bluuebunny/crossref_metadata_2025 huggingface dataset:
HPV/cervical cancer vaccination: parental preferences on age, place and information needs
Authors: Rose Sally , Lawton Beverley , Lanumata Tolotea , Hibma Merilyn , Baker Michael
Published: November 2018

INTRODUCTION: A vaccine against cervical cancer is available in New Zealand through school and primary care for girls aged 1218 years. Factors that might increase or hinder widespread uptake by the target population need to be identified. Aim: To describe parents preferences on where their daughter(s) receive the human papillomavirus (HPV) vaccine, at what age, and their information needs. METHODS: 3123 questionnaires were distributed to parents recruited from 14 schools in 2008, prior to the start of the school-based vaccination programme. Outcome measures were: preferred age and place of vaccination, and information needs of parents and their daughters. Tests for significance were performed to determine whether parental preferences differed by ethnic group (Maori, Pacific, New Zealand European and Other). RESULTS: A 25% response rate was achieved (769/3123). Receipt of the HPV vaccine in a clinic setting was preferred by 40% of parents; 25% preferred vaccination at school. Fifty percent preferred vaccination to occur at age 13 or older; 28% thought ages 10, 11 or 12 appropriate. One in three parents wanted more information and 65% said they would seek information from their family doctor before deciding on the vaccine for their daughter(s). DISCUSSION: We suggest that a programme delivered jointly in primary care and school settings, that is appropriately resourced for follow-up and information-sharing, would increase vaccine coverage. The rationale for vaccination at age 12 needs to be made clear to parents and evidence-based information needs to be delivered appropriately to parents and girls. KEYWORDS: Human papillomavirus (HPV); vaccination; cervical cancer; survey; ethnicity
General practitioners' views about diagnosing and treating depression in Maori and non-Maori patients
Authors: Thomas David , Arlidge Brooke , Arroll Bruce , Elder Hinemoa
Published: November 2018

INTRODUCTION: The study investigated general practitioners (GPs) views about recognising and treating depression among patients to establish possible reasons for reported lower levels of diagnosis and treatment of depression among Maori compared to non-Maori patients. METHODS: Semi-structured interviews with 23 GPs in the Auckland region, including both Maori and non-Maori GPs, elicited GPs views about risk factors for depression, recognising depression and circumstances in which GPs would prescribe medication or recommend other treatments for depression. FINDINGS: A framework was developed which incorporated the strategies GPs reported using to diagnose and treat depression. This consisted of three categories: (a) how depression is identified, (b) factors influencing treatment decisions, and (c) treatment outcomes. Reasons reported by GPs as most likely to lead to ethnic differences in diagnosing depression were greater stigma relating to admitting depression among Maori patients, Maori patients being less likely to talk about being depressed, and the need for patients to have effective communication with their GP. Effective communication, where Maori patients felt free to talk about personal feelings, was more likely when there was an established relationship between the GP and patient. CONCLUSION: The findings are consistent with previous reports that depression is less likely to be diagnosed by GPs among Maori patients, compared to non-Maori patients. GPs who are able to establish effective communication with patients, gain their trust and take account of the reluctance of some Maori patients to talk about personal feelings, are more likely to diagnose and treat depression effectively. KEYWORDS: Depression; diagnosis; treatment; primary care; Maori; ethnicity; New Zealand
Perspectives on adherence to blood pressure–lowering medications among Samoan patients: qualitative interviews
Authors: Chang Wai Kuinileti , Raina Elley C , Nosa Vili , Kennelly John , Mabotuwana Thusitha , Warren Jim
Published: November 2018

AIM: To explore influences on adherence to taking long-term medications among Samoan patients in an Auckland general practice. METHODS: Twenty Samoan participants from an Auckland general practice were identified and interviewed about their views on adherence or non-adherence to taking blood pressure–lowering medications. One-to-one semi-structured interviews using open-ended questions were undertaken in Samoan and English, recorded, transcribed and translated into English. Transcriptions were examined by two researchers to identify themes. FINDINGS: Patients with ‘high’ and ‘lower’ rates of adherence to taking usual medication were identified using medication possession ratio cut-offs from medical records of timely prescribing. Ten participants with ‘high’ and 10 with ‘lower’ rates of adherence were interviewed, including 11 women and nine men. Themes identified for those with lower adherence included ‘lack of transport’, ‘family commitments’, ‘forgetfulness’, ‘church activities’, ‘feeling well’ and ‘priorities’. Themes identified for those with high rates of adherence included ‘prioritising health’, ‘previous event’, ‘time management’, ‘supportive family members’ and ‘relationship with GP (language and trust)’. A theme common to both was ‘coping with the stress of multiple comorbidities’. CONCLUSION: Reasons for adherence and non-adherence to taking blood pressure–lowering medications among the Samoan patients interviewed were multifactorial and encompass personal, social, cultural and environmental factors. Interdisciplinary teams to support treatment decisions (including Pacific health professionals or community health workers), systematic identification of those with low rates of adherence, phone or text follow-up, use of church or family networks, provision of transport where needed and better tools and resources may help address this problem. KEYWORDS: Medication adherence; New Zealand; Pacific Islands; ethnic groups; qualitative research; antihypertensive agents
Reducing health didparities for low decile children and families: a nurse-led response
Authors: Riley Catrina , Crawford Ruth
Published: November 2018

BACKGROUND AND CONTEXT: Reducing health disparities for children living in deprived areas has been difficult to achieve. This paper describes the implementation of a nurse-led, child-specific clinic within a general practice setting to improve health outcomes for high needs Maori/Pacific Island and NZDep96 quintile groups 4 and 5 children and their whanau/families. ASSESSMENT OF PROBLEM: The medical centre that implemented the clinic had a high number of enrolled children with chronic and recurrent morbidities. Children frequently did not attend clinic appointments, and there was high use of after-hours services. RESULTS: An outcome audit after 18 months demonstrated a significant (>30%) reduction in eczema severity, daily irritability, and daily occurrence of pain. Post-intervention fewer children were hospitalised and there was a 50% reduction in antibiotic use. STRATEGIES FOR IMPROVEMENT: The aim of the nurse-led clinic was to improve health gains, facilitate morbidity control of chronic conditions, and to offer prevention strategies to promote wellness for the target population. The reduction of morbidity severity by 10% was measured with specific morbidity scoring systems for eczema, constipation and nocturnal enuresis. Other outcome indicators measured vomiting/reflux, wheezing/coughing, constipation/soiling, irritability, sleep disturbances, hospital admissions, and antibiotic use. LESSONS: Nurse-led clinics facilitated by nurses with advanced skills can reduce health disparities for the target population. The amount of time the nurse is able to spend with the child and whanau/family, and the provision of opportunistic assessments as required, has effected positive change in those children most in need. KEYWORDS: Child health; low decile families; Maori/Pacific families: chronic conditions; nurse-led clinic
Review of registration requirements for new part-time doctors in New Zealand, Australia, the United Kingdom, Ireland and Canada
Authors: Leitch Sharon , Dovey Susan
Published: November 2018

INTRODUCTION: By the time medical students graduate many wish to work part-time while accommodating other lifestyle interests. AIM: To review flexibility of medical registration requirements for provisional registrants in New Zealand, Australia, the United Kingdom, Ireland and Canada. METHODS: Internet-based review of registration bodies of each country, and each state or province in Australia and Canada, supplemented by emails and phone calls seeking clarification of missing or obscure information. RESULTS: Data from 20 regions were examined. Many similarities were found between study countries in their approaches to the registration of new doctors, although there are some regional differences. Most regions (65%) have a provisional registration period of one year. Extending this period was possible in 91% of regions. Part-time options were possible in 75% of regions. All regions required trainees to work in approved practice settings. DISCUSSION: Only the UK provided comprehensive documentation of their requirements in an accessible format and clearly explaining the options for part-time work. Australia appeared to be more flexible than other countries with respect to part- and full-time work requirements. All countries need to examine their registration requirements to introduce more flexibility wherever possible, as a strategy for addressing workforce shortages. KEYWORDS: Family practice; education, medical, graduate; government regulation
The Flinders Programme of Chronic Condition Self-Management in New Zealand: survey findings
Authors: Horsburgh Margaret , Bycroft Janine , Goodyear-Smith Felicity , Roy Dianne , Mahony Faith , Donnell Erin , Miller Denise
Published: November 2018

INTRODUCTION: The Flinders ProgramTM of Chronic Condition Self-Management in New Zealand (NZ) has been given focus as a useful and appropriate approach for self-management support and improvement of long-term condition management. AIM: To determine the use of the Flinders ProgramTM in NZ and identify barriers and enablers to its use. METHOD: A web-based survey was undertaken in June 2009 with 355 eligible participants of the 500 who had completed ‘Flinders’ training in NZ since 2005. RESULTS: 152 (43%) respondents completed the survey over a one-month time frame. Of those who responded, the majority were primary care nurses (80%; 118). Fifty-five percent (82) of survey respondents reported using some or all of the Flinders tools. Of these, 11% (16) reported using all of the tools or processes with 77% (104) of respondents having completed six or fewer client assessments utilising the Flinders tools. This indicates that respondents were relatively inexperienced with use of the Flinders ProgramTM. Barriers to implementation were identified as the time needed for structured appointments (up to one hour), funding, resistance from colleagues, lack of space and insufficient ongoing support. DISCUSSION: Despite the extent of training in the use of the Flinders ProgramTM, there is limited use in clinical practice of the tools and processes associated with the model. Without structured support for quality improvement initiatives and self-management programmes, the ability to implement learned skills and complex interventions is limited. KEYWORDS: Self-management; long-term conditions; chronic conditions; chronic illness; primary care; nurses
Repeat prescribing  reducing errors
Authors: Lillis Steven , Lord Hayley
Published: November 2018

BACKGROUND AND CONTEXT: Prescribing errors account for a significant proportion of overall error in general practice. Repeat prescribing occurs commonly in New Zealand and is a likely cause of error in practice. ASSESSMENT OF PROBLEM: This paper reports on two related aspects of repeat prescribing; an audit of adherence to a repeat prescribing protocol and self-reported repeat prescribing incidents in a network of 97 general practices. RESULTS: The audit of adherence to the repeat prescribing protocol revealed that some issues persist. In particular, prescribing medication outside an approved list and exceeding specified time limits or maximal scripts before clinical review were problematic. Repeat prescribing encompassed a range of departures of process from minor (such as prescription not available on time) to major (wrong medication). Corrective measures highlighted the importance of both the pharmacist and the patient in error detection. STRATEGIES FOR IMPROVEMENT: Repeat prescribing needs to be recognised as a process potentially fraught with error. Effective practice systems, patient involvement and enhanced pharmacy communication are important contributing factors in reducing error. LESSONS: There is need for robust data regarding error rates in prescribing and the impact of changing prescribing protocols on error rates. KEYWORDS: Medication errors; electronic prescribing
Recruitment and retention of primary care patients into a research study investigating medication adherence
Authors: Yen Chang Shih , Horsburgh Simon , Norris Pauline , Braund Rhiannon
Published: November 2018

INTRODUCTION: General practitioners (GPs) and patients are key sources of information for investigating primary health care. However, recruiting these into health care studies has been reported to be difficult. AIM: This study aimed to determine the recruitment and retention rates of GP practices and patients into a research project in the primary health care setting. METHODS: All general practices in Dunedin, New Zealand, with three or more practitioners were invited to participate in a study investigating medication adherence. In practices that agreed to participate, 100 patients were recruited from waiting rooms and followed up by telephone over six months. The main outcome measures included recruitment rates of GPs and patients, the level of retention and loss to follow-up of patients over a six-month period, the drop out and reasons for this drop out. RESULTS: Only two of the 15 practices agreed to participate. To recruit 100 patients, 203 people were approached. Reasons for not wanting to participate were recorded where possible. Of those that agreed to participate, 86% of doctor consultations resulted in a prescription and, of these prescriptions, 87% were reported to be collected as prescribed. At the end of six months, 68 patients still remained in the study. DISCUSSION: Patients were interested in being involved in this type of study and were recruited at a rate of 82% and 56% depending on the practice. After the initial drop out, most patients remained in the study until the conclusion. Recruitment of general practices remains challenging. KEYWORDS: Patient compliance; patient recruitment; primary health care
Outcomes of an interdisciplinary rehabilitation programme for the management of chronic low back pain
Authors: Gregg Chris , Hoffman Chris , Hall Hamilton , McIntosh Greg , Robertson Peter
Published: November 2018

BACKGROUND AND CONTEXT: The health and economic costs associated with chronic low back pain (CLBP) have increased substantially over the past few decades. Despite extensive research, a consistently valid, reliable and effective diagnostic and treatment regime for CLBP is yet to be determined. ASSESSMENT OF PROBLEM: This paper presents an established interdisciplinary rehabilitation model for CLBP initially developed by the Canadian Back Institute. An audit describes the symptomatic, functional and vocational outcomes achieved for patients who attended the programme over three years throughout a national network of primary health care facilities in New Zealand. RESULTS: Over a three-year period, 899 patients with CLBP completed their rehabilitation programme at one of eight affiliated clinics. Of the 899 patients discharged, 780 (86.8%) reported that their back pain had gone or reduced at the end of their rehabilitation. There was a statistically significant, and clinically relevant, improvement in both average pain and subjective functional scores from baseline assessment levels to discharge and follow-up scores (p<0.001). STRATEGIES FOR IMPROVEMENT: Previous studies have shown that functional rehabilitation can improve outcomes in individuals with CLBP. This audit provides further support for the development of interdisciplinary functional rehabilitation programmes to help manage CLBP within the community. LESSONS: The routine measurement of symptomatic, functional and vocational outcomes throughout the rehabilitation process can assist in quantifying the effect of treatment and providing evidence of value for patients, stakeholders and funding groups. KEYWORDS: Low back pain; outcomes; rehabilitation
Can the prevalence of diagnosed diabetes be estimated from linked national health records? The validity of a method applied in New Zealand
Authors: Thornley Simon , Wright Craig , Marshall Roger , Jackson Gary , Drury Paul , Wells Susan , Smith James , Cheuk Chan Wing , Pylypchuk Romana , Jackson Rod
Published: November 2018

INTRODUCTION: With projected global increases in the prevalence of Type 2 diabetes, the health sector requires timely assessments of the prevalence of this disease to monitor trends, plan services, and measure the efficacy of prevention programmes. AIM: To assess the validity of a method to estimate the prevalence of diagnosed diabetes from linked national health records. METHODS: We measured the agreement between a diabetes diagnosis (using combined national lists of drug dispensing, outpatient attendance, laboratory tests (HbA1c) and hospital diagnoses) and a primary care diabetes diagnosis in a (PREDICT™) cohort of 53 911 adult New Zealanders. The completeness of the diagnosis of diabetes in the cohort was estimated using capture-recapture methods. RESULTS: The primary care cohort had a high prevalence of recorded diabetes (20.9%, 11 266/53 911), similar to our derived prevalence of 20.1%. Of the participants with a diagnosis of diabetes, 89% (10 182/11 266) had a similar derived diagnosis, indicating that only about one in 10 people with a primary care diagnosis had not been either admitted to hospital, seen at outpatient clinics, prescribed diabetes drugs or undertaken regular HbA1c tests. The capture-recapture prevalence of diagnosed diabetes in this cohort was 23.7% indicating that primary care diagnoses in the cohort were about 90% complete. DISCUSSION: A method for estimating the prevalence of diagnosed diabetes from national health data shows high-level agreement with primary care records. Linked health data can provide an efficient method for estimating the prevalence of diagnosed diabetes in regions where such records are individually linked. KEYWORDS: Diabetes mellitus, Type 2; epidemiology; prevalence; medical records
Clinical teachers working in primary care: what would they like changed in the medical school?
Authors: Hawken Susan , Henning Marcus , Pinnock Ralph , Shulruf Boaz , Bagg Warwick
Published: November 2018

INTRODUCTION: General practitioners (GPs) working as clinical teachers are likely to influence medical students’ level of community-based learning. This paper aimed to ascertain clinical teachers’ views in relation to The University of Auckland about their clinical learning environment. METHOD: A total of 34 clinical teachers working in primary care contributed to this study. To gauge their level of involvement in teaching and learning, the clinical teachers were asked about issues such as their confidence, available time, sufficient clinical learning opportunities, clear learning objectives to teach students and what they would like changed. FINDINGS: The GPs appeared confident, felt there were sufficient learning opportunities for students and that their students were part of the team. Less experienced teachers expressed less confidence than more experienced peers. There was some hesitancy in terms of coping with time and feedback. Some clinical teachers were unclear about the learning objectives presented to students. CONCLUSION: Several issues that emerged—including available time and financial rewards – are difficult to resolve. Curriculum and selection are evolving issues requiring constant monitoring and alignment with increasing numbers of students studying medicine, increased ethical awareness, more diverse teaching systems and more advanced technologies. Non-faculty clinicians need adequate representation on curriculum committees and involvement in clinical education initiatives. Issues of cultural competency and professional development were raised, suggesting the need for more established links between university and GPs. KEYWORDS: Primary health care; clinical teaching; general practitioners
Is our focus right? Workforce development for primary health care nursing
Authors: McKinlay Eileen , Clendon Jill , OReilly Sue
Published: November 2018

INTRODUCTION: Effective workforce development is a key investment in producing quality health care. Service delivery stakeholders often assume that workforce development is best achieved through short clinical topic training or extended postgraduate courses; however, the views and preferences of primary health care (PHC) nurses have not routinely been sought. This study explores the workforce development needs of experienced PHC nurses in a provincial area of New Zealand. METHODS: In addition to a literature scan, two focus group interviews were held with nurses representing a broad range of PHC subspecialities. Participants also completed a brief survey regarding their own and colleagues education needs. Nurse leaders in three District Health Boards (DHBs) and one Primary Health Organisation (PHO) were asked for comments on workforce strategies. Datasets were analysed separately then triangulated for overall themes. FINDINGS: Thirty-one PHC nurses attended the two focus groups. Participants noted changes to their roles in the last three years, including new areas of clinical and workforce development. Participants in both focus groups largely focused on structural and organisational barriers to PHC workforce development. CONCLUSIONS: PHC nurses have priorities for workforce development that may differ from stakeholders, and offering clinical education opportunities alone may not be enough. Providing leadership education as well as career mentoring appears to be as important as clinical education and should happen in conjunction with other workforce development opportunities. This research demonstrates a need for a nationally agreed education strategy for the PHC nursing workforce. KEYWORDS: Nursing; workforce development; career mentors; leadership education
Potion or Poison? Guarana
Authors: Woods David
Published: November 2018

SUMMARY MESSAGE: The main constituent of guarana is caffeine, with smaller quantities of theophylline and theobromine. There is no evidence that the berries or extracts contain anything else that is therapeutically useful. Guarana is associated with many therapeutic properties, but there is no evidence to support these other than effects that can be attributed to caffeine. Guarana is widely available in herbal products and energy drinks. Excessive intake can cause the same effects as too much caffeine. It is not widely recognised that guarana has a high caffeine content and the labelling on some products is misleading. Although not specifically studied, guarana would be expected to exhibit the same range of adverse effects and drug interactions as those associated with caffeine.
PSA testing in general practice
Authors: Hodgson Fraser , Obertová Zuzana , Brown Charis , Lawrenson Ross
Published: November 2018

INTRODUCTION: In New Zealand, prostate-specific antigen (PSA) testing has increased significantly (275 000 tests/year). Controversy exists around PSA testing as part of an unorganised screening programme. AIM: To look at the use of PSA testing in a sample of general practices and investigate the reasons GPs undertake PSA testing. METHODS: Five Waikato general practices investigated looking at PSA laboratory tests of men =40 years in 2010 compared against GP notes. Testing rates, reasons for testing, histology and referral/s were examined for different age groups. A questionnaire was sent to the GPs to determine their views on PSA testing. RESULTS: One in four men aged 40+ years had a PSA test in 2010. Of these men, 71% were asymptomatic. More than half of men tested aged 70+ years were asymptomatic. Ten percent of all PSA tests were elevated. Twenty-one of 23 prostate cancers were diagnosed following an elevated PSA test: more than 80% of these men had histories of prostate pathology or lower urinary tract symptoms. The questionnaire confirmed that GPs believe in the benefits of PSA screening and it also showed they had difficulty in providing patients with information about pros and cons of PSA testing. DISCUSSION: All GPs in this study tested asymptomatic men. GPs in this study value PSA screening and believe that it reduces mortality rates. However, although PSA tests were most frequently done on asymptomatic patients, the majority of patients subsequently diagnosed with prostate cancer had been tested because of symptoms or had previous prostate problems. KEYWORDS: Prostate specific antigen (PSA); PSA testing; screening; prostate cancer; general practitioners
Does the order of presentation and number of online resources affect the frequency of access by learners?
Authors: Lillis Steven , Murton Samantha
Published: November 2018

INTRODUCTION: Provision of web-based resources is a valuable addition to face-to-face teaching in a blended learning environment. AIM: To understand how both order of presentation and number of online resources impacts on the frequency of access by learners in postgraduate vocational training in general practice. METHODS: Information was collected on how many times individual online resources were accessed. Data regarding access rates for 15 separate topics used in postgraduate general practice vocational training were aggregated. Analysis was on the basis of order of presentation where the mean of percentages of hits by order of presentation with standard deviations was calculated. RESULTS: The first four listed resources were accessed at a higher rate than the remainder of the resources. All resources after the first four were accessed at a relatively uniform low rate. DISCUSSION: It would appear that providing more than four resources per topic is associated with learner overload. The number of online resources to support face-to-face teaching should be limited to four. Resource material needs to be carefully considered in terms of how it adds educational value. The ability of resource material to present a different perspective on a topic and adherence to both curriculum and assessment objectives are important considerations. KEYWORDS: Education, medical; education, distance; internet; provision of resources; general practice
Factors influencing diagnostic decision-making
Authors: Callaghan Kathleen
Published: November 2018

INTRODUCTION: Identifying influences on diagnostic decisions is important because diagnostic errors often have far-reaching consequences for an individuals future within the workforce and their eligibility for Accident Compensation Corporationfunded treatment. Most investigations of factors biasing decision making have used quantitative techniques rather than qualitative methods. AIM: To identify factors influencing GPs diagnostic decision-making and to develop a valid questionnaire to determine the desirability and importance of each factors influence. METHODS: Focus groups and the Delphi method were combined with Rasch analysis to identify factors influencing GPs diagnostic decision-making and then examine the strength and stability of ratings of the factors desirability and importance. RESULTS: Thirty-nine factors were identified. Factors demonstrating high stability but no consensus included the importance of evidence-based medicine, the potential ramifications of a diagnosis, and the desirability of medicolegal issues. Factors for which there was disagreement in the first Delphi round but consensus in the second round included the importance of patient advocacy/support groups and the desirability of examination findings. Rasch analysis indicated that the questionnaire was close to the model (88.6% and 86.2% of variance in the ratings of importance and desirability explained). DISCUSSION: Participants readily identified factors influencing GPs diagnostic decision-making. Their ratings did not appear to support a prescriptive model of medicine, yet two cornerstones of prescriptive medicine, clinical information and probability of disease, were rated as highly desirable and important. KEYWORDS: Decision-making; diagnosis; bias; Rasch analysis; general practitioners
Maori cultural adaptation of a brief mental health intervention in primary care
Authors: Mathieson Fiona , Mihaere Kara , Collings Sunny , Dowell Anthony , Stanley James
Published: November 2018

INTRODUCTION: There are no brief psychological mental health interventions designed specifically for Maori in a primary care setting. AIM: To adapt an existing cognitive behavioural therapybased, guided self-management intervention for near-threshold mental health syndromes in primary care, for Maori, and to examine its acceptability and effectiveness. METHODS: Semi-structured interviews with primary care clinicians and Maori patients were conducted to inform adaptations to the intervention. Clinicians were then trained in intervention delivery. Patients were recruited if they self-identified as Maori, were aged 1865 years, were experiencing stress or distress and scored =35 on the Kessler-10 (K10) measure of global psychological distress. Patient and clinician satisfaction was measured through a questionnaire and semi-structured interviews. Post-intervention, patients mental health status was measured at two weeks, six weeks and three months. RESULTS: Maori adaptations included increased emphasis on forming a relationship; spirituality; increased use of Maori language and changes to imagery in the self-management booklets. Nine of the 16 patients recruited into the study completed the intervention. Patients and clinicians rated the intervention favourably and provided positive feedback. Improvement was seen in patients K10 scores using intention-to-treat rated global psychological distress following intervention. DISCUSSION: This study found that it was not difficult to adapt an existing approach and resources, and they were well received by both providers and Maori patients. Further research is required with a larger sample utilising a randomised controlled trial, to establish whether this approach is effective. KEYWORDS: Primary health care; Maori mental health; patient satisfaction; brief intervention
The anatomical placement of body organs by Australian and New Zealand patients and health professionals in general practice
Authors: Kljakovic Marjan , Risk Jo
Published: November 2018

INTRODUCTION: Understanding patients awareness of the anatomical placement of their body organs is important for doctorpatient communication. AIM: To measure the correct anatomical placement of body organs by people from Australian and New Zealand general practices METHOD: A questionnaire survey containing drawings of 11 organs placed in different locations within each drawing. RESULTS: Among 1156 participants, there was no difference in the proportion of correct placement of 11 organs between Australian (51.7%) and New Zealand (49.6%) general practices. There was a positive correlation between the proportion of correctly placed organs and the age participants left school (p=0.012) and a negative correlation with the number of GP visits in the previous year (p=0.040). Participants from rural Australia were more likely to correctly place organs than urban participants (p=0.018). The mean proportion of organs correctly placed for doctors was 80.5%, nurses 66.5%, allied health 61.5%, health administrators 50.6% and the remaining consulting patients 51.3%. DISCUSSION: Patients from Australian and New Zealand general practice were poorly aware of the correct placement of organs. Health professionals were moderately better than patients at correct placement. KEYWORDS: Health knowledge; attitudes; practice; anatomy; general practice
Learning from people with chronic pain: messages for primary care practitioners
Authors: Budge Claire , Carryer Jenny , Boddy Julie
Published: November 2018

INTRODUCTION: A large number of people live with chronic, non-malignant pain, which impacts on their work, social activity and quality of life. For many people pain appears to be inadequately treated and controlled, in part due to a reluctance to take appropriate medication. The aim of this study was to learn more about peoples experience of pain in the context of long-term illness, in order to inform primary health care practice. METHODS: Twenty people previously identified from a survey about chronic illness care were interviewed about their pain-related experiences. Interviews were taped and transcribed and a thematic analysis was carried out to identify the key themes relating to practitioners support of people with chronic pain. FINDINGS: Three main themes, which were common to all authors analyses and are considered most relevant to practice, are presented and discussed. These themes were labelled medication concerns, which encompasses side-effects, reluctance to take pills and pain medication as a choice; coping with pain, including acceptance, pacing yourself and non-pharmaceutical pain relief; and seeking help for pain, which included negative and positive experiences and lack of care continuity. CONCLUSION: Pain limited how participants lived, yet many were reluctant to take pain relief as prescribed, if at all. They found other ways of coping, and accepted their pain. Messages for practitioners include the importance of asking people about their pain, listening and acknowledging the reality of pain and its effect on daily life and providing education, reassurance and support for taking pain medication. KEYWORDS: Chronic disease; medication adherence; pain; primary health care; quality of life
A double-blind randomised controlled study of a brief intervention of bedtime restriction for adult patients with primary insomnia
Authors: Fernando III Antonio , Arroll Bruce , Falloon Karen
Published: November 2018

INTRODUCTION: Bedtime restriction is effective for volunteer patients with primary insomnia. AIM: To determine the effectiveness of bedtime restriction in adult volunteers with primary insomnia. METHODS: Patients were recruited in response to articles in local newspapers. The study hypothesis was not given in the articles. Patients were assessed as to whether or not they had primary insomnia. They completed a two-week sleep diary after which they met the investigators and were randomised to either bedtime restriction and basic sleep hygiene or the control group with basic sleep hygiene only. A total of 224 potential participants applied to be in the study. Of the 52 who had primary insomnia, 45 were randomly allocated to either control or intervention group and only two did not complete the study. Randomisation was concealed and participants were blinded regarding the treatment. The primary outcome was also measured in a blinded fashion. RESULTS: The outcome evaluated was patient description of better or much better quality of sleep versus the same, worse or much worse quality of sleep at six weeks. Overall, 73% (16/22) of those in the intervention group were either having better or much better quality of sleep after treatment, while in the control group this was 35% (8/23). The number needed to treat was 3 [95% CI 211] for bedtime restriction and sleep hygiene versus sleep hygiene alone. DISCUSSION: This is the first study using bedtime restriction designed to be feasible in primary care by using a brief intervention and a patient-oriented outcome. KEYWORDS: Insomnia; primary health care; randomized controlled trial
Characteristics of nurses providing diabetes community and outpatient care in Auckland
Authors: Daly Barbara , Arroll Bruce , Sheridan Nicolette , Kenealy Timothy , Scragg Robert
Published: November 2018

INTRODUCTION: There is a worldwide trend for diabetes care to be undertaken in primary care. Nurses are expected to take a leading role in diabetes management, but their roles in primary care are unclear in New Zealand, as are the systems of care they work in as well as their training. AIM: To describe and compare demographic details, education and diabetes experience, practice setting and facilities available for the three main groups of primary health care nurses working in the largest urban area in New Zealand. METHOD: Of the total number of practice nurses, district nurses and specialist nurses working in Auckland (n=1091), 31% were randomly selected to undertake a self-administered questionnaire and telephone interview in 20062008. RESULTS: Overall response was 86% (n=284 self-administered questionnaires, n=287 telephone interviews). Almost half (43%) of primary care nurses were aged over 50 years. A greater proportion of specialist nurses (89%) and practice nurses (84%) had post-registration diabetes education compared with district nurses (65%, p=0.005), from a range of educational settings including workshops, workplaces, conferences and tertiary institutions. More district nurses (35%) and practice nurses (32%) had worked in their current workplace for >10 years compared with specialist nurses (14%, p=0.004). Over 20% of practice nurses and district nurses lacked access to the internet, and the latter group had the least administrative facilities and felt least valued. DISCUSSION: These findings highlight an ageing primary health care nursing workforce, lack of a national primary health care post-registration qualification and a lack of internet access. KEYWORDS: Community health nursing; diabetes mellitus; internet; nurses; primary health care
Previous vaccination modifies both the clinical disease and immunological features in children with measles
Authors: Mitchell Peter , Turner Nikki , Jennings Lance , Dong Hongfang
Published: November 2018

INTRODUCTION: Measles that develops in previously vaccinated cases has been reported to be associated with modified disease, although severity has usually been assessed by the presence or absence of symptoms. To date no studies have attempted to subjectively grade the severity of the clinical features. AIM: To investigate both the objective and subjective severity of measles in vaccinated and unvaccinated cases in the context of a community outbreak. METHODS: A retrospective observational cohort study conducted in Christchurch in 2009 using notified data compared the presentation of measles in 14 confirmed cases that had received at least one MMR (measles, mumps, rubella) vaccination and 14 age-matched unvaccinated confirmed cases. Additional details on the subjective and objective severity of the illness were obtained from parents/guardians using a standardised telephone questionnaire. RESULTS: The vaccinated group had significantly fewer clinical features on presentation (p=0.01, RR=1.3, 95% CI 1.11.6) and a less severe illness objectively, as measured by height and duration of fever, the number of days needing medication other than paracetamol and days required in bed. Unvaccinated cases were 2.8 times more likely to have more severe clinical features than vaccinated cases (OR=2.8, 95% CI 1.55.0). Unvaccinated cases were 3.0 times more likely to develop IgM antibody (RR=3.0, 95% CI 0.99.3). DISCUSSION: Previously vaccinated children who develop measles are likely to have less severe disease and serology results that may be inconclusive, particularly for IgM antibody if tested in the first few days after the rash onset. KEYWORDS: Immunoglobulin M; measles; measles-mumps-rubella vaccine; polymerase chain reaction; vaccination
General practitioners views of pharmacists current and potential contributions to medication review and prescribing in New Zealand
Authors: Hatah Ernieda , Braund Rhiannon , Duffull Stephen , Tordoff June
Published: November 2018

INTRODUCTION: Internationally, non-medical practitioners are increasingly involved in tasks traditionally undertaken by general practitioners (GPs), such as medication review and prescribing. This study aims to evaluate GPs perceptions of pharmacists contributions to those services. METHODS: Semi-structured interviews were carried out in two localities with GPs whose patients had and had not undergone a pharmacist-led adherence support Medication Use Review (MUR). GPs were asked their opinions of pharmacists provision of MUR, clinical medication review and prescribing. Data were analysed thematically using NVivo 8 and grouped by strengths, weaknesses, opportunities and threats (SWOT) category. FINDINGS: Eighteen GPs were interviewed. GPs mentioned their own skills, training and knowledge of clinical conditions. These were considered GPs major strengths. GPs perceived weaknesses were their time constraints and heavy workloads. GPs thought pharmacists strengths were their knowledge of pharmacology and having more time for in-depth medication review than GPs. Nevertheless, GPs felt pharmacist-led medication reviews might confuse patients, and increase GP workloads. GPs were concerned that pharmacist prescribing might include pharmacists making a diagnosis. This is not the proposed model for New Zealand. In general, GPs were more accepting of pharmacists providing medication reviews than of pharmacist prescribing, unless appropriate controls, close collaboration and co-location of services took place. CONCLUSION: GPs perceived their own skills were well suited to reviewing medication and prescribing, but thought pharmacists might also have strengths and skills in these areas. In future, GPs thought that working together with pharmacists in these services might be possible in a collaborative setting. KEYWORDS: Community pharmacy services; general practitioners; New Zealand; primary health care; professional role
Sleep disorders among high school students in New Zealand
Authors: Fernando Antonio , Samaranayake Chinthaka , Blank Christopher , Roberts Gareth , Arroll Bruce
Published: November 2018

INTRODUCTION: Adolescents are known to have high risk factors for sleep disorders, yet the youth rates of sleep disturbances are unknown. AIM: This study aimed to determine the prevalence of sleep disorders among New Zealand high school students. METHODS: The Auckland Sleep Questionnaire (ASQ) was administered to high school students at six schools in the North Island. Schools were chosen to reflect a range of ethnicities and school deciles, which identify the socioeconomic status of households in the school catchment area. RESULTS: A total of 1388 students completed the ASQ. The median age was 17 years (range 1423) and females represented 43.5% (n=604) of the total group. A total of 37.2% of the students surveyed reported having significant sleep symptoms lasting longer than one month. Depression and anxiety were present in 51.7% and 44.8% of students reporting a sleep problem, respectively. A moderate correlation was observed between sleep problems and depression (r=0.34, p<0.01), and sleep problems and anxiety (r=0.31, p<0.01). Problem alcohol use and other substance use were more common in students with sleep symptoms (12.2% and 5.5% respectively). No difference was found in the rate of sleep problems reported by different ethnic groups. DISCUSSION: A considerable proportion of students surveyed reported significant sleep symptoms. This study has the potential to aid physicians within New Zealand in better appreciating the burden of sleep disorders faced by young people and in effectively assessing and managing different causes of sleep symptoms in this demographic. KEYWORDS: Adolescent; insomnia; sleep disorders; New Zealand
Button battery injury in children  a primary care issue?
Authors: Shepherd Michael , Hamill James , Barker Ruth
Published: November 2018

There is a well-described increase in the incidence of significant injury associated with button batteries in children. Button battery ingestion or insertion (ear/nose) is a time-sensitive injury mechanism, with severe injury occurring within hours. Prevention efforts are being developed that may include changes to packaging, public awareness campaigns, safe disposal mechanisms, changes to battery design and changes to device design. However, there is not a single, simple and effective prevention strategy available. This community hazard has significant implications for primary care. This article presents the clinical characteristics and epidemiology of button battery exposure and subsequent injury. It also describes the clinical recommendations, specifically an emphasis on early diagnosis, including maintaining a high index of suspicion; rapid removal where possible or urgent referral for operative intervention. KEYWORDS: Burns, chemical; child, preschool; infant; foreign bodies; thoracic injuries
Herpes zoster: when do patients present and who gets antiviral treatment?
Authors: Wallis Katharine , Hood Lynley , Rao Kavita
Published: November 2018

INTRODUCTION: Herpes zoster and its sequelae can have a serious impact on quality of life, particularly in the elderly. The duration and severity of herpes zoster symptoms can be reduced with antiviral treatment. Early treatment is most effective. AIM: To identify how soon after onset of herpes zoster symptoms adults presented to a suburban Dunedin general practice and to describe which patients received antiviral treatment. METHODS: Adult herpes zoster cases were identified from a large suburban general practice from 2004 to 2009. Duration of symptoms at presentation and antiviral prescription were identified from medical records and described by patient characteristics. RESULTS: We identified 278 incident cases. Approximately one-third presented within three days of symptoms, one-third after three days, and in one-third of cases the duration of symptoms was not documented. A higher percentage of patients with ophthalmic herpes zoster presented within three days (45%), while a lower percentage of men (24%) and patients from the lowest socioeconomic quintile (25%) presented within three days. Most incident cases received antiviral treatment. A higher percentage of patients with ophthalmic herpes zoster and patients who presented within three days of symptoms received antiviral treatment. Some patients who presented after seven days of symptoms also received treatment. Antiviral prescribing did not increase with patient age. DISCUSSION: Despite many adults with acute herpes zoster presenting after three days of symptoms, most received antiviral treatment. It is not known why many presented late. It is not known whether late treatment is effective. KEYWORDS: Antiviral treatment; general practice; herpes zoster virus; signs and symptoms