Nurses' work in relation to patient health outcomes: an observational study comparing models of primary care.

Background: Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into seven models of primary care: Traditional, Corporate, Health Care Home, Māori, Pacific, Trusts / Non-governmental organisations (Trust/NGOs) and District Health Board / Primary Care Organisations (DHB/PHO).

Hauora Māori - Māori health: a right to equal outcomes in primary care.

Background: For more than a century, Māori have experienced poorer health than non-Māori. In 2019 an independent Tribunal found the Government had breached Te Tiriti o Waitangi by "failing to design and administer the current primary health care system to actively address persistent Māori health inequities". Many Māori (44%) have unmet needs for primary care.

Towards a national equitable and sustainable clinical research infrastructure for Aotearoa New Zealand.

Clinical trials are a critical element of a modern, high-functioning, learning healthcare system. Clinical trials provide access to novel, as yet unfunded treatments, and deliver cutting-edge healthcare. Evidence from clinical trials ensures appropriateness of healthcare, allows disinvestment from practices that are found not to improve outcomes or be cost-effective, and supports the introduction of new approaches, all of which leads to improvement in health outcomes.

Is there equity of patient health outcomes across models of general practice in Aotearoa New Zealand? A national cross-sectional study.

Background: Primary care in Aotearoa New Zealand is largely delivered by general practices, heavily subsidised by government. Te Tiriti o Waitangi (1840) guarantees equal health outcomes for Māori and non-Māori, but differences are stark and longstanding. Seven models of primary care have evolved.

The societal cost of unintentional childhood injuries in Aotearoa.

Aims: To estimate the burden and inequity of unintentional childhood injury for children in Aotearoa.

Methods: We used administrative data from the Accident Compensation Corporation (ACC) and the Ministry of Health to estimate the direct, indirect and intangible costs of unintentional injuries in children aged under 15 and the inequity of the impact of childhood injury on discretionary household income. We used an incidence approach and attributed all costs arising from injuries to the year in which those injuries were sustained.

Men living with obesity in New Zealand: What does this mean for health care in general practice?

Introduction: More men than women live with overweight and obesity in New Zealand, yet we know little about their everyday lives or their weight management experiences in primary care. This study sought to link the weight management experiences of these men in primary care, with their experiences of life in general as big men.

Methods: Semi-structured interviews with participants selected purposively based on a priori criteria were conducted.

Do healthcare services behave as complex systems? Analysis of patterns of attendance and implications for service delivery.

Background: The science of complex systems has been proposed as a way of understanding health services and the demand for them, but there is little quantitative evidence to support this. We analysed patterns of healthcare use in different urgent care settings to see if they showed two characteristic statistical features of complex systems: heavy-tailed distributions (including the inverse power law) and generative burst patterns.

Methods: We conducted three linked studies.

Identifying influenza-like illness presentation from unstructured general practice clinical narrative using a text classifier rule-based expert system versus a clinical expert.

Background: We designed and validated a rule-based expert system to identify influenza like illness (ILI) from routinely recorded general practice clinical narrative to aid a larger retrospective research study into the impact of the 2009 influenza pandemic in New Zealand.

Methods: Rules were assessed using pattern matching heuristics on routine clinical narrative. The system was trained using data from 623 clinical encounters and validated using a clinical expert as a gold standard against a mutually exclusive set of 901 records.

Changes in Acceleration and Deceleration Capacity Throughout Professional Soccer Match-Play.

Russell, M, Sparkes, W, Northeast, J, Cook, CJ, Love, TD, Bracken, RM, and Kilduff, LP. Changes in acceleration and deceleration capacity throughout professional soccer match-play. J Strength Cond Res 30(10): 2839-2844, 2016-As the acceleration and deceleration demands of soccer are currently not well understood, this study aimed to profile markers of acceleration and deceleration capacity during professional soccer match-play.

The financial impact of clinical task substitution between practice nurses and GPs in New Zealand primary care centres.

Aim: To describe the financial impact on practice owners of increased clinical task substitution between practice nurses and GPs in New Zealand (NZ) primary care settings.

Method: Case studies of 9 primary health care centres involving: interviews; collation of service and financial information; and nurse and GP diaries covering 1826 consultations. Results were compared with previous NZ large N survey results to develop a model predicting the financial impact of task substitution.

Can clinical governance deliver quality improvement in Australian general practice and primary care? A systematic review of the evidence.

Objectives: To review the literature on different models of clinical governance and to explore their relevance to Australian primary health care, and their potential contributions on quality and safety.

Data Sources: 25 electronic databases, scanning reference lists of articles and consultation with experts in the field. We searched publications in English after 1999, but a search of the German language literature for a specific model type was also undertaken.

Routine mortality monitoring for detecting mass murder in UK general practice: test of effectiveness using modelling.

Background: The Shipman Inquiry recommended mortality rate monitoring if it could be 'shown to be workable' in detecting a future mass murderer in general practice.

Aim: To examine the effectiveness of cumulative sum (CUSUM) charts, cross-sectional Shewhart charts, and exponentially-weighted, moving-average control charts in mortality monitoring at practice level.

Design Of Study: Analysis of Scottish routine general practice data combined with estimation of control chart effectiveness in detecting a 'murderer' in a simulated dataset.

Explicit rationing of elective services: implementing the New Zealand reforms.

In an attempt to make rationing of elective surgery in the publicly funded health system more explicit, New Zealand has developed a booking system for surgery using clinical priority assessment criteria (CPAC). This paper is based on research undertaken to evaluate the use of CPAC. To explore whether the goals of explicit rationing were being met 69 interviews were undertaken with policy advisors, administrators and clinicians in six localities throughout New Zealand.

General practice as a complex system: a novel analysis of consultation data.

Background: Complex systems have specific properties of robustness and self organisation which arise from interacting components within the overall system and which govern the system's behaviour. These are typically associated with a power law distribution of event sizes. Commentators have suggested that health systems are complex, but there has been limited quantitative investigation of this issue.

Patterns of medical practice variation: variability in referral for back pain by New Zealand general practitioners.

Aims: To describe patterns of variation in referral among general practitioners, and to establish whether variability among practitioners within a geographic area is associated with high levels of utilisation in an area.

Method: Multilevel analysis of routinely collected primary care data. The four outcome measures were referral to physiotherapy, specialist assessment, radiology, and approval of earnings-related compensation.

Clinicians' reported use of clinical priority assessment criteria and their attitudes to prioritization for elective surgery: a cross-sectional survey.

Objectives: To explore the attitudes of clinicians working in New Zealand publicly funded hospitals towards prioritizing patients for elective surgery, and their reported use of clinical priority assessment criteria (CPAC).

Design: A cross-sectional study using a postal questionnaire. The questionnaire drew on themes identified from an earlier qualitative study.

Equity of access to elective surgery: reflections from NZ clinicians.

Objectives: To explore factors potentially influencing equitable access to elective surgery in New Zealand by describing clinicians' perceptions of equity and the factors they consider when prioritising patients for elective surgery.

Methods: A qualitative study in selected New Zealand localities. A purposive sample of 49 general practitioners, specialists and registrars were interviewed.

General Practice care of enduring mental health problems: an evaluation of the Wellington Mental Health Liaison Service.

Aims: To describe the development and evaluation of a primary care service for a population of mental health consumers who had previously been predominantly cared for by a specialist service.

Methods: Consumers were interviewed at regular intervals after entry to the programme. The Health of the Nation Outcomes Scale (HoNOS) and the Life Skills Profile (LSP) outcomes measures were used with consumers at intervals of 0,3,6,12 and 18 months after entry to the programme.

Whole population secondary prevention of coronary heart disease in Scotland: the HEARTS database.

Implementing the evidence base for the management of chronic disease is as challenging as discovering which interventions are effective. The HEARTS collaboration (Heart disease Evidence-based Audit and Research in Tayside Scotland) is achieving that goal for the secondary prevention of coronary heart disease (CHD by linking national databases to manually validated hospital and family practice electronic patient records. Specific data from the system is fed back to practices in a facilitated educational process and through the NHS intranet.

Attitudes of teachers to evidence based medicine.

Aim: To describe the attitudes of general practitioners and specialist clinical teachers toward teaching evidence based medicine (EBM).

Participants And Methods: Questionnaire survey of 114 general practitioner and 162 specialist university teachers teaching EBM.

Results: Two hundred and six (80%) teachers responded; 196 regularly consulted with patients, 21% had received training, and 40% taught EBM.

Use of, and attitudes to, clinical priority assessment criteria in elective surgery in New Zealand.

Objectives: To describe the ways patients access elective surgery in New Zealand, and to understand the use of, and attitudes to, clinical priority assessment criteria (CPAC) in determining access to publicly funded elective surgery.

Methods: A qualitative study in selected New Zealand localities. A purposive sample of general practitioners, surgeons and administrators in publicly funded hospitals were interviewed.