Patricia Leahy-Warren PhD,

Senior Lecturer School of Nursing and Midwifery, UCC

Primary & Secondary Health Care:

Challenges at the Interface

Dr P. Leahy-WarrenNational Healthcare Conference

April 2nd 2014

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

Dr P. Leahy-Warren

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

Primary Care 2001

• Vision for 520 teams

Dr P. Leahy-Warren

90-95% of care will take place in the community

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)

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

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)

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)

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

Patient/Client

Palliative Care

Chronic Sick

People with disabilities

Mental Health

CHILDREN

Older persons

Client Groups in Population

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

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).

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

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

CCli

Integrated Primary Care Team

Single Assessment Process

Specialist Services

Social Supports

IntegratedTechnology

Regulation of Quality & Standards

Integrated Care

Client/Patient

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