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An analysis of twenty years audiometry results in a noisy industry

Our study

The purpose of our study was to ascertain if the Hearing Conservation Programme has been of benefit to employees in this noisy industry over the last twenty years.

Authors of Report

Brett Ferguson, Kate Heer, Aaron Donaldson, Flora Gastrell, Amanda Charlton.

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An evaluation of Te Waka Hauora-A-Rohe the Maori Mobile Health Unit

The Health Status of Maori people has deteriorated significantly since European settlement in New Zealand.  Currently the incidence and associated mortality of many preventable diseases is greater in the Maori population than in the non-Maori population.

Causes of the current poor Health Status of the Maori:

Socio-economic, cultural factors and self esteem and generally regarding by the Maori community as among the most important reasons why Maori people experience a greater degree of ill-health as compared with non-Maori. (1) This is certainly confirmed by the high misery factor associated with unemployment, low earning capacity, poor housing and low educational attainment.  (2) It has been suggested that these factors explain, to a degree, why the Maori seem to adopt and persist with lifestyle habits which are well known to be associated with poor health.

Utilisation of a health system is often described in terms of affordability, availability, access awareness and acceptability.  In relation to poor health status, these five factors are linked to the economic inequality, adverse lifestyle behaviour and cultural differences express above.  The lower socio-economic status of Maori will have obvious effects on the accessibility of health care.  Utilisation of health services depends of knowledge of available services as well as whether a person can pay for the transport and the doctor’s fee.  Maori in rural areas may well face issues of accessibility to health care while Maori in urban areas may be unaware of services available to them.  Of particular relevance to Maori are issues of acceptability.  This is related to the Maori concept of health and the cultural differences existing between Maori and non-Maori attitudes towards health care.

Maori Concept of Health

In traditional Maori terms, health is an all-embracing concept which emphasizes the importance of the Wairua (Spiritual), Whanau (Family), Hinengaro (Mental) and Tinana (Physical) aspects.  In addition to these, Te Whenua (Land), Te Reo (Language), Te Ao Turoa (Environment) and Whanaungatanga (Extended Family), are central to the Maori culture and to health.  (1) In contrast to these concepts, the traditional Western model of health focuses on the physical aspects of health and sickness, often ignoring Maori cultural beliefs. It is no wonder that the Maori, with their holistic view of health, have found the rigid Western-style health system to be unacceptable, and consequently have suffered poorer health overall.

Te Waka Hauora-A-Rohe

In an attempt to overcome of the socio-economic and cultural problems of health care delivery to the Maori population in the Otago region, the Service Advisory Group on Maori Health to the Otago Area Health Board put forward the concept of a Maori Mobile Health Unit in 1989.  The aim of the unit was to provide a culturally acceptable service to the Maori people living within the Otago region. Months of consultation took place before the proposal for the unit was finally passed and in March 1991 a coordinator of Te Waka Hauora-A-Rohe was initiated as a two year pilot programme and as such it was decided that the unit would target aspects of health status in which Maori were disproportionately represented.  Coronary artery disease, diabetes, respiratory diseases (asthma, chronic bronchitis and emphysema), hearing and visual problems and cervical neoplasia were all targeted.  Procedures undertaken by the unit, therefore, include measurement of blood cholesterol, blood pressure, blood glucose, peak expiratory flow rates, carbon monoxide levels (in smokers), audiometry and visual testing, cervical smear tests and tympanometry (especially in children).

One of the goals for the unit was to work from the premise that “prevention is better than cure” and that early detection and referral to a registered medical practitioner would be fat more cost effective in the long term.  Other goals were to provide education on health issues through culturally appropriate methods and to investigate traditional “Maori Medicines”. (3)

While the Maori Mobile Health Unit targets Maori health issues and operates under “Kaupapa Maori” (Maori philosophy) anyone wishing to make sure of the service is welcomed.  At the time of this study Te Waka had given service to 552 Maori and 1358 non-Maori since its inception in March 1991.

The following study was undertaken in November and December 1992 and was envisaged as a preliminary assessment of patient satisfaction with the unit which would also act as a guide and source of reference for any subsequent studies to be carried out in evaluation of Te Waka Hauora-A-Rohe.

Authors of Report

Stephanie Inder, Philippa Johnstone, James Letts, Rachael McEwing, Andrew Palmer, Jo Paver, David Priest, John Rouse.

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An evaluation of the Māori dental health clinic

Introduction

The Problem

Dental health amongst the Māori has deteriorated significantly since European settlement in New Zealand.  Currently, the prevalence of many preventable oral and dental conditions is greater in the Māori population than in the non-Māori population.

Few surveys of Māori dental health were carried out before the 1970s.  These studies [1,2] in general revealed a high incidence of caries and periodontal disease among Māori children.  The 1976 and 1982 surveys of oral health among New Zealand adults [3,4] gave the first documented comparisons between the teeth of Māori and those of non-Māori.  Māori were found to have a greater mean number of decayed teeth and significantly higher Periodontal Index scores (a rating of periodontal disease).  Although exhibiting a high incidence of caries and decay, Māori had fewer filled teeth and greater "extraction need", i.e. teeth requiring extraction that had not received treatment.

Authors of Report

Tim Jackson, Robyn Oldfield, Craig Thornley, Nilesh Vasan.

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Patient satisfaction questionnaire: A pilot of Dunedin Public Hospital Inpatients’ evaluation of services

Introduction

Patients are the central focus of both health care delivery and quality assurance efforts.  It is therefore somewhat surprising that until recently patients’ views were generally considered external to the process of health care.  During the 1980s, however, the emphasis on outcome measurement and the growth of the private health care sector have lead to an increased interest in the significance of patients’ perception of health care.

Dunedin Hospital has used patient satisfaction questionnaires for many years and its most recent survey was introduced in 1990.  Management, staff and patients have expressed varying degrees of dissatisfaction with the current questionnaire (see Appendix A).  Although it attempts to be accessible (for example, it provides illustrated answer choices for the semi-literate), its methods and choices of questioning, relevance, range of response options, mode of distribution and rate of uptake and return have all been criticized.  Although all patient putatively have the option of filling it out and returning it, only about 10% do so, response rate to satisfaction questionnaires lower than 75% are considered less than ideal.  Our review of available patient satisfaction surveys used in New Zealand suggests that the Dunedin questionnaire is not unique in its shortcomings (see Appendix A).

It was in this context that our group was asked by the Hospital Manager to design and pilot a new patient satisfaction questionnaire for in-patient services at Dunedin Hospital.  Before presenting these findings, we review some of the literature about patient satisfaction and quality assurance, and outline the theoretical basis for the practical design of the questionnaire.

Authors of Report

Louise Moore, Jo-Dee Lattimore, Kim Mawson, Fiona Burns, Brett Lyons, John Danesh, Nelson Chen.

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Poisonous Plants:  Labelling and education

Abstract

Objectives

  1. To determine the range of poisonous plants sold in nurseries, the extent of labeling, and the type of information given to customers when buying poisonous plants.
  2. To establish the type of information concerning poisonous plants that customers and nursery staff feel should be made available to customers.

Setting

Nurseries in Dunedin who derive their main income from selling plants.

Subjects

20 nursery staff (owners or managers) and 117 nursery shop customers.

Method

Subjects were interviewed by the seven Trainee Interns and the standard survey forms were then analysed.

Results

  1. There is a wide range of poisonous plants sold in Dunedin nurseries.
  2. At present no poisonous plants are labeled as poisonous, and only verbal information is given at the point of sale of poisonous plats.
  3. Knowledge about poisonous plants varies widely amongst nursery staff.
  4. Both customers and nursery staff feel that the information available at present is inadequate and would like to see poisonous plants labeled as poisonous with additional information also being provided on request.

Recommendations

  1. Training about poisonous plants be made available to nursery staff.
  2. Poisonous plants labeled as such with additional information provided as desired.
  3. Trial scheme to be established.

Authors of Report

Glen Murphy, Penny Thornton, Kevin Plumpton, Fiona Timms, David Peacock, Brendon Yee, Carole-Ann Searle.

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Occupational sources of artificial ultraviolet light.  A descriptive survey of the range and significance of occupational sources of artificial ultraviolet radiation exposure

Foreward

This study was carried out for our clients, Cathy Logan of the Community Health Services Unit and Dr Mary J Sneyd of the Department of Preventive and Social Medicine; under the supervision of Dr Charlotte Paul also of the Department of Preventive and Social Medicine.

This health care evaluation was part of our final year of medical training.  It constituted an assessment of an identified health care problem in Dunedin.  This study could not have been carried out without the goodwill and assistance of the 49 worksites who shoes to participate in this study despite the unfortunate timing of this project over the pre-Christmas period.  We are grateful for their cooperation.

We would especially like to take Giles Wynn-Williams, Medical Physicist, without whose support and enthusiasm much of the measurement that was undertaken in this study could not have been accomplished.  We would also like to thank Dr Charlotte Paul, our supervisor, for shepherding us through the process of research, Prof Alistair Campbell of the Department of Medical Ethics, Shelia Williams, biostatistician to the Department of Preventive and Social Medicine and Ken Cooke of the Community Health Service Unit.  We are also grateful to Celia Chisholm for her generous work in typing this project.

Authors of Report

M Thomas, G Nind, T Peterson, S Pillai, K Pillai, A Tam, F Turnball, S Watchman.

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Satisfaction with the Child, Adolescent and Family Mental Health Service

Introduction

This Health Care Evaluation Project was carried out by a group of trainee interns that were asked to carry out a study by the Child, Adolescent & Family Mental Health Service to access consumer satisfaction.  It was envisaged that the parents of children referred to the service between January 1990 and December 1991 would be contacted.

Objectives

  1. What is the level of satisfaction with the service?
  2. Consumer perceived weakness/strengths of the service?
  3. Who was the main treatment provider?
  4. What is the effect of the service upon the problem?

Authors of Report

Andrew Broadbent, Christopher Chin, Alison Kirkman, Lee-ann Kitto, Warren Lee, Deborah Mason, Joanne Mitchell, Carolyn Smale.

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The complaints procedure: An evaluation of satisfaction with the current system and suggestions for change

We were approached by our client, Heather Buchan, Chief Medical Officer of the Otago Area Health Board (OAHB) who wished us to investigate how well complaints are currently being dealt with, what kind of system and standards for dealing with complaints there should be in the CHE, and what is the best way to regularly monitor the adequacy of the clinical complaints system in the future.  After discussion we decided that within the time constraints allowed we could not cover all of these aspects thoroughly.  In order to suggest improvements to the way in which complaints are handled by the OAHB it was necessary to evaluate the recent systems in operations at the Area Health Board and Dunedin Hospital from the point of view of both parties and staff.  This was the principal aim of our study.

Authors of Report

Helen Moore, Mark Pratt, Keryn Painter, Julian Stoddart, Michelle Nottage, Hamish Osborne and Ben Wilson.

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The effect of upper airway surgery on asthma

Introduction

The aim of our research project was to investigate the effect of upper airway surgery on asthma.

This investigation was undertaken at the request of Mr IA Stewart of the Department of Otolaryngoloy and Head and Neck Surgery, and as part of a community project sponsored by the Department of Social and Preventive Medicine.

Our project was based on the following propositions:  Anecdotal evidence suggest that some asthmatics improve dramatically following certain types of ear, nose and throat surgery, to the degree that the occasional severe asthmatic who is on systemic steroid medication is able either to discontinue or to markedly reduce such medication.  Could it be that improving the nasal airways or removing a potential infective focus decreases the frequency and or severity of asthma symptoms?

Because of time and resource limitations we considered that the best way for us to investigate this hypothesis was by a review of the literature, and to follow-up a small number of asthma sufferers who had had a relevant surgical procedure.  Because of experience and information obtained in carrying out this trial we envisage being able to aid our client in making decisions about how best to perform a more significant study, given the proviso that it would make a meaningful contribution to the literature..

Authors of Report

Anne Baxter, Bruce McKenzie, Joseph Morahan, Michael Reddy, Margaret Walker.

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