1. Prescribing in older people Presentation to HRB PCRC seminar 10 Sept ‘09 Tom O’Dowd & Susan Smith

2. Progress with Multimorbidity strand Publications –BJGP –BMC –Cochrane review (currently being peer-reviewed) –BJGP Additional funding –Irish Lung Foundation - clinical research fellow –Trinity College - OT research assistant –Adelaide Society - lecturers in health policy

3. Two or more chronic illnesses in the same individual From primary care in Canada : 18 - 44 years61% 45 - 64 years93% > 65 years98% Fortin et al BMJ 2007

4. Prevalence of conditions % in General practice in Ireland Smith, Ferede, O’Dowd Lipid disorders 15 Hypertension12.5 Depression5.5 NIDDM7.5 COPD6 Asthma5 Acute MI2 IHD-no angina 1.5 IHD-with angina 3.5 Cardiovascular disease other 2.5 Chronic alcohol abuse 3 Hiatus hernia 1

5. Single vs Multimorbidity Smith, Ferede, O’Dowd Single morbidity Multimorbidity Female20 (48%)30 (48%) Mean age5456 GP visits713 Current meds2.37.3

6. Research plan Intervention –Medicines management –Occupational therapy –Function using rehab model –Feasability project with pilot study of multifaceted intervention Oct 09-Sept 2010 –Grant application HRB for RCT

7. Policy implications Needs to be developed Current GMS contract is not geared to chronic illness Current hospital care is suited to simple & complicated care Planning conference on chronic disease with Adelaide Society in early 2010 –Will need input from HRB Primary Care Research Centre