scholarly journals Study protocol for an observational study to evaluate an accelerated chest pain pathway using point-of-care troponin in New Zealand rural and primary care populations

2020 ◽  
Vol 12 (2) ◽  
pp. 129
Author(s):  
Rory Miller ◽  
Joanna Young ◽  
Garry Nixon ◽  
John W. Pickering ◽  
Tim Stokes ◽  
...  

ABSTRACT INTRODUCTIONAccelerated diagnostic chest pain pathways are used widely in urban New Zealand hospitals. These pathways use laboratory-based troponin assays with good analytical precision. Widespread implementation has not occurred in many of New Zealand’s rural hospitals and general practices as they are reliant on point-of-care troponin assays, which are less sensitive and precise. An accelerated chest pain pathway using point-of-care troponin has been adapted for use in rural settings. A pilot study in a low-risk rural population showed no major adverse cardiac events at 30 days. A larger study is required to be confident that the pathway is safe. AIMSTo assess the safety and effectiveness of an accelerated chest pain pathway adapted for rural settings and general practice using point-of-care troponin to identify low-risk patients and allow early discharge. METHODSThis is a prospective observational study of an accelerated chest pain pathway using point-of-care troponin in rural hospitals and general practices in New Zealand. A total of 1000 patients, of whom we estimate 400 will be low risk, will be enrolled in the study. OUTCOME MEASURESThe primary outcome is the proportion of patients identified by the pathway as low risk for a 30-day major adverse cardiac event. Secondary outcomes include the proportion of low-risk patients who were discharged directly from general practice or rural hospitals, the proportion of patients reclassified as having acute myocardial infarction by the pathway and the proportion of patients with low and intermediate risk safely managed in the rural hospital.

2002 ◽  
Vol 25 (2) ◽  
pp. 57-62 ◽  
Author(s):  
Francesco Pelliccia ◽  
Cinzia Cianfrocca ◽  
Giuseppe Marazzi ◽  
Mario Pagliei ◽  
Marcello Mariani ◽  
...  

2020 ◽  
Vol 12 (4) ◽  
pp. 373
Author(s):  
Steven Lillis ◽  
Liza Lack

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.


2009 ◽  
Vol 27 (7) ◽  
pp. 889-892 ◽  
Author(s):  
Asia Kogan ◽  
Reuma Shapira ◽  
Basil S. Lewis ◽  
Ada Tamir ◽  
Gad Rennert

2012 ◽  
Vol 19 (5) ◽  
pp. 510-516 ◽  
Author(s):  
Sally J. Aldous ◽  
Mark A. Richards ◽  
Louise Cullen ◽  
Richard Troughton ◽  
Martin Than

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