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Evidence to inform health service organisation, service delivery and resource allocation

Health system performance during the economic crisis

DR Steve Thomas

The Resilience Study, led by Dr Steve Thomas at TCD, was a detailed forensic analysis of how the health system coped with a downsizing of resources by an analysis of a range of performance indicators.

These show a system that managed ‘to do more with less’ from 2008 to 2012 using increased efficiencies such as clinical care programmes; agreements between health service management and unions which allowed for increased flexibility and productivity; reduced professional fees and drug cost savings.

They also found that some of the efficiencies were achieved by transferring the cost of care onto people and through significant resource cuts.

Significantly, from 2013, the indicators show a system that has no choice but ‘to do less with less’.

They indicate diminishing returns from crude cuts, evident in declining hospital cases, increased wait-times, as well as cuts to home care hours and increasing costs of agency staffing.

Better care for at-risk babies

a baby's foot

Perinatal Ireland, a HRB-funded research group, encompassing all the major maternity hospitals on the island of Ireland, with access to a cohort over 55,000 births each year, has produced two sets of national guidelines based on their research findings. The first on how to manage multiple pregnancy, and the second on how to best monitor small and at-risk babies in the womb.

Their findings have had a global impact and will enable specialist imaging resources to be targeted where they can do the most good.

Dr Carol Sinnott

HRB Research Fellow, Dr Carol Sinnott, GP, has shown that people who suffered abusive experiences in childhood were 60% more likely to develop two or more chronic diseases in later life, than people who did not have adverse childhood experiences.

She says, 

'Interventions that target the coping strategies of survivors of childhood abuse and neglect may yield future benefits in chronic disease prevention. For example, interventions to help survivors avoid destructive coping strategies, such as alcohol abuse, smoking and drug abuse. These behaviours are significant contributors to the development of many chronic diseases.

These findings emphasise that multimorbidity is more complex than the simple accumulation of different disease labels, such as arthritis obesity, heart disease, depression or asthma. A person-centred, rather than a disease-centred approach is likely to yield better results’.

Early intervention in youth mental health

Prof Mary Cannon

Prof Mary Cannon, RCSI and Beaumont Hospital, is among the world most cited researchers and one of only 11 Irish researchers to be included the Thompson Reuters 'World's most influential minds' publication. Prof Cannon's HRB-funded research has had global impact on the understanding of mental ill-health in young people and adolescents, and the importance of early intervention to improve patient outcomes in vulnerable and at-risk young people.

Four-fold reduction in pressure sores with simple change to practice

assorted bandages and medical dressings

Zena Moore, a HRB Research Fellow at the Royal College of Surgeons in Ireland and practicing nurse, found that a simple change to conventional repositioning practices could dramatically reduce pressure ulcers among elderly patients and introduce significant savings and efficiencies in the delivery of care.

'The new method we introduced uses a 30 degree tilt rather than 90 degree rotations', explains Ms Moore.

'It resulted in a four-fold reduction the incidence of pressure ulcers, so it is clearly better for patients. But it is also less time consuming, requires less nursing staff and it is more cost effective when compared with standard care'.

Impartial evidence reviews and rapid evidence assessments at the request of the Depertment of Health

Front cover of the HRB publication called Suicide prevention - an evidence review 2015

The Evidence Generation Unit at the HRB has undertaken a number of comprehensive evidence reviews at the request of the Department of Health. These reviews collate the most relevant and up-to-date peer-reviewed science on a range of diverse topics and present that evidence to policy makers and service planners in summary form. Reviews completed to date include:

  • Suicide prevention - an evidence review 2015.
  • An analysis and comparison of the carbohydrate and fat shelves of the food pyramid in other similar countries.
  • Mentoring in post graduate medical training and education.
  • The integration of health and social care services.
  • The integration of health and wellbeing services with general health services.

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