SPHeRE Newsletter - Volume 2, Issue 1

VOLUME2 ISSUE 1 2015SPHeneRtwoErkPOPULATION HEALTH AND HEALTH SERVICES RESEARCH NETWORK UPDATEWelcome CONGRATULATIONSWelcome to the latest edition of the day a very clear focus emerged on the Medical SPHeRE Network Newsletter fo- application of research to practice and Researchcusing on the 1st Annual SPHeRE Confer- there was much discussion on how we Councilence: ‘Health Research, Policy and Practice best communicate the findings, particular- award- Creating links for Effective Collaboration’ ly from interventions that work, to thosewhich was held on 9th January. SPHeRE in decision making positions. Congratulations to Linda O’Keeffe (UCCscholars in attendance at the conference 2010 Cohort) who has recently beenwrote reflective pieces on individual ses- Planning for the 2nd SPHeRE Conference awarded a fully funded four year MRCsions for the newsletter. which will take place on 29th February Population Health Scientist Fellowship 2016 is already underway and we will noti- at the University of Bristol and the Lon-The conference was attended by 142 dele- fy everyone on our mailing list when the don School of Hygiene and Tropicalgates. There were three keynote presen- call for abstracts opens. Medicine to examine gender differencestations, 27 short, parallel presentations in cardiometabolic health across the lifeand 44 posters, which reflected the diver- The Book of Abstracts from the confer- course.sity of population health and health ser- ence is available on the SPHeRE website :vices research in Ireland. Throughout the The work will be supervised by Dr Laura www.sphereprogramme.ie. Howe, Prof. Debbie Lawlor and Dr Abi- gail Fraser at the University of Bristol and will involve extensive collaboration with a range of world leaders in cardi- ometabolic health and epidemiological methods including Prof. Patricia Kearney at UCC, Prof. George Davey Smith at University of Bristol and expert in metabolic medicine, Prof. Naveed Sattar at the University of Glas- gow. Prof Naomi Fulop (University of London and HSRN), Prof Steve Thomas (TCD), Prof Bernie Hannigan @sphereprogramme(Public Health Endland), Prof John Browne (UCC), Prof Hannah McGee (RCSI), Dr. Graham Love (HRB), #sphere15 Prof Anne Hickey (RCSI), Prof Charles Normand (TCD), Dr Declan Bedford (HRB), Prof Ruairi Brugha (RCSI).

Keynote PresentationsDoing Health Services Research that Matters: Examples, Issues and Challenges.Prof. Fulop outlined how health ser- Her second example study explored the need to be prepared for uncomfortable vices research is in a good place right relationships between the organisational findings. She believes a different skill setnow and stands to respond to the chal- and cultural characteristics of hospitals, and training is required than those associ-lenges facing the health care services at and how these impact upon clinical effec- ated with traditional PhDs and commend-present. Biomedical research, she believes tiveness, patient safety and patient experi- ed SPHeRE on its work in this area.only takes us so far, given that innovations ence. Whilst there is a good understandingare often taken up without testing and of the types of quality improvement un- By Paula Byrne (1st Year SPHeRE Scholareven if tested may not be evaluated on dertaken in healthcare, less is known of based in NUIG)implementation. the organisational and cultural processes that determine the effectiveness of theseShe outlined two illustrative examples methods. By examining the relationshipfrom her research. The first considered between these processes and quality fromwhat happens when acute stroke services macro (national healthcare system)are centralised, and examined the changes through meso (hospital) to micro (frontlineimplemented in the Greater Manchester clinical team) levels in each of the fiveArea and in London. The study, published partner countries, the study revealed howin the BMJ, asked if this approach works the dynamics and interactions betweenand at what cost. The rate of mortality at different levels impacted on sustained30 days fell in London but no equivalent quality of hospital care.change was seen in Manchester. The studyfound that resistance to change is an im- She emphasised the value of theory andportant factor, that what works in urban the need to figure out why and how some-areas may not work in rural areas and that thing works, and not simply whether itthe involvement of clinicians is very im- works. She described a ‘co-production’ ofportant. knowledge through collaboration and theThe Legacy of Austerity and the Irish Health System P rof. Steve Thomas’s keynote address the economy, with an increase in the debt highlighted the vulnerability of the to GDP ratio from 25 per cent to 124 per Irish health system as a key legacy of aus- cent between 2006 and 2014; vulnerability terity in Ireland, and stressed that this vul- of healthcare staff, with reductions in nerability is difficult to reverse. Prof. staffing and subsequent increases in work- Thomas outlined how the capacity re- load; and vulnerability of healthcare quali- strictions imposed by austerity in Ireland ty, with public spending on health falling led to some initial gains, or “recessionary disproportionately in Ireland, and an over- gold”, in the health system, with the intro- emphasis on budgets and head counts. duction of clinical programmes, a decrease Further, Prof. Thomas raised the issue of in drug unit costs, and increase in the reversibility and the challenges of restora- number of day cases in hospitals. Howev- tion, highlighting the difficulties of revers- er, austerity has also led to significant vul- ing the decisions and changes made as a nerability. This includes vulnerability of result of austerity. households, which have experienced in- creased unemployment and decreased By Daniela Rohde (1st Year SPHeRE Scholar incomes with mortgage repayments re- based in RCSI) maining largely unchanged; vulnerability in

Keynote Presentations CONGRATULATIONSGood Practice in Involving and Engaging patients in Research which will be of specific interest to re- Congratulations to Patrick Moran of searchers, with some research funders Trinity College Dublin on winning the now requiring applicants to describe pub- poster competition at the SPHeRE con- lic involvement in their research. The ference with his poster entitled “Cost- identified resources included training effectiveness analysis of a national courses and good practice guidelines for public access defibrillation pro- research funders from non-governmental gramme”. organisations and statutory bodies, as well as good practice guidance by a research The prize was presented by Pro- intensive university - University College gramme Director, Prof. Anne Hickey London. (RCSI).P rof. Bernie Hannigan presented on Overall, this presentation highlighted the Congratulations to Patrick Moore the subject of patient and public in- potential and benefits that public involve- (TCD, 2009), who recently passed hisvolvement and engagement in research. ment and engagement has to contribute Viva. Patrick's research focused on theThe INVOLVE definition of public involve- to health research. However, the Report of importance of proximity to death inment in research was used, describing this the Health Research Landscape in Ireland modelling future drug expenditures foras research being conducted “with or by highlighted that “the systematic involve- older people. Some of the findingsmembers of the public rather than “to”, ment in research of patients or other lay were published in the Applied Health“about” or “for” them”. people is not well developed”. The recom- Economics & Health Policy journal at mendations in this report include the de- the end of 2014.This presentation outlined the benefits velopment of an Irish Health Researchand characteristics of public and patient Forum with some recommendations being Patrick is pictured below with Dr. Mai-involvement and engagement in research. to identify how to include health service rin Ryan.Partnership with the public was identified users and lay people as research partners.as an imperative throughout the research This presentation highlighted the impera-process, with the overall outcome being to tive to develop the infrastructure at a stra-attain excellence in health research that tegic level to facilitate public involvementwould then lead to excellence in policy and engagement in research with theand practice. However, difficulties inher- overall goal of achieving excellence inent in this process were also outlined. Prof health research.Hannigan delineated available resourcesfor researchers and potential lay partners, By Anne Marie Malone (HRB Scholar based in TCD)Dr Peter Hyde, Dr Siobhan Hendrick, Dr Mairead O’Driscoll, Dr Teresa Maguire, Dr Fiona Keogh, Dr Anne Cody.

Parallel SessionsHealth Interventions: Learning from Research and PracticeThis session exposed both the success- the Galway-based PGAP programme which portance of translating these positive re- es and challenges in relation to the was found to reduce fatigue and fear search findings into practice as well as theimplementation of interventions devel- avoidant beliefs. Similarly, OptiMal, a 6- need to highlight and circulate these re-oped to tackle a variety of health prob- week occupation-based, self-management sults amongst key stakeholders. While fas-lems, in a range of settings, in Ireland. In programme for those suffering from multi- cinating evidence is being captured andterms of research and practice it highlight- morbidities, was found to increase the created in small pockets across the islanded problems inherent in scaling up inter- number of people frequently engaging in of Ireland, it is imperative we follow thisventions including recruitment, high levels activity. Dr Susan Coote closed this session through to large-scale implementation andof attrition and a lack of resources. with a motivating and inspiring presenta- put change on the agenda. tion which outlined her on-going work with By Emily Kelleher (2nd Year SPHeRE ScholarIn Ireland, chronic conditions prevail and people suffering from Multiple Sclerosis on based in UCC)the services required to treat these condi- the development of a web-based resourcetions are limited. This was aptly highlighted to encourage physical activity. Dr. Siobhan O’Higgins and Dr. Susan Cooteby Dr Caragh Behan, who reported that“while it takes 60 minutes for you to re- While the interventions described aboveceive help if your car breaks down, it takes were found to be effective, all speakers18 months to get help if your mind breaks revealed their frustrations at not beingdown”. Dr Behan subsequently outlined able to progress them further. They spokethe cost-effectiveness of DETECT, an early of waiting lists and the need to deliverintervention in psychosis delivered in Dub- more groups but in most cases this was notlin. Dr Brian McGuire reported that be- an option because of limited staff and/ortween 13-36% of the Irish population re- appropriate equipment. The session gener-port chronic pain and gave a synopsis of ated discussion encapsulating the im-Responding to Chronic Illness: The Case of DiabetesL isa Hynes presented a qualitative ex- than those prescribed metaformin. Young- regional centres was recommended. ploration of clinic attendance among er age groups were more likely to be pre-young adults with Type 1 Diabetes. Both scribed insulin than metaformin. Dr Geraldine Doyle from UCD completedpatients and clinicians were interviewed the session with a presentation on Patientregarding their thoughts and opinions on An analysis of diabetes related lower limb Level Costing: A Time Driven Activity Basedattendance at a specialist-led diabetes clin- amputations in a large urban teaching hos- Method for Costing Type 2 Diabetes inic. Lisa concluded that younger adults may pital was the title of Pauline Wilson’s Europe, Israel and Taiwan. The objective ofnot always attend at clinic but they do see study. Pauline is a Clinical Specialist Podia- this on-going study is to design and imple-it as a valuable resource. In addition, when trist in diabetes based in St James’ Hospital ment a methodology to measure and com-relationships are developed via an admis- (SJH), Dublin. She completed a retrospec- pare the micro-costs of the care of fivesion to hospital or a structured education tive analysis of HIPE data, using patient profiles of adults with Type 2 diabetes inprogramme this can lead to better attend- administration services, electronic patient Ireland. Patients with the same conditionances. records and the website www.RIP.ie for follow different pathways and delivery is further information. The study highlighted complex, fragmented and from multipleRonan Grimes’s retrospective cohort study the rise from thirty-nine amputations in sources.looked at treatment patterns in Type 2 2007 (major and minor) to seventy-fourDiabetes. Patients who started on sulpho- amputations in 2010 in SJH. Improved By Aine Ryan (2nd Year SPHeRE Scholarnylurea were commenced on insulin earlier communication between primary and sec- based in RCSI) ondary care, regional centres and super

SCHOLAR PUBLICATIONS Parallel SessionsBurns A, Höfer S, Curry P, Sexton E, Diverse Populations: PHHSR in practiceDoyle F. (2014). “Revisiting the dimen-sionality of the Hospital Anxiety and Martin Davoren presented research lines and clinical practise in those at highDepression Scale in an international exploring discrepancies in re- risk of cardiovascular mortality. The study,sample of patients with ischaemic heart sponse patterns and bias in the assess- using TILDA data, focused on those ageddisease” Journal of Psychosomatic Re- ment of health behaviour risk profiles in 50-64 years who had either an existingsearch, Volume 77, Issue 2 Pages 116– web-based versus self-administered sur- cardiovascular disease (CVD), diabetes121 veys among university students. The sur- without CVD, or a high or very high Sys- vey concentrated on undergraduate stu- tematic Coronary Risk Score (SCORE).Larkin, C., Di Blasi, Z., & Arensman, E. dents in UCC and consisted of sociodemo- Statins have long been used in the preven-(2014). “Risk Factors for Repetition of graphic, lifestyle and health-related varia- tion of secondary CVD. Adherence amongSelf-Harm: A Systematic Review of Pro- bles with particular focus on alcohol con- those with a history of CVD was 68.8%spective Hospital-Based Studies” PLoS sumption and well-being. The study while 57.4% of diabetics without CVD usedONE, 9(1), e84282. found, unsurprisingly, that self- statins. However, alarmingly, from a public administered questionnaires that were health perspective was the adherence ofMcKenna G, Allen PF, Woods N, distributed at lecture theatres yielded a those with high or very high SCORE (≥5%)O’Mahony D, Cronin M, DaMata C, Nor- much higher response rate compared to with only 19% found to be taking statins.mand C. (2014) “Cost-effectiveness of an identical web-based questionnaire (51% Catriona acknowledged there are difficul-tooth replacement strategies for partial- vs 2.4%). Significant differences were ob- ties in increasing statin adherence andly dentate elderly: a randomised con- served between the two surveys methods suggested patient compliance, lack of timetrolled trial” Community Dentistry and in key lifestyle and health related varia- and Government health policy as factorsOral Epidemiology; 42: 366-374 bles. However, the low response rate in impeding the implementation of CVD pre- the web-based survey make reliable com- vention guidelines. She also identified costMcKenna G, Allen PF, O’Mahony D, parisons between methods rather dubious as a potential barrier suggesting it wouldFlynn A, Cronin M, DaMata C, Woods N. and suggest that self-administered ques- be interesting to investigate if the reduc-(2014) “Comparison of functionally ori- tionnaires are much more reliable when tion in costs of statins leads to an increaseentated tooth replacement and remov- conducting research on undergraduate in adherence.able partial dentures on the nutritional students.status of partially dentate older pa- By Jamie Madden (3rd Year HRB Scholartients: a randomised controlled clinical Catriona Murphy presented work examin- based in UCC)trial” Journal of Dentistry; 42: 653-659 ing the gap in statin use between guide-McKenna G, Allen PF, O’Mahony D, Cro- Network Newsnin M, DaMata C, Woods N. (2015) “Theimpact of rehabilitation using remova- Have you participated in the SPHeREble partial dentures and functionally Network survey?orientated treatment on oral health-related quality of life: a randomised If so, thank you very much!controlled clinical trial” Journal of Den-tistry; 43: 66-71 If not, we would be very grateful if you would take the time to complete this short survey which will be very valuable to us in the process of ensuring that the Network isMoriarty F, Bennett K, Fahey T, Kenny relevant in the Irish context and inclusive of all those who should be involved. It shouldRA, Cahir C. (2015) “Longitudinal preva- take less than 10 minutes and would be very helpful in informing the future directionlence of potentially inappropriate medi- of the Network.cines and potential prescribing omis-sions in a cohort of community-dwelling The survey can be accessed through this link: Network Surveyolder people” Eur J Clinical Pharmacolo-gy. 2015.Wallace E, Salisbury C, Guthrie B, LewisC, Fahey T, Smith SM. (2015) “Managingpatients with multimorbidity in primarycare” BMJ;350:h176.

Photo GalleryProf John Browne, Dr Gerardine Doyle, Prof Mr Doug Beaton, Ms Mary Morrissey, Ms Eithne Dr Dona Tedstone, Dr Teresa Maguire, Ms Benniery Charles Normand Sexton, Ms Nora-Ann Donnelly Rickard, Dr Peter HydeMs Dee Gray, Ms Rebecca O’Connor Conference participants enjoy the poster presentations Dr Catriona Murphy, Ms Lorna Roe over coffeeProf Ruairi Brugha, Dr Catherine Hayes, Prof Steve Ms Mary Morrissey, Dr Margaret Curtin, Mr Kieran Ms Daniela Rohde, Bennery Rickard, Dr Bridget Thomas Walsh, Mr David O’Riordan KaneUpcoming EventsHSR Europe Spring Meeting 2015, Utrecht, the Netherlands, 23 - 24 April 2015.“Unlocking the demographic dividend” The International Association of Geriatrics and Gerontology European Region (IAGG-ER) Con-gress, Convention Centre, Dublin 23-26 April 2015“Implementation for Impact” the Global Implementation Conference, Convention Center Dublin, 27-28th May 2015.“Making life better – improving Health and Care for Adults” the Public Health Annual Scientific Conference 2015, Riddel Hall, StranmillisRoad, 10 June 2015.Health Services Research Network (HSRN) Symposium 2015, Nottingham Conference Centre, 1-2nd July 2015“Evidence and Innovation in Primary Care” the 44th Annual Conference of the Society for Academic Primary Care, Nuffield Departmentof Primary Care Health Sciences, University of Oxford, 8-10 July 2015.“Behaviour Change - Principles and Practice”, Centre for Behaviour Change Summer School, University College London 17-21 Aug 2015.The Health Research Board (HRB) supports excellent research that improves people’s health, patient care and health service delivery. We aim toensure that new knowledge is created and then used in policy and practice. In doing so, we support health system innovation and create new enter-prise opportunities.