Declan Bedford

How to improve the uptake of influenza vaccination in older persons at risk.

A study was carried out to ascertain if those older persons at risk from influenza in Ireland would respond to a personalised invitation to attend for vaccination. Of the 193 patients invited to attend for vaccination, 126 (65.3 per cent) presented for vaccination. This rose to 142 (73.6 per cent) after a reminder letter was went out. In the year previous to the study only 80 (41.5 per cent) of the same cohort of patients were vaccinated. This study has demonstrated how a simple invitation for influenza vaccination can dramatically improve the uptake rates.

Problem alcohol use among problem drug users : development of clinical guidelines for general practice.

BackgroundProblem alcohol use is common and associated with considerable adverse outcomes among patients who attend primary care in Ireland and other European countries for opiate substitution treatment.AimsThis paper aims to describe the development and content of clinical guidelines for the management of problem alcohol use among this population.MethodsThe guidelines were developed in three stages: (1) identification of key stakeholders, (2) development of evidence-based draft guidelines, and (3) determination of a modified ‘Delphi-facilitated’ consensus among the group members.ResultsThe guidelines incorporate advice for physicians on all aspects of care, including (1) definition of problem alcohol use among problem drug users, (2) alcohol screening, (3) brief intervention, and (4) subsequent management of patients with alcohol dependence.ConclusionsPrimary care has an important role to play in the care of problem alcohol use among problem drug users, especially opiate substitution patients. Further research on strategies to inform the implementation of these guidelines is a priority.

Heartwatch: a secondary prevention programme in primary care in Ireland

Background Heartwatch, a secondary prevention programme in primary care was initiated in 2003, based on the second European Joint Task Force recommendations for secondary prevention of coronary heart disease (CHD). The aim was to examine the effect of the first 2 years of the Heartwatch programme on cardiovascular risk factors and treatments. Design Prospective cohort study of patients with established CHD enrolled into the Heartwatch programme. Methods Four hundred and seventy (20%) general practitioners nationwide participated in the programme, recruiting 11542 patients with established CHD (earlier myocardial infarction, coronary intervention or coronary artery bypass surgery). Clinical data were electronically transferred by each general practitioner to a central database. Comparison of changes in risk factors and treatments at 1-year and 2-year follow-up from baseline were made using paired t-test for continuous and McNemars test for categorical data. Results Statistically significant changes in systolic blood pressure, diastolic blood pressure, total and low-density lipoprotien cholesterol and smoking status at 1 and 2 years (P < 0.0001) were observed. Little or no improvements were shown for exercise, BMI or waist circumference. Increases in the prescribing of statins, angiotensin-converting enzyme inhibitors and β-blockers over the course of the study were observed. Conclusion The Heartwatch programme has demonstrated significant improvements in the main risk factors and treatments for CHD. More effective interventions are required to reduce BMI, waist circumference and physical inactivity in this population. The increases in treatment uptake are approaching the optimal levels in this population. Eur J Cardiovasc Prev Rehabil 15:651–656

Hospitalisations and costs relating to ambulatory care sensitive conditions in Ireland

BackgroundAmbulatory care sensitive conditions (ACSCs) are conditions for which the provision of timely and effective outpatient care can reduce the risks of hospitalisation by preventing, controlling or managing a chronic disease or condition.AimsThe aims of this study were to report on ACSCs in Ireland, and to provide a baseline for future reference.MethodsUsing HIPE, via Health Atlas Ireland, inpatient discharges classified as ACSCs using definitions from the Victorian ACSC study were extracted for the years 2005–2008. Direct methods of standardisation allowed comparison of rates using the EU standard population as a comparison for national data, and national population as comparison for county data. Costs were estimated using diagnosis-related groups.ResultsThe directly age-standardised discharge rate for ACSC-related discharges increased slightly, but non-significantly, from 15.40 per 1,000 population in 2005 to 15.75 per 1,000 population in 2008. The number of discharges increased (9.5%) from 63,619 in 2005 to 69,664 in 2008, with the estimated associated hospital costs increasing (31.5%) from €267.8 million in 2005 to €352.2 million in 2008. Across the country, there was considerable variation in the discharge rates for the Top-10 ACSCs for the years 2005–2008. Significantly lower rates of hospitalisation were observed in more urban areas including Cork, Dublin and Galway. The most common ACSC in 2008 was diabetes with complications (29.8%).ConclusionsThe variation in rates observed indicates the scope of reducing hospitalisations and associated costs for ACSCs, across both adult’s and children’s services and particularly in relation to diabetes complications.

Factors associated with self-reported depression and self-esteem among school-going adolescents from a geographically defined region in Ireland

BackgroundRecent reviews indicate that mental health problems in the young are increasing.AimsTo measure the prevalence of, and risk factors associated with, depression and low self-esteem among Irish post-primary students.Method1,428 students, randomly selected from a sample of post-primary schools, were given an anonymised questionnaire. Analyses included bivariate and multivariate logistic regression.ResultsQuestionnaires were completed by 992 (69.9%) respondents. 206 (20.8%) had a high depression score. Being from a single parent family (OR 2.8, 95% Cl 1.5–5.4, p<0.001); having low self esteem (OR 13.44 95% Cl 8.9–20.3, p<0.001); being female (OR, 3.7, 95% Cl 2.5–5.6 p<0.001) and having a low fitness level (OR 1.8, 95% Cl 1.2–2.8 p<0.006) were independently associated with a high depression score.ConclusionsThe level of self-reported depression was high among these respondents and risk factors identified include having low self-esteem, being female, being from a single parent family and having a low fitness level.