Prevalence of invasive cancer in a large general practice patient population in New Zealand

ABSTRACT INTRODUCTIONThe prevalence of cancer in the community is likely to be increasing due to an ageing population, implementation of cancer screening programmes and advances in cancer treatment. AIMTo determine the prevalence of primary invasive cancers in a large general practice patient population in New Zealand and to characterise the health-care status of these cancer patients. METHODSData were sourced from the patient management system of a large general practice (n=11,374 patients) in a medium-sized Waikato town and from the New Zealand Cancer Registry dataset to identify patients diagnosed with cancer between January 2009 and December 2018. RESULTSThere were 206 cancer diagnoses in 201 patients; 35 cancers were diagnosed in 1887 Māori patients (1.9%) and 171 in 9487 non-Māori patients (1.8%). The age-standardised prevalence was 3092/100,000 in Māori patients and 1971/100,000 in non-Māori patients. The most prevalent cancers were breast, male genital organ, digestive organ and skin cancers. In May 2019, 81 of 201 (40.8%) patients with cancer were receiving only usual care from their general practitioner, whereas 66 (32.8%) were having their cancer managed in secondary care. Comorbidities were common, including hypertension (38.8%), gastrointestinal disorders (29.9%) and mood disorders (24.4%). DISCUSSIONResults suggest that there may be disparities in cancer prevalence between Māori and non-Māori patients, although this needs to be confirmed in other general practices. Furthermore, primary care appears to be responsible for most of the care in this patient cohort and workloads should be planned accordingly, particularly with the high incidence of comorbidities.

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

Journal of Primary Health Care ◽

10.1071/hc20098 ◽

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.

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‘Water dripping on a stone’: a feasibility study of a healthy weight management conversation approach in routine general practice consultations

Family Practice ◽

10.1093/fampra/cmaa122 ◽

2020 ◽

Author(s):

Jo Hilder ◽

Lesley Gray ◽

Maria Stubbe ◽

Sarah Duncan ◽

Anthony C Dowell

Keyword(s):

General Practice ◽

Weight Management ◽

Descriptive Analysis ◽

Healthy Weight ◽

Training And Education ◽

Patient Interviews ◽

Effective Training ◽

Survey Results ◽

General Practices ◽

Practice Patient

Abstract Background Primary health care has an important role to play in the management of weight and yet discussions of healthy weight management do not occur optimally, indicating a need for simple tools and training in brief weight counselling. The ‘FABS’ approach (focusing on four topic areas: Food, Activity, Behaviour and Support) was developed to address this. Objectives To explore the feasibility of the ‘FABS’ approach within routine general practice consultations and its effectiveness in facilitating healthy weight conversations. Method The FABS approach was run for a trial period in five New Zealand general practices. The approach entailed staff training, the addition to the practice patient management system of a template outlining potential topics for discussion and a patient handout. GPs were asked to use the approach with any adult patient with a body mass index of over 28 kg/m2. A descriptive analysis of anonymized quantitative practice data was conducted, with limited qualitative data from an online clinician questionnaire and interviews with GPs and patients. Results Over 4 months, the template was opened 862 times by 27 clinicians in 830 patient consultations. All FABS topics were raised at least once. Physical activity was raised most frequently, followed by two food-related topics. There was variation between practices and between GPs. GPs tended to raise more topics within a single consultation than the training recommended. The limited clinician survey results and patient interviews also indicated positive responses to the approach. Conclusions It is possible to provide an infrastructure for healthy weight conversation approaches within general practice so that patients receive supportive and consistent messages on a regular basis. General practice is an appropriate setting for this due to the ongoing relationships with patients and team-based approach, but there is a need for effective training and education to ensure appropriate and effectively delivery.

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General practice evolution in New Zealand: hybridisation in action

Journal of Primary Health Care ◽

10.1071/hc17043 ◽

2017 ◽

Vol 9 (3) ◽

pp. 220 ◽

Cited By ~ 4

Author(s):

Carol Atmore

Keyword(s):

Primary Care ◽

General Practice ◽

New Zealand ◽

Ageing Population ◽

Patient Centred Care ◽

Fiscal Constraint ◽

Current Climate ◽

Primary Care Health ◽

History Of ◽

Care Health

ABSTRACT This viewpoint outlines a brief history of primary care health reforms over the last 25 years, and how this history has influenced the business of caring. It also suggests where we should next look to improve the provision of equitable patient-centred care in the current climate of fiscal constraint, while meeting the challenges of an ageing population and increasing multimorbidity.

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The anatomical placement of body organs by Australian and New Zealand patients and health professionals in general practice

Journal of Primary Health Care ◽

10.1071/hc12239 ◽

2012 ◽

Vol 4 (3) ◽

pp. 239 ◽

Cited By ~ 1

Author(s):

Marjan Kljakovic ◽

Jo Risk

Keyword(s):

General Practice ◽

New Zealand ◽

Health Professionals ◽

Health Knowledge ◽

Doctor Patient Communication ◽

Correct Placement ◽

General Practices ◽

Gp Visits ◽

Health Administrators ◽

Better Than

INTRODUCTION: Understanding patients awareness of the anatomical placement of their body organs is important for doctorpatient communication. AIM: To measure the correct anatomical placement of body organs by people from Australian and New Zealand general practices METHOD: A questionnaire survey containing drawings of 11 organs placed in different locations within each drawing. RESULTS: Among 1156 participants, there was no difference in the proportion of correct placement of 11 organs between Australian (51.7%) and New Zealand (49.6%) general practices. There was a positive correlation between the proportion of correctly placed organs and the age participants left school (p=0.012) and a negative correlation with the number of GP visits in the previous year (p=0.040). Participants from rural Australia were more likely to correctly place organs than urban participants (p=0.018). The mean proportion of organs correctly placed for doctors was 80.5%, nurses 66.5%, allied health 61.5%, health administrators 50.6% and the remaining consulting patients 51.3%. DISCUSSION: Patients from Australian and New Zealand general practice were poorly aware of the correct placement of organs. Health professionals were moderately better than patients at correct placement. KEYWORDS: Health knowledge; attitudes; practice; anatomy; general practice

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The Nursing Presence in General Practice: Revealing Dimensions of Day-to-day Experience of Practice Nurses in New Zealand

10.26686/wgtn.16959151.v1 ◽

2021 ◽

Author(s):

◽

Katrina Fyers

Keyword(s):

Health Care ◽

General Practice ◽

Primary Health Care ◽

New Zealand ◽

Models Of Care ◽

Complex Nature ◽

Practice Nurses ◽

Nursing Leaders ◽

Primary Health ◽

General Practices

<p>This study makes visible and gives value to the day-to-day experience of practice nurses who work in New Zealand general practices. Nursing leaders internationally and locally have highlighted the importance of the Primary Health Care nurse to improving health outcomes, addressing inequalities and implementing new models of care. As one of the largest groups of Primary Health Care nurses, practice nurses have a significant part to play. There is however, no consensus and limited research related to the day-to-day experience of practice nurses. Therefore, the nature, extent, and contribution of nursing in general practice may be overlooked or misunderstood. Furthermore as an autonomous self-regulating profession, nursing has a responsibility to the public to provide understanding of nursing in the present and in the future, particularly when this relates to the care of families and the structure of health systems. Located within the qualitative research paradigm and utilising a narrative inquiry methodology, this study applies a 'supportive voice' to highlight the experience of five practice nurses, and in the process makes visible the dimensions of nursing work in New Zealand general practices. The five constructed narratives particularly draw attention to the complex nature of nursing work that practice nurses engage in daily, the importance of nurse-patient relationships and continuity of care and the significance of autonomous and specialty aspects of nursing practice. Ultimately, the value of the practice nurse in the day-to-day operation of general practice is brought to the fore.</p>

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Importance of accessibility and opening hours to overall patient experience of general practice: analysis of repeated cross-sectional data from a national patient survey

British Journal of General Practice ◽

10.3399/bjgp18x697673 ◽

2018 ◽

Vol 68 (672) ◽

pp. e469-e477 ◽

Cited By ~ 3

Author(s):

Thomas E Cowling ◽

Azeem Majeed ◽

Matthew J Harris

Keyword(s):

General Practice ◽

Patient Experience ◽

Patient Survey ◽

Cross Sectional ◽

National Patient ◽

General Practices ◽

The Uk ◽

Multilevel Linear Regression ◽

Practice Patient

BackgroundThe UK government aims to improve the accessibility of general practices in England, particularly by extending opening hours in the evenings and at weekends. It is unclear how important these factors are to patients’ overall experiences of general practice.AimTo examine associations between overall experience of general practice and patient experience of making appointments and satisfaction with opening hours.Design and settingAnalysis of repeated cross-sectional data from the General Practice Patient Surveys conducted from 2011–2012 until 2013–2014. These covered 8289 general practice surgeries in England.MethodData from a national survey conducted three times over consecutive years were analysed. The outcome measure was overall experience, rated on a five-level interval scale. Associations were estimated as standardised regression coefficients, adjusted for responder characteristics and clustering within practices using multilevel linear regression.ResultsIn total, there were 2 912 535 responders from all practices in England (n = 8289). Experience of making appointments (β 0.24, 95% confidence interval [CI] = 0.24 to 0.25) and satisfaction with opening hours (β 0.15, 95% CI = 0.15 to 0.16) were modestly associated with overall experience. Overall experience was most strongly associated with GP interpersonal quality of care (β 0.34, 95% CI = 0.34 to 0.35) and receptionist helpfulness was positively associated with overall experience (β 0.16, 95% CI = 0.16 to 0.17). Other patient experience measures had minimal associations (β≤0.06). Models explained ≥90% of variation in overall experience between practices.ConclusionPatient experience of making appointments and satisfaction with opening hours were only modestly associated with overall experience. Policymakers in England should not assume that recent policies to improve access will result in large improvements in patients’ overall experience of general practice.

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

International Journal for Equity in Health ◽

10.1186/s12939-021-01461-y ◽

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.

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Pharmacist integration into general practice in New Zealand

Journal of Primary Health Care ◽

10.1071/hc18103 ◽

2019 ◽

Vol 11 (2) ◽

pp. 159 ◽

Cited By ~ 2

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.

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Clinical pharmacist facilitators in primary care: a descriptive study of their roles and services provided in general practices of southern New Zealand

Journal of Primary Health Care ◽

10.1071/hc19073 ◽

2020 ◽

Vol 12 (1) ◽

pp. 88 ◽

Cited By ~ 1

Author(s):

Sivamanoj Yadav Boyina ◽

Tim Stokes ◽

Angela Renall ◽

Rhiannon Braund

Keyword(s):

General Practice ◽

New Zealand ◽

Clinical Pharmacy ◽

Clinical Pharmacist ◽

Retrospective Case ◽

Primary Health ◽

General Practices ◽

Pharmacist Services ◽

Geographical Locations ◽

Case Note Review

ABSTRACT INTRODUCTIONInternationally, the inclusion of pharmacists into general practice as clinical pharmacy facilitators has improved patient outcomes. However, clinical pharmacists are relatively new to southern New Zealand general practices and their range of services has not been studied. AIMSTo describe the implementation of clinical pharmacist services in general practices in the Southern region; to examine the tasks conducted by clinical pharmacy facilitators; and to determine the characteristics of patients who access this service. METHODSThe establishment and development of the clinical pharmacy facilitator role was determined by documentation held within the local Primary Health Organisation. The activities performed by clinical pharmacy facilitators were collected from patient medical records for the period 31 March 2015 to 31 March 2018. To describe the characteristics of patients receiving these services, a retrospective case note review of patients seen by the facilitators was conducted. RESULTSThe clinical pharmacy facilitator role was initiated with three pharmacists in three geographical locations across the region. Within 18 months, the number of facilitators was increased to eight. As a result of collaboration with the general practice team, 42% of referrals came from general practitioners directly. Overall, 2621 medicine-related problems were identified in 2195 patients. Dosage adjustment was the most common recommendation made by pharmacy facilitators. They consulted mostly older patients and patients taking five or more medicines. DISCUSSIONWith effective collaboration, clinical pharmacy facilitators can play a key role in optimisation of medicines therapy.

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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

Journal of Primary Health Care ◽

10.1071/hc19059 ◽

2020 ◽

Vol 12 (2) ◽

pp. 129

Author(s):

Rory Miller ◽

Joanna Young ◽

Garry Nixon ◽

John W. Pickering ◽

Tim Stokes ◽

...

Keyword(s):

General Practice ◽

New Zealand ◽

Chest Pain ◽

Point Of Care ◽

Rural Hospitals ◽

Low Risk ◽

Rural Settings ◽

Pain Pathway ◽

Risk Patients ◽

General Practices

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.

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