Reduced community antibiotic dispensing in New Zealand during 2015-2018: marked variation in relation to primary health organisation.

Aims: The overall rate of community antibiotic dispensing in New Zealand in recent decades has been high when compared with many other nations, but since 2015 has consistently declined each year. We aimed to determine whether the magnitude of reductions in community antibiotic dispensing in New Zealand between 2015 and 2018 differed in relation either to the patient's demographic features or in relation to the primary health organisation of the patient's registered general practitioner.

Methods: Demographic data on all patients registered with a general practice in New Zealand, and on all community pharmacy antibiotic dispensing for these patients during 2013-2018 were obtained from national healthcare databases.

Ethnic inequality in non-steroidal anti-inflammatory drug-associated harm in New Zealand: A national population-based cohort study.

Purpose: Non-steroidal anti-inflammatory drugs (NSAIDs) are associated with many serious complications and they are widely used in New Zealand (NZ). However, differences in NSAID-associated risk for these complications between ethnic groups are largely unknown. We assessed ethnic disparities in risk of hospital admission for upper gastrointestinal bleeding (UGIB), heart failure, and acute kidney failure (AKF) in NZ's primary care population prescribed and dispensed NSAIDs.

Trends in prescription medicine use by older people in New Zealand 2010- 2015: a national population-based study.

Background: Research investigating trends in the general prescription medicine use of older people in New Zealand is limited.

Aim: To examine trends in the use of outpatient medicines by older adults and assess changing patterns in use from 2010 to 2015.

Methods: A retrospective cohort study including all New Zealand primary care patients over 65 years of age utilising data from the national pharmaceutical claims database.

Mortality and morbidity of patients with treated and untreated epilepsy in New Zealand.

Objective: To investigate whether delayed or no treatment was associated with increased mortality and morbidity risks in people with newly diagnosed epilepsy.

Methods: We examined New Zealand hospitalization and antiseizure medication prescription data from 2007-2015. Mortality and hospital-diagnosed morbidities were compared between patients immediately treated after epilepsy diagnosis, treated after a delay, or untreated for the duration of follow-up, adjusted for age, sex, and ethnicity.

Fatal Toxicity Indices for Medicine-Related Deaths in New Zealand, 2008-2013.

Introduction: The fatal toxicity index (FTI) is a measure for assessing the relative risks of death due to the medicines prescribed in a population. This knowledge is useful for prescribers and informs medicine safety initiatives. This study aimed to calculate FTIs for the New Zealand population using three methodologies.

Deaths by poisoning in New Zealand, 2008-2013.

While a number of developed countries have witnessed a decline in carbon monoxide (CO) deaths and increasing numbers of opioid-related fatalities, it is not known whether these or other trends have occurred in New Zealand. The aim of this study was, therefore, to review deaths due to poisoning in New Zealand, describe the causative substances, and identify any trends. Retrospective study reviewing New Zealand's poison-related death findings recorded in the National Coronial Information System (NCIS) database over the 6-year period 2008-2013.

Ethnic disparities in community antibacterial dispensing in New Zealand, 2015.

Aims: There are significant ethnic disparities in the incidence of various infectious diseases in New Zealand. Antimicrobial stewardship interventions which ignore these disparities may have negative effects on the health of some ethnic groups. We aimed to determine the relationship between ethnicity and community antimicrobial dispensing in New Zealand, to inform the development of antimicrobial stewardship interventions in New Zealand.

Trends in Outpatient Prescription Medicine Use in New Zealand Children 2010-2015: A National Population-Based Study.

Background: Research examining trends in the outpatient prescription medicine use of New Zealand children is limited.

Objectives: Our objective was to provide an overview of prescription medicine use in New Zealand children and assess changing patterns in use from 2010 to 2015.

Methods: We conducted a retrospective cohort study including all New Zealand primary care-registered children aged < 18 years using data from the national pharmaceutical claims database.

Understanding medicines with a propensity to increase the risk of heart failure: Combining existing knowledge with targeted population assessment.

Purpose: Existing knowledge of medicines that increase the risk of an adverse event may be corroborated and augmented by population studies specifically assessing the risk associated with the concurrent use of these medicines and use by patients with existing comorbidity. An American Heart Association review recently identified a variety of medicines that may cause or exacerbate heart failure (HF), many with evidence from limited evaluation of population data. We assessed the risk of first-time HF associated with the use of 50 of these medicines by New Zealand's primary care population.

Prevalence and risk factors for chronic kidney disease in primary health care in the southern region of New Zealand.

Aim: While the prevalence of end stage kidney disease in New Zealand (NZ) is well defined, the prevalence of chronic kidney disease (CKD) in NZ is unknown. To estimate the prevalence of and risk factors for CKD in the southern region of New Zealand.

Methods: A retrospective electronic health record cohort study using data from the Southern Primary Care register covering 94% of the population.

A Pharmacoepidemiology Database System for Monitoring Risk Due to the Use of Medicines by New Zealand Primary Care Patients.

Introduction: The use of large record-linked healthcare databases for drug safety research and surveillance is now accepted practice. New Zealand's standardized national healthcare datasets provide the potential to automate the conduct of pharmacoepidemiological studies to provide rapid validation of medicine safety signals.

Objectives: Our objectives were to describe the methodology undertaken by a semi-automated computer system developed to rapidly assess risk due to drug exposure in New Zealand's population of primary care patients and to compare results from three studies with previously published findings.

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.

Atrial fibrillation in New Zealand primary care: Prevalence, risk factors for stroke and the management of thromboembolic risk.

Background Atrial fibrillation is a major risk factor for stroke and heart disease but there is limited information on its prevalence in New Zealand primary care or the treatment provided to manage thromboembolic risk. Our aim was to estimate the prevalence of atrial fibrillation, assess patient risk for thromboembolism and evaluate the appropriateness of risk reduction using antiplatelet and oral anticoagulation therapy. Design A retrospective cohort study utilising electronic medical records for 739,000 patients registered with 170 general practices in 2014.

Dunedin's free clinic: an exploration of its model of care using case study methodology.

Introduction: Models of care are important therapeutic modalities for achieving the goals of health care teams, but they are seldom explicitly stated or investigated.

Aim: To describe the model of care at Dunedin's free clinic, and assess whether this model catered to the particular needs of enrolled patients.

Methods: A mixed methods study was conducted using case study methodology to construct the clinic's model of care from multiple data sources, and to create a profile of patients' needs.

Patient outcomes from 10 years of annual diabetes reviews in New Zealand.

Aims: To examine trends in patient health outcomes 2001-2010 for patients receiving free annual diabetes reviews in New Zealand.

Methods: Clinical, demographic and hospital admissions data were analysed for 2175 Type 1 and 25,436 Type 2 diabetes mellitus patients presenting at 170 general practices. Changes in clinical measures and proportions of patients achieving guideline targets and receiving recommended processes of care were assessed by calendar year and for patients returning for successive annual diabetes reviews.

Ethnic disparities in asthma treatment and outcomes in children aged under 15 years in New Zealand: analysis of national databases.

Background: Mãori and Pacific children experience poorer outcomes relating to asthma management than other ethnicities.

Aims: To measure recommended treatment and outcomes for asthma in all New Zealand children by age, sex, and ethnic group.

Methods: Children aged <15 years dispensed >2 asthma medicines (N=80,514) were identified from the national pharmaceutical claims database.

Methods for retrospective detection of drug safety signals and adverse events in electronic general practice records.

Background: Examination of clinical data routinely recorded in general practice provides significant opportunities for identifying and quantifying medicine-related adverse events not captured by spontaneous adverse reaction reporting systems. Robust pharmacovigilance methods for detecting and monitoring adverse events due to treatment with new and existing medicines are required to estimate the true extent of adverse events experienced by primary care patients.

Objectives: The aim of the study was to examine evidence of adverse events contained in general practice electronic records and to study observed events related to selective serotonin reuptake inhibitors (SSRIs) as an example of drug-specific pharmaceutical surveillance achievable with these data.

Better use of primary care laboratory services following interventions to 'market' clinical guidelines in New Zealand: a controlled before-and-after study.

Context: Laboratory tests for inflammatory response, thyroid function and infectious diarrhoea were not being ordered as recommended by clinical guidelines.

Objective: To measure changes in community laboratory-test ordering following marketing programmes promoting guidelines recommendations.

Design: Controlled before-and-after study involving 2 years of national laboratory payment data before and after each intervention.

Delivering medicines in a challenging environment: the pharmaceutical sector in East Timor (a descriptive study).

Background: The health status of the East Timorese population is very poor and much of the health system was destroyed during the violence of 1999. As in other developing countries, the lack of appropriate and high quality medicines significantly compromises patient care throughout the health system. The aim of this study was to examine the purchase, distribution and supply of pharmaceuticals in East Timor, and to identify the challenges faced by the pharmaceutical sector.