scholarly journals Metabolic screening in primary care for patients with schizophrenia or schizoaffective disorder and taking antipsychotic medication

2020 ◽  
Vol 12 (1) ◽  
pp. 29 ◽  
Author(s):  
Rawiri Keenan ◽  
Lynne Chepulis ◽  
Joanna Ly ◽  
Sally Carter ◽  
Chunhuan Lao ◽  
...  
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Antipsychotic Medication ◽  
Schizoaffective Disorder ◽  
Best Practice ◽  
Complete Blood Count ◽  
Guideline Recommendation ◽  
Primary Care Doctors ◽  
Metabolic Screening ◽  
Practitioner Education

ABSTRACT INTRODUCTIONLife expectancy in patients with schizophrenia is 15–20 years less than the general population. A dominant cause of morbidity and mortality in these patients is cardiovascular disease. Adverse consequences of modifiable cardiovascular risk factors can be reduced by regular monitoring of metabolic outcomes and intervention if required. AIMTo evaluate the metabolic screening in primary care for patients with schizoaffective disorders managed in primary care. To show the usefulness of combining simple practice audits in evaluating such areas of clinical practice. METHODSAn audit was undertaken in eight general practices in the Waikato and Bay of Plenty regions of New Zealand. Specifically, the monitoring of patients with schizophrenia or schizoaffective disorder whose antipsychotic medication was prescribed by primary care doctors was audited. Patient monitoring was compared to the guideline recommendation of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Best Practice Advisory Centre (BPAC). RESULTSIn total, 117 patients were included in the audit and none were fully monitored, as recommended by the RANZCP guidelines. Although two-thirds of patients had been evaluated for glycosylated haemoglobin (HbA1c), lipids, blood pressure, complete blood count and weight, <10% of patients had had prolactin, waist circumference or electrocardiogram measurements recorded. The proportion of patients having a HbA1c measured was also significantly higher in younger patients and patients who were non-Māori or enrolled with an urban practice (all P<0.05). When using the simplified BPAC guidelines, half of all patients were correctly monitored. DISCUSSIONThese findings show there is room for improvement in the monitoring of patients receiving antipsychotic medication in primary care. This may indicate the need for clear guidance and general practitioner education around the monitoring requirements of these patients. Alternatively, a more simplified monitoring protocol may need to be developed. This audit has also shown that there is value in several practices completing the same audit and providing a larger cohort of patients for pooled data analysis.

scholarly journals Partner notification and retesting for Chlamydia trachomatis and Neisseria gonorrhoeae: a case-note review in New Zealand primary care

2018 ◽  
Vol 10 (2) ◽  
pp. 132 ◽  
Author(s):  
Sally B. Rose ◽  
Susan M. Garrett ◽  
Jane Kennedy ◽  
Kim Lund ◽  
Deborah Hutchings ◽  
...  
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Chlamydia Trachomatis ◽  
Neisseria Gonorrhoeae ◽  
Best Practice ◽  
Partner Notification ◽  
Sexual History ◽  
Management Guidelines ◽  
Clinical Records

ABSTRACT INTRODUCTION Bacterial sexually transmitted infections (STIs) contribute to a significant burden of ill-health despite being easy to diagnose and treat. STI management guidelines provide clinicians with evidence-based guidance on best-practice case management. AIM To determine the extent of adherence to STI management guidelines for partner notification, follow up and testing for reinfection following diagnosis of Chlamydia trachomatis and Neisseria gonorrhoeae. METHODS Retrospective review of electronic patient records for individuals diagnosed with chlamydia or gonorrhoea in eight primary care clinics in Wellington, New Zealand. At each clinic, 40 clinical records were reviewed (320 in total). Outcome measures were: overall numbers (%) of cases with documented evidence of reason for testing, sexual history, treatment, advice, partner notification and follow up. Partner notification outcomes were: n (%) with evidence of partner notification discussion and n (%) with partners advised, tested and treated. Proportions retested between 6 weeks and 6 months and n (%) positive on retesting were also determined. RESULTS Presenting features and treatment were generally well documented. Recent sexual history including number of partners was documented for half of cases reviewed (159/320). Partner notification discussion was documented for 74% (237/320) of cases, but only 24.4% (78/320) had documentation on numbers of partners notified and 17% (54/320) on numbers of partners treated. Testing for reinfection between 6 weeks and 6 months occurred for 24.7% (79/320), of whom 19% (15/79) re-tested positive. CONCLUSIONS This research suggests there are gaps in important aspects of patient care following bacterial STI diagnosis – a factor that may be perpetuating our high rates of infection. A more systematic approach will be needed to ensure people diagnosed with an STI receive the full cycle of care in line with best practice guidelines.

Registered nurse prescribing: A descriptive survey of prescribing practices in a single district health board in Aotearoa New Zealand

2020 ◽  
Vol 36 (3) ◽  
pp. 61-72
Author(s):  
Melinda McGinty ◽  
◽  
Betty Poot ◽  
Jane Clarke ◽  
◽  
...  
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Registered Nurse ◽  
Health Conditions ◽  
Health Board ◽  
Prescribing Practices ◽  
District Health ◽  
Survey Tool ◽  
Aotearoa New Zealand ◽  
Descriptive Survey

The expansion of prescribing rights in Aotearoa New Zealand has enabled registered nurse prescribers (RN prescribers) working in primary care and specialty teams, to enhance nursing care, by prescribing medicines to their patient population. This widening of prescribing rights was to improve the population’s access to medicines and health care; however, little is known about the medications prescribed by RN prescribers. This paper reports on a descriptive survey of self-reported RN prescribers prescribing in a single district health board. The survey tool used was a Microsoft Excel spreadsheet to record nurse’s area of practice, patient demographic details, health conditions seen, and medicines prescribed and deprescribed. Simple data descriptions and tabulations were used to report the data. Eleven RN prescribers consented to take part in the survey and these nurses worked in speciality areas of cardiology, respiratory, diabetes, and primary care. Findings from the survey demonstrated that RN prescribers prescribe medicines within their area of practice and within the limits of the list of medicines for RN prescribers. Those working in primary care saw a wider range of health conditions and therefore prescribed a broader range of medications. This survey revealed that the list of medications available for RN prescribers needs to be updated regularly to align with the release of evidence-based medications on the New Zealand Pharmaceutical Schedule. It is also a useful record for both educational and clinical settings of the types of medications prescribed by RN prescribers.

Australian and New Zealand Biosolids Partnership: Collaboration for more effective biosolids management

2010 ◽  
Vol 5 (2) ◽  
Author(s):  
Andrew Speers ◽  
Allen Gale ◽  
Nancy Penney
Keyword(s):  
New Zealand ◽  
Policy Development ◽  
Sustainable Management ◽  
Best Practice ◽  
Community Consultation ◽  
Critical Research ◽  
Community Attitudes ◽  
Relationship Of ◽  
The Relationship ◽  
Sustainability Framework

This paper describes an international biosolids management initiative, known as the Australian and New Zealand Biosolids Partnership (ANZBP). The ANZBP - known formerly as the Australasian Biosolids Partnership – comprises 33 members dedicated to promoting the sustainable management of biosolids across the two nations. Two critical research projects are described, each of which contributes to the ANZBP goal of promoting the sustainable management of biosolids. The first is a review of community attitudes to biosolids management, the outcomes of which will be used to refine communication tools and methods of community consultation and which will provide input to policy development over time. The second is a review of regulations in place in Australia and New Zealand carried out to identify inconsistencies and improvements that could be made. An outcome of this initiative is potentially the development of a best practice manual. The relationship of the two projects to a sustainability framework adopted by the ANZBP is also described, as is the relationship of the two projects to each other.

scholarly journals Geospatial analysis of emergency services use for public health assessment and intervention

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
G Cassourret
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Unemployment Rate ◽  
Emergency Services ◽  
Health Interventions ◽  
Healthcare Provision ◽  
Socioeconomic Determinants ◽  
Primary Care Doctors ◽  
Use Of Emergency Services ◽  
Neighborhood Level

Abstract The population is increasingly using emergency care services around the world. The underlying interrogation is whether this increase is a consequence from a dysfunction in healthcare provision, from a deterioration in the health status of the population or from socioeconomic determinants. We performed geospatial analyses with 3-year 1,081,026 Emergency Medical Services (EMS) responses in Paris and its suburbs. Incidence of calls per population and complaints were compared, at the neighborhood level, with demographic and socioeconomic determinants. Associations with characteristics of the health system such as the density of primary care doctors were also studied. Spatial autocorrelations were searched with Moran's I analyses. We found a positive correlation between the incidence of EMS calls by population for respiratory problems, and the level of poverty as well as the unemployment rate (p < 0.001). There was no significant correlation between psychiatric complaints and socioeconomic determinants. There was a strong correlation between calls for birth or imminent birth by woman of childbearing age and the unemployment rate among women, the unemployment rate overall and household median household income (p < 0.001). There was no correlation between the density of primary care providers and EMS activity by population. EMS data allowed us to powerfully identify specific socioeconomic determinants of health for a 7 million-inhabitant population at the district level. Results could be used to design and implement tailored public health interventions for maximum impact. The overuse of emergency services does not seem to stem solely from the decrease in the supply of primary care doctors. Innovatively, monitoring the actual use of emergency services could responsively inform policy makers and agencies responsible for prevention and health promotion about the specific needs of the population and the consequences of decisions on the organization of the provision of care. Key messages The use of emergency services is a valid metric to evaluate the health status of the population and identify socioeconomic determinants. It gives specific guidelines for public health interventions. Geospatial analyses can efficiently identify the specific needs of a population at the neighborhood level. It can participate to the evaluation of the organization of healthcare provision.

Familial hypercholesterolaemia in primary care: Awareness, knowledge and practices among primary care doctors in Malaysia

2016 ◽  
Vol 252 ◽  
pp. e41 ◽  
Author(s):  
A.S. Ramli ◽  
N.A. Mohd Mokhsin ◽  
S. Abdul Razak ◽  
M. Md Yasin ◽  
Z. Ismail ◽  
...  
Keyword(s):  
Primary Care ◽  
Familial Hypercholesterolaemia ◽  
Primary Care Doctors
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