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Assessing the Burden of Arthritis in New Zealand: a Feasibility Study

Aims

This is a feasibility study commissioned by a member of the Bone and Joint Decade to investigate the availability of prevalence, demographic, cost and disease burden data on arthritis in New Zealand.  The intention was to investigate whether enough data is available to carry out a future study of the burden of arthritis in New Zealand.

Methods

This being a review of data already available, we used recognised methods to gather information, including literature searches, internet searches, and interviews.  Having found data sources we assessed them for their usefulness and looked at solutions to filling the gaps where no data is available.

Findings

We found that although some data exist on arthritis in New Zealand it is often disparate and there are areas where no data is available.  Prevalence data gave conflicting results and was often not available for individual arthropathies.  Data on the burden of disease was estimated from Australian figures, although New Zealand calculations of years of life lost exist.  Most cost data has not been collected nationally and in some areas no information on resource utilisation is available.

Conclusion

We found that arthritis is an important group of diseases in New Zealand with a significant impact on the community which has been inadequately researched.  While a study would be possible based on existing data it would suffer from considerable uncertainty due to the frequent use of international estimates and difficulties with costing.

Recommendations

We recommend that further data be collected in a prospective study to complement existing data sources.

Authors of Report

Jim Duthie, Peter Fahmy, Michael Halstead, Rachel Highton, Dhiraj Kandath, Joanne Rogers, Kellie Sizemore

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Evaluation of End of Life Care at Dunedin Hospital: Next of Kin Perspectives

Aims

To assess whether patients who die in Dunedin Hospital receive adequate end of life care by medical staff as perceived by their next of kin.

  1. To ascertain ways by which this care may be improved.
  2. To identify lessons which medical students could learn before becoming doctors.

Method

A written questionnaire was formulated using a combination of Likert scale questions and open ended questions. This questionnaire examined the relatives’ perceptions of multiple aspects of end of life care, including communication with medical staff, management of pain and distress, and overall care of patients and their relatives. Three hundred and seventy-eight questionnaires were then sent to next of kin of patients over the age of 20 who died in Dunedin Public Hospital between 1st of January and 31st December 2003. Returned questionnaires were separated into responders, declined responses, and “returned to sender/deceased”. Quantitative data was then coded and analysed. Qualitative data was examined and analysed for recurrent themes and specific quotations noted.

Results

One hundred and seventy-six valid responses (49%) were included in the analysis. Of these, 95% of respondents had visited their relatives prior to their death and 85% were first degree relatives. One statistically significant finding was that relatives of older patients (>80) were more likely to respond.

Satisfaction rates with pain relief and distress management were high at 85% and 80% respectively. Seventy-eight percent (78%) of respondents felt their relative did not receive any unnecessary tests or treatments. Respondents were generally satisfied with most aspects of doctor communication. However, 12% of respondents felt that doctors were not at all available, and 25% of respondents replied that doctors did not adequately prepare them for the death of their relative. Respondent satisfaction with overall management of their relative was 75%.

Discussion

Overall, nearly 50% of participants replied, with almost all respondents being first-degree relatives involved in the end of life care of their relative. The collection of both quantitative and qualitative data allowed more detail pertinent to the quantitative questions to be collected.  Saturation of the qualitative data was probably achieved. Overall satisfaction rates were largely positive, ranging from ~50% to ~80%. However, a quarter of respondents felt that doctors were not able to adequately prepare them for the death of their relatives. A number of recurrent themes were identified in the quantitative analysis, including honest, open communication, availability of doctors, acknowledgement of dying and the humanity of the patient, respect for privacy, the avoidance of unnecessary procedures, and the value of nursing staff. These were recognized as potential areas for improvement of end of life care in Dunedin Public Hospital and recommendations were made.

Authors of Report

Sinan Albayati, Vaughn Alexis, Cameron Anderson, David Hernandez, Vincent King, Sarah Parker

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Everyday Choices: Services Needed by Disabled Children

This study was conducted in response to a proposal from CCS Otago to evaluate the service needs of CCS families in the Dunedin / Mosgiel area.

Based on the social model of disability the aims and objectives of this study were to determine the level of integration into community life experienced by disabled children and their families and the extent to which CCS Otago is helping to facilitate that integration.

A potential list of study participants (who had previously given written informed consent) was provided by CCS Otago in complete confidentiality and respondents were interviewed by members of the trainee intern study group.

The participants were interviewed using a standard questionnaire and data were collected regarding age and gender of the disabled child; school services, services received outside of school and extracurricular activities. The level of community involvement involving the child, the parent/care-giver and the family as a whole were also included.

A general level of satisfaction was found among those families interviewed who were receiving services. Problem areas were identified and a brief summary is presented.

Authors of Report

Jaslina Abdul Aziz, Rita Banhalmi, Claudia Ho-Peng, Joseph Koh, Jung Moon Park, Darryl Tong, Jonathan White, Vincent Wong Ming

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Getting to the Bottom of it: Pre Operative Radiotherapy for Rectal Cancer

Preoperative radiotherapy has been demonstrated to reduce rates of local recurrence in rectal cancers that invade through the bowel wall to the serosa.  For these benefits to accrue to patients in practice patients with rectal cancer must be investigated to identify the extent of tumour invasion and, where appropriate, referred for radiotherapy. 

Aim

A clinical audit of the selection of patients for preoperative radiotherapy at Dunedin Hospital between 1 January 1999 and 31 December 2003 was carried out.

Methods

Patients were identified from the patient databases held by the both the Surgical and Oncology departments.  Case notes were reviewed for information on patient demographics, preoperative staging, staging modalities, details of any preoperative radiotherapy, post operative pathological staging, follow up and recurrence. 

Results

One hundred and twenty patients were included.  A low rate of staging was observed with only 64% of patients being staged.  Those not staged were on average older and less likely to be under the care of a colorectal specialist than those staged.  Comparison of preoperative staging with postoperative staging demonstrated that preoperative staging of T3 tumours was correct in 77% of cases.  Of those staged preoperatively as T3, 31% were not referred for short course radiotherapy.  Tumour was identified at the resection margin in 16 patients, 10 of whom had not received any preoperative radiotherapy. 

Conclusions

There is scope for improvement in the rates of staging and measures to do so should focus on general surgeons and staging older persons.  Patients staged as having a T3 tumour preoperatively must be referred to the oncology service for consideration for radiotherapy.  As a consequence of these low rates of staging and referral the majority of those with positive resection margins had not received preoperative radiotherapy. 

Authors of Report

Mary Azer, Daniel Hobbs, Rajiv Kumar, Adrian Macquet, Aflah Roohullah, Sunaina Talwar, Ayesha Verrall

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Hearing Conservation in Dunedin Industry: Employers and Employees Persepectives

Background

Noise induce hearing loss is the most common occupational disease and accounts for significant disability. It is irreversible and treatment is difficult. The construction industry is at high risk and historically has a poor record of hearing conservation.

Aim

The aim was to identify compliance with and barriers to the OSH code of practice, and to assess the use of hearing protector devices in the Dunedin construction industry.

Methods

We interviewed both representatives of Dunedin construction industries and their employees with questionnaires designed to assess compliance with and barriers to the OSH guidelines.

Results

6/14 employers were interviewed. Worker protection in the form of hearing protector use appeared to be the main method of hearing conservation. Only 2/6 of the companies complied with OSH guidelines in supplying regular audiometry.  Major barriers to the use of hearing protectors included worker attitudes, lack of continuity with workers and poor OSH input.

106/106 employees were interviewed.  Employees’ knowledge of dangerous noise levels was poor.  96% of them used hearing protectors, with the average percentage of the day spent using them being 41-60%.  Barriers to the use of hearing protectors included discomfort and incompatibility with other safety equipment.

Conclusions

Hearing protector use is the major method of hearing conservation used in the Dunedin construction industry. Given the poor knowledge of dangerous noise levels and the inability of workers to correctly identify when they should use hearing protectors, the message of using hearing protectors 100% of the time should be pushed. Further strategies of improving hearing conservation are included in the discussion.

Authors of Report

Scott Andrews, Ben Carpenter, Gabriel Chong, Marissa Hampson, Sam Moon, Martin Wolley, Pranavan Yoganathan

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Patients' Views on Confidentiality of Medical Records and the Implications for Research

To investigate from patients in an outpatient setting what they know about confidentiality and their medical records. In particular who should have access to their medical records for research purposes and does this differ for different reasons of access. The aims were to answer the following questions.

  • Who do the group of patients believe owns their medical records
  • Do the patients value certain types of research over other types? This includes internal or external audit, academic and commercial research.
  • For the various scenarios (internal audit, external audit, academic research and commercial research) who should have to give permission for patients notes to be viewed.

Authors of Report

James Glasgow, Jethro Le Roy, William Moss, Kontoku Shimokawa , Michael Tawadrous, Hayden Waghorn, Marwan Al-zibari

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The Trials and Tribulations of Evaluating a Community Based Early Intervention Programme

Background

A number of children in our society are at risk of adverse outcomes because of poverty, neglect, violence or instability in the home. Home visitation programmes such as Family Start have been shown to lessen the impact of a disadvantaged start to life on children. However, evaluation of these programmes is often poor. Evaluation is a necessary tool to ensure the ongoing delivery of these programmes.

Methods

A literature review was conducted and from the results of this a study was designed to describe the client base and programme characteristics of Family Start. The characteristics were described both quantitative and qualitatively. The relationship of these characteristics to outcomes was then assessed. Simple descriptive statistics were used to describe the characteristics. The results of these analyses then enabled a proposal for future evaluation of the Family Start Dunedin Programme to be developed.

Results

The response rate to this study was very low (n=21). The average time from referral to engagement in the programme was 12 days. The average proposed length of engagement was 3 years and the current length of engagement was 13 months. Most of the mothers were European, their average age was 23 years and 7 mothers were noted to be solo mothers. Some families had no access to phone, car or even hot water. Clients had an average of 57 face-to-face contact hours, with 23 Born to Learn hours. In assessing impact of characteristics on outcome, there was no obvious association between points of engagement relative to birth and breastfeeding or immunisation rates. Developmental milestones attained at five months also did not appear to significantly improve with increased BTL hours. In the qualitative analysis, seven recurring themes were noted these included mental health, substance use, and history of abuse, accommodation problems, parental skills, maternal support and general health of the baby.

Discussion

It is impossible to draw definite conclusions about the effectiveness of Family Start Dunedin given the small sample size. However, there were some interesting trends noted that may form the basis of future research. This has been a useful pilot study and the proposal developed should be useful to future groups who wish to evaluate the effectiveness of Family Start.

Authors of Report

Claire Chu, Charlotte Hill, Mrudula Krishnaswamy, Felicity Meikle, Rupesh Puna, Tamsin Roberts, Lachie Smith, Aik Haw Tan

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Which Dunedin Hospital Patients Would Benefit From Referral to a Hospital-Based Palliative Care Service?

Background

Palliative care services in many countries have been developed almost exclusively for patients dying from cancer, but patients with life-limiting non-malignant disease can also benefit from palliative care intervention. The New Zealand Palliative Care Strategy (2001) requires District Health Boards to establish specialist palliative care teams in tertiary hospitals. Such teams have now been set up in all tertiary hospitals, except Dunedin. The Otago District Health Board has identified the need for a comprehensive palliative care service in Otago, including a hospital-based palliative care team.

Aims

The primary aim of this study was to determine which Dunedin Hospital patients with life-limiting non-malignant disease would benefit from referral to a hospital-based palliative care service. Secondary aims were to explore ideas about palliative care among different professional groups within a single ward in Dunedin Hospital; and to identify the potential benefits to patients, staff and the Otago District Health Board of a palliative care team based in Dunedin Hospital.

Results

Patients with life-limiting cardiac, respiratory, renal, neurological, and auto-immune disorders, especially those who were not coping or had inadequate support, were identified as potentially benefiting from a hospital-based palliative care service. Some differences in attitudes towards palliative care between different professional groups were observed, however the sample size was too small to draw any meaningful conclusions.  There appears to be a lack of palliative care services for patients with life-limiting non-malignant diseases in Otago. There was great enthusiasm and support for the idea of a hospital-based palliative care service in Dunedin. 

Conclusions

The proposed hospital-based palliative care team was perceived by staff to have benefits for patients, their families, staff and the Otago District Health Board. Expected patient benefits included improvements in symptom control, patient education, patient independence and autonomy, communication between service providers and the patient, and continuity of care.  Expected benefits for families included better communication between family and staff members, improved understanding of the patient’s illness, and access to support services. Staff benefits included improved resources and education about palliative care, support for staff members, and reduced workplace stress. Perceived benefits for the Otago District Health Board included reduced length of hospital stay, better utilisation of community resources, more efficient use of treatments, and increased patient, family, and staff satisfaction.

Key Recommendations

  • A hospital-based palliative care service should be set up in Dunedin Hospital as soon as possible
  • There is a need to educate staff about the role of the palliative care liaison team and the referral criteria
  • Referral to the hospital-based palliative care service should come following a multi-disciplinary team discussion
  • Protocols need to be developed so that patients have the most appropriate care

Authors of Report

Kirsten Anderson, Jean-Paul Banane, Geoffrey Carden, Natalie Carter, Michael Chan, Andrew Herd, Andrew Laurenson

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