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The Joint Clinic: Implementation and Process Evaluation of a New Outpatient Service

Abstract

Aims

The aims of the this study are to assess the implementation of the Joint Clinic proposal made to the Elective Services of the National Health Board, and to assess the process and functionality of the Joint Clinic.

Authors of report

Waseem Alzaher, Isaac Campbell, Jacob Edwards, Daniel Kim, John Liu, Calum Pears, Natasha Perry, Shanshan Yan.

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Review of the Before School Check (B4SC) Referral Process in Southland

Abstract

Aims

The B4 School Check (B4SC) is a public health screening programme, with the goal of ensuring every child in New Zealand has an optimal start to school. Our aim was to review the referral process of the B4SC in Southland. We specifically wanted to evaluate the appropriateness and timeliness of the referral process, detect any barriers to effective referrals and explore potential solutions to these barriers.

Methods

We used a descriptive, cross sectional study design with three separate arms. The first arm involved telephone questionnaires with the parents/guardians that had attended a B4SC with their child following which a referral was made. The second arm involved face-to-face interviews with the Public Health Nurses (PHNs) and Vision Hearing Technicians (VHTs) who currently carry out the B4SC in the Southland region of the Southern District Health Board (SDHB). The third arm involved either face-to-face or telephone interviews with organisations and professionals who receive referrals following B4 School Checks.

Results

Appropriateness: Eighty percent of parents/guardians felt the referral was necessary of helpful for their child. Twenty-five percent of the public health nurses and vision hearing technicians felt that all of their referrals were appropriate and the rest felt their referrals were mostly appropriate. Eighty-eight percent of the service providers generally felt the referrals they received were appropriate.
Timeliness: The majority of parents/guardians (eighty three percent) were satisfied with the time between the B4SC and their referral appointment. Seven out of eight of the service providers were able to make contact with clients between twenty four hours and two weeks. The one service that was unable to see referrals in a timely manner was the paediatric department at Southland Hospital.
Barriers: Barriers to appropriate and timely referrals identified across the three arms of the study included the cost of general practice and optometry appointments, lack of service availability, waiting lists, parental resistance and quality of referrals.

Conclusions

Based on our results we have made several recommendations to all parties involved in the B4SC process. We recommend a review of the pathways resulting in paediatric, immunisation, school dental service and growth referrals. We also feel there should also be increased feedback to the Well Child Service from referral providers, and improved communication both between health professionals, and between the Well Child Service and parents/guardians. In addition, we recommend a review of the current referral letter template used to make referrals, and a review of methods for ethnicity data collection within the programme.

Authors of report

Sophie Harmos, Jordon Wimsett, Sarah Cardoso, Michael Waterhouse, Hamish Nicolson, Neal Kerr.

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"Mind the Gap" Disparities in access to surgical services

Abstract

Aim

To determine whether or not disparities in general surgery access and resource allocation exist between District Health Boards (DHBs) in New Zealand.

Method

A standardised questionnaire was sent out to all DHBs following Ethics Approval and Maori Consultation. Quantitative data was also extracted from the National Minimum Dataset and Caseload Monitoring Reports. Measures sought included full-time equivalents, allocated theatre time, prioritisation scores, case weights and discharge volumes.

Results

For the year 1 July 2011 - 30 June 2012, delivered general and vascular surgery inpatient case weights/1000 residents ranged from 26.34-53.85 for 11 DHBs with similar coding practices; elective case weights/1000 ranged from 9.57-17.77, with adjustment for differences in funding. Average case-weights per discharge for general and vascular surgery, by DHB of residence, ranged from 0.93 -1.46 for the 11 DHBs with similar coding practices.

Conclusions

Although there are limitations regarding the measures used in this study, the results suggest that true discrepancies in access to general surgery between the DHBs of New Zealand do exist. Further research is indicated to pursue the extent of these disparities.

Authors of report

Sasha Ashraf, Christoffel Badenhorst, Georgia Buddle, Samuel Bush, Ryan Chaffey, Christopher Furkert, Megan Grinlinton, Alexandra Jacobson, Hannah Linkhorn.

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Management of excess weight in pregnancy in New Zealand: a qualitative study with Lead Maternity Carers

Abstract

Background

Adverse health effects associated with obesity during pregnancy are becoming increasingly evident as New Zealand is gripped by the obesity epidemic. This has highlighted the need for guidelines assisting with the management of these women during their pregnancy. Currently, detailed guidelines do not exist, and to ensure that any guidelines published in the future are appropriate and achievable, the current practice of LMC Midwives and factors which influence this must be taken into account.

Aim

To investigate in depth the knowledge and practice regarding excess weight in pregnancy of midwives who provide Lead Maternity Care (LMC) in Otago. Information gathered from this study should aid the guideline making process.

Methods

Three focus groups and one key informant interview were undertaken at Dunedin and Balclutha hospitals involving midwife LMCs recruited from the Otago region. These focus groups sought to investigate the knowledge and practice of midwife LMCs from this region. Focus groups were transcribed, analysed and key themes were generated from the focus group discussion.

Results

A total of 11 midwife LMCs took part in the study. Analysis of the focus group transcripts revealed five central themes: knowledge of gestational obesity, identification of baseline BMI and weight gain throughout pregnancy, current management, barriers to management and overcoming barriers. Each of these themes was subdivided into categories and subcategories and these were discussed systematically using representative quotes from the focus groups.

Discussion

The LMC midwives in the focus groups were all dedicated to providing the best care for their clients and exhibited notable empathy for women in this sensitive area. The midwifery scope of practice states that the midwife works in partnership with women to give the necessary support, care and advice during the pregnancy, labour and postpartum period. Participants had a good knowledge of the risks associated with excess gestational weight, yet knowledge around current guidelines was inconsistent. There were several methods used to calculate a woman’s BMI; interestingly objective measures such as weighing and measuring were not commonly used. Management of women with excess gestational weight varied considerably and many factors that influenced this were identified. The apparent gap between knowledge of what would be ideal management and what was actually done was explained by the midwives as a result of careful balancing of the perceived benefits with perceived harms. This, other factors and methods of overcoming barriers will be discussed later in the text as they are beyond the scope of the abstract. This study has given a unique insight into the practice of midwife LMCs in Otago and highlighted some of the issues they face when managing women with excess gestational weight. It has called to attention the need for guidelines, education and collaboration on the issue. The information gained from this adds strength to literature that already exists on the topic and should help with the generation of new guidelines for LMCs around the management of obesity in pregnancy.

Authors of report

Angus Cameron, Diana Fieldwick. Sarah McFadden, Justus Pienaar, Celine Sinclair, Melanie Stephen, Toby Struthers, Kirsten Taplin, Clara Watson.

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Assessing the Burden of Travel for Rural People Undergoing Cancer Treatment

Introduction

Cancer is the leading cause of mortality and morbidity, and a key health priority in many developed countries, including New Zealand. (1) Given the frequent need for prolonged specialist treatment, whether curative or palliative, a cancer diagnosis places a significant burden on individuals, their families and the wider community. The pervasive nature of cancer is such that few facets of a patient’s life are spared, and many will have significant financial, practical and psychosocial needs during and after their treatment.

With the trend towards centralisation of cancer services to secondary and tertiary care settings, frequent travel and/or relocation have become the reality for the significant proportion of patients who do not reside in main centres. (2) ‘Rural’ patients therefore face a variety of challenges over and above those experienced by their ‘urban’ counterparts. It is therefore crucial to quantify this ‘burden of travel’ and gain insight into how it may impact on cancer-related outcomes. We will also consider potential solutions and their applicability to the provision of cancer care in the Southern District Health Board (SDBH), Otago/Southland region.

Authors of report

Hamish Cameron, Heidi Chan, Suzy Cheng, Hayley Foster, Jesse-Ana Harris, Jun Lee, Sally Ma, Harriet Miller, Iqbal Muhamad.

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A Different Shade of Pink: The Holistic Needs of Breast Cancer Survivors

Background

There is a growing population of cancer survivors worldwide, as the incidence of cancer increases and the efficacy of treatment has improved. The five year survival rate for patients diagnosed with breast cancer in New Zealand is up to 85%. With 2750 women and 20 men in New Zealand being diagnosed with breast cancer every year, there are a significant number of breast cancer survivors now in need of support post-treatment.

Internationally there have been a limited number of studies examining the characteristics and needs of this population, as shown by the 2005 Institute of Medicine (IOM) report(1). This report recommended a structured care plan, “The Survivorship Care Plan”, to be written by the principal provider(s) who coordinate the oncology treatment, followed by primary care providers and support services. However, the implementation of this strategy has not been evaluated.

The New Zealand Ministry of Health guidelines (Guidance for Improving Supportive Care for Adults with Cancer in NZ) recommend that patients with cancer should have access to care and support services as part of an integrated cancer service(2). This service should have a seamless interface between hospital and community-based support services.

Locally, there have been a few pilot projects trialling survivorship programmes and implementing support for patients that have completed cancer treatment. These include the Bridge To Health programme run by the Cancer Society, as well as the EXPINKT programme (Exercise Training Beyond Breast Cancer) run by the School of Physical Education. No study has been done to date to assess the needs of breast cancer survivors and their experiences in accessing services in New Zealand.

Authors of report

Jordan Vincent, Benjamin Werkmeister, Kenji Takahashi, Matt Nobbs, Daniel Wong, Ummul Afila, Keith Jun Lee, Eve Teo, Bernard Teo.

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Adverse Drug Reaction Reporting - why do we bother?

Abstract

Introduction

Epidemiological studies have suggested that adverse drug reactions (ADR’s) have a significant affect on health and health resource consumption. ADR’s are thought to account for approximately 5% of all hospital admissions. New Zealand’s national pharmacovigilance centre, The Centre for Adverse Reactions Monitoring (CARM), is based in Dunedin, Otago. The centre receives around 4,000 reports a year through a variety of reporting networks.

Methods

398 questionnaires were sent out to health practitioner asking for feedback on the ADR system in New Zealand.

Results

Professional obligation, the ease and simplicity of the reporting process, to record an alert on the national medical warning system, and severe or unusual reactions were reported as strong motivators to report adverse drug reactions. Significant barriers to reporting were if the ADR was a mild or well known reaction, or if the reaction was not perceived to be important. In the final open question respondents indicated that ease of notification to CARM, learning of the importance of adverse drug reactions reporting at education courses and the feedback they got from CARM were reasons why New Zealand had such a high rate of quality reporting.

Conclusions and Discussion

There was an overwhelmingly positive attitude towards ADR with the main motivator being professional obligations. New Zealand health care practitioners felt that it was easy to report ADR to CARM and those they were taught of its importance at training courses. Main Barriers were not reporting ADR’s that were mild or well known.

Authors of report

Karyn Anderson, Frances Campbell, Lucy Hinton, Brigitte Hollander, Lauren Jordan, James Kennedy, Annie Manning, Steven McAuley, Natasha Ramathas

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