Accessibility Skip to Global Navigation Skip to Local Navigation Skip to Content Skip to Search Skip to Site Map Menu

Accessibility to Public Dermatology Services in Otago, New Zealand

Aim

To assess adequacy of public dermatology services in the Otago District Health Board (ODHB) region and identify causes for any inadequacy as well as potential solutions.

Method

We conducted a survey of all general practitioners (GPs) in the Otago region asking them about their experience of referring patients for a publicly-funded specialist dermatology appointment. We collected demographic and professional information on the GPs surveyed to assess whether experience levels or setting (rural or urban, group or solo practice) influenced their satisfaction with current levels of access to specialist opinion or management of unfamiliar or refractory skin conditions. We also asked for opinions on how to address any shortfalls identified.

A qualitative study of four chronic sufferers of skin complaints was also conducted to gain a patient perspective of impact on quality of life that such conditions bring. This was in the form of a semi-structured interview, which was then analysed for thematic consistency.

Finally, both resident private dermatologists in the region were interviewed to gain their expert opinion on the current state of publicly-funded care in the region, and information was sought from the Otago DHB about the current situation.

Results

Overall, 49% of GPs identified in the Otago region responded. Only 18% of non-respondents declined the survey, the remainder being lost due to difficulties locating or contacting them. Almost all, 92%, of GPs found it difficult to refer in the public sector; rating this as either 4 or 5 on a Likert scale of 1 to 5 for difficulty. There was consistency of opinion across urban and rural, although more urban GPs rated reported 4 or 5 on the scale than rural GPs. Also, dissatisfaction with the current service was greater amongst GPs who had worked in Otago for longer. Almost all, 92% of GPs, said they often urged patients who could afford it, to gain private consultation due to wait times in the public sector or because their patients would not qualify to be seen.

Views on solutions to the problem were similarly consistent. The majority of solutions given revolved around funding, employing or retaining public dermatologists in the Otago region. The next most common proposed solution was clear as 77% of GPs saw General Practitioners with a Special Interest (GPSIs) in Dermatology as a good way to address some of the issues with access. A surprising 50% of GPs were interested in specialist training in dermatology.

The four chronic sufferers interviewed gave consistent themes of impairment in physical, social, emotional and financial of their conditions.  All four said services in Otago could be substantially improved in terms of timely access and follow-up.

The dermatologists interviewed agreed that a full-time public sector dermatologist was needed in Otago. They saw potential in the GPSI concept but that this would only be feasible when the number of specialists in Otago reached a critical mass, and training could be afforded to GPs or allied health professionals whilst still coping with current demand. It was recognised that recruiting and retaining a public dermatologist would be difficult, and would be dependent on providing sufficient support staff and facilities.

Conclusions

Our findings were that general practitioners uniformly reported woefully inadequate access to publicly-funded dermatology services for the people of Otago. The only consistent and feasible solution to the status quo is to employ at least one full-time, publicly funded dermatologist for referrals from GPs in the region.  Consideration should be given to funding a position across Otago and Southland, and to the possibility of a joint appointment with the Medical School.

Authors of Report

Amar Bin Sadiq, Jessica Buchanan, Edwin Coates, Chloe Heyhoe, Rebecca Hope, Shiva Nair, Ken Nip, Robert Odlin, Ailin Omar

^ Top of Page

Audit of Leflunomide Use in Dunedin Public Hospital Rheumatology Outpatients 2002-2007

Aims

Rheumatologists at Dunedin Public Hospital (DPH) have an anecdotal impression that their patients experience worse side effects on leflunomide compared to MTX. Despite this, patient satisfaction on leflunomide remains high.

A comprehensive study of the efficacy and side effects profile of leflunomide in Dunedin patients has not been undertaken previously. This audit seeks to evaluate the clinical benefits, side effects profile, and satisfaction of patients who were prescribed leflunomide between 2002 and 2007 at DPH rheumatology outpatient clinics.

Authors of Report

Cheng Yee Chan, Gayathri Hemachandra, Hugh de Lautour, Tina Liu, Vivek Meiyappan, Oliver Rose, Catriona Stewart, Mark Stewart, Ing Soo Tiong, Stephen Young

^ Top of Page

Implementation of Heart Failure Management Guidelines at Dunedin Public Hospital

Introduction

Unlike most cardiovascular diseases, heart failure is increasing in incidence and prevalence. It is a major cause of morbidity and mortality in older patients (with the mean age being mid 70’s), and is the number one hospital discharge diagnosis in this population. It causes frequent hospital readmissions, reflecting acute decompensation and compromised quality of life for patients and increased cost and resource use for the healthcare system. Several pivotal clinical trials have generated knowledge regarding optimum drug therapy for heart failure, and help improve morbidity and mortality associated with this condition. New Zealand has a best practice guideline for the management of heart failure with the key aspect being drug therapy recommendations.

Method

This study examines the adherence by Cardiology and General Medicine Departments at Dunedin Hospital to the New Zealand guideline for the management of heart failure. A retrospective cross-sectional audit of admissions with ICD-10 coding of primary diagnosis of heart failure at the two respective departments between June 2007 and June 2008 was carried out. For each admission, the order in which drugs given for the management of heart failure was recorded by noting the time of administration of a particular drug as per drug chart. Other variables such as age, sex, ethnicity and comorbidities were also recorded. The data obtained was then analyzed using the Statistics/Data Analysis (Stata) program.

Results

There was a total of 195 admissions (168 patients) either to Internal Medicine or Cardiology ward with a primary diagnosis of heart failure identified for this study. Information on 135 out of the 195 events was obtained successfully.  Of these, 92 admissions were to the Internal Medicine ward while 43 were to the Cardiology ward. The mean age of patients was 82 and 73 years in the Internal Medicine and Cardiology group respectively. Hypertension was more prevalent in patients admitted to Internal Medicine (74% c.f 40%) while valvular heart disease and COPD was more prevalent in Cardiology group (26% c.f 12% and 35% c.f 17% respectively). Both the study groups had similar incidences of diabetes (28% vs 30%), IHD (46% vs 44%), AF (50% vs 49%) and renal disease (11% vs 12%). In terms of pharmacological management of heart failure, Frusemide was generally administered first line followed by ACEi/ARB as second line and Beta-blocker as third line. There was no statistical difference between the two study groups in the order of administration of drug therapy.

Discussion

Results of the study suggest that New Zealand guidelines for the treatment of heart failure are generally adhered to well by the Cardiology and Internal Medicine Departments at Dunedin Hospital. Our study suggests that the guidelines are adhered to more readily than shown in other international studies.

Authors of Report

Kanan Alshammari, Oliver Johnson, Sudish Lal, Norsilmi Niza Mat Zainin, Jithin Sajeev, Sandaradura Silva, Otto Strauss

^ Top of Page

Inappropriate Behaviour and Employee Value at Otago DHB

Background and Aims

This project was proposed by the Workplace Culture Development Project Group (WCDPG), of the Otago District Health Board (ODHB), and comprised part of a larger body of their work which had the ultimate goal of improving the overall workplace culture.

The primary aim of this project was to estimate the prevalence of inappropriate workplace behaviours among employees of the ODHB. Secondary aims were to collect ideas from staff members about the general workplace culture at the ODHB and ways to improve that culture, and to pilot the use of an online survey in gaining employee views and opinions.

Methods

We invited 400 randomly selected staff to participate in an online survey assessing their views and opinions about inappropriate behaviours and workplace culture at the ODHB. There were a total of six sections in the questionnaire; Section One: general views about the workplace, Section Two: prevalence of inappropriate behaviours, Section Three: perception of conflict management, Section Four: workplace demographics, Section Five: general demographics, and Section Six: feedback on the survey. The survey was available for 15 days during September 2008. Responses were numerically coded to allow the prevalence of both inappropriate behaviours and bullying to be calculated. Results were analysed using ‘R’ for Mac.

Results

From the random selection of 400 ODHB staff the response rate was 36%.  The distribution and proportions of participants’ occupations were comparable to those of staff across the whole ODHB. The gender composition of the study group was very similar to that of the entire ODHB staff with 20% males and 80% females in the study group compared to 23% males and 77% females in the ODHB. The age representation of the study group compared to the ODHB employee database was also very similar. However there was a notable lack of participants in the 20 – 35 year age range and over-representation of those in the 35 – 50 year group.

In Section One of the survey, participants were given statements about their workplace environment which they then chose to agree or disagree with (on a scale from ‘strongly agree’ to ‘strongly disagree’). These statements included that there was good communication, shared decision making, effective conflict resolution, and that they felt valued and satisfied in their job. Using Pearson’s product-moment correlation we found that the answers of this section were all strongly positively correlated and could therefore be summarised as an overall average. This showed that on average 16% of people strongly agreed with the statements, 30% agreed, 28% were neutral, 17% disagreed, and 9% strongly disagreed.

The prevalence of bullying in the ODHB within the previous 12 months was 30% (95% CI 24% – 38%).  Overall, the prevalence of persistently experienced inappropriate behaviour (occurred at least weekly) in the previous 12 months was 26% (95% CI 19 – 34%).  The most common persistent inappropriate behaviour was ‘unjustified criticism and monitoring of your work’ while the least common persistent inappropriate behaviour was ‘physical violence’. The most common inappropriate behaviour (any occurrence in the previous 12 months) was ‘attempts to belittle and undermine your work’.

When comparing results from Section One with the prevalence of bullying, we were able to show a significant increase in bullying prevalence with increasing levels of disagreement with the statements in that section (p-value for trend < 0.001).

People who agreed that their behaviour(s) might have been perceived as inappropriate over the past 12 months were significantly more likely to be bullied than those who didn’t think their behaviour could be perceived as inappropriate (p < 0.001).

When asked about conflict management, of the 106 (74%) people who felt they had experienced conflict or inappropriate behaviour in the past 12 months, 85 (80%) of them knew what to do about it and who to talk to. However, only 56 (53%) people did actually report the incident. Of the people that reported the incident 37 (66%) were happy with how it was dealt with.

There were no significant differences in the frequency of reported bullying between being a manager or not, having a manager or not, and the manager(s)’ gender. However, as participants’ level of disagreement increased with statements about ‘feeling supported’ by their managers and ‘having clear expectations from their manager(s)’, there was a significant upward trend in the prevalence of reported bullying (p-values for trend = 0.002 and < 0.001 respectively).

There was no significant difference observed in the prevalence of bullying according to personal demographic variables including; gender, age, first language, and income. When comparing the workplace variables to the prevalence of bullying, there was no significant difference in any of the variables which included occupation, hours of work, years of employment and workplace gender composition. 

Throughout the survey, several free text boxes for comments/opinions about the survey design and the questions were included. Common themes arising from these are included in more detail in the results section. 

Conclusions

Despite the shortcomings in our study, we conclude that the prevalence of inappropriate behaviours and bullying among employees at the ODHB is the same – if not lower – than comparable international studies. We have shown that there is a significant and inversely proportionate association between perceived employee value and perception of being bullied, and have gained valuable insights from employees as to the current workplace culture and ways to improve that culture in the ODHB. Finally, we conclude that an internet-based method of collecting employee views and opinions is a valid option for some and may enhance perceived confidentiality of answers, and could be a useful adjunct to paper-based surveys.

Authors of Report

Weng Onn Chan, Naomi Crooks, Margaret Fitiao, Adelle Hanna, Jed Hocart-Saunders, Kiarash Taghavi

^ Top of Page

Probiotics in Dunedin: Characteristics and Perceptions of Users and Non-Users of Probiotic Supplements

Background

Probiotics are widely available dietary supplements containing potentially beneficial bacteria or yeasts, which may have a number of positive health effects.  This study aims to estimate the prevalence of probiotic use in the Dunedin population, and compare demographics and perceptions of the risks and benefits of probiotics between those who do and don’t use them. 

Methods

Randomly selected cross-sectional telephone survey of Dunedin residents listed in the Dunedin white pages, enquiring about probiotic use, perceptions of probiotics, and demographic data.  Statistical analysis of data to determine prevalence of probiotic use and differences between users and non-users. 

Results

The prevalence of probiotic use in Dunedin was 8.4% (95% C.I. 6.6-10.4) and the lifetime prevalence was 25.4% (95% C.I. 22.6-28.5). The lifetime prevalence was highest among females (30.6%), Europeans (42.1%), and tertiary degree holders (34.2%). The mean age of users was 4 years lower than that of non-users. No correlation between probiotic use and NZDep scores was found.  80% of the non-users would consider use if recommended by doctors.  People have not used probiotics mainly because they had no need (38.6%) or never heard of them (26.1%). The most common indications of use were GI balance & GI upset (27.5%) and post-antibiotics (23%).  61.1% of the non-users did not know any benefits of probiotics and in both the user and the non-user groups, GI balance was the most common perceived benefit (36.5% and 14.2% respectively). 89.4% of non-users and 67.1% of users were unaware of any side effects. 

Conclusion

25% of the study population had used probiotics. User rate was highest among participants who were female, young, European, and educated. Most used probiotics for GI health or after taking antibiotics.

The majority of non-users stated they did not need probiotics or did not know about them. However, 80% said they would consider taking probiotics if recommended by a doctor.  

Authors of Report

Maisah Binsadiq, Jonathan Chen, Joseph Chung, Lauren Craig, Mark Sapsford, Lynda Thurston, Lily Wang, Ben Wilkins, Yu-Ching Yu

^ Top of Page

Psychiatry as a Career Choice: The Influence of Medical School Education and Clinical Experiences

Study Aims and Objectives

A literature review examining local and global trends in uptake of Psychiatry was undertaken, in addition a variety of research methods were used to investigate associations between various factors of Medical school education and experience and an individual’s likelihood to pursue a career in Psychiatry.

The overriding intention behind this project is to inform the Dunedin School of Medicine and any other key stakeholders, of positive and negative aspects of the current Psychiatric component of the Medical curricula, and its association with intent or actual pursuit of Psychiatry as a career. This will allow recommendations to be made in order to aid development of further interest in and ultimately recruitment of Psychiatrists in the future.

Authors of Report

Dave Feng, Grant Frow, Emma Heydon, Joe McKerras, Ollie Madigan, Jacob Milner, Simran Singh, Ruth Upsdell, Katy Young

^ Top of Page

Range, Frequency and Barriers to Stopping Treatments Used in the Community for Depression

Introduction

Treatment of depression in the community increasingly involves the use of anti-depressant medications, particularly Selective Serotonin Reuptake Inhibitors (SSRIs). With increasing use of these drugs, there is growing need for further information on the people using these treatments, the purpose for which these drugs are being prescribed and the experiences of withdrawal symptoms and other barriers to stopping SSRI treatment. 

Methods

A New Zealand wide cross-sectional postal survey conducted with a study population of one thousand people randomly selected from the New Zealand electoral roll.

Results

The study obtained a 32.4% response rate. 21% of study participants had received some form of treatment for depression, with 8.6% currently receiving treatment. Women were statistically more likely to have received treatment for depression. 11% of the study participants had received treatment with an SSRI, and 10% had received treatment with the older tricyclic antidepressants. 11% of those who had tried stopping an SSRI had physical discontinuation symptoms. The greatest barrier to ending treatment amongst this study population was the fear of a relapse of depression.

Conclusions

Our study showed similar lifetime prevalence of depression and rates of treatment with antidepressants to those found in previous studies. The greatest barrier to stopping treatment in this study population was the fear of recurrence of depression, while withdrawal symptoms were less prevalent than had been expected. Further research is required to establish the length of time people are receiving anti-depressant treatment and the reasons behind this. A more focused study is necessary to gain a complete picture of the importance and prevalence of barriers to stopping anti-depressant medications.

Authors of Report

Helen Chignell, Rosalie Evans, Nurrul Johari, Eunice Lau, Caroline Slater, Thomas Stevenson, Kelly Utting, Anura Vyagurunathar, Arpah Zakaria

^ Top of Page