A report on the history, extent and effects of heroin use in the electoral ward, Merchants Quay F 1979 - 1985.

A study on the extent and effects of heroin use in a small inner city community in the period 1979-1985 was conducted. A total of eighty-two persons were interviewed and all gave a history of heroin use. The extent of heroin use in the area was greatest in the 1979-1983 period and during this time it was concentrated in 15-19 year old males. Since 1983 there has been a clear decline in the total numbers of persons in the area who have ever used heroin, who are currently using heroin and in the numbers of those who are using heroin for the first time, a trend which coincides with the inception of a Concerned Parents Group. The profile of the heroin user is similar to the one described in previous Medico-Social Research Board studies

Follow up of a cohort of intravenous heroin users in north and south central Dublin and in Dun Laoghaire.

Three studies of intravenous heroin users, in electoral wards in the north and south of central Dublin and in Dun Laoghaire, were undertaken in 1982-84. One hundred and one out of 203 intravenous injectors in these three studies are known to have been tested in Dublin for infection by the Human Immunodeficiency Virus (HIV) and 87 of the 101, or 86% are HIV Positive. Ninety two had also been tested for Hepatitis B infection (Hab) and 76 of the 92 were positive for the hepatitis antigen. The majority of those at present known to be HIV Positive in the Republic of Ireland are, or were, intravenous drug users

General practitioner workforce planning: assessment of four policy directions

<p>Abstract</p> <p>Background</p> <p>Estimating the supply of GPs into the future is important in forecasting shortages. The lengthy training process for medicine means that adjusting supply to meet demand in a timely fashion is problematic. This study uses Ireland as a case study to determine the future demand and supply of GPs and to assess the potential impact of several possible interventions to address future shortages.</p> <p>Methods</p> <p>Demand was estimated by applying GP visit rates by age and sex to national population projections. Supply was modelled using a range of parameters derived from two national surveys of GPs. A stochastic modelling approach was adopted to determine the probable future supply of GPs. Four policy interventions were tested: increasing vocational training places; recruiting GPs from abroad; incentivising later retirement; increasing nurse substitution to enable practice nurses to deliver more services.</p> <p>Results</p> <p>Relative to most other European countries, Ireland has few GPs per capita. Ireland has an ageing population and demand is estimated to increase by 19% by 2021. Without intervention, the supply of GPs will be 5.7% less than required in 2021. Increasing training places will enable supply to meet demand but only after 2019. Recruiting GPs from overseas will enable supply to meet demand continuously if the number recruited is approximately 0.8 per cent of the current workforce per annum. Later retirement has only a short-term impact. Nurse substitution can enable supply to meet demand but only if large numbers of practice nurses are recruited and allowed to deliver a wide range of GP services.</p> <p>Conclusions</p> <p>A significant shortfall in GP supply is predicted for Ireland unless recruitment is increased. The shortfall will have numerous knock-on effects including price increases, longer waiting lists and an increased burden on hospitals. Increasing training places will not provide an adequate response to future shortages. Foreign recruitment has ethical considerations but may provide a rapid and effective response. Increased nurse substitution appears to offer the best long-term prospects of addressing GP shortages and presents the opportunity to reshape general practice to meet the demands of the future.</p

Chronic illness and multimorbidity among problem drug users: a comparative cross sectional pilot study in primary care

<p>Abstract</p> <p>Background</p> <p>Although multimorbidity has important implications for patient care in general practice, limited research has examined chronic illness and health service utilisation among problem drug users. This study aimed to determine chronic illness prevalence and health service utilisation among problem drug users attending primary care for methadone treatment, to compare these rates with matched 'controls' and to develop and pilot test a valid study instrument.</p> <p>Methods</p> <p>A cross-sectional study of patients attending three large urban general practices in Dublin, Ireland for methadone treatment was conducted, and this sample was compared with a control group matched by practice, age, gender and General Medical Services (GMS) status.</p> <p>Results</p> <p>Data were collected on 114 patients. Fifty-seven patients were on methadone treatment, of whom 52(91%) had at least one chronic illness (other then substance use) and 39(68%) were prescribed at least one regular medication. Frequent utilisation of primary care services and secondary care services in the previous six months was observed among patients on methadone treatment and controls, although the former had significantly higher chronic illness prevalence and primary care contact rates. The study instrument facilitated data collection that was feasible and with minimal inter-observer variation.</p> <p>Conclusion</p> <p>Multimorbidity is common among problem drug users attending general practice for methadone treatment. Primary care may therefore have an important role in primary and secondary prevention of chronic illnesses among this population. This study offers a feasible study instrument for further work on this issue. (238 words)</p

Development of a complex intervention to test the effectiveness of peer support in type 2 diabetes

BACKGROUND: Diabetes is a chronic illness which requires the individual to assume responsibility for their own care with the aim of maintaining glucose and blood pressure levels as close to normal as possible. Traditionally self management training for diabetes has been delivered in a didactic setting. In recent times alternatives to the traditional delivery of diabetes care have been investigated, for example, the concept of peer support which emphasises patient rather than professional domination. The aim of this paper is to describe the development of a complex intervention of peer support in type 2 diabetes for a randomised control trial in a primary care setting. METHODS: The Medical Research Council (MRC) framework for the development and evaluation of complex interventions for randomised control trials (RCT) was used as a theoretical guide to designing the intervention. The first three phases (Preclinical Phase, Phase 1, Phase 2) of this framework were examined in depth. The Preclinical Phase included a review of the literature relating to type 2 diabetes and peer support. In Phase 1 the theoretical background and qualitative data from 4 focus groups were combined to define the main components of the intervention. The preliminary intervention was conducted in Phase 2. This was a pilot study conducted in two general practices and amongst 24 patients and 4 peer supporters. Focus groups and semi structured interviews were conducted to collect additional qualitative data to inform the development of the intervention. RESULTS: The four components of the intervention were identified from the Preclinical Phase and Phase 1. They are: 1. Peer supporters; 2. Peer supporter training; 3. Retention and support for peer supporters; 4. Peer support meetings. The preliminary intervention was implemented in the Phase 2. Findings from this phase allowed further modeling of the intervention, to produce the definitive intervention. CONCLUSION: The MRC framework was instrumental in the development of a robust intervention of peer support of type 2 diabetes in primary care. TRIAL REGISTRATION: Current Controlled Trials ISRCTN42541690

An analysis of the effects of HIV infection in a cohort of intravenous drug users.

Intravenous drug use has been a serious problem for Dublin's deprived inner city areas since the late 1970's. In 1985, a cohort of all known intravenous drug users (IVDUs) was identified in one inner city electoral cohort and has been followed since then. The cohort was identified before the introduction of HIV testing. The prevalence of HIV infection and its consequences have continued to rise. By 1994, 80% of the group were known to have had a HIV test: 53 (65%) are seropositive. Twenty-one (26%) have died, almost all from the seropositive group. Thirty-six (44%) continued to inject heroin during 1994. The implications of these grim statistics are discussed

The natural history of injecting drug use: a 25-year longitudinal study of a cohort of injecting drug users in inner city Dublin.

Background Injecting drug use is associated with increased morbidity and mortality. This is the first longitudinal study of a community-based population of injecting drug users (IDUs) in the Republic of Ireland. Aim To establish the natural history of IDUs in a deprived Dublin community. Methods Eighty-two IDUs (heroin) were recruited over the summer months of 1985. The prevalence of drug use in this district electoral area was established in 1985 and followed-up over a 25-year period with two formal interviews in 1995 and 2010. Results It is a descriptive study of a cohort of IDUs established in 1985 prior to human immunodeficiency virus (HIV) testing being available. The majority of the cohort recruited included single, unemployed males aged 20 to 29 years, who had served a prison sentence. Fifty-one (63 %) of the cohort had died by 2010, of which 26 were attributed to HIV disease. The mean age of death was 35.9 years of age (standard deviation 4.1 years). Fifty-two (63 %) of the cohort tested positive for HIV and 58 (71 %) for hepatitis B between 1985 and 2010. The median survival time for those with a positive HIV status was 17 years (95 % CI 14.0–20.0) and for those with a positive hepatitis C status, 21 years (95 % CI 15.5–26.5). Conclusions The lifestyle of IDUs, as demonstrated by the experience of this cohort, has hazardous consequences resulting in high levels of morbidity and mortality. A relatively stable picture of HIV associated with IDUs is now emerging in Ireland, as is the case throughout most of the EU. HIV is a more manageable chronic disease, posing challenges for primary care in its treatment of former and existing IDUs who are ageing and now have other chronic diseases

The natural history of injecting drug use in a Dublin community (1985-1995).

This thesis puts opiate use into a historical, geographic and demographic context and then outlines the impact of the emergence of HIV infection on the general population and in particular on injecting drug users. The study described here is longitudinal and community based; a sustained attempt was made to identify all the drug users within one district electoral area and to interview them, first in 1985 and again 1995. There is a high level of mortality and morbidity in this cohort of drug users, which is closely associated with, but not exclusive to, HIV infection. Problem drug use is found in the most marginalised and deprived areas of Dublin City

Irish general practice and the human immunodeficiency virus.

Over a quarter (499) of general practitioners in the Republic of Ireland were sent a questionnaire on the human immunodeficiency virus (HIV) infection. Two hundred and fifty eight (51.7%) general practitioners returned completed questionnaires. Ninety six respondents (37.2%) had seen at least one HIV positive patient in their practice. In Dublin two thirds (67%) of respondents had seen HIV positive patients. A large majority (77.6%) of HIV positive people identified by the survey were attending general practitioners in the Eastern Health Board area. Most (61.2%) respondents favour the involvement of general practitioners in the future care of patients with HIV