Treatment Harms in Paediatric Primary Care.

The aim of this study was to describe the epidemiology in children of harms detectable from general practice records, and to identify risk factors. The SHARP study examined 9076 patient records from 44 general practices in New Zealand, with an enrolled population of 210,559 patients. "Harm" was defined as disease, injury, disability, suffering, and death, arising from the health system.

Epidemiology of healthcare harm in New Zealand general practice: a retrospective records review study.

Objectives: To determine the epidemiology of healthcare harm observable in general practice records.

Design: Retrospective cohort records review study.

Setting: 72 general practice clinics were randomly selected from all 988 New Zealand clinics stratified by rurality and size; 44 clinics consented to participate.

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

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. The secondary aim was to investigate factors potentially associated with medication-related harm.

Research using electronic health records: Balancing confidentiality and public good.

General practitioners are increasingly approached to participate in research and share de-identified patient information. Research using electronic health records has considerable potential for improving the quality and safety of patient care. Obtaining individual patient consent for the use of the information is usually not feasible.

Characteristics of a stratified random sample of New Zealand general practices.

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.

'Why worry about something you can't control?' Negotiated risk, longevity and health behaviours.

While we know about lay attitudes towards death and dying, we understand little about the ways people estimate their overall personal risk of life-limiting disease and/or death. This study contributes to the limited literature on lay longevity reckonings, with a particular focus on how these reckonings may influence health behaviours. Semi-structured interviews were held with 21 young older adults (54-65 years), addressing the core questions of 'What do you think you will die from, and how long do you expect to live?' Participants indicated their longevity estimation was guided by three key frameworks: family history, environment and lifestyle factors and lived experience.

Living into death: a case for an iterative, fortified and cross-sector approach to advance care planning.

Advance care planning (ACP) has been framed as best practice for quality palliative care, yet a growing body of literature affirms the need for an early iterative ACP process to begin when people are young and healthy. A significant gap appears to exist in the literature regarding the utility of death conversations outside the end-of-life context. Could 'death conversations' early in life be an effective tool by which doctor and patient can co-construct a more healthful way of life, and realistic relationship with death? And what variables must be taken into account for these conversations to proceed successfully? This paper provides a narrative exploration of the value of death conversations in the clinical context in New Zealand.

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

Background: Knowing where and why harm occurs in general practice will assist patients, doctors, and others in making informed decisions about the risks and benefits of treatment options. Research to date has been unable to verify the safety of primary health care and epidemiological research about patient harms in general practice is now a top priority for advancing health systems safety.

Objective: We aim to study the incidence, distribution, severity, and preventability of the harms patients experience due to their health care, from the whole-of-health-system lens afforded by electronic general practice patient records.

Cracking open death: death conversations in primary care.

INTRODUCTION Research supports talking about death outside the end-of-life context. Benefits include allaying death anxiety to increased engagement in health promotion interventions. Nonetheless, the focus on death conversations remains centred on the imminently dying.

Employing imaginative rationality: using metaphor when discussing death.

The prevalence of metaphors in medicine is widely acknowledged. In a qualitative study exploring expectations of longevity, we observed repeated recourse to the imaginative rationality provided by metaphors to express perspectives on longevity and death. Bafflement, acceptance, uncertainty and distress were conveyed through metaphors, providing valuable insight into the internal healthcare frameworks of participants.

Educating vocationally trained family physicians: a survey of graduates from a postgraduate medical education programme.

INTRODUCTION Since 1991 the University of Otago, Dunedin, New Zealand has offered postgraduate qualifications specifically designed to educate general practitioners (GPs) about their unique work environment. AIM To determine motivations and impacts of postgraduate education for practising GPs. METHODS Survey of the 100 graduates of the University of Otago, Dunedin postgraduate general practice programme.

Vaikoloa: Understanding depression in Tokelauan people in New Zealand.

BACKGROUND The Tokelauan language lacks a word for 'depression' and this can make diagnosing and treating depression in Tokelauan patients difficult for general practitioners. AIMS To describe the experience of depression in Tokelauans and thereby assist diagnosis and treatment of the illness. METHOD Ten semi-structured in-depth interviews were conducted.

The impact of patient's complaints on New Zealand dentists.

Background And Objectives: This study aimed to investigate the impact of receiving a patient complaint on dentists in New Zealand.

Method: A qualitative research method was chosen to investigate the experience of dentists in receipt of a complaint. Nine dentists practising in New Zealand who had received complaints from a variety of sources were interviewed.

Republished original viewpoint: complaints, shame and defensive medicine.

While the complaints process is intended to improve healthcare, some doctors appear to practise defensive medicine after receiving a complaint. This response occurs in countries that use a tort-based medicolegal system as well as in countries with less professional liability. Defensive medicine is based on avoiding malpractice liability rather than considering a risk-benefit analysis for both investigations and treatment.

Complaints, shame and defensive medicine.

While the complaints process is intended to improve healthcare, some doctors appear to practise defensive medicine after receiving a complaint. This response occurs in countries that use a tort-based medicolegal system as well as in countries with less professional liability. Defensive medicine is based on avoiding malpractice liability rather than considering a risk-benefit analysis for both investigations and treatment.

Public and private funding of general practice services for children and adolescents in New Zealand.

Objective: To measure public and private funding of general practice services for New Zealand children.

Methods: Computerized records from 111 general practices provided private payments for 118,905 general practice services to children aged 6-17 years. Government subsidies and public insurance payments provided public funding amounts for seven services.

Addressing stress-related impairment in doctors. A survey of providers' and doctors' experience of a funded counselling service in New Zealand.

Aims: In January 2006 the Medical Protection Society (MPS) and Medical Assurance Society (MAS) commenced a jointly funded counselling service for stressed doctors in New Zealand. Stressed and impaired doctors may impact negatively on patient care. This study aims to investigate the service's utilisation, acceptability, and utility, and to consider whether the service may improve the delivery of health services.

Defensive changes in medical practice and the complaints process: a qualitative study of New Zealand doctors.

Aim: To characterise doctors' responses to complaints.

Method: Survey of a systematic sample of New Zealand doctors, and indepth interviews with 12 doctors who recently received complaints.

Results: 714 written survey responses and 12 indepth interviews revealed changes consistent with positive and negative defensive medicine as well as changes in the direction of "good practice".

Evaluation of factors associated with positive IgM capture ELISA results in equids with clinical signs compatible with West Nile virus infection: 1,017 cases (2003).

Objective: To describe the prevalence of West Nile virus (WNV) infection and evaluate factors associated with positive IgM capture ELISA results in equids with clinical signs compatible with WNV infection.

Design: Retrospective case series.

Sample Population: Laboratory submission forms from 1,104 equids tested for WNV in Colorado in 2003.

The medical complaints and disciplinary process in New Zealand: doctors' suggestions for change.

Aim: To document New Zealand doctors' opinions about the complaints and disciplinary process, and to develop a proposal for change.

Method: A cross-sectional survey of New Zealand doctors randomly selected to include vocationally registered general practitioners, vocationally registered hospital-based specialists, and general registrants. Qualitative (thematic) analysis of written responses was used to categorise doctors' ideas about the complaints system, and to develop a proposal for change

Results: 453 doctors responded to the survey.

New Zealand doctors' attitudes towards the complaints and disciplinary process.

Aim: To examine attitudes held by doctors in New Zealand towards the complaints and disciplinary process.

Method: A questionnaire was sent to New Zealand doctors randomly selected to include vocationally registered general practitioners, vocationally registered hospital-based specialists, and general registrants.

Results: 598 respondents (33.