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A survey of GPs in Ireland The management of patients with suspected or diagnosed epilepsy &

A survey of GPs in Ireland The management of patients with suspected or diagnosed epilepsy & The extent & utilisation of Information & Communication Technology (ICT) in Irish General Practice Joint survey conducted by Beaumont Hospital Epilepsy Research Dept of &

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A survey of GPs in Ireland The management of patients with suspected or diagnosed epilepsy &

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  1. A survey of GPs in Ireland The management of patients with suspected or diagnosed epilepsy & The extent & utilisation of Information & Communication Technology (ICT) in Irish General Practice Joint survey conducted by Beaumont Hospital Epilepsy Research Dept of & the Irish College of General Practitioners Presenter: Mr Jarlath Varley RGN: (a) ANP: MSc: PhD Fellow May 23rd Hilton Hotel, Dublin 2

  2. Background to the Survey Health Informatics EPR development Evaluation Research Tertiary care OPD Epilepsy surgery Monitoring unit CNS Helpline Pregnancy registrar Information Primary care services Secondary care services Community care

  3. CHRONIC DISEASE MANAGEMENT: LINKING GOALS TO INFORMATION

  4. Electronic Patient Record (EPR) Local Hospital GP Tertiary Referral Public Health Background to the Electronic patient Record (EPR) & Epilepsy Care Health Records fragmented Local Hospital GP Tertiary Referral Public Health

  5. Pre-implementation phase of EPR development • What are the facilitators and/or barriers to implementing an EPR into the existing service… • What are the current pathways of care for epilepsy in Ireland… • GPs are the gatekeepers to epilepsy care services – link between primary/secondary and tertiary care… • What are the main issues… • GP attitudes to managing patients with suspected and/or diagnosed epilepsy… • Extent of computerisation in Irish General Practice…

  6. Study Methodology Research questions from current clinical practice Systematic review of the literature Identification & revision of emerging themes Initial draft of questionnaire 1st Review of questionnaire by expert groups – subsequent modification 2nd Review of questionnaire by expert groups - subsequent modification Review of questionnaire by sample group of GPs - subsequent modification 3rd Review of questionnaire by expert groups - subsequent modification Final draft of questionnaire prepared

  7. 750 postal questionnaires distributed 247 returned (35%) 50% > 10 years in practice, Highest response rate: Mid-large sized practices ( 3000-5000 pts) 60% urban/sub-urban. 15% rural Public/Private patient ratio (no significant difference). Section 1 - Profile of Respondents

  8. Section 1 - Profile of Respondents (Cont)

  9. Section II: GPs & Computerisation

  10. Section 2 (Cont) : GPs & Computerised Prescribing

  11. Section 3: GPs & Computerised Clinical Functions

  12. Section 4: The initial management of suspected Epilepsy by GPs

  13. Section 4 (Cont) : The management of Epilepsy & AED’s

  14. Section 4 (Cont) : Epilepsy Management in Primary care: The GP Perspective

  15. Section 5: Epilepsy Management & Access to Neurology Investigations & Services

  16. Comments from free text Box

  17. “Access to neurology is a joke - referral to A/E is the only way to access a neurological opinion” Two tier system –private patient access to service adequate- public pt service difficult, protracted and frustrating, more evident in neurology…” “We could deal with a lot more in GP if we had access to neurology advice & support” “I think GPs could provide more management for epilepsy if appropriate training was provided” “Access to neurology is deplorable- no point having more neurologists- without rapid access to diagnostic tools and urgent opd appointments”

  18. Conclusion: Epilepsy Management in Primary Care • Neurology/Epilepsy services very emotive subject – the two tier system….. • Existing referral pathways very unsatisfactory…… • Clarity regarding the primary role of the GP is required…. • Perceived lack of clinical expertise/guidance/knowledge available…… • Inappropriate Emergency Department referrals….. • Good support for the “shared care” model for epilepsy management…. • No evidence of incentivisation for GPs…. • Are GPs practicing “neurology by default” ?

  19. Conclusions: Information & Communication Technology in Primary Care • Findings demonstrate the increased utilisation of computerisation in primary practice • Broadband available and integrated in many practice’s • GPs open to integrating/accessing remote EPR • Continued reliance on paper method • Components of the General Practice software systems underused…..why? • Can ICT improve the primary/secondary/tertiary interface in respect of chronic disease management in Ireland??

  20. “..I would be very happy to take a shared care approach to managing patients with epilepsy, maintaining, educating and monitoring drug levels…..However access to hospital services is dreadful – I have patients waiting 2 years for initial assessment and I have no access to EEG, CT or MRI for public patients….” Full-Time DublinGP with over 5,000 patients (80% public) and at least 50 patients with epilepsy/suspected epilepsy WOULD YOU LIKE HER JOB?

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