• Over prescribing of antibiotics for acute respiratory tract infections; a qualitative study to explore Irish general practitioners' perspectives.

      O'Doherty, Jane; Leader, Leonard F W; O'Regan, Andrew; Dunne, Colum; Puthoopparambil, Soorej Jose; O'Connor, Raymond (BMC Family Practice, 2019-02-14)
      Anti-microbial resistance (AMR) is a global threat to public health and antibiotics are often unnecessarily prescribed for acute respiratory tract infections (ARTIs) in general practice. We aimed to investigate why general practitioners (GPs) continue to prescribe antibiotics for ARTIs despite increasing knowledge of their poor efficacy and worsening antimicrobial resistance. We used an explorative qualitative study design. Thirteen GPs were recruited through purposive sampling to represent urban and rural settings and years of experience. They were based in general practices within the Mid-West of Ireland. GPs took part in semi-structured interviews that were digitally audio recorded and transcribed. Three main themes and three subthemes were identified. Themes include (1) non-comprehensive guidelines; how guideline adherence can be difficult, (2) GPs under pressure; pressures to prescribe from patients and perceived patient expectations and (3) Unnecessary prescribing; how to address it and the potential of public interventions to reduce it. GPs acknowledge their failure to implement guidelines because they feel they are less usable in clinical situations. GPs felt pressurised to prescribe, especially for fee-paying patients and in out of hours settings (OOH), suggesting the need for interventions that target the public's perceptions of antibiotics. GPs behaviours surrounding prescribing antibiotics need to change in order to reduce AMR and change patients' expectations.
    • Interventions to develop collectivistic leadership in healthcare settings: a systematic review.

      De Brún, Aoife; O'Donovan, Roisin; McAuliffe, Eilish (BMC Health Services Research, 2019-01-25)
      Collective or shared leadership approaches have been associated with team performance outcomes in several sectors. Based on this evidence, there have been calls for more inclusive approaches to leadership in healthcare settings, but guidance on how to achieve collective leadership is lacking. This study synthesised knowledge of interventions to introduce collectivistic leadership in healthcare settings. The databases of PubMed, PsychInfo, ABI Inform, Cochrane and CINAHL and three grey literature databases were searched. Studies from any country were included if they reported on the development and evaluation and/or implementation of training/interventions to develop collectivistic leadership and reported individual and/or team-level outcomes. Results were synthesised using a narrative approach. The searches yielded 4448 records of which 21 met the eligibility criteria and were reviewed. Studies used a variety of interventions; eleven employed a team training approach, four described co-leadership, three explored service improvement, two detailed co-design approaches and one described an individual team development intervention. Most demonstrated moderate to good success in enabling collectivistic leadership, with benefits reported in staff engagement, satisfaction, and team performance. Whilst collectivistic leadership interventions have demonstrated positive outcomes, there is a need for more rigor and consistency in the evaluation of interventions aimed at developing collectivistic leadership approaches in health settings.
    • A Profile of Psychiatric In-Patient Admissions With No Fixed Abode (NFA) 2007-2016

      Daly, A; Craig, S; O’ Sullivan, E (Irish Medical Journal, 2019-01)
    • Five-year standardised mortality ratios in a cohort of homeless people in Dublin

      Ivers, Jo-Hanna; Zgaga, Lina; O'Donoghue-Hynes, Bernie; Heary, Aisling; Gallwey, Brian; Barry, Joe (BMJ Open, 2019-01)
    • Clarifying the mechanisms and resources that enable the reciprocal involvement of seldom heard groups in health and social care research: A collaborative rapid realist review process

      Ní Shé, Éidín; Morton, Sarah; Lambert, Veronica; Ní Cheallaigh, Cliona; Lacey,  Vanessa; Dunn, Eleanor; Loughnane, Cliona; O'Connor, Joan; McCann, Amanda; Adshead, Maura; Kroll, Thilo (Health Expectations, 2019-01)
    • Blue care: a systematic review of blue space interventions for health and wellbeing.

      Britton, Easkey; Kindermann, Gesche; Domegan, Christine; Carlin, Caitriona (Health Promotion International, 2018-12-18)
      There is increasing interest in the potential use of outdoor water environments, or blue space, in the promotion of human health and wellbeing. However, therapeutic nature-based practices are currently outpacing policy and the evidence base for health or wellbeing benefits of therapeutic interventions within blue space has not been systematically assessed. This systematic review aims to address the gap in understanding the impacts of blue space within existing interventions for targeted individuals. A systematic review was carried out, searching Google Scholar, SCOPUS, PubMed, etc. through to August 2017. Only blue space interventions were included that were specifically designed and structured with a therapeutic purpose for individuals with a defined need and did not include nature-based promotion projects or casual recreation in the outdoors. Thirty-three studies met the inclusion criteria and were assessed. Overall, the studies suggest that blue care can have direct benefit for health, especially mental health and psycho-social wellbeing. The majority of papers found a positive or weak association between blue care and health and wellbeing indicators. There was also some evidence for greater social connectedness during and after interventions, but results were inconsistent and mixed across studies with very few findings for physical health. This is the first systematic review of the literature on blue care. In summary, it has been shown that mental health, especially psycho-social wellbeing, can be improved with investment in blue spaces. Key areas for future research include improving understanding of the mechanisms through which blue care can improve public health promotion.
    • Irish general practitioners' view of perinatal mental health in general practice: a qualitative study.

      Noonan, Maria; Doody, Owen; O'Regan, Andrew; Jomeen, Julie; Galvin, Rose (BMC Family Practice, 2018-12-13)
      Identification of perinatal mental health problems and effective care for women who experience them are important considering the potentially serious impact that they may have on the wellbeing of the woman, her baby, family and wider society. General practitioners (GPs) play a central role in identifying and supporting women and this study aimed to explore GPs' experiences of caring for women with perinatal mental health problems in primary care. The results of this study may provide guidance to inform policy, practice, research and development of curriculum and continuous professional development resources. In-depth semi-structured interviews were undertaken between March and June 2017 with GPs (n = 10) affiliated with a University training programme for general practice in Ireland. Thematic data analysis was guided by Braun and Clarkes (2013) framework. Data were categorised into three themes with related subthemes: identification of perinatal mental health problems, decision making around perinatal mental health and preparation for a role in perinatal mental health. GPs described the multifaceted nature of their role in supporting women experiencing perinatal mental health issues and responding to complex psychological needs. Inbuilt tools on existing software programmes prompted GPs to ask questions relating to perinatal mental health. Limited access to referral options impacts on assessment and care of women. GPs desire further continuous professional development opportunities delivered in an online format and through monthly meetings and conference sessions. GPs require access to culturally sensitive; community based perinatal mental health services, translation services and evidence based perinatal psychological interventions. A standardised curriculum on perinatal mental health for trainee GPs needs to be established to ensure consistency across primary care and GP education should incorporate rotations in community and psychiatry placements.
    • National Audit of Hospital Mortality Annual Report 2017

      National Office of Clinical Audit (NOCA); National Office of Clinical Audit (National Office of Clinical Audit, 2018-12)
    • Irish Hip Fracture Database National Report 2017

      National Office of Clinical Audit; Health Service Executive (HSE) (National Office of Clinical Audit, 2018-11-29)
    • Barriers to progressing through a methadone maintenance treatment programme: perspectives of the clients in the Mid-West of Ireland's drug and alcohol services.

      Moran, Lisa; Keenan, Eamon; Elmusharaf, Khalifa (BMC Health Services Research, 2018-11-29)
      The 'perfect' journey through an Irish Methadone Maintenance Treatment Programme (MMTP) would have a client engage appropriately with all relevant services available to them, inclusive of psychiatry, counselling, out-reach support, nursing and psychology. Concurrently, a client would ideally adhere to their prescribed methadone-dosing regimen, until a client is stabilised allowing them to function optimally. At this point, a client should transfer to the GP community setting. Unfortunately, this fails to occur. To date, very few studies have specifically investigated the reasons why a cohort of clients remain 'trapped' in the high risk, specialist clinical setting. Qualitative detailed semi-structured interviews were undertaken with 17 clients of one of Ireland's Health Service Executive (HSE) Drug and Alcohol Services, entitled 'HSE Mid-West Limerick Drug and Alcohol Service'. Each client had a severe Opioid Use Disorder (OUD) and clients had spent on average 7.5 years engaging with the MMTP. Participants' life journey prior to an OUD included Adverse Childhood Experiences (ACEs) and early exposure to illicit drug use. Shared life events resulting in their initiating and sustaining an OUD involved continuous hardship into adulthood, mental illness and concurrent benzodiazepine use disorder, often resulting in harrowing accounts of participants' loneliness and lack of life purpose. Their living environments, an erroneous understanding of their illness and poor communication with allied health professionals further perpetuated their OUD. Positive factors influencing periods of abstinence were familial incentives and a belief in the efficacy of methadone. Clients own suggestions for improving their journeys included employing a multi-sectorial approach to managing OUD and educating themselves and others on opioid agonist treatments. If clients were not progressing appropriately, they themselves suggested enforcing a 'time-limit' on clients to engage with the programme or indeed for their treatment to be postponed. To optimise the functioning of the MMTP, three tasks need to be fulfilled: 1) Reduce the incidences of ACEs, 2) Diagnose and treat clients with a dual diagnosis 3) Educate clients, their families, the public and allied health care professionals on all aspects of OUD. A cross- departmental, inter-governmental approach is needed to address opioid misuse as a societal issue as a whole.
    • Wellbeing and Health in Ireland’s over 50s 2009-2016

      TILDA; Trinity College Dublin (The Irish Longitudinal Study on Ageing, 2018-11-28)
    • Self-management needs of Irish adolescents with Juvenile Idiopathic Arthritis (JIA): how can a Canadian web-based programme meet these needs?

      O'Sullivan, Grace; O'Higgins, Siobhán; Caes, Line; Saetes, Sophia; McGuire, Brian E; Stinson, Jennifer (Pediatric Rheumatology, 2018-11-08)
      Juvenile Idiopathic Arthritis (JIA) affects over 1000 children and adolescents in Ireland, potentially impacting health-related quality-of-life. Accessible self-management strategies, including Internet-based interventions, can support adolescents in Ireland where specialist rheumatology care is geographically-centralised within the capital city. This study interviewed adolescents with JIA, their parents, and healthcare professionals to (i) explore the self-management needs of Irish adolescents; and (ii) evaluate the acceptability of an adapted version of a Canadian JIA self-management programme (Teens Taking Charge: Managing Arthritis Online, or TTC) for Irish users. Focus groups and interviews were conducted with Irish adolescents with JIA (N = 16), their parents (N = 13), and Irish paediatric healthcare professionals (HCPs; N = 22). Adolescents were aged 12-18 (M Five themes emerged: independent self-management; acquiring skills and knowledge to manage JIA; unique challenges of JIA in Ireland; views on web-based interventions; and understanding through social support. Adolescents acknowledged the need for independent self-management and gradually took additional responsibilities to achieve this goal. However, they felt they lacked information to manage their condition independently. Parents and adolescents emphasised the need for social support and felt a peer-support scheme could provide additional benefit to adolescents if integrated within the TTC programme. All participants endorsed the TTC programme to gain knowledge about JIA and offered suggestions to make the programme relevant to Irish users. There is scope for providing easily-accessible, accurate information to Irish families with JIA. The acceptability of adapting an existing JIA self-management intervention for Irish users was confirmed.
    • Intensive home care packages for people with dementia: a realist evaluation protocol.

      Keogh, Fiona; Pierce, Maria; Neylon, Karen; Fleming, Padraic (2018-11-01)
      Dementia presents a significant challenge to health systems and to the person and family affected. Home care is increasingly seen as a key service in addressing this challenge in a person-centred and cost-effective way. Intensive Home Care Packages (IHCPs) were introduced in Ireland to provide personalised and high levels of support for people with dementia to remain at home or be discharged home from hospital, and to build on the work of the HSE & Genio Dementia Programme. This realist evaluation is concerned with real world questions of feasibility and effectiveness; specifically understanding in what ways IHCPs work, how optimum outcomes are achieved, for whom and in what contexts do IHCPs work best. A mixed-method, multi-stakeholder study was designed within a realist evaluation conceptual framework. The process evaluation includes semi-structured interviews with health service staff at all levels, social network analysis and secondary database analysis; the outcomes evaluation includes quantitative measures and qualitative data collected through in-depth interviews with people with dementia and family carers; and the cost evaluation includes analysis of data from the Resource Utilisation in Dementia (RUD). The four stage cycle of realist evaluation is adopted, with iterative rounds of theory formulation, data collection and theory testing throughout. This realist evaluation of a complex intervention involves a variety of data and perspectives in order to provide confidence in moving from hypothetical constructs about how IHCPs might work to explanations of potential or observable causal mechanisms. In spite of being a key form of service delivery in most healthcare systems, the ways in which home care works to produce the desired outcomes seems to be poorly understood. While there is much descriptive and comparative work, there is a lack of understanding regarding which patient groups might benefit most from home care, or the influence of different service or cultural contexts on outcomes from home care. As well as addressing the core research objectives, this study aims to make a contribution to the underlying theory of home care in ways that can progress our understanding of how outcomes are produced for home care recipients.
    • Child & Adolescent Emergency Mental Health Crisis: A Neglected Cohort

      McNicholas, F; University College Dublin (Irish Medical Journal, 2018-11)
    • A Cross-Sectional Study of Antibiotic Prescribing for Childhood Upper Respiratory Tract Infections in Irish General Practice

      Maguire, F; Murphy, ME; Rourke, R; Morgan, F; Brady, G; Byrne, E; O’Callaghan, ME (Irish Medical Journal, 2018-11)
    • Ethnic Minority Health in Ireland-Co-creating knowledge (EMH-IC): a participatory health research protocol.

      Hannigan, Ailish; Basogomba, Alphonse; LeMaster, Joseph; Nurse, Diane; O'Reilly, Fiona; Roura, Maria; Villarroel, Nazmy; MacFarlane, Anne (BMJ Open, 2018-10-31)
      International policy recommends continuous, cost-effective monitoring of health data to enable health services to identify and respond to health inequities as experienced by different ethnic groups. However, there is a lack of routinely collected ethnicity data, particularly in primary care, and very little implementation research internationally to understand how ethnic identifiers are introduced, embedded and used in healthcare settings. This paper describes a protocol for a novel participatory health research project with the objective of building the evidence base on ethnic minority health in Ireland. Findings on the participatory appraisal of ethnic identifiers as an intervention to generate useful data about minority and majority ethnic groups will have relevance in other settings and countries. This multidisciplinary project is designed as a participatory health research study where all stakeholders, including ethnic minority communities, participate in co-design of the research protocol, project governance, collaborative data interpretation and disseminating findings. A national catalogue of all routinely collected health data repositories will be electronically searched for any repositories that contain information on ethnicity. A secondary quantitative analysis of a population-representative cohort study, Growing Up in Ireland, will be carried out to compare the health of ethnic minority and majority groups. A qualitative case study informed by normalisation process theory will be carried out at three primary care sites to monitor the implementation of an ethnic identifier and identify barriers and levers to implementation. Ethical approval for the qualitative case study has been granted by the Irish Council for General Practitioners (06/09/17). Permission to access data from Growing Up in Ireland has been granted by the Director General of the Central Statistics Office. Dissemination will be carried out at community events and academic conferences, in peer-reviewed journal publications, and through academic and healthcare provider networks.
    • Voices that matter: end-of-life care in two acute hospitals from the perspective of bereaved relatives.

      Donnelly, Sarah; Prizeman, Geraldine; Coimín, Diarmuid Ó; Korn, Bettina; Hynes, Geralyn (BMC Palliative Care, 2018-10-19)
      End-of-life care (EoLC) is an experience that touches the lives of everyone. Dying in an acute hospital is a common occurrence in developed countries across the world. Previous studies have shown that there is wide variation in EoLC and at times is experienced as being of poor quality. Assessing and measuring the quality of care provided is a key component of all healthcare systems. This paper reports on the qualitative analysis of open-ended free text questions that were asked as part of a post-bereavement survey conducted in two adult acute hospitals in Ireland. This was a quantitative descriptive post-bereavement postal survey, gathering data retrospectively from relatives or friends of patients who died, utilising an adapted version of the VOICES (Views of Informal Carers - Evaluation of Services) questionnaire. VOICES MaJam has 29 core questions, seven questions requesting personal demographic information and four open-ended questions gathering descriptive data about the care experience during the patient's last admission to hospital. A total of 356 valid questionnaires were returned. Qualitative data were managed, coded and analysed with NVivo 10, using a template analysis framework approach. Three quarters (75%: n = 268) responded to at least one of the open-ended questions. Several key themes emerged, indicating areas that require particular attention in EoLC. Two themes relate to how care needs are met and how the hospital environment has a critical influence on EoLC experiences. The remaining three themes relate more to the interpersonal context including whether patients are treated with dignity and respect, the psychological, emotional and spiritual needs of patients and their family members and communication. Acute hospitals need to ensure that patients and their relatives receive high quality EoLC. Seeking the views of bereaved relatives should be considered by all hospitals and healthcare settings to ascertain the quality of care at end of life. This study contributes to our understanding and knowledge of what good EoLC looks like and where care can be improved, thus enabling hospitals to direct and inform quality improvement.
    • An Evaluation of the MindOut Programme in Disadvantaged Post-Primary Schools (Executive Summary)

      Dowling, Katherine; Barry, Margaret M.; Health Promotion Research Centre NUI Galway (Health Service Executive, 2018-10-01)
    • An Evaluation of The Role of The Traveller Mental Health Liaison Nurse in Carlow and Kilkenny

      Keogh, B; Brady, A.M; Downes, C; Doyle, L; Higgins, A; McCann, T; School of Nursing and Midwifery Trinity College Dublin (School of Nursing and Midwifery, Trinity College Dublin, The University of Dublin, 2018-10)
    • Exercise Rehabilitation Services Provided by Physiotherapy Departments in Cancer Care in Ireland

      Mulcahy, S; Prendergast, J; Foley, G; O Hare, A; Murphy, E; Guinan, E.M; Hussey, J; Trinity College Dublin (Irish Medical Journal, 2018-10)