bluuebunny/crossref_metadata_2025 huggingface dataset:
Improved motor function with Bowen therapy for rehabilitation in chronic stroke: a pilot study
Authors: Duncan Bruce , McHugh Patrick , Houghton Frank , Wilson Craig
Published: November 2018

INTRODUCTION: Bowen therapy is an established complementary therapy with anecdotal reports of effectiveness. However, there is limited published research to substantiate safety or effectiveness. This is a pilot study to explore the potential impact of Bowen therapy in chronic stroke. METHODS: A case series of 14 people with chronic stroke were offered 13 sessions of Bowen therapy over a three-month period. RESULTS: Motor assessments of the 13 people who participated showed improvementsgross motor function trended to improvement; SF-36 role-physical, physical health summary scale and total SF-36 scores showed statistically significantly improvements. However, grip strength reduced. CONCLUSIONS: In this pilot study, Bowen therapy was associated with improvements in neuromuscular function in people with chronic stroke. At this stage of study, it is not possible to conclude that there is definite benefit; however the results suggest that exploration through further research is appropriate. KEYWORDS: Bowen Therapy; stroke; rehabilitation
Patients’ and health professionals’ perceptions of teamwork in primary care
Authors: Pullon Susan , McKinlay Eileen , Stubbe Maria , Todd Lindsay , Badenhorst Christopher
Published: November 2018

INTRODUCTION: Effective teamwork in primary care settings is integral to the ongoing health of those with chronic conditions. This study compares patient and health professional perceptions about teams, team membership, and team members’ roles. This study aimed to test both the feasibility of undertaking a collaborative method of enquiry as a means of investigating patient perceptions about teamwork in the context of their current health care, and also to compare and contrast these views with those of their usual health professionals in New Zealand suburban general practice settings. METHODS: Using a qualitative methodology, 10 in-depth interviews with eight informants at two practices were conducted and data analysed using inductive thematic analysis. FINDINGS: The methodology successfully elicited confidential interviews with both patients and the health professionals providing their care. Perceptions of the perceived value of team care and qualities facilitating good teamwork were largely concordant. Patient and health professionals differed in their knowledge and understanding about team roles and current chronic care programmes, and had differing perceptions about health care team leadership. CONCLUSION: This study supports the consensus that team-based care is essential for those with chronic conditions, but suggests important differences between patient and health professional views as to who should be in a health care team and what their respective roles might be in primary care settings. These differences are worthy of further exploration, as a lack of common understanding has the potential to consistently undermine otherwise well-intentioned efforts to achieve best possible health for patients with chronic conditions. KEYWORDS: Primary health care; chronic disease; physicians; nurses; patients; patient care team
(Preventing) two birds with one stone: improving vitamin D levels in the elderly
Authors: Lawless Susie , White Phil , Murdoch Prue , Leitch Sharon
Published: November 2018

BACKGROUND AND CONTEXT: A majority of adults have sub-optimal vitamin D levels in the winter in southern New Zealand. This is associated with an increased risk of falls and fragility fractures in the elderly, with long-term adverse outcomes likely. Vitamin D supplementation decreases the risks of both falls and fractures. ASSESSMENT OF PROBLEM: An intervention was undertaken by a small urban general practice to increase the number of elderly patients receiving vitamin D supplementation by linking vitamin D prescription to the annual flu vaccination campaign. RESULTS: Uptake of the supplementation was high and costs to the practice low. Thirty-eight patients were identified for whom long-term supplementation with vitamin D was indicated. STRATEGIES FOR IMPROVEMENT: The study could have been strengthened by incorporating a more formal method of evaluating uptake. LESSONS: Encouraging patients to take supplements as a population-based strategy is a realistic intervention, and linking it to the flu vaccination campaign is both seasonally appropriate and efficient. KEYWORDS: Vitamin D deficiency; elderly; vitamin D supplementation; cholecalciferol; prevention; fragility fractures; intervention
Effectiveness of problem-solving treatment by general practice registrars for patients with emotional symptoms
Authors: Hassink-Franke Lieke , van Weel-Baumgarten Evelyn , Wierda Eric , Engelen Maike , Beek Mechtild , Bor Hans , van den Hoogen Henk , Lucassen Peter , van Weel Chris
Published: November 2018

INTRODUCTION: In general practice many patients present with emotional symptoms. Both patients and physicians desire effective non-pharmacological treatments. AIM: To study the effectiveness of problem-solving treatment (PST) delivered by trained general practice registrars (GP registrars) for patients with emotional symptoms. METHODS: In a controlled clinical trial we compared the effectiveness of PST versus usual care for patients with emotional symptoms. Dutch GP registrars provided either PST or usual care, according to their own preference. Patients were included if they (a) had presented for three or more consultations with emotional symptoms in the past six months; and (b) scored four or more on the 12-item General Health Questionnaire. Outcomes at three- and nine-month follow-up were standard measures of depression, anxiety and quality of life. RESULTS: Thirty-eight GP registrars provided PST and included 98 patients; 43 provided usual care and included 104 patients. PST patients improved significantly more than usual care patients: at nine-month follow-up, recovery rates for somatoform disorder and anxiety were higher in the PST group (OR 6.50, p=0.01 respectively OR 11.25, p=0.03). PST patients had improved significantly more on the domains social functioning, role limitation due to emotional problems and general health perception. DISCUSSION: Patients with emotional symptoms improved significantly more after PST delivered by motivated GP registrars than after usual care by GP registrars. Further research, with randomisation of interested registrars or interested GPs, is needed. KEYWORDS: Problem-solving treatment; emotional symptoms; mental health; general practice; GP registrars
Online access and literacy in Maori New Zealanders with diabetes
Authors: Reti Shane , Feldman Henry , Safran Charles
Published: November 2018

INTRODUCTION: Online web-based interventions can be effective ancillary tools for managing diabetes. There is a high prevalence of diabetes in New Zealand Maori, and yet this group has generally been a low priority for web-based interventions due to perceptions of low Internet access and Internet literacy. AIM: To assess Internet access and literacy in New Zealanders with diabetes, especially high-risk Maori. METHODS: A telephone survey of all patients with diabetes in an urban general practice. Internet access is assessed by Internet presence in the home, and Internet literacy by the ability to use email and the World Wide Web. RESULTS: One hundred percent response rate with 68 participants, including 38% Maori. Internet access for Maori was 70% and Internet literacy 41%. DISCUSSION: Internet access and literacy for Maori with diabetes may be higher than previously thought. Health policies may wish to focus effective and cost-efficient web-based interventions on this high diabetes risk group. Keywords: Diabetes mellitus; Maori; Internet; electronic mail; New Zealand; indigenous health services
Potion or Poison? Aloe vera
Authors: Goodyear-Smith Felicity
Published: November 2018

SUMMARY MESSAGE: Topical aloe vera may be effective in treating skin diseases such as psoriasis with little adverse effect apart from occasional rash. While there is weak evidence supporting its oral use in specific conditions, it may exacerbate a number of chronic conditions and has the potential for a number of drug interactions; hence its oral use is not recommended. As with any plant extract, caution is needed to ensure that a standardised pharmacological dose is being administered.
How to use interpreters in general practice: the development of a New Zealand toolkit
Authors: Gray Ben , Hilder Jo , Stubbe Maria
Published: November 2018

BACKGROUND AND CONTEXT: New Zealand is becoming more ethnically diverse, with more limited English proficiency (LEP) people. Consequently there are more primary care consultations where patients have insufficient English to communicate adequately. Because effective communication is essential for good care, interpreters are needed in such cases. ASSESSMENT OF PROBLEM: The literature on the use of interpreters in health care includes the benefits of using both trained interpreters (accuracy, confidentiality, ethical behaviour) and untrained interpreters (continuity, trust, patient resistance to interpreter). There is little research on the actual pattern of use of interpreters. RESULTS: Our research documented a low use of trained interpreters, despite knowledge of the risks of untrained interpreters and a significant use of untrained interpreters where clinicians felt that the communication was acceptable. A review of currently available guidelines and toolkits showed that most insist on always using a trained interpreter, without addressing the cost or availability. None were suitable for direct use in New Zealand general practice. STRATEGIES FOR IMPROVEMENT: We produced a toolkit consisting of flowcharts, scenarios and information boxes to guide New Zealand practices through the structure, processes and outcomes of their practice to improve communication with LEP patients. This paper describes this toolkit and the links to the evidence, and argues that every consultation with LEP patients requires clinical judgement as to the type of interpreting needed. LESSONS: Primary care practitioners need understanding about when trained interpreters are required. KEYWORDS: Communication barriers; primary health care; New Zealand; quality of health care; professionalpatient relations; cultural competency
Gender differences in financial barriers to primary health care in New Zealand
Authors: Jatrana Santosh , Crampton Peter
Published: November 2018

INTRODUCTION: Gender differences in health status and use of health care services have been established in the developed world with less attention paid to gender differences in financial barriers to primary care. Such barriers represent potentially avoidable mortality and morbidity. AIM: To examine gender differences in financial barriers to New Zealand primary health care. METHODS: Data from SoFIE-health, an add-on to Statistics New Zealandled Survey of Family, Income and Employment (SoFIE), analysed using logistic regression, controlling for demographic, socioeconomic, health behaviour and health variables. Access to primary health care includes general practitioner and dental care and prescription drugs. RESULTS: Odds of deferring seeing their doctor(s), dentist and buying a prescription respectively at least once during preceding 12 months, because they could not afford the cost of a visit or prescription, were greater for women compared to men (Odds Ratio (OR) 1.82, 95% CI: 1.671.99; OR 2.05, 95% CI: 1.782.34; and OR 1.58, 95% CI: 1.471.71; respectively). Adjusting for demographic, socioeconomic, health behaviour and health status attenuated OR to 1.45 (1.311.61) for deferring medical visit, 1.47 (1.261.71) buying prescription, and 1.35 (1.241.46) for deferring dental visit, although confidence intervals still excluded the null. DISCUSSION: Gender significantly associated with reporting cost barriers to primary health care, regardless of individual deprivation or income levels, suggesting that primary health care policies targeting gender-specific factors are warranted. Policy measures to reduce co-payments may improve access to care for both women and men, and may have positive health implications. KEYWORDS: Gender; primary health care; access barriers; New Zealand
Teamwork  general practitioners and practice nurses working together in New Zealand
Authors: Finlayson Mary , Raymont Antony
Published: November 2018

INTRODUCTION: Teamwork in primary health care has been encouraged in New Zealand and in the international literature. It may improve work satisfaction for staff, and satisfaction and outcomes for patients. Teamwork may be classified as being multi-, inter- or transdisciplinary and is likely to be influenced by the nature of the work and the organisational context. AIM: To describe and analyse teamwork between general practitioners and practice nurses in New Zealand. METHODS: Data were drawn from a survey of general practices and from interviews with primary health care staff and management. RESULTS: Doctors and nurses in general practice in New Zealand see themselves as a team. Evidence suggests that the nature of the work and the business context most often leads to a multidisciplinary style of teamwork. Some providers have adopted a more intense teamwork approach, often when serving more disadvantaged populations or in caring for those with chronic illnesses. DISCUSSION: Concepts of teamwork differ. This article provides a classification of teams and suggests that most general practice teams are multidisciplinary. It is hoped that this will help personnel to communicate their expectations of a team and encourage progressive team development where it would be of value. KEYWORDS: Teamwork; primary care; practice nurses; general practitioners
Viewpoint: Diagnosis in primary care: probabilistic reasoning
Authors: Arroll Bruce , Allan GM , Raina Elley C , Kenealy Tim , McCormack James , Hudson Ben , Hoare Karen
Published: November 2018

This article develops the concept of probabilistic reasoning as one of the techniques clinicians use in making a diagnosis. We develop the concept that every question and every examination is a diagnostic test ultimately leading to a rule in or rule out of a diagnosis. We also develop the concept of pre-test probability pointing out that false positive tests are an issue in low-prevalence settings and false negative tests are a problem. Investigative tests work best in medium-prevalence settings. The purpose of taking a history and conducting an examination is to increase the pre-test probability to a point where either treatment is commenced or more expensive/time-consuming/dangerous tests are indicated. Pre-test probabilities on their own can be used to rule out conditions. We also show how pre-test probabilities relate to the Fagan nomogram which enables visualisation of large changes in post-test probabilities which can lead to treatment/further investigation. KEYWORDS: Likelihood ratio; pre-test and post-test probability; diagnostic accuracy; probabilistic reasoning
Viewpoint: From ladder to platform: a new concept for pain management
Authors: Leung Lawrence
Published: November 2018

BACKGROUND: Pain remains one of the top five reasons for consultations in general practice, presenting either alone or as comorbidity. The World Health Organization (WHO) analgesic ladder proposed in 1986 has been the cornerstone of pain management, but is often inadequate in daily practice, especially when dealing with the diverse nature and etiology of various pain conditions. There is a need for a better concept which is universally applicable that acknowledges the value of, and need for, other domains of treatment for pain. OBJECTIVE: This article reviews the original ideas of the WHO analgesic ladder and proposes its extension to a platform model in the context of pain management. DISCUSSION: Pain affects both the physical and psychological wellbeing of patients and should not be treated with pharmacotherapy alone. The model of WHO analgesic ladder provides guidelines for choosing the analgesic agents, but has its limitations. Incorporating the latest paradigm of neuromatrix theory, both acute and chronic pain should be best managed with a broader perspective incorporating multimodal non-pharmacological and supportive treatments, illustrated by the concept of interacting domains on a broad platform as presented in this article. Different levels of pain severity and chronicity necessitate different analgesic platforms of management, and the clinician should move up or down the appropriate platform to explore the various treatment options as per the status and needs of the patient. KEYWORDS: Analgesic ladder; pain management; analgesic platform
Measuring socioeconomic position in New Zealand
Authors: Salmond Clare , Crampton Peter
Published: November 2018

INTRODUCTION: Measures of socioeconomic position (SEP) are widely used in health research. AIM: To provide future researchers with empirically based guidance about the relative utility of five measures of SEP in predicting health outcomes. METHODS: Data from 12 488 adults were obtained from the 2006 New Zealand Health Survey. Seven health-related outcome measures with expected variations by SEP are modelled using five measures of SEP: a census-based small-area index of relative socioeconomic deprivation, NZDep2006; a questionnaire-based individual-level index of socioeconomic deprivation, NZiDep; an index of living standards, ELSI; education, measured by highest qualification; and equivalised household income. RESULTS: After including the individual measure of deprivation, the area-based measure of deprivation adds useful explanatory power, and, separately, the broader spectrum provided by the living standards index adds only a small amount of extra explanatory power. The education and household income variables add little extra explanatory power. DISCUSSION: Both NZiDep and ELSI are useful health-outcome predictors. NZiDep is the cheapest data to obtain and less prone to missing data. The area index, NZDep, is a useful addition to the arsenal of individual SEP indicators, and is a reasonable alternative to them where the use of individual measures is impracticable. Education and household income, using commonly used measurement tools, may be of limited use in research if more proximal indicators of SEP are available. NZDep and NZiDep are cost-effective measures of SEP in health research. Other or additional measures may be useful if costs allow and/or for topic-related hypothesis testing. KEYWORDS: Deprivation; inequalities; living standards; New Zealand; socioeconomic position
Effectiveness of simulated clinical teaching in general practice: randomised controlled trial
Authors: Raina Elley C , Clinick Tara , Wong Chris , Arroll Bruce , Kennelly John , Doerr Henry , Moir Fiona , Fishman Tana , Moyes Simon , Kerse Ngaire
Published: November 2018

INTRODUCTION: There are shortages in community-based general practice placements for medical students. Innovative ways to teach the skills required in general practice are needed. AIM: To assess the effectiveness of simulated general practice clinics using actors, compared with standard community-based general practice attachments in medical undergraduate education. METHODS: Randomised controlled trial involving medical students. Outcome measures included self-reported knowledge, clinical confidence, communication skills, and attitudes within general practice assessed at baseline and after one week. Intervention students participated in 24 simulated consultations with actor-patients over four days. Control students spent four days working with community-based general practitioners and real patients. RESULTS: Of 138 eligible medical students in the first clinical year, 128 (93%) participated and 106/128 (82%) completed the study. Those participating in simulated clinics improved in confidence in history-taking (p=0.03), communication skills (p=0.04), and ability to detect depression (p<0.001) compared with those undertaking community attachments. Those in community-based attachments felt more confident in managing upper respiratory tract infections (p<0.001), screening in general practice (p=0.03) and managing illness in the patients home (p=0.04). There was no difference between the groups in other measures. DISCUSSION: Simulated clinics may assist with development of communication skills within the general practice consultation and may also be used to supplement community-based attachment with real patients. Even so, confidence in the management of common conditions and procedures improves more with real patients. KEYWORDS: Medical education; patient simulation; primary health care; randomised controlled trial
Potion or Poison? Resveratrol
Authors: Scahill Shane
Published: November 2018

SUMMARY MESSAGE: Although animal data may appear to be promising, the literature in humans reports that the collective evidence is not sufficiently strong to justify a recommendation for the administration of resveratrol to humans, beyond the dose available from dietary sources.
Potion or Poison? Probiotics
Authors: Scahill Shane
Published: November 2018

SUMMARY MESSAGE: Two types of probiotic (Lactobacillus rhamnosus and Saccharomyces boulardii) at high doses may prevent the onset of antibiotic-associated diarrhoea in children. Probiotics are generally well tolerated. Clinical benefit needs to be confirmed in larger studies across a greater range of probiotics. There is insufficient evidence to recommend probiotic therapy in adults as an adjunct to antibiotic therapy, specifically for Clostridium difficile-induced colitis.
Is it time to talk? Interpreter services use in general practice within Canterbury
Authors: Seers Kara , Cook Lynley , Abel Gillian , Schluter Philip , Bridgford Paul
Published: November 2018

INTRODUCTION: Effective communication is fundamental to successful health care service delivery, and has a positive impact on access, quality of care, health outcomes, and patient satisfaction. Although there are a growing number of New Zealanders who do not speak English proficiently, underutilisation of trained interpreter services appears to be common in primary health care settings. AIMS: To describe the pattern of interpreter service need and utilisation by general practice services, and to identify key barriers and enabling factors to the use of trained interpreters. METHODS: A mixed methods study was employed. Census and Partnership Health Canterbury Te Kei o Te Waka (PHC) databases were combined, and quantitative analysis used to derive interpreter service need and utilisation patterns. Transcripts of focus groups and interviews from general practitioners, practice nurses and practice administration staff within the PHC were analysed, using qualitative methods to identify barriers and enablers to interpreter service use. RESULTS: For the years 20082010, approximately 10 742 consultations per year involved a non-English-speaking patient, yet in only approximately 74.8 (0.7%) consultations per year were interpreter services utilised. Analysis of focus groups and interviews identified four global themes that represented barriers for interpreter service utilisation; namely, practicalities, expectations, knowledge of service, and systems. DISCUSSION: The current use of interpreter services in PHC general practice appears to be significantly less than the need. In order to maximise health outcomes and reduce risk, strategies must be initiated to counter the barriers currently inhibiting interpreter service use, including adopting best practice policies. KEYWORDS: Communication; communication barriers; general practice; primary health care
Large increase in opportunistic testing for chlamydia during a pilot project in a primary health organisation
Authors: Azariah Sunita , McKernon Stephen , Werder Suzanne
Published: November 2018

INTRODUCTION: The Auckland chlamydia pilot project was one of three funded by the Ministry of Health to trial implementation of the 2008 Chlamydia Management Guidelines. Chlamydia is the most commonly notified sexually transmitted infection in New Zealand. AIM: To increase opportunistic testing in under-25-year-olds and to improve documentation of partner notification in primary care. METHODS: A four-month pilot was initiated in Total Healthcare Otara using a nurse-led approach. Laboratory testing data was analysed to assess whether the pilot had any impact on chlamydia testing volumes in the target age-group. Data entered in the practice management system was used to assess follow-up and management of chlamydia cases. RESULTS: During the pilot there was a 300% increase in the number of chlamydia tests in the target age-group from 812 to 2410 and the number of male tests increased by nearly 500%. Twenty-four percent of people tested were positive for chlamydia, with no significant difference in prevalence by ethnicity. The pilot resulted in better documentation of patient follow-up in the patient management system. DISCUSSION: There was a large increase in chlamydia testing during the pilot with a high prevalence found in the population tested. Chlamydia remains an important health problem in New Zealand. The cost benefit of increased chlamydia screening at a population level has yet to be established. KEYWORDS: Chlamydia; notification, partner; pilot project; prevalence; primary health care
Potion or Poison? Coenzyme Q10
Authors: Scahill Shane
Published: November 2018

SUMMARY MESSAGE: There are no Cochrane Database Systematic Reviews (CDSR) reporting the clinical efficacy of coenzyme Q10 in statin-associated myopathy. Coenzyme Q10 is generally well tolerated. A systematic review suggests that rather than hypothesising about potential clinical benefits, large clinical studies are required to allow robust systematic review. Further, there is insufficient evidence to recommend the routine administration of concomitant coenzyme Q10 for prevention of statin-associated myopathy.
Patient and family perceptions of hospice services: I knew they werent like hospitals
Authors: Bray Yvonne , Goodyear-Smith Felicity
Published: November 2018

INTRODUCTION: The vision for palliative care service provision in New Zealand is for all people who are dying and their families to have timely access to culturally appropriate, quality palliative care services. An Auckland hospices records show that the ethnically diverse population statistics were not reflected in the referrals for hospice services. The aim of this research was to gain a patient-and-their-family perspective on the hospice, including exploration of components of service care that could be improved for various cultural groups. METHODS: Patients currently under the care of the hospice and family members were recruited from hospice records. Semi-structured interviews were conducted to explore the emerging issues. The study collected data from a purposive sample of 18 palliative care patients or carer family members, ranging in age from 39 to 81 years, who reflected the ethnic diversity of the population of the region. Interviewing was carried out by an experienced research assistant and continued until data saturation was reached. FINDINGS: Four key themes emerged  hospice personnels approach to patients, quality of service, cultural barriers, and strategies for future improvement. It was determined that the latter two were the most significant to address in this article. CONCLUSION: The study revealed the need for information-giving and education, including public profiling of the hospice to strengthen community involvement. Strategies to reduce ethnic disparities include strengthening the awareness of, and access to, services by connecting with cultural groups through churches, community and specific cultural media. KEYWORDS: Cultural competency; hospice care; palliative care; patient education; terminal care
Staff views of an opportunistic chlamydia testing pilot in a primary health organisation
Authors: McKernon Stephen , Azariah Sunita
Published: November 2018

INTRODUCTION: The Auckland chlamydia pilot was one of three pilots funded by the Ministry of Health to trial implementation of the 2008 Chlamydia Management Guidelines prior to national roll-out. AIM: To assess what elements in the testing programme pilot worked best for staff and to determine how an opportunistic testing programme could be better configured to meet staff needs and preferences. METHODS: A staff survey listed key chlamydia testing tasks in chronological order, and service interventions supporting these tasks. Staff were asked to rate each task on its difficulty prior to the pilot, and then on the difference the pilot had made to each task. They were also asked to rate service interventions on their usefulness during the pilot implementation. RESULTS: The survey had a response rate of 94%. The testing tasks posing the greatest difficulties to staff were those involving patient interactions (41%) and management of follow-up (52%). About 70% of staff felt tasks were improved by the pilot. Staff considered the three most useful service interventions to be a chlamydia-specific template created for the practice management system, provision of printed patient resources, and regular team discussions with other staff. DISCUSSION: A significant proportion of staff reported difficulties with routine tasks required for opportunistic testing for chlamydia, highlighting the need to involve staff during programme design. Practice nurseled approaches to future opportunistic testing programmes should be considered as nurses had a more positive response to the pilot and nurse-led approaches have been shown to be successful overseas. KEYWORDS: Chlamydia trachomatis; general practitioners; health care surveys; medical receptionist; nurses; pilot projects; primary health care; staff development
Patients perceptions of their general practitioners health and weight influences their perceptions of nutrition and exercise advice received
Authors: Fraser Sally , Leveritt Michael , Ball Lauren
Published: November 2018

INTRODUCTION: General practitioners (GPs) play an important role in the management of patients who are overweight or obese. Previous research suggests that GPs physical characteristics may influence patients perceptions of health care received during consultations, mediating the likelihood of patients following health advice provided by GPs. This study aimed to explore patients perceptions of their GPs health status and its influence on patients perceptions of healthy eating and exercise advice. METHODS: An interpretive approach to phenomenology underpinned the qualitative inquiry and study design. Twenty-one participants (aged 55.9 ± 6.5 years; 14 females, 7 males) who had previously received healthy eating and/or exercise advice from a GP participated in an individual semi-structured interview. A constant comparison approach to thematic analysis was conducted. FINDINGS: Participants identified three key indicators of perceived health of their GP. These included the GPs physical appearance, particularly weight status; perceived absence of ill health; and disclosure of a GPs health behaviours. Participants expressed favourable perceptions of the weight status of their GP. Participants expected their GP to be a healthy role model and often, but not always, felt more confident receiving advice from a GP that they perceived as healthy. CONCLUSION: The findings highlight that a GPs perceived health status influences patients perceptions of the health advice received during consultations. These findings provide a foundation for future research that may allow GPs to modify patients perceptions of their health status in order to facilitate behaviour change in overweight or obese patients. KEYWORDS: Body weight; general practitioners; obesity; overweight; physicians; primary health care
Barriers to Maori sole mothers' primary health care access
Authors: Lee Rochelle , North Nicola
Published: November 2018

INTRODUCTION: International research consistently shows that sole mothers experience poorer health and suboptimal health care access. New Zealand studies on sole mothers’ health report similar findings. The aim of this exploratory research was to better understand the experiences of Maori sole mothers’ access to health services, particularly primary health care, for personal health needs. METHODS: This qualitative study employed a general inductive design informed by a Kaupapa Maori approach, providing guidance on appropriate cultural protocols for recruiting and engaging Maori participants. Distributing written information and snowballing techniques were used to purposively recruit seven Maori sole mothers. Data collection involved semi-structured interviews which were digitally recorded and transcribed verbatim. Data were analysed using general inductive thematic analysis to identify commonalities and patterns in participants’ experiences. FINDINGS: The dominant themes that emerged captured and described participants’ experiences in accessing health care. The major barrier to access reported was cost. Compounding cost, transport difficulties and location or scheduling of services were additional barriers to health service accessibility. Child-related issues also posed a barrier, including prioritising children’s needs and childcare over personal health needs. CONCLUSION: The findings illuminate Maori sole mothers’ experiences of accessing health care and the complex socioeconomic inequalities affecting access options and uptake of services. Further investigation of barriers to access is needed. The study has implications for addressing barriers to access at policy, funding and practice levels to improve health outcomes and equitable health care access for Maori sole mothers. KEYWORDS: Health services accessibility; Maori; primary health care; single parent; single-parent family; socioeconomic factors
Access to general health care services by a New Zealand population with serious mental illness
Authors: Wheeler Amanda , McKenna Brian , Madell Dominic
Published: November 2018

INTRODUCTION: Literature suggests that good quality health care access can have a positive impact on the health of people with serious mental illness (SMI), but literature relating to patterns of access by this group is equivocal. AIM: This study was designed to explore health care access patterns in a group of people with SMI and to compare them with a general New Zealand population group, in order for health providers to understand how they might contribute to positive health outcomes for this group. METHODS: The study surveyed 404 mental health consumers aged 1865 years receiving care from one district health board in Auckland about their patterns of health care access. Results were compared with those from the New Zealand Health Survey of the general population. RESULTS: Findings suggest that the SMI consumer respondents had poorer physical health than the general population respondents, accessed health care services in more complex ways and were more particular about who they accessed for their care than the general population respondents. There was some concern from SMI consumers around discrimination from health care providers. The study also suggested that some proactive management with SMI consumers for conditions such as metabolic syndrome was occurring within the health care community. DISCUSSION: The first point of access for SMI consumers with general health problems is not always the family general practitioner and so other health professionals may sometimes need to consider the mental and physical health of such consumers in a wider context than their own specialism. KEYWORDS: General practice; health services accessibility; mental disorders; mental health; primary health care
Prognostic factors associated with low back pain outcomes
Authors: Gregg Chris , McIntosh Greg , Hall Hamilton , Hoffman Chris
Published: November 2018

INTRODUCTION: An improved understanding of prognostic factors associated with low back pain (LBP) outcomes will refine expectations for patients, clinicians and funders alike and improve allocation of health resources to treat the condition. AIM: To establish the link between a range of clinical and sociodemographic prognostic variables for LBP against three separate, clinically relevant outcome measures. METHODS: This was a retrospective, non-experimental study of 1076 consecutive LBP cases treated during a three-year period. Multivariate logistic regression analysis was used to determine the association between potential prognostic variables and outcome measures: clinically relevant reduction in pain, improvement in perceived function, and successful return to work six months after rehabilitation. RESULTS: Patients with clinically relevant improvements in LBP were more likely to have a shorter duration of pain (odds ratio [OR] 1.89), lower baseline pain (OR 1.19), a directional preference for extension activities (OR 1.45) and a history of spine surgery (OR 1.38). Clinically relevant gains in perceived function were observed in patients who were younger (OR 0.98) or those with shorter symptom duration (OR 1.74). Prognostic variables associated with a successful return to work included being female (OR 1.79), having a job available (OR 2.36), intermittent pain (OR 1.48) or a directional preference for extension activities (OR 1.78). DISCUSSION: This study demonstrated that there are a variety of prognostic variables to consider when determining outcome for an individual with LBP. The relative importance of each variable may differ depending on the outcome measured. KEYWORDS: Low back pain; patient outcome assessments; prognosis
General practice ethnicity data: evaluation of a tool
Authors: Neuwelt Pat , Crengle Sue , Cormack Donna , McLeod Melissa , Bramley Dale
Published: November 2018

INTRODUCTION: There is evidence that the collection of ethnicity data in New Zealand primary care is variable and that data recording in practices does not always align with the procedures outlined in the Ethnicity Data Protocols for the Health and Disability Sector. In 2010, The Ministry of Health funded the development of a tool to audit the collection of ethnicity data in primary care. The aim of this study was to pilot the Ethnicity Data Audit Tool (EAT) in general practice. The goal was to evaluate the tool and identify recommendations for its improvement. METHODS: Eight general practices in the Waitemata District Health Board region participated in the EAT pilot. Feedback about the pilot process was gathered by questionnaires and interviews, to gain an understanding of practices experiences in using the tool. Questionnaire and interview data were analysed using a simple analytical framework and a general inductive method. FINDINGS: General practice receptionists, practice managers and general practitioners participated in the pilot. Participants found the pilot process challenging but enlightening. The majority felt that the EAT was a useful quality improvement tool for handling patient ethnicity data. Larger practices were the most positive about the tool. CONCLUSION: The findings suggest that, with minor improvements to the toolkit, the EAT has the potential to lead to significant improvements in the quality of ethnicity data collection and recording in New Zealand general practices. Other system-level factors also need to be addressed. KEYWORDS: Data collection; ethnicity; general practice; primary health care
Pulmonary involvement in patients presenting with extra-pulmonary tuberculosis: thinking beyond a normal chest x-ray
Authors: Herath Samantha , Lewis Christopher
Published: November 2018

INTRODUCTION: Recognition of pulmonary involvement in extra-pulmonary tuberculosis (TB) may be an important public health issue, as smear-negative pulmonary TB is responsible for about 17% of new infections. Pulmonary TB can be present despite a normal chest x-ray (CXR), even in human immunodeficiency virus (HIV)negative patients. In this retrospective clinical audit, we reviewed a case series of HIV-negative patients with extra-pulmonary tuberculosis to identify the proportion with concurrent pulmonary TB despite an unremarkable CXR. METHODS: Clinical notes, microbiology results and CXR reports were reviewed from consecutive patients treated at Auckland City Hospital for extra-pulmonary TB from January 2007 to July 2010. RESULTS: Of the sample of 103 patients with extra-pulmonary TB, the majority of patients were born in an Asian country (n=70; 68%). The commonest presentation of extra-pulmonary TB was lymphadenopathy (n=51; 50%), followed by pleural (n=24; 23%) and bone (n=6; 6%) disease. Extra-pulmonary TB was diagnosed by biopsy or excision of the extra-pulmonary site in the majority (n=74; 72%), and by sputum testing alone in 26 (25%). The majority had CXR abnormalities (n=76; 74%). In the group with a normal CXR (n=27), 55% (n=15) had sputum cultures performed. In total, 18% (n=5) of patients with extra-pulmonary TB and a normal CXR had pulmonary TB, of whom two were smear positive. DISCUSSION: In patients with extra-pulmonary TB, sputum testing should be considered to detect concurrent pulmonary TB even if a CXR is normal, especially in immunosuppressed or symptomatic patients. This may aid diagnosis and determine infectivity and consequent public health action. KEYWORDS: Chest x-ray; sputum; tuberculosis; tuberculosis, pulmonary
Impact of an undergraduate course on medical students self-perceived nutrition intake and self-efficacy to improve their health behaviours and counselling practices
Authors: Crowley Jennifer , Ball Lauren , Leveritt Michael , Arroll Bruce , Yeo Han Dug , Wall Clare
Published: November 2018

INTRODUCTION: Doctors are increasingly involved in the management of chronic disease and counsel patients about their lifestyle behaviours, including nutrition, to improve their health outcomes. AIM: This study aimed to assess the impact of a medical undergraduate course containing nutrition content on medical students self-perceived nutrition intake and self-efficacy to improve their health behaviours and counselling practices. METHODS: A total of 239 medical students enrolled in a 12-week nutrition-related course at The University of Auckland were invited to complete an anonymous questionnaire before and after the course. The questionnaire was adapted from a previous evaluation of a preventive medicine and nutrition course at Harvard Medical School. RESULTS: Sixty-one medical students completed both pre- and post-course questionnaires (25.5%). At baseline, medical students described their eating habits to be more healthy than non-medical students (p=0.0261). Post-course, medical students reported a higher frequency of wholegrain food intake (p=0.0229). Medical students also reported being less comfortable making nutrition recommendations to family and friends post-course (p=0.008). Most medical students (63.9%) perceived increased awareness of their own dietary choices, and some (15.3%) reported an increased likelihood to counsel patients on lifestyle behaviour post-course. DISCUSSION: Students can increase awareness of their own nutrition behaviour after undertaking a course that includes nutrition in the initial phase of their medical degree. Further investigation of how medical students confidence to provide nutrition advice evolves throughout their training and in future practice is required. KEYWORDS: Exercise; health behavior; medical education; nutritional sciences
A piece of the jigsaw of primary care: health professional perceptions of an integrated care model of hepatitis C management in the community
Authors: Treloar Carla , Gray Rebecca , Brener Loren
Published: November 2018

INTRODUCTION: There is growing interest in increasing uptake of hepatitis C (HCV) treatment. HCV is strongly associated with injecting drug use and is a stigmatised illness. People with HCV may be reluctant to engage with health care services. A community-based, nurse-led integrated care clinic was established in Christchurch, New Zealand with the intention of bridging the health care gap for those unwilling or unable to access mainstream health care. This paper explores the experiences and perceptions of health professionals regarding the implementation of this clinic, with particular attention paid to the interprofessional relationships relevant to the clinic. METHODS: Qualitative, in-depth interviews were conducted with 24 stakeholders, including four staff of the clinic and other service providers with varying relationships to the clinic. FINDINGS: Participants generally endorsed the clinic model and described its operation as easy to access, non-judgmental and non-threatening, and, therefore, able to attract and engage hard-to-reach clients. The clinic model was also thought to support more effective use of health resources. Some participants expressed concerns regarding the potential poaching of patients from other services (particularly general practice) and indicated a preference for HCV treatment services to be restricted to hospital settings. CONCLUSION: The findings of this study suggest the need to address concerns of general practitioners regarding patient poaching. Key information to disseminate is the clinics success in engaging with complex clients and contribution to more efficacious use of health service resources. These activities may require the advocacy of a key local opinion leader acting as knowledge broker. KEYWORDS: Community health services; hepatitis C; interprofessional relations; primary health care; qualitative research
Prevalence and risk factors for tobacco smoking among pre-adolescent Pacific children in New Zealand
Authors: Nosa Vili , Gentles Dudley , Glover Marewa , Scragg Robert , McCool Judith , Bullen Chris
Published: November 2018

INTRODUCTION: Pacific New Zealanders have a high prevalence of smoking, with many first smoking in their pre-adolescent years. AIM: To identify risk factors for tobacco smoking among Pacific pre-adolescent intermediate school children. METHODS: A cross-sectional survey of 2208 Pacific students aged between 10 and 13 years from four South Auckland intermediate schools who were asked about their smoking behaviour between the years 2007 and 2009. RESULTS: The prevalence of Pacific ever-smokers (for 2007) in Year 7 was 15.0% (95% Confidence Interval [CI] 12.0%18.3%) and Year 8, 23.0% (95% CI 19.5%26.7%). Multivariate modelling showed the risk factors for ever-smoking were Cook Island ethnic group (OR 1.72; 95% CI 1.262.36, ref=Samoan), boys (OR 1.47; 95% CI 1.141.89), age (OR 1.65; 95% CI 1.362.00), exposure to smoking in a car within the previous seven days (OR 2.24; 95% CI 1.673.01), anyone smoking at home within the previous seven days (OR 1.52; 95% CI 1.122.04) and receiving more than $NZ20 per week as pocket money/allowance (OR=1.91, 95% CI 1.232.96). DISCUSSION: Parents control and therefore can modify identified risk factors for Pacific childrens smoking initiation: exposure to smoking at home or in the car and the amount of weekly pocket money the child receives. Primary health care professionals should advise Pacific parents to make their homes and cars smokefree and to monitor their childrens spending. This study also suggests a particular need for specific Cook Island smokefree promotion and cessation resources. KEYWORDS: Adolescent; child; ethnic group; New Zealand; Pacific; smoking