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

2. Division of Population Health Sciences Overview Background Collaborative opportunities –Exploring potential of large databases –Patient safety –Quality of care –Education and training of graduates

3. Division of Population Health Sciences Overview Background Collaborative opportunities –Exploring potential of large databases –Patient safety –Quality of care –Education and training of graduates

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

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

6. Division of Population Health Sciences

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

8. Division of Population Health Sciences GP Electronic Health Record (EHR)

9. Division of Population Health Sciences EHR UK Ireland

10. Division of Population Health Sciences

16. Trial data query system

17. Division of Population Health Sciences Recruitment RCT

18. Division of Population Health Sciences Visualisation- patient recruitment

19. Division of Population Health Sciences Diagnostic code recoded- type 1 NIDDM

20. Division of Population Health Sciences Overview Background Collaborative opportunities –Exploring potential of large databases –Patient safety –Quality of care –Education and training of graduates

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

22. Division of Population Health Sciences Overview Background Collaborative opportunities –Exploring potential of large databases –Patient safety –Quality of care –Education and training of graduates

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

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

25. Division of Population Health Sciences OPTI-SCRIPT study development

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

27. Division of Population Health Sciences OPTI-SCRIPT website

28. Division of Population Health Sciences

29. OPTI-SCRIPT RCT results Participants 21 GP practices (32% cluster response rate) 196 patients (37% response rate) Minimisation InterventionControl 11 practices 99 patients 10 practices 97 patients

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

31. Division of Population Health Sciences Outcome – Proportion with no PIP GroupNNumber of patients with no PIP % of patients with no PIP Intervention994747.5 Control972222.7 Adjusted odds ratio = 3.06 (95% CI 1.4,6.5; P=0.004)* *adjusted for gender, age, baseline PIP, number repeat medications, GP practice size

32. Division of Population Health Sciences National contemporaneous control – PCRS Intervention period, Sep 2012 – August 2013 prevalence of 38% Odds of having no PIP in OPTI-SCRIPT intervention compared to odds of having no PIP in the national PCRS cohort Odds Ratio95% CI 2.491.68, 3.69

33. Division of Population Health Sciences Overview Background Collaborative opportunities –Exploring potential of large databases –Patient safety –Quality of care –Education and training of graduates

34. Division of Population Health Sciences Overview Background Collaborative opportunities –Exploring potential of large databases –Patient safety –Quality of care –Education and training of graduates

35. Division of Population Health Sciences

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