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Issue

Vol 129 No 1435: 27 May 2016

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Issue Summary

SUMMARY

Cardiac rehabilitation in New Zealand moving forward

Jocelyne Benatar, Fiona Doolan-Noble, Andrew McLachlan

To reduce the risk of another heart attack or of death, patients need to focus on becoming smoke free, exercising, taking the right combination of drugs for life, managing depression and anxiety and eating healthily. The challenge is that hospital stays are short (average 2-3 days) and patients are increasingly complex (often older, have kidney disease, obesity, diabetes). Primary health care providers have neither the time nor resource to comprehensively manage patients in the immediate period post discharge when patients are often still unstable. Modern cardiac rehabilitation is cost effective vehicle and improves patient outcomes, but programs need to be standardised and adequately resourced. The challenge for cardiac rehabilitation is to be flexible to address patient s needs and increasingly complex medical issues. Access to prescribed exercise programs and individualised sessions, for example nurse specialist clinics, needs to be increased nationwide.

SUMMARY

A national survey of cardiac rehabilitation services in New Zealand: 2015

Geoff Kira, Fiona Doolan-Noble, Grace Humphreys, Gina Williams, Helen OShaughnessy, Gerry Devlin

Cardiac rehabilitation is a suite of interventions that promote recovery from a heart event. A survey of all cardiac rehabilitation services in New Zealand was undertaken in 2015. Many units did not meet the guidelines standards set out in the 2002 New Zealand Cardiac Rehabilitation Best Practice guidelines. It is unknown what effect this has on patient outcomes because there is no standardised process of collecting patient-specific outcome indicator data, for example smoking cessation, for comparison between services. We conclude it is crucial that a national database of cardiac rehabilitation be established to support improved cardiac rehabilitation services.

SUMMARY

Dispensing data captures individual-level use of aspirin for cardiovascular disease prevention, despite availability over-the-counter

Vanessa Selak, Yulong Gu, Natasha Rafter, Sue Crengle, Andrew Kerr, Chris Bullen

The use of triple therapy (aspirin/antiplatelet, blood pressure-lowering and statin medication) is monitored as a national quality indicator in New Zealand among people who have had a cardiovascular event (eg, heart attack or stroke), for whom all three medications are recommended. Monitoring is undertaken using national pharmaceutical dispensing data, but because aspirin is available over-the-counter (ie, without being prescribed by a doctor and dispensed by a pharmacist), dispensing data may underestimate aspirin use. We compared aspirin medication use measured by self-report and dispensing data among New Zealand patients for whom triple therapy was recommended by their general practitioner, and found that the level of agreement between these two measures was comparable to that for blood pressure-lowering and statin medication, which are not available over-the-counter. We conclude that in New Zealand, aspirin dispensing is a valid source of data for the use of this medication among patients with cardiovascular indications, despite its availability over-the-counter.

SUMMARY

Antimicrobial stewardship using pharmacy data for the nurse-led school-based clinics in Counties Manukau District Health Board for management of group A streptococcal pharyngitis and skin infection

Jia-Yun Catherine Tsai, Philippa Anderson, Laura Broome, Tracy McKee, Diana Lennon

Antimicrobial dispensing data sampled from pharmacies participating in the programme show that the antimicrobial prescribing pattern is conservative and well complies with the operating guidelines. There was very limited use of second-line antimicrobials for recurrent pharyngitis, and repeating exposure per person is uncommon. This audit provides affirmation that antimicrobials are used in an efficient and judicious way in the programme.

SUMMARY

Medical students: where have they come from; where are they going?

Phillippa Poole, Tom Stoner, Antonia Verstappen, Warwick Bagg

Shortages of doctors in regional and rural (RR) areas in New Zealand continue. This study explored the relationship between geographic background and intended location of future practice of University of Auckland medical students over the past decade. Over a fifth of medical students were from RR backgrounds, with most admitted to medical school through a designated rural entry pathway. These RR students were nearly three times more likely than urban students to intend to work in an RR area, but nearly half had switched towards an urban career intention by graduation. Of all students intending an RR career, the number of urban students exceeded the number of RR background students. Next steps are to better understand factors which consolidate RR career choices in both groups.

SUMMARY

Funding New Zealand s public healthcare system: time for an honest appraisal and public debate

Lyndon Keene, Philip Bagshaw, M Gary Nicholls, Bill Rosenberg, Christopher M Frampton, Ian Powell

Contrary to claims made by successive New Zealand Governments that current trends in public health spending are unsustainable, government data show the country can afford to spend more on health. There are compelling health and economic grounds for doing so. If our growing health care needs are not met, they still have to be borne by the economy. Investment in health can mitigate those costs, improve the country s productivity and improve the quality of life.

ALL ARTICLES
SUMMARY

Cardiac rehabilitation in New Zealand moving forward

Jocelyne Benatar, Fiona Doolan-Noble, Andrew McLachlan

Flexible sigmoidoscopy and bowel cancer screening: reply to Professor Cox

Paul Frankish, Michael Hulme-Moir, Russell Walmsley

Defence of the Living Dead: zombies as vectors for transmitting positive health messages

Rajan Ragupathy

A national survey of cardiac rehabilitation services in New Zealand: 2015

Geoff Kira, Fiona Doolan-Noble, Grace Humphreys, Gina Williams, Helen OShaughnessy, Gerry Devlin

Menevit the data never seen

Lance Gravatt

Alexander Keith Jeffery

Lesley and Bill Gillespie

Allied health professionals perspectives of working with dysphagia in a rural paediatric team

Aimee Burgess, Suzanne Purdy, Bianca Jackson

More flexible approaches are needed to improve cardiac rehabilitation

Ralph AH Stewart

Losartan and amlodipine overdose case report of a patient with anuric renal failure prior to the onset of hypotension

Fiona Croft, Emma Brunette-Lawrey

Clemens Franzmayr

E Eliot, J Keightley

A few notes on a case of complicated fracture of the femur of unusual type

A 'Rottie' appendix

Jonathan Paulin, Omid Yassaie

Dispensing data captures individual-level use of aspirin for cardiovascular disease prevention, despite availability over-the-counter

Vanessa Selak, Yulong Gu, Natasha Rafter, Sue Crengle, Andrew Kerr, Chris Bullen

Clinical insignificance of alcohol in salbutamol metered-dose inhalers it s time to stop flogging the horse

Felix SF Ram, Elissa M McDonald

Freemasons Postgraduate Fellowships in Paediatrics and Child Health for 2017

Antimicrobial stewardship using pharmacy data for the nurse-led school-based clinics in Counties Manukau District Health Board for management of group A streptococcal pharyngitis and skin infection

Jia-Yun Catherine Tsai, Philippa Anderson, Laura Broome, Tracy McKee, Diana Lennon

Medical students: where have they come from; where are they going?

Phillippa Poole, Tom Stoner, Antonia Verstappen, Warwick Bagg

Cardiovascular risks associated with clarithromycin

Funding New Zealand s public healthcare system: time for an honest appraisal and public debate

Lyndon Keene, Philip Bagshaw, M Gary Nicholls, Bill Rosenberg, Christopher M Frampton, Ian Powell

SUMMARY

Cardiac rehabilitation in New Zealand moving forward

Jocelyne Benatar, Fiona Doolan-Noble, Andrew McLachlan

To reduce the risk of another heart attack or of death, patients need to focus on becoming smoke free, exercising, taking the right combination of drugs for life, managing depression and anxiety and eating healthily. The challenge is that hospital stays are short (average 2-3 days) and patients are increasingly complex (often older, have kidney disease, obesity, diabetes). Primary health care providers have neither the time nor resource to comprehensively manage patients in the immediate period post discharge when patients are often still unstable. Modern cardiac rehabilitation is cost effective vehicle and improves patient outcomes, but programs need to be standardised and adequately resourced. The challenge for cardiac rehabilitation is to be flexible to address patient s needs and increasingly complex medical issues. Access to prescribed exercise programs and individualised sessions, for example nurse specialist clinics, needs to be increased nationwide.

SUMMARY

A national survey of cardiac rehabilitation services in New Zealand: 2015

Geoff Kira, Fiona Doolan-Noble, Grace Humphreys, Gina Williams, Helen OShaughnessy, Gerry Devlin

Cardiac rehabilitation is a suite of interventions that promote recovery from a heart event. A survey of all cardiac rehabilitation services in New Zealand was undertaken in 2015. Many units did not meet the guidelines standards set out in the 2002 New Zealand Cardiac Rehabilitation Best Practice guidelines. It is unknown what effect this has on patient outcomes because there is no standardised process of collecting patient-specific outcome indicator data, for example smoking cessation, for comparison between services. We conclude it is crucial that a national database of cardiac rehabilitation be established to support improved cardiac rehabilitation services.

SUMMARY

Dispensing data captures individual-level use of aspirin for cardiovascular disease prevention, despite availability over-the-counter

Vanessa Selak, Yulong Gu, Natasha Rafter, Sue Crengle, Andrew Kerr, Chris Bullen

The use of triple therapy (aspirin/antiplatelet, blood pressure-lowering and statin medication) is monitored as a national quality indicator in New Zealand among people who have had a cardiovascular event (eg, heart attack or stroke), for whom all three medications are recommended. Monitoring is undertaken using national pharmaceutical dispensing data, but because aspirin is available over-the-counter (ie, without being prescribed by a doctor and dispensed by a pharmacist), dispensing data may underestimate aspirin use. We compared aspirin medication use measured by self-report and dispensing data among New Zealand patients for whom triple therapy was recommended by their general practitioner, and found that the level of agreement between these two measures was comparable to that for blood pressure-lowering and statin medication, which are not available over-the-counter. We conclude that in New Zealand, aspirin dispensing is a valid source of data for the use of this medication among patients with cardiovascular indications, despite its availability over-the-counter.

SUMMARY

Antimicrobial stewardship using pharmacy data for the nurse-led school-based clinics in Counties Manukau District Health Board for management of group A streptococcal pharyngitis and skin infection

Jia-Yun Catherine Tsai, Philippa Anderson, Laura Broome, Tracy McKee, Diana Lennon

Antimicrobial dispensing data sampled from pharmacies participating in the programme show that the antimicrobial prescribing pattern is conservative and well complies with the operating guidelines. There was very limited use of second-line antimicrobials for recurrent pharyngitis, and repeating exposure per person is uncommon. This audit provides affirmation that antimicrobials are used in an efficient and judicious way in the programme.

SUMMARY

Medical students: where have they come from; where are they going?

Phillippa Poole, Tom Stoner, Antonia Verstappen, Warwick Bagg

Shortages of doctors in regional and rural (RR) areas in New Zealand continue. This study explored the relationship between geographic background and intended location of future practice of University of Auckland medical students over the past decade. Over a fifth of medical students were from RR backgrounds, with most admitted to medical school through a designated rural entry pathway. These RR students were nearly three times more likely than urban students to intend to work in an RR area, but nearly half had switched towards an urban career intention by graduation. Of all students intending an RR career, the number of urban students exceeded the number of RR background students. Next steps are to better understand factors which consolidate RR career choices in both groups.

SUMMARY

Funding New Zealand s public healthcare system: time for an honest appraisal and public debate

Lyndon Keene, Philip Bagshaw, M Gary Nicholls, Bill Rosenberg, Christopher M Frampton, Ian Powell

Contrary to claims made by successive New Zealand Governments that current trends in public health spending are unsustainable, government data show the country can afford to spend more on health. There are compelling health and economic grounds for doing so. If our growing health care needs are not met, they still have to be borne by the economy. Investment in health can mitigate those costs, improve the country s productivity and improve the quality of life.

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