Steven Lillis

Palliative care provision by rural general practitioners in New Zealand.

OBJECTIVES The aim of this study was to ascertain the workload for rural general practitioners providing palliative care and to identify barriers to care for patients living in rural areas of New Zealand. DESIGN AND METHODS This was a cross-sectional survey of rural general practitioners using a postal questionnaire. RESULTS One hundred eighty-six questionnaires were returned. Of respondents, 98% provided palliative care. The estimated mean number of patients cared for in the previous 12 months was 7.3. Specialist medical advice from a hospice or palliative care consultant was accessed by 77% of respondents. District and community nursing was available to over 90% of respondents but this was not universally available 24 hours a day in all areas. Forty-seven percent of rural palliative care patients died at home. CONCLUSIONS Commitment of general practitioners to palliative care appeared high although the workload was a relatively small part of their activity. There seems to be a need for wider availability of specialist advice, 24-hour nursing cover, and some support services. A commitment to supporting domiciliary services is needed if large increases in institutional care are to be avoided in the future.

Epidemiology of thyroid disease in Hamilton (New Zealand) general practice

Objective: To retrospectively review health records in two general practices in Hamilton, New Zealand (NZ) linking three data sources to estimate the prevalence of diagnosed thyroid dysfunction (TD).

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. Methods “Harm” is defined as disease, injury, disability, suffering, and death, arising from the health system. The study design is a stratified, 2-level cluster, retrospective records review study. Both general practices and patients will be randomly selected so that the study’s results will apply nationally, after weighting. Stratification by practice size and rurality will allow comparisons between 6 study groups (large, medium-sized, small; urban and rural practices). Records of equal numbers of patients from each study group will be included in the study because there may be systematic differences in patient harms in different types of practices. Eight general practitioner investigators will review 3 years of electronic general practice health records (consultation notes, prescriptions, investigations, referrals, and summaries of hospital care) from 9000 patients registered in 60 general practices. Double-blinded reviews will check the concordance of reviewers’ assessments. Study data will comprise demographic data of all 9000 patients and reviewers’ assessments of whether patients experienced harm arising from health care. Where patient harm is identified, their types, preventability, severity, and outcomes will be coded using the Medical Dictionary for Regulatory Activities (MedDRA) 18.0. Results We have recruited practices and collected electronic records from 9078 patients. Reviews of these records are under way. The study is expected to be completed in August 2017. Conclusions The design of this complex study is presented with discussion on data collection methods, sampling weights, power analysis, and statistical approach. This study will show the epidemiology of patient harms recorded in general practice records for all of New Zealand and will show whether this epidemiology differs by rural location and clinic size.

Progress Testing for Medical Students at The University of Auckland: Results from The First Year of Assessments

Background Progress testing is a method of assessing longitudinal progress of students using a single best answer format pitched at the standard of a newly graduated doctor. Aim To evaluate the results of the first year of summative progress testing at the University of Auckland for Years 2 and 4 in 2013. SUBJECTS: Two cohorts of medical students from Years 2 and 4 of the Medical Program. Methods A survey was administered to all involved students. Open text feedback was also sought. Psychometric data were collected on test performance, and indices of reliability and validity were calculated. Results The three tests showed increased mean scores over time. Reliability of the assessments was uniformly high. There was good concurrent validity. Students believe that progress testing assists in integrating science with clinical knowledge and improve learning. Year 4 students reported improved knowledge retention and deeper understanding. Conclusion Progress testing has been successfully introduced into the Faculty for two separate year cohorts and results have met expectations. Other year cohorts will be added incrementally. Recommendation Key success factors for introducing progress testing are partnership with an experienced university, multiple and iterative briefings with staff and students as well as demonstrating the usefulness of progress testing by providing students with detailed feedback on performance.

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. 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.

A qualitative exploration of student perceptions of the impact of progress tests on learning and emotional wellbeing

BackgroundProgress testing was introduced to the MBChB programme at the University of Auckland in 2013. As there has been a focus in published literature on aspects relating to the format or function of progress tests, the purpose of this study was to explore a qualitative student perspective on the introduction of progress testing and its impact on approaches to learning and perceived stress.MethodsThis article presents the qualitative aspects of a longitudinal evaluation study. The qualitative data were derived from eight focus groups of Year 2–5 medical students in the University of Auckland medical programme.ResultsTwo themes, ‘Impact on Learning’ and ‘Emotional Wellbeing’ and their subthemes offered insight into student perceptions and behaviour. Students described a variety of learning responses to progress testing that clustered around the employment of a range of learning strategies based on their experience of sitting progress tests and their individualised feedback. A range of emotional responses were also expressed, with some finding progress tests stressful, while others enjoyed not needing to intensively cram before the tests.ConclusionsProgress tests appear to influence the approach of students to their learning. They employ a mix of learning strategies, shaped by their performance, individualised feedback and the learning environment. While students expressed some stress and anxiety with respect to sitting progress tests, this form of testing was viewed by these students as no worse, and sometimes better than traditional assessments.