Journal articles on the topic 'Irish primary care'
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Payne, D. "Irish government to revamp primary care." BMJ 323, no. 7325 (December 8, 2001): 1323. http://dx.doi.org/10.1136/bmj.323.7325.1323d.
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Varzgaliene, Laima, Adrienne Heerey, Charlie Cox, Tomas McGuinness, Genevieve McGuire, Jochen WL Cals, Eamonn O'Shea, and Maureen Kelly. "Point-of-care testing in primary care: needs and attitudes of Irish GPs." BJGP Open 1, no. 4 (November 14, 2017): bjgpopen17X101229. http://dx.doi.org/10.3399/bjgpopen17x101229.
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BackgroundStudies outside of Ireland have demonstrated that GPs believe point-of-care tests (POCTs) are useful and would like to have more of these tests available in daily practice. This study establishes the views of Irish GPs on this topic for the first time and also explores GPs’ perceptions of barriers to having POCT devices in primary care.AimTo establish Irish GPs' perception of the benefits and barriers to POCT use. Design & settingA quantitative cross-sectional observational survey of Irish GPs attending continuing medical educational meetings (CME) in November 2015. MethodData was collected using an anonymous and confidential questionnaire. ResultsOut of a total of 250, 70% of GPs (n = 143) completed the questionnaire. Of these, 92% (n = 132) indicated they would like to have access to POCTs. Guidance in decision making 43% (n = 61), reduced referral rates 29% (n = 42), and diagnosis assistance 13% (n = 18) were the main benefits expressed. Cost 45% (n = 64) and time 34% (n = 48) were the main barriers identified.ConclusionThis study proved that Irish GPs would also like increased access to POCTs. They feel that these tests would benefit patient care. Unsurprisingly, cost and time were two barriers identified to using POCT devices, which supports outcomes from studies. Radical changes would be required in primary care to facilitate implementation of POCTs and attention must be paid to how the costs of POCTs will be funded. This study may act as a prompt for future international research to further explore this area.
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Chotirmall, Sanjay Haresh, Gillian Lee, Mary Cosgrave, Ciaran Donegan, and Allan Moore. "Optimisation of dementia management in Irish primary care." International Journal of Geriatric Psychiatry 23, no. 8 (August 2008): 880. http://dx.doi.org/10.1002/gps.2049.
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Mannion, Mairead, Siobhan Meehan, Phil Shankey, and Velma Harkins. "An Irish experience of insulin initiation in primary care." Primary Care Diabetes 1, no. 4 (December 2007): 222–23. http://dx.doi.org/10.1016/j.pcd.2007.10.011.
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Burke, Triona, and Catherine O’ Neill. "Community nurses working in piloted primary care teams: Irish Republic." British Journal of Community Nursing 15, no. 8 (August 2010): 398–404. http://dx.doi.org/10.12968/bjcn.2010.15.8.74867.
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Wright, Brenda, and Vincent Russell. "Integrating mental health and primary care services: a challenge for psychiatric training in Ireland." Irish Journal of Psychological Medicine 24, no. 2 (June 2007): 71–74. http://dx.doi.org/10.1017/s0790966700010272.
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AbstractA Vision for Change, the report of the Expert Group on Mental Health Policy asserts as one of its key recommendations the enhancement and formalisation of links between specialist mental health services and primary care. As part of a higher training post in psychiatry a consultation-liaison service was provided by a senior registrar in three rural general practices. This paper describes the experience of this initiative from an educational perspective and discusses the broader implications for Irish psychiatric training. With an emerging emphasis on collaborative mental health care there needs to be an appreciation of the specific set of skills that psychiatry trainees must learn in order to be effective in primary care settings. The tandem development of the appropriate services and training in an Irish context will require dedicated funding and resources.
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Ryan, CristÃn, Denis O'Mahony, Julia Kennedy, Peter Weedle, and Stephen Byrne. "Potentially inappropriate prescribing in an Irish elderly population in primary care." British Journal of Clinical Pharmacology 68, no. 6 (December 2009): 936–47. http://dx.doi.org/10.1111/j.1365-2125.2009.03531.x.
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McMahon, A., M. Hodgins, and C. C. Kelleher. "Feasibility of a men’s health promotion programme in Irish primary care." Irish Journal of Medical Science 171, no. 1 (January 2002): 20–23. http://dx.doi.org/10.1007/bf03168935.
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Buckley, Brendan, Eamonn Shanahan, Niall Colwell, Eva Turgonyi, Peter Bramlage, and Ivan J. Perry. "Blood Pressure Control in Hypertensive Patients in Irish Primary Care Practices." Journal of Clinical Hypertension 11, no. 8 (August 2009): 432–40. http://dx.doi.org/10.1111/j.1751-7176.2009.00151.x.
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Cahill, Suzanne, Maeve Clark, Cathal Walsh, Henry O'Connell, and Brian Lawlor. "Dementia in primary care: the first survey of Irish general practitioners." International Journal of Geriatric Psychiatry 21, no. 4 (2006): 319–24. http://dx.doi.org/10.1002/gps.1464.
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Byrne, Catherine J., Caitriona Cahir, Carmel Curran, and Kathleen Bennett. "High‐risk prescribing in an Irish primary care population: trends and variation." British Journal of Clinical Pharmacology 83, no. 12 (August 16, 2017): 2821–30. http://dx.doi.org/10.1111/bcp.13373.
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Barrett, Emer M., Juliette Hussey, and Catherine D. Darker. "Feasibility of a physical activity pathway for Irish primary care physiotherapy services." Physiotherapy 103, no. 1 (March 2017): 106–12. http://dx.doi.org/10.1016/j.physio.2016.02.001.
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Curran, Ciara, Sinead Lydon, Maureen Kelly, Andrew Murphy, Caoimhe Madden, and Paul O’Connor. "Safety Climate measurement in Ireland: a comparison with England and Scotland." British Journal of General Practice 68, suppl 1 (June 2018): bjgp18X696869. http://dx.doi.org/10.3399/bjgp18x696869.
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BackgroundSafety climate (SC) measurement is a key component of quality and safety initiatives in healthcare settings.AimWe aimed to measure SC in Irish primary care, examine whether perceptions of safety varied according to respondent characteristics, and compare responses from Irish sample to published data from England and Scotland.MethodThe PC-SafeQuest Survey was administered to all practice staff within general practices in Ireland. This survey consists of 30 items divided into five safety subscales (workload, communication, leadership, teamwork, and safety systems). Multiple regression analysis was used to identify demographic predictor variables of perceived safety. The effect size of the difference between the Irish sample and previously published English and Scottish samples was calculated for each PC-SafeQuest subscale, and the overall SC score.ResultsResponse rate was 38.5% across participating practices. Workload had the lowest overall mean score for Irish responders. It was only possible to identify variables predictive of the workload subscale. GP Principals had a significantly more negative perception of the impact of workload on patient safety than administrative staff. Comparisons across the Irish, English and Scottish samples identified a medium size effect difference in Workload. Scottish responders perceived workload to have less of a negative impact on safety than Irish or English responders (d=0.602, 0.67 respectively).ConclusionIrish safety climate data are similar to those of England and Scotland – all emphasise the negative impact of workload. These data highlight the importance of considering workload and its impact on patient safety in primary care internationally.
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Nachev, Dr Anatoli. "Assessment of Healthcare Services using Models Based on Support Vector Machines." International Journal of Engineering and Advanced Technology 12, no. 2 (December 30, 2022): 44–49. http://dx.doi.org/10.35940/ijeat.b3905.1212222.
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This article presents a case study that provides assessment of access to the Irish healthcare system and the services it provides. We explore factors related to unmet heath care needs using recent survey data. Our approach is based on using support vector machines for building predictive models that analyse and measure those factors. The proposed methodology is novel for the domain. Following the behavioural model for access to medical care, we group factors into three categories: predisposing, enabling, and needs, and analyse each group. Experimental results show and measure the primary causes of imbalances and inequalities of treatment in the Irish healthcare system today.
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Hughes, Martina, Michael Byrne, and Joy Synnott. "Prevalence of psychological distress in general practitioner adult attendees." Clinical Psychology Forum 1, no. 206 (February 2010): 33–38. http://dx.doi.org/10.53841/bpscpf.2010.1.206.33.
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One in three Irish GP practice adult attendees were found to have varying degrees of psychological distress. That 89 per cent were not receiving treatment for their mental health problems also highlights the need for improved primary care mental health services.
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Keane, S., M. Clarke, D. McGrath, N. Farrelly, and S. MacHale. "Eating Disorder Examination Questionnaire (EDE-Q): norms for female university students attending a university primary health care service in Ireland." Irish Journal of Psychological Medicine 34, no. 1 (August 10, 2015): 7–11. http://dx.doi.org/10.1017/ipm.2015.35.
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ObjectivesThe Eating Disorder Examination Questionnaire (EDE-Q) is a self-report questionnaire that is used to identify probable cases of eating disorders. Norms are needed for interpretation of scores. The aim of this study is to establish norms for the EDE-Q among female university students attending a university primary health care service in Ireland and to present prevalence of key eating disorder behaviours.MethodsThe EDE-Q was administered to a consecutive sample of 200 female students aged 18–30 years attending a university primary health care service.ResultsThe mean global EDE-Q score was 1.51 (s.d.=1.28). There was a positive association between body mass index and the global EDE-Q score; 5.8% of the sample scored in the clinically significant range on the global EDE-Q score.ConclusionsThis study presents normative EDE-Q data for an Irish female university sample. These norms may inform clinicians and/or researchers in the evaluation of EDE-Q scores in Irish female university students
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O'Hara, R., N. Cavanagh, M. Cassidy, and M. Cullina. "The role of transferrin saturation as a screening test for hereditary haemochromatosis in an Irish population seeking medical care." Annals of Clinical Biochemistry: International Journal of Laboratory Medicine 40, no. 2 (March 1, 2003): 169–74. http://dx.doi.org/10.1258/000456303763046111.
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Background: Genetic studies have indicated a high prevalence of mutations for hereditary haemochromatosis (HH) in Irish populations. Given the high cost of genetic screening and the ethical implications thereof, we assessed the role of transferrin saturation (TS) as a primary screening test for HH in an Irish population seeking medical care. Methods: TS and ferritin were measured on 330 consecutive blood specimens received in the laboratory for routine screening. Patients with TS > 45% were genetically screened for the C282Y and H63D mutations. Results: Twenty-six patients had TS values > 45%. Of these, specimens were available for genetic screening on 20 patients. Three previously undiagnosed patients were found to be C282Y homozygotes and one a compound heterozygote (C282Y/H63D). The prevalence of C282Y homozygotes was 0·93%, which is similar to the reported prevalence found in Irish populations by genetic screening. Conclusion: Given the number of positive findings in this study, we conclude that, in the absence of a national programme, TS could be used as part of a health-screening panel in the Irish setting. Patients expressing iron overload would be detected before organ damage occurred, leading to less severe clinical disease and better patient prognosis.
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Cadogan, Sharon Louise. "Testing times ahead? An exploration of laboratory use in Primary Care." Boolean: Snapshots of Doctoral Research at University College Cork, no. 2015 (January 1, 2015): 37–41. http://dx.doi.org/10.33178/boolean.2015.8.
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Healthcare budgets worldwide are facing increasing pressure to reduce costs and improve efficiency, while maintaining quality. Laboratory testing has not escaped this pressure. A major component of healthcare budgets, the demand for testing, is increasing at a faster rate than medical activity. And, while laboratory testing is undoubtedly a valuable first step in any diagnosis, the sheer volume of testing may be conducive to waste. Laboratory services cost the Health Service Executive (HSE) approximately €469 million each year. That is over 10 times the budget of a small hospital for a whole year. In terms of volume, there are over 76 million tests performed annually in Irish laboratories. These tests are made up of both urgent and non-urgent tests and originate from various sources including A&E, inpatient, outpatient and primary care, with approximately half from the latter. Laboratory testing is an integral part of day-to-day primary care practice, with approximately ...
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Curran, Ciara, Sinéad Lydon, Maureen E. Kelly, Andrew W. Murphy, Caoimhe Madden, and Paul O’Connor. "Perceived safety climate in Irish primary care settings—a comparison with Scotland and England." European Journal of General Practice 24, no. 1 (January 1, 2018): 252–57. http://dx.doi.org/10.1080/13814788.2018.1524002.
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Breen, Claire. "The Right to Education of Persons with Disabilities: Disabled in Interpretation and Application." Netherlands Quarterly of Human Rights 21, no. 1 (March 2003): 7–37. http://dx.doi.org/10.1177/016934410302100102.
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In July 2001, the Irish Supreme Court decided that the right to a free primary education as contained in the Irish Constitution could not be extended to a 23-year-old autistic man, Jamie Sinnott. Much of the Supreme Court judgment is an exercise in statutory interpretation. The Court considered the meaning of both ‘primary’ and ‘education’ in the context in which it appeared in the Constitution – that of the rights of parents regarding the education of their children. Whilst it was happy to find that the type of on-going care and support required by Jamie Sinnott could be classified as education, nevertheless, the majority of the Irish Supreme Court limited the meaning of ‘primary’ education to that required by children and thereby excluding the care and support, which it recognised as ‘education’, required by profoundly handicapped adults. The impact of the Court's exercise in statutory interpretation is that, in Ireland, the right to free primary education is to be defined with regard to age and not needs. This paper examines the decision of the Irish Supreme Court against the background of the general right to education as provided for in international human rights law in an effort to ascertain the extent to which the Supreme Court decision, as it reflects Irish domestic law regarding the provision of free primary education, correlates with Ireland's international human rights obligations. In so doing, it will reveal the limited extent to which the rights of disabled person have been ‘integrated’ into the general right to education. To that end, Part 1 of this article will focus upon the Sinnott Case as it provides an effective summary of domestic law regarding primary education as contained in the Constitution, statute and case law as well as being the benchmark for the rights of disabled persons to education in Ireland. Part 2 will consider the provisions of international human rights law regarding that pertain to the rights of disabled persons. Part 3 will consider the right to education as provided for in international human rights treaties by comparing the provisions regarding the general right to education, provisions regarding primary education, and provisions regarding persons with disabilities. Part 4 concludes this article by drawing together the right to education and the rights of disabled individuals in an analysis of language and interpretation in an effort to determine the extent to which the rights of individuals, such as Jamie Sinnott are protected by both national and international law.
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Kierans, Joanne, and Michael Byrne. "A potential model for primary care mental health services in Ireland." Irish Journal of Psychological Medicine 27, no. 3 (September 2010): 152–56. http://dx.doi.org/10.1017/s0790966700001361.
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AbstractObjectives:A high demand for the inclusion of psychosocial interventions for primary care mental health presentations has become more apparent in recent years. Current policies have proposed models of care highlighting principles required for a quality service. However, implementation has been slow to date. This article aims to inform the current debate relating to primary care service delivery models for mental health presentations and to contribute towards future planning initiatives.Method:A narrative review of a range of policies and selected articles relevant to primary care mental health in an Irish context.Results:The search produced four distinct themes: current service provision in Ireland; stakeholders' views; psychological care options; and potential service structures. Thereafter, a potential service delivery model is proposed. This formulated model employs a combination of elements from the reviewed themes to provide a clinically- and cost-effective, equitable and accessible service driven by service user and carer input.Conclusions:Although this review was selective in nature, the proposed potential model can complement future research agendas for more favourable primary care practice in Ireland. Recommendations are made for the planning of services including policy implementation procedures, training and communication.
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Mishtal, Joanna, Karli Reeves, Dyuti Chakravarty, Lorraine Grimes, Bianca Stifani, Wendy Chavkin, Deirdre Duffy, et al. "Abortion policy implementation in Ireland: Lessons from the community model of care." PLOS ONE 17, no. 5 (May 9, 2022): e0264494. http://dx.doi.org/10.1371/journal.pone.0264494.
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Background In 2018, the right to lawful abortion in the Republic of Ireland significantly expanded, and service provision commenced on 1 January, 2019. Community provision of early medical abortion to 9 weeks plus 6 days gestation delivered by General Practitioners constitutes the backbone of the Irish abortion policy implementation. We conducted a study in 2020–2021 to examine the barriers and facilitators of the Irish abortion policy implementation. Methods We collected data using qualitative in-depth interviews (IDIs) which were conducted in-person or remotely. We coded and analysed interview transcripts following the grounded theory approach. Results We collected 108 IDIs in Ireland from May 2020 to March 2021. This article draws on 79 IDIs with three participant samples directly relevant to the community model of care: (a) 27 key informants involved in the abortion policy development and implementation representing government healthcare administration, medical professionals, and advocacy organisations, (b) 22 healthcare providers involved in abortion provision in community settings, and (c) 30 service users who sought abortion services in 2020. Facilitators of community-based abortion provision have been: a collaborative approach between the Irish government and the medical community to develop the model of care, and strong support systems for providers. The MyOptions helpline for service users is a successful national referral model. The main barriers to provision are the mandatory 3-day wait, unclear or slow referral pathways from primary to hospital care, barriers for migrants, and a shortage and incomplete geographic distribution of providers, especially in rural areas. Conclusions We conclude that access to abortion care in Ireland has been greatly expanded since the policy implementation in 2019. The community delivery of care and the national helpline constitute key features of the Irish abortion policy implementation that could be duplicated in other contexts and countries. Several challenges to full abortion policy implementation remain.
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Russell, Vincent, Linda O’Rourke, and Kieran C. Murphy. "Undergraduate learning in psychiatry: can we prepare our future medical graduates better?" Irish Journal of Psychological Medicine 37, no. 2 (April 30, 2020): 73–76. http://dx.doi.org/10.1017/ipm.2020.16.
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Irish medical schools attract an increasingly diverse student population and produce graduates who will practise in many parts of the world. There are particular implications in this for the planning and delivery of the undergraduate psychiatry curriculum. In all countries, mental health services struggle for equitable resourcing, and mental health care within general medical services remains relatively neglected. The traditional undergraduate psychiatry offering has been justifiably criticised for being excessively oriented towards secondary care when the vast majority of medical graduates will pursue careers in primary care or in specialties other than psychiatry. Recently published articles in the Irish Journal of Psychological Medicine address the current challenges and opportunities in providing an undergraduate experience that better prepares students for the mental health aspects of medical practice in a global context. We summarise and discuss these contributions and the recent Royal College of Psychiatrists publication Choose Psychiatry: Guidance for Medical Schools.
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McDarby, Geraldine, and Breda Smyth. "Identifying priorities for primary care investment in Ireland through a population-based analysis of avoidable hospital admissions for ambulatory care sensitive conditions (ACSC)." BMJ Open 9, no. 11 (November 2019): e028744. http://dx.doi.org/10.1136/bmjopen-2018-028744.
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BackgroundIn 2016, the Irish acute hospital system operated well above internationally recommended occupancy targets. Investment in primary care can prevent hospital admissions of ambulatory care sensitive conditions (ACSCs).ObjectiveTo measure the impact of ACSCs on acute hospital capacity in the Irish public system and identify specific care areas for enhanced primary care provision.DesignNational Hospital In-patient Enquiry System data were used to calculate 2011–2016 standardised bed day rates for selected ACSC conditions. A prioritisation exercise was undertaken to identify the most significant contributors to bed days within our hospital system. Poisson regression was used to determine change over time using incidence rate ratios (IRR).ResultsIn 2016 ACSCs accounted for almost 20% of acute public hospital beds (n=871 328 bed days) with adults over 65 representing 69.1% (n=602 392) of these. Vaccine preventable conditions represented 39.1% of ACSCs. Influenza and pneumonia were responsible for 99.8% of these, increasing by 8.2% (IRR: 1.02; 95% CI 1.02 to 1.03) from 2011 to 2016. Pyelonephritis represented 47.6% of acute ACSC bed days, increasing by 46.5% (IRR: 1.07; 95% CI 1.06 to 1.08) over the 5 years examined.ConclusionsPrioritisation for targeted investment in integrated care programmes is enabled through analysis of ACSC’s in terms of acute hospital bed days. This analysis demonstrates that primary care investment in integrated care programmes for respiratory ACSC’s from prevention to rehabilitation at scale could assist with bed capacity in acute hospitals in Ireland. In adults 65 years and over, including chronic obstructive pulmonary disease patients, the current analysis supports targeting community based pulmonary rehabilitation including pneumococcal and influenza vaccination programmes in order to reduce the burden of infection and hospitalisations. Further exploration of pyelonephritis is necessary in order to ascertain patient profile and appropriateness of admissions.
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Loftus Moran, Orla, Mary Casey, Laserina O'Connor, and Walter Cullen. "Quality care metrics for nurses working in general practice, mapping the evidence: a scoping review protocol." HRB Open Research 5 (January 21, 2022): 10. http://dx.doi.org/10.12688/hrbopenres.13483.1.
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Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands over the past three decades. However, as nursing care in general practice advances at pace, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to carefully assess the role and facilitate development of services are required. Nursing quality care metrics (QCM) are an established mechanism which measure nursing care process, evaluate quality, and impact of care, and inform service development. The use of nursing QCM has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development of QCM within Irish GPN settings. Aim: To explore and map the literature regarding the use, application, and impact of nursing quality care metrics within a general practice, primary care setting. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O’Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCM which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about QCM, their use in general practice or primary care settings, and enrich understanding of their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary care in Ireland.
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Wren, Maev-Ann, and Sheelah Connolly. "A European late starter: lessons from the history of reform in Irish health care." Health Economics, Policy and Law 14, no. 03 (December 26, 2017): 355–73. http://dx.doi.org/10.1017/s1744133117000275.
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AbstractThe Irish health care system is unusual within Europe in not providing universal, equitable access to either primary or acute hospital care. The majority of the population pays out-of-pocket fees to access primary health care. Due to long waits for public hospital care, many purchase private health insurance, which facilitates faster access to public and private hospital services. The system has been the subject of much criticism and repeated reform attempts. Proposals in 2011 to develop a universal health care system, funded by Universal Health Insurance, were abandoned in 2015 largely due to cost concerns. Despite this experience, there remains strong political support for developing a universal health care system. By applying an historical institutionalist approach, the paper develops an understanding of why Ireland has been a European outlier. The aim of the paper is to identify and discuss issues that may arise in introducing a universal healthcare system to Ireland informed by an understanding of previous unsuccessful reform proposals. Challenges in system design faced by a late-starter country like Ireland, including overcoming stakeholder resistance, achieving clarity in the definition of universality and avoiding barriers to access, may be shared by countries whose universal systems have been compromised in the period of austerity.
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O'Neill, Kate N., Sheena M. McHugh, and Patricia M. Kearney. "Cycle of Care for people with diabetes: an equitable initiative?" HRB Open Research 2 (January 10, 2019): 3. http://dx.doi.org/10.12688/hrbopenres.12890.1.
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Background: Structured management of uncomplicated diabetes in primary care constitutes good quality diabetes care. The cycle of care is a national initiative that financially remunerates general practitioners to provide structured diabetes care for people with type 2 diabetes. However, eligibility for the cycle of care is limited to those with means-tested public health insurance. We investigate the national coverage of the cycle of care and describe the socio-demographic and clinical profile of those eligible and non-eligible for the initiative. Methods: A cross-sectional analysis of The Irish LongituDinal study on Ageing (TILDA) Wave 1 was conducted. Type 2 diabetes was defined using self-reported doctor-diagnosis of diabetes, age at diagnosis and use of insulin/oral hypoglycaemic agents. Findings were applied to the 2016 Irish census figures to estimate the absolute population eligible and non-eligible for the cycle of care. Pearson’s chi-square test was used to compare the profiles of those eligible and non-eligible for the initiative. Results: Of the 8,107 TILDA participants, 609 had type 2 diabetes (7.9% [95%CI: 7.3%, 8.5%]) and 31.6% (95%CI: 27.8, 35.6) of these were not eligible for the cycle of care. Applying these estimates to census data, an estimated 36,567 (95%CI: 32,170, 41,196) individuals aged ≥50 years with type 2 diabetes in Ireland are not eligible for the initiative. Those not eligible were less likely to be on insulin and more likely to be managing their diabetes without medication. Conclusions: Nearly one-third of people with type 2 diabetes aged ≥50 years are not eligible for the cycle of care and appear to fit the outlined criteria for uncomplicated diabetes which can be appropriately managed in primary care. Financial barriers to managing uncomplicated diabetes in primary care exist. It is essential that the cycle of care is extended to all those likely to benefit from regular structured diabetes management.
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Tierney, Edel, Rachel McEvoy, Ailish Hannigan, and Anne E. MacFarlane. "Implementing community participation via interdisciplinary teams in primary care: An Irish case study in practice." Health Expectations 21, no. 6 (May 16, 2018): 990–1001. http://dx.doi.org/10.1111/hex.12692.
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O’Sullivan, M., W. Cullen, and A. MacFarlane. "Primary care teams in Ireland: a qualitative mapping review of Irish grey and published literature." Irish Journal of Medical Science (1971 -) 184, no. 1 (May 18, 2014): 69–73. http://dx.doi.org/10.1007/s11845-014-1128-x.
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Tracey, Marsha, Emmy Racine, Fiona Riordan, Sheena M. McHugh, and Patricia M. Kearney. "Understanding the uptake of a national retinopathy screening programme: An audit of patients with diabetes in two large primary care centres." HRB Open Research 2 (July 26, 2019): 17. http://dx.doi.org/10.12688/hrbopenres.12926.1.
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Background: Diabetic retinopathy (DR) affects 8.2% of the Irish population with type 2 diabetes over 50 years and is one of the leading causes of blindness among working-age adults. Regular diabetic retinopathy screening (DRS) can reduce the risk of sight loss. In 2013, the new national screening programme (RetinaScreen) was introduced in Ireland. Maximising DRS uptake (consent to participate in the programme and attendance once invited) is a priority, therefore it is important to identify characteristics which determine DRS uptake among those with diabetes in Ireland. We report uptake in an Irish primary care population during the initial phase of implementation of RetinaScreen and investigate factors which predict consenting to participate in the programme. Methods: In two primary care practices, data were extracted from records of people with diabetes (type 1 and type 2) aged ≥18 years who were eligible to participate in RetinaScreen between November 2013 and August 2015. Records were checked for a RetinaScreen letter. RetinaScreen were contacted to establish the status of those without a letter on file. Multivariable Poisson regression was used to examine associations between socio-demographic variables and consenting. Adjusted incident rate ratios (IRR) with 95% CI were generated as a measure of association. Results: Of 722 people with diabetes, one fifth (n=141) were not registered with RetinaScreen. Of 582 who were registered, 63% (n=365) had participated in screening. Most people who consented subsequently attended (n=365/382, 96%). People who had attended another retinopathy screening service were less likely to consent (IRR 0.65 [95%CI 0.5-0.8]; p<0.001). Other predictors were not significantly associated with consent. Conclusions: Over one third of people eligible to participate in RetinaScreen had not consented. Research is needed to understand barriers and enablers of DRS uptake in the Irish context. Implementing strategies to improve DRS uptake (consent and attendance) should be a priority.
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Tracey, Marsha, Emmy Racine, Fiona Riordan, Sheena M. McHugh, and Patricia M. Kearney. "Understanding the uptake of a national retinopathy screening programme: An audit of people with diabetes in two large primary care centres." HRB Open Research 2 (November 27, 2019): 17. http://dx.doi.org/10.12688/hrbopenres.12926.2.
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Background: Diabetic retinopathy (DR) affects 8.2% of the Irish population with type 2 diabetes over 50 years and is one of the leading causes of blindness among working-age adults. Regular diabetic retinopathy screening (DRS) can reduce the risk of sight loss. In 2013, the new national screening programme (RetinaScreen) was introduced in Ireland. Maximising DRS uptake (consent to participate in the programme and attendance once invited) is a priority, therefore it is important to identify characteristics which determine DRS uptake among those with diabetes in Ireland. We report uptake in an Irish primary care population during the initial phase of implementation of RetinaScreen and investigate factors which predict consenting to participate in the programme. Methods: In two primary care practices, data were extracted from records of people with diabetes (type 1 and type 2) aged ≥18 years who were eligible to participate in RetinaScreen between November 2013 and August 2015. Records were checked for a RetinaScreen letter. RetinaScreen were contacted to establish the status of those without a letter on file. Multivariable Poisson regression was used to examine associations between socio-demographic variables and consenting. Adjusted incident rate ratios (IRR) with 95% CI were generated as a measure of association. Results: Of 722 people with diabetes, one fifth (n=141) were not registered with RetinaScreen. Of 582 who were registered, 63% (n=365) had participated in screening. Most people who consented subsequently attended (n=365/382, 96%). People who had attended another retinopathy screening service were less likely to consent (IRR 0.65 [95%CI 0.5-0.8]; p<0.001). Other predictors were not significantly associated with consent. Conclusions: Over one third of eligible participants in RetinaScreen had not consented. Research is needed to understand barriers and enablers of DRS uptake in the Irish context. Implementing strategies to improve DRS uptake, barriers to consent in particular, should be a priority.
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Tracey, Marsha, Emmy Racine, Fiona Riordan, Sheena M. McHugh, and Patricia M. Kearney. "Understanding the uptake of a national retinopathy screening programme: An audit of people with diabetes in two large primary care centres." HRB Open Research 2 (December 13, 2019): 17. http://dx.doi.org/10.12688/hrbopenres.12926.3.
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Background: Diabetic retinopathy (DR) is estimated to affect 25–26% of the Irish population with diabetes and is one of the leading causes of blindness among working-age adults. Regular diabetic retinopathy screening (DRS) can reduce the risk of sight loss. In 2013, the new national screening programme (RetinaScreen) was introduced in Ireland. Maximising DRS uptake (consent to participate in the programme and attendance once invited) is a priority, therefore it is important to identify characteristics which determine DRS uptake among those with diabetes in Ireland. We report uptake in an Irish primary care population during the initial phase of implementation of RetinaScreen and investigate factors which predict consenting to participate in the programme. Methods: In two primary care practices, data were extracted from records of people with diabetes (type 1 and type 2) aged ≥18 years who were eligible to participate in RetinaScreen between November 2013 and August 2015. Records were checked for a RetinaScreen letter. RetinaScreen were contacted to establish the status of those without a letter on file. Multivariable Poisson regression was used to examine associations between socio-demographic variables and consenting. Adjusted incident rate ratios (IRR) with 95% CI were generated as a measure of association. Results: Of 722 people with diabetes, one fifth (n=141) were not registered with RetinaScreen. Of 582 who were registered, 63% (n=365) had participated in screening. Most people who consented subsequently attended (n=365/382, 96%). People who had attended another retinopathy screening service were less likely to consent (IRR 0.65 [95%CI 0.5-0.8]; p<0.001). Other predictors were not significantly associated with consent. Conclusions: Over one third of eligible participants in RetinaScreen had not consented. Research is needed to understand barriers and enablers of DRS uptake in the Irish context. Implementing strategies to improve DRS uptake, barriers to consent in particular, should be a priority.
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Copty, Mimi, and David L. Whitford. "Mental health in general practice: assessment of current state and future needs." Irish Journal of Psychological Medicine 22, no. 3 (September 2005): 83–86. http://dx.doi.org/10.1017/s079096670000906x.
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AbstractObjectives: To determine the extent of mental health services provided in the community in one Irish health board area. To examine the influence of postgraduate mental health training of GPs on provision of mental health services.Method: Questionnaire and focus group methods were employed to determine views on mental health service provision. Data analysis was with parametric and non-parametric tests of association including student's t and chi-squared tests. Thematic analysis of the focus groups was carried out.Results: Twenty-five per cent of patients attending general practice have mental health problems and over 95% of these problems are dealt with in primary care. Only 32% of GPs had received postgraduate training in psychological therapies. GPs with postgraduate training in psychological therapies were more likely to estimate a higher proportion of their patient population with mental health problems and less likely to refer to psychiatric services. A need for support from other health care professionals in primary care was also identified.Conclusion: The majority of patients with mental health problems are treated in primary care. Further training of GPs and increased resources would improve mental health care in primary care and lead to fewer referrals to psychiatric services.
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Eswaramoorthy, Brinda, Ratan Gupta, Meenakshi Bhatt, and Manas Pratim Roy. "The Clinical Profile, Early Warning Score, and Outcome of Children Aged 0–12 Years Referred to a Tertiary Care Hospital in North India." Journal of Child Science 11, no. 01 (January 2021): e193-e198. http://dx.doi.org/10.1055/s-0041-1731334.
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AbstractPediatric patients are referred for multiple reasons, either for better therapeutic services or diagnostic purposes. The clinical condition of patients at the time of referral can significantly affect the outcome of such patients and there is not much data on this aspect. The overall objective of this study was to study the demographic and clinical profile, the causes for referral, and the outcome of pediatric patients being referred to a single tertiary care hospital. This was a prospective observational study done in the Department of Pediatrics of a single tertiary care hospital in North India over the course of 1 year. Patients referred from other health facilities in the age group 0 to 12 years who were admitted in the pediatric ward of the hospital were enrolled. The primary objective was to study the clinical profile and outcome (mortality) of these patients. The secondary objectives were to study the referral pattern of the referred patients, causes for referral, and the severity of illness at the time of admission as assessed by Irish Pediatric Early Warning Score (PEWS) and its correlation with the outcome. The outcomes were categorized as: discharge, death, left against medical advice, referred to other centers, others. Early warning scores are useful to measure the severity of disease and to follow patients' progress. The Irish PEWS score was used in this study to provide a rapid measure of the degree of sickness. Respiratory system disorders and neonatal illnesses were the most common illnesses observed. Most patients had low disease severity as per Irish PEWS score. The overall mortality rate among the referred patients was 19.25%. Patients with younger age, higher scores, neonatal illnesses, and neurological disorders had higher risk of mortality. Training of health personnel at primary and secondary levels in the commonly encountered illnesses will improve provision of care at the local level and decrease low risk referrals.
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Loftus Moran, Orla, Mary Casey, Laserina O'Connor, and Walter Cullen. "Quality care process metrics for nurses working in general practice, mapping the evidence: a scoping review protocol." HRB Open Research 5 (April 14, 2022): 10. http://dx.doi.org/10.12688/hrbopenres.13483.2.
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Background: Irish general practice nursing roles have developed and grown exponentially in response to changing policy, clinical and workforce demands, this is reflective of international primary healthcare nursing trends. However, as nursing care in general practice advances, comprehensive evaluation of the general practice nurse (GPN) role has not been undertaken. Therefore, processes which enable robust data collection to assess the role and facilitate development of services are required. Nursing quality care metrics are an established mechanism which evaluate quality of care. Nursing quality care process metrics (QCP-Ms) specifically refer to measurement of care delivered directly to patients by nurses, benchmarking these interventions adherence to best practice guidance. The use of nursing metrics has been adopted within seven distinct healthcare settings in Ireland but not general practice. This scoping review is the first stage of a project which aims to inform development and implementation of QCP-Ms by Irish GPNs. Aim: To explore and map the literature regarding the development and implementation of QCP-Ms within general practice settings. Methods: The following five-stage methodological framework for scoping reviews proposed by Arksey and O’Malley will be used: (1) identifying the research question, (2) identifying relevant studies, (3) study selection, (4) charting/mapping the data and (5) collating, summarizing, and reporting results. The review will be conducted and reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Conclusions: The focus of this scoping review relates to QCP-Ms which specifically measure the work of general practice nurses. It is envisioned that synthesis of international literature will give a broad perspective about nursing QCP-Ms, their use in general practice or primary healthcare settings, enriching understanding regarding their development. It is anticipated that findings will provide key information to policy makers and health professionals interested in planning, strengthening, and delivering primary healthcare.
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Phelan, Darra. "The psychiatrist in primary care: let's look before we leap." Irish Journal of Psychological Medicine 12, no. 1 (March 1995): 17–21. http://dx.doi.org/10.1017/s0790966700001981.
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AbstractObjective: Irish psychiatrists may begin to spend, as their British have counterparts have, at least some of their time delivering a psychiatric service from primary care settings. It was therefore decided to review the origins and development of attitudes towards and outcome this practice in Britain.Method: A literature search and review of relevant papers was undertaken.Results: Collaboration between psychiatrists and general practitioners began to expand significantly in the 1970s and 1980s. Three main models are used, the shifted outpatient model, the selected consultation model and the liaison-attachment team model. The shifted out-patient model is liked by patients whose attendance rate is better at such clinics and in some areas this model has resulted in a fall in hospital admission rates. There is a paucity of papers examining outcome of the other models. Results of the one extensively studied team liaison approach reports higher treated prevalence rates and lower admission rates for those patients referred. There was no effect on detection of illness by GPs and the service was much more costly.Conclusions: While some benefits may result from use of the shifted out-patient approach, they are not compelling enough to enable a firm recommendation for its widespread implementation to be made. The results to date suggest the team-liaison approach does not produce benefits sufficient to outweigh the increased cost. The selected consultation model may hold greater potential but needs to be more extensively researched. Finally the structure of general practice in Ireland, with so few GPs working in multiple partner practices makes it highly unlikely that the widespread introduction of collaboration will be feasible.
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Smith, Simon, Nur Syifa Ilyani Abd Manan, Shannon Toner, Amr Al Refaie, Nicole Müller, Patrick Henn, and Colm M. P. O’Tuathaigh. "Age-related hearing loss and provider-patient communication across primary and secondary care settings: a cross-sectional study." Age and Ageing 49, no. 5 (April 7, 2020): 873–77. http://dx.doi.org/10.1093/ageing/afaa041.
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Abstract Background The prevalence of age-related hearing loss (ARHL) increases with age. Older adults are amongst the most dependent users of healthcare and most vulnerable to medical error. This study examined health professionals’ strategies, as well as level of formal training completed, for communication with older adults with ARHL, and their views on the contribution of ARHL to suboptimal quality of patient care. Methods A 17-item questionnaire was distributed to a sample of Irish primary care physicians, as well as hospital-based clinicians providing inpatient palliative care and geriatric services. Results A total of 172 primary care physicians and 100 secondary care providers completed the questionnaire. A total of 154 (90%) primary and 97 (97%) secondary care providers agreed that ARHL had a negative impact on quality of care. Across both settings, 10% of respondents reported that communication issues contributed to multiple medication error events each year. Although only 3.5% of secondary care providers and 13% of primary care physicians attended formal training on communication with hearing-impaired patients, 66.5% of respondents were confident in their capacity to communicate with these patients. Primary care physicians reported that they either never used assistive hearing technology (44%) or were unfamiliar with this technology (49%). Conclusions Primary and secondary care health providers reported that ARHL reduces patient care quality and may initiate errors leading to patient harm. Formal training addressing the communication needs of ARHL patients appears to be underdeveloped, and there is a limited familiarity with assistive hearing technology. This is both an error in health professional training and healthcare services.
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Homeniuk, Robyn, Fintan Stanley, Joseph Gallagher, and Claire Collins. "Heartwatch: an Irish cardiovascular secondary prevention programme in primary care, a secondary analysis of patient outcomes." BMJ Open 13, no. 1 (January 2023): e063811. http://dx.doi.org/10.1136/bmjopen-2022-063811.
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ObjectivesTo investigate patient follow-up data from Heartwatch: Ireland’s secondary prevention programme for cardiovascular disease delivered in general practice.DesignRetrospective descriptive study based on secondary analysis of routinely collected data from Heartwatch.SettingHeartwatch targeted 20% of general practices in Ireland and recruited 475 general practitioners across 325 practices.ParticipantsThe patient population included people with a history of acute myocardial infarction, percutaneous transluminal coronary angioplasty or a coronary artery bypass graft. Over 16 000 patients entered the programme however, to assess the long-term progress of patients, we identified a cohort of 5700 patients with at least 8 years in the programme.InterventionsA standard protocol for continuing care of patients for the secondary prevention of cardiovascular disease was administered by general practices. The programme was designed using WHO and European Society of Cardiology guidelines on secondary prevention.Outcome measuresA Continuing Care (CCare) score out of eight was the primary outcome measure used. It was calculated based on programme targets for well-known cardiovascular risk factors: exercise, systolic blood pressure, LDL cholesterol, optimally controlled glucose, smoking status, and pharmacological treatment.ResultsAfter 1 year, 37% of the 8-year cohort had achieved a CCare score >5 increasing to 44% after year 8. Patient sex was predictive of better scores; male patients had almost a half-point advantage (0.432, 99% CI: 0.335 to 0.509). Patients who enrolled earlier following their qualifying event and patients with more frequent visits were also more likely to achieve higher CCare scores.ConclusionsOverall, patients are not likely to meet all targets set by secondary prevention guidelines, however, supporting patient self-management may impact on this. Early enrolment after a cardiac event and frequent structured care visits should be priorities in the design and implementation of similar programmes. Ongoing evaluation of them is necessary to improve outcomes.
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Hayes, Peter, Monica Casey, Liam G. Glynn, Gerard J. Molloy, Hannah Durand, Eoin O’Brien, Eamon Dolan, et al. "Measuring adherence to therapy in apparent treatment-resistant hypertension: a feasibility study in Irish primary care." British Journal of General Practice 69, no. 686 (July 29, 2019): e621-e628. http://dx.doi.org/10.3399/bjgp19x705077.
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BackgroundApparent treatment-resistant hypertension (aTRH) is defined as uncontrolled blood pressure (BP) in patients taking three or more antihypertensive medications. Some patients will have true treatment-resistant hypertension, some undiagnosed secondary hypertension, while others have pseudo-resistance. Pseudo-resistance occurs when non-adherence to medication, white-coat hypertension (WCH), lifestyle, and inadequate drug dosing are responsible for the poorly controlled BP.AimTo examine the feasibility of establishing non-adherence to medication, for the first time in primary care, using mass spectrometry urine analysis. Operationalisation would be established by at least 50% of patients participating and 95% of samples being suitable for analysis. Clinical importance would be confirmed by >10% of patients being non-adherent.Design and settingEligible patients with aTRH (n = 453) in 15 university research-affiliated Irish general practices were invited to participate.MethodParticipants underwent mass spectrometry urine analysis to test adherence and ambulatory BP monitoring (ABPM) to examine WCH.ResultsOf the eligible patients invited, 52% (n = 235) participated. All 235 urine samples (100%) were suitable for analysis: 174 (74%) patients were fully adherent, 56 (24%) partially adherent, and five (2%) fully non-adherent to therapy. A total of 206 patients also had ABPM, and in total 92 (45%) were categorised as pseudo-resistant. No significant associations were found between adherence status and patient characteristics or drug class.ConclusionIn patients with aTRH, the authors have established that it is feasible to examine non-adherence to medications using mass spectrometry urine analysis. One in four patients were found to be partially or fully non-adherent. Further research on how to incorporate this approach into individual patient consultations and its associated cost-effectiveness is now appropriate.
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Morrison, Laura, Rebecca Clarke, Claire McAteer, Eamon Dolan, and Marie O'Connor. "251 Communicating End of Life Care Decisions in an Acute Hospital." Age and Ageing 48, Supplement_3 (September 2019): iii17—iii65. http://dx.doi.org/10.1093/ageing/afz103.155.
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Abstract Background Research by the Irish Hospice Foundation reports 43% of Irish deaths occur in hospital. The aim of this study was to review in-hospital deaths in a university teaching hospital to examine whether escalation of care and resuscitation instructions were documented clearly where death was a likely outcome during hospitalisation. Methods Medical records from 50 deaths in 2018 were reviewed. A proforma was designed to record detail on: demographics, if death was expected, and if resuscitation status, ceiling of care and discussion of these with the patient or family were clearly documented. Results 50 patients were included, median age 83.5 years. In 84%, end of life was anticipated by the medical team. 74% of patients were seen by palliative care. The most common cause of death was pneumonia/respiratory sepsis (46%) and median length of stay was 13 days. 3 patients (6%) had cardiac arrest calls. A clear ceiling of care was recorded in 46% of cases. Goals of care were documented as discussed with the patient in 2% of cases and family in 78%. Resuscitation status was recorded as discussed with family in 62% and the patient in 4%. Resuscitation status was documented in 96% of cases; 60% by the primary team, 36% by on-call staff. In only 54% of cases the name, position and Medical Council number of the person recording resuscitation status were all clearly written. Resuscitation status was correctly documented on the Early Warning Score chart in 32% of cases. Conclusion Clear documentation around treatment escalation plans is needed in patients admitted to an acute hospital. Resuscitation status and ceiling of care, if appropriate, should be decided and documented by the primary team where possible and discussed with the patient/family. This study showed a need to improve documentation and discussion with patients and families approaching end of life.
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Bourque, Meghan, and Tony Foley. "293 Improving the Quality of Dementia Care in General Practice: A Qualitative Study." Age and Ageing 48, Supplement_3 (September 2019): iii1—iii16. http://dx.doi.org/10.1093/ageing/afz102.64.
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Abstract Background The prevalence of dementia in Ireland is rising. General Practitioners (GPs) play a central role in caring for people with dementia. There is a growing demand for community-based care, emphasized by the Irish National Dementia Strategy (INDS). The INDS advocates a multidisciplinary, community-based approach to dementia care. However, there is a paucity of research exploring GPs’ views on dementia since publication of the INDS. The aim of the study is to develop a deeper understanding of how to improve the quality of dementia care in General Practice from the perspective of Irish GPs. Methods Semi-structured interviews were conducted with GPs. GPs who completed a continuing professional development module in Cork on dementia in primary care were purposively recruited. Interviews were analyzed thematically. Analysis was iterative and ongoing with data collection. Results 12 (34.3%) GPs agreed to participate. 10 interviews have been conducted to-date. Participants were evenly distributed by sex (5 male, 5 female). Experience in General Practice varied (3-32 years). Most GPs practiced in mixed urban-rural settings (n=8) and had nursing home commitments (n=7). The average interview length was approximately 45 minutes. Three major themes emerged from the data set: factors promoting care in current practice; resistance to care; and recommendations to improve care. Continuity of care, early disease recognition, coding, audit, and coordinated care teams were recognized as factors promoting quality care. Time, funding, access to secondary care, and inadequate community resources hindered care. GPs emphasized the need for coordinated community services, GP education, review of the chronic disease management scheme for GPs, and service standardization in order to improve care. Conclusion GPs find dementia care to be a complex, challenging aspect of primary care. While education and training is advocated by GPs, service delivery also needs to be reconfigured. Dementia needs to be included under chronic disease management in Ireland and services must become standardized.
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Barry, Tomás, Alan Batt, Gina Agarwal, Matthew Booker, Mary Casey, and Geoff McCombe. "Potential for Paramedic roles in Irish General Practice: A qualitative study of stakeholder’s perspectives." HRB Open Research 5 (August 12, 2022): 40. http://dx.doi.org/10.12688/hrbopenres.13545.2.
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Background: Irish health policy emphasises the role of Primary Care and General Practice however, there is a growing shortage of General Practitioners (GPs) in Ireland. Paramedics have traditionally focused on emergency care in the community. More recently Paramedics have taken on roles in General Practice in international jurisdictions, but not yet in Ireland. This study aimed to explore key stakeholder perceptions of ‘the potential for Paramedic roles in Irish General Practice’. Methods: We conducted an exploratory, qualitative stakeholder consultation study incorporating in-depth semi structured telephone interviews followed by thematic analysis. Interviews were conducted with a total of eighteen participants that included six senior Paramedics (Advanced Paramedics), seven General Practitioners (GPs), three Practice Nurses and two Practice Managers. Results: Participants in this study expressed polarised views on the potential for Paramedic roles in Irish General Practice. Paramedics were enthusiastic, highlighting opportunity for professional development and favourable working conditions. GPs, Practice Nurses and Managers were more circumspect and had concerns that Paramedic scope and skillset was not currently aligned to General Practice care. GPs, Practice Nurses and Managers emphasised a greater role for expanded General Practice Nursing. There were varied perceptions on what the potential role of a Paramedic in General Practice might entail, but consensus that Government support would be required to facilitate any potential developments. Conclusions: The findings of this research can inform future development of novel roles in Irish General Practice and suggests that there is appetite from within the Paramedic profession to pursue such roles. A pilot demonstration project, grounded in an action research framework could address data gaps and potential concerns. Any future developments should occur in tandem with and with due consideration for the expansion of General Practice Nursing in Ireland.
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Barry, Tomás, Alan Batt, Gina Agarwal, Matthew Booker, Mary Casey, and Geoff McCombe. "Potential for Paramedic roles in Irish General Practice: A qualitative study of stakeholder’s perspectives." HRB Open Research 5 (May 23, 2022): 40. http://dx.doi.org/10.12688/hrbopenres.13545.1.
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Background: Irish health policy emphasises the role of Primary Care and General Practice however, there is a growing shortage of General Practitioners (GPs) in Ireland. Paramedics have traditionally focused on emergency care in the community. More recently Paramedics have taken on roles in General Practice in international jurisdictions, but not yet in Ireland. This study aimed to explore key stakeholder perceptions of ‘the potential for Paramedic roles in Irish General Practice’. Methods: We conducted an exploratory, qualitative stakeholder consultation study incorporating in-depth semi structured telephone interviews followed by thematic analysis. Interviews were conducted with a total of eighteen participants that included six senior Paramedics (Advanced Paramedics), seven General Practitioners (GPs), three Practice Nurses and two Practice Managers. Results: Participants in this study expressed polarised views on the potential for Paramedic roles in Irish General Practice. Paramedics were enthusiastic, highlighting opportunity for professional development and favourable working conditions. GP’s, Practice Nurses and Managers were more circumspect and had concerns that Paramedic scope and skillset was not currently aligned to General Practice care. GP’s, Practice Nurses and Managers emphasised a greater role for expanded General Practice Nursing. There were varied perceptions on what the potential role of a Paramedic in General Practice might entail, but consensus that Government support would be required to facilitate any potential developments. Conclusions: The findings of this research can inform future development of novel roles in Irish General Practice and suggests that there is appetite from within the Paramedic profession to pursue such roles. A pilot demonstration project, grounded in an action research framework could address data gaps and potential concerns. Any future developments should occur in tandem with and with due consideration for the expansion of General Practice Nursing in Ireland.
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Croke, Aisling, Frank Moriarty, Fiona Boland, Laura McCullagh, Karen Cardwell, Susan M. Smith, and Barbara Clyne. "Integrating clinical pharmacists within general practice: protocol for a pilot cluster randomised controlled trial." BMJ Open 11, no. 3 (March 2021): e041541. http://dx.doi.org/10.1136/bmjopen-2020-041541.
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IntroductionManaging patients with multiple conditions (multimorbidity) is a major challenge for healthcare systems internationally, particularly in older patients. Multimorbidity and subsequent polypharmacy increase treatment burden and the risk of potentially inappropriate prescribing, and both are complex to manage in primary care. Limited evidence suggests integration of pharmacists into general practice teams could improve medication management for patients with multimorbidity and polypharmacy. Building on findings from a non-randomised, uncontrolled General Practice Pharmacist (GPP) feasibility study conducted in Irish primary care, the aim of this study is to conduct a pilot cluster randomised controlled trial (cRCT) of the GPP study, to assess feasibility, intervention impact, costs and appropriateness of continuing to a definitive cRCT.Methods and analysisThis pilot cRCT will involve 8 general practitioner (GP) practices and 120 patients. Practices will identify and recruit patients aged ≥65 years, who are taking ≥10 regular medications. Practices will be allocated to intervention or control after baseline data collection. Intervention practices will have a pharmacist integrated within their service, working with GPs, patients and practice staff to optimise prescribing and other medication-related activities. Control practices will provide standard GP care. The primary feasibility outcomes will include recruitment rate, uptake of medication reviews and study retention. For the primary clinical outcome, the number of potentially inappropriate prescribing incidences per patient will be collected. Secondary outcomes will include medication-related outcomes, patient-reported outcome measures, and data pertaining to the role and impact of the pharmacist on prescribing. In addition, economic and process evaluations will be conducted.Ethics and disseminationThis trial has been approved by the Irish College of General Practitioners Research Ethics Committee and will be performed in accordance with the Declaration of Helsinki. The results will be reported in peer-reviewed journals and be presented at national and international conferences.Trial registration numberISRCTN Registry (https://doi.org/10.1186/ISRCTN18752158).
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Riordan, Fiona, Katie Murphy, Colin Bradley, Patricia M. Kearney, Susan M. Smith, and Sheena M. McHugh. "Acceptability and feasibility of conducting a pilot trial in Irish primary care: lessons from the IDEAs study." HRB Open Research 4 (July 14, 2021): 73. http://dx.doi.org/10.12688/hrbopenres.13306.1.
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Introduction Understanding primary care practices’ ‘readiness’ to engage in trials and their experience is important to inform trial procedures and supports. Few studies report on the feasibility of study procedures though this is a central part of pilot trials. We explored the acceptability and feasibility of study procedures of a cluster randomised pilot trial of an intervention in primary care to improve uptake of Ireland’s national diabetic retinopathy programme. Methods As part of the embedded mixed-methods process evaluation, quantitative and qualitative data were gathered across four general practices participating in the intervention. Interviews were conducted with a purposive sample of staff. Research logs on time spent on intervention delivery, staff assignment, resources, problems/changes, and reasons for drop-outs, were maintained over the course of intervention rollout, and practice audit data were analysed. Quantitative outcomes included recruitment, retention, completion, and data quality and completeness. Qualitative data on perceptions and experience of the pilot trial procedures were analysed using the Framework Method. Findings Nine staff (3 GPs, 4 nurses, 2 administrators) were interviewed. An interest in the topic area or in research motivated practices to take part in the trial. Reimbursement meant they could ‘afford’ to participate. Staff valued the researcher briefing at the start of the trial, to avoid ‘going in slightly blind’. While staff varied in audit skills and confidence, and some found this aspect of data collection challenging, a ‘step-by-step’ audit manual and regular researcher contact, helped them stay on track and troubleshoot during data collection. Audit quality was acceptable overall, however there were some issues, incorrect assignment of patient status being most common. Conclusion The IDEAs trial procedures were acceptable and feasible for primary care staff, however, challenges with conducting the audit may reflect staff skills gaps and the need for greater guidance and support from researchers.
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McCrossan, P., C. McCafferty, C. Murphy, and J. Murphy. "Retrospective review of administration of childhood primary vaccination schedule in an Irish tertiary neonatal intensive care unit." Public Health 129, no. 7 (July 2015): 896–98. http://dx.doi.org/10.1016/j.puhe.2015.05.005.
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D’Urso, Giulio, Jennifer Symonds, Seaneen Sloan, and Dympna Devine. "Bullies, victims, and meanies: the role of child and classmate social and emotional competencies." Social Psychology of Education 25, no. 1 (January 20, 2022): 293–312. http://dx.doi.org/10.1007/s11218-021-09684-1.
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AbstractThis study used a personal oriented approach to identify distinct combinations of children’s experiences of bullying and victimisation in the Irish primary school context. The study investigated the social and emotional characteristics that predicted those profiles at individual and classroom levels. The sample of 2,062 participants was drawn from the Irish national cohort study Children’s School Lives. We analysed teacher reports of individual children’s strengths and difficulties and neglect, and child reports of experiences of bullying, victimisation, and care from classmates. Latent profile analysis revealed five main profiles of bullying and victimisation in Irish primary schools. Approximately 40% of the children were distributed in the atypical profiles (i.e., bullies, meanies, victims, and bully-victims) with the other 60% of children reporting very low levels of bullying and victimisation. Multilevel modelling predicted the profile membership from a set of social and emotional predictors from individual and classroom levels. At the individual level, being a bully was predicted by higher child neglect, hyperactivity, conduct problems, and peer problems; being a meanie was predicted by hyperactivity, peer problems, and less caring classmates; being a victim was predicted by child neglect, conduct problems, and less caring classmates; and being a bully-victim was predicted by conduct problems and less caring classmates. At the classroom level, being a victim was predicted by being in a classroom comprised of younger children, and in classrooms where children were less caring on average. Theoretical and psycho-educational implications are discussed.
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Hegarty, Josephine M., Meredith Wallace, and Harry Comber. "Uncertainty and Quality of Life Among Men Undergoing Active Surveillance for Prostate Cancer in the United States and Ireland." American Journal of Men's Health 2, no. 2 (May 23, 2007): 133–42. http://dx.doi.org/10.1177/1557988307300467.
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Background. Prostate cancer continues to be the most common site of male cancers, particularly among older men in Europe and the United States, and the second most common male cancer worldwide. Active surveillance involves the use of no local or systemic therapy once prostate cancer has been diagnosed. A description of uncertainty and quality of life among men undergoing active surveillance in samples from both the United States and Ireland has the potential to enhance global health care delivery. Methods. The specific aim of this study is to enhance the understanding of the experience of active surveillance for prostate cancer among Irish and American men by measuring quality of life and levels of uncertainty among men over the age of 65 in receipt of the active surveillance management option for prostate cancer. A quantitative, descriptive survey design was used. Results. Twenty-nine men completed questionnaires. The results reveal that men undergoing active surveillance in the United States have slightly higher levels of uncertainty. Primary appraisal, opportunity, and danger appraisal were consistent between samples from both countries. Total affective and health-related quality-of-life scores were similar among active surveillance participants in both countries, but subscale scores identified both similarities and differences. Irish men had lower mean role and social function than U.S. men, and higher general health and energy. Irish men reported more urine bother and less sexual bother than U.S. men. Conclusion. To assist men with prostate cancer who are treated with the active surveillance management option, health care professionals must develop an awareness of how prostate cancer affects the man's physical and psychological health care outcomes.
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Carmody, Kevin, Martin Rouse, Dermot Nolan, and Diarmuid Quinlan. "GPs’ practice and attitudes to initiating isotretinoin for acne vulgaris in Ireland: a cross-sectional questionnaire survey in primary care." British Journal of General Practice 70, no. 698 (August 10, 2020): e651-e656. http://dx.doi.org/10.3399/bjgp20x712337.
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BackgroundIsotretinoin is prescribed in secondary care for severe acne vulgaris. Anecdotal reports suggest that GPs in Ireland currently initiate isotretinoin.AimTo ascertain the prevalence and management of isotretinoin in Irish general practice and to describe GPs’ attitudes about the use of isotretinoin in Ireland.Design and settingA cross-sectional questionnaire survey of GPs in Ireland between October 2018 and February 2019.MethodTwo short questionnaires were developed: one for GPs who prescribe isotretinoin and one for GPs who do not prescribe isotretinoin. Questionnaires were distributed via email and online via GP Forum to GPs in Ireland.ResultsOf a total 298 GPs who completed the questionnaire, 52 (17%) initiated isotretinoin. Older GPs (aged 35 years) and male GPs were more likely to prescribe isotretinoin. GPs cited prolonged dermatology waiting lists (n = 34, 65%) and a special interest in dermatology (n = 31, 60%) as two key drivers to initiating isotretinoin. However, this study found evidence of suboptimal blood monitoring, pregnancy testing, and contraceptive advice. Most GPs (n = 246, 83%) did not initiate isotretinoin and identified multiple barriers: medicolegal concerns (n = 150, 61%), being unaware that GPs may initiate isotretinoin (n = 135, 55%), and being unfamiliar with managing isotretinoin (n = 102, 41%). Important enablers to initiating isotretinoin cited by GPs include Irish College of General Practitioners guidelines (n = 118, 48%) and dermatologist support (n = 119, 48%). Two-thirds of the GPs questioned (n = 164, 67%) expressed an interest in initiating isotretinoin and most (n = 223, 91%) agreed that GPs can safely manage isotretinoin.ConclusionFew GPs in Ireland currently initiate treatment of acne with isotretinoin, and there is suboptimal adherence to recommended monitoring. Barriers to and enablers for GPs initiating isotretinoin were identified. Most GPs expressed an interest in initiating isotretinoin.
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O'Connor, Raymond, Patrick J. Murphy, Michael E. O'Callaghan, Susan M. Smith, Liam Glynn, Claire Collins, Rory O'Driscoll, and Andrew W. Murphy. "Development of a primary care research network focused on chronic disease: a feasibility study for both practices and research networks." HRB Open Research 4 (August 16, 2021): 89. http://dx.doi.org/10.12688/hrbopenres.13311.1.
Full textAbstract:
Background: High quality data should be a key resource for research and planning of healthcare, but low quality general practice data has been documented internationally. This study assessed the feasibility of collecting reliable chronic disease data in Irish general practice, using a program of training and feedback to improve the quality of coding for chronic conditions in practice information systems. Methods: Training in chronic disease coding and reporting was provided to a purposive sample of general practices in Ireland. From July to December 2020, practices reported the number of patients receiving free medical care, and the number of patients coded with each of eight chronic conditions: type 2 diabetes mellitus (T2DM), asthma, chronic obstructive pulmonary disease (COPD), ischaemic heart disease (IHD), heart failure (HF), atrial fibrillation (ATF), transient ischaemic attack (TIA) and cerebrovascular accident/stroke (CVA). Calculated prevalences were compared with national and international estimates. Results: We recruited and trained 16 practices with 65.5 full-time equivalent GPs and a study-eligible patient population of 36,327. There was a large degree of variation across practices for all conditions. For example, in July, reported prevalence of IHD ranged from 0.3% to 10.2% (a 34-fold difference), and reported prevalence of HF ranged from 0.2% to 4.0% (a 20-fold difference). No single practice had high or low prevalences across all conditions. Changes over time across all practices were minimal, averaging between 0.1% and 0.3% for all conditions. By December, a large degree of variation across practices remained. Across all conditions, average prevalences were higher than previously published estimates. Conclusions: Although hampered by the COVID-19 pandemic, it was feasible to implement this programme of training and feedback to report on chronic disease data recorded in general practice. Coding quality in Irish general practice is highly varied, and improvement would require a greater degree of intervention, including audit.