Research projects

Mental health

• Dr Jim Ross
• Dr Shyamala Nada-Raja
• Dr Kristin Kenrick
• Nick Erskine
• Sinead Van Rooy

Breast cancer

• Roz McKechnie
• Professor Susan Dovey

Palliative care

• Professor Susan Dovey
• Emily Dwight

Ultrasound and echocardiography

• Dr Garry Nixon (Principal Investigator)
• Kati Blattner
• Roz McKechnie
• Professor Susan Dovey
• Associate Professor Chrys Jaye
• Rick Audas
• Carol Horgan
• John Wigglesworth
• Marara Rogers-Koroheke

Helicobacter pylori infection in eastern Nepal

• T W Sherpa
• K T Sherpa
• Dr Garry Nixon
• E Heydon
• J Heydon
• Professor Susan Dovey

COMHEART: Building mental health in rural communities

• Dr Jim Ross
• Dr Shyamala Nada-Raja
• Nick Erskine
• Sinead Van Rooy

Evaluating access of rural populations to complex diagnostic investigations in TIA / stroke

• Dr Garry Nixon
• Associate Professor Chrys Jaye
• Roz McKechnie

Healthcare in the rural Otago and Southland setting: A pilot study

• Professor Susan Dovey
• A Chhibber

How close is the match of the 'rural' in medical students' rural origin and the 'rural' in rural healthcare?

• Dr Alison Belton
• Dr Martyn Williamson
• Stacey Shaw

Impact of rural generalist clinician performed ultrasound and echocardiography

• Dr Garry Nixon (Principal Investigator)
• Kati Blattner
• Roz McKechnie
• Professor Susan Dovey
• Associate Professor Chrys Jaye
• Rick Audas
• Carol Horgan
• John Wigglesworth
• Marara Rogers-Koroheke

Rural hospital services

• Dr Martyn Williamson

Defining what type of rural background leads to increased intention of rural practice

• Dr Martyn Williamson
• Dr Alison Belton
• Dr Branko Sijnja
• Stacey Goodson

Distance learning

• Mr Tony Egan

Education and vocational training for rural hospital generalists

• Professor Susan Dovey

Outcomes of the Rural Medical Immersion Programe

• Dr Branko Sijnja
• Professor Susan Dovey
• Kate Margetts

Pros, cons, and barriers to teaching Rural Medical Immersion Programme students

• Dr Branko Sijnja
• Professor Susan Dovey
• William Parkyn

Safe and Effective Clinical Outcomes (SECO) clinics

• Mr Tony Egan
• Dr Martyn Williamson
• Dr Jim Ross
• Jessica Young

Read more about the SECO clinics

Student attitudes to rural practice

• Dr Martyn Williamson

Uncovering inequalities: A fit-for-purpose definition of 'rural' for health research and policy in New Zealand

The limited urban / rural analyses of routinely-collected data undertaken in Aotearoa New Zealand (NZ) has failed to demonstrate the health inequalities that are evident in similar countries. This is at odds with evidence of disparities in access to individual health services and the observed poor health status of residents of rural towns. It is possible that the apparent lack of effect of rurality on health outcomes in NZ is an artifact arising from the definition of 'rural' used in health statistics.

Geographic Classification for Health (GCH): Developing a new rural-urban classification for NZ health research and policy

Aims

To develop a 'fit for health purpose' rural-urban classification for analysis of health data (at national and local levels), and to use it with key national data collections to determine the magnitude of urban-rural health disparities in health outcomes and access to health services in Aotearoa/New Zealand.

Design and methods

Statistics NZ Is completing work on a new rural urban classification, the Urban Accessibility Classification ( UAC ). The UAC is a generic classification not designed for use in health.

The research team will modify the UAC with health and health services in mind. Potential modifications will then be tested using enrolment in general practices classified as rural or urban by local PHOs and by using a co-design process to get 'on the ground' feedback from the rural health stakeholders.

The resulting Geographic Classification for Health ( GCH ) and the most commonly used existing Stats NZ classification (Urban/rural experimental profile; UREP ) will be used to analyse routinely collected data from the Ministry of Health to quantify current levels of urban/rural inequity in health service access and outcomes and the extent to which older classifications may have been masking disparities.

Research impact

A fit for purpose process of classifying residential addresses as either urban or rural will generate a better understanding of health outcomes and healthcare access for rural New Zealanders. Better informed health policy can then drive the innovation needed to deliver an effective and efficient health service for all New Zealanders, regardless of where they live. This has particular importance to those whose health status is most vulnerable to the additional burden of distance – those with high levels of deprivation, the elderly, and those with disabilities.

Funding

The study is being funded with a NZ Health Research Council Project Grant.

Co-design and stakeholder input

Feedback from stakeholders is an important aspect of this project. It is essential that the GCH groups together communities that are similar with respect to health services. It needs to 'makes sense on the ground' to NZ's rural health stakeholders.   It also needs to meet the analytical needs of NZs health research community.

If you have an interest in rural health, health research or health policy, and interested in providing feedback on the proposed Geographic Classification for Health, we would like to hear from you.

Please feel free to contact via email.
Email michelle.smith@otago.ac.nz

Project team

This team includes researchers who have previously worked together from the University of Otago and the University of Waikato, with expertise in rural health, health geography, Māori health, biostatistics, data management and population health.

Professor Garry Nixon – Rural Health
Garry is in clinical rural practice in Central Otago (28 yrs.) and Associate Dean Rural University of Otago. He teaches the postgraduate rural diploma which provides regular contact with the next generation of NZ's rural doctors. He brings expertise is rural health and in leading project teams that are geographically dispersed. Garry is the PI on the project.

Gabrielle Davie
Gabrielle is Senior Research Fellow (biostatistician) at the University of Otago. She has 16yrs' research experience using NZ's administrative health data. Gabrielle is the  Deputy Director of the Injury Prevention Research Unit and co-lead of the Dunedin School of Medicine Administrative Data for Health Research Hub. Gabrielle will lead the Dunedin based team, provide biostatistical advice and lead the analysis of routinely collected national health data sets.

Dr David Fearnley
Rural hospital doctor for over 18 yrs including Clinical Director roles and undertaking consulting work to DHBs on rural health services. He was first author on a paper highlighting the problems with NZ's rural health data (2016 with GN&RL). He will provide a rural health perspective to the data analysis, lead the write up of publications and be involved in implementation in the rural health and DHB sectors.

Jesse Whitehead
Jesse is a PhD candidate (spatial equity, accessibility, and sustainability of GP services in Waikato) at the National Institute of Demographic and Economic Analysis, University of Waikato, with a background in geography and GIS analysis of health services. He will liaise with Statistics NZ and work on both the rural-urban classification and the  GIS accessibility index. Jesse is well connected in the NZ and overseas rural health communities and will have an important role in translating the geographic aspects of the findings for those in the rural health and health research sectors.

Brandon De Graaf
Brandon is a Research Fellow (Data Manager/Programmer), University of Otago. His expertise is in information science including programming, geocoding, process optimization and automation. Brandon will provide data management, geospatial and machine modeling and analysis, and produce physical maps for publications.

Professor Sue Crengle
Sue is a GP, Public Health Medicine Specialist and senior Māori health researcher, University of Otago.  She has experience in co-design studies and helped develop the NZ Index of Multiple Deprivation. Sue will advise on the Māori specific analyses, interpretation of data and facilitate engagement with Māori stakeholders including implementation in the Māori health research community.

Professor Ross Lawrenson
Ross is Professor of Population Health (University of Waikato), Population Health Advisor Strategy and Funding at Waikato DHB and NZ Rural GP Network board member. He brings expertise in epidemiology and health services research with a long history in rural health research including co-design studies with rural/Māori communities.

Michelle Smith
Michelle's role on the project is as research nurse/assistant. Michelle is an Associate Charge Nurse at Dunstan Hospital, Central Otago. She has expertise working on other rural health research projects including a current project on to validate a rural chest pain pathway.

Advisers

Professor John Humphreys, (Emeritus Professor Rural Health Geography, Monash Uni.) and Professor John Wakerman (Menzies School of Health Research, Alice Springs) are recognised Australian authorities in this field. They developed the Modified Monash classification ( MMM ) that has recently been adopted by the Australian Govt. for the allocation of rural primary care funding. They have published extensively, including on the development of the MMM and research translation in evidence based rural health policy.

Dr Katharina Blattner is a senior lecturer rural health University of Otago, and Senior Medical Officer for Hauora Hokianga. Kati brings expertise in rural health service delivery research, and a Hokianga perspective (a remote, predominantly Māori, Northland community). She is well placed to assist with the uptake of the UIC-H in the rural sector.

Urban versus rural disparities in access to CT services

In April 2008 Oamaru Hospital became the smallest public hospital in New Zealand to install a computed tomography (CT) scanner. CT scanners are still uncommon outside urban centres in New Zealand. This project has found that:

• Large rural versus urban disparities exist in CT utilisation in southern New Zealand
• A rural CT can eliminate these disparities without apparent overservicing
• CT can be introduced in a rural hospital with minimal logistical problems

Costs in attending specialist appointments

Fearnley, D., Kerse, N., & Nixon, G. (2016). The price of 'free': Quantifying the costs incurred by rural residents attending publically funded outpatient clinics in rural and base hospitals. Journal of Primary Health Care, 8(3), 204-209. doi: 10.1071/HC16014

Point of care laboratory testing

This project looked at the impact of point of care laboratory testing in a remote rural hospital which resulted in change in clinical practice.

Blattner, K., Nixon, G., Dovey, S., Jaye, C., & Wigglesworth, J. (2010). Changes in clinical practice and patient disposition following the introduction of point-of-care testing in a rural hospital. Health Policy, 96, 7-12. doi: 10.1016/j.healthpol.2009.12.002
Blattner, K., Nixon, G., Jaye, C., & Dovey, S. (2010). Introducing point-of-care testing into a rural hospital setting: Thematic analysis of interviews with providers. Journal of Primary Health Care, 2(1), 54-60.
Blattner, K., & Ward, C. (2011). Point of care testing in Hokianga Hospital or 'How to get a good night's sleep in a lab-free zone'. New Zealand Journal of Medical Laboratory Science, 65, 39-41.

Cardiac exercise testing

The impact and safety of a generalist-led cardiac exercise tolerance testing service in two rural centres.

Published evidence, both within New Zealand and internationally, suggests rural patients have inferior access to cardiovascular diagnostic investigations including cardiac exercise tolerance tests (ETT) compared with urban patients, and have poorer outcomes as a result. Despite a significantly higher prevalence of ischaemic heart disease (IHD) in Māori as compared with non Māori, intervention rates for Māori are low.

This study describes the feasibility, clinical impact, and cost-effectiveness of a rural generalist-led ETT service for primary care patients in two different rural communities.

Blattner, K., Nixon, G., Horgan, C., Coutts, J., Rogers, M., Wong, B., Wigglesworth, J., Wilkins, G. Evaluation of a rural primary-referred cardiac exercise tolerance test service. New Zealand Medical Journal, 127(1406).

Clinician performed ultrasound

This observational study examined the role of clinician-performed ultrasound (CPU) in six New Zealand rural hospitals over a nine-month period. It examined quality and safety by reviewing recorded images and comparing results with those of formal imaging. Impact on patient management was evaluated by reviewing clinical records. The extent to which the CPU impacted on patient disposition (discharge, admission to rural hospital, or transfer to a base hospital) was assessed by recording the clinician's planned management both before and after undertaking the CPU.

Over 1000 scans were included in the study.  The most commonly performed scans were cardiac, IVC, gallbladder, kidney, and focused assessment with sonography for trauma (FAST).  Image quality was assessed as good in 62%, adequate in 31%, and non-diagnostic in 7%, of cases. Clinicians correctly interpreted their images in 90% of cases. In 8% of cases the disposition was deescalated, resulting in a financial saving to the healthcare system, and in 4% of cases it was escalated, resulting in improved patient outcomes.

Overall impact on patient management

In 26% of cases the specialist panel decided that the CPU had no or minimal impact on management. In 48.6% of cases there was some impact, for 22% of cases the impact was significant, and for 0.4% of cases the CPU had a potentially life saving-impact. In 3% of cases the CPU was judged to have had a negative impact on patient care. In 17 cases this was in the form of an incorrect diagnosis. In six cases it was a delay in accessing definitive investigation or treatment, and in four cases it was determined that an alternative imaging modality should have been used.

This study suggests that rural New Zealand doctors have a broader scope of CPU practice than their urban emergency physician colleagues. Overall CPU appears to have a positive impact on patient care and, by reducing inter-hospital transfers, results in savings to the healthcare system.

The study  was funded by the Health Research Council  2011 / 2012.

Investigators

• Garry Nixon
• Kati Blattner

Partners

Hokianga Health Services
Central Otago Health Services

Status

The final write-up is being prepared. Articles are being prepared for publication.