Projects & Research

Chronic Disease Management (CDM) in Ireland

 

The Adelaide Health Foundation has undertaken a major piece of research to determine the readiness of the healthcare system within Ireland to effectively respond to and manage chronic disease.

Worldwide chronic illnesses are increasingly becoming a primary concern for healthcare systems. As populations age and those with chronic illness live longer the numbers of chronically ill patients increase. Chronic illnesses usually have a long duration with progression of symptoms impacting on the physical, emotional and mental well being of individuals leading to a reduced quality of life, and increased morbidity and mortality. The 2014 World Health Organisation’s (WHO) chronic disease profile for Ireland attributed 88% of deaths in Ireland to chronic illnesses such as cardiovascular disease, diabetes, cancer and chronic respiratory disease. Healthcare systems, therefore, have to increasingly address the management of individuals with chronic illnesses. The WHO has recommended the Chronic Care Model (CCM) to guide healthcare system reform worldwide.

According to the CCM, optimal chronic care is achieved when a prepared, proactive healthcare team interacts with an informed, activated patient. In line with this, patients are now seen as partners in managing chronic illness. The opinions of key stakeholders with regard to the readiness of the healthcare system to deliver effective CDM are vital to understanding ongoing reforms within our health service. Understanding stakeholders’ views and needs and how these may vary with factors such as age, sex, geography and local socio-economic circumstances, is essential for good planning and monitoring of chronic disease management within Ireland.

We believe that in this context it is most important to understand the beliefs, experiences and attitudes of frontline clinical staff such as general practitioners, hospital consultants, and practice nurses working within primary care, as well as patients with chronic multi-morbidities.

This work has been completed in conjunction with the Department of Public Health & Primary Care, TCD and through a series of collaborative partnerships with the Irish College of General Practitioners, the Royal College of Physicians of Ireland, and the Irish Practice Nurses Association. READ MORE

 

Health Assets and Needs Assessment (HANA) in Tallaght

HANA Report Cover

In 2002 a Tallaght Health Needs Assessment was conducted by the then Department of Community Health & General Practice, Trinity College and funded by the Adelaide Hospital Society. This was a cross sectional study conducted within 13 electoral divisions of Tallaght. A health needs approach seeks to determine what is 'lacking in the physical, social, psychological and environmental conditions under which residents of the area live and what can be done to improve them'. Since this assessment was completed in 2002 the definition and concept of health has developed to a wider more scoping definition. The World Health Organisation defines health as 'a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity'. This is similar to the broader definition of health which has been adopted in the recent Government policy 'Healthy Ireland' framework for health. With a more extensive definition comes an expansion of factors that influence health.

Health is determined not only by access to quality healthcare services and lifestyle choices but also by a person’s socio-economic conditions, including housing, employment, transport, access to fresh food. A greater focus on patient-centred care and empowerment in health care, together with an acknowledgement of the shortcomings of a needs based approach and cut backs, has led to an impetus to find new ways of working and finding solutions. These developments have contributed to the emergence of a health asset approach and health assessments now commonly include an investigation of both health assets and health needs.

The inclusion of health assets assessments adds value to the needs assessment by identifying factors which protect and support health, changing the role of residents to co-producers of health, while strengthening their capacity. A focus on assets can provide new ways of challenging health inequalities, improve health behaviours and outcomes and reduce demand on services, making them more efficient and effective while making visible the potential in a community. In addition, it is widely acknowledged that there is a need for a greater focus on health assets as articulated by the WHO.

The aim of the HANA study is to examine health needs in the Tallaght community through a repeat of the methodology employed in the 2002 Tallaght Health Needs Assessment but with an expansion to identify and map health assets in Tallaght. This will allow us to assess any changes in health needs in Tallaght since 2002; identify and map and existing health assets; establish the relationship of the community with existing health assets; and provide recommendations for the health of the Tallaght community and people in the context of the findings of the assessment as well as current policy documents and existing datasets.

The HANA project is co-funded by the Adelaide Health Foundation and Tallaght Hospital. Our partners in the project include South Dublin County Council and the Health Services Executive.
READ THE REPORT HERE

Integrated Healthcare in Ireland

Budget pooling or ring-fenced funding for integrated services, the need for integrated care pathways, the importance of investing in Information Technology and integrating it within and across services, the introduction of unique patient identifiers and the implementation of electronic medical records, and the incorporation of social care as part of Universal Health Insurance. These proposals are among a set of 24 evidence based recommendations arising from Integrated Healthcare in Ireland – a Critical Analysis and a Way Forward.

The Adelaide Health Foundation (AHF) is dedicated to the development of policies that facilitate the provision of the best possible healthcare, based on the best available evidence. It is one of the functions of the AHF to evaluate current policy and practice, through research and analysis. Integration is easy to talk about but difficult to achieve. The implementation of integrated care is complex with many factors facilitating and hampering reform. In the Irish context there are demand constraints due to demographic and epidemiological changes, rising patient expectations coupled with supply constraints such as staff shortages, and continuing cost escalations through the development of medical technology and equipment. Supply and demand characteristics are not independent and may interact in complex ways.

Organisation and regulatory factors, such as health system governance and financing, can also influence demand and supply. Patients using the Irish healthcare system have long been saying that the lack of integration is a major frustration for them. A challenging financial environment and demographic change resulting in rising demand and increasing numbers of people with complex needs, means health and social care must be at the forefront. The focus must be on people’s wants and needs rather than on the organisations and structures that deliver care. We need to prevent ill health and support people to stay healthy rather than only intervening in a crisis. Never has there been a more pressing need to change the status quo.

Patient and Family Participation in Healthcare Design and Delivery

(A PhD co-funded by the Adelaide Health Foundation and the Irish Research Council)

Patient and family participation in healthcare design and delivery is when the views of patients and family members are sought and taken into account in designing, planning, delivering and improving new and existing healthcare services. For example, patient and family involvement in decision-making discussions, the development of patient charters, patient and family setting of priorities. Internationally, numerous interventions to encourage patient and family participation have been tested. However, no consensus has been reached due to heterogeneity in the interventions tested, the patient groups employed and underlying health systems. In Ireland there has been limited research on patient and family participation in healthcare design and delivery. The national policy framework ‘Healthy Ireland’ has identified increased service user involvement as one of the key performance indicators for the healthcare system going forward.

The primary aim of the PhD is to systematically develop, implement and evaluate an intervention to encourage patient and family participation in Irish healthcare design and delivery from a mental and a medical healthcare perspective.

The research will focus on opinions and utilisation of patient and family participation in the design and delivery of Irish healthcare services from the perspective of patients, family members, healthcare providers and policy leaders in a mental and medical healthcare service. Identification of the most appropriate type and level of intervention to encourage participation. The identified intervention will be implemented and assessed in relation to impact on level of treatment satisfaction and patient and family participation.

It is expected that this will lead to improved levels of treatment satisfaction and patient and family engagement in health services. A taxonomy of interventions to encourage patient and family participation which can be tested on a wider scale, implemented nationally and in different services will be developed. Baseline data from which to measure levels of patient and family participation will be gathered.