TY - JOUR T1 - Why do healthcare professionals fail to escalate as per the early warning system (EWS) protocol? A qualitative evidence synthesis of the barriers and facilitators of escalation JF - BMC Emergency Medicine Y1 - 2021 A1 - O’Neill, S.M A1 - Clyne, B A1 - Bell, M A1 - Casey, A A1 - Leen, B A1 - Smith, SM A1 - Ryan, M A1 - O’Neill, M VL - 21 IS - 15 ER - TY - JOUR T1 - What is the impact of multimorbidity on out-of-pocket healthcare expenditure among community-dwelling older adults in Ireland? A cross-sectional study JF - BMJ Open Y1 - 2022 A1 - Larkin, J A1 - Walsh, B A1 - Moriarty, F A1 - Clyne, B A1 - Harrington, P A1 - Smith, SM VL - 12:e060502 ER - TY - JOUR T1 - Variation in medical practice: getting the balance right JF - Fam Pract Y1 - 2012 A1 - Wallace, E A1 - Smith, SM A1 - Fahey, T KW - clinical practice KW - medical interventions KW - variation in medical practice AB - Contemporary clinical practice is characterized by its complexity as the volume and diversity of medical interventions, whether they are drugs, procedures or diagnostic tests, are increasing and threaten to overwhelm our capacity to deliver patient-centred care. Consider some statistics: the average American citizen can expect to undergo seven operations in their lifetime, 10% will undergo an MRI scan annually (three times higher than the rate in neighbouring Canada) and 50% of Medicare beneficiaries are prescribed five or more medications. In Ireland, one-fifth of the whole population aged over 70 years are taking long-term Proton Pump Inhibitor (PPI) therapy.1–3 The consequences of this phenomenon for patients in terms of benefit (increase quantity and quality of life) versus harm (medicalization of a person, side effects of therapies and costs to the health service budget) give rise to questions concerning the epidemiology of health care utilization and how it differs between and within countries. Seminal work carried out by John Wennberg, a health services researcher and epidemiologist who developed the Dartmouth Atlas Health Project (www.dartmouthatlas.org), has produced an emerging science that examines variation in medical practice and raises important questions about what constitutes ‘appropriate’ health care. This editorial outlines the taxonomy of medical practice variation with clinical … VL - 29 UR - http://www.ncbi.nlm.nih.gov/pubmed/23008518 IS - 5 ER - TY - JOUR T1 - Trends and interaction of polypharmacy and potentially inappropriate prescribing in primary care over 15 years in Ireland: a repeated cross-sectional study JF - BMJ Open Y1 - 2015 A1 - Moriarty, F A1 - Hardy, C A1 - Bennett, K A1 - Smith, SM A1 - Fahey, T AB - Objectives To examine: (1) changes in polypharmacy in 1997, 2002, 2007 and 2012 and; (2) changes in potentially inappropriate prescribing (PIP) prevalence and the relationship between PIP and polypharmacy in individuals aged ≥65 years over this period in Ireland. Methods This repeated cross-sectional study using pharmacy claims data included all individuals eligible for the General Medical Services scheme in the former Eastern Health Board region of Ireland in 1997, 2002, 2007 and 2012 (range 338 025–539 752 individuals). Outcomes evaluated were prevalence of polypharmacy (being prescribed ≥5 regular medicines) and excessive polypharmacy (≥10 regular medicines) in all individuals and PIP prevalence in those aged ≥65 years determined by 30 criteria from the Screening Tool for Older Persons’ Prescriptions. Results The prevalence of polypharmacy increased from 1997 to 2012, particularly among older individuals (from 17.8% to 60.4% in those aged ≥65 years). The adjusted incident rate ratio for polypharmacy in 2012 compared to 1997 was 4.16 (95% CI 3.23 to 5.36), and for excessive polypharmacy it was 10.53 (8.58 to 12.91). Prevalence of PIP rose from 32.6% in 1997 to 37.3% in 2012. High-dose aspirin and digoxin prescribing decreased over time, but long-term proton pump inhibitors at maximal dose increased substantially (from 0.8% to 23.8%). The odds of having any PIP in 2012 were lower compared to 1997 after controlling for gender and level of polypharmacy, OR 0.39 (95% CI 0.39 to 0.4). Conclusions Accounting for the marked increase in polypharmacy, prescribing quality appears to have improved with a reduction in the odds of having PIP from 1997 to 2012. With growing numbers of people taking multiple regular medicines, strategies to address the related challenges of polypharmacy and PIP are needed. VL - 5 UR - http://bmjopen.bmj.com/content/5/9/e008656.full IS - 9 ER - TY - JOUR T1 - Training postgraduate doctors to manage patients with multimorbidity: a systematic review JF - PROSPERO International prospective register of systematic reviews Y1 - 2013 A1 - Lewis, Cliona A1 - Wallace, E A1 - Kyne, L A1 - Cullen, W A1 - Smith, SM UR - http://www.crd.york.ac.uk/prospero/display_record.asp?ID=CRD42013004010#.U_IHd_ldVqU ER - TY - JOUR T1 - A systematic review of the probability of repeated admission score in community-dwelling adults JF - J Am Geriatr Soc Y1 - 2013 A1 - Wallace, E A1 - Hinchey, T A1 - Dimitrov, B A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM KW - Aged KW - Aged, 80 and over KW - Brazil KW - Calibration KW - Decision Support Techniques KW - Europe KW - Female KW - Health Care Costs KW - Health Services for the Aged KW - Humans KW - Male KW - Mortality KW - Patient Readmission KW - Probability KW - Reproducibility of Results KW - Risk Assessment KW - Sensitivity and Specificity KW - United States KW - Validation Studies as Topic AB - OBJECTIVES: To perform a systematic review of the Probability of Repeated Admission (Pra) score in community-dwelling adults to assess its performance in a range of validation studies in the community setting. DESIGN: Systematic review and meta-analysis. SETTING: Primary and community care. PARTICIPANTS: Community-dwelling older people. MEASUREMENTS: The primary outcome was hospital admission; secondary outcomes were mortality, hospital days, functional decline, other health service use, and costs. RESULTS: Nine validation studies describing 11 cohorts of individuals aged 65 and older were identified. A metaanalysis of the Pra score in five cohorts (8,843 individuals) with comparable and available data revealed good discrimination performance (summary area under the receiver operating characteristic curve 69.7% (standard error 2.8%)). Pooled specificity was high (96%, 95% confidence interval (CI)=95.8–96.7%), indicating that a Pra score of 0.5 or greater effectively rules in the likelihood of admission, but pooled sensitivity was low (12%, 95% CI=10.5–13.6%). Calibration performance was good, with an overall risk ratio of 1.12 (95% CI=0.89–1.42), indicating that the Pra score reliably predicted hospital admissions. CONCLUSION: The Pra score performs well in predicting hospital admission in community-dwelling adults categorized as high risk according to the score. This tool has clinical and healthcare policy utility in terms of targeting elderly people at highest risk of hospital admission, but the low pooled sensitivity of the score indicates that it is not a reliable way of excluding hospital admission in those stratified as low risk. VL - 61 UR - http://onlinelibrary.wiley.com/doi/10.1111/jgs.12150/abstract IS - 3 ER - TY - JOUR T1 - Sustained effectiveness of a multifaceted intervention to reduce potentially inappropriate prescribing in older patients in primary care (OPTI-SCRIPT study) JF - Implementation Science Y1 - 2016 A1 - Clyne, B A1 - Smith, SM A1 - Hughes, CM A1 - Boland, F A1 - Cooper, J A1 - Fahey, T A1 - on behalf of the OPTI-SCRIPT study team VL - 11 IS - 79 ER - TY - JOUR T1 - Risk prediction models to predict emergency hospital admission in community-dwelling adults. A systematic review JF - Med Care Y1 - 2014 A1 - Wallace, E A1 - Stuart, Ellen A1 - Vaughan, Niall A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM KW - community-dwelling adults KW - emergency hospital admission KW - risk prediction model AB - Abstract BACKGROUND: Risk prediction models have been developed to identify those at increased risk for emergency admissions, which could facilitate targeted interventions in primary care to prevent these events. OBJECTIVE: Systematic review of validated risk prediction models for predicting emergency hospital admissions in community-dwelling adults. METHODS: A systematic literature review and narrative analysis was conducted. Inclusion criteria were as follows; POPULATION: community-dwelling adults (aged 18 years and above); Risk: risk prediction models, not contingent on an index hospital admission, with a derivation and ≥1 validation cohort; PRIMARY OUTCOME: emergency hospital admission (defined as unplanned overnight stay in hospital); STUDY DESIGN: retrospective or prospective cohort studies. RESULTS: Of 18,983 records reviewed, 27 unique risk prediction models met the inclusion criteria. Eleven were developed in the United States, 11 in the United Kingdom, 3 in Italy, 1 in Spain, and 1 in Canada. Nine models were derived using self-report data, and the remainder (n=18) used routine administrative or clinical record data. Total study sample sizes ranged from 96 to 4.7 million participants. Predictor variables most frequently included in models were: (1) named medical diagnoses (n=23); (2) age (n=23); (3) prior emergency admission (n=22); and (4) sex (n=18). Eleven models included nonmedical factors, such as functional status and social supports. Regarding predictive accuracy, models developed using administrative or clinical record data tended to perform better than those developed using self-report data (c statistics 0.63-0.83 vs. 0.61-0.74, respectively). Six models reported c statistics of >0.8, indicating good performance. All 6 included variables for prior health care utilization, multimorbidity or polypharmacy, and named medical diagnoses or prescribed medications. Three predicted admissions regarded as being ambulatory care sensitive. CONCLUSIONS: This study suggests that risk models developed using administrative or clinical record data tend to perform better. In applying a risk prediction model to a new population, careful consideration needs to be given to the purpose of its use and local factors. VL - 52 UR - http://www.ncbi.nlm.nih.gov/pubmed/25023919 IS - 8 ER - TY - JOUR T1 - Retraction of statins article is not in the public interest: better characterisation of benefits and risks is crucial JF - BMJ Y1 - 2014 A1 - Fahey, T A1 - Smith, SM VL - 348 IS - g4028 ER - TY - JOUR T1 - Reducing emergency admissions through community based interventions JF - BMJ Y1 - 2016 A1 - Wallace, E A1 - Smith, SM A1 - Fahey, T A1 - Roland, M AB - Reducing emergency admissions to hospital, both as a measure of care quality and to contain spiralling healthcare expenditure, is gathering interest internationally. Emergency admissions in the United Kingdom rose by 47% from 1998 to 2013, from 3.6 million to 5.3 million, with only a 10% increase in population over this period.1 These admissions are expensive; in 2012 they cost the NHS £12.5bn (€16.8bn; $18.3bn).1 Emergency admission is used as a performance measure for healthcare systems. One of the quality measures for accountable care organisations under the US Affordable Care Act2 is to reduce emergency admissions for three chronic medical conditions: chronic obstructive pulmonary disease (COPD), congestive heart failure, and asthma.3 UK policy makers took a step further and introduced a financial incentive for general practitioners to identify the 2% of their practice population at highest risk of emergency admission and to manage them proactively (case management). We discuss the uncertainties around identification, prevention, and management of patients at high risk of emergency admission and suggest alternative approaches. VL - 352 UR - http://www.bmj.com/content/352/bmj.h6817.long IS - h6817 ER - TY - JOUR T1 - A protocol for the evaluation of the process and impact of embedding formal and experiential Public and Patient Involvement training in a structured PhD programme JF - Journal of Multimorbidity and Comorbidity Y1 - 2021 A1 - Foley, L A1 - Kiely, B A1 - Croke, A A1 - Larkin, J A1 - Smith, SM A1 - Clyne, B A1 - Pierce, M A1 - Murphy, E VL - 11 ER - TY - JOUR T1 - Protocol for a mixed methods process evaluation of the LinkMM randomised controlled trial “Use of link workers to provide social prescribing and health and social care coordination for people with complex multimorbidity in socially deprived areas” [versio JF - HRB Open Research Y1 - 2021 A1 - Kiely, B A1 - O'Donnell, P A1 - Byers, V A1 - Galvin, E A1 - Boland, F A1 - Smith, SM A1 - Connolly, D A1 - O'Shea, E A1 - Clyne, B VL - 4:38 ER - TY - JOUR T1 - A process evaluation of a cluster randomised trial to reduce potentially inappropriate prescribing in older people in primary care (OPTI-SCRIPT study) JF - Trials Y1 - 2016 A1 - Clyne, B A1 - Cooper, J A1 - Hughes, CM A1 - Fahey, T A1 - Smith, SM VL - 17 IS - 1 ER - TY - JOUR T1 - Primary care-based link workers providing social prescribing to improve health and social care outcomes for people with multimorbidity in socially deprived areas (the LinkMM trial): Pilot study for a pragmatic randomised controlled trial JF - Journal of Multimorbidity and Comorbidity Y1 - 2021 A1 - Kiely, B A1 - Connolly, D A1 - Clyne, B A1 - Boland, F A1 - O'Donnell, P A1 - O'Shea, E A1 - Smith, SM VL - 11 ER - TY - JOUR T1 - Prevalence of prescribing in pregnancy using the Irish primary care research network: a pilot study JF - BMC Pregnancy and Childbirth Y1 - 2015 A1 - Dillon, P A1 - O'Brien, K A1 - McDonnell, R A1 - Donnelly-Swift, E A1 - Galvin, R A1 - Roche, A A1 - Cronin, K A1 - Walsh, DR A1 - Schelten, R A1 - Smith, SM A1 - Fahey, T KW - FDA pregnancy-risk categories KW - Medication use KW - Pregnancy KW - Prescribing AB - 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. VL - 15 UR - http://www.biomedcentral.com/1471-2393/15/67/abstract IS - 67 ER - TY - JOUR T1 - Prevalence of potentially inappropriate prescribing and prescribing omissions in older Irish adults: findings from The Irish LongituDinal Study on Ageing study (TILDA) JF - European Journal of Clinical Pharmacology Y1 - 2014 A1 - Galvin, R A1 - Moriarty, F A1 - Cousins, G A1 - Cahir, C A1 - Motterlini, N A1 - Bradley, MC A1 - Hughes, CM A1 - Bennett, K A1 - Smith, SM A1 - Fahey, T A1 - Kenny, RA KW - older people KW - Potential prescribing omissions KW - potentially inappropriate prescribing KW - START KW - STOPP AB - Abstract Purpose We sought to estimate the prevalence of potentially inappropriate prescriptions (PIP) and potential prescribing omissions (PPOs) using a subset of the STOPP/START criteria in a population based sample of Irish adults aged ≥65 years using data from The Irish LongituDinal Study on Ageing (TILDA). Methods A subset of 26 PIP indicators and 10 PPO indicators from the STOPP/START criteria were applied to the TILDA dataset. PIP/PPO prevalence according to individual STOPP/START criteria and the overall prevalence of PIP/PPO were estimated. The relationship between PIP and PPOs and polypharmacy, age, gender and multimorbidity was examined using logistic regression. Results The overall prevalence of PIP in the study population (n = 3,454) was 14.6 %. The most common examples of PIP identified were NSAID with moderate-severe hypertension (200 participants; 5.8 %) and aspirin with no history of coronary, cerebral, or peripheral vascular symptoms or occlusive event (112 participants; 3.2 %). The overall prevalence of PPOs was 30 % (n = 1,035). The most frequent PPO was antihypertensive therapy where systolic blood pressure consistently >160 mmHg (n = 341, 9.9 %), There was a significant association between PIP and PPO and polypharmacy when adjusting for age, sex and multimorbidity (adjusted OR 2.62, 95 % CI 2.05–3.33 for PIP and adjusted OR 1.46, 95 % CI 1.23–1.75 for prescribing omissions). Conclusion Our findings indicate prescribing omissions are twice as prevalent as PIP in the elderly using a subset of the STOPP/START criteria as an explicit process measure of potentially inappropriate prescribing and prescribing omissions. Polypharmacy was independently associated with both PPO and PIP. Application of such screening tools to prescribing decisions may reduce unnecessary medication, related adverse events, healthcare utilisation and cost. UR - http://link.springer.com/article/10.1007/s00228-014-1651-8# ER - TY - JOUR T1 - Potentially inappropriate prescribing in two populations with differing socio-economic profiles: a cross-sectional database study using the PROMPT criteria JF - European Journal of Clinical Pharmacology Y1 - 2016 A1 - Cooper, J A1 - Moriarty, F A1 - Ryan, C A1 - Smith, SM A1 - Bennett, K A1 - Fahey, T A1 - Wallace, E A1 - Cahir, C A1 - Williams, David A1 - Teeling, Mary A1 - Hughes, CM AB - The purpose of this study is to establish the prevalence of potentially inappropriate prescribing (PIP) in middle-aged adults (45–64 years) in two populations with differing socio-economic profiles, and to investigate factors associated with PIP, using the PROMPT (PRescribing Optimally in Middle-aged People's Treatments) criteria. UR - http://dx.doi.org/10.1007/s00228-015-2003-z ER - TY - JOUR T1 - Potentially inappropriate prescribing in children JF - Family Practice Y1 - 2015 A1 - Barry, E A1 - Smith, SM VL - 32 IS - 6 ER - TY - JOUR T1 - ‘Potentially inappropriate or specifically appropriate?’ Qualitative evaluation of general practitioners views on prescribing, polypharmacy and potentially inappropriate prescribing in older people JF - BMC Family Practice Y1 - 2016 A1 - Clyne, B A1 - Cooper, J A1 - Hughes, CM A1 - Fahey, T A1 - Smith, SM VL - 17 IS - 1 ER - TY - JOUR T1 - Optimized retrieval of primary care clinical prediction rules from MEDLINE to establish a Web-based register JF - J Clin Epidemiol Y1 - 2011 A1 - Keogh, C A1 - Wallace, E A1 - O'Brien, K A1 - Murphy, Paul J A1 - Teljeur, C A1 - McGrath, Brid A1 - Smith, SM A1 - Niall Doherty A1 - Dimitrov, B A1 - Fahey, T KW - Abstracting and Indexing as Topic KW - Databases, Bibliographic KW - Humans KW - Information Storage and Retrieval KW - MEDLINE KW - Primary Health Care KW - Sensitivity and Specificity KW - Subject Headings AB - OBJECTIVES: Identifying clinical prediction rules (CPRs) for primary care from electronic databases is difficult. This study aims to identify a search filter to optimize retrieval of these to establish a register of CPRs for the Cochrane Primary Health Care field. STUDY DESIGN AND SETTING: Thirty primary care journals were manually searched for CPRs. This was compared with electronic search filters using alternative methodologies: (1) textword searching; (2) proximity searching; (3) inclusion terms using specific phrases and truncation; (4) exclusion terms; and (5) combinations of methodologies. RESULTS: We manually searched 6,344 articles, revealing 41 CPRs. Across the 45 search filters, sensitivities ranged from 12% to 98%, whereas specificities ranged from 43% to 100%. There was generally a trade-off between the sensitivity and specificity of each filter (i.e., the number of CPRs and total number of articles retrieved). Combining textword searching with the inclusion terms (using specific phrases) resulted in the highest sensitivity (98%) but lower specificity (59%) than other methods. The associated precision (2%) and accuracy (60%) were also low. CONCLUSION: The novel use of combining textword searching with inclusion terms was considered the most appropriate for updating a register of primary care CPRs where sensitivity has to be optimized. VL - 64 UR - http://www.sciencedirect.com/science/article/pii/S0895435610004233 IS - 8 ER - TY - JOUR T1 - OPTIMAL, an occupational therapy led self-management support programme for people with multimorbidity in primary care: a randomized controlled trial JF - BMC Family Practice Y1 - 2015 A1 - Garvey, J A1 - Connolly, D A1 - Boland, F A1 - Smith, SM KW - multimorbidity KW - Occupational therapy KW - Randomised controlled trial KW - Self-management AB - Background We investigated the effectiveness of an occupational therapy led self-management support programme, OPTIMAL, designed to address the challenges of living with multiple chronic conditions or multimorbidity in a primary care setting. Methods Pragmatic feasibility randomised controlled trial including fifty participants with multimorbidity recruited from family practice and primary care settings. OPTIMAL is a six-week community-based programme, led by occupational therapy facilitators and focuses on problems associated with managing multimorbidity. The primary outcome was frequency of activity participation. Secondary outcomes included self-perception of, satisfaction with and ability to perform daily activities, independence in activities of daily living, anxiety and depression, self-efficacy, health-related quality of life, self-management support, healthcare utilisation and individualised goal attainment. Outcomes were collected within two weeks of intervention completion. Results There was a significant improvement in frequency of activity participation, measured using the Frenchay Activities Index, for the intervention group compared to the control group (Adjusted Mean Difference at follow up 4.22. 95% Confidence Interval 1.59-6.85). There were also significant improvements in perceptions of activity performance and satisfaction, self-efficacy, independence in daily activities and quality of life. Additionally, the intervention group demonstrated significantly higher levels of goal achievement, following the intervention. No significant differences were found between the two groups in anxiety, depression, self-management scores or healthcare utilisation. Conclusions OPTIMAL significantly improved frequency of activity participation, self-efficacy and quality of life for patients with multimorbidity. Further work is required to test the sustainability of these effects over time but this study indicates that it is a promising intervention that can be delivered in primary care and community settings. Trial registration Trial Number: ISRCTN67235963 VL - 16 UR - http://www.biomedcentral.com/1471-2296/16/59/abstract IS - 59 ER - TY - JOUR T1 - Multimorbidity in primary care: developing the research agenda JF - Fam Pract Y1 - 2009 A1 - Mercer, Stewart W A1 - Smith, SM A1 - Wyke, Sally A1 - O'Dowd, T A1 - Watt, Graham C M KW - Aged KW - Chronic Disease KW - Comorbidity KW - Forecasting KW - Great Britain KW - Health Services Needs and Demand KW - Humans KW - International Cooperation KW - Primary Health Care KW - Quality Assurance, Health Care AB - Multimorbidity - usually defined as the co-existence of two or more long-term conditions in an individual - is the norm rather than the exception in primary care patients1,2 and will become more prevalent as populations age.3,1 Multimorbidity cuts across the vertical paradigms in which most health research and policy is envisaged, supported and carried out, reflecting not only specialist interests in particular problems and diseases, but also the tendency of research to focus on easily defined issues. “Complicated” patients with multimorbidity are usually excluded from such research. Although complexity is under-represented in the research literature, it is common place in general medical practice, where the challenges are “horizontal”, integrating not only at the level of the clinical encounter, but also in the co-ordination of services to support patients with multiple problems. The challenge of carrying out research on multimorbidity is to reflect, investigate, inform and improve these aspects of generalist clinical practice. Given that multimorbidity is a challenge facing practitioners and patients alike it has attracted surprisingly little research interest.4 The research to date has largely focussed on analysis of the impact of multimorbidity on individuals and healthcare systems, with very few studies examining interventions to improve outcomes.5 One of ‘multimorbidity's many challenges’1 includes setting a research agenda to systematically begin to answer important practical issues in supporting people with multimorbidity. Given the scale and complexity of the task, the first difficulty is simply knowing where to start. In order to gather views from the academic primary care community on the research agenda in multimorbidity we held workshops in Ireland (July 2008) and Scotland (January 2009) under the aegis of the Society for Academic Primary Care and the Scottish School of Primary Care respectively. The workshops were attended by approximately 50 delegates, including patient representatives, primary care professionals, and academics; both explored issues of definition, outcome measures, studies and interventions. The common themes that emerged are outlined below. VL - 26 UR - http://fampra.oxfordjournals.org/content/26/2/79.long IS - 2 ER - TY - JOUR T1 - Multimorbidity in a cohort of patients with type 2 diabetes JF - European Journal of General Practice Y1 - 2013 A1 - Teljeur, C A1 - Smith, SM A1 - Paul, G A1 - Kelly, Alan A1 - O'Dowd, T KW - Diabetes KW - patient involvement AB - ABSTRACT Background: People with type 2 diabetes frequently have a variety of related and unrelated chronic conditions. These additional conditions have implications for patient education, treatment burden and disease management. Objectives: The aim of this study was to examine the nature of multimorbidity, and its impact on GP visits, polypharmacy and glycaemic control as measured by HbA1c, in a cohort of patients with type 2 diabetes attending general practice in Ireland. Methods: A cohort of 424 patients with type 2 diabetes enrolled in a cluster randomized controlled trial based in Irish general practice was examined. Patient data included: medical conditions, HbA1c, health service utilization, socio-economic status and number of prescribed medications. Results: 90% of patients had at least one additional chronic condition and a quarter had four or more additional chronic conditions. 66% of patients had hypertension; 25% had heart disease; and 16% had arthritis. General practitioner visits and polypharmacy increased significantly with increasing numbers of chronic conditions. When comparing patient self-report with medical records, patients who reported a higher proportion of their conditions had better glycaemic control with a significantly lower HbA1c score. Conclusion: There was a high prevalence of multimorbidity in these patients with type 2 diabetes and the results suggest that glycaemic control is related to patients’ awareness of their chronic conditions. The variety of conditions emphasizes the complexity of illness management in this group and the importance of maintaining a generalist and multidisciplinary approach to their clinical care. Read More: http://informahealthcare.com/doi/abs/10.3109/13814788.2012.714768 VL - 19 UR - http://informahealthcare.com/doi/abs/10.3109/13814788.2012.714768 IS - 1 ER - TY - JOUR T1 - Multimorbidity and functional decline in community-dwelling adults: a systematic review. Health and Quality of Life Outcomes JF - 2015 Y1 - 2015 A1 - Ryan, A A1 - Wallace, E A1 - O'Hara, P A1 - Smith, SM VL - 13 UR - http://epubs.rcsi.ie/cgi/viewcontent.cgi?article=1100&context=gpart IS - 168 ER - TY - JOUR T1 - Managing patients with multimorbidity: systematic review of interventions in primary care and community settings JF - BMJ Y1 - 2012 A1 - Smith, SM A1 - Soubhi, Hassan A1 - Fortin, M A1 - Hudon, Catherine A1 - O'Dowd, T AB - OBJECTIVE: To determine the effectiveness of interventions designed to improve outcomes in patients with multimorbidity in primary care and community settings. DESIGN: Systematic review. DATA SOURCES: Medline, Embase, CINAHL, CAB Health, Cochrane central register of controlled trials, the database of abstracts of reviews of effectiveness, and the Cochrane EPOC (effective practice and organisation of care) register (searches updated in April 2011). ELIGIBILITY CRITERIA: Randomised controlled trials, controlled clinical trials, controlled before and after studies, and interrupted time series analyses reporting on interventions to improve outcomes for people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. Outcomes included any validated measure of physical or mental health and psychosocial status, including quality of life outcomes, wellbeing, and measures of disability or functional status. Also included were measures of patient and provider behaviour, including drug adherence, utilisation of health services, acceptability of services, and costs. DATA SELECTION: Two reviewers independently assessed studies for eligibility, extracted data, and assessed study quality. As meta-analysis of results was not possible owing to heterogeneity in participants and interventions, a narrative synthesis of the results from the included studies was carried out. RESULTS: 10 studies examining a range of complex interventions totalling 3407 patients with multimorbidity were identified. All were randomised controlled trials with a low risk of bias. Two studies described interventions for patients with specific comorbidities. The remaining eight studies focused on multimorbidity, generally in older patients. Consideration of the impact of socioeconomic deprivation was minimal. All studies involved complex interventions with multiple components. In six of the 10 studies the predominant component was a change to the organisation of care delivery, usually through case management or enhanced multidisciplinary team work. In the remaining four studies, intervention components were predominantly patient oriented. Overall the results were mixed, with a trend towards improved prescribing and drug adherence. The results indicated that it is difficult to improve outcomes in this population but that interventions focusing on particular risk factors in comorbid conditions or functional difficulties in multimorbidity may be more effective. No economic analyses were included, although the improvements in prescribing and risk factor management in some studies could provide potentially important cost savings. CONCLUSIONS: Evidence on the care of patients with multimorbidity is limited, despite the prevalence of multimorbidity and its impact on patients and healthcare systems. Interventions to date have had mixed effects, although are likely to be more effective if targeted at risk factors or specific functional difficulties. A need exists to clearly identify patients with multimorbidity and to develop cost effective and specifically targeted interventions that can improve health outcomes. VL - 345 UR - http://www.bmj.com/content/345/bmj.e5205 ER - TY - JOUR T1 - Managing patients with multimorbidity in primary care JF - BMJ Y1 - 2015 A1 - Wallace, E A1 - Salisbury, C A1 - Guthrie, Bruce A1 - Lewis, Cliona A1 - Fahey, T A1 - Smith, SM KW - multimorbidity KW - primary care VL - 350 UR - http://www.bmj.com/content/350/bmj.h176 IS - h176 ER - TY - JOUR T1 - Managing fatigue in patients with chronic conditions in primary care JF - Family Practice Y1 - 2013 A1 - Connolly, D A1 - O’Toole, L A1 - Redmond, P A1 - Smith, SM VL - 30 UR - http://fampra.oxfordjournals.org/content/30/2/123.extract.html IS - 2 ER - TY - JOUR T1 - Link workers providing social prescribing and health and social care coordination for people with multimorbidity in socially deprived areas (the LinkMM trial): protocol for a pragmatic randomised controlled trial JF - BMJ Open Y1 - 2021 A1 - Kiely, B A1 - Clyne, B A1 - Boland, F A1 - O'Donnell, P A1 - Connolly, D A1 - O'Shea, E A1 - Smith, SM VL - 11 ER - TY - JOUR T1 - The Inverse Care Law and the Potential of Primary Care in Deprived Areas JF - The Lancet Y1 - 2021 A1 - Mercer, Stewart W A1 - Patterson, J A1 - Robson, JP A1 - Smith, SM A1 - Walton, E A1 - Watt, Graham C M VL - 397 IS - 10276 ER - TY - JOUR T1 - Interventions to Address Potentially Inappropriate Prescribing in Community-Dwelling Older Adults: A Systematic Review of Randomized Controlled Trials JF - Journal of the American Geriatrics Society Y1 - 2016 A1 - Clyne, B A1 - Fitzgerald, C A1 - Quinlan, A A1 - Hardy, C A1 - Galvin, R A1 - Fahey, T A1 - Smith, SM VL - 64 IS - 6 ER - TY - JOUR T1 - Interventions for improving outcomes in patients with multimorbidity in primary care and community settings JF - Cochrane Database Syst Rev Y1 - 2012 A1 - Smith, SM A1 - Soubhi, Hassan A1 - Fortin, M A1 - Hudon, Catherine A1 - O'Dowd, T KW - Age Factors KW - Chronic Disease KW - Community Health Services KW - Comorbidity KW - Disease Management KW - Humans KW - Patient-Centered Care KW - Primary Health Care KW - Randomized Controlled Trials as Topic KW - Risk Factors KW - Treatment Outcome AB - BACKGROUND: Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. While this is not a new phenomenon, there is greater recognition of its impact and the importance of improving outcomes for individuals affected. Research in the area to date has focused mainly on descriptive epidemiology and impact assessment. There has been limited exploration of the effectiveness of interventions for multimorbidity. OBJECTIVES: To determine the effectiveness of interventions designed to improve outcomes in patients with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. SEARCH METHODS: We searched MEDLINE, EMBASE, CINAHL, CAB Health, AMED, HealthStar, The Cochrane Central Register of Controlled Trials (CENTRAL), the EPOC Register and the Database of Abstracts of Reviews of Effectiveness (DARE), and the EPOC Register in April 2011. SELECTION CRITERIA: We considered randomised controlled trials (RCTs), controlled clinical trials (CCTs), controlled before and after studies (CBAs), and interrupted time series analyses (ITS) reporting on interventions to improve outcomes for people with multimorbidity in primary care and community settings. The outcomes included any validated measure of physical or mental health, psychosocial status including quality of life outcomes, well-being, and measures of disability or functional status. We also included measures of patient and provider behaviour including measures of medication adherence, utilisation of health services, and acceptability of services and costs. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for eligibility, extracted data, and assessed study quality. Meta-analysis of results was not possible so we carried out a narrative synthesis of the results from the included studies. MAIN RESULTS: Ten studies examining a range of complex interventions for patients with multimorbidity were identified. All were RCTs and there was low risk of bias. Two of the nine studies focused on specific co-morbidities. The remaining studies focused on multimorbidity, generally in older patients. All studies involved complex interventions with multiple elements. In six of the ten studies, the predominant intervention element was a change to the organisation of care delivery, usually through case management or enhanced multidisciplinary team work. In the remaining four studies, the interventions were predominantly patient oriented. Overall the results were mixed with a trend towards improved prescribing and medication adherence. The results indicate that it is difficult to improve outcomes in this population but that interventions focusing on particular risk factors or functional difficulties in patients with co-morbid conditions or multimorbidity may be more effective. Cost data were limited with no economic analyses included, though the improvements in prescribing and risk factor management in some studies provided potentially significant cost savings. AUTHORS' CONCLUSIONS: This review highlights the paucity of research into interventions to improve outcomes for multimorbidity with the focus to date being on co-morbid conditions or multimorbidity in older patients. The limited results suggest that interventions to date have had mixed effects but have shown a tendency to improve prescribing and medication adherence, particularly if interventions can be targeted at risk factors or specific functional difficulties in people with co-morbid conditions or multimorbidity. There is a need for clear definitions of participants, consideration of appropriate outcomes, and further pragmatic studies based in primary care settings. VL - 4 UR - http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006560.pub2/abstract;jsessionid=D2206ED1424E7EEAA91B88C4BA4F8E11.f03t01 ER - TY - JOUR T1 - Interventions for improving outcomes in patients with multimorbidity in primary care and community settings JF - Cochrane Database of Systematic Reviews Y1 - 2016 A1 - Smith, SM A1 - Wallace, E A1 - O'Dowd, T A1 - Fortin, M KW - Age Factors KW - Chronic Disease [therapy] KW - Community Health Services KW - Comorbidity KW - Disease Management KW - Humans[checkword] KW - Patient-Centered Care [methods] KW - Primary Health Care KW - Randomized Controlled Trials as Topic KW - Risk Factors KW - Treatment Outcome SN - 1465-1858 UR - http://dx.doi.org/10.1002/14651858.CD006560.pub3 IS - 3 ER - TY - JOUR T1 - Integrating clinical pharmacists within general practice: protocol for a pilot cluster randomised controlled trial JF - BMJ Open Y1 - 2021 A1 - Croke, A A1 - Moriarty, F A1 - Boland, F A1 - McCullagh, L A1 - Cardwell, K A1 - Smith, SM A1 - Clyne, B VL - 11 ER - TY - JOUR T1 - Improving the external validity of clinical trials: the case of multiple chronic conditions JF - Journal of Comorbidity Y1 - 2013 A1 - Fortin, M A1 - Smith, SM KW - clinical trials KW - Comorbidity KW - external validity KW - internal validity KW - multimorbidity KW - multiple chronic conditions AB - The U.S. Department of Health and Human Services vision and strategic framework on multiple chronic conditions(MCCs) incorporates recommendations designed to facilitate research that will improve our knowledge about interventions and systems that will benefit individuals with MCCs (or multimorbidity). The evidence base supporting the management of patients with MCCs will be built through intervention trials specifi cally designed to address multimorbidity and identifi cation of MCCs in participants across the clinical trial range. This article specifically focuses on issues relating to external validity with specifi c reference to trials involving patients with MCCs. The exclusion of such patients from clinical trials has been well documented. Randomized control trials (RCTs) are considered the “gold standard” of evidence, but may have drawbacks in relation to external validity, particularly in relation to multimorbidity. It may, therefore, be necessary to consider a broader range of research methods that can provide converging evidence on intervention effects to address MCCs. Approaches can also be taken to increase the usefulness of RCTs in general for providing evidence to inform multimorbidity management. Additional improvements to RCTs would include better reporting of inclusion and exclusion criteria and participant characteristics in relation to MCCs. New trials should be considered in terms of how they will add to the existing evidence base and should inform how interventions may work in different settings and patient groups. Research on treatments and interventions for patients with MCCs is badly needed. It is important that this research includes patient-centered measures and that generalizability issues be explicitly addressed. VL - 3 UR - http://jcomorbidity.com/index.php/test/article/view/27 IS - 2 ER - TY - JOUR T1 - Impact of Potentially Inappropriate Prescribing on Adverse Drug Events, Health Related Quality of Life and Emergency Hospital Attendance in Older People Attending General Practice: A Prospective Cohort Study JF - J Gerontol A Biol Sci Med Sci Y1 - 2016 A1 - Wallace, E A1 - McDowell, R A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM ER - TY - JOUR T1 - Impact of an occupation-based self-management programme on chronic disease management JF - Australian Occupational Therapy Journal Y1 - 2013 A1 - O’Toole, L A1 - Connolly, D A1 - Smith, SM KW - activities of daily living;group work KW - health promotion;occupational performance KW - Primary Health Care AB - ntroduction There is a need for the development and evaluation of occupational therapy interventions enabling participation and contributing to self-management for individuals with multiple chronic conditions. This pilot study aimed to assess the feasibility and potential impact of an occupation-based self-management programme for community living individuals with multiple chronic conditions. Methods Sixteen participants completed a six-week programme. Assessments were conducted at baseline, immediately post-intervention and at eight-week follow-up. Sixteen participants provided immediate follow-up data and 15 participants provided eight-week follow-up data. Outcome measures included participation in occupations; perceptions of occupational performance and satisfaction; self-efficacy; depression, anxiety and quality of life. Focus groups explored participants' perceptions of the programme. Results The findings are promising and indicate that the programme delivery was feasible. Significant differences were found immediately post-intervention in frequency of activity participation (P = 0.008), including domestic (P = 0.040) and work/leisure activities (P = 0.015), self-perceptions of occupational performance (P = 0.017) and satisfaction with same (P = 0.023). At eight-week follow-up, significant differences continued to be found in frequency of activity participation (P = 0.018), including work/leisure activities (P = 0.038), perceptions of occupational performance (P = 0.010) and satisfaction (P = 0.008) and self-efficacy (P = 0.050). No differences were found in anxiety, depression or quality of life at follow-up periods. Focus group data supported the programme's impact on activity participation and self-efficacy. Conclusion Despite the small sample in this pilot study there were significant improvements in occupational performance and the findings provide support for the programme. However, there is a need to test the intervention rigorously with a definitive randomised trial in a primary care setting. VL - 60 UR - http://onlinelibrary.wiley.com/doi/10.1111/1440-1630.12008/pdf IS - 1 ER - TY - JOUR T1 - Impact analysis studies of clinical prediction rules relevant to primary care: a systematic review JF - BMJ Open Y1 - 2016 A1 - Wallace, E A1 - Uijen, M A1 - Clyne, B A1 - Zarabzadeh, A A1 - Keogh, C A1 - Galvin, R A1 - Smith, SM A1 - Fahey, T VL - 6:e009957 IS - 3 ER - TY - JOUR T1 - How to design and evaluate interventions to improve outcomes for patients with multimorbidity JF - Journal of Comorbidity Y1 - 2013 A1 - Smith, SM A1 - Bayliss, EA A1 - Mercer, Stewart W A1 - Gunn, J A1 - Vestergaard, M A1 - Wyke, Sally A1 - Salisbury, C A1 - Fortin, M KW - Comorbidity KW - Family Practice KW - interventions KW - multimorbidity AB - Multimorbidity is a major challenge for patients and healthcare providers. The limited evidence of the effectiveness of interventions for people with multimorbidity means that there is a need for much more research and trials of potential interventions. Here we present a consensus view from a group of international researchers working to improve care for people with multimorbidity to guide future studies of interventions. We suggest that there is a need for careful consideration of whom to include, how to target interventions that address specific problems and that do not add to treatment burden, and selecting outcomes that matter both to patients and the healthcare system. Innovative design of these interventions will be necessary as many will be introduced in service settings and it will be important to ensure methodological rigour, relevance to service delivery, and generalizability across healthcare systems VL - 3 UR - http://jcomorbidity.com/index.php/test/article/view/21 IS - 1 ER - TY - JOUR T1 - GPs’ perceptions of their relationship with the pharmaceutical industry: a qualitative study JF - BJGP Open Y1 - 2021 A1 - Larkin, J A1 - Pericin, I A1 - Collins, M A1 - Smith, SM A1 - Byrne, D A1 - Moriarty, F VL - 5 IS - 5 ER - TY - JOUR T1 - GPs' and pharmacists' experiences of managing multimorbidity: a 'Pandora's box' JF - Br J Gen Pract Y1 - 2010 A1 - Smith, SM A1 - O'Kelly, Siobhan A1 - O'Dowd, T KW - Attitude of Health Personnel KW - Chronic Disease KW - Family Practice KW - Humans KW - Interprofessional Relations KW - Ireland KW - Pharmacists KW - Physicians, Family KW - Professional Practice AB - BACKGROUND: Multimorbidity is defined as the occurrence of two or more chronic diseases in one individual. Patients with multimorbidity generally have poorer health and functioning and higher rates of attendance in primary care and specialty settings. AIM: To explore the views and attitudes of GPs and pharmacists managing patients with multimorbidity in primary care. DESIGN OF STUDY: Qualitative study using focus groups. SETTING: Primary care in Ireland. METHOD: Three focus groups were held in total, involving 13 GPs and seven pharmacists. Focus groups were recorded, transcribed, and analysed using the 'framework' approach. RESULTS: The predominant themes to emerge from the focus groups were: 1) the concept of multimorbidity and the link to polypharmacy and ageing; 2) health systems issues relating to lack to time, inter-professional communication difficulties, and fragmentation of care; 3) individual issues from clinicians relating to professional roles, clinical uncertainty, and avoidance; 4) patient issues; and 5) potential management solutions. CONCLUSION: This study provides information on the significant impact of multimorbidity from a professional perspective. It highlights potential elements of an intervention that could be designed and tested to achieve improvements in the management of multimorbidity, outcomes for individuals affected, and the experiences of those providing healthcare. VL - 60 UR - http://bjgp.org/content/60/576/e285 IS - 576 ER - TY - JOUR T1 - Framework for the impact analysis and implementation of Clinical Prediction Rules (CPRs) JF - BMC Med Inform Decis Mak Y1 - 2011 A1 - Wallace, E A1 - Smith, SM A1 - Perera-Salazar, Rafael A1 - Vaucher, Paul A1 - McCowan, Colin A1 - Collins, Gary A1 - Verbakel, Jan A1 - Lakhanpaul, Monica A1 - Fahey, T KW - Decision Support Techniques KW - Evidence-Based Medicine KW - Humans KW - Physician's Practice Patterns KW - Research Design AB - Clinical Prediction Rules (CPRs) are tools that quantify the contribution of symptoms, clinical signs and available diagnostic tests, and in doing so stratify patients according to the probability of having a target outcome or need for a specified treatment. Most focus on the derivation stage with only a minority progressing to validation and very few undergoing impact analysis. Impact analysis studies remain the most efficient way of assessing whether incorporating CPRs into a decision making process improves patient care. However there is a lack of clear methodology for the design of high quality impact analysis studies.We have developed a sequential four-phased framework based on the literature and the collective experience of our international working group to help researchers identify and overcome the specific challenges in designing and conducting an impact analysis of a CPR.There is a need to shift emphasis from deriving new CPRs to validating and implementing existing CPRs. The proposed framework provides a structured approach to this topical and complex area of research. VL - 11 UR - http://www.biomedcentral.com/1472-6947/11/62 ER - TY - JOUR T1 - The experience of financial burden for people with multimorbidity: A systematic review of qualitative research. JF - Health Expect Y1 - 0 A1 - Larkin, J A1 - Foley, L A1 - Smith, SM A1 - Harrington, P A1 - Clyne, B VL - 24 IS - 2 ER - TY - JOUR T1 - The experience of financial burden for patients with multimorbidity: A protocol for a systematic review of qualitative research [version 2; peer review: 2 approved] JF - HRB Open Research Y1 - 2020 A1 - Larkin, J A1 - Foley, L A1 - Smith, SM A1 - Harrington, P A1 - Clyne, B VL - 2:16 ER - TY - JOUR T1 - The epidemiology of malpractice claims in primary care; a systematic review JF - BMJ Open Y1 - 2013 A1 - Wallace, E A1 - Lowry, J A1 - Smith, SM A1 - Fahey, T KW - malpractice KW - primary care AB - Abstract Objectives The aim of this systematic review was to examine the epidemiology of malpractice claims in primary care. Design A computerised systematic literature search was conducted. Studies were included if they reported original data (≥10 cases) pertinent to malpractice claims, were based in primary care and were published in the English language. Data were synthesised using a narrative approach. Setting Primary care. Participants Malpractice claimants. Primary outcome Malpractice claim (defined as a written demand for compensation for medical injury). We recorded: medical misadventure cited in claims, missed/delayed diagnoses cited in claims, outcome of claims, prevalence of claims and compensation awarded to claimants. Results Of the 7152 articles retrieved by electronic search, a total of 34 studies met the inclusion criteria and were included in the narrative analysis. Twenty-eight studies presented data from medical indemnity malpractice claims databases and six studies presented survey data. Fifteen studies were based in the USA, nine in the UK, seven in Australia, one in Canada and two in France. The commonest medical misadventure resulting in claims was failure to or delay in diagnosis, which represented 26–63% of all claims across included studies. Common missed or delayed diagnoses included cancer and myocardial infarction in adults and meningitis in children. Medication error represented the second commonest domain representing 5.6–20% of all claims across included studies. The prevalence of malpractice claims in primary care varied across countries. In the USA and Australia when compared with other clinical disciplines, general practice ranked in the top five specialties accounting for the most claims, representing 7.6–20% of all claims. However, the majority of claims were successfully defended. Conclusions This review of malpractice claims in primary care highlights diagnosis and medication error as areas to be prioritised in developing educational strategies and risk management systems. VL - 3 UR - http://bmjopen.bmj.com/content/3/7/e002929.abstract IS - 7 ER - TY - JOUR T1 - 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) JF - BMC Trials Y1 - 2013 A1 - Clyne, B A1 - Bradley, MC A1 - Motterlini, N A1 - Clear, Daniel A1 - McDonnell, R A1 - Smith, SM A1 - Hughes, CM A1 - Fahey, T VL - 14 UR - http://www.ncbi.nlm.nih.gov/pubmed/23497575 IS - 1 ER - TY - JOUR T1 - Effectiveness of link workers providing social prescribing on health outcomes and costs for adult patients in primary care and community settings. A protocol for a systematic review of the literature. [version 2; peer review: 2 approved]. JF - HRB Open Research Y1 - 2020 A1 - Kiely, B A1 - Croke, A A1 - O'Shea, E A1 - Connolly, D A1 - Smith, SM VL - 2:21 ER - TY - JOUR T1 - The effectiveness of integrating clinical pharmacists within general practice to optimise prescribing and health outcomes in primary care patients with polypharmacy: A protocol for a systematic review [version 2; peer review: 2 approved]. JF - HRB Open Research Y1 - 2020 A1 - Croke, A A1 - James, O A1 - Clyne, B A1 - Moriarty, F A1 - Cardwell, K A1 - Smith, SM VL - 2:32 ER - TY - JOUR T1 - Effectiveness of a Multifaceted Intervention for Potentially Inappropriate Prescribing in Older Patients in Primary Care: A Cluster-Randomized Controlled Trial (OPTI-SCRIPT Study) JF - Annals of Family Medicine Y1 - 2015 A1 - Clyne, B A1 - Smith, SM A1 - Hughes, CM A1 - Boland, F A1 - Bradley, MC A1 - Cooper, J A1 - Fahey, T A1 - on behalf of the OPTI-SCRIPT study team VL - 13 UR - http://www.annfammed.org/content/13/6/545.abstractN2 - PURPOSE Potentially inappropriate prescribing (PIP) is common in older people and can result in increased morbidity, adverse drug events, and hospitalizations. The OPTI-SCRIPT study (Optimizing Prescr IS - 6 N1 - 10.1370/afm.1838 JO - The Annals of Family Medicine ER - TY - JOUR T1 - Effect of the OPTIMAL programme on self-management of multimorbidity in primary care: a randomised controlled trial JF - British Journal of General Practice Y1 - 2021 A1 - O'Toole, L A1 - Connolly, D A1 - Boland, F A1 - Smith, SM VL - 71 IS - 705 ER - TY - JOUR T1 - Effect of social prescribing link workers on health outcomes and costs for adults in primary care and community settings: a systematic review JF - BMJ Open Y1 - 2022 A1 - Kiely, B A1 - Croke, A A1 - O'Shea, M A1 - Boland, F A1 - O'Shea, E A1 - Connolly, D A1 - Smith, SM VL - 12:e062951 ER - TY - JOUR T1 - The development of the PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) criteria JF - BMC Health Services Research Y1 - 2014 A1 - Cooper, J A1 - Ryan, C A1 - Smith, SM A1 - Wallace, E A1 - Bennett, K A1 - Cahir, C A1 - Williams, David A1 - Teeling, Mary A1 - Hughes, CM A1 - PROMPT Steering Group KW - Delphi technique KW - Explicit criteria KW - Middle-age KW - multimorbidity KW - Polypharmacy KW - potentially inappropriate prescribing AB - Abstract Background Whilst multimorbidity is more prevalent with increasing age, approximately 30% of middle-aged adults (45–64 years) are also affected. Several prescribing criteria have been developed to optimise medication use in older people (≥65 years) with little focus on potentially inappropriate prescribing (PIP) in middle-aged adults. We have developed a set of explicit prescribing criteria called PROMPT (PRescribing Optimally in Middle-aged People’s Treatments) which may be applied to prescribing datasets to determine the prevalence of PIP in this age-group. Methods A literature search was conducted to identify published prescribing criteria for all age groups, with the Project Steering Group (convened for this study) adding further criteria for consideration, all of which were reviewed for relevance to middle-aged adults. These criteria underwent a two-round Delphi process, using an expert panel consisting of general practitioners, pharmacists and clinical pharmacologists from the United Kingdom and Republic of Ireland. Using web-based questionnaires, 17 panellists were asked to indicate their level of agreement with each criterion via a 5-point Likert scale (1 = Strongly Disagree, 5 = Strongly Agree) to assess the applicability to middle-aged adults in the absence of clinical information. Criteria were accepted/rejected/revised dependent on the panel’s level of agreement using the median response/interquartile range and additional comments. Results Thirty-four criteria were rated in the first round of this exercise and consensus was achieved on 17 criteria which were accepted into the PROMPT criteria. Consensus was not reached on the remaining 17, and six criteria were removed following a review of the additional comments. The second round of this exercise focused on the remaining 11 criteria, some of which were revised following the first exercise. Five criteria were accepted from the second round, providing a final list of 22 criteria [gastro-intestinal system (n = 3), cardiovascular system (n = 4), respiratory system (n = 4), central nervous system (n = 6), infections (n = 1), endocrine system (n = 1), musculoskeletal system (n = 2), duplicates (n = 1)]. Conclusions PROMPT is the first set of prescribing criteria developed for use in middle-aged adults. The utility of these criteria will be tested in future studies using prescribing datasets. Keywords: Potentially inappropriate prescribing; Explicit criteria; Delphi technique; Middle-age; Polypharmacy; Multimorbidity VL - 14 UR - http://www.biomedcentral.com/1472-6963/14/484 ER - TY - JOUR T1 - Developing an International Register of Clinical Prediction Rules for Use in Primary Care: A Descriptive Analysis JF - Ann of Fam Med Y1 - 2014 A1 - Keogh, C A1 - Wallace, E A1 - O'Brien, K A1 - Galvin, R A1 - Smith, SM A1 - Lewis, Cliona A1 - Cummins, Anthony A1 - Cousins, G A1 - Dimitrov, B A1 - Fahey, T KW - clinical decision support systems KW - clinical prediction rule KW - decision aid KW - decision making KW - primary care KW - score card AB - Abstract PURPOSE We describe the methodology used to create a register of clinical prediction rules relevant to primary care. We also summarize the rules included in the register according to various characteristics. METHODS To identify relevant articles, we searched the MEDLINE database (PubMed) for the years 1980 to 2009 and supplemented the results with searches of secondary sources (books on clinical prediction rules) and personal resources (eg, experts in the field). The rules described in relevant articles were classified according to their clinical domain, the stage of development, and the clinical setting in which they were studied. RESULTS Our search identified clinical prediction rules reported between 1965 and 2009. The largest share of rules (37.2%) were retrieved from PubMed. The number of published rules increased substantially over the study decades. We included 745 articles in the register; many contained more than 1 clinical prediction rule study (eg, both a derivation study and a validation study), resulting in 989 individual studies. In all, 434 unique rules had gone through derivation; however, only 54.8% had been validated and merely 2.8% had undergone analysis of their impact on either the process or outcome of clinical care. The rules most commonly pertained to cardiovascular disease, respiratory, and musculoskeletal conditions. They had most often been studied in the primary care or emergency department settings. CONCLUSIONS Many clinical prediction rules have been derived, but only about half have been validated and few have been assessed for clinical impact. This lack of thorough evaluation for many rules makes it difficult to retrieve and identify those that are ready for use at the point of patient care. We plan to develop an international web-based register of clinical prediction rules and computer-based clinical decision support systems. VL - 12 UR - http://www.ncbi.nlm.nih.gov/pubmed/25024245 IS - 4 ER - TY - JOUR T1 - COMMENTARY: Is a Change from the National Early Warning System (NEWS) Warranted in Patients with Chronic Respiratory Conditions Y1 - 2021 A1 - O'Neill, SM A1 - Bell, M A1 - Casey, A A1 - Leen, B A1 - Clyne, B A1 - Tyner, B A1 - Smith, SM A1 - Watkinson, PJ A1 - O'Neill, M A1 - Ryan, M ER - TY - JOUR T1 - Chronic respiratory disease and multimorbidity: prevalence and impact in a general practice setting JF - Respir Med Y1 - 2011 A1 - O'Kelly, Siobhan A1 - Smith, SM A1 - Lane, S A1 - Teljeur, C A1 - O'Dowd, T KW - Adolescent KW - Adult KW - Aged KW - Chronic Disease KW - Comorbidity KW - Cross-Sectional Studies KW - Female KW - General Practice KW - Humans KW - Ireland KW - Lung Diseases KW - Male KW - Middle Aged KW - Prevalence KW - Socioeconomic Factors KW - Urban Health Services KW - Young Adult AB - BACKGROUND: Multimorbidity is defined as two or more co-existing chronic conditions in an individual and is common in general practice. It is associated with poorer outcomes for patients. This study aimed to establish the prevalence of multimorbidity in patients with chronic respiratory disease in general practice and to describe its impact on health service use. METHODS: Cross-sectional study based in general practice in Dublin. Drug and disease code searches were performed to identify adult patients with a diagnosis of chronic respiratory disease. Medical records were reviewed for chronic respiratory diagnosis, other chronic conditions, demographic characteristics, General Practitioner (GP) and practice nurse utilisation rates, and numbers of medications. RESULTS: In a general practice population of 16,946 patients 3.9% had chronic respiratory disease and 60% of these had one or more co-existing chronic condition(s). GP and practice nurse utilisation rates, and number of medications were significantly higher among those with multimorbidity compared with those with respiratory disease alone. Multivariate analysis showed that increasing age and low socio-economic status were significantly associated with multimorbidity. CONCLUSION: The majority of patients with chronic respiratory disease have multimorbidity. Clinical guidelines based on single disease entities and outcomes are not as easy to implement and may not be as effective in this group. VL - 105 UR - http://www.sciencedirect.com/science/article/pii/S0954611110003409 IS - 2 ER - TY - JOUR T1 - Caring for People With Multiple Chronic Conditions JF - Preventing Chronic Disease Y1 - 2015 A1 - Smith, SM CY - Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA. VL - 12 SN - 1545-1151 UR - http://dx.doi.org/10.5888/pcd12.150438 JO - Prev Chronic Dis ER - TY - JOUR T1 - Antibiotics for Acute Bronchitis JF - JAMA Y1 - 2014 A1 - Smith, SM A1 - Smucny, J A1 - Fahey, T KW - adverse effects KW - clinical improvement KW - Cough-related outcomes AB - CLINICAL QUESTION: Are antibiotics associated with improved outcomes in patients with acute bronchitis? BOTTOM LINE: Prescribing antibiotics for acute bronchitis was associated with reduced overall and nighttime cough and with an approximately half-day reduction in duration of cough, in days feeling ill, and in days with impaired activities. However, at follow-up, there were no significant differences in patients receiving antibiotics compared with those receiving placebo in overall clinical improvements or limitations in work or other activities. There was a significant increase in adverse effects in the antibiotic group, particularly gastrointestinal symptoms. VL - 312 UR - http://www.ncbi.nlm.nih.gov/pubmed/25536260 IS - 24 ER - TY - JOUR T1 - Adverse outcomes in older adults attending emergency department: systematic review and meta-analysis of the Triage Risk Stratification Tool. JF - European Journal of Emergency Medicine Y1 - 2013 A1 - Cousins, G A1 - Bennett, K A1 - Dillon, Grace A1 - Smith, SM A1 - Galvin, R KW - Aged KW - emergency service KW - systematic review KW - triage/methods AB - Abstract The objective of this study was to assess the predictive ability of the Triage Risk Stratification Tool (TRST) in identifying older adults at risk of adverse outcomes [return to emergency department (ED), hospitalization, or a composite outcome] within 30 and 120 days following discharge from ED. A systematic search was conducted to identify studies validating the TRST in older adults aged at least 65 years discharged from ED. The methodological quality of selected studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies tool. A score of at least 2 was used to identify high-risk patients. A bivariate random effects model was applied to generate pooled estimates of sensitivity and specificity. The discriminative ability of the tool was assessed using the c statistic. Heterogeneity was assessed graphically and statistically using the variance of the logit-transformed sensitivity and specificity. Six studies (3233 patients) were included. With a cutoff of at least 2, the pooled sensitivity of the TRST for a composite outcome at 30 days was 0.58 (95% confidence interval 0.52-0.65), the specificity was 0.61 (95% confidence interval 0.58-0.64). Similar values were obtained for the composite outcome at 120 days and the individual outcomes at both timepoints. The c statistic was consistently low across the outcomes and timepoints. There was little heterogeneity across studies. In conclusion, the TRST is limited in its ability to discriminate between older adults with or without an adverse outcome following discharge from ED. The low levels of heterogeneity gives us confidence that the pooled estimates reflect the predictive ability of the TRST in clinical practice. VL - 20 UR - http://www.ncbi.nlm.nih.gov/pubmed/23510897 IS - 4 ER - TY - JOUR T1 - Addressing potentially inappropriate prescribing in older patients: Design and pilot study of an intervention in primary care JF - BMC Health Services Research Y1 - 2013 A1 - Clyne, B A1 - Bradley, MC A1 - Smith, SM A1 - Hughes, CM A1 - Clear, Daniel A1 - McDonnell, R A1 - Williams, David A1 - Fahey, T KW - Medical research council framework KW - Multifaceted intervention KW - potentially inappropriate prescribing KW - Randomised controlled trial AB - 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 PB - BMC Health Services Research VL - 13 UR - http://www.biomedcentral.com/1472-6963/13/307 IS - 1 ER - TY - Generic T1 - Variation in prescribing of anti-diabetic medications, including newer injectable medications, in Ireland in 2013 and 2014. RCSI Research Day 25th February 2016 Y1 - 2016 A1 - Murphy, M A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - Validity of the Blatchford score to predict need for intervention for patients with upper gastrointestinal haemorrhage: a systematic review and meta-analysis. AUDGPI 2012, 9 March 2012 Dublin Y1 - 2012 A1 - Hullegie, K A1 - Keogh, C A1 - Smith, SM A1 - Fahey, T UR - http://hrbcentreprimarycare.ie/ppt/Blatchford%20score_WSM.pdf ER - TY - Generic T1 - Validity of the Blatchford score to predict need for intervention for patients with upper gastrointestinal haemorrhage: a systematic review and meta-analysis. RCSI Research Day, 25 April 2012, Dublin Y1 - 2012 A1 - Hullegie, K A1 - Keogh, C A1 - Smith, SM A1 - Fahey, T UR - http://hrbcentreprimarycare.ie/ppt/Blatchford%20score_WSM.pdf ER - TY - Generic T1 - Validity of the Blatchford score to predict need for intervention for patients with upper gastrointestinal haemorrhage: a systematic review and meta-analysis. Winter Scientific Meeting 2011, Royal College of Physicians, 14 December 2011, Dublin Y1 - 2011 A1 - Hullegie, K A1 - Keogh, C A1 - Smith, SM A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/Hullegie_Blatchford%20score_WSM.pdf ER - TY - Generic T1 - Risk management in General Practice: an educational initiative for undergraduate general practice teaching. Society of Academic Primary Care, 2-4 October 2012, Glasgow, Scotland Y1 - 2012 A1 - Wallace, E A1 - Lowry, J A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - Risk management in general practice; an educational initiative for the undergraduate general practice curriculum. The International Forum on Quality and Safety in Health Care, 16-19 April 2013, London Y1 - 2013 A1 - Wallace, E A1 - Lowry, J A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - Prevalence of Medication Use in Pregnancy Using the Irish Primary Care Research Network Database. RCSI Research Day 20th March 2014 Y1 - 2014 A1 - Roche, A A1 - Walsh, DR A1 - Cronin, K A1 - Schelten, R A1 - McDonnell, R A1 - O'Brien, K A1 - Boland, F A1 - Swift-Donnelly, Erica A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - Multimorbidity and functional decline in community-dwelling adults: a systematic review 2015. Society of Academic Primary Care Conference, University of Oxford, 8-10th July 2015 Y1 - 2015 A1 - Ryan, A A1 - Wallace, E A1 - O'Hara, P A1 - Smith, SM ER - TY - Generic T1 - Interventions to address potentially inappropriate prescribing in primary care: a systematic review of randomised control trials. RCSI Research Day. March 2015 Y1 - 2015 A1 - Fitzgerald, C A1 - Clyne, B A1 - Quinlan, A A1 - Hardy, C A1 - Galvin, R A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - The Impact of OPTIMAL, an Occupation-Based Self-Management Programme, on Occupational Participation for Individuals with Multimorbidity: A Randomised Controlled Trial AUDGPI Cork 6-7 March 2014 Y1 - 2014 A1 - Garvey, J A1 - Connolly, D A1 - Boland, F A1 - Smith, SM AB - Background Multimorbidity, defined as the co-existence of two or more long-term conditions, presents a multitude of challenges to both the individual and healthcare services. There is a need to develop interventions to improve outcomes for individuals with multimorbidity (Smith SM et al. Cochrane review, 2012) and exploratory work indicated that an occupational therapy intervention may be effective (O’Toole, Connolly & Smith, 2013). Objectives The objective of this study was to evaluate the effectiveness of an occupation-based self-management programme (OPTIMAL) in a sample of adults with multimorbidity. Methods This research was guided by the Medical Research Council Framework for the development and evaluation of complex interventions (MRC, 2008). This current study was an exploratory RCT in the preliminary stages of Phase III. The Consolidated Standards of Reporting Trials (CONSORT) guidelines were used to guide the research. Participants were recruited from primary care team members, primarily GPs, in the South Inner City Dublin region. Eligibility criteria included age over eighteen years, a minimum of two chronic conditions and a minimum of four repeat medications. UR - http://hrbcentreprimarycare.ie/ppt/MSc SM MM Poster AUDGPI 2014 Final Version.pdf ER - TY - Generic T1 - Feasibility of medicines review to reduce Potentially Inappropriate Medicines in the elderly: the OPTI-SCRIPT cluster randomized controlled trial. ISPOR 16th Annual European Congress, Dublin, November 2013 Y1 - 2013 A1 - Clyne, B A1 - Bradley, MC A1 - Smith, SM A1 - Hughes, CM A1 - Fahey, T ER - TY - Generic T1 - The experience of financial burden for people with multimorbidity: A systematic review of qualitative research. 2020 Dec 2.Poster presentation at the 7th Annual SPHeRE Conference, Virtual Conference. February 2021 Y1 - 2021 A1 - Larkin, J A1 - Foley, L A1 - Smith, SM A1 - Harrington, P A1 - Clyne, B ER - TY - Generic T1 - The epidemiology of malpractice claims in primary care: a systematic review. AUDGPI Annual Scientific Meeting 2013, University of Limerick, 8 March 2013. Limerick Y1 - 2013 A1 - Wallace, E A1 - Lowry, J A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - Effectiveness of interventions in primary care to improve glycated haemoglobin and cardiovascular risk factor levels in patients with poorly-controlled type 2 diabetes mellitus: a systematic review. SPHeRE Research Day 29th February 2016 Y1 - 2016 A1 - Murphy, M A1 - Galvin, R A1 - Fahey, T A1 - Byrne, S A1 - Smith, SM ER - TY - Generic T1 - Effectiveness of interventions in primary care to improve glycated haemoglobin and cardiovascular risk factor levels in patients with poorly-controlled type 2 diabetes mellitus: a systematic review.SAPC 6th-8th of July 2016 Dublin Castle/RCSI.. Y1 - 2016 A1 - Murphy, M A1 - Galvin, R A1 - Fahey, T A1 - Byrne, M A1 - Smith, SM ER - TY - Generic T1 - Developing a web-based international register of clinical prediction rules for primary care SAPC ASM, University of Nottingham, 3 – 5 July 2013, Nottingham, UK Y1 - 2013 A1 - Keogh, C A1 - Wallace, E A1 - O'Brien, K A1 - Galvin, R A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - Cochrane review: Antiviral agents for infectious mononucleosis (glandular fever). SAPC 6th -8th of July 2016 Dublin Castle/RCSI. Y1 - 2016 A1 - De Paor, M A1 - O'Brien, K A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - Antibiotic prescribing patterns of Irish general practitioners in the international context: preliminary results from a pilot study RCSI Research Day 20 March 2014 Y1 - 2014 A1 - Schelten, K A1 - Cronin, K A1 - Walsh, DR A1 - Roche, A A1 - McAteer, C A1 - O'Brien, K A1 - McDonnell, R A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - Addressing potentially inappropriate prescribing in primary care: results from the OPTI-SCRIPT cluster randomised controlled trial. IGS October 2014 Y1 - 2014 A1 - Clyne, B A1 - Smith, SM A1 - Hughes, CM A1 - Bradley, MC A1 - Boland, F A1 - Fahey, T ER - TY - Generic T1 - Addressing potentially inappropriate prescribing in primary care: results from the OPTI-SCRIPT cluster randomised controlled trial. AUDGPI Cork 6-7March 2014 Y1 - 2014 A1 - Clyne, B A1 - Smith, SM A1 - Hughes, CM A1 - Bradley, MC A1 - Boland, F A1 - Fahey, T UR - http://hrbcentreprimarycare.ie/ppt/AUDGPI_14 Final.pdf ER - TY - Generic T1 - What is the impact of multimorbidity on out-of-pocket healthcare expenditure among community-dwelling older adults in Ireland? A cross-sectional study. Rural WONCA, University of Limerick, June 2022 Y1 - 2022 A1 - Larkin, J A1 - Walsh, B A1 - Moriarty, F A1 - Clyne, B A1 - Harrington, P A1 - Smith, SM ER - TY - Generic T1 - What is the impact of multimorbidity on out-of-pocket healthcare expenditure among community-dwelling older adults in Ireland? A cross-sectional study. SAPC ASM, University of Central Lancashire, July 2022 Y1 - 2022 A1 - Larkin, J A1 - Walsh, B A1 - Moriarty, F A1 - Clyne, B A1 - Harrington, P A1 - Smith, SM ER - TY - Generic T1 - What is the impact of levels of activity and function on the development multimorbidity over time? Elevator pitch SAPC 6th-8th of July 2016 Dublin Castle/RCSI. Y1 - 2016 A1 - Ryan, A A1 - Murphy, C A1 - Galvin, R A1 - Smith, SM ER - TY - Generic T1 - Variation in prescribing of anti-diabetic medications, including newer injectable medications, in Ireland in 2013 and 2014. SAPC 6th -8th of July 2016 Dublin Castle/RCSI. (Elevator Pitch) Y1 - 2016 A1 - Murphy, M A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - Variation in prescribing of anti-diabetic medications, including newer injectable medications, in Ireland in 2013 and 2014. AUDGPI 10th March 2016 Y1 - 2016 A1 - Murphy, M A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - Variation in prescribing of anti-diabetic medications, including newer injectable medications, in Ireland in 2013 and 2014. SPHeRE Research Day 29th February 2016 Y1 - 2016 A1 - Murphy, M A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - Trends in polypharmacy and prescribing appropriateness from 1997 to 2012. Health Services Research and Pharmacy Practice (HSRPP) Conference, Belfast, 16/17th April 2015. Frank Moriarty Awarded Best Oral Presentation Y1 - 2015 A1 - Moriarty, F A1 - Hardy, C A1 - Bennett, K A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - Trends and interaction of potentially inappropriate prescribing and polypharmacy over 15 years in Ireland: a repeated cross-sectional study. Society for Social Medicine 59th Annual Scientific Meeting 2-4th September 2015 Y1 - 2015 A1 - Moriarty, F A1 - Hardy, C A1 - Bennett, K A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - Risk prediction models to predict emergency hospital admission in community-dwelling adults AUDGPI Cork 6-7 March 2014 Y1 - 2014 A1 - Wallace, E A1 - Stuart, Ellen A1 - Vaughan, Niall A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM UR - http://hrbcentreprimarycare.ie/ppt/Emma Wallace AUDGPI 2014.pdf ER - TY - Generic T1 - Risk prediction models to predict emergency hospital admission in community-dwelling adults: a systematic review. SPHeRE Conference, RCSI Dublin, January 2015 Y1 - 2015 A1 - Wallace, E A1 - Stuart, Ellen A1 - Vaughan, Niall A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - Risk prediction models to predict emergency hospital admission in community dwelling adults: a systematic review. NAPCRG New York 21-24 Nov 2014 Y1 - 2014 A1 - Wallace, E A1 - Stuart, Ellen A1 - Vaughan, Niall A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - The rise and fall of potentially inappropriate prescribing: trends and interaction with polypharmacy over 15 years in Ireland. Society for Academic Primary Care 44th Annual Conference, University of Oxford, 8th July 2015 Y1 - 2015 A1 - Moriarty, F A1 - Hardy, C A1 - Bennett, K A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - Register of Clinical Prediction Rules, methodological quality assessment and implementation strategies. European General Practice Research Network conference. October 14-17th, 2010, Zurich, Switzerland Y1 - 2010 A1 - Wallace, E A1 - Keogh, C A1 - Smith, SM A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/Emma%20Wallace%20EGPRN%20presentation.ppt ER - TY - Generic T1 - Register of Clinical Prediction Rules, Methodological Quality assessment and Implementation Strategies. 39th Annual Scientific Meeting of the SAPC, 7- 9 July 2010, University of East Anglia, Norwich Y1 - 2010 A1 - Wallace, E A1 - Keogh, C A1 - Smith, SM A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/Emma%20Wallace%20SAPC%20presentation.pdf ER - TY - Generic T1 - Quality of Prescribing Indicators for Children in Primary Care. SAPC ASM, University of Nottingham, 3 – 5 July 2013, Nottingham, UK Y1 - 2013 A1 - O'Brien, K A1 - Cooper, J A1 - Boland, F A1 - Cummins, Anthony A1 - Redmond, P A1 - Smith, SM A1 - Hughes, CM A1 - Fahey, T ER - TY - Generic T1 - A process evaluation of a cluster randomised trial to reduce potentiallt inappropiate prescribing in older patients in Primary Care (OPTI-SCRIPT) SAPC July 9-11 2014 Edinburgh Y1 - 2014 A1 - Clyne, B A1 - Cooper, J A1 - Hughes, CM A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - Primary care-based link workers providing social prescribing to improve health and social care outcomes for people with multimorbidity in socially deprived areas (Link MM Trial). Oral presentation at Annual AUDGPI and ICGP (Virtual) Conference. March 2021 Y1 - 2021 A1 - Kiely, B A1 - Galvin, E A1 - Byers, V A1 - Clyne, B A1 - Boland, F A1 - Connolly, D A1 - O'Shea, E A1 - Smith, SM ER - TY - Generic T1 - Predicting hospital admission in community dwelling adults: a systematic review of the Probability of Repeated Admission (Pra) score. Annual Scientific Meeting, Department of Public Health & Primary Care, 20-21 January 2011.Trinity College Dublin Y1 - 2011 A1 - Smith, SM ER - TY - Generic T1 - Potentially inappropriate prescribing in a middle-aged population: a cross-sectional study in Northern Ireland using the Enhanced Prescribing Database. Health Services Research & Pharmacy Practice Conference April 2015 Y1 - 2015 A1 - Cooper, J A1 - Moriarty, F A1 - Ryan, C A1 - Smith, SM A1 - Wallace, E A1 - Bennett, K A1 - Cahir, C A1 - Williams, David A1 - Teeling, Mary A1 - Fahey, T A1 - Hughes, CM ER - TY - Generic T1 - OPTIMAL, an Occupational Therapy Led Self-management Support Programme for People with Multimorbidity in Primary Care: A Randomized Controlled Trial NAPCRG New York 21-24 Nov 2014 Y1 - 2014 A1 - Garvey, J A1 - Smith, SM ER - TY - Generic T1 - OPTIMAL, an Occupational Therapy Led Self-management Support Programme for People with Multimorbidity in Primary Care: A Randomized Controlled Trial SAPC July 9-11 Edinburgh Y1 - 2014 A1 - Garvey, J A1 - Smith, SM ER - TY - Generic T1 - One year follow up survey of participants in the LinkMM trial: Link worker engagement and community resource use. AUDGPI AGM March 2022 Y1 - 2022 A1 - Kiely, B A1 - Loomba, S A1 - Boland, F A1 - Byers, V A1 - Galvin, E A1 - Clyne, B A1 - Connolly, D A1 - O'Shea, E A1 - Smith, SM ER - TY - Generic T1 - Multimorbidity and systematic reviews, Cochrane Ireland 10th Annual Meeting, DCU Jan 26th 2014 Y1 - 2014 A1 - Smith, SM UR - http://www.hrbcentreprimarycare.ie/ppt/SMSmith Cochrane DCU Jan 2014.pdf ER - TY - Generic T1 - Multimorbidity and functional decline in community-dwelling adults: a systematic review. Irish Society of Chartered Physiotherapists Conference, Dublin, 6th November 2015. Y1 - 2015 A1 - Ryan, A A1 - Wallace, E A1 - O'Hara, P A1 - Smith, SM ER - TY - Generic T1 - Multimorbidity and functional decline in community-dwelling adults: a systematic review 2015. SPHeRE Conference, RCSI, Dublin, 29th February 2016. Y1 - 2016 A1 - Ryan, A A1 - Wallace, E A1 - O'Hara, P A1 - Smith, SM ER - TY - Generic T1 - Multimorbidity and functional decline in community-dwelling adults: a systematic review. RCSI Research Day 25th February 2016. Y1 - 2016 A1 - Ryan, A A1 - Wallace, E A1 - O’Hara, P A1 - Smith, SM ER - TY - Generic T1 - Managing Multimorbdity. Irish Society of Chartered Physiotherpaists, Annual Meeting Crioke Park, Nov 8th 2014 Y1 - 2014 A1 - Smith, SM ER - TY - Generic T1 - Invited lecture on 'Improving outcomes in patients with multimorbdity in primary care settings: what is the evidence?" Co-morbidity in Rheumatology, Royal College Physicians, London. 15th September 2014 Y1 - 2014 A1 - Smith, SM ER - TY - Generic T1 - Interventions to address potentially inappropriate prescribing in primary care: a systematic review of randomised control trials. Health Services Research & Pharmacy Practice (HSRPP) Conference April 2015 Y1 - 2015 A1 - Clyne, B A1 - Fitzgerald, C A1 - Quinlan, A A1 - Hardy, C A1 - Galvin, R A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - Interventions to address potentially inappropriate prescribing in primary care: a systematic review of randomised control trials Society for Social Medicine 59th Annual scientific Meeting 2-4 Sept 2015 Dublin Y1 - 2015 A1 - Clyne, B A1 - Fitzgerald, C A1 - Quinlan, A A1 - Hardy, C A1 - Galvin, R A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - Interventions and outcome assessment for patients with multimorbidity. AUDGPI 2011, Annual Scientific Meeting, Department of Public Health & Primary Care, 20-21 January 2011.Trinity College Dublin, Royal College of Physicians in Ireland Y1 - 2011 A1 - Smith, SM ER - TY - Generic T1 - Integrating clinical pharmacists within general practice: protocol for a pilot cluster randomised controlled trial. Oral presentation at Annual Joint Scientific Meeting of the AUDGPI and ICGP (Virtual) Conference. March 2021 Y1 - 2021 A1 - Croke, A A1 - Moriarty, F A1 - Boland, F A1 - McCullagh, L A1 - Cardwell, K A1 - Smith, SM A1 - Clyne, B ER - TY - Generic T1 - Impact of potentially inappropriate prescribing on adverse health outcomes in community-dwelling older people: a prospective cohort study. SAPC 6th-8th of July 2016 Dublin Castle/RCSI. Y1 - 2016 A1 - Wallace, E A1 - McDowell, R A1 - Bennett, K A1 - Fahey, T A1 - Smith, SM ER - TY - Generic T1 - The IDAPP framework for the impact analysis of Clinical Prediction Rules (CPRs). SAPC 2011, 6-8 July 2011, Bristol, UK Y1 - 2011 A1 - Wallace, E A1 - Smith, SM A1 - International Diagnostic and Prognosis Prediction (IDAPP) Group UR - http://hrbcentreprimarycare.ie/ppt/SAPC%202011.ppt ER - TY - Generic T1 - The HRB Centre for Primary Care Research. Collaborative Funding Meeting. Health Services and Population Health Research Alliance, 29th January 2013. NUI Galway Y1 - 2013 A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - GPs’ perceptions of their relationship with the pharmaceutical industry: a qualitative study. Oral presentation at Annual Joint Scientific Meeting of the AUDGPI and ICGP (Virtual).Conference. March 2021 Y1 - 2021 A1 - Larkin, J A1 - Pericin, I A1 - Collins, M A1 - Smith, SM A1 - Byrne, D A1 - Moriarty, F ER - TY - Generic T1 - The experience of financial burden for people with multimorbidity: A systematic review of qualitative research. Oral presentation at Annual Joint Scientific Meeting of the AUDGPI and ICGP (Virtual).Conference. March 2021 Y1 - 2021 A1 - Larkin, J A1 - Foley, L A1 - Smith, SM A1 - Harrington, P A1 - Clyne, B ER - TY - Generic T1 - Effectiveness of interventions in primary care to improve glycated haemoglobin and cardiovascular risk factor levels in patients with poorly-controlled type 2 diabetes mellitus: a systematic review.RCSI Research Day 25th February 2016 Y1 - 2016 A1 - Murphy, M A1 - Galvin, R A1 - Fahey, T A1 - Byrne, S A1 - Smith, SM ER - TY - Generic T1 - Effectiveness of interventions in primary care to improve glycated haemoglobin and cardiovascular risk factor levels in patients with poorly-controlled type 2 diabetes mellitus: a systematic review. AUDGPI 10th March 2016 Y1 - 2016 A1 - Murphy, M A1 - Galvin, R A1 - Fahey, T A1 - Byrne, S A1 - Smith, SM ER - TY - Generic T1 - Effectiveness of interventions in patients with multimorbidity in primary care.WONCA Europe July, 2014 Y1 - 2014 A1 - Smith, SM UR - http://www.hrbcentreprimarycare.ie/ppt/Interventions for MM_WONCA_S Smith 30 june.pdf ER - TY - Generic T1 - Effectiveness of a quality improvement intervention on potentially inappropriate prescribing in older patients in primary care: a cluster randomised controlled trial (the OPTI-SCRIPT study)(NAPCRG winner B Clyne from 2014) SAPC Oxford July 2015 Y1 - 2015 A1 - Clyne, B A1 - Smith, SM A1 - Hughes, CM A1 - Boland, F A1 - Bradley, MC A1 - Cooper, J A1 - Fahey, T ER - TY - Generic T1 - Effectiveness of a multifaceted intervention on potentially inappropriate prescribing in older patients in primary care: a cluster randomised controlled trial (the OPTI-SCRIPT study) NAPCRG New York 21-24 Nov 2014 Y1 - 2014 A1 - Clyne, B A1 - Smith, SM A1 - Hughes, CM A1 - Boland, F A1 - Bradley, MC A1 - Cooper, J A1 - Fahey, T ER - TY - Generic T1 - Effectiveness of a multifaceted intervention on potentially inappropriate prescribing in older patients in primary care: a cluster randomised controlled trial (the OPTI-SCRIPT study). SAPC July 9-11 2014 Edinburgh Y1 - 2014 A1 - Clyne, B A1 - Smith, SM A1 - Hughes, CM A1 - Boland, F A1 - Bradley, MC A1 - Cooper, J A1 - Fahey, T ER - TY - Generic T1 - Effect of social prescribing link workers on health outcomes and costs for adults in primary care and community settings: a systematic review. SAPC ASM, University of Central Lancashire, July 2022 Y1 - 2022 A1 - Kiely, B A1 - Croke, A A1 - O'Shea, M A1 - Boland, F A1 - Connolly, D A1 - O'Shea, E A1 - Smith, SM ER - TY - Generic T1 - 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 Y1 - 2014 A1 - Zarabzadeh, A A1 - McDonnell, R A1 - Corrigan, D A1 - Galvin, R A1 - Smith, SM A1 - Fahey, T ER - TY - Generic T1 - Developing a Web-based International Register of Clinical Prediction Rules for Primary Care. North American Primary Care Research Group (NAPCRG), 1-5 December 2012, New Orleans, Louisiana, USA Y1 - 2012 A1 - Smith, SM A1 - Keogh, C A1 - Wallace, E A1 - Galvin, R A1 - O'Brien, K A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/ppt/International register for primary care CPRs.pptx ER - TY - Generic T1 - Chronic Respiratory Disease and Multimorbidity: Prevalence and impact in a General Practice Setting. Irish Thoracic Society Annual Scientific Meeting 2009, 5 November 2009, Irish Thoracic Society, Galway, Ireland Y1 - 2009 A1 - O'Kelly, Siobhan A1 - Smith, SM A1 - Lane, S A1 - Teljeur, C A1 - O'Dowd, T UR - http://www.hrbcentreprimarycare.ie/ppt/OKellyS/SOKellyITS09.pdf ER - TY - Generic T1 - The Challenge of Multimorbidity.‘Hearts and Minds’: Physical Health in people with severe mental illness. 25 Jan 2013. St John of God Hospital, Stillorgan, Dublin Y1 - 2013 A1 - Smith, SM UR - http://www.hrbcentreprimarycare.ie/ppt/S Smith_MM Psych.pdf ER - TY - Generic T1 - Workshop for early career academics in primary care on systematic reviews. AUDGPI Conference, Belfast March 2015 Y1 - 2015 A1 - Wallace, E A1 - Galvin, R A1 - Smith, SM ER - TY - Generic T1 - What do we know about multimorbidity and how to approach this in the future? National Conference on Multimorbidity. Hosted by Research Unit of Chronic Conditions, Bispebjerg University Hospital, Department of Public Health, University of Copenhagen. 31/05 Y1 - 2016 A1 - Smith, SM ER - TY - Generic T1 - Prescribing in older people. Prescribing in older people seminar. HRB Centre for Primary Care Research seminar on older people, 10 September 2009, HRB Centre for Primary Care Research, Dublin Y1 - 2009 A1 - Smith, SM A1 - O'Dowd, T UR - http://www.hrbcentreprimarycare.ie/ppt/SmithS/Prescribing%20in%20older%20people-SS.ppt ER - TY - Generic T1 - OptiMaL: A primary care- based intervention for people with multimorbidity. COTEC-ENOTHE NUI Galway, 15th -19th of June 2016. Y1 - 2016 A1 - Connolly, D A1 - Garvey, J A1 - O’Toole, L A1 - Boland, F A1 - Smith, SM ER - TY - Generic T1 - Multimorbidity: the research agenda? Division of Population Health Science, Academic Seminar Series, RCSI, 12 January 2012, Dublin. Y1 - 2012 A1 - Smith, SM UR - http://www.hrbcentreprimarycare.ie/ppt/SS%20MM%20Div%20sem%20Jan%202012.pptx ER - TY - Generic T1 - Methodological Quality of Clinical Prediction Rules. 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 - Wallace, E A1 - Smith, SM A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 ER - TY - Generic T1 - International Register and Clinical Domains in Primary Care. Clinical Prediction Rules – International Forum for Diagnostic and Prognostic Strategies in Primary Care, 4 June 2010, HRB Centre for Primary Care Research, Dublin Y1 - 2010 A1 - Keogh, C A1 - Wallace, E A1 - O'Brien, K A1 - Murphy, Paul J A1 - Teljeur, C A1 - McGrath, Brid A1 - Smith, SM A1 - Niall Doherty A1 - Dimitrov, B A1 - Fahey, T UR - http://www.hrbcentreprimarycare.ie/default.aspx?ID=124 ER - TY - Generic T1 - An International Perspective on Designing Interventions For Multimorbidity in Primary Care. The Multiple Chronic Conditions Research Network, AHRQ, 23 April 2013, Maryland. USA Y1 - 2013 A1 - Smith, SM A1 - Soubhi, Hassan A1 - Fortin, M A1 - Hudon, Catherine A1 - O'Dowd, T UR - http://www.hrbcentreprimarycare.ie/ppt/SMSmith_webinar.ppt ER - TY - Generic T1 - Improving outcomes for patients with multimorbidity. Dagens Medicine Conference. Copenhagan 31st May 2016 Y1 - 2016 A1 - Smith, SM ER - TY - Generic T1 - Framework for the evaluation and implementation of clinical prediction rules. Clinical Prediction Rules – International Working Group, 29-30 September 2010, Oxford, UK Y1 - 2010 A1 - Smith, SM UR - http://www.hrbcentreprimarycare.ie/ppt/SSmith_OxfordCPR.ppt ER - TY - Generic T1 - Chronic respiratory disease and multimorbidity: prevalence and impact in a general practice setting. October 2009, EGPRN Dubrovnik, Croatia Y1 - 2009 A1 - O'Kelly, Siobhan A1 - Smith, SM A1 - Lane, S A1 - Teljeur, C A1 - O'Dowd, T ER - TY - Generic T1 - Chronic Diseases: what happens when they come in multiples? RCSI Mini-med School Open Lecture series. RCSI, 29 February 2012, Dublin. Y1 - 2012 A1 - Smith, SM UR - http://hrbcentreprimarycare.ie/ppt/SSmith%20MM%20minimed%20Feb%202012%20.ppt ER - TY - Generic T1 - The Challenge of Multimorbidity. Meeting of the Donegal Clinical Society, 20 April 2013, Donegal Y1 - 2013 A1 - Smith, SM UR - http://www.hrbcentreprimarycare.ie/ppt/SSmith Donegal Clinical Society.pdf ER - TY - Generic T1 - CGP Summer School Workshop on Prescribing in Older Patients. ICGP Summer School Workshop on Managing Frailty in Patients in General Practice. 21 June 2012, Kilkenny Y1 - 2012 A1 - O'Connell, Michael P A1 - Smith, SM ER - TY - Generic T1 - 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 T2 - 9th International Conference on Knowledge, Information and Creativity Support Systems Y1 - 2014 A1 - Zarabzadeh, A A1 - McDonnell, R A1 - Corrigan, D A1 - Galvin, R A1 - Smith, SM A1 - Fahey, T JF - 9th International Conference on Knowledge, Information and Creativity Support Systems ER - TY - CONF T1 - Utility of electronic international register of clinical prediction rules relevant to primary care T2 - The 29th International Symposium on Computer-Based Medical Systems (CBMS 2016) Y1 - 2016 A1 - Zarabzadeh, A A1 - McDonnell, R A1 - Paz Berrios, S A1 - Dempsey, J A1 - Harrington, E A1 - Smith, SM A1 - Fahey, T JF - The 29th International Symposium on Computer-Based Medical Systems (CBMS 2016) CY - Dublin (June 20, 2016) and in Belfast (June 21 – 23, 2016) ER -