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Issue

Vol 132 No 1491: 8 March 2019

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Issue Summary

SUMMARY

District health board of residence, ethnicity and socioeconomic status all impact publicly funded insulin pump uptake in New Zealand patients with type 1 diabetes

Benjamin J Wheeler, Rhiannon Braund, Barbara Galland, Anastasia Mikuscheva, Esko Wiltshire, Craig Jefferies, Michel de Lange

Insulin pump therapy is becoming increasingly common for those living with type 1 diabetes, and has been publicly funded in New Zealand since 2012. This study aimed to examine national uptake of publicly funded insulin pumps from 2012 to 2016 using data provided by the Ministry of Health. The main findings show that from 2012 to 2016 there has been a steadily increasing uptake of pumps. Despite publicly funded access, disparities in use appear to exist, including by district health board of residence as well as traditionally described socio-demographic barriers to healthcare (ethnicity, socioeconomic status, age, gender). Efforts to understand and reduce these disparities are required.

SUMMARY

New Zealand Society of Gastroenterology Guidelines on Therapeutic Drug Monitoring in Inflammatory Bowel Disease

Afrasyab Khan, Arvenia B Berahmana, Andrew S Day, Murray L Barclay, Michael Schultz

Various medications are available for the treatment of inflammatory bowel disease. The effective use of these medications is important and leads to better outcomes. Monitoring the level of medications and/or their breakdown products (therapeutic drug monitoring) in a patient s blood can lead to more effective and individualised dosage recommendations. These blood tests are available in New Zealand. Therapeutic drug monitoring can decrease the risk of drug toxicity and help in decision making for further treatment if one therapy seems to be failing. This document represents the New Zealand Society of Gastroenterology Guidelines on Therapeutic Drug Monitoring in Inflammatory Bowel Disease.

SUMMARY

Considering evidence for ethnicity bias using assessment case scenarios and medical student correctness and certainty

Mike Tweed, Gordon Purdie, Cameron Lacey

Analysis of student responses allowing for the ethnicity of the patient as described in a test can be used to investigate for evidence of variations in response patterns. Variations in response patterns may indicate bias based on ethnicity. In this study, no difference in correctness of responses, certainty in responses or correctness for levels of certainty was detected.

SUMMARY

Developing a regional cancer service; lessons from the Waitemata Cancer Patient Experience Survey

Jonathan Koea, Sue French, Karen Hellesoe, Peter Sandiford

A cancer patient experience survey used in the National Health System (NHS) in the UK was administered to patients with a diagnosis of cancer at Waitemata District Health Board in 2013 and 2015. Overall patient experience benchmarked with or exceeded that of the NHS in clinical metric s such as wait for clinic appointment, provision for family support and confidence in medical care. The survey did indicate further need for detailed information to be available to patients on financial support such as the pharmaceutical subsidy card.

SUMMARY

Relationship between estimated glomerular filtration rate and incident cardiovascular disease in an ethnically diverse primary care cohort

Emma Church, Katrina Poppe, Matire Harwood, Suneela Mehta, Corina Grey, Vanessa Selak, Mark R Marshall, Susan Wells

This is a large study examining whether there is a relationship between kidney function (eGFR) and the risk of having a cardiovascular event such as a heart attack or stroke in New Zealanders. The esti-mated Glomerular Filtration Rate (eGFR) result indicates how well the kidneys filter waste from the blood and it can identify the presence of kidney damage. The study found that participants with worse kidney function were more likely to go on to have a cardiovascular event. Patients included in the study attended their family doctor for their heart and diabetes check. At this check, a doctor or nurse collects information on any risk factors and calculates a patient s risk of having a heart attack or stroke over the next five years. The CVD risk is used to guide treatment decisions. After taking into account other CVD risk factors such as smoking, blood pressure and cholesterol levels, Mori and Pa-cific patients without diabetes or CVD were at higher risk of developing heart disease with worsen-ing eGFR compared to Europeans. Indian people had similar risk and Other Asians had lower risk compared to Europeans. Further studies are needed to understand whether including kidney func-tion as part of the heart and diabetes check could improve the accuracy of risk prediction and lead to more tailored care of patients seeing their doctor.

SUMMARY

Vision screening in New Zealand: an audit of the B4 School Check

William Muller, Logan Mitchell, Graham Wilson

This study reviewed the results of the four-year-old vision screening programme (B4 School Check) in Southern and Tairawhiti DHBs over a six-month period in 2016. Of the 2,109 children screened, 176 (8.3%) failed the vision test and were referred on to either optometrist or DHB ophthalmology clinic. Only 91 (51.7%) were determined to have been seen as a result of that referral, and of them 39 (42.8%) were found to have normal vision. Of those referred and seen with abnormal vision, the vast majority (>92%) needed glasses for simple refractive error, while only 10% required any treatment other than glasses. Concerningly, 48.3% of children referred from the B4SC vision screening pro-gramme were not able to be confirmed as having received optometric or ophthalmic review as a con-sequence of that referral.

SUMMARY

The factors that lead to a delay between general practitioner referral of symptomatic patients and specialist diagnosis of colorectal cancer: an audit in the Bay of Plenty District Health Board

Ada Yee, Tara Linton, Mei-Sze Lee, Simon Raimes

Most patients diagnosed with colon or rectal cancer (CRC) have been referred to a specialist by their GP. The Ministry of Health provides guidelines for symptoms that raise a High Index of Suspicion (HIS) for CRC and if GPs refer patients with HIS then they should have a fast track diagnosis within two weeks. This audit examined the referral information of 181 patients who were referred by their GP and subsequently diagnosed with CRC and found that only 36% actually satisfied the HIS criteria. Patients who did not satisfy the criteria generally waited a lot longer for a diagnosis. This suggests that the HIS criteria are too strict, and we believe it is now necessary to review these and also to in-troduce a national referral form that prompts the GP to include all the essential information that might then facilitate a more rapid diagnosis.

ALL ARTICLES
SUMMARY

District health board of residence, ethnicity and socioeconomic status all impact publicly funded insulin pump uptake in New Zealand patients with type 1 diabetes

Benjamin J Wheeler, Rhiannon Braund, Barbara Galland, Anastasia Mikuscheva, Esko Wiltshire, Craig Jefferies, Michel de Lange

Comment on: Quality of electronic records documenting adverse drug reactions

John S Fountain, Susan H Kenyon

New Zealand Society of Gastroenterology Guidelines on Therapeutic Drug Monitoring in Inflammatory Bowel Disease

Afrasyab Khan, Arvenia B Berahmana, Andrew S Day, Murray L Barclay, Michael Schultz

Considering evidence for ethnicity bias using assessment case scenarios and medical student correctness and certainty

Mike Tweed, Gordon Purdie, Cameron Lacey

Subclavian Aneurysm Cured by Proximal and Distal Ligature

By STANLEY BROWN, F.R.C.S.

Nothing short of universal healthcare coverage, fully funded and without charge both in primary and hospital care is good enough for New Zealand

Stephen Main

Developing a regional cancer service; lessons from the Waitemata Cancer Patient Experience Survey

Jonathan Koea, Sue French, Karen Hellesoe, Peter Sandiford

Relationship between estimated glomerular filtration rate and incident cardiovascular disease in an ethnically diverse primary care cohort

Emma Church, Katrina Poppe, Matire Harwood, Suneela Mehta, Corina Grey, Vanessa Selak, Mark R Marshall, Susan Wells

Advancing transgender healthcare teaching in Aotearoa/New Zealand

Althea Gamble Blakey, Gareth Treharne

Vision screening in New Zealand: an audit of the B4 School Check

William Muller, Logan Mitchell, Graham Wilson

Beau lines and telogen effluvium following aluminium phosphide poisoning

Samaneh Nakhaee, Nasim Zamani, Omid Mehrpour

Where are we going with cancer treatment in New Zealand?

Tamara Mullaney, Frank Frizelle

Pre-eclampsia and risk of dementia later in life

The factors that lead to a delay between general practitioner referral of symptomatic patients and specialist diagnosis of colorectal cancer: an audit in the Bay of Plenty District Health Board

Ada Yee, Tara Linton, Mei-Sze Lee, Simon Raimes

Successful intravascular lithotripsy for severely calcified left anterior descending coronary artery stenosis

Aleksandra Pineda, Aniket Puri, Bijan Jahangiri

Lifespan of New Zealand Second World War veterans from one large cemetery: the case for a national-level study

Nick Wilson, Glyn Harper

Switching from gabapentin to pregabalin

Pauline McQuoid

SUMMARY

District health board of residence, ethnicity and socioeconomic status all impact publicly funded insulin pump uptake in New Zealand patients with type 1 diabetes

Benjamin J Wheeler, Rhiannon Braund, Barbara Galland, Anastasia Mikuscheva, Esko Wiltshire, Craig Jefferies, Michel de Lange

Insulin pump therapy is becoming increasingly common for those living with type 1 diabetes, and has been publicly funded in New Zealand since 2012. This study aimed to examine national uptake of publicly funded insulin pumps from 2012 to 2016 using data provided by the Ministry of Health. The main findings show that from 2012 to 2016 there has been a steadily increasing uptake of pumps. Despite publicly funded access, disparities in use appear to exist, including by district health board of residence as well as traditionally described socio-demographic barriers to healthcare (ethnicity, socioeconomic status, age, gender). Efforts to understand and reduce these disparities are required.

SUMMARY

New Zealand Society of Gastroenterology Guidelines on Therapeutic Drug Monitoring in Inflammatory Bowel Disease

Afrasyab Khan, Arvenia B Berahmana, Andrew S Day, Murray L Barclay, Michael Schultz

Various medications are available for the treatment of inflammatory bowel disease. The effective use of these medications is important and leads to better outcomes. Monitoring the level of medications and/or their breakdown products (therapeutic drug monitoring) in a patient s blood can lead to more effective and individualised dosage recommendations. These blood tests are available in New Zealand. Therapeutic drug monitoring can decrease the risk of drug toxicity and help in decision making for further treatment if one therapy seems to be failing. This document represents the New Zealand Society of Gastroenterology Guidelines on Therapeutic Drug Monitoring in Inflammatory Bowel Disease.

SUMMARY

Considering evidence for ethnicity bias using assessment case scenarios and medical student correctness and certainty

Mike Tweed, Gordon Purdie, Cameron Lacey

Analysis of student responses allowing for the ethnicity of the patient as described in a test can be used to investigate for evidence of variations in response patterns. Variations in response patterns may indicate bias based on ethnicity. In this study, no difference in correctness of responses, certainty in responses or correctness for levels of certainty was detected.

SUMMARY

Developing a regional cancer service; lessons from the Waitemata Cancer Patient Experience Survey

Jonathan Koea, Sue French, Karen Hellesoe, Peter Sandiford

A cancer patient experience survey used in the National Health System (NHS) in the UK was administered to patients with a diagnosis of cancer at Waitemata District Health Board in 2013 and 2015. Overall patient experience benchmarked with or exceeded that of the NHS in clinical metric s such as wait for clinic appointment, provision for family support and confidence in medical care. The survey did indicate further need for detailed information to be available to patients on financial support such as the pharmaceutical subsidy card.

SUMMARY

Relationship between estimated glomerular filtration rate and incident cardiovascular disease in an ethnically diverse primary care cohort

Emma Church, Katrina Poppe, Matire Harwood, Suneela Mehta, Corina Grey, Vanessa Selak, Mark R Marshall, Susan Wells

This is a large study examining whether there is a relationship between kidney function (eGFR) and the risk of having a cardiovascular event such as a heart attack or stroke in New Zealanders. The esti-mated Glomerular Filtration Rate (eGFR) result indicates how well the kidneys filter waste from the blood and it can identify the presence of kidney damage. The study found that participants with worse kidney function were more likely to go on to have a cardiovascular event. Patients included in the study attended their family doctor for their heart and diabetes check. At this check, a doctor or nurse collects information on any risk factors and calculates a patient s risk of having a heart attack or stroke over the next five years. The CVD risk is used to guide treatment decisions. After taking into account other CVD risk factors such as smoking, blood pressure and cholesterol levels, Mori and Pa-cific patients without diabetes or CVD were at higher risk of developing heart disease with worsen-ing eGFR compared to Europeans. Indian people had similar risk and Other Asians had lower risk compared to Europeans. Further studies are needed to understand whether including kidney func-tion as part of the heart and diabetes check could improve the accuracy of risk prediction and lead to more tailored care of patients seeing their doctor.

SUMMARY

Vision screening in New Zealand: an audit of the B4 School Check

William Muller, Logan Mitchell, Graham Wilson

This study reviewed the results of the four-year-old vision screening programme (B4 School Check) in Southern and Tairawhiti DHBs over a six-month period in 2016. Of the 2,109 children screened, 176 (8.3%) failed the vision test and were referred on to either optometrist or DHB ophthalmology clinic. Only 91 (51.7%) were determined to have been seen as a result of that referral, and of them 39 (42.8%) were found to have normal vision. Of those referred and seen with abnormal vision, the vast majority (>92%) needed glasses for simple refractive error, while only 10% required any treatment other than glasses. Concerningly, 48.3% of children referred from the B4SC vision screening pro-gramme were not able to be confirmed as having received optometric or ophthalmic review as a con-sequence of that referral.

SUMMARY

The factors that lead to a delay between general practitioner referral of symptomatic patients and specialist diagnosis of colorectal cancer: an audit in the Bay of Plenty District Health Board

Ada Yee, Tara Linton, Mei-Sze Lee, Simon Raimes

Most patients diagnosed with colon or rectal cancer (CRC) have been referred to a specialist by their GP. The Ministry of Health provides guidelines for symptoms that raise a High Index of Suspicion (HIS) for CRC and if GPs refer patients with HIS then they should have a fast track diagnosis within two weeks. This audit examined the referral information of 181 patients who were referred by their GP and subsequently diagnosed with CRC and found that only 36% actually satisfied the HIS criteria. Patients who did not satisfy the criteria generally waited a lot longer for a diagnosis. This suggests that the HIS criteria are too strict, and we believe it is now necessary to review these and also to in-troduce a national referral form that prompts the GP to include all the essential information that might then facilitate a more rapid diagnosis.

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