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Professor Tony Dowell - Primary Health Care & General Practice

Background and interests

Tony Dowell is Professor of Primary Health Care and Deputy Dean at the University of Otago, Wellington, and a practicing General Practitioner at the Island Bay Medical Centre. He has been a member of the Department since 1997, when he arrived from the UK to take up the inaugural Chair of General Practice and Head of Department. He qualified in Medicine at Leeds University in the UK and after junior medical training worked in Malawi, central Africa. Returning to the UK he completed General Practice training and entered academic practice in Leeds. Prior to moving to New Zealand he was inaugural Director of the Centre for Research in Primary Care at Leeds. His current academic interests include research in mental health care, health services research and communication in health care consultation settings.

Teaching activities

Undergraduate medical education.

Teaching in psychological medicine and community practice in 4th – 6th year class settings.
He was one of the founders of a cultural immersion teaching programme which ran for over ten years on the East Coast of the North Island.

Postgraduate.

Regular contributions to postgraduate programmes in Primary Care, Public Health and Psychological medicine.
He is currently supervising PhD students in the areas of back pain, acute respiratory infection, the acculturation of international medical graduates, sleep disturbance in dementia and professional attitudes to obesity in men.

Research activities

Tony’s research activities have spanned a wide range of topics relevant to primary care, using both quantitative and qualitative methodologies. Current research themes include:

Mental health
- Primary mental health service delivery. Recent projects have included an evaluation of mental health initiatives and the development and piloting of a toolkit for primary mental health care.
- The Anti-depressant Cessation Trial (ACT); a randomized controlled trial of SSRI withdrawal for those with stable depression.
- Development and piloting of a problem solving/ cognitive behavioural ultra-brief intervention (UBI) in routine primary care consultations.
- Classification of mental disorder. Tony is a member of a WHO panel exploring classification issues in mental health for the ICD_11 classification of disease.

Communication in health care
Tony is a founding member of the Applied Research on Communication in Health (ARCH) research group. This group consisting of clinicians, social scientists and sociolinguists is undertaking current projects in the content and quality of consultations in diabetes care, the management of overweight patients and interpreted consultations in general practice and primary care settings.

Quality in health care
Tony has been involved for a number of years in the development of indicators of performance in primary care. He is currently a member of panels at the Quality and Safety Commission developing an Atlas of Variation, and indicators for Ambulatory Sensitive Hospitalisation.

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Publications

Dowell, A., Stubbe, M., Macdonald, L., Tester, R., Gray, L., Vernall, S., … Dew, K. (2018). A longitudinal study of interactions between health professionals and people with newly diagnosed diabetes. Annals of Family Medicine, 16(1), 37-44. doi: 10.1370/afm.2144

Gray, L., Stubbe, M., Macdonald, L., Tester, R., Hilder, J., & Dowell, A. C. (2018). A taboo topic? How general practitioners talk about overweight and obesity in New Zealand. Journal of Primary Health Care, 10(2), 150-158. doi: 10.1071/HC17075

Millar, E., Stanley, J., Gurney, J., Stairmand, J., Davies, C., Semper, K., Dowell, A., … Sarfati, D. (2018). Effect of multimorbidity on health service utilisation and health care experiences. Journal of Primary Health Care, 10(1), 44-53. doi: 10.1071/HC17074

Stairmand, J., Gurney, J., Stanley, J., Millar, E., Davies, C., Semper, K., Dowell, A., Mangin, D., Lawrenson, R., & Sarfati, D. (2018). The impact of multimorbidity on people's lives: A cross-sectional survey. New Zealand Medical Journal, 131(1477), 78-90. Retrieved from https://www.nzma.org.nz/journal

Turner, N. M., MacRae, J., Nowlan, M. L., McBain, L., Stubbe, M. H., & Dowell, A. (2018). Quantifying the incidence and burden of herpes zoster in New Zealand general practice: A retrospective cohort study using a natural language processing software inference algorithm. BMJ Open, 8, e021241. doi: 10.1136/bmjopen-2017-021241

Authored Book - Research

Dowell, A. C. (2000). A Sunrise, a Supernova and a Free Breakfast: Research and Education in General Practice. Dunedin: University of Otago Press, 44p.

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Chapter in Book - Research

Gray, B., Hilder, J., Macdonald, L., Tester, R., Dowell, A., & Stubbe, M. (2017). A New Zealand perspective on providing healthcare for patients with limited English proficiency. In E. A. Jacobs & L. C. Diamond (Eds.), Providing health care in the context of language barriers. (pp. 189-209). Bristol, UK: Multilingual Matters.

White, S. J., Stubbe, M., Macdonald, L., Dowell, A. C., Dew, K., & Gardner, R. (2016). The referred consultation. In S. White & J. A. Cartmill (Eds.), Communication in surgical practice. (pp. 9-34). Sheffield, UK: Equinox.

Stubbe, M., White, S. J., Macdonald, L., Dowell, A. C., Gardner, R., & Dew, K. (2016). Do surgeons want to operate? Negotiating the treatment plan in surgical consultations. In S. White & J. A. Cartmill (Eds.), Communication in surgical practice. (pp. 124-152). Sheffield, UK: Equinox.

Dew, K., Stubbe, M., Dowell, A., & Macdonald, L. (2012). Side effects talk in general practice consultations. In B. R. Bates & R. Ahmed (Eds.), Medical communication in clinical contexts. (pp. 95-126). Dubuque, IA: Kendall Hunt.

Dowell, T., Morris, C., Dodd, T., & Mcloughlin, B. (2012). Psychological interventions in primary care mental health. In G. Ivbijaro (Ed.), Companion to primary care mental health. (pp. 241-264). London: Wonca & Radcliffe.

Dowell, A. C., & Neal, R. D. (2000). Vision and change in primary care: Past, present and future. In P. Tovey (Ed.), Contemporary Primary Care and Change: Issues and Themes. (pp. 9-25). Buckingham, Philadelphia: Open University Press.

Dowell, A. C. (1999). Multidisciplinary teamwork in Maternity Care. In Community based maternity care. (pp. 9-26). Oxford University Press..

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Journal - Research Article

Dowell, A., Stubbe, M., Macdonald, L., Tester, R., Gray, L., Vernall, S., … Dew, K. (2018). A longitudinal study of interactions between health professionals and people with newly diagnosed diabetes. Annals of Family Medicine, 16(1), 37-44. doi: 10.1370/afm.2144

Turner, N. M., MacRae, J., Nowlan, M. L., McBain, L., Stubbe, M. H., & Dowell, A. (2018). Quantifying the incidence and burden of herpes zoster in New Zealand general practice: A retrospective cohort study using a natural language processing software inference algorithm. BMJ Open, 8, e021241. doi: 10.1136/bmjopen-2017-021241

Stairmand, J., Gurney, J., Stanley, J., Millar, E., Davies, C., Semper, K., Dowell, A., Mangin, D., Lawrenson, R., & Sarfati, D. (2018). The impact of multimorbidity on people's lives: A cross-sectional survey. New Zealand Medical Journal, 131(1477), 78-90. Retrieved from https://www.nzma.org.nz/journal

Millar, E., Stanley, J., Gurney, J., Stairmand, J., Davies, C., Semper, K., Dowell, A., … Sarfati, D. (2018). Effect of multimorbidity on health service utilisation and health care experiences. Journal of Primary Health Care, 10(1), 44-53. doi: 10.1071/HC17074

Gray, L., Stubbe, M., Macdonald, L., Tester, R., Hilder, J., & Dowell, A. C. (2018). A taboo topic? How general practitioners talk about overweight and obesity in New Zealand. Journal of Primary Health Care, 10(2), 150-158. doi: 10.1071/HC17075

Signal, L., Semper, K., Stairmand, J., Davies, C., Millar, E., Dowell, T., … Mangin, D., & Sarfati, D. (2017). A walking stick in one hand and a chainsaw in the other: Patients’ perspectives of living with multimorbidity. New Zealand Medical Journal, 130(1455), 65-76. Retrieved from https://www.nzma.org.nz/journal

Roberts, K., Nie, J.-B., & Dowell, T. (2017). From knowing silence to curious engagement: The role of general practitioners to discuss and refer to complementary and alternative medicine. Journal of Interprofessional Education & Practice, 9, 104-107. doi: 10.1016/j.xjep.2017.09.004

McDonald, J., McBain, L., Dowell, A. C., & Morris, C. (2017). GPs' views and experiences of prescribing non-steroidal anti-inflammatory drugs: A qualitative study. BJGP Open, 1(2), bjgpopen17X100869. doi: 10.3399/bjgpopen17X100869

Hilder, J., Gray, B., Dowell, A., Macdonald, L., Tester, R., & Stubbe, M. (2017). ‘It depends on the consultation’: Revisiting use of family members as interpreters for general practice consultations – when and why? Australian Journal of Primary Health, 23, 257-262. doi: 10.1071/PY16053

Gray, B., Hilder, J., Macdonald, L., Tester, R., Dowell, A., & Stubbe, M. (2017). Are research ethics guidelines culturally competent? Research Ethics, 13(1), 23-41. doi: 10.1177/1747016116650235

Gibson, R. H., Gander, P. H., Dowell, A. C., & Jones, L. M. (2017). Non-pharmacological interventions for managing dementia-related sleep problems within community dwelling pairs: A mixed-method approach. Dementia, 16(8), 967-984. doi: 10.1177/1471301215625821

Dowell, A., Darlow, B., Macrae, J., Stubbe, M., Turner, N., & McBain, L. (2017). Childhood respiratory illness presentation and service utilisation in primary care: A six-year cohort study in Wellington, New Zealand, using natural language processing (NLP) software. BMJ Open, 7(7), e017146. doi: 10.1136/bmjopen-2017-017146

Goldberg, D. P., Lam, T.-P., Minhas, F., Razzaque, B., Robles, R., Bobes, J., … Dowell, A. C., … Reed, G. M. (2017). Primary care physicians' use of the proposed classification of common mental disorders for ICD-11. Family Practice. Advance online publication. doi: 10.1093/fampra/cmx033

Dowell, A., Morris, C., McDonald, L., & Stubbe, M. (2017). "I can't bend it and it hurts like mad": Direct observation of gout consultations in routine primary health care. BMC Family Practice, 18(91). doi: 10.1186/s12875-017-0662-9

Goldberg, D. P., Reed, G. M., Robles, R., Minhas, F., Razzaque, B., Fortes, S., … Dowell, A. C., … Saxena, S. (2017). Screening for anxiety, depression, and anxious depression in primary care: A field study for ICD-11 PHC. Journal of Affective Disorders, 213, 199-206. doi: 10.1016/j.jad.2017.02.025

Darlow, B., Perry, M., Dean, S., Mathieson, F., Baxter, G. D., & Dowell, A. (2016). Putting physical activity while experiencing low back pain in context: Balancing the risks and benefits. Archives of Physical Medicine & Rehabilitation, 97(2), 245-251. doi: 10.1016/j.apmr.2015.09.020

Morris, C., Macdonald, L., Stubbe, M., & Dowell, A. (2016). "It's complicated": Talking about gout medicines in primary care consultations: A qualitative study. BMC Family Practice, 17(1), 114. doi: 10.1186/s12875-016-0515-y

Goldberg, D. P., Reed, G. M., Robles, R., Bobes, J., Iglesias, C., Fortes, S., … Dowell, A., … Saxena, S. (2016). Multiple somatic symptoms in primary care: A field study for ICD-11 PHC, WHO's revised classification of mental disorders in primary care settings. Journal of Psychosomatic Research, 91, 48-54. doi: 10.1016/j.jpsychores.2016.10.002

Barton, J., Dew, K., Dowell, A., Sheridan, N., Kenealy, T., Macdonald, L., Tester, R., … Gray, L., & Stubbe, M. (2016). Patient resistance as a resource: Candidate obstacles in diabetes consultations. Sociology of Health & Illness, 38(7), 1151-1166. doi: 10.1111/1467-9566.12447

Theadom, A., Parag, V., Dowell, T., McPherson, K., Starkey, N., Barker-Collo, S., … on behalf of the BIONIC Research Group. (2016). Persistent problems 1 year after mild traumatic brain injury: A longitudinal population study in New Zealand. British Journal of General Practice, 66(642), e16-e23. doi: 10.3399/bjgp16X683161

Collings, S., Mathieson, F., Dowell, A., Stanley, J., Hatcher, S., Goodyear-Smith, F., Lane, B., & Munsterman, A. (2015). Clinical effectiveness of an ultra-brief intervention for common mental health syndromes in primary care: Study protocol for a cluster randomized controlled trial. Trials, 16, 260. doi: 10.1186/s13063-015-0778-y

Barker-Collo, S., Jones, K., Theadom, A., Starkey, N., Dowell, A., McPherson, K., … on behalf of the BIONIC Research Group. (2015). Neuropsychological outcome and its correlates in the first year after adult mild traumatic brain injury: A population-based New Zealand study. Brain Injury, 29(13-14), 1604-1616. doi: 10.3109/02699052.2015.1075143

Pullon, S., McKinlay, B., Yager, J., Duncan, B., McHugh, P., & Dowell, A. (2015). Developing indicators of service integration for child health: Perceptions of service providers and families of young children in a region of high need in New Zealand. Journal of Child Health Care, 19(1), 18-29. doi: 10.1177/1367493513496673

MacRae, J., Darlow, B., McBain, L., Jones, O., Stubbe, M., Turner, N., & Dowell, A. (2015). Accessing primary care Big Data: The development of a software algorithm to explore the rich content of consultation records. BMJ Open, 5(8), e008160. doi: 10.1136/bmjopen-2015-008160

Lagolago, W., Theadom, A., Fairbairn-Dunlop, P., Ameratunga, S., Dowell, A., McPherson, K. M., … on behalf of the BIONIC Research Group. (2015). Traumatic brain injury within Pacific people of New Zealand. New Zealand Medical Journal, 128(1412). Retrieved from https://www.nzma.org.nz/journal

Barker-Collo, S., Jones, A., Jones, K., Theadom, A., Dowell, A., Starkey, N., … on behalf of the BIONIC Research Group. (2015). Prevalence, natural course and predictors of depression 1 year following traumatic brain injury from a population-based study in New Zealand. Brain Injury, 29(7-8), 859-865. doi: 10.3109/02699052.2015.1004759

Woodbridge, M. R., Dowell, A. C., & Gray, L. (2015). 'He said he had been out doing the traffic': General practitioner perceptions of sexually transmitted infection and HIV testing strategies for men. Journal of Primary Health Care, 7(1), 50-56.

Darlow, B., Dean, S., Perry, M., Mathieson, F., Baxter, G. D., & Dowell, A. (2015). Easy to harm, hard to heal: Patient views about the back. Spine, 40(11), 842-850. doi: 10.1097/brs.0000000000000901

Theadom, A., Cropley, M., Parmar, P., Barker-Collo, S., Starkey, N., Jones, K., … on behalf of the BIONIC Research Group, including Dowell, T. (2015). Sleep difficulties one year following mild traumatic brain injury in a population-based study. Sleep Medicine, 16(8), 926-932. doi: 10.1016/j.sleep.2015.04.013

MacRae, J., Love, T., Baker, M. G., Dowell, A., Carnachan, M., Stubbe, M., & McBain, L. (2015). Identifying influenza-like illness presentation from unstructured general practice clinical narrative using a text classifier rule-based expert system versus a clinical expert. BMC Medical Informatics & Decision Making, 15, 78. doi: 10.1186/s12911-015-0201-3

Darlow, B., Dean, S., Perry, M., Mathieson, F., Baxter, G. D., & Dowell, A. (2014). Acute low back pain management in general practice: Uncertainty and conflicting certainties. Family Practice, 31(6), 723-732. doi: 10.1093/fampra/cmu051

Darlow, B., Perry, M., Stanley, J., Mathieson, F., Melloh, M., Baxter, G. D., & Dowell, A. (2014). Cross-sectional survey of attitudes and beliefs about back pain in New Zealand. BMJ Open, 4(5), e004725. doi: 10.1136/bmjopen-2013-004725

White, S. J., Stubbe, M. H., Macdonald, L. M., Dowell, A. C., Dew, K. P., & Gardner, R. (2014). Framing the consultation: The role of the referral in surgeon-patient consultations. Health Communication, 29(1), 74-80. doi: 10.1080/10410236.2012.718252

Darlow, B., Perry, M., Mathieson, F., Stanley, J., Melloh, M., Marsh, R., Baxter, G. D., & Dowell, A. (2014). The development and exploratory analysis of the Back Pain Attitudes Questionnaire (Back-PAQ). BMJ Open, 4(5), e005251. doi: 10.1136/bmjopen-2014-005251

Te Ao, B., Brown, P., Tobias, M., Ameratunga, S., Barker-Collo, S., Theadom, A., … Dowell, A., … on behalf of the BIONIC Research Group. (2014). Cost of traumatic brain injury in New Zealand: Evidence from a population-based study. Neurology, 83(18), 1645-1652. doi: 10.1212/wnl.0000000000000933

Claridge, R., Gray, L., Stubbe, M., Macdonald, L., Tester, R., & Dowell, A. C. (2014). General practitioner opinion of weight management interventions in New Zealand. Journal of Primary Health Care, 6(3), 212-220.

Mathieson, F., Collings, S., Dowell, A., Goodyear-Smith, F., Stanley, J., & Hatcher, S. (2013). Collaborative research: A case example of dissemination of CBT in primary care. Cognitive Behaviour Therapist, 6, e4. doi: 10.1017/S1754470X13000093

Darlow, B., Dowell, A., Baxter, G. D., Mathieson, F., Perry, M., & Dean, S. (2013). The enduring impact of what clinicians say to people with low back pain. Annals of Family Medicine, 11(6), 527-534. doi: 10.1370/afm.1518

White, S. J., Stubbe, M. H., Dew, K. P., Macdonald, L. M., Dowell, A. C., & Gardner, R. (2013). Understanding communication between surgeon and patient in outpatient consultations. ANZ Journal of Surgery, 83(5), 307-311. doi: 10.1111/ans.12126

Lam, T. P., Goldberg, D. P., Dowell, A. C., Fortes, S., Mbatia, J. K., Minhas, F. A., & Klinkman, M. S. (2013). Proposed new diagnoses of anxious depression and bodily stress syndrome in ICD-11-PHC: An international focus group study. Family Practice, 30(1), 76-87. doi: 10.1093/fampra/cms037

Feigin, V. L., Theadom, A., Barker-Collo, S., Starkey, N. J., McPherson, K., Kahan, M., Dowell, A., … for the BIONIC Study Group. (2013). Incidence of traumatic brain injury in New Zealand: A population-based study. Lancet Neurology, 12(1), 53-64. doi: 10.1016/s1474-4422(12)70262-4

Perera, G. A. R., Dowell, A. C., & Morris, C. J. (2013). Constructing a framework for quality activity in primary care. Australian Health Review, 37(1), 98-103. doi: 10.1071/AH11097

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