Corey Burke, John Broughan, Geoff McCombe, Ronan Fawsitt, Áine Carroll and Walter Cullen
“Integrated care” (IC) is an approach to health and social care delivery that aims to prevent problems arising from fragmented care systems. The collective content of the IC…
Abstract
Purpose
“Integrated care” (IC) is an approach to health and social care delivery that aims to prevent problems arising from fragmented care systems. The collective content of the IC literature, whilst valuable, has become extensive and wide-ranging to such a degree that knowing what is most important in IC is a challenge. This study aims to address this issue.
Design/methodology/approach
A scoping review was conducted using Arksey and O'Malley's framework to determine IC priority areas.
Findings
Twenty-one papers relevant to the research question were identified. These included studies from many geographical regions, encompassing several study designs and a range of populations and sample sizes. The findings identified four priority areas that should be considered when designing and implementing IC models: (1) communication, (2) coordination, collaboration and cooperation (CCC), (3) responsibility and accountability and (4) a population approach. Multiple elements were identified within these priorities, all of which are important to ensuring successful and sustained integration of care. These included education, efficiency, patient centredness, safety, trust and time.
Originality/value
The study's findings bring clarity and definition to what has become an increasingly extensive and wide-ranging body of work on the topic of IC. Future research should evaluate the implementation of these priorities in care settings.
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Luke Sheeran-Purcell, Geoff McCombe, John Broughan, Emils Sietins, Ronan Fawsitt, Martina Queally, Timothy Lynch and Walter Cullen
Readmissions to the hospital are expensive and can have negative health consequences for patients. Older adults are at greater risk of readmission. Patient perspectives are…
Abstract
Purpose
Readmissions to the hospital are expensive and can have negative health consequences for patients. Older adults are at greater risk of readmission. Patient perspectives are valuable in identifying areas for improvement in the transition of care. The purpose of this qualitative study is to increase our understanding of patients’ perspectives on the transition of care from hospital to primary care.
Design/methodology/approach
This study employs a qualitative methodology to conduct semi-structured interviews with patients who have been discharged from hospitals in the Ireland East Hospital Group region. Remote interviews were conducted with 18 participants from eight general practices. Transcripts were analysed using thematic analysis as described by Braun and Clarke.
Findings
The three main themes identified were communication, outpatient supports and patient education. Gaps in communication do occur, but patients are often too external to comment. Patients benefit from a wide variety of outpatient supports including general practice, family, carers, allied health professionals and voluntary organisations. Access and cost are barriers to these supports. Participants were generally positive towards proposed primary care-based interventions such as follow-up appointments with general practitioners (GPs) and education sessions.
Originality/value
This study highlights a number of areas for improvement in the transition of care in current practice including communication between services and access to outpatient care. It also suggests directions for further research, such as explorations of healthcare provider perspectives and pilot studies of readmission reduction interventions.
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Shane Dunlea, Geoff McCombe, John Broughan, Áine Carroll, Ronan Fawsitt, Joe Gallagher, Kyle Melin and Walter Cullen
Throughout the world, healthcare policy has committed to delivering integrated models of care. The interface between primary–secondary care has been identified as a particularly…
Abstract
Purpose
Throughout the world, healthcare policy has committed to delivering integrated models of care. The interface between primary–secondary care has been identified as a particularly challenging area in this regard. To that end, this study aimed to examine the issue of integrated care from general practitioners’ (GPs) perspectives in Ireland.
Design/methodology/approach
This multimethod study involved a cross-sectional survey and semi-structured interviews with GPs in the Ireland East region. A total of 1,274 GPs were identified from publicly available data as practising in the region, of whom the study team were able to identify 430 GPs with email addresses. An email invite was sent to 430 potential participants asking them to complete a 34-item online questionnaire and, for those who were willing, an in-depth interview was conducted with a member of the study team.
Findings
In total, 116 GPs completed the survey. Most GPs felt that enhancing integration between primary and secondary care in Ireland was a priority (n = 109, 93.9%). Five themes concerning the state of integrated care and initiatives to improve matters were identified from semi-structured interviews with 12 GPs.
Originality/value
The uniqueness of this study is that it uses a multimethod approach to provide insight into current GP views on the state of integrated care in Ireland, as well as their perspectives on how to improve integration within the Irish healthcare system.
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Aimee O'Farrell, Geoff McCombe, John Broughan, Áine Carroll, Mary Casey, Ronan Fawsitt and Walter Cullen
In many healthcare systems, health policy has committed to delivering an integrated model of care to address the increasing burden of disease. The interface between primary and…
Abstract
Purpose
In many healthcare systems, health policy has committed to delivering an integrated model of care to address the increasing burden of disease. The interface between primary and secondary care has been identified as a problem area. This paper aims to undertake a scoping review to gain a deeper understanding of the markers of integration across the primary–secondary interface.
Design/methodology/approach
A search was conducted of PubMed, SCOPUS, Cochrane Library and the grey literature for papers published in English using the framework described by Arksey and O'Malley. The search process was guided by the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA).
Findings
The initial database search identified 112 articles, which were screened by title and abstract. A total of 26 articles were selected for full-text review, after which nine articles were excluded as they were not relevant to the research question or the full text was not available. In total, 17 studies were included in the review. A range of study designs were identified including a systematic review (n = 3), mixed methods study (n = 5), qualitative (n = 6) and quantitative (n = 3). The included studies documented integration across the primary–secondary interface; integration measurement and factors affecting care coordination.
Originality/value
Many studies examine individual aspects of integration. However, this study is unique as it provides a comprehensive overview of the many perspectives and methodological approaches involved with evaluating integration within the primary–secondary care interface and primary care itself. Further research is required to establish valid reliable tools for measurement and implementation.
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Vicente Jara-Vera and Carmen Sánchez-Ávila
The distribution of natural numbers in the Ulam spiral manifests a series of unexpected regularities of the elusive prime numbers. Their sequencing remains a topic of research…
Abstract
Purpose
The distribution of natural numbers in the Ulam spiral manifests a series of unexpected regularities of the elusive prime numbers. Their sequencing remains a topic of research interest, with many ramifications in different branches of Mathematics, especially in number theory and the prime factorisation problem. Accordingly, the focus of the research is on the most known and widespread asymmetric cryptographic system, that is, the RSA encryption.
Design/methodology/approach
This paper presents the presence of one, two, three or four adjacencies for the diverse primes that appear in a spiral, considering the Hardy–Littlewood twin prime conjecture and the constellations of primes.
Findings
Through equations, the calculation formulas of primes inside a spiral that have one to four primes in their adjacent places is offered, with approximate expressions that facilitate the operations, showing that the adjacencies decrease very rapidly as the spiral progresses, although without disappearing.
Originality/value
A generalisation to cases in which the distances to the prime values change in an ascending way in accordance with the step of the Ulam spiral is offered.
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Jason Loughrey and Herath Vidyaratne
The purpose of this paper is to analyse the association between farm/farmer characteristics and unsubsidized farm insurance premium expenditure in Ireland. The distribution of…
Abstract
Purpose
The purpose of this paper is to analyse the association between farm/farmer characteristics and unsubsidized farm insurance premium expenditure in Ireland. The distribution of farm insurance expenditures is wide, and it is important to understand the extent to which individual factors influence demand for different levels of insurance premium.
Design/methodology/approach
The quantile regression approach and farm accountancy data from the Teagasc National Farm Survey are used to model the association between farm/farmer characteristics and farm insurance demand in Ireland.
Findings
Asset values (livestock, buildings and machinery) are positively associated with total insurance expenditure. Both forestry area and crop area are significantly associated with farm insurance expenditure with a stronger influence on the middle and upper part of the distribution. The interaction between farm income and farmer age is positively associated with insurance expenditure pointing to the importance of farm income protection.
Research limitations/implications
The research is mainly concerned with insuring against substantive risks, which are capable of threatening the asset base and continuation of the farm business. Future research can integrate questions in relation to farm safety and farmer health with research on the economic survival of the farm business.
Practical implications
Farmers in Ireland adopt unsubsidized farm insurance as a risk management tool. This situation is relevant to other EU member states including Belgium, Denmark, Germany and Sweden. The findings can be used to inform stakeholders and policymakers about the relative impact of different factors on insurance expenditure.
Originality/value
Previous research has typically focused on the linear relationship between farm/farmer characteristics and insurance demand without accounting for variability across the size distribution. This research is based on the quantile regression approach where the association between farm/farmer characteristics and farm insurance expenditure can be assessed at different points of the distribution.
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Margaret Wood and Feng Su
The purpose of this paper is to explore parents as “stakeholders” in higher education in England and how they perceive teaching excellence.
Abstract
Purpose
The purpose of this paper is to explore parents as “stakeholders” in higher education in England and how they perceive teaching excellence.
Design/methodology/approach
The study adopted a qualitative research design using an interpretative approach through which the authors aimed to develop understandings of parents’ perspectives as higher education “stakeholders”. The empirical data were gathered via focus group interviews and an online survey with 24 participants in the UK.
Findings
This study found that the majority of parents wished to be treated as an important stakeholder group in higher education. Parent participants perceived that teaching excellence could be evidenced through indicators and measures, for example, the design and delivery of the courses, progress measures, contact hours, speed of return of marked work, graduate employability and so on. They also saw value and significance in the students’ exposure to ideas and perspectives not previously experienced, in zeal and passion in the teaching, and in an academically nurturing, understanding and supportive pedagogical relationship between academic and student.
Originality/value
This study uncovered some apparent tensions, contradictions and challenges for parents as stakeholders in higher education, for example, in reconciling the co-existence of their desire to be involved and engaged with scope for students to be formed as independent young adults. Parents’ desire to measure teaching excellence is also compounded by their concern that excellent teaching is thereby reduced to a box-ticking exercise. This study has implications for higher education institutions wishing to engage parents as a stakeholder group in a meaningful way.