Pauline Clerkin

The impact of direct provision accommodation for asylum seekers on organisation and delivery of local primary care and social care services: A case study

BackgroundMany western countries have policies of dispersal and direct provision accommodation (state-funded accommodation in an institutional centre) for asylum seekers. Most research focuses on its effect on the asylum seeking population. Little is known about the impact of direct provision accommodation on organisation and delivery of local primary care and social care services in the community. The aim of this research is to explore this issue.MethodsIn 2005 a direct provision accommodation centre was opened in a rural area in Ireland. A retrospective qualitative case study was designed comprising in-depth interviews with 37 relevant stakeholders. Thematic analysis following the principles of framework analysis was applied.ResultsThere was lack of advance notification to primary care and social care professionals and the community about the new accommodation centre. This caused anxiety and stress among relevant stakeholders. There was insufficient time to plan and prepare appropriate primary care and social care for the residents, causing a significant strain on service delivery. There was lack of clarity about how primary care and social care needs of the incoming residents were to be addressed. Interdisciplinary support systems developed informally between healthcare professionals. This ensured that residents of the accommodation centre were appropriately cared for.ConclusionsDirect provision accommodation impacts on the organisation and delivery of local primary care and social care services. There needs to be sufficient advance notification and inter-agency, inter-professional dialogue to manage this. Primary care and social care professionals working with asylum seekers should have access to training to enhance their skills for working in cross-cultural consultations.

Role flexibility among telemedicine service providers in the north-west and west of Ireland.

A recent review of telemedicine services in the north-west and west of Ireland identified 11 telemedicine services, most of which were in the early stages of implementation. A qualitative approach was used to review them. Semistructured interviews were conducted with a multidisciplinary group of primary- and secondary-care providers (n = 21) who were involved with either synchronous or asynchronous telemedicine services. Data were analysed according to the principles of framework analysis. Participants described the ways in which they were flexible about their workload, professional identities and roles to facilitate the organization and delivery of telemedicine services, and to ensure that services ran smoothly. While the positive effect of product champions and members of a wider supportive network or alliance on the conception and development of telemedicine services must be acknowledged, questions remain about associated long-term implementation and sustainability.

AN ANALYSIS OF PRIMARY CARE ELEMENTS OF INNOVATIVE PERSONALISED, COMMUNITY-BASED SUPPORTS FOR PEOPLE WITH DEMENTIA AND THEIR FAMILIES/CARERS IN IRELAND

Comparative case studies, with ethnographic data collection over 250 hours, were undertaken in 3 sites to explore how such care was enacted in practice. Results: Integrative analysis highlighted 7 key issues influencing the provision of good EoLC including: early planning discussions; co-ordinating care including liaison between day and night staff and out of hours care; working effectively with primary care; managing hospitalisation; recognising end of life and providing supportive care; ensuring care after death and valuing staff and ensuring ongoing learning.Conclusions:This data, together findings from evidence reviews, informed the development of an evidence-based intervention comprising a Dementia Nurse Care Facilitator and supporting resources (e.g. evidence-based scenarios of common problems in EoLC) which will be evaluated in a forthcoming pilot trial.