Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

1. Royal College of Surgeons in IrelandColáiste Ríoga na Máinleá in Éirinn Connected health: collaborative opportunities for ICON and academia Tom Fahey Professor of General Practice, RCSI Medical School & Principal Investigator, HRB Centre for Primary Care Research

2. Overview • Background • Collaborative opportunities • Exploring potential of large databases • Patient safety • Quality of care • Education and training of graduates

3. Overview • Background • Collaborative opportunities • Exploring potential of large databases • Patient safety • Quality of care • Education and training of graduates

4. My own background • Professor of General Practice, RCSI 2006 onwards • Medical graduate UCD, trained epidemiology & Public Health (TCD & Oxford) • Previously (UK 14 years) • Professor (University Dundee) • SL (University of Bristol) • L (University of Oxford)

5. Roles • Professor & Head of Department • Principal investigator HRB Centre for Primary Care Research • Chair of Research, Irish College of General Practitioners • Other roles • Academic collaborator EU FP7 TRANSFoRm • Medical advisory group Irish Medicines Board

7. Overview • Background • Collaborative opportunities • Exploring potential of large databases • Patient safety • Quality of care • Education and training of graduates

8. GP Electronic Health Record (EHR)

9. EHR • UK • Ireland

16. Trial data query system

17. Recruitment RCT

18. Visualisation- patient recruitment

19. Diagnostic code recoded- type 1 NIDDM

20. Overview • Background • Collaborative opportunities • Exploring potential of large databases • Patient safety • Quality of care • Education and training of graduates

21. TRANSFoRm- WP4 patient safety WP4 Evidence Repository Research Study Designer WT 5.2 GP EHRs With CDSS Study Criteria Design Clinical Evidence Service Evidence Management Tools Find Eligible Patient Research Study Management WT 4.5 Evidence Mining and Analysis Recruit Eligible Patient Evidence Analysis & Extraction Tool Study Data Management

22. Overview • Background • Collaborative opportunities • Exploring potential of large databases • Patient safety • Quality of care • Education and training of graduates

23. Potentially Inappropriate Prescribing (PIP) • PIP is prevalent in the older population (> 70 years) • Republic of Ireland 36% • Northern Ireland 34% • United Kingdom 29%

24. The prevalence of the most common STOPP/START PIP indicators across three regions

25. OPTI-SCRIPT study development

26. Study overview PCRS – National Contemporaneous Control - Observational comparison to national prescribing data (376,858 patients, 2,000+ practices)

27. OPTI-SCRIPT website

29. OPTI-SCRIPT RCT results • Participants • 21 GP practices (32% cluster response rate) • 196 patients (37% response rate) • Minimisation

30. Study design & methodology – cluster RCT • Primary outcome measure: • Proportion of patients with no PIP • Mean PIP per group • Data collection baseline & immediate post intervention • Between group differences: • Random effects logistic regression • Cluster mean • Random effects poisson regression • Process evaluation

31. Outcome – Proportion with no PIP Adjusted odds ratio = 3.06 (95% CI 1.4,6.5; P=0.004)* *adjusted for gender, age, baseline PIP, number repeat medications, GP practice size

32. National contemporaneous control – PCRS • Intervention period, Sep 2012 – August 2013 prevalence of 38% • Odds of having no PIP in OPTI-SCRIPT intervention compared to odds of having no PIP in the national PCRS cohort

33. Overview • Background • Collaborative opportunities • Exploring potential of large databases • Patient safety • Quality of care • Education and training of graduates

34. Overview • Background • Collaborative opportunities • Exploring potential of large databases • Patient safety • Quality of care • Education and training of graduates

36. Discussion • Collaboration • Joint funding • HRB Centre renewal • Horizon 20:20 • Training of graduates