title: An evaluation of Te Rau Puawai workforce 100: Te Rau Puawai support team and staff perspectives

authors: Nikora, Linda Waimarie

subjects: Maori students

abstract: To evaluate the Te Rau Puawai programme, the Ministry of Health commissioned the
Maori and Psychology Research Unit of the University of Waikato in July 2001. The
overall aim of the evaluation was to provide the Ministry with a clearer understanding
of the programme including: the perceived critical success factors, the barriers if any
regarding Te Rau Puawai, the impact of the programme, the extent to which the
programme may be transferable, gaps in the programme, and suggested
improvements.
The Te Rau Puawai support team were identified as an important source of support
for bursars particularly the support provided by the coordinator and administrator.
This report documents the perspectives of four members of the telephone support
team (including the coordinator), and individual interviews held with the coordinator
and the administrator in addressing the objectives of the evaluation.

text: An evaluation of Te Rau Puawai workforce 100: Te Rau Puawai support team and staff perspectives To evaluate the Te Rau Puawai programme, the Ministry of Health commissioned the
Maori and Psychology Research Unit of the University of Waikato in July 2001. The
overall aim of the evaluation was to provide the Ministry with a clearer understanding
of the programme including: the perceived critical success factors, the barriers if any
regarding Te Rau Puawai, the impact of the programme, the extent to which the
programme may be transferable, gaps in the programme, and suggested
improvements.
The Te Rau Puawai support team were identified as an important source of support
for bursars particularly the support provided by the coordinator and administrator.
This report documents the perspectives of four members of the telephone support
team (including the coordinator), and individual interviews held with the coordinator
and the administrator in addressing the objectives of the evaluation.

year: 2002-05-01

title: Rising demand for health care: The sustainability of community general practice in the Waikato

authors: Amey, Janet Heather

subjects: General practice

abstract: Community general practice is the cornerstone of New Zealand’s health system, providing first contact health care, care coordination and acting as gatekeeper to expensive hospital services. An ageing population now brings increasing demand for the care provided in general practice, with chronic conditions a major contributing factor. This rising demand, alongside limited workforce capacity will seriously test general practice sustainability. 

These evolving and multifaceted challenges are within the context of long-standing health access and outcome inequalities, particularly for Māori (and more recently the Pacific population) compared with Pākehā. The pursuit of equity is inherent in all health sector strategies, but any meaningful improvement will necessitate wide-ranging reform of current planning, funding and service delivery pathways across traditional sector boundaries.

The sustainability of general practice is about the sustainability and efficiency of the entire health system. To better measure the contribution of general practice care to the system, and improve demand projections, an expanded service use measure was developed, combining services of a general practice nature from Emergency Department and Accident & Medical settings with services delivered in community general practice.

Drawing on approaches from demography, epidemiology and health services research, linked demographic and health administrative data were used to undertake a retrospective, observational study of service use for 235,666 people enrolled with the Pinnacle Midlands Health Network in 2013/14. Using the new expanded measure, service use levels at a locality level were established by age, gender, ethnic group, chronic condition status, practice funding model, high needs status, income and geography of residence.

Significant variation was found in annual average consults (1.0 to 13.4 consults in 2013/14). Statistical analysis identified age, chronic conditions and gender as the key demand drivers responsible for such variation, with regional level results masking significant spatial variation. Where the cost of care was lower, people used a higher level of services in the enrolled practice setting and a lower level outside of it, suggesting the importance of affordable care. Māori and Pacific used significantly fewer services than Pākehā although there was substantial sub-regional variation. Using the expanded measure, the vast majority of care was delivered in the enrolled setting, including for those with chronic conditions.

Demand projections, based on the expanded measure of general practice, out to 2038 show the uneven geography of future demand due to disordered cohort flows and sub-regional population contexts. Overall, demand for services is projected to rise by 34 per cent to almost two million consults across the Waikato District Health Board catchment, with this driven predominantly by services for those aged 65+ years (or 45+ years in Hamilton City, Waikato and Waipa Districts).

Models of care are being transformed as general practices and Primary Health Organisations look to the future. Reorganisation of work roles, improved use of health information and use of emerging health technologies will be required to re-configure general practice in preparation for an ageing future, and to eliminate recalcitrant health inequalities. Real and inclusive collaboration across traditional system boundaries is perhaps the greatest challenge to general practice sustainability.

text: Rising demand for health care: The sustainability of community general practice in the Waikato Community general practice is the cornerstone of New Zealand’s health system, providing first contact health care, care coordination and acting as gatekeeper to expensive hospital services. An ageing population now brings increasing demand for the care provided in general practice, with chronic conditions a major contributing factor. This rising demand, alongside limited workforce capacity will seriously test general practice sustainability. 

These evolving and multifaceted challenges are within the context of long-standing health access and outcome inequalities, particularly for Māori (and more recently the Pacific population) compared with Pākehā. The pursuit of equity is inherent in all health sector strategies, but any meaningful improvement will necessitate wide-ranging reform of current planning, funding and service delivery pathways across traditional sector boundaries.

The sustainability of general practice is about the sustainability and efficiency of the entire health system. To better measure the contribution of general practice care to the system, and improve demand projections, an expanded service use measure was developed, combining services of a general practice nature from Emergency Department and Accident & Medical settings with services delivered in community general practice.

Drawing on approaches from demography, epidemiology and health services research, linked demographic and health administrative data were used to undertake a retrospective, observational study of service use for 235,666 people enrolled with the Pinnacle Midlands Health Network in 2013/14. Using the new expanded measure, service use levels at a locality level were established by age, gender, ethnic group, chronic condition status, practice funding model, high needs status, income and geography of residence.

Significant variation was found in annual average consults (1.0 to 13.4 consults in 2013/14). Statistical analysis identified age, chronic conditions and gender as the key demand drivers responsible for such variation, with regional level results masking significant spatial variation. Where the cost of care was lower, people used a higher level of services in the enrolled practice setting and a lower level outside of it, suggesting the importance of affordable care. Māori and Pacific used significantly fewer services than Pākehā although there was substantial sub-regional variation. Using the expanded measure, the vast majority of care was delivered in the enrolled setting, including for those with chronic conditions.

Demand projections, based on the expanded measure of general practice, out to 2038 show the uneven geography of future demand due to disordered cohort flows and sub-regional population contexts. Overall, demand for services is projected to rise by 34 per cent to almost two million consults across the Waikato District Health Board catchment, with this driven predominantly by services for those aged 65+ years (or 45+ years in Hamilton City, Waikato and Waipa Districts).

Models of care are being transformed as general practices and Primary Health Organisations look to the future. Reorganisation of work roles, improved use of health information and use of emerging health technologies will be required to re-configure general practice in preparation for an ageing future, and to eliminate recalcitrant health inequalities. Real and inclusive collaboration across traditional system boundaries is perhaps the greatest challenge to general practice sustainability.

year: 2018

title: The Development of a Novel Controlled Release Drug Delivery System

authors: Babu, Kavitha Mary Vadakkel

subjects: Controlled Release Drug Delivery

abstract: The aim of this research was to formulate, characterise and assess the feasibility of a novel drug delivery system known as the in situ gelling matrix (ISGM) where a hydrophilic polymer is suspended in a non-aqueous solvent that converts into a gel when injected subcutaneously or intramuscularly thus giving a controlled release matrix for a drug.  Although the concept has been patented with claims that this kind of drug delivery is achievable in theory for a wide variety of candidate substances, actual formulation studies for making a commercially viable product for this technology are completely lacking in practice.   The research embodied in this thesis addresses this lack.  Initial studies involved conducting a biocompatibility study using the HET-CAM (hens egg test - chorioallantoic membrane) test on a range of possible ingredients for the delivery system.  The materials deemed biocompatible were then carried through to a screening process where the physical stability of the hydrophilic polymers in non-aqueous solvents was monitored.  It was found that the hydrophilic polymers tested sedimented rapidly in the non-aqueous solvents indicating such a system was not physically stable.  Consequently, density-inducing or viscosity-inducing agents were added to the non-aqueous solvents to retard the sedimentation rate.  The addition of polycarbophil, a viscosity-inducing agent, clearly increased the viscosity of the system.  However, undesirable formation of polycarbophil globules occurred during the manufacturing process, which caused batch-to-batch variations in the viscosity of the continuous phase. Various manufacturing methods were tested before arriving at the optimum procedure to prevent globule formation using a high speed dispersion tool.  A final physical sedimentation analysis of candidate continuous phases and hydrophilic polymers was conducted for determining the ideal combination of ingredients to use in the system.  These investigations finally led to the adoption of an optimum mix of components consisting of 10% (w/w) hydroxypropyl methylcellulose (HPMC) (the hydrophilic polymer) suspended in a continuous phase of propylene glycol (the non-aqueous solvent) containing 0.67% (w/w) polycarbophil (the viscosity inducing agent).

Using this mix of components, the in situ gelling matrix system was then subjected to various characterisation studies including infrared (IR), differential scanning calorimetry (DSC), ultraviolet-visible (UV-Vis) spectrophotometry and redispersion studies.  The chemical stability of the hydrophilic polymer and the continuous phase (the non-aqueous solvent and polycarbophil) was monitored and were found to be chemically stable over a 9 month period.  

The feasibility of the in situ gelling matrix technology as a controlled release device was assessed using the drug propranolol.  In vitro drug release studies were conducted using a custom-built dissolution apparatus.  The effect of various parameters such as the concentration of the hydrophilic gelling agent on the drug release rate was investigated.  Increasing the concentration of the gelling agent in the formulation resulted in a slower rate of release.  The drug release data were modelled using the Higuchi relationship and a power law relationship to compare the effects of the various parameters on the release rate

Stability studies on the drug in the in situ gelling matrix system were carried out by storing samples in accelerated ageing conditions of 40 C / 75% relative humidity for 4 weeks.  During this time, the samples were analysed each week by high performance liquid chromatography (HPLC).  These demonstrated that no apparent drug degradation had occurred over the 4-week period. This indicates that the drug propranolol in the in situ gelling matrix system is stable under ambient conditions for at least 4 weeks.  

The results of this study demonstrated that the in situ gelling matrix technology is potentially viable as a drug delivery system and provide a practical methodology for the commercial development of such systems.

text: The Development of a Novel Controlled Release Drug Delivery System The aim of this research was to formulate, characterise and assess the feasibility of a novel drug delivery system known as the in situ gelling matrix (ISGM) where a hydrophilic polymer is suspended in a non-aqueous solvent that converts into a gel when injected subcutaneously or intramuscularly thus giving a controlled release matrix for a drug.  Although the concept has been patented with claims that this kind of drug delivery is achievable in theory for a wide variety of candidate substances, actual formulation studies for making a commercially viable product for this technology are completely lacking in practice.   The research embodied in this thesis addresses this lack.  Initial studies involved conducting a biocompatibility study using the HET-CAM (hens egg test - chorioallantoic membrane) test on a range of possible ingredients for the delivery system.  The materials deemed biocompatible were then carried through to a screening process where the physical stability of the hydrophilic polymers in non-aqueous solvents was monitored.  It was found that the hydrophilic polymers tested sedimented rapidly in the non-aqueous solvents indicating such a system was not physically stable.  Consequently, density-inducing or viscosity-inducing agents were added to the non-aqueous solvents to retard the sedimentation rate.  The addition of polycarbophil, a viscosity-inducing agent, clearly increased the viscosity of the system.  However, undesirable formation of polycarbophil globules occurred during the manufacturing process, which caused batch-to-batch variations in the viscosity of the continuous phase. Various manufacturing methods were tested before arriving at the optimum procedure to prevent globule formation using a high speed dispersion tool.  A final physical sedimentation analysis of candidate continuous phases and hydrophilic polymers was conducted for determining the ideal combination of ingredients to use in the system.  These investigations finally led to the adoption of an optimum mix of components consisting of 10% (w/w) hydroxypropyl methylcellulose (HPMC) (the hydrophilic polymer) suspended in a continuous phase of propylene glycol (the non-aqueous solvent) containing 0.67% (w/w) polycarbophil (the viscosity inducing agent).

Using this mix of components, the in situ gelling matrix system was then subjected to various characterisation studies including infrared (IR), differential scanning calorimetry (DSC), ultraviolet-visible (UV-Vis) spectrophotometry and redispersion studies.  The chemical stability of the hydrophilic polymer and the continuous phase (the non-aqueous solvent and polycarbophil) was monitored and were found to be chemically stable over a 9 month period.  

The feasibility of the in situ gelling matrix technology as a controlled release device was assessed using the drug propranolol.  In vitro drug release studies were conducted using a custom-built dissolution apparatus.  The effect of various parameters such as the concentration of the hydrophilic gelling agent on the drug release rate was investigated.  Increasing the concentration of the gelling agent in the formulation resulted in a slower rate of release.  The drug release data were modelled using the Higuchi relationship and a power law relationship to compare the effects of the various parameters on the release rate

Stability studies on the drug in the in situ gelling matrix system were carried out by storing samples in accelerated ageing conditions of 40 C / 75% relative humidity for 4 weeks.  During this time, the samples were analysed each week by high performance liquid chromatography (HPLC).  These demonstrated that no apparent drug degradation had occurred over the 4-week period. This indicates that the drug propranolol in the in situ gelling matrix system is stable under ambient conditions for at least 4 weeks.  

The results of this study demonstrated that the in situ gelling matrix technology is potentially viable as a drug delivery system and provide a practical methodology for the commercial development of such systems.

year: 2007