%0 Journal Article %J Fam Pract %D 2013 %T Tackling transitions in patient care: the process of medication reconciliation %A Redmond, P %A Grimes, T %A McDonnell, R %A Boland, F %A Hughes, CM %A Fahey, T %K medication reconciliation %B Fam Pract %V 30 %P 483-4 %8 2013 Oct %@ http://fampra.oxfordjournals.org/content/30/5/483.extract %G eng %U http://fampra.oxfordjournals.org/content/30/5/483.extract %N 5 %R 10.1093/fampra/cmt051 %0 Journal Article %J BMC Pregnancy and Childbirth %D 2015 %T Prevalence of prescribing in pregnancy using the Irish primary care research network: a pilot study %A Dillon, P %A O'Brien, K %A McDonnell, R %A Donnelly-Swift, E %A Galvin, R %A Roche, A %A Cronin, K %A Walsh, DR %A Schelten, R %A Smith, SM %A Fahey, T %K FDA pregnancy-risk categories %K Medication use %K Pregnancy %K Prescribing %X Abstract Background: To establish the prevalence and patterns of prescribing to pregnant women in an Irish primary care setting. Methods: We reviewed electronic healthcare records routinely collected in primary care, of pregnant women attending nine Dublin-based General Practices affiliated to the Irish Primary Care Research Network (IPCRN) for antenatal care between January 2007 and October 2013 (n = 2,361 pregnancies). Results: Excluding folic acid, 46.8% (n = 1,104) of pregnant women were prescribed at least one medication. Amoxicillin (11.1%, n = 263) and co-amoxiclav (8.0%, n = 190) were the most commonly prescribed medication followed by topical clotrimazole (4.9%, n = 117), salbutamol inhalers (4.1%, n = 96) and paracetamol (4.0%, n = 95). General Medical Services (GMS) patients were more likely to receive a prescription than private patients (OR 2.81; 95%CI (2.28, 3.47)). We applied the US FDA pregnancy-risk categories as a proxy measure of prescribing appropriateness, with FDA Category D and X medications considered inappropriate. FDA Category D drugs were prescribed in 5.9% (n = 140) of pregnancies. FDA Category X drugs were prescribed in 4.9% (n = 116) of pregnancies but after exclusion of oral contraceptives, progestogens, infertility treatments Category X medications were prescribed in 0.6% (n = 13) of pregnancies. After the initial antenatal consultation the prescribing prevalence of FDA Category D medications reduced to 4.7% (n = 110) and Category X to 3.1% (n = 72). Conclusions: The overall prevalence of prescribing to pregnant women in our cohort is low compared to studies internationally, however similar levels of prescribing for FDA Category D and X were found. Following the initial antenatal consultation levels of prescribing of the FDA Category D and X medications reduced, however there is potential to further reduce their use in early pregnancy. The IPCRN database has provided valuable information on the current practice of antenatal prescribing within this pilot group of practices however it is limited by the absence of morbidity and pregnancy outcome data. %B BMC Pregnancy and Childbirth %V 15 %8 03/15 %G eng %U http://www.biomedcentral.com/1471-2393/15/67/abstract %N 67 %9 Published Journal Article %R 10.1186/s12884-015-0489-0 %0 Journal Article %J eGEMS %D 2015 %T A Multi-step Maturity Model for the implementation of Electronic and Computable Diagnostic Clinical Prediction Rules (eCPRs) %A Corrigan, D %A McDonnell, R %A Zarabzadeh, A %A Fahey, T %K clinical prediction rules %K Evidence Based Medicine %K Health Information Technology %K Learning Health System %K Research Translation %X Introduction: The use of Clinical Prediction Rules (CPRs) has been advocated as one way of implementing actionable evidence-based rules in clinical practice. The current highly manual nature of deriving CPRs makes them difficult to use and maintain. Addressing the known limitations of CPRs requires implementing more flexible and dynamic models of CPR development. We describe the application of Information and Communication Technology (ICT) to provide a platform for the derivation and dissemination of CPRs derived through analysis and continual learning from electronic patient data. Model Components: We propose a multistep maturity model for constructing electronic and computable CPRs (eCPRs). The model has six levels – from the lowest level of CPR maturity (literaturebased CPRs) to a fully electronic and computable service-oriented model of CPRs that are sensitive to specific demographic patient populations. We describe examples of implementations of the core model components – focusing on CPR representation, interoperability, electronic dissemination, CPR learning, and user interface requirements. Conclusion: The traditional focus on derivation and narrow validation of CPRs has severely limited their wider acceptance. The evolution and maturity model described here outlines a progression toward eCPRs consistent with the vision of a learning health system (LHS) – using central repositories of CPR knowledge, accessible open standards, and generalizable models to avoid repetition of previous work. This is useful for developing more ambitious strategies to address limitations of the traditional CPR development life cycle. The model described here is a starting point for promoting discussion about what a more dynamic CPR development process should look like. %B eGEMS %V 3 %G eng %U http://repository.academyhealth.org/egems/vol3/iss2/8/ %N 2 %R 10.13063/2327-9214.1153 %0 Journal Article %J The Cochrane Collaboration %D 2013 %T Interventions for improving medication reconciliation across transitions of care (Protocol) %A Redmond, P %A Grimes, T %A McDonnell, R %A Boland, F %A Hughes, CM %A Fahey, T %X This is the protocol for a review and there is no abstract. The objectives are as follows: To assess the effect of medication reconciliation on medication discrepancies, patient related outcomes and healthcare utilisation in patients receiving this intervention during transitions of care compared to patients not receiving medication reconciliation. %B The Cochrane Collaboration %I John Wiley & Sons, Ltd %G eng %R 10.1002/14651858.CD010791 %0 Journal Article %J Family Practice %D 2016 %T GPs’ and community pharmacists’ opinions on medication management at transitions of care in Ireland %A Redmond, P %A Carroll, H %A Grimes, T %A Galvin, R %A McDonnell, R %A Boland, F %A McDowell, R %A Hughes, CM %A Fahey, T %X Objective. The aim of this study was to survey GPs and community pharmacists (CPs) in Ireland regarding current practices of medication management, specifically medication reconciliation, communication between health care providers and medication errors as patients transition in care.Methods. A national cross-sectional survey was distributed electronically to 2364 GPs, 311 GP Registrars and 2382 CPs. Multivariable associations comparing GPs to CPs were generated and content analysis of free text responses was undertaken.Results. There was an overall response rate of 17.7% (897 respondents—554 GPs/Registrars and 343 CPs). More than 90% of GPs and CPs were positive about the effects of medication reconciliation on medication safety and adherence. Sixty per cent of GPs reported having no formal system of medication reconciliation. Communication between GPs and CPs was identified as good/very good by >90% of GPs and CPs. The majority (>80%) of both groups could clearly recall prescribing errors, following a transition of care, they had witnessed in the previous 6 months. Free text content analysis corroborated the positive relationship between GPs and CPs, a frustration with secondary care communication, with many examples given of prescribing errors.Conclusions. While there is enthusiasm for the benefits of medication reconciliation there are limited formal structures in primary care to support it. Challenges in relation to systems that support inter-professional communication and reduce medication errors are features of the primary/secondary care transition. There is a need for an improved medication management system. Future research should focus on the identified barriers in implementing medication reconciliation and systems that can improve it. %B Family Practice %V 33 %P 172-178 %G eng %U http://fampra.oxfordjournals.org/content/33/2/172.abstract %R 10.1093/fampra/cmw006 %0 Journal Article %J BMC Trials %D 2013 %T Effectiveness of medicines review with web-based pharmaceutical treatment algorithms in reducing potentially inappropriate prescribing in older people in primary care: a cluster randomized trial (OPTI-SCRIPT study protocol) %A Clyne, B %A Bradley, MC %A Motterlini, N %A Clear, Daniel %A McDonnell, R %A Smith, SM %A Hughes, CM %A Fahey, T %B BMC Trials %V 14 %P 72 %8 03/2013 %G eng %U http://www.ncbi.nlm.nih.gov/pubmed/23497575 %N 1 %& 72 %R doi: 10.1186/1745-6215-14-72 %0 Journal Article %J BMC Health Services Research %D 2013 %T Addressing potentially inappropriate prescribing in older patients: Design and pilot study of an intervention in primary care %A Clyne, B %A Bradley, MC %A Smith, SM %A Hughes, CM %A Clear, Daniel %A McDonnell, R %A Williams, David %A Fahey, T %K Medical research council framework %K Multifaceted intervention %K potentially inappropriate prescribing %K Randomised controlled trial %X Background Potentially inappropriate prescribing (PIP) in older people is common in primary care and can result in increased morbidity, adverse drug events, hospitalizations and mortality. The prevalence of PIP in Ireland is estimated at 36% with an associated expenditure of over €45 million in 2007. The aim of this paper is to describe the application of the Medical Research Council (MRC) framework to the development of an intervention to decrease PIP in Irish primary care. Methods The MRC framework for the design and evaluation of complex interventions guided the development of the study intervention. In the development stage, literature was reviewed and combined with information obtained from experts in the field using a consensus based methodology and patient cases to define the main components of the intervention. In the pilot stage, five GPs tested the proposed intervention. Qualitative interviews were conducted with the GPs to inform the development and implementation of the intervention for the main randomised controlled trial. Results The literature review identified PIP criteria for inclusion in the study and two initial intervention components - academic detailing and medicines review supported by therapeutic treatment algorithms. Through patient case studies and a focus group with a group of 8 GPs, these components were refined and a third component of the intervention identified - patient information leaflets. The intervention was tested in a pilot study. In total, eight medicine reviews were conducted across five GP practices. These reviews addressed ten instances of PIP, nine of which were addressed in the form of either a dose reduction or a discontinuation of a targeted medication. Qualitative interviews highlighted that GPs were receptive to the intervention but patient preference and time needed both to prepare for and conduct the medicines review, emerged as potential barriers. Findings from the pilot study allowed further refinement to produce the finalised intervention of academic detailing with a pharmacist, medicines review with web-based therapeutic treatment algorithms and tailored patient information leaflets. Conclusions The MRC framework was used in the development of the OPTI-SCRIPT intervention to decrease the level of PIP in primary care in Ireland. Its application ensured that the intervention was developed using the best available evidence, was acceptable to GPs and feasible to deliver in the clinical setting. The effectiveness of this intervention is currently being tested in a pragmatic cluster randomised controlled trial. Trial registration Current controlled trials ISRCTN41694007 %B BMC Health Services Research %I BMC Health Services Research %V 13 %P 307 %G eng %U http://www.biomedcentral.com/1472-6963/13/307 %N 1 %R 10.1186/1472-6963-13-307 %0 Generic %D 2014 %T Prevalence of Medication Use in Pregnancy Using the Irish Primary Care Research Network Database. RCSI Research Day 20th March 2014 %A Roche, A %A Walsh, DR %A Cronin, K %A Schelten, R %A McDonnell, R %A O'Brien, K %A Boland, F %A Swift-Donnelly, Erica %A Smith, SM %A Fahey, T %G eng %0 Generic %D 2015 %T Patient preferences for breast cancer referral: Development and pilot study. RCSI Research Day. March 2015 %A Aherne, Emma %A O'Brien, K %A Walsh, A %A McDonnell, R %A Joyce, D %A Galvin, R %A Fahey, T %G eng %0 Generic %D 2014 %T Patient preferences for breast cancer referral: Development and pilot study. ICHAMS RCSI Dublin October 2014. Awarded 1st Prize %A Aherne, Emma %A O'Brien, K %A Quinlan, A %A McDonnell, R %A Hardy, C %A Galvin, R %A Fahey, T %G eng %0 Generic %D 2014 %T Medication Reconciliation - Unintentional discontinuation of long term medication post hospitalisation NAPCRG New York 21-24 Nov 2014 %A Redmond, P %A Grimes, T %A McDonnell, R %A Boland, F %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2015 %T Cross-sectional survey of general practitioners’ and community pharmacists’ opinions on medication management at transitions of care in Ireland. RCSI Research Day. March 2015 %A Carroll, H %A Redmond, P %A Grimes, T %A Galvin, R %A McDonnell, R %A Boland, F %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2014 %T Antibiotic prescribing patterns of Irish general practitioners in the international context: preliminary results from a pilot study RCSI Research Day 20 March 2014 %A Schelten, K %A Cronin, K %A Walsh, DR %A Roche, A %A McAteer, C %A O'Brien, K %A McDonnell, R %A Smith, SM %A Fahey, T %G eng %0 Generic %D 2016 %T Unintentional discontinuation of long term medication post hospitalisation. AUDGPI 10th March 2016 %A Redmond, P %A McDonnell, R %A Grimes, T %A Boland, F %A Zarabzadeh, A %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2015 %T Medication Reconciliation Cohort Study – The potentially unintentional discontinuation of long term medication post hospitalisation. WONCA October 2015, Istanbul %A Redmond, P %A Grimes, T %A McDonnell, R %A Boland, F %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2013 %T The Irish Primary Care Research Network (iPCRN): Overview of current work and future plans. PIP Meeting 25th November RCSI %A McDonnell, R %A Redmond, P %G eng %U http://hrbcentreprimarycare.ie/ppt/Ronan%20&%20Patrick.pdf %0 Generic %D 2014 %T IPCRN - An Overview. National Association of General Practice Trainees Conference 2014 Lyrath Estate Hotel, Kilkenny , 23–24 October 2014 %A McDonnell, R %G eng %0 Generic %D 2014 %T IPCRN - An Overview. Kildare ICGP Faculty Meeting, Naas Hospital, 9 October 2014 %A McDonnell, R %G eng %0 Generic %D 2015 %T Interventions for improving medication reconciliation across transitions of care – systematic review. Oral Presentation. SAPC, Oxford, UK %A Redmond, P %A Grimes, T %A McDonnell, R %A Boland, F %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2016 %T Is hospitalisation associated with the unintentional discontinuation of appropriate long-term medication in the GP record? SAPC 6th -8th of July 2016 Dublin Castle/RCSI. %A Redmond, P %A McDowell, R %A Grimes, T %A Boland, F %A Zarabzadeh, A %A McDonnell, R %A Hughes, CM %A Fahey, T %G eng %0 Generic %D 2014 %T Development of an electronic platform for an international register of Clinical Prediction Rules relevant to primary care. Healthcare Informatics Society of Ireland Conference, Dublin Castle 19-20 Nov 2014 %A Zarabzadeh, A %A McDonnell, R %A Corrigan, D %A Galvin, R %A Smith, SM %A Fahey, T %G eng %0 Conference Proceedings %B 9th International Conference on Knowledge, Information and Creativity Support Systems %D 2014 %T A Proposed Clinical Prediction Rule Register Supporting Primary Care Decision Making 9th International Conference on Knowledge, Information and Creativity Support Systems Cyprus 6-8 Nov 2014 %A Zarabzadeh, A %A McDonnell, R %A Corrigan, D %A Galvin, R %A Smith, SM %A Fahey, T %B 9th International Conference on Knowledge, Information and Creativity Support Systems %G eng %0 Conference Paper %B The 29th International Symposium on Computer-Based Medical Systems (CBMS 2016) %D 2016 %T Utility of electronic international register of clinical prediction rules relevant to primary care %A Zarabzadeh, A %A McDonnell, R %A Paz Berrios, S %A Dempsey, J %A Harrington, E %A Smith, SM %A Fahey, T %B The 29th International Symposium on Computer-Based Medical Systems (CBMS 2016) %C Dublin (June 20, 2016) and in Belfast (June 21 – 23, 2016) %8 06/2016 %G eng