The HRB's annual report includes the work of 48 researchers carried out during the past year. Hélène Hofmanreports.
A selection of recent breakthroughs in the field of health research, funded by the Health Research Board's (HRB's) annual budget of over €50 million, are available from today as part of the agency's annual report 2007.
The HRB is the leading agency for supporting and funding health research in Ireland. In addition to the research published in A Picture of Health - A selection of Ireland health research 2007 report, it has a research portfolio worth about €160 million.
The report is written in plain English and presents the work of 48 researchers from eight hospitals and five third-level institutions completed in the past year.
"As the research we fund comes to an end we feel it's important to look at what's come out of them. A Picture of Health is part of this," says Mairead O'Driscoll, acting director of research strategy and funding with the HRB. "The research that is funded covers a wide spectrum from basic medical science to health economics. This year there was a particular emphasis on health services and health economics. For example, some of the research focused on prescription practices which are very topical at the moment," she says.
The projects featured span a range of areas in healthcare including public health, nursing, health services research, cardiac disease and molecular biology. As well as featuring outlines of research into prescription practices, it also showcases research into children's mental health, new treatments for heart disease and health information systems aimed at improving patient care.
A Picture of Health aims to raise awareness of the value of health research among the public, healthcare policymakers and health professionals.
It is expected that the research undertaken will have an impact on healthcare practice here in the coming years.
However, O'Driscoll warns that it could be some time before some of the projects are put into practice. "The challenge with research is that it's so long term. Sometimes it can take 10 or 15 years before we see an impact. Some projects coming through - like looking at novel antibiotics to treat MRSA - will take a lot of time before they come into use," says O'Driscoll.
A Picture of Health - A selection of Irish health research 2007 is available from the HRB website at www.hrb.ie/publications. For a hard copy of the report contact Claire Redmond by e-mail: credmond @hrb.ie or tel: 01-2345108.
A Picture of Health includes the work of 48 researchers from around the State. The following is a selection of those project:
The epilepsy electronic patient record
When Mary Fitzsimons, a medical physicist, and her colleagues with the Epilepsy Programme in Beaumont decided they wanted to move away from paper-based patient records and invest in an electronic patient record (EPR) that could be used across several departments, they couldn't find one that met their needs. As a result, they've spent three years developing their own system.
"Hospitals rely heavily on paper-based records. If you've ever been in hospital there's a paper chart for you and if you have a long-term condition like epilepsy, where there is continuous care, that paper record is likely to be as thick as a phonebook," says Fitzsimons.
"We had some databases already but there were different ones in various departments that didn't match so we started looking for ways to co-ordinate these databases," she says.
With the help of the hospital's IT department, Fitzsimons and her colleagues have been working on a web-based, electronic patient record that would consolidate all the relevant information relating to a patient with epilepsy.
"As with all health records we need to include generic information like name and address and medical history. However, one aspect that interested us in particular was the inclusion of a part for anti-epileptic medication history. Medication is very important when it comes to epilepsy.
"Many people will have gained control of their seizures with certain medication, but others may not. As a result, it's important to have details of every medication they've tried, whether it worked, what the side effects were, etc, explains Fitzsimons.
The epilepsy EPR is being developed on a modular basis and will grow to include both generic patient information as well as more specific details relating to epilepsy. It will be introduced at Beaumont this year, and it is hoped it will be rolled out to neurologists in Cork and Galway, enabling them to begin sharing patient data.
As well as making it easier for clinicians to share data and allowing multiple users to consult the same file at once, it is hoped the system will also improve the quality of the data recorded and reduce errors in transcribing.
"Ultimately, we hope this will be useful at primary care level and help with continuity of care. For example, a GP may be helping a patient control their epilepsy and they may occasionally visit a specialist at Beaumont and it could be useful for the doctor to have access to those records," says Fitzsimons.
The team has now been awarded a second grant to look at the impact the EPR system will have on inpatient and outpatient epilepsy care.
Over the next five years the project, entitled Revoluntionising Chronic Disease Management with Information and Communication Technology: A socio-technology project applied to epilepsy care in Ireland, will look at how the EPR can improve services. In future, it is hoped that the epilepsy EPR concept could be applied to other chronic diseases such as diabetes.
Inequalities in
prescribing
Dr Kathleen Bennett and Dr Cara Usher from the Department of Pharmacology and Therapeutics in Trinity College Dublin analysed prescription databases. They discovered that age, gender and geographical location can all have an impact on what medication you are prescribed.
"Under the National Health Strategy of 2001 everyone should be getting the same standard of treatment. We wanted to see if there were inequalities in the system and looked at variations in prescribing in relation to age gender and geographical region," says Bennett.
The study used the GMS scheme (now the Health Service Executive Primary Care Reimbursement Service) and Long Term Illness scheme databases, which include information from 2000 to 2007 on all prescriptions as well as patients' age, gender and which part of the country they live in. It built on earlier work that showed that women and the elderly are disadvantaged when it comes to the prescription of heart medication.
"The information on the databases does not say which diseases the different types of medication were prescribed for, so we chose to look at people who were prescribed diabetes and cardiovascular medication. In both these cases the medication is very specific and wouldn't be prescribed in any other cases," says Bennett.
People with diabetes have a two-five times higher risk of dying from heart disease than the rest of the population and the Irish Cardiovascular Health Strategy recommends that patients with diabetes should be treated like those who have pre-existing heart disease. As a result, they should be prescribed with secondary preventative therapy.
"However, what we found was that if you live in one region rather than another there is a one and a half fold variation in what you will be prescribed and it is not equitable for gender and age," says Bennett.
For example, the study found that while there were high rates of prescribing secondary preventative therapies in what was the Midland Health Board Region, rates were low in the western regions. Rates of prescribing aspirin, which has been proven to prevent heart disease, were high in the eastern region, and statins, which control cholesterol and ACE inhibitor, a blood pressure drug, had consistently high prescription levels in the southeast.
The study also showed that patients over 75 were less likely to be prescribed statins and fibrates than other patients and men were more likely to receive aspirin, ACE inhibitors or fibrates than women.
The experience of having a loved one in intensive care
Margaret McKiernan, a clinical nurse manager in the Intensive Care Unit (ICU) at Mercy University Hospital Cork, wanted to look at ways of improving the care given to families with a critically ill relative.
"From my experience as a clinical nurse manager in ICU and even earlier as a staff nurse I saw how stressful it was for people when a loved one is in intensive care," says McKiernan. "The literature suggests the need to stabilise critically ill patients takes priority over the assessment and care of families."
Over the course of a year, McKiernan completed detailed interviews with families on their experience of having a loved one in intensive care. She identified four recurrent themes in their needs: the need to know; being there with the patient; making sense of the situation; and caring and support.
"The need to know was a huge thing for all the participants regardless of whether the patient was stable or not. When families are out of their normal social context they find it more difficult to process information and need someone there to reinforce the information. They felt that the nurse could act as that link between the doctor and them," she says.
Similarly, the families interviewed said they felt it was important to have contact with the person in ICU. "They said that being next to them helped because it was tangible proof that they were still there. All wanted to have open visiting to help them keep on top of everything else in their lives," she says.
She found that small acts including hair washing and applying make-up to the relative helped make sense of the situation and gave a sense of security and reassurance.
Finally, the families said they needed support to be able to cope and stay strong for the patient. According to McKiernan, they felt the nurses could best provide this support, though some said they preferred the nurse to focus entirely on the patient.
McKiernan presented the findings of her research to the Royal College of Nursing Research Conference in Dundee earlier this year and hopes it will be carried forward through links with hospitals in Britain and Ireland.
She now wants to look at incorporating family care into a more organised package within ICU and look at evaluating specific nursing interventions to help families with loved ones in intensive care.