TY - JOUR T1 - Risk of mortality on and off methadone substitution treatment in primary care: a national cohort study JF - Addiction Y1 - 2015 A1 - Cousins, G A1 - Boland, F A1 - Courtney, Brenda A1 - Barry, Joe A1 - Lyons, S A1 - Fahey, T KW - All-cause mortality;cohort study;drug-related deaths;maintenance treatment;methadone;mortality;opioid;supervised consumption AB - Aim To assess whether risk of death increases during periods of treatment transition, and investigate the impact of supervised methadone consumption on drug-related and all-cause mortality. Design National Irish cohort study. Setting Primary care. Participants A total of 6983 patients on a national methadone treatment register aged 16–65 years between 2004 and 2010. Measurement Drug-related (primary outcome) and all-cause (secondary outcome) mortality rates and rate ratios for periods on and off treatment; and the impact of regular supervised methadone consumption. Results Crude drug-related mortality rates were 0.24 per 100 person-years on treatment and 0.39 off treatment, adjusted mortality rate ratio 1.63 [95% confidence interval (CI) = 0.66–4.00]. Crude all-cause mortality rate per 100 person-years was 0.51 on treatment versus 1.57 off treatment, adjusted mortality rate ratio 3.64 (95% CI = 2.11–6.30). All-cause mortality off treatment was 6.36 (95% CI = 2.84–14.22) times higher in the first 2 weeks, 9.12 (95% CI = 3.17–26.28) times higher in weeks 3–4, compared with being 5 weeks or more in treatment. All-cause mortality was lower in those with regular supervision (crude mortality rate 0.60 versus 0.81 per 100 person-years) although, after adjustment, insufficient evidence exists to suggest that regular supervision is protective (mortality rate ratio = 1.23, 95% CI = 0.67–2.27). Conclusions Among primary care patients undergoing methadone treatment, continuing in methadone treatment is associated with a reduced risk of death. Patients' risk of all-cause mortality increases following treatment cessation, and is highest in the initial 4-week period. VL - 111 UR - http://onlinelibrary.wiley.com/doi/10.1111/add.13087/full IS - 1 ER - TY - JOUR T1 - Developing an electronic health record (EHR) for methadone treatment recording and decision support JF - BMC Med Inform Decis Mak Y1 - 2011 A1 - Xiao, Liang A1 - Cousins, G A1 - Courtney, Brenda A1 - Hederman, Lucy A1 - Fahey, T A1 - Dimitrov, B KW - Decision Support Techniques KW - Drug Therapy, Computer-Assisted KW - Electronic Health Records KW - Episode of Care KW - Humans KW - Medical Record Linkage KW - Methadone KW - Practice Guidelines as Topic KW - Semantics KW - Systematized Nomenclature of Medicine KW - User-Computer Interface AB - BACKGROUND: In this paper, we give an overview of methadone treatment in Ireland and outline the rationale for designing an electronic health record (EHR) with extensibility, interoperability and decision support functionality. Incorporating several international standards, a conceptual model applying a problem orientated approach in a hierarchical structure has been proposed for building the EHR. METHODS: A set of archetypes has been designed in line with the current best practice and clinical guidelines which guide the information-gathering process. A web-based data entry system has been implemented, incorporating elements of the paper-based prescription form, while at the same time facilitating the decision support function. RESULTS: The use of archetypes was found to capture the ever changing requirements in the healthcare domain and externalises them in constrained data structures. The solution is extensible enabling the EHR to cover medicine management in general as per the programme of the HRB Centre for Primary Care Research. CONCLUSIONS: The data collected via this Irish system can be aggregated into a larger dataset, if necessary, for analysis and evidence-gathering, since we adopted the openEHR standard. It will be later extended to include the functionalities of prescribing drugs other than methadone along with the research agenda at the HRB Centre for Primary Care Research in Ireland. VL - 11 UR - http://www.biomedcentral.com/1472-6947/11/5 ER - TY - Generic T1 - Overview of utilization and examples of CDSSs and eCPRs. Clinical Prediction Rules – International Forum for Diagnostic and Prognostic Strategies in Primary Care, 4 June 2010, HRB Centre for Primary Care Research Y1 - 2010 A1 - Courtney, Brenda A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 ER -