• A computer based, automated analysis of process and outcomes of diabetic care in 23 GP practices.

      Hill, F; Bradley, C; University College Cork, Cork. fghill@imagine.ie (Irish Medical Journal (IMJ), 2012-02)
      The predicted prevalence of diabetes in Ireland by 2015 is 190,000. Structured diabetes care in general practice has outcomes equivalent to secondary care and good diabetes care has been shown to be associated with the use of electronic healthcare records (EHRs). This automated analysis of EHRs in 23 practices took 10 minutes per practice compared with 15 hours per practice for manual searches. Data was extracted for 1901 type II diabetics. There was valid data for >80% of patients for 6 of the 9 key indicators in the previous year. 543 (34%) had a Hba1c > 7.5%, 142 (9%) had a total cholesterol >6 mmol/l, 83 (6%) had an LDL cholesterol >4 mmol/l, 367 (22%) had Triglycerides > 2.2 mmol/l and 162 (10%) had Blood Pressure > 160/100 mmHg. Data quality and key indicators of care compare well with manual audits in Ireland and the U.K. electronic healthcare records and automated audits should be a feature of all chronic disease management programs.
    • Establishing a general practitioner led minor injury service: mixed methods evaluation at 10 months with an emphasis on use of radiology by GPs in the out-of-hours setting.

      Redmond, P; Darker, C; McDonnell, M; O'Shea, B; TCD/HSE General Practice Training Scheme, Department of Public Health and Primary Care, Trinity College Centre for Health Sciences, Tallaght Hospital, Tallaght, Dublin 24, Ireland. predmond@rcsi.ie (Irish journal of medical science, 2013-06)
      A mixed methods study was conducted to evaluate a recently established general practitioner (GP) led minor injury (MI) service; it included a patient feedback study, a qualitative enquiry into the experience of the MI GPs, and analysis of use of radiology.
    • General practitioner's reported use of clinical guidelines for hypertension and ambulatory blood pressure.

      Flynn, E; Flavin, A; Western Regional General Practice Training Programme, Co Galway. evaflynn@hotmail.com (Irish Medical Journal (IMJ), 2012-03)
      ABPM is an invaluable clinical tool, as it has been shown to improve blood pressure control in primary care. Many clinical guidelines for hypertension advocate ambulatory blood pressure monitoring. This study aims to quantify the use of clinical guidelines for hypertension and to explore the role of ABPM in Primary Care. A questionnaire survey was sent to GPs working in the West of Ireland. 88% (n=139) of GPs use clinical guidelines that recommend the use of ABPM. 82% (n=130) of GPs find use of clinic blood pressure monitoring insufficient for the diagnosis and monitoring of hypertension. Despite good access to ABPM, GPs report lack of remuneration, 72% (n=116), cost 68% (n=108), and lack of time, 51% (n=83) as the main limiting factors to use of ABPM. GPs recognise the clinical value of ABPM, but this study identifies definite barriers to the use of ABPM in Primary Care.
    • Home visits: why do rates vary so much?

      Stewart, P; Stewart, R; Donegal Specialist Training Programme in General Practice, Education Centre, St. Conals, Letterkenny, Co Donegal. pspstewart62@gmail.com (Irish Medical Journal (IMJ), 2012-03)
      Data including information on patient age, gender, who initiated the visit and call classification was collected during office hours from 12 G.P. rural teaching practices with a combined GMS patient population of 24,720, over a 2 month period. There were a total of 603 home visits, giving an annual visiting rate of 143/1000. Visiting rates varied between practices from 45 to 305/1000 per year. When high visiting practices (>210/1000/year) were compared to low visiting rate practices (>90/1000/year), patients tended to be older (79.7 v. 74.5 years) and calls were 12 times more likely to be doctor initiated (16.6% v. 1.4%) or classified as routine( 50.7% v. 44.9%). The variation between practices was related in part to patient age but appears largely due to differences in doctor home visiting behaviour. There are no recent figures on home visiting in Ireland.