptimal periconceptional use of folic acid and its potential effect on oral clefts.

Cost effectiveness of peer support for type 2 diabetes.

Objectives: The aim of this study is to examine the cost-effectiveness of a group-based peer support intervention in general practice for patients with type 2 diabetes.

Methods: Incremental cost utility analysis combining within trial and beyond trial components to compare the lifetime costs and benefits of alternative strategies:

Control: standardized diabetes care;

Intervention: group-based peer support in addition to standardized diabetes care. Within trial analysis was based on a cluster randomized controlled trial of 395 patients with type 2 diabetes in the east of Ireland.

Interventions for improving outcomes in patients with multimorbidity in primary care and community settings.

Background: Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. While this is not a new phenomenon, there is greater recognition of its impact and the importance of improving outcomes for individuals affected. Research in the area to date has focused mainly on descriptive epidemiology and impact assessment.

Spatial variation in general medical services income in dublin general practitioners.

The general medical services (GMS) scheme provides care free at the point of use for the 30% most economically deprived section of the population and the elderly. Almost all people of over-70-year olds are eligible for the GMS scheme potentially directing resources away from those most in need. The aim of this study is to analyse the relationship between practice GMS income and deprivation amongst Dublin-based general practitioners (GPs).

Psychological family intervention for poorly controlled type 2 diabetes.

Objective: To evaluate the effectiveness of a psychological, family-based intervention to improve diabetes-related outcomes in patients with poorly controlled type 2 diabetes.

Methods: This study was a randomized controlled trial of a psychological family-based intervention targeted at individuals with poorly controlled type 2 diabetes. Recruitment and follow-up occurred at specialist diabetes clinics.

The distribution of GPs in Ireland in relation to deprivation.

The aim of this study was to describe the distribution of GP services in Ireland with respect to deprivation. Seven percent of rural inhabitants live within walking distance of the nearest GP compared to 89% of city dwellers. The longest average travel times occur in the most deprived rural areas.

GPs' and pharmacists' experiences of managing multimorbidity: a 'Pandora's box'.

Background: Multimorbidity is defined as the occurrence of two or more chronic diseases in one individual. Patients with multimorbidity generally have poorer health and functioning and higher rates of attendance in primary care and specialty settings.

Aim: To explore the views and attitudes of GPs and pharmacists managing patients with multimorbidity in primary care.

General practitioner workforce planning: assessment of four policy directions.

Background: Estimating the supply of GPs into the future is important in forecasting shortages. The lengthy training process for medicine means that adjusting supply to meet demand in a timely fashion is problematic. This study uses Ireland as a case study to determine the future demand and supply of GPs and to assess the potential impact of several possible interventions to address future shortages.

Primary medical care in Irish prisons.

Background: An industrial dispute between prison doctors and the Irish Prison Service (IPS) took place in 2004. Part of the resolution of that dispute was that an independent review of prison medical and support services be carried out by a University Department of Primary Care. The review took place in 2008 and we report here on the principal findings of that review.

Does sharing care across the primary-specialty interface improve outcomes in chronic disease? A systematic review.

Objective: To determine the effectiveness of shared care interventions designed to improve the management of chronic disease across the primary-specialty care interface.

Study Design And Methods: Systematic review using the Cochrane Collaboration method.

Results: Twenty studies were identified, 19 of which were randomized controlled trials.

Consultation charges in Ireland deter a large proportion of patients from seeing the GP: results of a cross-sectional survey.

Objective: To estimate the effect of a consultation charge on the health-seeking behaviour of patients.

Methods: Cross-sectional survey of patients carried out in Northern Ireland, where services are free at the point of delivery, and the Republic of Ireland, where 70% of the population are charged a consultation fee to see the general practitioner (GP).

Results: There were 11 870 respondents to the survey (response rate 52%).