The document discusses the role of general practitioners in a seamless health system. It covers several topics: 1) Background on general practice and the core functions of primary care like first contact care, comprehensive care, and care coordination. 2) Safe prescribing practices for general practitioners, including data showing increasing polypharmacy and prevalence of potentially inappropriate prescribing over time. 3) Quality improvement through health data and communication between primary and secondary care to ensure safe diagnosis, referrals, and medicines management.

1. The role of the general practitioner in a
Seamless Health System
Tom Fahey
Department of General Practice & HRB Centre
for Primary Care Research

2. Overview
• Background & context
• Safe prescribing
• Safe diagnosis & referral
• Quality improvement- health data &
communication

3. Background & context
• 20+ years general practice & public health medicine
• Clinical research
• Undergraduate & postgraduate education

5. Core functions of primary care
• First contact provision of care
• Comprehensiveness of care
• Continuity of care
• Coordination of care
• Gate-keeping role

6. General practice
• “In general practice the people stay and the diseases
come and go. In hospital the diseases stay and the
people come and go”
• “Sign of a coherent discipline is one that does its
own research and teaching”
• Dr Iona Health former President RCGP

7. Overview
• Background & context
• Safe prescribing
• Safe diagnosis & referral
• Quality improvement- health data &
communication

11. Proportion of eligible population by
number of regular medicines
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Under 5 yrs 5-15 yrs 16-44 yrs 45-64 yrs 65 yrs and over
Proportionofpeopleprescribedregularmedication
Age group
1997
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15+

12. Proportion of eligible population by
number of regular medicines
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Under 5 yrs 5-15 yrs 16-44 yrs 45-64 yrs 65 yrs and over
Proportionofpeopleprescribedregularmedication
Age group
2002
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15+

13. Proportion of eligible population by
number of regular medicines
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Under 5 yrs 5-15 yrs 16-44 yrs 45-64 yrs 65 yrs and over
Proportionofpeopleprescribedregularmedication
Age group
2007
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15+

14. Proportion of eligible population by
number of regular medicines
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Under 5 yrs 5-15 yrs 16-44 yrs 45-64 yrs 65 yrs and over
Proportionofpeopleprescribedregularmedication
Age group
2012
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15+

15. Polypharmacy prevalence
0%
10%
20%
30%
40%
50%
60%
70%
Under 5 yrs 5-15 yrs 16-44 yrs 45-64 yrs 65 yrs and over
Major polypharmacy (≥10 meds)
1997
2002
2007
2012

16. Prevalence of individual PIP criteria

17. Cost of PIP-RoI
• Gross cost of PIP for one year (2007) €38,664,640
• Total expenditure (gross cost, VAT,+pharmacist
dispensing fee) €45,631,319
• Total expenditure accounted for 9% of overall
expenditure on pharmaceuticals in those aged ≥ 70
years in 2007

18. The prevalence of the most common STOPP/START PIP
indicators across three regions

19. Medicines management
• Dynamic process that requires timely
communication between primary & secondary care
– Reconciliation
– Appropriateness
– Safety
– Interactions
– Monitoring

20. Overview
• Background & context
• Safe prescribing
• Safe diagnosis & referral
• Quality improvement- health data &
communication

32. Overview
• Background & context
• Safe prescribing
• Safe diagnosis & referral
• Quality improvement- health data &
communication

37. Copyright ©2009 BMJ Publishing Group Ltd.
Rates of common surgical procedures among Medicare patients
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44. Conclusion
• Coherence
– Use of evidence & research
– Use of comparative clinical data
• Communication
– Information & communication technology
– Unique identifier
• Realities of clinical practice
– Uncertainty and transparency