Health Care In Ireland Research Articles

A Specialised Antenatal Music Therapy (SAMT) programme for pregnant women with mental health conditions: A mixed-methods proof-of-concept study in Ireland

ABSTRACT Introduction Perinatal mental health has a long-term impact on maternal and infant well-being. Non-pharmacological treatment options are needed for pregnant women and emerging evidence has shown the potential of music therapy to improve perinatal mental health and antenatal attachment. However, research is lacking on individual music therapy for pregnant women with mental health conditions and formal music therapy services are currently absent within perinatal mental health care in Ireland. This mixed-methods, proof-of-concept study aimed to assess the feasibility and preliminary evidence on the effectiveness of a specialised antenatal music therapy (SAMT) programme for pregnant women attending the Specialist Perinatal Mental Health Service (SPMHS). Method Pregnant women between 25 and 33 weeks gestation with various mental health conditions were recruited through the SPMHS to receive six in-person or online sessions of SAMT. Feasibility outcomes included retention, adherence, and fidelity.\\ Assessment of participants’ wellbeing, anxiety, and antenatal attachment were conducted before and after SAMT and each session. Semi-structured interviews were conducted and analysed using thematic analysis. Results Twelve pregnant women were included and nine completed SAMT and assessments, demonstrating a 75% retention rate. High levels of adherence and fidelity were reported. Significant improvements were observed in participants’ wellbeing, anxiety levels, and antenatal attachment. Qualitative findings highlighted the therapeutic benefits, the accessibility and challenges of the online setting, distinctive therapeutic experiences, and participants’ recommendations. Discussion The findings suggest implementing SAMT within the Irish SPMHS is feasible and beneficial. The study offers insights into the therapeutic mechanisms of SAMT and supports the progression to a larger trial.

Tracking aspects of healthcare activity during the first nine months of COVID-19 in Ireland: a secondary analysis of publicly available data.

Sláintecare aims to introduce universal healthcare in Ireland. The COVID-19 pandemic poses both challenges and opportunities to this process. This study explored the impact of COVID-19 on aspects of Irish healthcare during the first nine months of the pandemic and considers the implications for Sláintecare implementation. Secondary analysis was undertaken on publicly available data on three key domains of the Irish healthcare system: primary care, community-based allied healthcare, and hospitals. Descriptive statistics were computed using Microsoft Excel 2016. Up to March 2021, 3.76 million COVID-19 tests were performed by Ireland's public healthcare system, 2.48 million (66.0%) of which were referred from the community. General practitioners delivered 2.31 million telephone triages of COVID-19 symptoms, peaking in December 2020 when 416,607 consultations occurred. Patient numbers across eight allied healthcare specialties fell by 35.1% versus previous years, with the greatest reductions seen in speech and language therapy (49.0%) and audiology (46.1%). Hospital waiting lists increased from 729,937 to 869,676 (or by 19.1%) from January 2019 to January 2021. In January 2021, 629,919 patients awaited a first outpatient clinic appointment, with 170,983 (27.1%) waiting longer than 18 months. The largest outpatient lists were observed in orthopaedic surgery (n=77,257); ear, nose and throat surgery (n=68,073); and ophthalmology (n=47,075). The proportion of patients waiting more than 12 months for a day-case gastrointestinal endoscopy rose from 6.0% in January 2020 to 19.0% in January 2021. Healthcare activity has been significantly disrupted by COVID-19, leading to increased wait times and greater barriers to healthcare access during the pandemic. Yet, Ireland's health system responses also revealed strong willingness and ability to adapt and to implement novel solutions for healthcare delivery, rapidly and at scale. This has demonstrated what is achievable under Sláintecare and provides a unique opportunity to 'build back better' towards sustainable recovery.

‘Look up from the waiting list and see the bigger picture’: a qualitative analysis of clinical specialist physiotherapist perspectives on low back pain care in Ireland

IntroductionHealthcare systems are struggling to deliver high-quality low back pain (LBP) care. In 2012 specialist physiotherapist-led musculoskeletal (MSK) triage services were introduced in Irish hospitals to expedite patient care and alleviate pressure on elective orthopaedic/ rheumatology consultant clinics. Specialist physiotherapists have expertise to inform health service improvement and reform, but their perspectives of LBP healthcare delivery have received scant attention. ObjectivesTo explore specialist physiotherapists’ perspectives on LBP care in Ireland, the barriers and facilitators to quality LBP care and the development of MSK interface services in primary care settings. DesignCross-sectional observational study using an anonymous electronic survey with thematic framework analysis of response data from open-ended questions. ParticipantsThirty-four clinical specialist physiotherapists in Irish MSK triage services. ResultsThematic analysis resulted in six overarching themes, grouped into two categories. One category pertained to LBP healthcare in Ireland with the following three themes: 1) Inadequate health services for patients with LBP; 2) Need for defined LBP clinical pathways; 3) Need for a multisectoral approach to spine health. Themes in the second category, pertaining to the development of community-based MSK interface services, were: 4) Concern regarding isolation from secondary care services; 5) Unrealistic expectations of MSK triage; 6) Improved communication and collaboration with primary care services. ConclusionSpecialist physiotherapists have concerns regarding LBP health services and persistence of a biomedical, secondary care-led approach. They advocate for investment in primary care multi-disciplinary teams, enhanced integration across primary and secondary care, development of a national clinical pathway and a multisectoral approach. Contribution of paper•This study captures, for the first time, the perspectives of specialist physiotherapists on LBP healthcare delivery enabling a better understanding of the ‘on-the-ground’ issues in delivering quality LBP healthcare.•Opportunities for LBP healthcare service improvement are identified at micro, meso and macro health system levels.•The findings can be used to inform the development and implementation of a new national LBP clinical pathway and community-based MSK triage clinics.

Integrating Irish health care: How can we use the United Nations Convention on the Rights of Persons with Disabilities and Nine Pillars of Integrated Care?

Introduction: Over 1 billion (15%) of the world’s population are estimated to experience some form of disability, of whom up to 190 million people live with significant difficulties in functioning, often requiring health care services.
 Despite a myriad of policies and research, disabled people globally continue to be denied their human rights and face enduring barriers to full participation in society.
 The United Nations Convention on the Rights of Persons with Disabilities (UN CRPD) is an International Treaty setting out legal obligations on States to promote and protect the rights of persons with disabilities. It provides a unique opportunity to improve the quality of life of all disabled people. The convention identifies that disability arises as a result of barriers in society, including negative attitudes, inappropriate or inaccessible services that result in discrimination against persons with disabilities. The convention includes persons who are or will require Integrated Care. A number of the fifty Articles of the Convention are relevant as a framework to guide the implementation of Integrated Care for and with persons with disabilities. The aim of this workshop was to seek to understand how UNCRPD articles and the IFIC 9 pillars might inform priorities for integrated care.
 Methods: Led and co-designed by people with disabilities, a workshop was held to seek to understand from a broad audience how to use the UNCRPD to frame integrated health care in Ireland in parallel with the IFIC 9 pillars of integrated care.
 The workshop used a World Café methodology, a participatory multi-stakeholder action research process that takes place in a cafe style setting and supports the development of collective knowledge among individuals and communities to address shared problems.
 Participants were allocated into four groups to discuss the following four questions under the guidance of facilitators -
 1.In the context of the UNCRPD and the IFIC 9 pillars of integrated care what are the top 3 priorities to be addressed for people with disabilities across Ireland?
 2.What is currently happening in advancing integrated care for people with disabilities in Ireland?
 3.What would a successful, innovative integrated care system for people with disabilities in Ireland look like?
 4.What are the top 3 solutions you would like to see and work to see implemented immediately?
 Feedback and perspectives were captured on post-it notes and flipcharts and subsequently collated by facilitators. Data were reviewed, and a thematic analysis was conducted.
 Results: There were 20 participants from diverse backgrounds, including experts by experience, disabled persons organisations, academia and health services. Four key themes were generated through inductive thematic analysis: 1) the importance of co-production, 2) the need for equity as opposed to equality, 3) the need for data collection, sharing and knowledge mobilisation and 4) the need for a socioecological integrated care system for people with disabilities.
 Conclusions: Having policies and conventions, and models for the rights of persons with disabilities is not sufficient to ensure implementation. Successful implementation of integrated care needs enablers, including co-production of initiatives with persons with disabilities.

"In All Circumstances": Home Births and Collaborative Health Care in Ireland, 1900-1950.

This article examines the development of a collaborative model of home-based reproductive caregiving in Ireland from 1900 to 1950, focusing on the interactions of different practitioners in childbirth cases in the domestic sphere. In Ireland the move to obstetrics and trained nursing and midwifery was gradual, complicated by the needs and wants of ordinary women, who were reluctant to give up their trusted care givers and who actively sought to maintain long-standing domestic health care traditions. The result was a hybrid and collaborative model of domestic reproductive health care, requiring the attention of different practitioners, placing them in the same space, and necessitating that they work together. This dynamic and evolving system provided most pregnant, laboring, and postparturient women with essential reproductive care, but it would be overtaken by hospital-based reproductive medicine by around 1950, remaining only in folklore and memory by the late twentieth century.

Improving access to healthcare in Ireland: an implementation failure.

There are significant barriers to accessing health and social care services in Ireland including high user charges, long waits and limited availability of some services. While a number of reform proposals have committed to improving access to health care, implementation of these proposals has been limited. The aim of this paper is to identify and discuss policy implementation failures concerned with improving access to health and social care services in Ireland. Four potential reasons for the repeated failure to implement stated reform proposals are identified including a failure to identify and address the practicalities of implementation, competing health care demands, the political cycle and stakeholder resistance. While there has been a shift in Irish health care policy documents in the last 10 years with increasing emphasis on ensuring access to health care based on need rather than ability to pay, a repeated failure to implement the proposed reforms raises questions as to whether there is a real commitment to improving access to health care.

COVID-19 vaccination requirements for Ireland's healthcare students.

International debate on COVID-19 policy issues, notably negative social consequences, is vital when grappling with the pandemic legacy. Drawing from the second author's experiences in the Irish healthcare and higher education sectors, this commentary scrutinises measures that discriminated against students who declined novel COVID-19 pharmaceuticals. In so doing, it serves as a point of contrast to fear-based interventions. Connections are made with relevant literature when urging those in authority to ensure that policies intended to maximise vaccine coverage are seen to be fair and convincing. The commentary concludes with some reflections that could underpin more defensible policymaking and inform future research.

Factors that help and hinder transgender and nonbinary youth accessing gender care in Ireland: A multistakeholder exploration.

The purpose of this study was to identify the common factors that help and hinder transgender and nonbinary youth accessing gender-specific health care in Ireland and to identify how these factors may be perceived differently by young people seeking gender-affirming care, their parents, and health-care providers. Qualitative investigation utilizing framework analysis (FA). In-depth one-one interviews were conducted with transgender and nonbinary youth (n = 10), parents of youth (n = 10), and gender-specific health-care providers (n = 10). Maximum variation and snowball sampling were used to recruit participants across Ireland. An interview guide codesigned with an expert panel of gender-diverse youth was utilized. Interviews were audio-recorded and transcribed verbatim. FA was used to code the data and identify key issues and recommendations. Four themes were derived: (1) "Needing bricks to build" (structural factors); (2) "Enduring and convincing" (diagnostic factors); (3) "Being me, hiding me"; (personal factors); and (4) "It takes a tribe" (interpersonal factors). Each stakeholder group perceived different factors as help or hindrance in accessing care with varying intensities. Paramount to the future of gender services in Ireland is the investment of resources for children and young adults. Assessment is likely to remain a component of gender care, but youth recommend distinct revisions to the assessment process. Additional research would be useful in exploring the intersection of neurodiversity and gender as it pertains to health-care navigation. Family and peer support is a strong protective factor and enabler of health-care access among youth. Access to gender-specific health care remains difficult for transgender and non-binary youth. An understanding of the complexity of this healthcare navigation by healthcare professionals may help to mitigate future negative experiences. This study explores some of the clinical considerations that arise for this population from provider perspectives while elucidating the experiences of youth and parents attempting to access care. Further research is needed on longitudinal outcomes following medical and surgical interventions for transgender youth, including nonbinary identities.

Tracking aspects of healthcare activity during the first nine months of COVID-19 in Ireland: a secondary analysis of publicly available data

Background: Sláintecare aims to introduce universal healthcare in Ireland. The COVID-19 pandemic poses both challenges and opportunities to this process. This study explored the impact of COVID-19 on aspects of Irish healthcare during the first nine months of the pandemic and considers the implications for Sláintecare implementation. Methods: Secondary analysis was undertaken on publicly available data on three key domains of the Irish healthcare system: primary care, community-based allied healthcare, and hospitals. Descriptive statistics were computed using Microsoft Excel 2016. Results: Up to March 2021, 3.76 million COVID-19 tests were performed by Ireland’s public healthcare system, 2.48 million (66.0%) of which were referred from the community. General practitioners delivered 2.31 million telephone triages of COVID-19 symptoms, peaking in December 2020 when 416,607 consultations occurred. Patient numbers across eight allied healthcare specialties fell by 35.1% versus previous years, with the greatest reductions seen in speech and language therapy (49.0%) and audiology (46.1%). Hospital waiting lists increased from 729,937 to 869,676 (or by 19.1%) from January 2019 to January 2021. In January 2021, 629,919 patients awaited a first outpatient clinic appointment, with 170,983 (27.1%) waiting longer than 18 months. The largest outpatient lists were observed in orthopaedic surgery (n=77,257); ear, nose and throat surgery (n=68,073); and ophthalmology (n=47,075). The proportion of patients waiting more than 12 months for a day-case gastrointestinal endoscopy rose from 6.0% in January 2020 to 19.0% in January 2021. Conclusions: Healthcare activity has been significantly disrupted by COVID-19, leading to increased wait times and greater barriers to healthcare access during the pandemic. Yet, Ireland’s health system responses also revealed strong willingness and ability to adapt and to implement novel solutions for healthcare delivery, rapidly and at scale. This has demonstrated what is achievable under Sláintecare and provides a unique opportunity to ‘build back better’ towards sustainable recovery.

My Health, My Language - multilingual video messages on health in Ireland.

In Ireland, 12% of the population was born outside of Ireland. Issues such as language, knowledge of entitlements and health systems may impact the health of some migrants and public health. Multilingual video messages have the potential to overcome some of these issues. Video messages on twenty-one health topics in up to twenty-six languages have been created. They are presented by healthcare workers living and working in Ireland who originate from other countries in a friendly relaxed style. Videos are commissioned by the Health Service Executive, Ireland's national health service. Scripts are written with medical, communication and migrant expertise. Videos are platformed on the HSE website, shared on social media, via QR code posters and by individual clinicians. Video topics to date include how to access health care in Ireland, the role of a GP, screening services, vaccinations, antenatal care, postnatal health, contraception and breastfeeding. There have been over 200,000 views of videos. Evaluation is underway. The importance of trusted information has been highlighted by the COVID-19 pandemic. Video messages presented by a professional who is culturally familiar have the potential to improve self-care, appropriate use of health services and uptake of prevention programmes. The format overcomes issues with literacy and a person can watch a video multiple times. Limitations include reaching those without internet access. Videos do not replace the need for interpreters but are a tool to improve understanding of systems, entitlements and health information, efficient for clinicians and empowering for individuals.

Tracking aspects of healthcare activity during the first nine months of COVID-19 in Ireland: a secondary analysis of publicly available data

Background: Sláintecare aims to introduce universal healthcare in Ireland. The COVID-19 pandemic poses both challenges and opportunities to this process. This study explored the impact of COVID-19 on aspects of Irish healthcare during the first nine months of the pandemic and considers the implications for Sláintecare implementation. Methods: Secondary analysis was undertaken on publicly available data on three key domains of the Irish healthcare system: primary care, community-based allied healthcare, and hospitals. Descriptive statistics were computed using Microsoft Excel 2016. Results: Up to March 2021, 3.76 million COVID-19 tests were performed by Ireland’s public healthcare system, 2.48 million (66.0%) of which were referred from the community. General practitioners delivered 2.31 million telephone triages of COVID-19 symptoms, peaking in December 2020 when 416,607 consultations occurred. Patient numbers across eight allied healthcare specialties fell by 35.1% versus previous years, with the greatest reductions seen in speech and language therapy (49.0%) and audiology (46.1%). Hospital waiting lists increased from 729,937 to 869,676 (or by 19.1%) from January 2019 to January 2021. In January 2021, 629,919 patients awaited a first outpatient clinic appointment, with 170,983 (27.1%) waiting longer than 18 months. The largest outpatient lists were observed in orthopaedic surgery (n=77,257); ear, nose and throat surgery (n=68,073); and ophthalmology (n=47,075). The proportion of patients waiting more than 12 months for a day-case gastrointestinal endoscopy rose from 6.0% in January 2020 to 19.0% in January 2021. Conclusions: Healthcare activity has been significantly disrupted by COVID-19, leading to increased wait times and greater barriers to healthcare access during the pandemic. Yet, Ireland’s health system responses also revealed strong willingness and ability to adapt and to implement novel solutions for healthcare delivery, rapidly and at scale. This has demonstrated what is achievable under Sláintecare and provides a unique opportunity to ‘build back better’ towards sustainable recovery.

Creating universal health care in Ireland: A legal context

In this paper we establish a working definition of, and develop a legal rationale for, the insertion of a constitutional Right to Health (RTH) protection in the Constitution of Ireland. We propose that a legal framework exists for the judicial enforcement of a right to health in Ireland, as based on parallels drawn between Irish case law and that of RSA, a comparable common law constitutional democracy with a developed jurisprudential approach to its constitutional RTH. When modelled after precedential international provisions, this right strengthens and defends health policy goals (such as universal health care) through a common-law system of governmental accountability. Additionally, national rights to health have observable correlations with improved public health, and it stimulates institutional initiatives. The 1937 Constitution of Ireland includes several personal, social, and economic rights, and a RTH would complement the existing right to primary education as a socio-economic right. We note these considerations were discussed during the legislative proposal made in the 32nd Dáil for a constitutional RTH, which emerged in response to Ireland’s ongoing efforts toward health policy reform.

Editors' Introduction: Women's Health and Reproductive Justice in Ireland

Editors' Introduction:Women's Health and Reproductive Justice in Ireland Cara Delay (bio) and Claire Bracken (bio) We began conceiving of this special issue in the heady weeks and months following the May 2018 vote to repeal the republic's antiabortion Eighth Amendment (1983). For just a moment all things seemed possible in terms of Irish women's health-care rights and realities. Even then, however, our training in reproductive justice—a framework created by American Black women encouraging us to move beyond a rights-based or legalistic framework to instead focus on intersectional access to women's bodily autonomy and the real-world contexts of reproduction (Ross, Radical Reproductive Justice; Ross, "What Is Reproductive Justice?"; Sister Song; Silliman et al.)—cautioned us against being overly optimistic. In working and living in the United States, we knew firsthand that legality often is less important to abortion access than a person's race or ethnicity, region, immigration status, and/or socioeconomic status.1 In late 2018, despite the referendum in the republic, the actual abortion legislation that would emerge was unclear. Moreover, Ireland's healthcare system, especially for women, had long been, as Jo Murphy-Lawless's work both here and previously has exposed, particularly dismal (Murphy-Lawless, "The Silencing of Women in Childbirth"; Murphy-Lawless, Reading Birth and Death). When limited legal abortion was introduced in the republic in early 2019, and, later that year, Northern Ireland took steps to decriminalize abortion, it became evident that actually providing abortion services island-wide would be a [End Page 5] complicated endeavor, one that necessitated a careful examination of the entire health-care system (Bloomer et al.). Thus a more general context of women's health in Ireland helps to elucidate and unpack the complexities and impact of the postrepeal moment. This is just one of the reasons that this special issue's substantial charting of the repeal campaign, momentum, and moment is placed alongside work that explores women's health in Ireland more generally, both past and present. Reproductive Justice and the Politics of Women's Health The legacies of the past—the shame conjoined with female sexuality, the "architecture of containment" (Smith), and "shame-industrial complex" (Hogan, Republic of Shame) that placed the "deviant" in institutions, and the reality that the state consistently "has protected its institutions rather than women themselves" (Murphy-Lawless in this issue)—not only troubled Irish women's access to legal abortion but also affected the health care that they received more generally, North and South. As several essays in this issue suggest, the island's history of institutionalization in Magdalen laundries, asylums, and mother-and-baby homes should also be read alongside the realities of inadequate health care for women and their oppressions by and through the medical establishment. Biopower, writes Abby Bender in this issue, "seeps into the other spaces of the nation." More specifically, the essays collated here encourage us to expand the notion of Smith's "architecture of containment" to include hospitals and indeed all health-care systems on the island.2 Murphy-Lawless's essay, for example, explains how the maternity-care system's neoliberal, "consumer-choice" worldviews and policies have resulted in not only deficient care but in some cases tragic and unnecessary maternal deaths. The Irish health-care system's neglect of and negligence toward women is also a key focus of Beth Sundstrom's article in this issue on the cervical-cancer prevention crisis in Ireland. So too is Luz Mar Gonzalez-Arias's analysis of Celia de Fréine's poetry collection Blood Debt, an important work that stages a powerful reckoning of the medical establishment with respect to the hepatitis C scandal, which saw 1,600 women contract the virus through infected Anti-D [End Page 6] immunoglobulin in the 1970s and 1990s. Through the voice of a poetic speaker who was infected with hepatitis C, de Fréine's collection hauntingly explores the politics of women's embodiment, health, and trauma. This special issue of Éire-Ireland contains one of de Fréine's poems, "scéal scéil"/"hearsay," from Fiacha Fola (2004) and Blood Debts (2014), which...

Help, I can’t help: A qualitative study of psychiatric nurse’s perspectives on their care for people who hear voices

WHAT IS KNOWN ABOUT THE SUBJECT?: There are no studies on the perceptions of psychiatric nurses on interventions they provided to people hearing voices while in an acute psychiatric unit in Ireland. There are three studies focussed on psychiatric nurses' experiences of caring for people that hear voices, two based in England and one based in Australia. Only two of these studies is focussed on nurses working in an acute psychiatric unit. WHAT IS THIS PAPER ADDS TO EXISTING KNOWLEDGE?: This study used semi-structured interviews to explore perceptions of psychiatric nurses in the Republic of Ireland on interventions they provided people hearing voices while in an acute psychiatric unit. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Further quantitative and qualitative research into the nursing practice for people experiencing auditory hallucinations, in both in-patient and community settings. Follow up supports and supervision after the completion training programmes should be implemented, to ensure the transition of skills and knowledge to the clinical environment. Further investigation into whether or not psychiatric nurses are well prepared for the developments outlined in national polices. ABSTRACT: Aims and Objectives To explore the perspectives and experiences of Irish psychiatric nurses working in acute care in regard to their role in addressing hearing voices in the people in their care, with a view to gain insight in the nurses' personal experiences, interventions they provide, attitudes, knowledge, facilitating factors and challenges. Background Treatment of auditory hallucinations often takes place in acute psychiatric care. Traditionally treatment was focused on medication, but this is no longer the sole approach, with psychosocial interventions gaining ground. Psychiatric nurses have the potential to provide these interventions. As part of the changing emphasis of mental health care in Ireland towards more responsibilities for psychiatric nurses, there is a need to establish whether psychiatric nurses are prepared to take up these added responsibilities. Design A qualitative study, comprising of semi-structured interviews (n=16). Results Four themes emerged through thematic analysis. These included (a) the importance of therapeutic relationships; (b) reservations about the emphasis on medication; (c) limitations to interventions; and (d) the lack of focus/structure of interventions. Conclusions The use of systematic psychosocial interventions for people who hear voices is not well supported in the acute psychiatric settings the psychiatric nurses in the study worked in.

Addiction psychiatry and COVID-19: impact on patients and service provision.

The Coronavirus Disease 2019 (COVID-19) pandemic has undoubtedly had a major impact on the provision of physical healthcare in Ireland and worldwide. The mental health impact of this pandemic cannot be underestimated, particularly relating to patients suffering from addiction. Heightened public stress and anxiety levels, increasing isolation and the physical consequences of addiction play a large role in the proliferation and ongoing relapse of substance misuse and behavioural addiction. Service provision is an ongoing challenge not only due to the increasing need for services given the increased mental health burden of COVID-19 but also the restrictions in place in clinical areas to achieve social distancing. The necessary adaptations to service provision provide opportunities for the analysis of current processes used in our addiction unit and the introduction of new processes to our service. The current crisis tests the sustainability of the service to provide the high standard of care required for these patients.

"What Bothers Me Most Is the Disparity between the Choices that People Have or Don't Have": A Qualitative Study on the Health Systems Responsiveness to Implementing the Assisted Decision-Making (Capacity) Act in Ireland.

Objective: The Assisted Decision-Making (ADM) (Capacity) Act was enacted in 2015 in Ireland and will be commenced in 2021. This paper is focused on this pre-implementation stage within the acute setting and uses a health systems responsiveness framework. Methods: We conducted face-to-face interviews using a critical incident technique. We interviewed older people including those with a diagnosis of dementia (n = 8), family carers (n = 5) and health and social care professionals (HSCPs) working in the acute setting (n = 26). Results: The interviewees reflected upon a healthcare system that is currently under significant pressures. HSCPs are doing their best, but they are often halted from delivering on the will and preference of their patients. Many older people and family carers feel that they must be very assertive to have their preferences considered. All expressed concern about the strain on the healthcare system. There are significant environmental barriers that are hindering ADM practice. Conclusions: The commencement of ADM provides an opportunity to redefine the provision, practices, and priorities of healthcare in Ireland to enable improved patient-centred care. To facilitate implementation of ADM, it is therefore critical to identify and provide adequate resources and work towards solutions to ensure a seamless commencement of the legislation.

Developing a university-accredited Lean Six Sigma curriculum to overcome system blindness.

This paper discusses the development of a Lean Six Sigma (LSS) postgraduate education programme that has enabled the delivery of over 90 quality improvement projects led by its graduates across 50 healthcare organizations in Ireland. A key success factor in embedding and sustaining LSS in these organizations was the accreditation by a major, national, research-intensive university of the LSS education programme from which the students graduated. To ensure the programme’s approval by the university it was necessary to contextualize LSS within established conceptual frameworks. This helped counter misconceptions that what was proposed was technical training in tools and techniques to provide quick fixes for routine healthcare process issues. Two related conceptual frameworks were selected to frame the curriculum: Senge’s Fifth Discipline and Deming’s System of Profound Knowledge. This paper focuses on how a central element of both frameworks, systems thinking or appreciation for a system, was enacted in the curriculum using Oshry’s work on system blindness. Showing how systems thinking was conceptualized in the curriculum established the legitimacy and credibility of the programme within academia. This led to the approval of the first university-accredited graduate programme in LSS for healthcare in Ireland.

Using a historical genealogical approach to examine Ireland's health care system.

The health of a nation tells much about the nature of a social contract between citizen and state. The way that health care is organised, and the degree to which it is equitably accessible, constitutes a manifestation of the effects of moments and events in that country's history. Research around health inequalities often focuses on demonstrating current conditions, with little attention paid to how the conditions of inequality have been achieved and sustained. This article presents a novel approach to inequalities research that focuses on examining powerful historical discourses as legitimising processes that serve to sustain unequal conditions. The use of this Foucauldian historical genealogical approach in a study of the Irish health care system is explored and proposed as a novel approach to the research of health inequities.

A pilot study of the duration of GP consultations in Ireland

BackgroundGeneral practitioner (GP)-led primary care is the linchpin of health care in Ireland. Reflecting international trends, there are increasing concerns about the sustainability of the current Irish GP service due to an increasing workload. Objective data on the duration of GP consultations are currently not available in Ireland. The objective of this pilot study is to demonstrate how the duration of consultations can be collected, using readily available administrative data.MethodsSoftware was developed to extract the duration of GP consultations using the opening and closing of electronic patient records associated with a GP consultation. GP practices (N = 3) comprising 15 GPs were recruited from a university-affiliated research network. A retrospective analysis of GP consultations with patients with diabetes for the 9 years between 2010 and 2018 was used to assess the feasibility of using this system to measure the duration of consultations.ResultsThe average duration of a consultation was 14.1 min for the 9 years spanning 2010 to 2018. Patients had an average time between consultations of 99 days.ConclusionsThis pilot study confirms that an administrative data set can be utilised at negligible cost to monitor GP practice consultation workload over time. Our preliminary pilot data show that GP consultation durations among participating practices were longer than the 5–11.7 min reported in the UK and show an increase over the period. Clearly, a larger number of practices and patients are required to substantiate this finding.

Study Abroad Course for Pre-pharmacy and Pharmacy Students to Learn About Global Health

Objective. To design, implement, and assess a study abroad course in Ireland for pre-professional and Doctor of Pharmacy (PharmD) students. Methods. An elective study abroad course was created for pre-professional and PharmD students at North Dakota State University. The course included comparison of the US and Ireland's health care delivery systems and participation in history and cultural experiences in Ireland. Prior to the trip, students and preceptors attended seminars related to the culture of Ireland. The three-week trip to Ireland took place between the spring and summer semesters in 2016. Student assignments while abroad included completion of a self-reflection journal with daily entries describing what the student learned and how the experience impacted them, and completion and presentation of a term paper comparing Ireland's pharmacy system with that in the United States. Pre- and post-travel surveys were conducted to assess students' perceptions of and learning from the experience, and to identify areas for course improvement. Results. Students' evaluations of the course and travel experiences were positive. However, students' perceptions of their cultural awareness were largely unchanged. Conclusion. The course was well received by students. Other PharmD programs may benefit from implementing similar study abroad experiences.