scholarly journals Medication-related harm in New Zealand general practice: a retrospective records review

2021 ◽  
pp. BJGP.2020.1126
Author(s):  
Sharon Leitch ◽  
Susan Dovey ◽  
Wayne Cunningham ◽  
Alesha Smith ◽  
Jiaxu Zeng ◽  
...  
Keyword(s):  
General Practice ◽  
New Zealand ◽  
Immunomodulatory Agents ◽  
Factors Associated ◽  
Increased Risk ◽  
Cardiovascular Medications ◽  
General Practices ◽  
Review Study ◽  
Inform Decision Making ◽  
Related Harm

Background: The extent of medication-related harm in general practice is unknown. Aim: To identify and describe all medication-related harm in electronic general practice records. Design and Setting: Retrospective cohort records review study in 44 randomly selected New Zealand general practices for the three years 2011-2013. Methods: Eight general practitioners reviewed 9076 randomly selected patient records. Medication-related harms were identified when the causal agent was prescribed in general practice. Harms were coded by type, preventability, and severity. The number and proportion of patients who experienced medication-related harm was calculated. Weighted logistic regression was used to identify factors associated with harm. Results 976/9076 study patients (10.8%) experienced 1,762 medication-related harms over three years. After weighting, the incidence rate of all medication-related harms was 73.9 harms per 1000 patient-years, and the incidence of preventable or potentially preventable medication-related harms was 15.6 per 1000 patient-years. Most harms were minor (1390/1762, 78.9%), but one in five harms were moderate or severe (373/1762, 21.1%); three patients died. Eighteen study patients were hospitalised; after weighting this correlates to a hospitalisation rate of 1.1 per 1000 patient-years. Increasing age, number of consultations, and number of medications were associated with increased risk of medication-related harm. Cardiovascular medications, antineoplastic and immunomodulatory agents, and anticoagulants caused most harm by frequency and severity. Conclusion Medication-related harm in general practice is common. This study adds to the evidence about the risk posed by medication in the real world. Findings can be used to inform decision-making in general practice.

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

2012 ◽  
Vol 4 (3) ◽  
pp. 239 ◽  
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 doctor–patient 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

scholarly journals Epidemiology of Patient Harms in New Zealand: Protocol of a General Practice Records Review Study

2017 ◽  
Vol 6 (1) ◽  
pp. e10 ◽  
Author(s):  
Susan M Dovey ◽  
Sharon Leitch ◽  
Katharine A Wallis ◽  
Kyle S Eggleton ◽  
Wayne K Cunningham ◽  
...  
Keyword(s):  
General Practice ◽  
New Zealand ◽  
Review Study

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

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>

A chlamydia education and training program for general practice nurses: reporting the effect on chlamydia testing uptake

2021 ◽  
Vol 27 (1) ◽  
pp. 36
Author(s):  
Anna Wood ◽  
Sabine Braat ◽  
Meredith Temple-Smith ◽  
Rebecca Lorch ◽  
Alaina Vaisey ◽  
...  
Keyword(s):  
General Practice ◽  
Training Program ◽  
Treatment Effect ◽  
Controlled Trial ◽  
Education And Training ◽  
Practice Nurses ◽  
Chlamydia Testing ◽  
Increased Risk ◽  
General Practices ◽  
And Training

The long-term health consequences of untreated chlamydia are an increased risk of pelvic inflammatory disease, ectopic pregnancies and infertility among women. To support increased chlamydia testing, and as part of a randomised controlled trial of a chlamydia intervention in general practice, a chlamydia education and training program for general practice nurses (GPN) was developed. The training aimed to increase GPNs’ chlamydia knowledge and management skills. We compared the difference in chlamydia testing between general practices where GPNs received training to those who didn’t and evaluated acceptability. Testing rates increased in all general practices over time. Where GPNs had training, chlamydia testing rates increased (from 8.3% to 19.9% (difference=11.6%; 95% CI 9.4–13.8)) and where GPNs did not have training (from 7.4% to 18.0% (difference=10.6%; 95% CI 7.6–13.6)). By year 2, significantly higher testing rates were seen in practices where GPNs had training (treatment effect=4.9% (1.1 – 8.7)), but this difference was not maintained in year 3 (treatment effect=1.2% (−2.5 – 4.9)). Results suggest a GPN chlamydia education and training program can increase chlamydia testing up to 2 years; however, further training is required to sustain the increase beyond that time.

scholarly journals Characteristics of a stratified random sample of New Zealand general practices

2018 ◽  
Vol 10 (2) ◽  
pp. 114 ◽  
Author(s):  
Sharon Leitch ◽  
Susan M. Dovey ◽  
Ari Samaranayaka ◽  
David M. Reith ◽  
Katharine A. Wallis ◽  
...  
Keyword(s):  
Health Care ◽  
New Zealand ◽  
Health Care Services ◽  
Chi Square ◽  
Care Services ◽  
Practice Characteristics ◽  
Practice Size ◽  
Rural And Urban ◽  
General Practices ◽  
Review Study

ABSTRACT INTRODUCTION Practice size and location may affect the quality and safety of health care. Little is known about contemporary New Zealand general practice characteristics in terms of staffing, ownership and services. AIM To describe and compare the characteristics of small, medium and large general practices in rural and urban New Zealand. METHODS Seventy-two general practices were randomly selected from the 2014 Primary Health Organisation database and invited to participate in a records review study. Forty-five recruited practices located throughout New Zealand provided data on staff, health-care services and practice ownership. Chi-square and other non-parametric statistical analyses were used to compare practices. RESULTS The 45 study practices constituted 4.6% of New Zealand practices. Rural practices were located further from the nearest regional base hospital (rural median 65.0 km, urban 7.5 km (P < 0.001)), nearest local hospital (rural 25.7 km, urban 7.0 km (P = 0.002)) and nearest neighbouring general practitioner (GP) (rural 16.0 km, urban 1.0 km (P = 0.007)). In large practices, there were more enrolled patients per GP FTE than both medium-sized and small practices (mean 1827 compared to 1457 and 1120 respectively, P = 0.019). Nurses in large practices were more likely to insert intravenous lines (P = 0.026) and take blood (P = 0.049). There were no significant differences in practice ownership arrangements according to practice size or rurality. CONCLUSION Study practices were relatively homogenous. Unsurprisingly, rural practices were further away from hospitals. Larger practices had higher patient-to-doctor ratios and increased nursing scope. The study sample is small; findings need to be confirmed by specifically powered research.

scholarly journals Risk of Burnout in Danish GPs and Exploration of Factors Associated with Development of Burnout: A Two-Wave Panel Study

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Anette Fischer Pedersen ◽  
Christina Maar Andersen ◽  
Frede Olesen ◽  
Peter Vedsted
Keyword(s):  
General Practice ◽  
Panel Study ◽  
Medical Specialty ◽  
Important Predictor ◽  
Job Turnover ◽  
Health Providers ◽  
Turnover Rates ◽  
Factors Associated ◽  
Increased Risk ◽  
Retirement Status

Background. We assessed risk of burnout in GPs during a 7-year followup and examined whether (1) thoughts about changing medical specialty increased the risk of burnout and (2) burned out GPs had higher job turnover rates than burnout-free GPs. Methods. In 2004 and 2012, all GPs in the county of Aarhus, Denmark, were invited to participate in a survey. Retirement status of physicians who participated in 2004 was obtained through the Registry of Health Providers in 2012. Results. 216 GPs completed both surveys. The risk of developing burnout during the 7-year followup was 13.2% (8.2–19.6%). GPs who in 2004 were burnout-free and reported that they would not select general practice as medical specialty again had a statistically significant increased risk of burnout in 2012 (OR = 4.5; 95% CI = 1.2–16.5; P=0.023). Among GPs with burnout in 2004, 25.0% had withdrawn from general practice during followup compared to 28.8% of burnout-free GPs in 2004 (adj. OR = 0.99; 95% CI = 0.48–2.02; P=0.975). Conclusion. The 7-year incidence of burnout was 13%. Thoughts about changing medical specialty were an important predictor of burnout. Burned out GPs had not higher job turnover rates than burnout-free GPs.

Cardiovascular and Respiratory Risk Factors and Symptoms among General Practice Patients with Long-Term Mental Illness

1996 ◽  
Vol 169 (6) ◽  
pp. 733-739 ◽  
Author(s):  
Tony Kendrick
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
General Practice ◽  
Mentally Ill ◽  
Respiratory Mortality ◽  
Respiratory Problems ◽  
Primary Care Teams ◽  
Increased Risk ◽  
General Practices

BackgroundIn the past psychiatric in-patients suffered increased cardiovascular and respiratory mortality. The present study investigated whether increased risks persist among patients in the community and are being addressed in general practice.MethodA survey of 101 long-term mentally ill adults in 16 general practices in the South Thames (West) Region.ResultsTwenty-six patients were found to be obese (body mass index > 30 kg/m2), 53 were current smokers and 11 were hypertensive (mean systolic blood pressure > 160 mmHg or mean diastolic blood pressure > 100 mmHg, or both). Twenty-one reported daily cough and sputum, 24 shortness of breath, 11 wheezing and seven chest pain on exertion. These rates were significantly higher than population rates in a contemporary national survey. Nearly all the risk factors were recorded in the general practice records but few attempts to intervene were apparent.ConclusionsLong-term mentally ill patients remain at increased risk of cardiovascular and respiratory problems in the community. Primary care teams should make special efforts to tackle risk factors among this group.

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 Clinical pharmacists in Dutch general practice: an integrated care model to provide optimal pharmaceutical care

2021 ◽  
Author(s):  
Ankie Hazen ◽  
Vivianne Sloeserwij ◽  
Bart Pouls ◽  
Anne Leendertse ◽  
Han de Gier ◽  
...  
Keyword(s):  
General Practice ◽  
Professional Identity ◽  
Training Program ◽  
Integrated Care ◽  
Clinical Pharmacist ◽  
Care Model ◽  
Clinical Pharmacists ◽  
General Practices ◽  
Related Harm ◽  
Qualitative Analyses

AbstractBackground Medication-related harm is a major problem in healthcare. New models of integrated care are required to guarantee safe and efficient use of medication. Aim To prevent medication-related harm by integrating a clinical pharmacist in the general practice team. This best practice paper provides an overview of 1. the development of this function and the integration process and 2. its impact, measured with quantitative and qualitative analyses. Setting Ten general practices in the Netherlands. Development and implementation of the (pragmatic) experiment We designed a 15-month workplace-based post-graduate learning program to train pharmacists to become clinical pharmacists integrated in general practice teams. In close collaboration with general practitioners, clinical pharmacists conduct clinical medication reviews (CMRs), hold patient consultations for medication-related problems, carry out quality improvement projects and educate the practice staff. As part of the Pharmacotherapy Optimisation through Integration of a Non-dispensing pharmacist in a primary care Team (POINT) intervention study, ten pharmacists worked full-time in general practices for 15 months and concurrently participated in the training program. Evaluation of this integrated care model included both quantitative and qualitative analyses of the training program, professional identity formation and effectiveness on medication safety. Evaluation The integrated care model improved medication safety: less medication-related hospitalisations occurred compared to usual care (rate ratio 0.68 (95% CI: 0.57–0.82)). Essential hereto were the workplace-based training program and full integration in the GP practices: this supported the development of a new professional identity as clinical pharmacist. This new caregiver proved to align well with the general practitioner. Conclusion A clinical pharmacist in general practice proves a feasible integrated care model to improve the quality of drug therapy.

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