patricia leahy warren, senior lecturer school of nursing and midwifery, ucc
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Primary and Secondary Healthcare: Challenges at the InterfaceTRANSCRIPT
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Patricia Leahy-Warren PhD,
Senior Lecturer School of Nursing and Midwifery, UCC
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Primary & Secondary Health Care:
Challenges at the Interface
Dr P. Leahy-WarrenNational Healthcare Conference
April 2nd 2014
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Objectives• Health Strategy and Policy• Challenges– Changing demographic profiles in population– Changes in delivery of services– Primary Care Teams– Information/communication– Economics/Resources
• Innovations • Conclusion
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Determinants of Health
At least 30% of cancers and 80% of heart disease, stroke and Type 2 diabetes can be prevented through regular physical activity, a healthy diet and non use of tobacco products
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Primary Care 2001
• Vision for 520 teams
Dr P. Leahy-Warren
90-95% of care will take place in the community
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Demographics
• Population: 4.593M• Population ≥65:
535,393 • Projected increase:
20-25% by 2036 • The population of
older adults increased by 14.4%
• Aged ≥100: 389 - an increase of 100 persons since 2006
• Life expectancy: 80.6 yrs• Chronic morbidities: – cardiovascular – cancer – chronic respiratory
disease– diabetes– Mental health
(dementia, depression, suicide etc.)
(CSO, 2011, 2012; NSP, 2014)
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Demographics…contd
• Highest birth rate in EU with 71,986 in 2012• Population of children aged 0-4 years is
356,329, by 18% • Population of Primary school-aged (5-12)
children is 504,267, by 12% • Number of children eligible for PHN service is
860,596
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Children & Young People
• 1: 100 infants are sometimes or often unwell and 17% infants have some minor problems
• 13% of infants admitted to hospital since their birth & spend 6 nights in hospital. ̴�
• A total of 153,905 hospital discharges in 2012 of which 14,085 were due to accidents
• More than half of the total hospital discharges in 2011 among children were children < 5 years
• 25% of three year old children are either overweight or obese (GUI; TSNC)
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Children & Young People…Contd• At age 3 years 16% of were reported as having at least one
longstanding illness, condition or disability (asthma (5.8%), eczema (3.9%), and digestive problem (1.2%)
• The average age for detection of severe hearing loss is over 3 years of age, which is above the acceptable age by international standards
• 31,626 referrals to the Social Work Services related to child protection concerns in 2012
• Nearly 10% of children aged 9-17 reported smoking cigarettes every day
• Over 20% of children aged 10-17 reported that they had been drunk at least once in the last 30 days
• There were 21 suicides of children aged 10-17 in 2009(GUI; TSNC)
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Changes in Health Service Delivery• >1.8 million Medical Cards (40.6%) 46% since
2008• 61% of adults are overweight & cost of obesity per
annum is aprox €1.13 billion• Chronic disease is due to by 40% by 2020• Advances in the development of medical
technologies are cost-intensive• Early discharge & more complex discharges• Complex care in the community• Backdrop of reduced resources
(NSP, 2014)Dr P. Leahy-Warren
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Patient/Client
Palliative Care
Chronic Sick
People with disabilities
Mental Health
CHILDREN
Older persons
Client Groups in Population
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CommunicationNothing is so simple that it cannot be misunderstood. — Freeman Teague, Jr
• Means of communication as barrier to smooth, safe, satisfactory transitioning – Inefficient information systems – Absence of Health Information legislation– Incompatible/insufficient access to IT systems– No standardisation of documentation/records e.g.
notification of births/CFHNA (O’Dwyer, 2012)– Lack of consistent data for auditability
• Need for a shared understanding of integrated care
Dr P. Leahy-Warren
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Primary Care Teams in Ireland• Many GPs (41.6%) (N=423)not part of a primary care team at
present but 10.1% will be part of team shortly (ICGP, 2011)• Primary Care Teams report that GPs in 54% of PCTs regularly
attend team meeting (Office of the Comptroller & Auditor General (OCAG) 2011).
• Presence of local primary care manager has Improved communications & team concept (ICGP 2011)
• Many GPs (64.6%) say that PCT are not functioning well (ICGP OCAG) 2011).
• GPs use computerised medical records……other PCT members (PHNS, RGNs, etc) have limited access and do not use computerised assessment.
• Major problems in team communications linked to lack of IT structures (OCAG 2011).
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Innovations • Cois Ti Maternity Care• Community Rehabilitation and Support Team (CRST)• Hospital at Home• Standardised assessment e.g. Child and Family Health
Needs Assessment • Child Health Information Technology App (CHeITA)• Promotion of self-care management of chronic illness• Increase in nurse-Led care and clinics • Further research to demonstrate concrete outcomes
and measures of success of primary care in Irish context
Dr P. Leahy-Warren
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Conclusion• Policy …challenges of demography and funding• Individual and collective responsibility for
health• Shift from high-cost, reactive and bed-based
care to care that is preventive, proactive and centred closer to people’s homes with main focus on wellness as well as an effective and efficient response to ill health
• Research and innovation with clear positive patient outcomes
Dr P. Leahy-Warren
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CCli
Integrated Primary Care Team
Single Assessment Process
Specialist Services
Social Supports
IntegratedTechnology
Regulation of Quality & Standards
Integrated Care
Client/Patient
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References• Begley, C., et al. (2013) Differences between clinical specialist and advanced
practitioner clinical practice, leadership, and research roles, responsibilities, and perceived outcomes (the SCAPE study). Journal of Advanced Nursing 69 (6), 1323-1337
• Central Statistics Office (CSO) 2012) Census 2011 Stationery Office, Dublin• Department of Health (2013) Healthy Ireland A Framework for Improved Health and
Well Being, Dublin: Stationery Office• Department of Health (2010) Primary Care Dublin: DoH• Department of Health (2010) Qualoity and Fairness Care Dublin: DoH• Department of Health (2012) Future Health A Strategic Framework for Reform of the
Health Service 2012 – 2015, Dublin: DoH• Growing up in Ireland http://www.growingup.ie/index.php?id=83• Health Service National Service Plan 2014 Dublin HSE• IMO Budget Submission 2014 http://www.imo.ie/IMO-Budget-2014-Submission.PDF• Office of the Comptroller and Auditor General Corporate Report (2011) Dublin
OCAG • O’ Riordan, M (2011) ICGP Report on Primary Care Teams: A GP Perspective• http://www.icgp.ie/go/archive/CF613CF0-19B9-E185-83176841131F682B.html• The State of the Nation's Children (2006) http://
www.dcya.gov.ie/docs/State_of_the_Nations_Children_Report/408.htmDr P. Leahy-Warren