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Zhang M, Kelly C, McCarthy T, Tierney P, Brennan A, Burke L, McGrath C, Mullooly M, Murray D, Bennett K. Examining the COVID-19 impact on cancer surgery in Ireland using three national data sources. GLOBAL EPIDEMIOLOGY 2024; 8:100159. [PMID: 39239393 PMCID: PMC11375242 DOI: 10.1016/j.gloepi.2024.100159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 07/22/2024] [Accepted: 08/01/2024] [Indexed: 09/07/2024] Open
Abstract
Background The healthcare system in Ireland was profoundly affected by COVID-19. This study aimed to explore the impact of the pandemic on cancer surgery in Ireland, from 2019 to 2022 using three national health data sources. Methods A repeated cross-sectional study design was used and included: (i) cancer resections from the National Histopathology Quality Improvement (NHQI) Programmes; (ii) cancer surgery from the National Cancer Registry Ireland (NCRI), and (iii) cancer surgery from Hospital Inpatient Enquiry (HIPE) System. Cancer surgery was presented by invasive/in situ and invasive only cancers (NCRI & HIPE), and by four main cancer types (breast, lung, colorectal & melanoma for NCRI & HIPE data only). Results The annual number of cancer resections (NHQI) declined by 4.4% in 2020 but increased by 4% in 2021 compared with 2019. NCRI data indicated invasive/in-situ cancer surgery for the four main cancer types declined by 14% in 2020 and 5.1% in 2021, and by 12.3% and 7.3% for invasive cancer only, compared to 2019. Within HIPE for the same tumour types, invasive/in situ cancer surgery declined by 21.9% in 2020 and 9.9% in 2021 and by 20.8% and 9.6% for invasive cancer only. NHQI and HIPE data indicated an increase in the number of cancer surgeries performed in 2022. Conclusions Cancer surgery declined in the initial pandemic waves suggests mitigation measures for cancer surgery, including utilising private hospitals for public patients, reduced the adverse impact on cancer surgery.
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Affiliation(s)
- Mengyang Zhang
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | | | | | | | | | - Louise Burke
- Department of Pathology, Cork University Hospital/School of Medicine, University College Cork, Cork, Ireland
| | - Caitriona McGrath
- National Specialty Quality Improvement Programmes, Royal College of Physicians of Ireland, Dublin 2, Ireland
| | - Maeve Mullooly
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Deirdre Murray
- National Cancer Registry Ireland, Cork, Ireland
- School of Public Health, University College Cork, Cork, Ireland
| | - Kathleen Bennett
- School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
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Bhardwaj A, Hayes P, Browne J, Grealis S, Maguire D, O'Hora J, Dowling I, Kennedy N, Toomey CM. Barriers, facilitators and referral patterns of general practitioners, physiotherapists, and people with osteoarthritis to exercise. Physiotherapy 2024; 125:101416. [PMID: 39393262 DOI: 10.1016/j.physio.2024.101416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 07/04/2024] [Accepted: 07/18/2024] [Indexed: 10/13/2024]
Abstract
BACKGROUND Barriers and facilitators of general practitioners (GPs), physiotherapists (PTs), and people with hip and knee osteoarthritis (PwOA) may influence uptake of and referral to guideline-based exercise treatments for OA. OBJECTIVE To identify barriers and facilitators of GPs, PTs and PwOA to uptake of and referral to exercise treatments for OA. METHODS An online survey was circulated to GPs, PTs, and PwOA in Ireland from March to September 2021. Data were collected on demographics, barriers and facilitators, and referral patterns to exercise treatments for OA. Frequency distributions were used to illustrate demographics, barriers and facilitators, and referral patterns to exercise treatments for OA. RESULTS 388 stakeholders responded (GPs = 148; PTs = 154; PwOA = 86). Barriers and facilitators were related to (1) stakeholder (e.g., patient tiredness and fatigue), (2) healthcare setting (e.g., appropriate referrals from GP or other sources), and (3) treatment (e.g., low-cost community-based exercise programmes) factors. While 91% of GPs would refer PwOA to physiotherapy if no barriers existed, only 60% would in their current practice. Only 33% of PwOA reported receiving a GP referral to physiotherapy. CONCLUSION Stakeholder, healthcare setting and treatment barriers and facilitators of GPs, PTs, and PwOA influence uptake of and referral to exercise treatments for OA. Future strategies Future strategies addressing these factors may improve implementation of guideline-based management for OA. CONTRIBUTION OF THE PAPER.
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Affiliation(s)
- Avantika Bhardwaj
- School of Allied Health, University of Limerick, Limerick V94 T9PX, Ireland; Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland.
| | - Peter Hayes
- Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland; School of Medicine, University of Limerick, Limerick V94 T9PX, Ireland
| | - Jacqui Browne
- Patient Representative, IMPACT Steering Committee, Ireland
| | - Stacey Grealis
- Patient Representative, IMPACT Steering Committee, Ireland; EULAR Centre of Excellence, Centre for Arthritis and Rheumatic Diseases, Dublin Academic Medical Centre, University College Dublin, Belfield, Dublin 4, Ireland
| | - Darragh Maguire
- Physiotherapy Department, National Orthopaedic Hospital Cappagh, Dublin D11 EV29, Ireland
| | - John O'Hora
- Community Healthcare West, Co. Roscommon F42 VX53, Ireland
| | - Ian Dowling
- Ian Dowling Physiotherapy Clinic, Limerick V94 YA00, Ireland
| | - Norelee Kennedy
- School of Allied Health, University of Limerick, Limerick V94 T9PX, Ireland; Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland
| | - Clodagh M Toomey
- School of Allied Health, University of Limerick, Limerick V94 T9PX, Ireland; Health Research Institute, University of Limerick, Limerick V94 T9PX, Ireland
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Bhardwaj A, FitzGerald C, Graham M, MacFarlane A, Kennedy N, Toomey CM. Barriers and facilitators to implementation of an exercise and education programme for osteoarthritis: a qualitative study using the consolidated framework for implementation research. Rheumatol Int 2024; 44:1035-1050. [PMID: 38649534 PMCID: PMC11108926 DOI: 10.1007/s00296-024-05590-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 04/04/2024] [Indexed: 04/25/2024]
Abstract
Targeted efforts to better understand the barriers and facilitators of stakeholders and healthcare settings to implementation of exercise and education self-management programmes for osteoarthritis (OA) are needed. This study aimed to explore the barriers and facilitators to the implementation of Good Life with osteoArthritis in Denmark (GLA:D), a supervised group guideline-based OA programme, across Irish public and private healthcare settings. Interviews with 10 physiotherapists (PTs; 8 public) and 9 people with hip and knee OA (PwOA; 4 public) were coded by the Consolidated Framework for Implementation Research (CFIR) constructs in a case memo (summary, rationale, quotes). The strong positive/negative implementation determinants were identified collaboratively by rating the valence and strength of CFIR constructs on implementation. Across public and private settings, PTs and PwOA strongly perceived GLA:D Ireland as evidence-based, with easily accessible education and modifiable marketing/training materials that meet participants' needs, improve skills/confidence and address exercise beliefs/expectations. Despite difficulties in scheduling sessions (e.g., work/caring responsibilities), PTs in public and private settings perceived advantages to implementation over current clinical practice (e.g., shortens waiting lists). Only PTs in public settings reported limited availability of internal/external funding, inappropriate space, marketing/training tools, and inadequate staffing. Across public and private settings, PwOA reported adaptability, appropriate space/equipment and coaching/supervision, autonomy, and social support as facilitators. Flexible training and tailored education for stakeholders and healthcare settings on guideline-based OA management may promote implementation. Additional support on organising (e.g., scheduling clinical time), planning (e.g., securing appropriate space, marketing/training tools), and funding (e.g., accessing dedicated internal/external grants) may strengthen implementation across public settings.
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Affiliation(s)
- Avantika Bhardwaj
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland.
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland.
| | - Christine FitzGerald
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Margaret Graham
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
- Department of Nursing & Midwifery, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Anne MacFarlane
- School of Medicine, University of Limerick, Limerick, V94 T9PX, Ireland
- Participatory Health Research Unit, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Norelee Kennedy
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
| | - Clodagh M Toomey
- School of Allied Health, University of Limerick, Limerick, V94 T9PX, Ireland
- Health Research Institute, University of Limerick, Limerick, V94 T9PX, Ireland
- Participatory Health Research Unit, University of Limerick, Limerick, V94 T9PX, Ireland
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Windrim EB, McGuire BE, Durand H. Women's experiences of seeking healthcare for abdominal pain in Ireland: a qualitative study. BMC Womens Health 2024; 24:166. [PMID: 38454395 PMCID: PMC10921746 DOI: 10.1186/s12905-024-02995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 02/23/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Evidence suggests that women's abdominal pain is more likely to be minimised or dismissed by healthcare professionals than men's. This can have a detrimental impact on health-related outcomes as well as quality of life. The aim of this study was to explore women's experiences of seeking healthcare for abdominal pain in Ireland. METHOD A qualitative design and opportunity sampling approach were employed in this study. Fourteen women living in Ireland with experience of seeking healthcare for abdominal pain took part in one-to-one semi-structured interviews via video-conferencing software. Data were analysed using reflexive thematic analysis. RESULTS Four themes were constructed from the data: [1] "Just Get on with It" - Normalisation and Invalidation; [2] "Bad Enough"? Costs of (Not) Seeking Help; [3] "Fight Your Case," Fight for Care; and [4] "Out of the Loop" - Systemic Barriers to Care. Perceived invalidation of pain by healthcare professionals was common, as was internalised normalisation of pain. This created challenges when negotiating pain management solutions. Despite functional interference, participants felt their pain needed to reach an extreme level of severity before seeking help. Costs of private healthcare were implicated in delayed help-seeking. Participants felt the onus was on them to fight for care. Social support and information-seeking facilitated participants in this fight while systemic issues were identified as barriers to adequate care. Despite their frustrations, participants expressed empathy for healthcare professionals operating in a flawed system. CONCLUSIONS Participants described mostly negative experiences of seeking healthcare for abdominal pain, characterised by dismissal of symptoms and internalisation of normative views of women's pain as less worthy of care. These experiences reinforced participants' views that self-advocacy is essential to access care for their pain. There are systemic issues at play within the Irish healthcare system that limit women's ability to access abdominal pain management support. Education and training for healthcare professionals on the Gender Pain Gap and its implications for patient care, as well as clear referral pathways for women presenting with abdominal pain, may help to ensure more equitable healthcare delivery for individuals with abdominal pain in Ireland.
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Affiliation(s)
| | - Brian E McGuire
- School of Psychology, University of Galway, Galway, Ireland
- Centre for Pain Research, University of Galway, Galway, Ireland
| | - Hannah Durand
- Division of Psychology, University of Stirling, Stirling, Scotland.
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Lightbourne A, Foley S, Dempsey M, Cronin M. Living With Endometriosis: A Reflexive Thematic Analysis Examining Women's Experiences With the Irish Healthcare Services. QUALITATIVE HEALTH RESEARCH 2024; 34:311-322. [PMID: 37988744 PMCID: PMC10905982 DOI: 10.1177/10497323231214114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2023]
Abstract
Endometriosis is an incurable chronic condition associated with debilitating pain and subfertility, affecting 1 in 10 women. The current study aims to explore the perceptions and experiences of women with endometriosis regarding the diagnosis, support and treatment options available in Ireland. It will further determine whether additional supports or improvements are needed to care well and effectively for women with this disease in the Irish healthcare system. A qualitative study design was deemed most suitable. Twenty participants, women aged 18 and over with a diagnosis of endometriosis and experience of the Irish healthcare system, were recruited through purposeful sampling to complete semi-structured, one-to-one online interviews. Data was analysed using reflexive thematic analysis, and five themes were identified: 'dismissive attitudes normalising severe pain', 'inadequate health system', 'the impact of delayed diagnoses', 'lack of education and awareness' and 'navigating ignorance, taboo and societal views'. Insights into the experiences and needs of women diagnosed with endometriosis in Ireland were gained, and we discuss the implications of our findings for Irish healthcare services with reference to feminist health equity and recent national action plans. We propose a series of recommendations for patient-centred care models including increased access to training and education, as well as support for longer-term chronic pain management.
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Affiliation(s)
| | - Sarah Foley
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Maria Dempsey
- School of Applied Psychology, University College Cork, Cork, Ireland
| | - Mary Cronin
- School of Public Health, University College Cork, Cork, Ireland
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Conneely M, Leahy S, Trépel D, Robinson K, Boland F, Moriarty F, Galvin R. Is There Evidence of an Association Between Acute Health Care Utilization and Function in Older Adults Over Time? A Population-Based Cohort Study. Innov Aging 2022; 7:igac072. [PMID: 36760657 PMCID: PMC9904187 DOI: 10.1093/geroni/igac072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives Acute health care use varies by age, with older adults the highest users of acute health care services. Using data from The Irish Longitudinal Study on Ageing (TILDA), the aim of this study was to investigate the association between acute health care utilization (emergency department [ED] visit with or without hospitalization) at baseline and subjective and objective measures of function measured at 4-year follow-up. Research Design and Methods This study represents a secondary analysis of a prospective cohort study, where data from Wave 1 (baseline) and Wave 3 of TILDA were analyzed in conjunction with a public and patient involvement group of older adults. Acute health care utilization was defined as an ED visit with or without hospitalization in the previous 12 months. Function was assessed objectively using the Timed Up and Go (TUG) test and a measure of grip strength, and subjectively using self-report limitations in activities of daily living (ADL) and instrumental ADL (IADL). Results A total of 1 516 participants met the study inclusion criteria. Mean age was 70.9 ± 4.6 years and 48% were male. At baseline, 1 280 participants reported no acute health care use. One hundred and eighteen indicated an ED visit but no hospitalization in the previous 12 months and 118 reported both an ED visit and hospitalization. Adjusting for all covariates, compared to those with no acute health care utilization, those with an ED visit with no hospital admission had poorer TUG performance at follow-up (β = 0.67, 95% confidence interval: 0.34, 1.29, p = .039). Discussion and Implications This paper supports previous research that acute health care events, specifically ED usage, are associated with reduced function for older adults as assessed by TUG at follow-up. No associations were observed for grip strength, ADL, or IADL. Further research is required in this area, exploring ED visits and the possible benefits of evaluating older adults at this stage.
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Affiliation(s)
- Mairéad Conneely
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Siobhán Leahy
- Department of Sport, Exercise & Nutrition, School of Science & Computing, Atlantic Technological University, Galway, Ireland
| | - Dominic Trépel
- Trinity Institute of Neurosciences, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Katie Robinson
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Fiona Boland
- Data Science Centre and the Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Rose Galvin
- School of Allied Health, Faculty of Education and Health Sciences, Ageing Research Centre, Health Research Institute, University of Limerick, Limerick, Ireland
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Keegan C, Brick A, Henry E, Bergin A. Projected private hospital expenditure in Ireland, 2018-2035: What role for demographics, cost, and Sláintecare? Int J Health Plann Manage 2021; 37:999-1017. [PMID: 34787926 DOI: 10.1002/hpm.3381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/12/2021] [Accepted: 10/25/2021] [Indexed: 11/12/2022] Open
Abstract
Despite private hospitals occupying an important role in the delivery of acute hospital care in Ireland, an understanding of future spending pressures on these services is limited. Particularly, a key dimension of Ireland's ambitious roadmap for healthcare reform (Sláintecare) seeks to remove private practice from public hospitals. However, to date, there has been no examination of how this reform could impact private hospital demand and expenditure, and ultimately, the capacity to treat public patients. Using previously unavailable administrative health insurer data and a healthcare macro-simulation projection model, we project real (volume-based) and nominal expenditure on private hospital services over the medium-term (2018-2035). We develop a number of projection scenarios that vary assumptions in relation to population growth and ageing, healthy ageing, and the future cost of care delivery. Additionally, by developing profiles of private activity in public hospitals, we examine how the removal of private practice from public hospitals could impact on demand and expenditure in private hospitals over time. Findings from this analysis have implications for capital investment and workforce planning in private hospitals, and failure to meet future demand could have implications for access to care in public hospitals. Moreover, should private practice be ended in public hospitals, most complex private in-patient and emergency care is likely to remain within the public hospitals with limited capacity benefits for the public system.
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Affiliation(s)
- Conor Keegan
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland.,School of Social Sciences & Philosophy, Trinity College Dublin, Dublin, Ireland
| | - Aoife Brick
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland.,School of Social Sciences & Philosophy, Trinity College Dublin, Dublin, Ireland
| | - Edward Henry
- JE Cairnes School of Business and Economics, Discipline of Economics, National University of Ireland Galway, Galway, Ireland
| | - Adele Bergin
- Social Research Division, Economic and Social Research Institute, Dublin, Ireland.,School of Social Sciences & Philosophy, Trinity College Dublin, Dublin, Ireland
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Penno E, Sullivan T, Barson D, Gauld R. Private choices, public costs: Evaluating cost-shifting between private and public health sectors in New Zealand. Health Policy 2020; 125:406-414. [PMID: 33402263 DOI: 10.1016/j.healthpol.2020.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/09/2020] [Accepted: 12/17/2020] [Indexed: 01/17/2023]
Abstract
New Zealand's dual public-private health system allows individuals to purchase health services from the private sector rather than relying solely upon publicly-funded services. However, financial boundaries between the public and private sectors are not well defined and patients receiving privately-funded care may subsequently seek follow-up care within the public health system, in effect shifting costs to the public sector. This study evaluates this phenomenon, examining whether cost-shifting between the private and public hospital systems is a significant issue in New Zealand. We used inpatient discharge data from 2013/14 to identify private events with a subsequent admission to a public hospital within seven days of discharge. We examined the frequency of subsequent public admissions, the demographic and clinical characteristics of the patients and estimated the direct costs of inpatient care incurred by the public health system. Approximately 2% of private inpatient events had a subsequent admission to a public hospital. Overall, the costs to the public system amounted to NZ$11.5 million, with a median cost of NZ$2800. At least a third of subsequent admissions were related to complications of a medical procedure. Although only a small proportion of private events had a subsequent public admission, the public health system incurred significant costs, highlighting the need for greater understanding and discussion around the interface between the public and private health systems.
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Affiliation(s)
- Erin Penno
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand; Centre for Health Systems and Technology, University of Otago, New Zealand
| | - Trudy Sullivan
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand; Centre for Health Systems and Technology, University of Otago, New Zealand.
| | - Dave Barson
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Gauld
- Centre for Health Systems and Technology, University of Otago, New Zealand; Otago Business School, University of Otago, Dunedin, New Zealand
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