The Irish College of GPs’ Research, Policy and Information Department are delighted to announce the winners of the 2024 Research Bursaries and Grants.
Best Published Paper Award
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.
Dr Jim Slein Research Bursary in Substance Misuse or Health Inequalities/Inequity
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.
Maria Kidney Cancer Research Bursary 2024
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.
Research and Quality Improvement in General Practice Grant 2024
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
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.
Winner No. 3: Dr Meera Kugadas, Implementation of a practice policy on contraception counselling, documentation and monitoring in patients of childbearing potential on Valproate
Winner No. 4: Conor Murphy, GP Referrals for Suspected Cancer in Ireland: Protocol for a Cross-Sectional Study (GRACCHUS)
Research, Improvement & Innovation in Education Grant 2024
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.
Winner No. 2: Dr Gary Foley, Simulation Training for Irish GP Trainees
Rural General Practice Research and Innovation Grant 2024
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