Grants and Bursaries

The Irish College of GPs Best Published Paper award acknowledges general practice researchers who have disseminated their research findings by publication in a peer-reviewed journal. This award is sponsored by the Irish College of GPs Research, Policy and Information Department.

Winners:       Dr John Travers and Dr Emma Wallace

Winner No. 1:     Dr John Travers, ‘Building resilience and reversing frailty: a randomised controlled trial of a primary care intervention for older adults’

Objective:      To study the effectiveness of an optimised exercise and dietary protein intervention.

Study Design:      Multicentre, randomised-controlled, parallel-arm trial.

Results:      Of the 359 adults screened, 197 were eligible and 168 enrolled; 156 (92.9%) attended follow-up (mean age 77.1; 67.3% women; 79 intervention, 77 control). At baseline, 17.7% of intervention and 16.9% of control participants were frail by SHARE-FI. At follow-up, 6.3 and 18.2% were frail, respectively. The odds ratio of being frail between intervention and control groups post-intervention was 0.23 (95% confidence interval: 0.07–0.72; P = 0.011), adjusting for age, gender and site. Absolute risk reduction was 11.9% (CI: 0.8%–22.9%). The number needed to treat was 8.4. Grip strength (P < 0.001) and bone mass (P = 0.040) improved significantly. 66.2% found the intervention easy, and 69.0% reported feeling better.

Conclusion:      A combination of exercises and dietary protein significantly reduced frailty and improved self-reported health.

Winner No. 2:     Dr Emma Wallace, ‘Adverse drug reactions and associated patient characteristics in older community-dwelling adults: a 6-year prospective cohort study’.

Objective:      To examine the cumulative incidence and severity of ADRs and associated patient characteristics in a sample of community-dwelling older adults.

Study Design:      Prospective cohort study of older adults (aged ≥70 years, N=592) recruited from 15 general practices in the Republic of Ireland.

Results:      A total of 211 ADRs were recorded for 159 participants, resulting in a cumulative incidence of 26.9% over 6 years. The majority of ADRs detected were mild (89.1%), with the remainder classified as moderate (10.9%). Eight moderate ADRs, representing 34.8% of moderate ADRs and 3.8% of all ADRs, required an emergency hospital admission. ADRs were independently associated with female sex (adjusted odds ratio [OR] 1.83, 95%confidence interval [CI]=1.17 to 2.85; P=0.008), polypharmacy (5–9 drug classes) (adjusted OR1.81, 95% CI=1.17 to 2.82; P=0.008), and major polypharmacy (≥10 drug classes) (adjusted OR=3.33, 95% CI=1.62 to 6.85; P=0.001).

Conclusion:      This prospective cohort study of ADRs in general practice shows that over one-quarter of older adults experienced an ADR over a 6-year period. Polypharmacy is independently associated with ADR risk in general practice, and older adults on ≥10 drug classes should be prioritised for regular medication review.

The Dr Jim Slein Bursary acknowledges general practice researchers who have undertaken a research project investigating substance misuse or health inequality/inequity. This grant is kindly supported by Dr Jim Slein's family. 

Winner:     Dr Thomas Cronin, Prevalence and risk factors of frailty in people experiencing homelessness: a systematic review and meta-analysis.    

     
Background:      The experience of homelessness has been associated with premature ageing and an earlier onset of geriatric syndromes. Identification of frailty, followed by appropriate intervention, may help improve health outcomes for people experiencing homelessness (PEH). 

Sampling strategy: A systematic review of studies examining the prevalence and risk factors for frailty in PEH was conducted and reported using the PRISMA checklist. Searches were conducted in Ovid MEDLINE, PsycInfo, Web of Science and CINAHL from inception to July 2024. A meta-analysis examining the prevalence of frailty and pre-frailty was completed with a narrative synthesis of related risk factors.  

Results:      A total of 1672 articles were screened for eligibility, and 11 studies were included, containing 1017 participants from seven countries. Six different screening tools were employed to detect frailty in the included studies. The range of frailty prevalence was 16-70%, and pre-frailty prevalence was 18-60%. The pooled frailty prevalence from studies employing the Fried Criteria was 39% (95% CI 15-66); the Clinical Frailty Scale: 37% (95% CI 24-51); the Edmonton Frailty Scale: 53% (95% CI 44-63); and the Tilburg Fraily Indicator: 31% (95% CI 8-60). High heterogeneity was observed between the studies. Identified risk factors for developing frailty in PEH included being female, increased years spent homeless, and drug addiction.

 
Conclusions:     This study highlights a high prevalence of frailty and pre-frailty in PEH, further emphasising the need to address homelessness as a major threat to health. Considerations should also be given towards screening for frailty in PEH and developing strategies that optimise the care of PEH who are frail. Future research should focus on developing appropriate frailty detection tools in PEH and feasible interventions to reverse frailty and build resilience in this group.  

This bursary acknowledges general practice researchers who have undertaken a cancer related research project in the past two years. The work does not have to be already published but there should be an intention to publish in a peer-reviewed journal.

Winner:     Alexander Carroll, Establishing the Research Usefulness of Irish GP Data (ERUDITE-1): A Comparison of Cancer Incidence in Primary Care Records with National Cancer Registry Data

Background:      Primary care datasets offer valuable longitudinal data for research and policy-making. However, Ireland's primary care data infrastructure is limited, with inconsistent diagnostic coding raising concerns about its research utility. While gaps in coding for chronic conditions are well-documented, cancer diagnosis validation remains unaddressed. This study assesses the utility of Irish GP data by comparing cancer incidence rates derived from primary care records with those from the National Cancer Registry Ireland (NCRI)

Methodology:    We conducted a retrospective cohort study using anonymised data from 43 GP practices within the Irish Primary Care Research Network (IPCRN). Following RECORD guidelines, data from 1 January 2011 to 5 April 2018 were extracted via a standardised tool. Cancer cases were identified using ICD-10 and ICPC-2 codes, focusing on the 20 most common cancers reported by the NCRI. Incidence rates per 100,000 person-years were calculated and compared with NCRI data. Statistical analyses included chisquared tests to assess deviations between observed and expected case counts for each cancer type, adjusted for age and sex. Weighted average percentage deviation analysis was used to quantify relative differences across datasets.    

Results:      The study cohort included 51,250 patients with a mean follow-up of 5.3 years, during which 3,432 new cancer cases were identified. Prostate, leukaemia, and cervical cancers showed the most accurate coding, aligning closely with NCRI data. In contrast, 16 cancers, including breast, lung, and pancreas, were significantly underrepresented (p < 0.05). Coding practices varied widely across GP practices, with rates ranging from 0.03 to 54.2 codes per patient. ICPC-2 coding was predominantly used but lacked granularity for certain cancers (e.g., melanoma, brain, liver), leading to grouping errors. Reliance on ICD-10 for specific cancers provided greater accuracy but was inconsistently applied across practices 

Conclusions:     This study highlights the significant discrepancies between cancer incidence rates recorded in Irish GP datasets and those reported by the NCRI, with most cancers being underrepresented. The findings reflect variability in coding practices, a lack of standardisation between ICD-10 and ICPC-2 systems, and the absence of mortality data as key barriers to the effective use of primary care datasets for cancer surveillance and research. Although some cancers, such as prostate and leukaemia, were accurately coded, others, including bladder, melanoma, liver, brain, and thyroid cancers, showed marked underreporting. 
Addressing these challenges requires a coordinated effort to improve the accuracy and reliability of primary care data in Ireland. Standardising diagnostic coding practices across GP practices, ideally through the adoption of a single system such as ICD-10 or SNOMED CT, is essential. Additionally, integrating GP datasets with national mortality registries would address gaps in survival and dropout data, enhancing the completeness and utility of these datasets for epidemiological studies. Training for GPs on the importance of accurate diagnostic coding, coupled with routine data validation, would further support these efforts. 
Accurate and reliable cancer incidence data are essential for the development of effective screening programmes, the allocation of healthcare resources, and evidence-based health policy formulation. By addressing the limitations identified in this study, Irish GP datasets could align with the robust systems seen in countries such as the UK, Australia, and the Netherlands, enabling significant advancements in cancer research and public health outcomes. Future work should prioritise the implementation of these recommendations, ensuring that primary care data can fulfil its potential as a resource for cancer surveillance and health system improvement.

The Irish College of GPs Research and Quality Improvement grant aims to support projects that have the potential to inform and improve practice. These grants are funded by the Irish College of GPs Research and Education fund

Winners:     Dr Thomas Cronin, Roisin Doogue, Dr Meera Kugadas, Dr Conor Murphy

Winner No.1:       Dr Thomas Cronin, Frailty in Adults Experiencing Homelessness: establishing and delivering an intervention to reverse frailty and build resilience

Background:     Homelessness in Ireland is at the highest level recorded. The number of people experiencing homelessness increased by 33% in the year to 2023, and by 23% in the previous year, compounding annual growth for over a decade [1,2]. People who are homeless are at higher risk of frailty [3-4]. Contributing factors such as malnutrition, sarcopenia and social exclusion are more prevalent. Frailty presents at an earlier age in people experiencing homelessness [3] and may not routinely be considered or treated by clinicians despite its negative impact on health. Mortality and quality of life are significantly worse as a result of increased frailty

Methodology:     If interested and willing to consent, eligible participants will be provided a leaflet with strength exercises and a discussion on how strength exercises have been shown to delay and reverse frailty and build resilience. The information leaflet will have a photographic overview of a self-directed exercise regime, based on tested exercises and multi-disciplinary team input. They will also be provided with information on post exercise protein consumption as part of a normal balanced diet.

Results:     Our dissemination strategy aims to ensure broad recognition and utilisation of our research findings, maximising its impact within the medical community. We plan to employ a multifaceted approach that encompasses traditional academic channels, digital platforms, collaboration with stakeholders, and targeted outreach efforts.

Conclusions:   We intend to publish our research findings in high-impact peer-reviewed journals within the field of primary care and family medicine. Specifically, we aim to target journals with wide readership and relevance to our research topic, ensuring that our work reaches a diverse audience of healthcare professionals and researchers.

Winner No. 2:     Roisin Doogue, Task-shifting from GPs to general practice nurses in rural general practice, an exploration of the views of GPs and GPNs.

Background:     The demand on Irish General Practice is increasing significantly. There is both a growing and ageing population leading to a higher demand on healthcare services (Crosbie et al. 2020; Connolly and Flanagan 2024). Policy changes such as Sláintecare, are aimed at shifting healthcare delivery towards community settings, which has increased the workload and demands on general practice (Government of Ireland 2023). There is also a projected shortage of GPs, with estimates suggesting a deficit of between 1,260 and 1,660 GPs by 2028 (HSE 2015). This is already apparent in many rural communities where GPs who are retiring cannot find a replacement, and many patients are unable to register with a GP. Solutions to this workforce crisis include new approaches to training, recruitment and retention of GPs, and recruiting, upskilling and educating general practice nurses (GPNs) to help manage this workload.

Methodology:      A phenomenological approach will be used in this research. Semi-structured interviews will be conducted with participating GPs and GPNs. GPs and GPNs working in rural general practice will be invited to take part in either face-to-face or telephone interviews. GPs and GPNs will be recruited through the ULEARN GP network, Irish General Practice Nurses Education Association (IGPNEA) and the Rural, Island and Dispensing Doctor’s of Ireland network.

Results:       The data will be coded independently by the research team who will then meet to compare themes before developing and validating final themes. The results will provide insights into the key priorities for task-shifting in rural general practice and explore barriers and enablers to this process. It is important that expansion of nursing practice in this setting results from an exploration of general practice need and contributes to improved access and quality care outcomes for patients. The results will be available to GPs, GPNs, researchers, health planners and educational institutions. 

Conclusions:    Advancing nursing roles in rural general practice may contribute to the current challenges in primary care. Exploration of the challenges and facilitators to task-shifting may prevent fragmentation of services, improve access, and enable the delivery of advanced nursing care in acute and chronic illnesses, preventative care and many clinical conditions.

Winner No. 3:      Dr Meera Kugadas, Implementation of a practice policy on contraception counselling, documentation and monitoring in patients of childbearing potential on Valproate

Background:   Sodium valproate is a medication used in the treatment of bipolar affective disorder and epilepsy. It is known to cause birth defects in the developing foetus and problems with the development and learning of the child if their mother takes this medicine during pregnancy (1). Studies have shown the risk of serious developmental disorders to be up to 30-40%, and of congenital malformations to be approximately 11% (1). Because of this it is important that both patients and health care professionals (HCPs) are aware of the risk and that patients are counselled appropriately on the risk. One study from RCSI showed that while most practitioners are aware of the teratogenic risk of valproate, the experience implementing key elements of counselling and monitoring patients of childbearing potential on valproate in practice varied (2). Because of this, we felt it was important to look at a method of standardizing counselling and monitoring patients of childbearing potential on valproate at a practice level.

Aim:   To improve the quality and consistency of contraception counselling provided to patients of childbearing potential who are prescribed valproate, and reducing the risk of teratogenic effects associated with valproate exposure during pregnancy.

Conclusion:   Results will be disseminated to relevant stakeholders, and results are expected to be published in a poster, presentation, and/or journal article format.

Winner No. 4:      Conor Murphy, GP Referrals for Suspected Cancer in Ireland: Protocol for a Cross-Sectional Study (GRACCHUS)

Background:     Cancer remains a leading global cause of morbidity and mortality, responsible for 1 out of every 6 deaths worldwide. This trend is mirrored in Ireland, where cancer poses a significant public health challenge, with approximately 43,000 new cases diagnosed annually, leading to over 9,000 deaths—accounting for nearly one-third of all mortalities. Lung cancer is the leading cause of cancer-related deaths in Ireland, responsible for 20% of cancer mortality, followed by breast cancer in women and prostate cancer in men, with colorectal cancer affecting both genders. Cancer survival is influenced by a range of factors, including tumour biology, patient comorbidities, and access to effective treatments, but early diagnosis remains the most important predictor of survival. In Ireland, early diagnosis rates vary significantly between cancer types, with only 33% of lung cancers diagnosed at an early stage, compared to 79% of breast cancers. Five-year survival rates are similarly stark, with lung cancer survival at just 24%, compared to 66% for colorectal cancer and 88% for breast cancer. This highlights the critical need for earlier diagnosis to improve survival rates.

Methodology:  This is a retrospective study that will analyse electronic health record (EHR) data from a network of general practices in Ireland. Specifically, we will examine electronic RAC referrals for breast, prostate, lung cancer, and melanoma, by GPs in Ireland from 2013-2023. The study will be conducted in two phases.
The first phase will use a data collection tool and has three steps: 1) a descriptive analysis of utilisation of RAC pathways over time and how this varies by GP practice; 2) a series of descriptive analyses, which, for each referral type, examines how the prevalence or degree of a referral characteristic varies over time, and 3) a series of regression analyses which seek to explain the variation in the number of referrals (of a particular type) from a GP practice varies as a function of GP practice characteristics, patients characteristics and time. 
The second phase involves: 1) a descriptive analysis of outcomes of RAC referrals over time, and 2) an exploration and analysis of characteristics predictive of cancer diagnosis and outcomes over time. We will adhere to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) Checklist for cross-sectional studies. 

Results:   Our finding will be shared with the National Cancer Control Programme (NCCP) through policy briefs and targeted reports. These documents will summarise key results and offer practical recommendations for optimising RAC use across Ireland. To engage the public, we will work with patient advocacy groups, such as the Irish Cancer Society, to ensure that lay summaries of the research are accessible to non-specialists. This will help raise awareness about cancer referral processes and promote the importance of early diagnosis, ultimately contributing to improving cancer outcomes in Ireland.

Conclusions:    Dissemination of this work is a priority. In the first instance, we intend to submit the study protocol for publication. To ensure that study findings reach a wide audience and have a meaningful impact, we have developed a robust dissemination plan that targets key stakeholders, including healthcare professionals, academic researchers, policymakers, and the public.

These grants are intended to support research, quality improvement, and innovation in undergraduate or postgraduate education in general practice and are supported through the Irish College of GPs’ Research and Education fund.

Winners:     Dr Ben Jacobs and Dr Gary Foley

Winner No. 1:       Dr Ben Jacobs, Protocol to develop a specialised curriculum in primary care cancer research – the PRiCAN Scholars Network in an Irish medical school.

Background:   General practice is fundamental within the broader network of health care services known as “primary care”, which refers to all health care services located within the patient’s community. This includes General practitioners (GPs), GP nurses, Public Health Nurses (PHNs), community-based pharmacists, dental practitioners, physiotherapists, occupational therapists, psychotherapists, and medical social workers. In many healthcare systems across the world—such as those in Ireland, the UK, the Netherlands, Denmark, Australia, and New Zealand—primary care is the first point of contact with the health system.

Methodology:  This protocol for developing a curriculum in primary care cancer research for the PRiCAN Scholars Network is based on Kern’s six-step approach to curriculum development and is reported according to the “DoCTRINE Guidelines” for innovation in medical education (23). Kern’s model offers a structured, methodical framework that is well-suited for the development of a medical curriculum (22). Following Kern’s approach, we will begin with problem identification and general needs assessment, including a wide-ranging stakeholder engagement process crucial for understanding the specific educational requirements in primary care cancer research. The subsequent steps involve a targeted needs assessment of learners, setting specific goals and objectives, selecting appropriate educational strategies, implementing these strategies, and finally evaluating and refining the curriculum.

Results:    Various evaluation and feedback mechanisms will be established to comprehensively evaluate the impact of the curriculum within the PRiCAN Scholars Network and develop a robust feedback system to continuously refine the programme. These evaluation tools will be tailored to the small cohort size and the specialised nature of the curriculum. This may include pre- and post-curriculum assessments to gauge knowledge and skills acquisition, regular reflective journals or portfolios to track progress, and specific project evaluations to assess research competencies. We will implement surveys and feedback forms that are designed to capture detailed qualitative and quantitative feedback from both students and faculty. Utilize online platforms for continuous and convenient feedback collection. This can include discussion forums or digital suggestion boxes where students can share thoughts and feedback asynchronously. We will also schedule regular feedback sessions, including one-on-one meetings and small group discussions, to gather in-depth feedback from the students. These sessions will allow for a more nuanced understanding of the students' experiences and challenges.

Conclusion:      Disseminating the findings and progress of the PRiCAN Scholars Network will be integral to the initiative’s success and sustainability. The dissemination strategy is designed to engage multiple stakeholders, ensuring that students, faculty, healthcare professionals, and the broader academic community can benefit from the outcomes of this project. We will adopt a multiphased, multimodal dissemination approach that includes both formal and informal channels of communication, ensuring a broad and sustained impact.

Winner No. 2:   Dr Gary Foley, Simulation Training for Irish GP Trainees

Background:    I have conducted a pilot half day simulation training for 4th year GP trainees on the TCD/ICGP training scheme in collaboration with Tallaght University Hospital (TUH).  Following focused feedback from the GP trainees that attended the simulation, and feedback from the wider GP community after presenting the results at WONCA I have created a full day simulation programme for GP trainees. This includes a morning session that focuses on theory for emergencies in practice, but more importantly teaching on equipment (nebuliser, AED) and medicine use (nebules and benzylpenicillin). There will also be communication training for when speaking to patients, parents and the ambulance service. The afternoon session will then focus on 4 different scenarios, meningococcal sepsis in an infant, acute asthma exacerbation in a child, anaphylaxis in a teenager and cardiac arrest in an adult. Emergencies in general practice are very different than when they occur in secondary care, this course aims to provide GP trainees with the fundamental principles who of how to manage these scenarios safely from a clinical perspective, but also teach them about the human factors, situational awareness and the nuances of emergencies when they happen in the community setting. With the ICGP in the early days of establishing a formalised simulation group, this day will provide the baseline data to further forward this initiative and form an established standardised simulation programme that can used in other schemes.

Aims & Objectives:      
1.    Improve crisis management for GP trainees when in independent practice
2.    Improve human factors and situation awareness for GP trainees during emergencies in GP
3.    Provide focused teaching on equipment and medicine use for the following emergencies, sepsis in an infant, acute asthma exacerbation in a child, anaphylaxis and adult cardiac arrest
4.    Develop an appropriate simulation program that can be used across other GP training schemes.

Conclusion:    The pilot project has been presented at the Nation Sepsis Summit held in Dublin, September 2024, winning best oral and poster presentation for our sim scenario based on “Sepsis in the infant”. It was also presented as an oral presentation at WONCA 2024, where discussions are taking place to create a Human Factors committee within the WONCA organisation, with a possible Irish simulation lead. If successful, the entire journey from pilot to full day immersion will be written up for a peer review journal focused on medical education.

The Irish College of GPs is this year delighted to include a grant to support research and scholarship in rural general practice. 

Winner:   Yogesh Acharya, A scoping review of current strategies in recruiting and retaining general practice doctors in rural practice in Ireland

Background: The General Practitioner (GP) shortage is growing internationally, and Ireland is no exception, especially in rural practice. Although a combination of factors contributes to this, rural GP practices have always faced challenges in attracting and retaining healthcare professionals, which have worsened in recent years. 

The rural GP shortage in Ireland is a multifaceted problem driven by demographic changes, financial constraints, professional isolation, and a challenging work environment. Despite rural practice being rewarding in terms of patient-public relationship and the comprehensive nature of the consultation, Irish rural practice is struggling to attract a new workforce and replace retiring GPs. Addressing this issue will require policy changes, financial incentives, and strategic planning to ensure that rural communities can access the necessary healthcare. Without significant intervention, the shortage of GPs in rural Ireland could worsen, leading to even more substantial health inequalities between urban and rural populations.

Study Design: This scoping review will be conducted as per the ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR)’ 2018 guidelines, which will contain 20 essential and 2 optional items for reporting. 

Conclusion: We plan to disseminate information/results to the public through newsletters and social media both during and after the project's conclusion to create project awareness. The information could also be spread through reports and publications, such as journal articles in a reputable journal in the field of general practice. We also aim to present the outcomes at the scientific conference to disseminate them to a greater audience.