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Flu vaccination in Otago students: the status quo

Abstract

Influenza is a viral infection which causes significant morbidity and mortality. It spreads by respiratory droplets and has the potential to cause major epidemics even among healthy people. An effective prevention is vaccination, however, the uptake among young and healthy individuals is low. This study aims to identify facilitative factors and barriers with regards to the uptake of influenza vaccination.

5,200 email surveys were sent to random students at the University of Otago. The contents included basic demographics and facilitative factors and barriers with regards to the uptake of the influenza vaccine. The survey was open for approximately 2 weeks after which it was closed and the data was analysed.

Of the 5,200 emails sent out, 1,536 responses were analysed. The study found that the top barriers were cost, lack of time and that students cannot be bothered. The top facilitators were protection of self, the vaccine being free of charge, and protection of community. Subgroup analyses also suggested variations based on accommodation and the type of course students were studying.

Based on the findings, the study suggests that potential methods of improving uptake would be to reduce cost, provide more appointment times more suitable for students, and campaigns highlighting the protection of oneself and others.

Authors of report

Adrian Best, Mayble Chee, Michael Chen, Aakash Chhibber, Albert Cho, Nemani Delaibatiki, Ilse Jacobs, Kate Johnstone, Devind Vijan

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What stops me going to the doctor? Barriers to access primary health care in the Clutha region

Abstract

Background

A significant proportion of the New Zealand population reports poor access to primary healthcare. Data from all around the world has shown that access is poorer in rural regions compared to urban regions. This has not been studied objectively in rural regions in New Zealand.

Aim

This study aimed to determine the prevalence of poor access to General Practitioners (GPs) in a rural population (Clutha Region), and the possible causes of this.

Methods

800 participants were randomly selected from a population of 6,031 people aged over 18 enrolled at Clutha Health First (CHF), a community based GP practice in Balclutha, New Zealand. The study consisted of a 10 minute telephone questionnaire asking a range of questions regarding the barriers which prevent people from accessing their GP. Of the 800 participants there were 92 withdrawals, 44 exclusions, and 399 were unable to be reached. 265 interviews were completed giving a response rate of 33.1%.

Results

79 out of 265 (29.8%) reported difficulty accessing the GP on one or more occasions in the last 3 years. 44 out of 265 (16.6%) reported difficulty in the past year. Respondents reporting difficulty in the last 3 years were 3.3 (1.7-5.0) times as likely to be female, and 4.2 (1.7-10) times as likely to be 25-40 than over 65 years of age. Those who cited discontinuity of care as a barrier to access were 7.7 (1.7-33.3) times as likely to be women than men. There was no relationship demonstrated between difficulty of access and the variables of income, education, number of visits to the GP and having a chronic health condition.

Conclusion

Access to GPs for those enrolled at CHF is better than the New Zealand average. Our results indicate that females, those in younger age groups, and those from larger households are more likely to experience poor access to primary care. Interventions aimed to increase access to GPs should be developed with these demographic groups in mind.

Authors of report

Robert Cole, Ryo Eguchi, Jamie Leong, Ram Lukka, Grace Oh, Brynn Ong, Seong Shin, Blasé Stevens, Meg Yen

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Patients’ reflections on lung conditions

Abstract

Background

Chronic Obstructive Pulmonary Disease (COPD) affects approximately 1 in 15 adults over the age of 45 in New Zealand. 70-80% of these cases can be attributed to a current or prior smoking history. Previous qualitative research in other countries has suggested that there is both a stigma associated with COPD, often related to its association with smoking, and also some potential confusion from patients in regards to the numerous diagnostic terms which may be used when discussing COPD. No research at present focuses on a New Zealand demographic.

Aim

To look at the knowledge, stigma and perceived blame that a diagnosis of a chronic lung condition brings to patients.

Methods

Two groups of patients identified as having a chronic lung condition from the pulmonary function database at Dunedin Hospital (smokers and non-smokers) were recruited via mail and telephone. Semi-structured interviews with participants were conducted, exploring the understanding of their condition, their insight into how they believe others such as family and medical professionals may perceive them in regards to this condition, and views on how their behaviour may have contributed to their disease. Interviews were then transcribed, analysed, and coded into overarching themes and smaller sub themes.

Results

A total of 11 participants (6 non-smokers and 5 smokers) took part in the study. Five main themes emerged from analysis of the interview transcripts: Illness experience, coping strategies, perspectives, knowledge, and contributing factors. These main themes were in turn made up of a number of sub-themes, which were then discussed with reference to pertinent quotations obtained from the interviews.

Discussion

Illness experience of lung conditions remains a personal experience, yet common themes recurred across participants interviewed. Family and friends were valuable social support that helps to reduce the use of negative coping strategies such as avoidance and minimisation. There was overall poor recognition and understanding in both groups of the term COPD, as well as confusion regarding treatment and prognosis of other lung conditions. This may have been attributable to inconsistency in use of terms or incomplete information provision by health professionals. Smoking, but not symptoms of lung conditions themselves, was consistently identified by both groups as a source of stigma. Participants tended to externalise blame for their condition on factors such as social norms of smoking, environmental and occupational exposures. Compared to smokers, non-smokers tended to feel their behaviour had contributed less to their condition, harboured less guilt, and engaged more in proactive behaviours such as exercise.

The study provided new insights into a New Zealand context of patient illness perspectives of chronic lung conditions, and emphasises the need for health professionals to practice effective and consistent communication skills with patients. The results of this study could help guide future qualitative and quantitative research into this area.

Authors of report

Shona Cole, Kiri Diack, Lee Gribbon, Cory Malbon, Hugh McKenzie, Richard McLeod, Peter Meffan, Sarah Rance, Naveen Weerantunga

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Media reporting of health interventions in New Zealand: A retrospective analysis

Abstract

Aim

To evaluate New Zealand media articles on their coverage of key issues regarding health interventions and whether it is consistent with available evidence.

Methods

A retrospective analysis was carried out of all articles published in five New Zealand media sources over a six-week period between 15 October and 26 November 2014. Articles were included if their primary focus was on health interventions that involved medications, devices or in-hospital procedures. The articles were assessed for coverage of key issues using a previously published 10 point criteria. A literature review was done to compare the content with scientific evidence.

Results

We identified 30 articles for review. Only 4 out of 30 articles covered indications, benefits and risks, and of these 2 were consistent with available evidence (7%, 95% CI (1% to 22%)). For articles that discussed at least one of indications, benefits or risks, and there was corresponding evidence available, there was a high level of consistency with the evidence (89%, 95% CI (77% to 95%)). The overall mean value of coverage from the ten point criteria was 51% (95% CI (45% to 58%)). Single questions regarding the potential harm, costs associated with the intervention, and the availability of alternative options were particularly poorly covered. They were rated as “satisfactory” in 13%, 23% and 33% of the 30 articles, respectively.

Conclusion

New Zealand news articles covering medical treatments and interventions are largely consistent with available evidence but are incomplete. Vital information is being consistently missed, especially around the potential harms and costs of medical interventions.

Authors of report

Jason Kingan, Celina Ledgard, Anuja Liyanage, Jennifer McLean, Fouad Nahab, Christian Robinson, Fergus Stewart, Samuel Strachan, Kathryn Tucker, Betty Zhang

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Triage-related interventions to improve patient flow: A qualitative study with emergency department staff members

Abstract

Hospital emergency departments have typically been plagued by long patient wait times and overcrowding which present a threat to patient safety that is especially compounded at busy times of day. Many methods have been implemented in order to avoid these problems with minimal effect. One way to mitigate this wasted time, which has the potential to benefit both the patient and patient flow within the emergency department, is to add value to the first point of contact by putting a senior decision maker closer to the front door. The aim of our study was thus to investigate the perceptions of current staff members within the Dunedin Hospital emergency department (ED) regarding the present triage system and alternative models.

We applied a qualitative content analysis under the method known as the framework model. To collect our raw data we developed a questionnaire that was used to assess the opinions of staff members within the Dunedin Hospital emergency department. We attempted to interview five individuals from five different staff groups: consultants, registrars, house officers, triage nurses and nurses. These interviews were recorded and later transcribed then codes and themes were applied to the raw data in order to summarise and analyse the content.

Overall, the triage model allows patients to have an initial quick assessment when they arrive to the emergency department. All participating groups were of the opinion that the current triage model was appropriately staffed by triage nurses, and triage nurses can correctly identify the acutely unwell patients. However, many flaws were identified in this triage model. Most staff felt that having a consultant involved in the triage process in general would allow for a more rapid assessment of patients as well as enabling quick treatment and discharge of patients with relatively mild presentations.

We concluded that long waiting times for low priority patients was seen by most as reasonable practice within the current model and that the current model works well provided the department is not overwhelmed. However, a significant role for a physician at the front end of ED is needed.

Authors of report

Chanel Heather, Rowena Peters, Mathew Lees, Ahmed Al-Risi, Oliver Aughton, Aqilah Imtiaz, Jamie Sinclair, Marjolein Woolstein

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Alcohol supports: Students’ awareness and suggestions. A mixed methods study

Abstract

Background

There is a high prevalence of hazardous drinking amongst University Students. The University of Otago and Student Health offer a number of alcohol support services, however students’ knowledge and perception of these services is unclear.

Aims

To identify what resources are available to students who wish to learn more about changing their relationship with alcohol, identify the various ways in which the University and Student Health provide education and messaging with respect to hazardous alcohol use, determine students’ level of awareness and view on efficacy of resources, and encourage the study population to suggest new ideas for new alcohol support services.

Methods

A written survey was carried out amongst University students recruited from the waiting room of Student Health, and four focus groups were carried out with student flat and residential college groups. Surveys were analysed using descriptive statistics while focus groups were transcribed, analysed and key themes generated.

Results

228 students were approached, of which 220 completed the survey (96% response rate). 38% of survey students reported being aware of Student Health as an alcohol support service when unprompted. When listed, 81% of students were aware of Student Health services, with 76% stating they would be willing to use the counselling service. Seven key themes were developed from focus group analysis: Awareness of Student Health, Perception of Student Health, Student’s Acceptance of Student Health, Authoritarian View of University, Personal Supports, Other Services and New Ideas.

Discussion

Despite knowing about Student Health and being willing to use it, students had a negative perception of Student Health because of issues including perceived confidentiality breaches, punishment and judgement, and inappropriateness of alcohol screening. Students showed a willingness to discuss issues with friends and flatmates. New ideas should be student-led, group-based interventions free from judgement.

Authors of report

Thomas Clarkson, Manesh Deo, Shyam Deo, Tom Gudsell, Halimah Haji Ilias, James Waetford Luca Killick, Cara Lucas, Gunveen Singh

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Does the quality of GP referral affect the outcome of the child’s secondary care?

Abstract

Objective

To determine whether the quality of a GP referral letter received by secondary outpatient services influences the outcome and response received by the patient.

Methods

Using a modified audit tool developed by the Royal New Zealand College of General Practitioners, 95 referral letters made from the community to Dunedin Public Hospital’s paediatric outpatients service were assessed. Based on the audit tool, each referral letter was given a percentage which indicated quality. The outcome of the referral letter was recorded. Additionally, time to be seen and whether or not further investigations were required were recorded.

Results

The mean audit score was 60.9% with a reference range 27.6% 94.2%. 77% of referral letters scored over 50% and 62% scored between 50% and 80%. 17 out of 72 patients who had no investigations done by their GP required investigations, of which 14 were available at the GP’s request. 37% of accepted referrals were seen in clinic after 120 days, however we appreciate this may be due to limitations in the nature of visiting specialists, or due to initial appointments not being carried out.

Conclusion

The quality of referral letter does not appear to influence the outcome and response received by the patient, despite omission of some pertinent information. However, the use of resources may be improved as a result of more efficient written communication between the GP and specialist.

Authors of report

Stephan French, Tengo Kandelaki, Jonathan Lee, Teriana Maheno, Sarah Ng, Rachael Springer, Stephanie Boyes, Clare Ogilvy, Mari Fernandez

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Evaluation of Pact Client Outcomes Assessment Tool

Abstract

Introduction

Pact is a non-governmental support organisation which provides services to people with experience of mental illness and/or intellectual disability. Quality assurance is maintained by regular assessment of how well it is meeting the goal of improving the lives of its clients. To facilitate this assessment, Pact devised a Client Outcomes Assessment Tool in 2009. It is a 41-item questionnaire assessing 8 dimensions of quality of life (QOL) that is administered three-monthly to clients to assess their QOL and this data is provided to their support workers. Pact have approached us to carry out an evaluation project focussing on the use of this tool and the data that has been collected from it.

Aims and Methods

  1. Quantitative analysis of QOL data collected from the Client Outcomes Assessment Tool from 2010 to 2014, and subgroup analysis by client and service characteristics
  2. Qualitative interviews of eight PACT support workers on their views of the usefulness and ease of implementation of this tool;

Results

QOL measured by the Pact Client Outcomes Assessment Tool was stable from 2010 to 2014. Clients in a rural setting had a higher QoL compared to those who were residing in Dunedin. Thoughts on the tool varied amongst support workers. The tool was a good opportunity to engage with clients, especially new clients; but there were suggestions on improving administration of the tool and tailoring the questionnaire to different client demographics.

Conclusion

QOL was maintained in clients who utilized Pact services over 5 years, however continued research and further longitudinal and comprehensive analysis is needed to gain a complete understanding of how Pact services truly affect client QoL over time. Overall, we found the Pact Client Assessment Tool to be adequate, however further refinement of the tool and data collection is needed.

Authors of report

Sebastian Ang, Laura Dalzell, Nicole Donald, Hayden Donnelley, Sephanie Gamble, Jessica Kelly, Lucy Kent, Nina Luo, Kamil Patel

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