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Finalised Research Projects

Research Study on Clinical Care Pathways in Ophthalmology

In common with other specialties, ophthalmology services have developed over many years, and have adapted to new challenges and new techniques and technology.   The current pattern of delivery of services has some obvious inefficiencies, and it will be possible to provide improved services within current resources by changing the pathways followed by patients.  The purpose of this study is to provide an understanding of current patterns of use of services, to identify scope for improved efficiency in the delivery of care and to analyse the feasibility and cost of developing new pathways.  The research will be linked closely to the Clinical Programme in Ophthalmology and the wider set of HSE Clinical Programmes.

PI: Prof Charles Normand
Research Assistant: Giulia Faedo

Cost effectiveness of palliative care services in the Republic of Ireland

This project examines evidence on the cost and cost effectiveness of alternative models of specialist palliative care (SPC) (e.g., variations in the mix of specialist palliative in-patient, day and home care) in Ireland.

This research was funded by the Atlantic Philanthropies.

Read Final Report PDF

Doctor Migration Project

Ireland has the second highest level of dependency in the OECD on foreign-trained doctors (OECD 2010). 33% of doctors registered with the Irish Medical Council in 2010 were from non-EU countries. According to 2006 figures 54% of Ireland's Non-Consultant Hospital Doctor (NCHD) posts are filled by non-Irish nationals (PMDB, 2006). A high proportion of these non-Irish NCHDs are in posts that are not recognised for higher professional training, which has implications for their future careers and for health workforce planning in Ireland.

Despite the important contribution of non-EU doctors to the Irish health system, little is known about them – whether they intend to settle permanently in Ireland or move on, and their satisfaction with career and training prospects. These factors will influence whether these doctors remain in Ireland, return home or emigrate onwards. Such personal decisions (to stay or leave) could have significant implications for health workforce planning and for Ireland’s ability to staff its health system. Given that Ireland could not continue its current system of health provision without migrant doctors, it is crucial to address this information deficit.

Doctor Migration Project 
The HRB funded Doctor Migration Project, a collaboration between TCD and RCSI, aims to provide a better understanding of the needs, aspirations and career plans of non-EU doctors.  In addition the project aims to help policy makers identify strategies for providing employment to non-EU doctors in ways that meets their career goals and the needs of the Irish health system. The project will build on the HRB funded RCSI Nurse Migration Project (2006 to 2010) and PhD research carried out at TCD on South African doctors in Ireland (current).

http://www.doctormigration.com/

Lead researcher: Dr Niamh Humphries (RCSI)
Researcher: Ms Ella Tyrrell
PI: Prof Ruairi Brugha
Co Investigators: Prof Charles Normand, Dr Stephen Thomas

Economics of Tobacco Control

Sponsored by the Research Institute for a Tobacco Free Society (RIFTFS)

The workplace smoking ban was introduced into Ireland in March 2004 and has subsequently been an effective public health policy measure.  There was concern that it might have had a negative economic impact on the hospitality industry and on the economy overall. To examine this issue further RIFTFS funded a PhD studentship and in December 2006 Ms Laura Maran was appointed as a PhD student under the direction of Prof Charles Normand.  The research is also considering some important related issues on tobacco taxation and pricing, especially around the substitutability of different tobacco products.  RIFTFS will fund the studentship for a further year to November 2009.

Project Researchers:  Charles Normand & Laura Maran

For more information: http://www.tri.ie/

Foundations for Social Health Insurance in Ireland

Sponsored by the Adelaide Hospital Society
These reports, commissioned by the Adelaide Hospital Society, explore the prospects for introducing Social Health Insurance (SHI) in Ireland. The Irish healthcare system is unusual in having no subsidy for access to GP services for the majority of the population, and a high proportion of the population with supplementary private medical insurance. This has produced unplanned inequities which are exacerbated by a lack of transparency in health financing. The previous reports on SHI (Thomas, Normand and Smith, 2006 & 2008) explored the options for SHI design that would be most relevant for the current challenges. Selected scenarios for SHI were set out and costed, and their financing implications calculated for households. In addition, the reports highlighted the issues of transition and implementation, noting the institutional, stakeholder and capacity bottlenecks which need to be addressed if SHI is to become a reality.

A third report has been prepared which constructs a relevant and viable design for both the financing and organisation of SHI in Ireland.

References:

Stephen Thomas, Charles Normand and Samantha Smith (2006) “Social Health Insurance: Options for Ireland.” Prepared for the Adelaide Hospital Society. Health Policy and Management. Trinity College Dublin.

Stephen Thomas, Charles Normand and Samantha Smith (2008) “Social Health Insurance: Further Options for Ireland.” Prepared for the Adelaide Hospital Society. Health Policy and Management. Trinity College Dublin.

Stephen Thomas, Padhraig Ryan, Charles Normand (2010) Effective Foundations for the Financing and Organisation of Social Health Insurance in Ireland". Prepared for the Adelaide Hospital Society. Health Policy and Management. Trinity College Dublin.

Mary O’Riordan, Stephen Thomas, (2011) “Support for Policy Development of SHI in Ireland: A Review of Stakeholder Views and Values”. Prepared for the Adelaide Hospital Society. Health Policy and Management, Trinity College Dublin and National University of Ireland, Galway

 

Revolutionising Chronic Disease Management with ICT: A socio-technical project applied to epilepsy care in Ireland

Sponsored by the Health Research Board

This is a health services research and development programme about aligning people, processes and technology to optimise chronic disease management. The People - patients with chronic disease, their families and healthcare providers; Processes - access to healthcare services, the manner and location of service delivery, procedures for follow-up care, and the interface between clinical care and clinical research environments; Technology - the application of information and communication technology (ICT) in healthcare practices. Timely sharing and exchange of standardised information and efficient communication both within and across organisational boundaries is key to achieving an effective management of chronic diseases. An eHealth domain linking healthcare services to healthcare constituencies and patients and healthcare professionals at any location facilitates information sharing and exchange and promotes a continuum of healthcare services for the benefit of the patient. eHealth is defined as the transaction of healthcare services over an electronic medium such as the Internet (including the World Wide Web, intranet, extranet). Using epilepsy as an ideal exemplar of a chronic disease, this research programme is a socio-technical enquiry aimed at designing, developing, deploying and evaluating an eHealth domain for epilepsy care and research in Ireland. An epilepsy electronic patient record (EPR) which has been developed at Beaumont Hospital, Dublin will be the foundation upon which the eHealth domain will be established and assessed in terms of user acceptability, clinical outcomes, benefits to clinical research and cost-effectiveness. Lessons learned from the model applied in this programme will benefit others who undertake similar projects in the future.

Principal Investigator: Mary Fitzsimons
Project Researchers: Charles Normand & Jarlath Varley

The Evaluation of Clinical Nurse and Midwife Specialists and Advanced Nurse and Midwife Practitioners in Ireland (SCAPE)

Sponsored by the National Council for the Professional Development of Nursing and Midwifery

Researchers: Professor Cecily Begley, Professor Imelda Coyne, Professor Agnes Higgins, Dr. Joan Lalor, Dr. Fintan Sheerin, Dr. Naomi Elliott, Professor Charles Normand and Professor Catherine Comiskey in partnership with a group from NUIG including Professor Kathy Murphy, Dr Declan Devane, Dr Dympna Casey, Ms Adeline Cooney, Ms Frances Farrelly, Dr Maura Dowling and Ms Miriam Brennan

HRB Report on Demographic Change

This is a collaboration with the Economic and Social Research Institute, and examines the implications of the changing demographic conditions for the health and social services.  It is estimating the likely changes in the population numbers and structure till 2021, and how these are likely to affect hospital care, pharmaceuticals, long term care and primary and community care.

Departmental Researchers: Charles Normand, Steve Thomas, Maev-Ann Wren

A predictive model of long-term care demand

This project is funded by CARDI and is a collaboration with Queen’s University Belfast and Age Action Ireland which aims to analyse factors affecting residential and community long-term care (LTC) demand for older people in Northern Ireland and the Republic and to develop a model for forecasting future demand. The model will supply an interactive tool for policy-makers that will assist in planning for the care needs of older people and also supply an evidence-based assessment of present and future needs that will assist advocates for older people in making a case for improved care provision and in analysing the impact on care of proposed policy changes.

TCD lead authors Dr Maev-Ann Wren and Prof Charles Normand with Prof Davis Coakley and Prof Bob Stout, co-chairs of CARDI at the launch of the CARDI funded report Towards the Development of a Predictive Model of Long-Term Care Demand for Northern Ireland and the Republic of Ireland.

Read Final Report

Amnesty International - Costing Implementation of Vision for Change Mental Health Service Provision

Vision for Change (VfC), published in 2006, provides a blueprint for the delivery of modern mental health services in Ireland, including adopting a ‘recovery’ approach that entails person-centred, self-determined and empowering care, and enabling social inclusion.  Progress towards implementation of the new models of service provision has been slower than planned, and there is a risk that the current crisis in Government finance may slow the process further. 

To avoid further delay and policy stagnation it is important to develop a better understanding of progress to date in implementing VfC, what changes may be sensibly made in the light of emerging evidence and experience in service innovations and to strengthen the basis for future planning.  A key task is to look in more detail at what resources are being used for provision of the current mental health services, what would be saved if existing services were replaced, and what would be the costs associated with feasible (if not necessarily ideal) provision of services within the VfC models that would reflect a recovery approach.  This may point the way to areas where more rapid progress might be made even when resources are very scarce.  It would also allow investigation of more limited versions of the change in service configuration to be considered that could nevertheless represent an improvement on the current patterns of services as a first step towards full implementation of VfC.  It may also help make a strong case for additional resources should the advantages be clearly large and the additional costs modest.

The purpose of this project is to work with managers and clinical staff in the HSE to develop better understanding and tools to take forward the implementation of VfC in the context of the very scarce resources available to the health sector and to provide an evidence base for lobbying Government. 

PI: Prof Charles Normand
Research Assistant: Giulia Faedo

Efficiency Review of the BreastCheck Screening Programme

The Efficiency Review of the BreastCheck Screening Programme was commissioned by the Department of Health in order to prepare for the age extension of BreastCheck to women up to the age of 69 years, as provided for in the Programme for Government.

This review was a collaboration with University College Cork.