scholarly journals Pharmacist integration into general practice in New Zealand

2019 ◽  
Vol 11 (2) ◽  
pp. 159 ◽  
Author(s):  
Robert Haua ◽  
Jeff Harrison ◽  
Trudi Aspden
Keyword(s):  
General Practice ◽  
New Zealand ◽  
Online Questionnaire ◽  
District Health ◽  
Long Term Conditions ◽  
The North ◽  
Medicines Reconciliation ◽  
Medication Reviews ◽  
General Practices

ABSTRACT IntroductionPharmacist integration into general practice is gaining momentum internationally, with benefits noted in reducing medication errors, improving chronic disease management and alleviating general practitioner workforce shortages. Little is known about how general practice pharmacists are working in New Zealand. AimThis study characterised the current landscape of pharmacist integration into general practice in New Zealand. MethodsAn online questionnaire was developed, piloted and distributed to all pharmacists in New Zealand. ResultsThirty-six responses were analysed. Respondents were more likely to be female, have been pharmacists for at least 10 years and all but one held formal postgraduate clinical pharmacy qualifications. Seven pharmacists were working as pharmacist prescribers. Primary health organisations (PHOs) were the most common employer, with funding primarily derived from either PHOs or District Health Boards. Pharmacist integration into general practice appears to have progressed further in particular regions of New Zealand, with most respondents located in the North Island. Tasks performed by respondents included medication reviews, managing long-term conditions and medicines reconciliation. Increased job satisfaction compared with previous roles was reported by most respondents. Funding and a general lack of awareness about pharmacists’ professional scope were seen as barriers to further expansion of the role. DiscussionThis study describes the characteristics of pharmacists currently working in general practices in New Zealand and provides insights into key requirements for the role. Understanding the way practice pharmacists are currently employed and funded can inform general practices considering employing pharmacists.

scholarly journals Medication risk management and health equity in New Zealand general practice: a retrospective cross-sectional study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Sharon Leitch ◽  
Jiaxu Zeng ◽  
Alesha Smith ◽  
Tim Stokes
Keyword(s):  
General Practice ◽  
New Zealand ◽  
Cross Sectional Study ◽  
Alert System ◽  
Cross Sectional ◽  
Aotearoa New Zealand ◽  
Current Medication ◽  
General Practices ◽  
Medication Risk

Abstract Background Despite an overt commitment to equity, health inequities are evident throughout Aotearoa New Zealand. A general practice electronic alert system was developed to notify clinicians about their patient’s risk of harm due to their pre-existing medical conditions or current medication. We aimed to determine whether there were any disparities in clinician action taken on the alert based on patient ethnicity or other demographic factors. Methods Sixty-six New Zealand general practices from throughout New Zealand participated. Data were available for 1611 alerts detected for 1582 patients between 1 and 2018 and 1 July 2019. The primary outcome was whether action was taken following an alert or not. Logistic regression was used to assess if patients of one ethnicity group were more or less likely to have action taken. Potential confounders considered in the analyses include patient age, gender, ethnicity, socio-economic deprivation, number of long term diagnoses and number of long term medications. Results No evidence of a difference was found in the odds of having action taken amongst ethnicity groups, however the estimated odds for Māori and Pasifika patients were lower compared to the European group (Māori OR 0.88, 95 %CI 0.63–1.22; Pasifika OR 0.88, 95 %CI 0.52–1.49). Females had significantly lower odds of having action taken compared to males (OR 0.76, 95 %CI 0.59–0.96). Conclusions This analysis of data arising from a general practice electronic alert system in New Zealand found clinicians typically took action on those alerts. However, clinicians appear to take less action for women and Māori and Pasifika patients. Use of a targeted alert system has the potential to mitigate risk from medication-related harm. Recognising clinician biases may improve the equitability of health care provision.

scholarly journals General practice ethnicity data: evaluation of a tool

2014 ◽  
Vol 6 (1) ◽  
pp. 49 ◽  
Author(s):  
Pat Neuwelt ◽  
Sue Crengle ◽  
Donna Cormack ◽  
Melissa McLeod ◽  
Dale Bramley
Keyword(s):  
Primary Care ◽  
General Practice ◽  
New Zealand ◽  
Data Collection ◽  
System Level ◽  
Inductive Method ◽  
Health Board ◽  
District Health ◽  
General Practices ◽  
Ethnicity Data

INTRODUCTION: There is evidence that the collection of ethnicity data in New Zealand primary care is variable and that data recording in practices does not always align with the procedures outlined in the Ethnicity Data Protocols for the Health and Disability Sector. In 2010, The Ministry of Health funded the development of a tool to audit the collection of ethnicity data in primary care. The aim of this study was to pilot the Ethnicity Data Audit Tool (EAT) in general practice. The goal was to evaluate the tool and identify recommendations for its improvement. METHODS: Eight general practices in the Waitemata District Health Board region participated in the EAT pilot. Feedback about the pilot process was gathered by questionnaires and interviews, to gain an understanding of practices’ experiences in using the tool. Questionnaire and interview data were analysed using a simple analytical framework and a general inductive method. FINDINGS: General practice receptionists, practice managers and general practitioners participated in the pilot. Participants found the pilot process challenging but enlightening. The majority felt that the EAT was a useful quality improvement tool for handling patient ethnicity data. Larger practices were the most positive about the tool. CONCLUSION: The findings suggest that, with minor improvements to the toolkit, the EAT has the potential to lead to significant improvements in the quality of ethnicity data collection and recording in New Zealand general practices. Other system-level factors also need to be addressed. KEYWORDS: Data collection; ethnicity; general practice; primary health care

scholarly journals Medication Risk Management and Health Equity in New Zealand General Practice: A Retrospective Cross-Sectional Study

2020 ◽  
Author(s):  
Sharon Leitch ◽  
Jiaxu Zeng ◽  
Alesha Smith ◽  
Tim Stokes
Keyword(s):  
General Practice ◽  
New Zealand ◽  
Cross Sectional Study ◽  
Alert System ◽  
Cross Sectional ◽  
Aotearoa New Zealand ◽  
Current Medication ◽  
General Practices ◽  
Medication Risk

Abstract BackgroundDespite an overt commitment to equity, health inequities are evident throughout Aotearoa New Zealand. A general practice electronic alert system was developed to notify clinicians about their patient’s risk of harm due to their pre-existing medical conditions or current medication. We aimed to determine whether there were any disparities in clinician action taken on the alert based on patient ethnicity or other demographic factors.MethodsSixty-six New Zealand general practices from throughout New Zealand participated. Data were available for 1611 alerts detected for 1582 patients between 1 Jan 2018 and 1 July 2019. The primary outcome was whether action was taken following an alert or not. Logistic regression was used to assess if patients of one ethnicity group were more or less likely to have action taken. Potential confounders considered in the analyses include patient age, gender, ethnicity, socio-economic deprivation, number of long term diagnoses and number of long term medications.ResultsNo evidence of a difference was found in the odds of having action taken amongst ethnicity groups, however the estimated odds for Māori and Pasifika patients were lower compared to the European group (Māori OR 0.88, 95%CI 0.63–1.22; Pasifika OR 0.88, 95%CI 0.52–1.49). Females had significantly lower odds of having action taken compared to males (OR 0.76, 95%CI 0.59–0.96).ConclusionThis analysis of data arising from a general practice electronic alert system in New Zealand found clinicians typically took action on those alerts. However, clinicians appear to take less action for women and Māori and Pasifika patients. Use of a targeted alert system has the potential to mitigate risk from medication-related harm. Recognising clinician biases may improve the equitability of health care provision.

Awareness and use of online appointment booking in general practice: analysis of GP Patient Survey data

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711365
Author(s):  
Mayam Gomez-Cano ◽  
Helen Atherton ◽  
John Campbell ◽  
Abi Eccles ◽  
Jeremy Dale ◽  
...  
Keyword(s):  
General Practice ◽  
Survey Data ◽  
Secondary Analysis ◽  
Patient Survey ◽  
Long Term Conditions ◽  
Patient Groups ◽  
General Practices ◽  
Roll Out ◽  
Do So

BackgroundGeneral practices are required to provide online booking to patients in line with policy to digitise access. However, uptake of online booking by patients is currently low and there is little evidence about awareness and use by different patient groups.AimTo examine variability in awareness and use of online appointment booking in general practice.MethodSecondary analysis of two questions from the GP Practice Survey data (2018) asking about awareness and use of online booking of appointments. Multivariable logistic regression was used to examine associations with age, gender, ethnicity, deprivation, the presence of a long-term condition, long-term sickness and being deaf.ResultsIn total, 43.3% (277 278/647 064) of responders reported being aware of being able to book appointments online, while only 15% (93 671/641 073) reported doing so. There was evidence of variation by all factors considered, with strong deprivation gradients in both awareness and use (for example, most versus least deprived quintile OR for use: 0.63 (95% CI = 0.61 to 0.65). There was a reduction in awareness and use in patients >75 years of age. Patients with long-term conditions were more aware and more likely to use online booking.ConclusionWhile over 40% of patients know that they can book appointment online, the number that actually do so is far lower. With the constant push for online services within the NHS and the roll out of the NHS app, practices should be aware that not all patient groups will book appointments online and that other routes of access need to be maintained to avoid widening health inequalities.

scholarly journals An Investigation of Variation in Emergency Admission Rates between New Zealand General Practices: a national database linkage study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Hywel Lloyd ◽  
Andrew Tomlin ◽  
Susan Dovey
Keyword(s):  
New Zealand ◽  
Role Models ◽  
Admission Rate ◽  
Emergency Admission ◽  
National Database ◽  
Long Term Conditions ◽  
Emergency Admissions ◽  
Admission Rates ◽  
General Practices

ABSTRACT ObjectiveTo quantify variation in emergency admission rates between all New Zealand general practices and to investigate the influence of patients with long-term conditions. ApproachThis retrospective cohort study linked three national data collection. The Primary Health Organisation (PHO) Enrolment Collection provided practice register data on age sex ethnicity and deprivation. The National Minimum Dataset for Hospital Events (NMDS) allowed access to discharge data. The national Pharmaceutical Collection enabled medicine use to provide a proxy measures of patient morbidity. Expected emergency admission rates for each practice in 2014 were calculated using indirect standardisation with the total registered patient population of all study practices as the reference population. A standardised emergency admission ratio (SAR) of the actual admission rate to the expected admission rate was calculated for each practice. ResultOver the fourteen year period 2001-2014 total emergency admissions from all causes in New Zealand increased by 42%. Arranged and waiting list admissions increased by 29% over the same period. Emergency admissions represented 54% of all admissions by 2014 and increased by 56%. Patients with hospital diagnoses for long-term conditions accounted for 56.5% of all emergency admissions and 78.6% of all associated bed days. More females had unplanned admissions than males (p<0.001, 95% CI 0.48%-0.59%) and more Maori (p<0.001, 95% CI 1.33%-1.49%) and Pacific Island patients (p<0.001, 95% CI 0.96%-1.17%) were admitted than Europeans. Increasing deprivation status was significantly associated with an increased likelihood of admission (p<0.001; chi-squared test for trend). Practices with the highest SARs in 2014 tended to have the highest admission rates in that year and in previous years. They also had high admission rates for both high and low risk patient groups. ConclusionThis study indicates that there is considerable variation in the emergency admission rates of New Zealand general practices and in their standardised emergency admission rates after adjusting for differences in patient demography. A more meaningful measure of true disease morbidity is required to understand more the role ‘models of care’ play in the degree of variation of emergency admission. Keywords: Emergency Admission, practice variation, primary care, New Zealand

scholarly journals Patients’ experiences of pharmacists in general practice: an exploratory qualitative study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Georgios Dimitrios Karampatakis ◽  
Nilesh Patel ◽  
Graham Stretch ◽  
Kath Ryan
Keyword(s):  
General Practice ◽  
Policy Development ◽  
Structured Interview ◽  
Long Term Conditions ◽  
Face To Face ◽  
Audio Recordings ◽  
Data Saturation ◽  
Minor Ailments ◽  
Medication Reviews ◽  
General Practices

Abstract Background Since 2015, pharmacists have been integrating into English general practices and more recently into primary care networks. General practice-based pharmacists provide a range of patient-facing services, such as medication reviews, management of long-term conditions and minor ailments, prescribing duties and answering queries over the telephone. Literature reports patients’ satisfaction with general practice-based pharmacists’ services, however, previous research captured only limited experiences. The aim of the current study was to pursue an extensive exploration of patients’ experiences of pharmacists in general practice. Methods General practice-based pharmacists, working in practices in West London, Surrey and Berkshire, handed invitation packs to patients seen during consultations. Patients that wanted to take part in the study were invited to undertake a qualitative, in-depth, face-to-face, semi-structured interview within the practice with which each patient was registered. Interviews lasted from 15 min to more than 1 h and were audio-recorded. Recruitment continued until data saturation. Audio-recordings were transcribed verbatim and transcripts analysed thematically. Results Twenty participants were interviewed. Four themes were discerned: awareness (“I had been coming to this practice for 24 years and I didn’t know that there was a pharmacist”); accessibility (“People ring for a GP [general practitioner] appointment … it’s Monday and they [receptionist] tells you ‘We can slot you in on Friday’ … with a pharmacist on board, they can [instantly] look at you”); interactions (“I’ve always had a really good interaction with them [pharmacists] and they listen and they take on board what I’m trying to say”); and feedback (“It’s easier [to collect feedback instantly] because I could have forgotten half of what they [pharmacists] have told me in an hour or so’s time”). Conclusions Findings indicate that pharmacists’ integration into general practices could improve accessibility to, and the quality of, care received. The findings will assist policy development to provide general practice-based pharmacists’ services as per patients’ needs.

scholarly journals Are the needs of people with multiple long-term conditions being met? Evidence from the 2018 General Practice Patient Survey

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e041569
Author(s):  
Lucina Rolewicz ◽  
Eilís Keeble ◽  
Charlotte Paddison ◽  
Sarah Scobie
Keyword(s):  
General Practice ◽  
Unmet Need ◽  
Patient Survey ◽  
Secondary Outcome ◽  
Community Based ◽  
Long Term Conditions ◽  
Local Services ◽  
Community Based Services ◽  
Practice Patient

ObjectivesTo investigate individual, practice and area level variation in patient-reported unmet need among those with long-term conditions, in the context of general practice (GP) appointments and support from community-based services in England.DesignCross-sectional study using data from 199 150 survey responses.SettingPrimary care and community-based services.ParticipantsRespondents to the 2018 English General Practice Patient Survey with at least one long-term condition.Primary and secondary outcome measuresThe primary outcomes were the levels of unmet need in GP and local services among patients with multiple long-term conditions. Secondary outcomes were the proportion of variation explained by practice and area-level factors.ResultsThere was no relationship between needs being fully met in patients’ last practice appointment and number of long-term conditions once sociodemographic characteristics and health status were taken into account (5+conditions−OR=1.04, 95% CI 0.99 to 1.09), but there was a relationship for having enough support from local services to manage conditions (5+conditions−OR=0.84, 95% CI 0.80 to 0.88). Patients with multimorbidity that were younger, non-white or frail were less likely to have their needs fully met, both in GP and from local services. Differences between practices and local authorities explained minimal variation in unmet need.ConclusionsLevels of unmet need are high, particularly for support from community services to manage multiple conditions. Patients who could be targeted for support include people who feel socially isolated, and those who have difficulties with their day-to-day living. Younger patients and certain ethnic groups with multimorbidity are also more likely to have unmet needs. Increased personalisation and coordination of care among these groups may help in addressing their needs.

scholarly journals Repeat prescribing policy in New Zealand general practice: making it better

2020 ◽  
Vol 12 (4) ◽  
pp. 373
Author(s):  
Steven Lillis ◽  
Liza Lack
Keyword(s):  
General Practice ◽  
New Zealand ◽  
General Practitioners ◽  
Local Development ◽  
Policy Research ◽  
Practice Research ◽  
Annual Conference ◽  
Protected Time ◽  
Repeat Prescribing ◽  
General Practices

ABSTRACT INTRODUCTIONRepeat prescribing is common in New Zealand general practice. Research also suggests that repeat prescribing is a process prone to error. All New Zealand general practices have to comply with requirements to have a repeat prescribing policy, with the details of the policy to be designed by the practice. AIMTo inform the development of practice policy, research was undertaken with experienced general practitioners to identify and mitigate risk in the process. METHODSAt the 2019 annual conference of the Royal New Zealand College of General Practitioners, a workshop was held with 58 experienced general practitioner participants. The group was divided into six small groups, each with the task of discussing one aspect of the repeat prescribing process. The results were then discussed with the whole group and key discussion points were transcribed and analysed. RESULTSIssues identified included: improving patient education on appropriateness of repeat prescribing; having protected time for medicine reconciliation and the task of repeat prescribing; reducing the number of personnel and steps in the process; and clarity over responsibility for repeat prescribing. DISCUSSIONThis research can inform the local development of a repeat prescribing policy at the practice level or be used to critique existing practice policies. Attention was also drawn to the increasing administrative burden that repeat prescribing contributes to in general practice.

scholarly journals Characteristics and outcomes of clusters of multimorbid patients in UK general practice

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
Y Zhu ◽  
D Edwards ◽  
S Kiddle ◽  
R Payne
Keyword(s):  
Cardiovascular Disease ◽  
General Practice ◽  
Health Services ◽  
Mortality Risk ◽  
Service Use ◽  
Service Utilisation ◽  
Validation Data ◽  
Long Term Conditions ◽  
Co Morbidity

Abstract Background Current clinical specialities, guidelines and quality of care metrics are organised around single diseases and treatments of multiple conditions are rarely coordinated, resulting in insufficient or even conflicting care. This study uses large scale English general practice (GP) records to identify and characterise clusters of patients based on their multimorbidity to allow better design of health services and highlight groups that require additional interventions. Methods This is a retrospective cohort study that includes multimorbid adult patients (N = 113,211), from a random sample of 391,669 English patients with valid GP records in 2012 where 38 long-term conditions were defined. Latent class analysis, stratified by age groups, was used to identify multimorbidity clusters. Class solutions are validated and associations between multimorbidity clusters, patient characteristics, public health service utilisation and mortality are assessed. Results Poor socioeconomic status is associated with clusters with higher service use and mortality risk. Physical-mental health co-morbidity is a major component of multimorbidity across all age strata. The clusters with highest age-stratified mortality risk in under 65 year olds were linked to alcohol and substance misuse, whereas in over 65 year olds they were linked to cardiovascular disease. The largest cluster in the 85+ years strata (58%) has the lowest number of morbidities, a low degree of service use and mortality. Consistency was seen across identification and validation data. Conclusions We find a clear distinction between morbidity clusters, both in the prevalence of long term conditions within them, and in their associations with outcomes (service use and mortality). Specific health services and interventions might be more effective when targeted on the distinct types of multimorbidity we have identified, with a particular focus on the morbidity clusters associated with the worst patient outcomes. Key messages The first study to derive age stratified multimorbidity clusters from a large GP record system, whose patients are representative of the English population. Knowledge about particularly dangerous clusters of multimorbidity, such as those involving alcohol and drug use in 18–64 years old, and cardiovascular disease in those 65 years or older.

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