Geographic inequalities in non-acute healthcare supply: evidence from Ireland.

Background: Recent reforms in Ireland, as outlined in Sláintecare, the report of the cross-party parliamentary committee on health, are focused on shifting from a hospital-centric system to one where non-acute care plays a more central role. However, these reforms were embarked on in the absence of timely and accurate information about the capacity of non-acute care to take on a more central role in the system. To help address this gap, this paper outlines the most comprehensive analysis to date of geographic inequalities in non-acute care supply in Ireland. Methods: Data on the supply of 10 non-acute services including primary care, allied health, and care for older people, were collated. Per capita supply for each service is described for 28 counties in Ireland (Tipperary and Dublin divided into North and South), using 2014 supply and population data. To examine inequity in the geographic distribution of services, raw population in each county was adjusted for a range of needs indicators. Results: The findings show considerable geographic inequalities across counties in the supply of non-acute care. Some counties had low levels of supply of several types of non-acute care. The findings remain largely unchanged after adjusting for need, suggesting that the unequal patterns of supply are also inequitable. Conclusions: In the context of population changes and the influence of non-need factors, the persistence of historical budgeting in Ireland has led to considerable geographic inequities in non-acute supply, with important lessons for Ireland and for other countries. Such inequities come into sharp relief in the context of COVID-19, where non-acute supply plays a crucial role in ensuring that acute services are preserved for treating acutely ill patients.

A profile of physiotherapy supply in Ireland.

BACKGROUND: The lack of information on public and private physiotherapy supply in Ireland makes current and future resource allocation decisions difficult. AIM: This paper estimates the supply of physiotherapists in Ireland and profiles physiotherapists across acute and non-acute sectors, and across public and private practice. It examines geographic variation in physiotherapist supply, examining the implications of controlling for healthcare need. METHODS: Physiotherapist headcounts are estimated using Health Service Personnel Census (HSPC) and Irish Society of Chartered Physiotherapists (ISCP) Register data. Headcounts are converted to whole-time equivalents (WTEs) using the HSPC and a survey of ISCP members to account for full- and part-time working practices. Non-acute supply per 10,000 population in each county is estimated to examine geographic inequalities and the raw population is adjusted in turn for a range of need indicators. RESULTS: An estimated 3172 physiotherapists were practising in Ireland in 2015; 6.8 physiotherapists per 10,000, providing an estimated 2620 WTEs. Females accounted for 74% of supply. Supply was greater in the non-acute sector; 1774 WTEs versus 846 WTEs in the acute sector. Physiotherapists in the acute sector were located mainly in publicly financed institutions (89%) with an even public/private split observed in the non-acute sector. Non-acute physiotherapist supply is unequally distributed across Ireland (Gini coefficient = 0.12; 95% CI 0.08-0.15), and inequalities remain after controlling for variations in healthcare needs across counties. CONCLUSION: The supply of physiotherapists in Ireland is 30% lower than the EU-28 average. Substantial inequality in the distribution of physiotherapists across counties is observed.

Estimating the prevalence and incidence of type 2 diabetes using population level pharmacy claims data: a cross-sectional study.

OBJECTIVE: To estimate the prevalence and incidence of type 2 diabetes using a national pharmacy claims database. RESEARCH DESIGN AND METHODS: We used data from the Health Service Executive-Primary Care Reimbursement Service database in Ireland for this cross-sectional study. Prevalent cases of type 2 diabetes were individuals using an oral hypoglycemic agent, irrespective of insulin use, in 2012. Incident cases were individuals using an oral hypoglycemic agent in 2012 who had not used one in the past. Population level estimates were calculated and stratified by age and sex. RESULTS: In 2012, there were 114 957 prevalent cases of type 2 diabetes giving a population prevalence of 2.51% (95% CI 2.49% to 2.52%). Among adults (≥15yrs), this was 3.16% (95% CI 3.15% to 3.18%). The highest prevalence was in those aged 70+ years (12.1%). 21 574 people developed type 2 diabetes in 2012 giving an overall incidence of 0.48% (95% CI 0.48% to 0.49%). In adults, this was 0.60% (95% CI 0.60% to 0.61%). Incidence rose with age to a maximum of 2.08% (95% CI 2.02% to 2.15%) in people aged 65-69 years. Men had a higher prevalence (2.96% vs 2.04%) and incidence (0.54% vs 0.41%) of type 2 diabetes than women. CONCLUSIONS: Pharmacy claims data allow estimates of objectively defined type 2 diabetes at the population level using up-to-date data. These estimates can be generated quickly to inform health service planning or to evaluate the impact of population level interventions.

Child Health Care in Ireland.

The Irish health care system is based on a complex and costly mix of private, statutory, and voluntary provisions. The majority of health care expenditure comes from the state, with a significant proportion of acute hospital care funded from private insurance, but there are relatively high out-of-pocket costs for most service users. There is free access to acute hospital care, but not for primary care, for all children. About 40% of the population have free access to primary care. Universal preventive public health services, including vaccination and immunization, newborn blood spot screening, and universal neonatal hearing screening are free. Major health challenges include poverty, obesity, drug and alcohol use, and mental health. The health care system has been dominated for the last 5 years by the impact of the current recession, which has led to very sharp cuts in health care expenditure. It is unclear if the necessary substantial reform of the system will happen. Government policy calls for a move toward a patient-centered, primary care-led system, but without very substantial transfers of resources and investment in Information and Communication Technology, this is unlikely to occur.

National and subnational hypertension prevalence estimates for the Republic of Ireland: better outcome and risk factor data are needed to produce better prevalence estimates.

BACKGROUND: Hypertension is a global public health challenge. National prevalence estimates can conceal important differences in prevalence in subnational areas. This paper aims to develop a consistent set of national and subnational estimates of the prevalence of hypertension in a country with limited data for subnational areas. METHODS: A nationally representative cross-sectional Survey of Lifestyle, Attitudes and Nutrition (SLÁN) 2007 was used to identify risk factors and develop a national and a subnational model of the risk of self-reported, doctor-diagnosed hypertension among adults aged 18+ years in the Republic of Ireland. The subnational model's group-specific risk estimates were applied to group-specific population count estimates for subnational areas to estimate the number of adults with doctor-diagnosed hypertension in subnational areas in 2007. A sub-sample of older adults aged 45+ years who also had their blood pressure objectively measured using a sphygmomanometer was used to estimate the national prevalence of diagnosed and undiagnosed hypertension among adults aged 45+ years. RESULTS: The prevalence of self-reported, doctor-diagnosed hypertension among adults aged 18+ years was 12.6% (95% CI = 11.7%-13.4%). After adjustment for other explanatory variables the risk of self-reported, doctor-diagnosed hypertension was significantly related to age (p < 0.001), body mass index (p < 0.001), smoking (p = 0.001) and fruit and vegetable consumption (p = 0.003). Among adults aged 45+ years the prevalence of undiagnosed hypertension (38.7% (95% CI 34.6%-42.8%)) was higher than self-reported, doctor-diagnosed hypertension (23.4% (95% CI = 22.0%-24.7%)). Among adults aged 45+ years, the prevalence of undiagnosed hypertension was higher among men (46.8%, 95% CI 41.2%-52.4%) than women (31.2%, 95% CI 25.7%-36.6%). There was no significant variation in the prevalence of self-reported, doctor-diagnosed hypertension across subnational areas. CONCLUSIONS: Services need to manage diagnosed hypertension cases and to detect and manage undiagnosed cases. Further population level improvements in lifestyle risk factors for hypertension are key in developing a more integrated approach to prevent cardiovascular disease. Better subnational data on hypertension outcomes and risk factors are needed to better describe the distribution of hypertension risk and hypertension prevalence in subnational areas.

Prevalence of diabetes in the Republic of Ireland: results from the National Health Survey (SLAN) 2007.

BACKGROUND: Current estimates of diabetes prevalence in the Republic of Ireland (RoI) are based on UK epidemiological studies. This study uses Irish data to describe the prevalence of doctor-diagnosed diabetes amongst all adults aged 18+ years and undiagnosed diabetes amongst those aged 45+ years. METHODS: The survey of lifestyle attitudes and nutrition (SLAN) 2007 is based on a nationally representative sample of Irish adults aged 18+ years (n = 10,364). Self-reported doctor-diagnosed diabetes was recorded for respondents in the full sample. Diabetes medication use, measured height and weight, and non-fasting blood samples were variously recorded in sub-samples of younger (n = 967) and older (n = 1,207) respondents. RESULTS: The prevalence of doctor-diagnosed diabetes amongst adults aged 18+ years was 3.5% (95% CI 3.1%-3.9%). After adjustment for other explanatory variables; the risk of self-reported doctor-diagnosed diabetes was significantly related to age (p < 0.0001), employment status (p = 0.0003) and obesity (p = 0.0003).Amongst adults aged 45+ years, the prevalence of doctor-diagnosed diabetes was 6.1% (95% CI 5.3% - 6.9% ) [corrected] and undiagnosed diabetes was 2.8% (95% CI 1.4% - 4.1%). This represented 31.2% of diabetes cases in this age group. CONCLUSION: Notwithstanding methodological differences, these prevalence estimates are consistent with those in the UK and France. However, the percentage of undiagnosed cases amongst adults aged 45+ years appears to be higher in the RoI. Increased efforts to improve early detection and population level interventions to address adverse diet and lifestyle factors are urgently needed.