Primary Care Conference19 Nov 2014

Role of Research in Primary Care

• Strategic context for health research

• Overview of HRB

• Primary care research in Ireland

• Examples of primary care research linked

to practice

Overview

Health Research Plans

• HRG Action Plan for Health

Research 2009-2013

Set the strategic direction, goals,

targets and actions to reap the health,

social and economic benefits of our

investment in health research

• HRB Strategic Business Plan

2010 -2014

• National Research

Prioritisation Exercise 2012

1. Patient-oriented research2. Population Health3. Health Services Research

• Projects• Applied Programmes• Centres/networks• Short courses/workshops• Fellowships and Career

Awards• Research Infrastructure• EU/International

opportunities

• Increase high quality, interdisciplinary health research

• Enhance research partnerships, collaborations and networks

• Focus on translation and application of knowledge

• Enhance use of existing health and social data

• Increase evidence-informed policy and practice

HRB Strategy - Key Themes

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To

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Year

Capital (€M)

Revenue (€M)

2001 2003 2005 2007 2008 2009 2010 2011 20121999

HRB Annual Income 1999-2012

HRB Portfolio analysis

Overview of HRB grant

funding portfolio

Projects & Programmes

• Health Research Awards

• Definitive Interventions

• HRB/Medical Research Charity Group

Awards

Training/Career Development

• Cochrane Training/Cochrane

Fellowships

• PhD Fellowships for Health and Social

Care professionals (P/T and F/T)

• Structured PhD Scholars -SPHERE

• ICE Awards (post doc)

• Research Leaders (Pop Health / HSR)

• Clinician Scientists

Centres and Research Networks

• HRB Centre in Health and Diet

Research

• HRB Centre in Primary Care Research

• All Ireland Institute in Hospice and

Palliative Care – research network

• Trials Methodology Network

• Clinical Research Facilities (Dublin,

Cork, Galway)

• Clinical Trials Networks

EU/International Opportunities

• Horizon 2020

• Wellcome Trust

• US Ireland

Global and national context for

primary care

• Demographics – ageing population

• More people living with chronic diseases

• Shift in model from acute care to primary /

community and self care

• Shift from illness model to health and wellbeing

• Emphasis on health promotion and behaviour

change (lifestyle factors)

Case for primary care research

• Need for an evidence base to support practice

• Evidence to underpin clinical practice and healthcare policy must be obtained by R&D in primary care

• Quality standards and protocols derive from research

• Need research to inform policy on staffing, organisation or primary care

• Process of conducting research important as the outcome

• Involvement by primary care professionals in research leads to faster dissemination and adoption of research evidence

Issues for primary care research

in Ireland*

• Lack of infrastructure

• Difficulties getting evidence implemented

• Limited capacity of the primary care community to conduct research

• Lack of any system for provision of payments to GPS to engage in research

• Clinical academic career structure in primary care ‘unattractive’

* Mant Report 2006

HRB developments

• Increased funding for health services, clinical research and patient research

• Practical support through the TMRN (Trials Methodology Research Network)

• Support for population or community based studies through the CRFs (Clinical Research Facilities)

• Support for Primary care professionals through funding schemes, e.g. HPFs (note: few applications from GPs)

• Investment in Centre for Primary Care Research (10 years, €8 million)

• Establishment of the Irish Primary Care Research Network

Themes in primary care research

• Harnessing technology to improve primary care practice and health outcomes (e.g. access to primary care diagnostics)

• Chronic disease management and multi-morbidity• Role of primary care in reducing inequalities in terms of

access and health outcomes• Safer primary care (patient safety)• Evaluation of primary care reforms• Mental health and primary care• Workforce management in primary care• Role of primary care in health promotion and behaviour

change

Examples of HRB funded

primary care research projects

• Framework for community involvement in decision making in primary care (Anne MacFarlane, Limerick)

– Examined user involvement projects for quality, user experience and impact on service

– Design a framework for the HSE to implement high quality user involvement projects

• Developing and evaluating a complex intervention to influence quality and quantity of anti-microbial prescribing (Andrew Murphy, Galway)

– Examining prescribing practices for urinary tract infections in Ireland and other countries

– Evaluating interventions to reduce the amount of antibiotics prescribed

• Towards early intervention for youth mental health (Walter Cullen, Limerick)

– Developing an intervention to address barriers to ‘early intervention’ for mental and substance use disorders among young people

CPCR

• Includes RCSI, TCD, NUIG and QUB

• Focusing on

– Safer medicines (safer prescribing, medicines management)

– Safer diagnosis ( clinical decision support systems; generating and

applying clinical prediction rules)

– Evaluating intervention studies - in an elderly cohort, in a

population of poorly controlled diabetes patients

– More rational use of antibiotics

– Managing multi-morbidity

• Established the Irish Primary Care Network

iPCRN (Irish Primary Care

Network) www.icprn.ie

• Collaboration between the ICGP, the HRB Primary Care Research

Centre (in RCSI) and WestRen (NUIG)

• Aims to:

o Establish a national network of GP practices whose purpose is to

participate in clinical research for the benefit of their patients and

o To enhance general practice through research training and activity

• The iPCRN:

o Facilitates GP's in maintaining The Medical Council's requirements

for professional competence - particularly in in the areas of audit

and research

o Enables GP's to become more involved in planned research trial

activities in the community

o Enhances collaboration among network partners through access to

literature, resources and training materials in research methodology

o Provides General Practice with new applications/tools to audit and

manage their patient care

Conclusions

• Clear need for primary care research to improve service

delivery

• Key themes and questions for primary care research in

Ireland

• Need to encourage more primary care professionals

(GPs, nurses, therapists, dentists) to engage in health

services and clinical research

• Need to work in multi and interdisciplinary partnerships

for better research

• Much improved environment for primary care research -

support and infrastructure