A mixed-methods evaluation of an Irish remote model of opioid substitution treatment.

INTRODUCTION: Providing health care to rural communities is a challenge, particular for marginalised groups like people who use drugs. The ongoing COVID-19 pandemic further increases these challenges. The use of remote models of care, including telemedicine, help to mitigate the impact of COVID-19 and provide new opportunities to engage existing and new patients in treatment. It is recognised that people who used opioids have increased health needs and struggle to engage in health care compared to the general population. Opioid substitution treatment (OST) is effective at reducing these health inequalities but coverage is often inadequate. To increase access to OST during the pandemic, a national remote model of OST was developed in Ireland. An evaluation is being conducted 18 months after commencement to evaluate its effectiveness at engaging people in OST, its impact on their drug use, general health and quality of life. The evaluation also aims to describe the experiences of both services providers and users and report aspects that can be modified and improved. METHODS: A mixed-methods evaluation is being conducted. It consists of a chart review that collects demographic data (age, sex, family details and education and employment status). It also includes the collection and analysis of data on engagement in treatment, changes in drug use and general health. A series of one-to-one interviews are being conducted (service providers (n=12) and service users (n=10).Thematic analysis of the interview narratives will be conducted using NVivo 11. RESULTS AND DISCUSSION: The results will be ready in 2022.

GPs at the Edge: a quantitative description of Irish Rural General Practice.

INTRODUCTION: Currently, more than 1.6 million Irish people live rurally. Rural populations in Ireland are older and have more health needs compared with younger urban areas. Meanwhile, since 1982, the proportion of general practices in rural areas has decreased by 10%. In this study, we look at new survey data to investigate the needs and challenges of rural general practice in Ireland. METHODS: This study will make use of survey responses from the 2021 membership survey by the Irish College of General Practitioners (ICGP). The anonymous, online, survey was sent by email to the ICGP membership in late 2021, with a series of questions pertaining to practice location, and prior experience of living and working in a rural area designed specifically for this project. A series of statistical tests will be undertaken as appropriate for the data. RESULTS: This study is ongoing; we aim to present data on the demographics of those working in rural general practice and related factors. DISCUSSION: Previous research has shown that people who grew up or trained in rural areas are more likely to work there after qualifying. As the analysis of this survey continues, it will be important to see if this pattern is evident here as well.

GPs at the Edge: GATE, a qualitative investigation into the experience of delivering care in Irish Rural General Practice.

INTRODUCTION: Over a third of Irish people live rurally. However, only a fifth of Irish general practices are located in rural communities and longstanding issues such as distance to other health services, professional isolation, and recruitment and retention of rural healthcare professionals (HCPs) threaten rural general practice's sustainability. This ongoing study seeks to understand what it is like to provide care to Ireland's rural and remote populations. METHODS: This is a qualitative study, consisting of semi-structured interviews with GPs and practice nurses working in practices that serve rural populations across Ireland. Topic guides were developed after a literature review and a series of pilot interviews. Interviews are scheduled to be finished in February 2022. RESULTS: This study is ongoing so results are yet to be finalised. Initial key themes include a great level of professional satisfaction that GPs and practice nurses experience from caring for entire families from the 'cradle to grave' and from the complex issues they face in practice. A rural general practice acts as the medical port-of-call for patients, with both practice nurses and GPs having experiences with emergency and pre-hospital medicine. A key difficulty identified is access to secondary and tertiary care services, with distance to services and high demand as the main barriers. DISCUSSION: Working in rural general practice gives HCPs great professional satisfaction but access to other health services remains a challenge. Final conclusions may be compared with other delegates' experiences.

Heartwatch: an Irish cardiovascular secondary prevention programme in primary care, a secondary analysis of patient outcomes.

OBJECTIVES: To investigate patient follow-up data from Heartwatch: Ireland's secondary prevention programme for cardiovascular disease delivered in general practice. DESIGN: Retrospective descriptive study based on secondary analysis of routinely collected data from Heartwatch. SETTING: Heartwatch targeted 20% of general practices in Ireland and recruited 475 general practitioners across 325 practices. PARTICIPANTS: The patient population included people with a history of acute myocardial infarction, percutaneous transluminal coronary angioplasty or a coronary artery bypass graft. Over 16 000 patients entered the programme however, to assess the long-term progress of patients, we identified a cohort of 5700 patients with at least 8 years in the programme. INTERVENTIONS: A standard protocol for continuing care of patients for the secondary prevention of cardiovascular disease was administered by general practices. The programme was designed using WHO and European Society of Cardiology guidelines on secondary prevention. OUTCOME MEASURES: A Continuing Care (CCare) score out of eight was the primary outcome measure used. It was calculated based on programme targets for well-known cardiovascular risk factors: exercise, systolic blood pressure, LDL cholesterol, optimally controlled glucose, smoking status, and pharmacological treatment. RESULTS: After 1 year, 37% of the 8-year cohort had achieved a CCare score >5 increasing to 44% after year 8. Patient sex was predictive of better scores; male patients had almost a half-point advantage (0.432, 99% CI: 0.335 to 0.509). Patients who enrolled earlier following their qualifying event and patients with more frequent visits were also more likely to achieve higher CCare scores. CONCLUSIONS: Overall, patients are not likely to meet all targets set by secondary prevention guidelines, however, supporting patient self-management may impact on this. Early enrolment after a cardiac event and frequent structured care visits should be priorities in the design and implementation of similar programmes. Ongoing evaluation of them is necessary to improve outcomes.

A mixed methods study of the awareness and management of familial hypercholesterolaemia in Irish general practice.

Introduction: Familial Hypercholesterolemia (FH) is one of the most common genetic disorders, with an estimated global prevalence of 1:200-500, which leads to premature cardiovascular disease. Nevertheless, public and professional awareness of FH is often lacking, with an estimated 20,000 largely undiagnosed cases in Ireland. Purpose: The overall aim of the project was to test the feasibility of a model of care that would include electronic record screening, clinical assessment, and coding of possible FH patients across a network of general practices in Ireland. In addition, a secondary aim was to gauge the awareness and knowledge of FH across the network. Methods: This study took part in multiple phases, employing a mixed methods design. The study included a validated questionnaire, tailored online educational resources, a retrospective chart review of patients with a history of elevated LDL cholesterol (LDLc) and an active review with a selection of those patients. Results were analyzed using SPSS V27, where descriptive statistics and relevant correlation tests were employed. Results: Eighteen general practices agreed to take part in the study. In the initial survey, respondents rated their personal and practice familiarity with FH as slightly below average. Around one-third of respondents were not aware of FH guidelines. Of over 55,000 adult patient records searched, only 0.2% had a recorded FH diagnosis and 3.9% had ever had an LDLc above 4.9 mmol/l. Eight practices completed 198 chart reviews. Among these, 29.8% of patients had a family history recorded, and 22.2% had a family history of CVD recorded. Female patients had higher averages for highest and recent LDLc. Seventy patients underwent a clinical review-with 27% of these patients identified as "probable" or "definite FH." There was a statistically significant (p = 0.002) relationship between FH status and whether the patient had other CVD risk factors. Conclusion: General practitioners in Ireland had similar levels of awareness of FH compared to findings from elsewhere. The activities discussed encouraged clinicians to consider FH when talking to their patients, especially those with elevated LDLc at an early age. Broader awareness of the condition could increase conversations about FH and benefit patient outcomes.

How COVID-19 has affected general practice consultations and income: general practitioner cross-sectional population survey evidence from Ireland.

Objectives: How general practice is delivered in many countries has drastically changed due to the COVID-19 pandemic. This study aimed to answer the question of how general practice has changed in Ireland in response to COVID-19. Design: The Irish College of General Practitioners surveyed its membership before and after the global pandemic hit Ireland using a cross-sectional online survey instrument. Setting: This study focuses on primary care, specifically general practice, in Ireland. Participants: In February 2020 before the global pandemic, 526 general practices across Ireland submitted responses to the survey; 538 general practices responded to the second survey during the pandemic in June 2020. This covers 32% and 33% of practices in Ireland, respectively. Main outcome measures: The type of consultations by general practitioners (GPs) and practice nurses in both surveys is the main outcome measure reported in this paper. Other changes such as the perceived change in attendance by certain patient groups and practice income are also reported. Results: Face-to-face consultations significantly (p<0.001) decreased from a median of 26 (IQR 21.3-30) to a median of 8 (IQR 6-13). GP telemedicine consultations increased (p<0.001) from a median of 2.4 (IQR 0-5.3) to a median of 11.3 (IQR 6-19). The majority of practices (80.0%) reported reduced practice profit. Respondents reported a decline in non-COVID-19-related consultations among certain patient cohorts-92.0% for children under 6 years old; 79.5% for patients over 70 years. Conclusions: It is likely that the way general practice is delivered will not return to as it was before the COVID-19 pandemic and increased telemedicine can be expected. However, it is necessary to assess the impact of this shift on patient health and to assess healthcare provider and patient experience to ensure continued high-quality care and patient safety.

Scoping review protocol: the use of telemedicine in providing opioid agonist treatment and related psychosocial supports.

INTRODUCTION: The global opioid-related disease burden is significant. Opioid agonist treatment (OAT) can be effective in reducing illicit opioid use and fatal overdose, and improving multiple health and social outcomes. Despite evidence for its effectiveness, there are significant deficits in OAT globally. COVID-19 has required rapid adaptation of remote models of healthcare. Telemedicine is not used routinely in OAT, and little is known about the current levels of use and effectiveness. The objective of this review is to describe models of telemedicine and their efficacy. METHODS AND ANALYSIS: This scoping review uses the review methodology described by Arksey and O'Malley and adapted by Levac et al. The search strategy developed by the medical librarian at the Irish College of General Practitioners in conjunction with the research team will involve five databases (PubMed, EMBASE, the Cochrane Library, PsycInfo and OpenGrey) and the hand searching of reference lists. A limited initial search of two databases will be completed to refine search terms, followed by a second comprehensive search using newly refined search terms of all databases and finally hand searching references of included studies. To be included, studies must report on remote ways of providing OAT (including assessment, induction and monitoring) or related psychosocial support; be published in English after 2010. Two researchers will independently screen titles, abstracts and full-text articles considered for inclusion. Data will be extracted onto an agreed template and will undergo a descriptive analysis of the contextual or process-oriented data and simple quantitative analysis using descriptive statistics. ETHICS AND DISSEMINATION: Research ethics approval is not required for this scoping review. The results of this scoping review will inform the development of a national remote model of OAT. The results will be published in peer-reviewed journals and presented at relevant conferences.