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Access by post-coronary (cardiac infarction) patients to appropriate rehabilitation services

Introduction

It is accepted that a cardiac rehabilitation programme for patients following a myocardial infraction might provide, when indicated, the following services (1-10):

  1. Education of patient
  2. Structured exercise programme
  3. Smoking reduction/cessation programme
  4. Weight reduction programme
  5. Dietary lipid monitoring programme
  6. Control of other medical conditions, e.g. hypertension, diabetes mellitus
  7. Psychological counselling
  8. Vocational counselling
  9. Occupational counselling
  10. Family counselling

The aims of such cardiac rehabilitation programme are twofold: 

  1. To facilitate a return to the patient’s previous or better level of function in the community
  2. To help reduce any identified risk factors associated with coronary heart disease, thus improving the patient’s future prognosis.

Such a programme has existing in Dunedin for over two decades involving many different disciplines and aimed at improving life expectancy and quality of life for around 200 people suffering from myocardial infarctions each year.  To be effective, a rehabilitation programme must be available and accessible to all post-coronary patients and cater for the whole patient as well as taking into consideration his/her family.  The delivery of such a programme requires much liaison between disciplines, ensuring that each discipline has a defined role, thus delivering a complete service to the patient.

Assessing the effectiveness of such a programme is not easy because it involves so many different disciplines and the grading of the success of the programme, like the quality of life has a tendency to be subjective rather than objective.

A retrospective pilot study involving 40 patients was undertaken over a six week period between September and October 1987.  The aim of the study was to determine the extent of access by post coronary (cardiac infarction) patients to appropriate rehabilitation services.  The client for this project was Associate Professor N.J. Restieaux.  The study was conducted by sixth year medical students from the University of Otago Medical School.

A non-random sample of post coronary patients who had been admitted to Dunedin Public Hospital Coronary Care Unit were followed up and their respective General Practitioner interviewed.  The patients were selected according to criteria as indicated under “Method”.  They came from the Otago Hospital Board catchment area.

The study attempted to determine whether:

  1. the hospital was providing optimal or adequate services;
  2. the services were functioning effectively;
  3. patients were using services available to them? – if not, why not?
  4. there was a place (or a greater role) for organizations such as the National Heart Foundation to offer better support such as rehabilitation.

Authors of Report

Samantha King, Gopinath Nayar, Annabelle J. Olliver, David Oxner, Paul Trott.

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Adolescent use of hospital based primary health care services

Abstract

On behalf of Dr John Clarkson of the Child Health Committee, five trainee inters undertook to determine the demographic data of the adolescent population presenting to hospital staff self-referral outpatient departments and whether a significant number of adolescents were presenting to Accident and Emergency (A & E) with problems related to chronic illness.

All A & E records for one week reviewed to obtain demographic data, and data relating to the presenting problem.  All adolescents attending A & E and Sexually Transmitted Disease (STD) clinics over a period of a week were interviewed by a member of the group and a questionnaire completed, to determine the nature of the presenting problem and level of satisfaction with no service.

Twenty five percent of the adolescent population interviewed suffered from chronic illnesses, the most common being asthma.  Only 3 percent of the population interviewed had presented with problems related to chronic illness.

The majority of those who had used the clinic on previous occasions were satisfied with the service

A one-week survey of STD clinic attenders found that the majority had a concurrent chronic illness, but that most had a regular family doctor.

Authors of Report

J, Cooke, M. Featherston, R. Fitzgerald, G. Johnston, J. Webber.

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AIDS: Knowledge and attitudes in Otago

Abstract

A postal questionnaire was sent to 307 people, during July 1987.  The questionnaire examined public knowledge, attitudes and strategies for education for future planning by the Southern Regional Health Services Association.  According to the age group those respondents aged 45-59 years scored best in the knowledge section.  The younger ages 18-29 years and 30-44 years scored closely, while the elderly scored least.  However, more than 10% of respondents were incorrect in their answers concerning the most basic questions, and an even larger number were unsure about casual contract as a method of AIDS virus transmission.  Many people did not realise all blood donations in New Zealand were screened for AIDS virus.  Attitudes reflected current controversy concerning the availability of free needles and condoms.  Fifty five percent of respondents were definitely in favour of compulsory blood testing even though the question did not specify which groups of people might be tested.  The vast majority made a strong plea for more information about AIDS.

Authors of Report

Noelyn Buisman, Andrew Chan Mow, Thomas Currie, Fenella Devereux, Bernard Fanning, Timothy Hawkins, Helen Holden.

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Antenatal education a survey of urban and rural users and non users

Two hundred and fifty four Dunedin women and fifty women from Clyde and surrounding district took part in a six week survey.  The survey examined, postnatally, the delivery and subjective benefits received from the antenatal services available to these women.

Amongst the primaparous women 102/111 (92%) attending some form of antenatal education and 49/120 (41) of multiparas attending reporting and 97% and 88% respectively positive subjective benefit received from their courses.  In the Clyde sample 14/17 (82%) primiparas and 8/27 multiparas attending the antenatal courses available at Dunstan Hospital and Alexandra with multiparas report 27/27 (100%) perceived benefit for the first time mothers.

We found primiparous non-attenders tended to be single younger women, of lower socio-economic class and less well educated when compared with attending primiparas.  Amongst multiparous women, non-attenders tended to be of higher parity, slightly lower socio-economic class but otherwise equivalent to their attending counterparts.  Numbers were too small to show such distinctions in the rural sample.

We recorded a commendable attendances rate for the antenatal courses and a high level of satisfaction although a few suggested improvements.  We did not record a significant group of single young lower class mothers who may benefit from separate antenatal classes acknowledging that these over represent the at-risk mother.

Our rural study showed that the present antenatal courses are well attending and greatly valued by the Clyde community.

Authors of Report

Christopher Johnstone, Nicola Jordan, David McLean, Maletino Mafi, Bart Nuijsink, Nicole Sauerland, Helen Weir.

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Dermatitis among apprentice hairdressers in the greater Dunedin area

Introduction

Contact dermatitis is a recognized occupational disease among hairdressers(1) and affects in particular the apprentice(2).  Contact dermatitis can be divided into two groups:  irritant, action of substance on the skin; or allergic, due to sensitization of the skin by allergen(3).

Irritant contact dermatitis is generally attributed to constant exposure to water and to detergents, including shampoos(1).  Apprentice hairdressers spend a large proportion of their time shampooing and are at considerable risk of developing an irritant dermatitis on their hands(4).  There is, however, considerable individual variation in susceptibility(5), with an increased risk in atopic apprentice hairdressers(6).

Allergic contact dermatitis is caused by sensitization to an allergen, which gives rise to a cell mediated Type IV delayed hypersensitivity reaction.  This is a different mechanism from the IgE mediated dermatitis seen in atopic individuals, who are more susceptible to allergic contact dermatitis than the general population.  There is a variable latent interval between first handling a sensitiser and the development of an allergic dermatitis, subsequent exposure leading to recurrence within 24 to 72 hours (5,6).  Sensitisation can occur several years after beginning hairdressing, however over 70% of those who develop an allergic contact dermatitis do so within the first two years(1).  The allergens to which hairdressers become sensitized are constituents of the solutions used for bleaching, dyeing and perming hair(1,2,8).

Dermatitis involves a sequence of events which appears as erythema, swelling, vesiculation and exudation, and it is often difficult to clinically differentiate irritant and allergic dermatitis(5,6).  Diagnostic patch testing confirms allergic contact dermatitis, however, while a positive patch test is indicative of allergic dermatitis this does not exclude an irritant component.  It is also possible for a substance to act as an irritant and as a sensitizing agent in an individual(7).

Previous studies have reported an incidence of irritant dermatitis in apprentice hairdressers ranging from 60%(1) to 90%(2), while the incidence for allergic dermatitis is reported to range from 5%(15) to 10%.  Studies of incidence of this disease in New Zealand have not, to our knowledge, been done.  It was felt that occupational dermatoses, and occupational dermatitis in hairdressers in particular, in an under-recognised condition in New Zealand.  This study is an attempt to gauge to some extent the scope of the problem.

In addition this study attempts to assess current compliance with industrial health legislation pertaining to occupational dermatoses, specifically that among hairdressers.  Occupational dermatitis is a notifiable disease, and skin diseases arising from work due to hairdressing chemical was first introduced as a specific category in 1979.  Those who suffer from occupational dermatitis are entitled to medical care and benefits.  This is stated in the ILO Convention No. 121 1967, of which New Zealand is a signatory.  In New Zealand Compensation is acquired from the Accident Compensation Corporation, which treats the disease as a Personal Injury by Accident (Section 28, 1982).  Thus those who suffer from occupational dermatitis are entitled to free medical consultations, both primary physician and specialist, and lump sum disability payment for permanent disability or having to cease employment.  The latter sum is only paid out on the recommendation of a specialist.  (Personal communication: ACC).

Authors of Report

Susan Bain, Nicholas Lawn, Michael Mackey, David Matthews, Martha Na Nagara, Paul Snelling.

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The effectiveness of hospital doctors in communicating with general practitioners in the Dunedin area

Introduction

In the New Zealand Health Care Care System general practitioners are responsible for longitudinal primary care, and the hospital is, for the most part, a temporary intervention into the primary unit.  General practitioners consult the hospital system when requiring advice or when the needs of their patients’ exceed the resources they have available to provide adequate care.  When a patient becomes involved in the hospital system, the general practitioner relinquishes some control of that person’s medical care.  However in most cases, the patient, having received the specialist care, returns to the community and once again his health is the sole responsibility of the general practitioner.  Throughout this exchange it is vital that good communication takes place.  Usually this is in the form of a letter or telephone call and follows a hospital admission, hospital discharge or outpatient referral.

Our study has looked at the effectiveness of communication between hospital doctor and general practitioner as viewed by general practitioners in the greater Dunedin locality.  The area of communication we have concentrated on has been that which occurs during the following a hospital admission, i.e.

  1. Communication received from the hospital to the general practitioner while the patient is in hospital
  2. Communications received from the hospital following patient discharge.  This can be further divided into:
    • Immediate discharge letter
    • Consultant/registrar (hospital) report

The aims of our study are:

  1. Assess what Dunedin general practitioners think of the hospital doctors’ ability to communicate information about patients in hospital
  2. Devise methods for improving this situation if it is concerned necessary
  3. Generate interest enabling a reciprocal study to be performed, looking at how well general practitioners themselves, communicate with their hospital colleagues.

Authors of Report

R Blackhall, A Clark, S Creighton, J Moloney, L Tyrie.

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