This document discusses the role of research in primary care in Ireland. It provides an overview of the Health Research Board (HRB) and its support for primary care research through funding, centers, networks and training. There is a need for primary care research to develop an evidence base and improve practice. The HRB has increased funding for primary care research projects and established the Irish Primary Care Research Network to facilitate research. Key themes include chronic disease management, health promotion, and evaluating reforms.

1. Primary Care Conference
19 Nov 2014
Role of Research in Primary Care

2. Overview
• Strategic context for health research
• Overview of HRB
• Primary care research in Ireland
• Examples of primary care research linked
to practice

3. Health Research Plans
• HRG Action Plan for Health
Research 2009-2013
• HRB Strategic Business Plan
2010 -2014
• National Research
Prioritisation Exercise 2012
Set the strategic direction, goals,
targets and actions to reap the health,
social and economic benefits of our
investment in health research

4. 1. Patient-oriented research
2. Population Health
3. Health Services Research
• Projects
• Applied Programmes
• Centres/networks
• Short courses/workshops
• Fellowships and Career
Awards
• Research Infrastructure
• EU/International
opportunities

5. HRB Strategy - Key Themes
• 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

6. HRB Annual Income 1999-2012
60.0
50.0
40.0
30.0
20.0
10.0
0.0
1 2 3 4 5 6 7 8 9 10
Total Income (€M)
Year
Capital (€M)
Revenue (€M)
1999 2001 2003 2005 2007 2008 2009 2010 2011 2012

7. HRB Portfolio analysis

8. 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

9. 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)

10. 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

11. 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

12. 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

13. 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

14. 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

16. 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

17. 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

18. 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