Contact tracing during the COVID-19 outbreak: a protocol for enabling rapid learning from experiences and exploring the psychological impact on contact tracers

Background: Given the unprecedented nature of the COVID-19 pandemic, the Irish health system required the redeployment of public sector staff and the recruitment of dedicated contact tracing staff in the effort to contain the spread of the virus. Contact tracing is crucial for effective disease control and is normally carried out by public health teams. Contact tracing staff are provided with rapid intensive training but are operating in a dynamic environment where processes and advice are adapting continuously. Real-time data is essential to inform strategy, coordinate interconnected processes, and respond to needs. Given that many contact tracers have been newly recruited or redeployed, they may not have significant experience in healthcare and may experience difficulties in managing the anxieties and emotional distress of the public. Aim: (i) identify emerging needs and issues and feed this information back to the Health Service Executive for updates to the COVID-19 Contact Management Programme (CMP); (ii) understand the psychological impact on contact tracers and inform the development of appropriate supports. Methods: We will use a mixed-methods approach. A brief online survey will be administered at up to three time points during 2021 to measure emotional exhaustion, anxiety, general health, and stress of contact tracing staff, identify tracing systems or processes issues, as well as issues of concern and confusion among the public. Interviews will also be conducted with a subset of participants to achieve a more in-depth understanding of these experiences. Observations may be conducted in contact tracing centres to document processes, practices, and explore any local contextual issues. Impact: Regular briefs arising from this research with data, analysis, and recommendations will aim to support the work of the CMP to identify problems and implement solutions. We will deliver regular feedback on systems issues; challenges; and the psychological well-being of contact tracing staff.

Contact tracing during the COVID-19 outbreak: a protocol for enabling rapid learning from experiences and exploring the psychological impact on contact tracers

Background: Given the unprecedented nature of the COVID-19 pandemic, the Irish health system required the redeployment of public sector staff and the recruitment of dedicated contact tracing staff in the effort to contain the spread of the virus. Contact tracing is crucial for effective disease control and is normally carried out by public health teams. Contact tracing staff are provided with rapid intensive training but are operating in a dynamic environment where processes and advice are adapting continuously. Real-time data is essential to inform strategy, coordinate interconnected processes, and respond to needs. Given that many contact tracers have been newly recruited or redeployed, they may not have significant experience in healthcare and may experience difficulties in managing the anxieties and emotional distress of the public. Aim: (i) identify emerging needs and issues and feed this information back to the Health Service Executive for updates to the COVID-19 Contact Management Programme (CMP); (ii) understand the psychological impact on contact tracers and inform the development of appropriate supports. Methods: We will use a mixed-methods approach. A brief online survey will be administered at up to three time points during 2021 to measure emotional exhaustion, anxiety, general health, and stress of contact tracing staff, identify tracing systems or processes issues, as well as issues of concern and confusion among the public. Interviews will also be conducted with a subset of participants to achieve a more in-depth understanding of these experiences. Observations may be conducted in contact tracing centres to document processes, practices, and explore any local contextual issues. Impact: Regular briefs arising from this research with data, analysis, and recommendations will aim to support the work of the CMP to identify problems and implement solutions. We will deliver regular feedback on systems issues; challenges; and the psychological well-being of contact tracing staff.

Antipsychotic prescribing in GMS paediatric and young adult population in Ireland 2005–2015: repeated cross-sectional study

Objectives: To examine the rates of antipsychotic prescribing in the Irish paediatric and young adult population enrolled in the Irish General Medical Services Scheme pharmacy claims database from the Health Service Executive Primary Care Reimbursement Services database, with a focus on age and sex differences. To examine concomitant prescribing of certain other related medicines in this population. Methods: Data were obtained from the Irish General Medical Services (GMS) scheme pharmacy claims database from the Health Service Executive (HSE) – Primary Care Reimbursement Services (PCRS). Participants included children aged <16 years and youth aged 16–24 years availing of medicines under the HSE-PCRS GMS scheme between January 2005 and December 2015. Outcome measures included prescribing rates of antipsychotics from 2005 to 2015, differences in prescribing rates between different ages and sexes, and percentage of concomitant prescriptions for antidepressants, psychostimulants, anxiolytics and hypnosedatives. Results: Overall the trend in prescribing rates of antipsychotic medications was stable at 3.94/1000 in 2005 compared with 3.97/1000 in 2015 for children <16 years, and 48.37/1000 eligible population in 2005 compared to 39.64/1000 in 2015 for those aged 16–24. There was a significant decrease in prescribing rates for males in the 16–24 age group. Conclusions: While rates of antipsychotic prescribing have decreased or remained stable over the timeframe of the study, we did find a significant proportion of this population were prescribed antipsychotics. This study also shows that co-prescribing of antidepressants increased and highlights the need for guidelines for antipsychotic prescribing in children and youth in terms of clinical indication, monitoring, co-prescribing and treatment duration.

Primary Mental Health Care Part 3: Demonstration of a Proposed New Model for Primary Mental Health Care

The current primary mental health care system in Ireland is limited. A different vision of primary mental health care requires national awareness of the limitations of ‘A Vision for Change’1 and it’s followed up policy document, ‘Sharing the Vision’.2 Awareness alone is insufficient, requiring the additional properties of ambition, conviction, and engagement to overhaul the current system. In this third paper on Primary Mental Health Care, a truly changed vision of care is presented and demonstrated to be successfully at work in one third level counseling service, at the University of Limerick. This model is contrasted with the current medicalized model and proposed as a replacement model of primary mental health care for Ireland. A number of recommendations are made, including the suggestions that the proposed model of service delivery based on the model at the University of Limerick be piloted outside of the third level sector, within the Health Service Executive of Ireland.

Cancer Patients’ Satisfaction with Virtual Clinics in Ireland During COVID-19.

Background The COVID-19 pandemic has led to an unprecedented lockdown of Ireland and significant healthcare challenges including outpatient department clinics. As a result, these cancer clinics were conducted virtually by telephone. The aim of this study is to measure cancer patients’ satisfaction with telephone consultations.Methods Cancer patients on active treatment or surveillance in an Irish university hospital were invited to complete a questionnaire issued via “Survey Monkey”. It comprised ten questions and assessed whether patients concerns were adequately addressed and preference to continue with virtual consultations. Patients recorded what was absent from the current environment when compared with previous clinics.Results This survey was issued to 180 cancer patients including 65 (36%) men and 115 females (64%) with a median age of 65 (range 20 – 92) years. Fifty-four patients (30%) completed this anonymised questionnaire. Over 96% (n=52) of cancer patients agreed/strongly agreed their concerns were addressed satisfactorily and similarly 93% (n=50) felt reassured after this consultation. One-third of patients (n=18) would prefer for all out-patient consultations to revert to those in the pre COVID-19 era and 11% agreed all future consultations should continue virtually. The remaining, 30 patients (56%) agreed with the later though only in certain circumstances. Twenty-eight patients missed (56%) missed the face-to-face interaction and reassurance provided by a physical examination. Conclusion This is the first Irish oncology study which examined cancer patients perspective of Health Service Executive directed virtual outpatient clinics. Face-to-face consultations are crucial for optimal cancer patient care and cannot be eliminated completely.

Doctor Retention in Ireland - Where Are the Failings That Prolong the Problem? Comment on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle"

The issue of doctor retention has been a challenge in Ireland for many years. Poor working conditions including poor supervision, cost of training, bullying, worsening mentoring experiences and speciality specific issues are a substantial challenge faced by doctors in Ireland, thus leading to a higher degree of emigration. While some changes have been introduced to the system and have some positive effects, the root causes of doctor emigration have not been addressed. This commentary reviews the publication by Brugha et al published in the IJHPM in April 2020 on "Doctor Retention: A Cross-sectional Study of How Ireland Has Been Losing the Battle" and explains why the current system needs to change for the benefit of patient safety, doctor well-being and better patient care. Ireland’s Health Service Executive intends to take steps towards developing a new model of medical workforce to address the issue of recruitment and retention challenges within the healthcare system.

Knowledge and confidence of clinicians in Irish CAMHS when working with transgender youth; and the factors clinicians report will assist them in this work

Objectives: The Health Service Executive (HSE) Quality Improvement Division (2016) report states that young people who identify as transgender are one of the highest risk groups for suicidal ideation, self-harm, and completed suicides and may require significant input in Irish Child and Adolescent Mental Health Services (CAMHS). This research represents the first exploration of CAMHS staff’s capacity within an Irish mental health service to support transgender youth by considering their knowledge about and confidence in working with these youth. Method: A multi-method design was used to evaluate the knowledge and confidence levels of CAMHS clinicians in supporting transgender youth and to identify what factors would enable them to conduct this work. A questionnaire and a survey about supporting transgender youth were distributed to all clinicians in five Irish-based CAMHS services (N = 71), using an online platform. Additionally, semi-structured interviews were conducted with six clinicians. Quantitative, content, and thematic analyses were performed. Results: CAMHS staff reported limited knowledge and experience about supporting transgender youth. Findings indicated that both of these factors undermined their confidence in supporting these youths. Clinicians expressed a need for additional clinical education delivered through expert consultation, presentations, and learning from ‘experts by experience’. Conclusion: CAMHS clinicians need and want further clinical education about supporting transgender youth and their families. Recommendations are made for enhancing the knowledge, confidence, and competence of CAMHS clinicians using methods identified as acceptable by clinicians, in order to best support these youths.

Establishing prison-led contact tracing to prevent outbreaks of COVID-19 in prisons in Ireland

Background Preventing transmission of COVID-19 within prisons is both important and challenging. The confined conditions in prisons can encourage person-to-person spread with the potential for outbreaks occurring. Contact tracing is an important contributor to the longer-term management strategy for COVID-19 in prisons as well as in the community but is highly resource-intensive. This paper describes the approach to contact tracing taken by the Irish Prison Service (IPS). Methods The IPS National Infection Control Team, in collaboration with the National Quality Improvement (QI) team and Health Service Executive (HSE) in Ireland, implemented a programme to develop and train in-prison contact tracing teams (CTTs). CTTs were run by prison staff with experience of working with detainees, prison IT systems and CCTV. Protocols for undertaking contact tracing for both detainee and staff cases of COVID-19 were established. Results All prisons, and two support agencies, within the IPS now have fully functional in-prison CTTs. Every CTT has responded to at least one case COVID-19, undertaken contact tracing and instigated quarantine of contacts. Conclusions A partnership approach with development of prison-led CTTs can provide an effective mechanism for contact tracing of COVID-19 cases within the prison setting.

Improving Transfer Medication Reconciliation in an Emirati Tertiary Hospital Utilizing the Irish Health Service Executive Model

Transfer is a vulnerable setting that increases the risk of medication errors. Medication reconciliation (MedRec) ensures accurate medication transfer at interfaces of care. It is addressed as a key performance indicator (KPI) in a tertiary hospital. The issue was failure to meet the KPI of more than 75%; the objective was to improve compliance with transfer MedRec. A quality improvement project was conducted utilizing physician active education, leadership support, and the Irish Health Service Executive (HSE) change model. Compliance with the KPI did not improve with monthly monitoring and physician education. Following leadership support, compliance increased from 56% to 72% but was not sustained. Adoption of the change model yielded a sustainable improvement from 65% to 81% within 1 year of the intervention and a reduction in medication errors. Improvement in the MedRec process requires a culture of accountability to change. HSE expedited stakeholders’ engagement and implementation of the planned interventions.