Improving health services at a stroke – with research
Researcher profile: Professor Anne Hickey is on a mission to bring in more psychological and cognitive supports for people following a stroke. She talks to Claire O'Connell...
When a person survives a stroke, do they get enough support when they leave the hospital? And what factors contribute to ‘adverse events’ in hospitals such as getting the wrong medication, or falling?
Professor Anne Hickey from the Royal College of Surgeons in Ireland is on a mission to find out. Her work has helped to improve stroke care in Ireland over the last decade, and she has been taking stock of adverse events in Irish hospitals so we have data to better understand and help to avoid them.
Anne recalls being interested in health – and particularly the brain – as a student and she studied psychology at Trinity College Dublin, where she became friends with a postgraduate researcher called Hannah McGee.
'Sometimes your career is shaped because of the people you are around in college', says Anne.
It was Hannah who suggested Anne’s name (amongst others) for a summer student placement at RCSI, looking at ways to measure quality of life. The placement went so well that Anne decided to apply for doctoral research, and she became the first woman with a psychology background to get HRB funding for a PhD.
Rehab after stroke
In the last 10-15 years, Anne has been deeply involved in assessing services for people who have had a stroke in Ireland, which is the leading cause of acquired disability here. Working with colleagues - including Hannah McGee, who is now Dean of the Faculty of Health Sciences at RCSI - Anne helped to carry out the first national audit of stroke care, which was published in 2008.
'It showed that stroke care here was suboptimal', says Anne. 'There were basic things we didn’t have such as specialised stroke units, for which there was hugely strong evidence internationally'.
That research helped to raise awareness about deficiencies in acute stroke care, and the services in hospitals in Ireland have since vastly improved - but what happens when people return to their communities and still need help?
Anne has been finding out. She is co-investigator on the ASPIRE-S (Action on Secondary Prevention Interventions and Rehabilitation in Stroke) study, which recruited more than 300 patients who were in hospital with an acute stroke in Ireland and followed them up 6 months later to assess secondary prevention targets and to ask about rehabilitation services they were getting in the community.
'We found that people were likely to meet physiotherapists, public health nurses, speech and language therapists, or occupational therapists but there was little or no psychological intervention, even though some of the major difficulties people were facing were related to mood and cognition', she explains.
This is particularly troubling, because a person with cognitive impairment may have trouble sticking to their medication regime and, as a result, could have another stroke or need nursing home care.
'There’s a huge human and economic cost', says Anne, who has now started a HRB-funded project to model how long-term rehabilitation including cognitive support could be provided in the community over the next 20 years in Ireland.
Anne has also been taking stock of adverse events in Irish hospitals, such as patients getting infections after operations, falling, or receiving inappropriate medicines or doses, and people needing to return to hospital because they were discharged before they were ready.
This research has identified system-related factors such as overcrowding (which can aid the spread of infection) and pressure on staff to discharge patients.
'We are hoping to go back and do a second study to look at more recent data on adverse events', says Anne. 'These studies give people tangible data and insights to work with'.
Structure brings skills
As well as carrying out her own research, Anne was the first Director of the HRB’s SPHeRe (Structured Population and Health-services Research Education) Programme, which helps early-stage health researchers to develop skills in these areas during their PhD.
'The aim has been to lift the profile of population health and health services research across Ireland', she says.
The national programme, which has been running for five years and is co-directed between the RCSI, Trinity College Dublin and University College Cork, has built a network of experts and hosts an annual conference to share the findings of research with policy makers and healthcare practitioners.
'I think the SPHeRE programme is fantastic, we are all very proud of it', says Anne. 'The HRB is very focused on supporting early-stage researchers – and structured PhD programmes are undoubtedly a much better way to do a PhD'.
Good quality perspective
With a husband and three daughters – including two in university – Anne has a busy life outside of work, but she prioritises time for fresh air and exercise. 'We will get out and walk 15 km at the weekend, or go for a good 60km cycle', she says.
Reflecting on how health research has changed over the last 10 years, she is struck by how skills and disciplines are blurring and blending together to improve health services and population health.
'In stroke rehab alone it brings together cognitive psychology, medicine, epidemiology, health economics, physiotherapy – the list goes on', she says. 'Working in this area you get a range of perspectives, and that combination of disciplines is what brings out the quality'.