Our study indicates that hospital-initiated prescriptions are responsible for a significant proportion, both in volume and cost of GP prescribing.

Background:Methadone maintenance treatment in primary care is cost-eff ective and improves outcomes for opiate-dependent patients. A more developed understanding of the evolving needs of this important cohort will facilitate further improvements in their integrated care within the community. Objectives: The aim of this study was to compare the burden of chronic disease, multi-morbidity and intensity of health-service use between methadone-maintained patients (MMPs) and matched controls in primary care. Methods: This is a retrospective matched case-control design. Data on chronic disease and health service use was collected in 13 computerized GP surgeries on 414 patients (207 MMPs and 207 controls). Twelve months of records were examined. MMPs were compared with controls matched by gender, age, socio-economic status (SES) and GP surgery. Results: MMPs suff ered more chronic disease (OR ϭ 9.1, 95% CI: 5.4 -15.1, P Ͻ 0.001) and multi-morbidity (OR ϭ 6.6, 95% CI: 4.3 -10.2, P Ͻ 0.001). They had higher rates of respiratory, psychiatric and infectious disease. MMPs of lower SES had more chronic disease than their peers (OR ϭ 7.2, 95% CI: 2.4 -22.0, P Ͻ 0.001). MMPs attended the doctor more often with medical problems (OR ϭ 15.4, 95% CI: 8.2 -28.7, P Ͻ 0.001), with a frequent requirement to have medical issues addressed during methadone-management visits. Their care generated more telephone calls (OR ϭ 4.4, 95% CI: 2.8 -6.8, P Ͻ 0.001), investigations (OR ϭ 1.8, 95% CI: 1.2 -2.7, P ϭ 0.003), referrals (2.6, 95% CI: 1.7 -4.0, P Ͻ 0.001), emergency department visits (2.1, 95% CI: 1.3 -3.6, P ϭ 0.004), outpatient attendances (2.3, 95% CI: 1.51 -1.43, P Ͻ 0.001) and hospital admissions (3.6, 95% CI: 1.6 -8.1, P ϭ 0.001). Conclusion:Correcting for routine methadone care and drug-related illnesses, MMPs had a higher burden of chronic disease and used both primary and secondary health services more intensively than matched controls.

Longitudinal patient journeys encompass different phases with characteristic dynamics and are likely to require different interventions and strategies - thus being 'adaptive' to the changing complex dynamics of the patient's illness and care needs. CACC journey types provide a clinical tool for health professionals to focus time and care interventions in response to patterns of instability in multiple domains in chronic illness care.

BackgroundGeneral Practice Co-Operatives provide most out of hours care in communities in Ireland. Limited data exists on patient complaints. This study reports on complaints at Kildare and West Wicklow Doctors on Call (‘K Doc’), a GP Co-Operative in Ireland, examining the impact of a formal risk reduction strategy implemented (2010-2013). The aim of the study was to determine if it was possible to reduce the rate of written complaints per 1000 consultations through a formal approach encompassing evaluation of complaints, improved communication in relation to complaints, and more direct use of insights gained from complaints analysis in continuing professional development at the Co-Operative.MethodsInitially, complaints submitted over an 18 month period (01.06.08 to 31.12.09) were analysed. Complaint rate (number of complaints per 1000 consultations), complainant demographics, aspects of complaint response at the Co-Operative, and nature of complaint were recorded. Based on analysis, a risk reduction strategy was undertaken, including procedural change, focused training and education. Areas selected for improvement during a second phase of data collection included complaints rate, timeliness of Co-Operative response to complaint, and rate of complaint notification to patient’s GP. Further analysis was then carried out over a 45 month period (01.01.10 to 30.09.13).ResultsFrom 2008-2013, 216,716 patient consultations occurred. Complaints were received from 131 individuals, regarding 125 patients. Following introduction of risk reduction strategy, complaints rate reduced by 36 %, from 0.77 to 0.49 per 1000 consultations (p = 0.02) between the two periods of data collection. Timeliness of response from Co-Operative to the complainant improved from 63 % to 75 %. Notification of complaint to the patient’s GP improved from 48 % to 96 %.Most complaints were not associated with medically significant events. The largest categories of complaint related to clinical care (55 % n = 69), cost (46 %, n = 58), communication (42 %, n = 53), and process of care (15 %, n = 19). Mothers of affluent paediatric patients were most likely to make formal complaints.ConclusionsThis study reports a statistically significant reduction in complaints rate of 36 % following introduction of risk reduction strategies at a GP Co –Operative. Out of hours consulting is known to be an area of high medical risk. Findings are of interest where number and costs of complaints against GPs are elsewhere reported to be rising, contributing to medical inflation, and to public concern.

GPs are conflicted regarding the acceptability of weighing the child but almost all parents believed it helpful. A minority of obese children responded negatively.