Fergus Desmond O'Kelly

A new short form individual quality of life measure (SEIQoL-DW): application in a cohort of individuals with HIV/AIDS

Quality of life is an increasingly important outcome measure in medicine and health care. Many measures of quality of life present patients with predetermined lists of questions that may or may not be relevant to the individual patient. This paper describes a brief measure, the SEIQoL-DW, which is derived from the schedule for evaluation of individual quality of life (SEIQoL). The measure allows respondents to nominate the areas of life which are most important, rate their level of functioning or satisfaction with each, and indicate the relative importance of each to their overall quality of life. Given its practicality and brevity, the measure should prove particularly useful in clinical situations where patient generated data on quality of life is important. This article describes the first clinical application of the measure, assessing the quality of life of a cohort of patients with HIV/AIDS managed in general practice.

Hepatitis C infection among drug users attending general practice

Background The prevalence of hepatitis C (HCV) infection among injection drug users is high and addiction-related care is increasingly being provided by GPs in Ireland.Aims To determine the prevalence and associated factors of HCV infection among injecting drug users attending general practice.Methods The records of 571 patients attending 42 general practices in the Eastern Regional Health Authority (ERHA) area for methadone maintenance treatment were reviewed.Results The HCV status was recorded in 380 cases (67%). Of these, 193 had a test performed by their GP, 74 had been tested by another service and 113 had no evidence of being tested, but HCV status was recorded based on information provided by the patient himself. A total of 276 cases were identified as being HCV positive (prevalence 73%), with no difference in prevalence between the three sources of information (p=0.12). A history of injecting drug use was the major determinant of testing for HCV.Conclusions While a large proportion of drug users attending GPs for methadone maintenance treatment are known to be HCV positive, a considerable number have not been tested. Barriers to testing need to be explored to facilitate comprehensive screening.

Seventeen year mortality in a cohort of patients attending opioid agonist treatment in Ireland. Commentary on ‘methadone-maintained patients in primary care have higher rates of chronic disease’ (O’Toole et al., European Journal of General Practice 2014;20:275–80)

The paper by O’Toole et al.,[1] provides a real-world example of the high morbidity among people attending primary care for opioid agonist treatment (OAT). We wish to highlight the accompanying high mortality rate in this population. OAT has substantially changed the course of the drug use epidemic.[2–4] Although noted to reduce morbidity and mortality of patients attending specialized treatment clinics, limited longitudinal information is available on cohorts of such patients. To explore the mortality rates, we conducted a prospective observational study through the Registrar of Births, Deaths and Marriages in Ireland and the Central Treatment List (CTL), which followed a cohort of patients (n1⁄4 98) recruited for a methadone treatment study in 1996. All patients attended specialist services for OAT and were randomly selected from those who did meet clinical criteria for transfer to general practice for continuing care.[5] Research Ethics Committee of the Irish College of General Practitioners approved the study. At baseline, the cohort was predominantly male (77%), with a mean age of 33 years (SD: 5.7) and a median school-leaving age of 15 years (range: 6–21). The average age of first heroin use was 17 years (SD 3.2), with a mean age of a first injection at 19 (SD: 4.0). Fifty (51%) participants had been in drug treatment on four or more occasions. The cohort had a mean of 5.1 treatments, including detoxification programmes, abstinence-oriented programmes, narcotics anonymous and previously attempted, unsuccessful methadone maintenance programmes. The average time spent in their current methadone programme was 3.3 years (SD: 1.5), mean dose 60.8 mg (SD: 20.2). At follow-up in 2013, 27 (27.6%) of the 98 participants had died in Ireland and had relevant entries in the Register of Deaths, 19 (19.4%) were currently in OAT and the status of the remaining 52 (53%) was ‘alive,’ as per the Irish death registry. The 52 patients ‘alive’ had left the (CTL) register, but no further CTL information was available on their status. The death certificates recorded multiple causes for most patients who had died; only six had a single cause. Drug toxicity and/or overdose were the most commonly listed causes of death (see Figure 1). Our results are biased by the small sample size, nonprobabilistic sampling framework, study location and