DSpace Collection: Public Health & Primary Care (Scholarly Publications)

The effect of differential eligibility for free GP services on GP utilisation in Ireland

Sun, 01 Jan 2012 00:00:00 GMT

Title: The effect of differential eligibility for free GP services on GP utilisation in Ireland Author: SMITH, SAMANTHA; NOLAN, ANNE Abstract: Internationally, there is extensive empirical evidence that a strong primary care-led health system is associated with improved health outcomes, increased quality of care, decreased health inequalities and lower overall health-care costs. Within primary care, factors influencing access to, and utilisation of, general practitioner (GP) services have been widely examined and this paper focuses on the role of user financial incentives. In particular, user charges for health care have been observed to deter health-care utilisation. Relative to other countries, the Irish health-care system is unusual in that the majority of the population are required to pay out-of-pocket for GP care. However, in 2005 the Irish government extended eligibility for free GP care to a further small subset of the population. Using micro-data from a nationally representative survey of the population in 2007, this paper analyses the impact of differential coverage of free GP services on GP utilisation in Ireland. Results from multivariate regression analysis indicate that GP utilisation is significantly more likely in the context of free GP care, controlling for a range of demographic, socio-economic and health factors. Interpretation of the results for the new category of coverage is complicated by possible pent-up demand and selection effects. Description: PUBLISHED

Writing Henry: The moralities of representation

Sat, 01 Jan 2011 00:00:00 GMT

Title: Writing Henry: The moralities of representation Author: LARKAN, FIONA Abstract: Extreme human suffering and death has the potential to bring about a paralysing discomfiture, not merely about situations witnessed, but about how they should be represented. Should it be enough to tell the story, free from the trappings of disciplinary theories, of one man's attempt to live his death according to his own moral framework, and hope that there are enough people who will take the time to contemplate it? The story below is Henry's story. It does not seek to arouse moral sentiment by the exposition of one man's suffering. Nor does it attempt to valorise the man, or romanticize the abject poverty in which he lived. Rather it seeks to represent a life lived - to the death - on its own terms and according to its own morality. While drawn to the life-force of this man, and the brutality of his circumstances, my personal, moral and emotional responses conflict with my academic and social position. This demands a level of conscious intersubjectivity and critical self-reflection which, I argue, is a necessary part of the process that is too often glossed as fieldwork experiences or 'data' but in fact represents part of our lifeworld. Description: PUBLISHED

Spatial Variation in General Medical Services Income in Dublin General Practitioners

Sat, 01 Jan 2011 00:00:00 GMT

Title: Spatial Variation in General Medical Services Income in Dublin General Practitioners Author: O'DOWD, THOMAS; KELLY, ALAN Abstract: The general medical services (GMS) scheme provides care free at the point of use for the 30% most economically deprived section of the population and the elderly. Almost all people of over-70-year olds are eligible for the GMS scheme potentially directing resources away from those most in need. The aim of this study is to analyse the relationship between practice GMS income and deprivation amongst Dublin-based general practitioners (GPs). The practice GMS income in Dublin was analysed in relation to practice characteristics including the number of GPs, catchment area population, proportion of over-70-year olds in the catchment area, catchment deprivation, number of GMS GPs within 2 km, and average GMS practice income within 2 km. Practice GMS income was highest in deprived areas but is also a valuable source of income in the least deprived areas. The capitation rate for over-70-year olds provides an incentive for GPs to locate in affluent areas and potentially directs resources away from those in greater need. Description: PUBLISHED

Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer

Fri, 01 Jan 2010 00:00:00 GMT

Title: Diagnostic accuracy systematic review of rectal bleeding in combination with other symptoms, signs and tests in relation to colorectal cancer Author: TELJEUR, CONOR Abstract: Background: Rectal bleeding is a recognised early symptom of colorectal cancer. This study aimed to assess the diagnostic accuracy of symptoms, signs and diagnostic tests in patients with rectal bleeding in relation to risk of colorectal cancer in primary care. Methods: Diagnostic accuracy systematic review. Medline (1966 to May 2009), Embase (1988 to May 2009), British Nursing Index (1991 to May 2009) and PsychINFO (1970 to May 2009) were searched. We included cohort studies that assessed the diagnostic utility of rectal bleeding in combination with other symptoms, signs and diagnostic tests in primary care. An eight-point quality assessment tool was produced to assess the quality of included studies. Pooled positive likelihood ratios (PLRs), sensitivities and specificities were calculated. Results: Eight studies incorporating 2323 patients were included. Average weighted prior probability of colorectal cancer was 7.0% (range: 3.3–15.4%, median: 8.1%). Age greater than or equal to60 years (pooled PLR: 2.79, 95% confidence interval (CI) 2.00–3.90), weight loss (pooled PLR: 1.89, 95% CI: 1.03–3.07) and change in bowel habit (pooled PLR: 1.92, 95% CI: 0.54–3.57) raise the probability of colorectal cancer into the range of referral to secondary care but do not conclusively ‘rule in’ the diagnosis. Presence of severe anaemia has the highest diagnostic value (pooled PLR: 3.67, 95% CI: 1.30–10.35), specificity 0.95 (95% CI: 0.93–0.96), but still only generates a post-test probability of 21.6%. Conclusions: In patients with rectal bleeding who present to their general practitioner, additional ‘red flag’ symptoms have modest diagnostic value. These findings have implications in relation to recommendations contained in clinical practice guidelines. Description: PUBLISHED

An Extension in Eligibility for Free Primary Care and Avoidable Hospitalisations: A Natural Experiment

Sat, 01 Jan 2011 00:00:00 GMT

Title: An Extension in Eligibility for Free Primary Care and Avoidable Hospitalisations: A Natural Experiment Author: NOLAN, ANNE Abstract: In the Republic of Ireland, approximately 30 per cent of the population (‘medical card patients') are entitled to free GP services. Eligibility is determined primarily on the basis of an income means test. The remaining 70 per cent of the population (‘private patients') must pay the full cost of GP consultations. In July 2001, eligibility for a medical card was extended to all those over 70 years of age, regardless of income. This extension in eligibility provides a natural experiment whereby we can examine the influence of access to free GP services on avoidable hospitalisations. Avoidable hospitalisations are those that are potentially avoidable with timely and effective access to primary care services or that can be treated more appropriately in a primary care setting. Using hospital discharge data for the period 1999-2004, the purpose of this paper is to test the proposition that enhanced access to GP services for the over 70s after July 2001 led to a decline in avoidable hospitalisations among this group. The results indicate that while avoidable hospitalisations for the over 70s did decline after 2001, they also fell for the under 70s, meaning that a significant difference-in-difference effect could not be identified. Description: PUBLISHED

Understanding How Incentives Influence Motivation and Retention of Health Workers

Sat, 01 Jan 2011 00:00:00 GMT

Title: Understanding How Incentives Influence Motivation and Retention of Health Workers Author: BIDWELL, POSY; THOMAS, STEPHEN DAVID Editor: Stefane Kabene Abstract: A critical factor in addressing the human resources crisis in low and middle income countries (LMIC) is the ability to recruit, motivate and retain health workers. Failure in this area is one of the main causes of decline in availability of services and quality of care. Various financial and non-financial incentives have been implemented and this chapter will explore available evidence to see whether they have influenced motivation. Additionally, Maslow’s hierarchy of needs is used to determine if there is a hierarchy of how incentives are valued. While Maslow’s model is a useful tool to classify themes of health worker needs, it would appear that workers are motivated without each level having to be fulfilled in turn. While financial incentives may help with retention, they can cause erosion of professional ethos, do not increase job satisfaction or act as motivators to perform well. More research needs to be done in order to design more effective human resources strategies. Description: PUBLISHED

Prevalence and predictors of smoking in "smoke-free" bars. Findings from the International Tobacco Control (ITC) Europe Surveys

Sat, 01 Jan 2011 00:00:00 GMT

Title: Prevalence and predictors of smoking in "smoke-free" bars. Findings from the International Tobacco Control (ITC) Europe Surveys Author: ALLWRIGHT, SHANE PATRICIA ANN Abstract: National level smoke-free legislation is implemented to protect the public from exposure to second-hand tobacco smoke (SHS). The first aim of this study was to investigate how successful the smoke-free hospitality industry legislation in Ireland (March 2004), France (January 2008), the Netherlands (July 2008), and Germany (between August 2007 and July 2008) was in reducing smoking in bars. The second aim was to assess individual smokers’ predictors of smoking in bars post-ban. The third aim was to examine country differences in predictors and the fourth aim was to examine differences between educational levels (as an indicator of socioeconomic status). This study used nationally representative samples of 3,147 adult smokers from the International Tobacco Control (ITC) Europe Surveys who were surveyed pre- and post-ban. The results reveal that while the partial smoke-free legislation in the Netherlands and Germany was effective in reducing smoking in bars (from 88% to 34% and from 87% to 44% respectively), the effectiveness was much lower than the comprehensive legislation in Ireland and France which almost completely eliminated smoking in bars (from 97% to 3% and from 84% to 3% respectively). Smokers who were more supportive of the ban, were more aware of the harm of SHS, and who had negative opinions of smoking were less likely to smoke in bars post-ban. Support for the ban was a stronger predictor in Germany. SHS harm awareness was a stronger predictor among less educated smokers in the Netherlands and Germany. The results indicate the need for strong comprehensive smoke-free legislation without exceptions. This should be accompanied by educational campaigns in which the public health rationale for the legislation is clearly explained. Keywords: Ireland; France; Netherlands; Germany; smoking; public policy; health promotion; socioeconomic status; second-hand smoke Description: PUBLISHED

Prevalence, predictors and perinatal outcomes of peri-conceptional alcohol exposure-retrospective cohort study in an urban obstetric population in Ireland

Sat, 01 Jan 2011 00:00:00 GMT

Title: Prevalence, predictors and perinatal outcomes of peri-conceptional alcohol exposure-retrospective cohort study in an urban obstetric population in Ireland Author: MURPHY, DEIRDRE; MULLALLY, AOIFE; BARRY, JOSEPH Abstract: Background: Evidence-based advice on alcohol consumption is required for pregnant women and women planning a pregnancy. Our aim was to investigate the prevalence, predictors and perinatal outcomes associated with peri-conceptional alcohol consumption. Methods: A cohort study of 61,241 women who booked for antenatal care and delivered in a large urban maternity hospital between 2000 and 2007. Self-reported alcohol consumption at the booking visit was categorised as low (0-5 units per week), moderate (6-20 units per week) and high (>20 units per week). Results: Of the 81% of women who reported alcohol consumption during the peri-conceptional period, 71% reported low intake, 9.9% moderate intake and 0.2% high intake. Factors associated with moderate alcohol consumption included being in employment OR 4.47 (95% CI 4.17 to 4.80), Irish nationality OR 16.5 (95% CI 14.9 to 18.3), private health care OR 5.83 (95% CI 5.38 to 6.31) and smoking OR 1.86 (95% CI 1.73 to 2.01). Factors associated with high consumption included maternal age less than 25 years OR 2.70 (95% CI 1.86 to 3.91) and illicit drug use OR 6.46 (95% CI 3.32 to 12.60). High consumption was associated with very preterm birth (<32 weeks gestation) even after controlling for socio-demographic factors, adjusted OR 3.15 (95% CI 1.26-7.88). Only three cases of Fetal Alcohol Syndrome were recorded (0.05 per 1000 total births), one each in the low, moderate and high consumption groups. Conclusions: Public Health campaigns need to emphasise the importance of peri-conceptional health and prepregnancy planning. Fetal Alcohol Syndrome is likely to be under-reported despite the high prevalence of alcohol consumption in this population. Description: PUBLISHED

Peer support for patients with type 2 diabetes: cluster randomised controlled trial.

Sat, 01 Jan 2011 00:00:00 GMT

Title: Peer support for patients with type 2 diabetes: cluster randomised controlled trial. Author: O'DOWD, THOMAS; PAUL, GILLIAN MARGARET; KELLY, ALAN Abstract: OBJECTIVE: To test the effectiveness of peer support for patients with type 2 diabetes. DESIGN: Cluster randomised controlled. SETTING: 20 general practices in the east of the Republic of Ireland. PARTICIPANTS: 395 patients (192 in intervention group, 203 in control group) and 29 peer supporters with type 2 diabetes. INTERVENTION: All practices introduced a standardised diabetes care system. The peer support intervention ran over a two year period and contained four elements: the recruitment and training of peer supporters, nine group meetings led by peer supporters in participant's own general practice, and a retention plan for the peer supporters. MAIN OUTCOME MEASURES: HbA(1c); cholesterol concentration; systolic blood pressure; and wellbeing score. RESULTS: There was no difference between intervention and control patients at baseline. All practices and 85% (337) of patients were followed up. At two year follow-up, there were no significant differences in HbA(1c) (mean difference -0.08%, 95% confidence interval -0.35% to 0.18%), systolic blood pressure (-3.9 mm Hg, -8.9 to 1.1 mm Hg), total cholesterol concentration (-0.03 mmol/L, -0.28 to 0.22 mmol/L), or wellbeing scores (-0.7, -2.3 to 0.8). While there was a trend towards decreases in the proportion of patients with poorly controlled risk factors at follow-up, particularly for systolic blood pressure (52% (87/166) >130 mm Hg in intervention v 61% (103/169) >130 mm Hg in control), these changes were not significant. The process evaluation indicated that the intervention was generally delivered as intended, though 18% (35) of patients in the intervention group never attended any group meetings. CONCLUSIONS: A group based peer support intervention is feasible in general practice settings, but the intervention was not effective when targeted at all patients with type 2 diabetes. While there was a trend towards improvements of clinical outcomes, the results do not support the widespread adoption of peer support. Trial registration Current Controlled Trials ISRCTN42541690. Description: PUBLISHED

Before and after study of bar workers' perceptions of the impact of smoke-free workplace legislation in the Republic of Ireland

Mon, 01 Jan 2007 00:00:00 GMT

Title: Before and after study of bar workers' perceptions of the impact of smoke-free workplace legislation in the Republic of Ireland Author: ALLWRIGHT, SHANE PATRICIA ANN; KELLY, ALAN Abstract: BACKGROUND: Objectives: To compare support for, and perceptions of, the impacts of smoke-free workplace legislation among bar workers in the Republic of Ireland (ROI) pre- and post-implementation, and to identify predictors of support for the legislation. METHODS: Setting: Public houses (pubs) in three areas of the ROI. Design: Comparisons pre- and post-implementation of smoke-free workplace legislation. Participants: From a largely non-random selection, 288 bar workers volunteered for the baseline survey; 220 were followed up one year later (76.4%). Outcome measures: Level of support for the legislation, attitude statements concerning potential impacts of the law and modelled predictors of support for the legislation. RESULTS: Pre-implementation 59.5% of participants supported the legislation, increasing to 76.8% post-implementation. Support increased among smokers by 27.3 percentage points from 39.4% to 66.7% (p < 0.001) and among non-smokers by 12.4% percentage points from 68.8% to 81.2% (p = 0.003).Pre-legislation three-quarters of participants agreed that the legislation would make bars more comfortable and was needed to protect workers' health. Post-legislation these proportions increased to over 90% (p < 0.001). However, negative perceptions also increased, particularly for perceptions that the legislation has a negative impact on business (from 50.9% to 62.7%, p = 0.008) and that fewer people would visit pubs (41.8% to 62.7%, p < 0.001). After adjusting for relevant covariates, including responses to the attitude statements, support for the ban increased two to three-fold post-implementation. Regardless of their views on the economic impact, most participants agreed, both pre- and post-implementation, that the legislation was needed to protect bar workers' health. CONCLUSION: Smoke-free legislation had the support of three-quarters of a large sample of bar workers in the ROI. However, this group holds complex sets of both positive and negative perspectives on the legislation. Of particular importance is that negative economic perceptions did not diminish the widely held perception that the ban is needed to protect workers' health. Description: PUBLISHED