Simon Horsburgh

Do they want it? Do they use it? The ‘Demand-Side’ of e-Government in Australia and New Zealand

Abstract Drawing on 435 telephone interviews in Australia and 498 in New Zealand, this paper investigates the ‘demand’ side of e-government. That is, we examine the use of and support for e-government measures. Whilst respondents were generally supportive of e-government on a number of measures, we find that the majority were reluctant to use some of the more sophisticated ‘transactional’ e-government measures, and less than half had even visited a government website. High users of information and communications technologies (ICT) were more likely to use e-government measures, and are more positive towards e-government in general across several measures. Similar to a number of U.S. studies, we find a ‘digital divide,’ where older age, and less education were associated with lower ICT and e-government use and support. Income level was not a statistically significant predictor in all cases however, and gender was not significant for e-government support.

Fatal work related injuries in agricultural production and services to agriculture sectors of New Zealand, 1985-94

OBJECTIVES To describe work related fatal injuries to agricultural workers in New Zealand to identify priority areas for further research and injury control measures. METHODS Injury deaths in New Zealanders aged 15–84 inclusive for the period 1985–94 were identified and the coroners files for these obtained. These files were then reviewed to determine whether the death arose as a result of work activities. Those deaths considered to be work related were coded for information relating to decedent demographics and the circumstances of the fatal injury. Work related deaths from injury occurring in the agricultural production and services to agriculture sectors were analysed. RESULTS The rate of fatal injuries to male agricultural workers over the study period was 21.2/100 000, with injury deaths in the agricultural sectors accounting for nearly a quarter of all work related fatal injuries in New Zealand in that time. There was no significant decline in fatal injuries to agricultural workers in the study decade. Workers in the 65–84 age bracket were at substantially higher risk of fatal injury than other age groups. Machinery and motor vehicles were commonly associated with fatal injury, with overturns on or next to embankments and slopes being the most frequent scenario. CONCLUSIONS The results of this study highlight fatal injuries in older workers and machinery incidents (particularly tractors overturning) as priority areas for further research into contributing factors and injury control measures.

The clinical governance development index: results from a New Zealand study

Background Clinical governance is seen as pivotal to improving healthcare quality, yet there are few available tools for tracking progress on its implementation. With this in mind, the authors developed a Clinical Governance Development Index (CGDI) designed to track performances between healthcare organisations and over time. Methods A survey on implementation of government policy on clinical governance was sent to 3402 New Zealand public hospital specialists. Responses to seven survey items were weighted and combined to form the CGDI. Final scores for each of New Zealands 21 District Health Boards were converted to percentages. Results The mean CGDI score was 47.3%, with significant differences in performances across the 21 District Health Boards (F(20, 1178)=3.233, p=0.0000). Scores were higher in boards where respondents perceived governing boards and management worked to support clinical leadership. Conclusion The CGDI offers a simple method for measuring the extent to which a healthcare organisation is working to develop clinical governance. Its use in New Zealand provides a baseline for tracking clinical governance over time. The CGDI could be easily adapted for use in other healthcare systems.

Gout: Joints and beyond, epidemiology, clinical features, treatment and co-morbidities

Gout is a common inflammatory arthritis precipitated by an inflammatory reaction to urate crystals in the joint. Gout is increasingly being recognised as a disease primarily of urate overload with arthritis being a consequence of this pathological accumulation. It is associated with a number of important co-morbidities including chronic kidney disease, obesity, diabetes and cardiovascular disease. The prevalence of gout is increasing around the world. Significant progress has been made in determining the genetic basis for both gout and hyperuricaemia. Environmental risk factors for gout have been identified as certain foods, alcohol and several medications. There is, however, little evidence that changing these environmental risks improves gout on an individual level. Treatment of gout encompasses two strategies: firstly treatment of inflammatory arthritis with non-steroidal anti-inflammatories, corticosteroids, colchicine or interleukin-1 inhibitors. The second and most important strategy is urate lowering, to a target of 0.36 mmol/L (6 mg/dL) or potentially lower in those with tophi (collections of crystalline urate subcutaneously). Along with urate lowering, adequate and prolonged gout flare prophylaxis is required to prevent the precipitation of acute attacks. Newer urate lowering agents are in development and have the potential to significantly expand the potential treatment options. Education of patients regarding the importance of life long urate lowering therapy and prophylaxis of acute attacks is critical to treatment success as adherence with medication is low in chronic diseases in general but especially in gout.

Is Public Trust in Government Associated With Trust in E-Government?

The term e-government describes the use of information and communications technology, particularly the Internet, for the delivery of public services. As governments invest in e-government, there is only limited knowledge of the extent of public trust in the new electronic modes of delivery; we also know little about whether there is any relationship between trust in government and trust in e-government. This article reports on research designed to probe this issue. Drawing on survey data from Australia and New Zealand, a series of hypotheses are tested pertaining to relationships between public trust in government and e-government, in the use of information and communications technology and trust in e-government, and support for e-government investment and development. Trust in government was found not to be correlated with trust in facets of e-government service provision but was associated with support for e-government investment. More intensive Internet users were more likely to trust e-government services.

Too much and too little? Prevalence and extent of antibiotic use in a New Zealand region

OBJECTIVES Although antibiotic use in the community is a significant contributor to resistance, little is known about social patterns of use. This study aimed to explore the use of antibiotics by age, gender, ethnicity, socio-economic status and rurality. METHODS Data were obtained on all medicines dispensed to ambulatory patients in one isolated town for a year, and data on antibiotics are presented in this paper. Demographic details were obtained from pharmacy records or by matching to a national patient dataset. RESULTS During the study year, 51% of the population received a prescription for one or more antibiotics, and on average people in the region received 10.15 defined daily doses (DDDs). Prevalence of use was higher for females (ratio, 1.18), and for young people (under 25) and the elderly (75 and over), and the amount in DDDs/person/year broadly followed this pattern. Māori (indigenous New Zealanders) were less likely to receive a prescription (48% of the population) than non-Māori (55%) and received smaller quantities on average. Rural Māori, including rural Māori children, received few prescriptions and low quantities of antibiotics compared with other population groups. CONCLUSIONS The level of antibiotic use in the general population is high, despite campaigns to try to reduce unnecessary use. The prevalence of acute rheumatic fever is high amongst rural Māori, and consequently treatment guidelines recommend prophylactic use of antibiotics for sore throat in this population. This makes the comparatively very low level of use of antibiotics amongst rural Māori children very concerning.

The Equity in Prescription Medicines Use Study: Using community pharmacy databases to study medicines utilisation

PURPOSE Pharmacy dispensing databases provide a comprehensive source of data on medicines use free from many of the biases inherent in administrative databases. There are challenges associated with using pharmacy databases however. This paper describes the methods we used, and their performance, so that other researchers considering using pharmacy databases may benefit from our experiences. METHODS Data were collected from all nine pharmacy dispensing databases in an isolated New Zealand town for the period October 2005-September 2006. Probabilistic record matching was used to link individuals across pharmacies. Patient addresses from the pharmacy data were geo-located to small areas so an area measure of socioeconomic deprivation could be assigned. Medicines were coded according to the ATC-DDD drug classification system. RESULTS Data on 619,264 dispensings were collected. Record matching reduced an initial pool of individuals from 54,484 to 38,027. Socioeconomic deprivation ranks were assigned for 30,972 (93%) of the 33,375 unique addresses identified, or 36,048 (95%) of individuals. ATC codes were assigned to 613,490 (99%) of the dispensings, with DDDs assigned to 561,223 (91%). Overall, 93% of dispensing records had complete demographic and drug information. CONCLUSIONS The methods described in this paper generated a rich dataset for medicines use research. These methods, while initially resource-intensive, can to a great extent be automated and applied to other locations, and will hopefully prove useful to other researchers facing similar challenges with using pharmacy databases. However, it is difficult to envisage these methods being viable on a long-term or national scale.

Geographical access to community pharmacies in New Zealand

Geographic access to community pharmacies is an important aspect of access to appropriate medicines. This study aimed to explore changes in the number and location of pharmacies in New Zealand and determine whether some populations have poor geographical access to pharmacies. Pharmacy numbers in New Zealand have been declining since the mid-1980s, and, adjusted for population growth, there are now only half the number there was in 1965. While the urbanisation of pharmacies has been matched by loss of population in rural areas, the loss of pharmacies from smaller rural towns leaves many people with poor access to pharmacy services.

Medicalisation or Under-treatment? Psychotropic Medication Use by Elderly People in New Zealand

Abstract The increased use of information technology in health care allows researchers to generate data on rates of medication use among population groups, raising questions as to whether these rates are too high or too low. This paper presents findings from a study of records of all prescription medication dispensed in one New Zealand region (Te Tāirawhiti) over a one year period. The study examined patterns of psychotropic medication use amongst older people, by age, gender, ethnicity and socio-economic position. It concludes that the chances of being defined as needing psychotropic medication, that is, of being ‘medicalised’, are not evenly spread through the elderly population. Gender, age and ethnicity impacted significantly on whether prescriptions were received. Our results suggest the need for a nuanced understanding of the medicalisation of unhappiness and deviant behaviour amongst the elderly which takes into account barriers to treatment for some social groups.

Measuring progress with clinical governance development in New Zealand: perceptions of senior doctors in 2010 and 2012

BackgroundClinical governance has become a core component of health policy and services management in many countries in recent years. Yet tools for measuring its development are limited. We therefore created the Clinical Governance Development Index (CGDI), aimed to measure implementation of expressed government policy in New Zealand.MethodsWe developed a survey which was distributed in 2010 and again in 2012 to senior doctors employed in public hospitals. Responses to six survey items were weighted and combined to form the CGDI. Final scores for each of New Zealand’s District Health Boards (DHBs) were calculated to compare performances between them as well as over time between the two surveys.ResultsNew Zealand’s overall performance in developing clinical governance improved between the two studies from 46% in 2010 to 54% in 2012 with marked differences by DHB. Statistically significant shifts in performance were evident on all but one CGDI item.ConclusionsThe CGDI is a simple yet effective method which probes aspects of organisational commitment to clinical governance, respondent participation in organisational design, quality improvement, and teamwork. It could be adapted for use in other health systems.