Vol 135 No 1566: 2 December 2022

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Issue Summary

Editorial

SUMMARY

Doctor owned investigation and treatment facilities: a conflict of interest or a pragmatic way forward?

Peter Robertson

Doctor owned investigation and treatment facilities are common in the New Zealand health system and provide important capacity for the delivery of a large amount of community based and specialised care. A consultation document on "doctors and health related commercial organisations" from the Medical Council of New Zealand proposes changes to existing guidance which would limit a clinician’s ability to refer to a facility in which they have an ownership interest. This change could potentially lead to detrimental impacts on patients, clinicians and the health system. Disclosure and communication are key to ensuring any potential conflict of interest is managed.

Article

SUMMARY

An assessment of burnout in New Zealand orthopaedic resident medical officers

Tanushk Luke Brito Martyn, Earle Savage, Simon Bruce Murdoch MacLean

Orthopaedic surgical training is a long and arduous commitment to both the trainee and their family that is ultimately necessary to create a competent surgeon that can fulfil the requirements necessary to treat the population of New Zealand to an acceptable standard of healthcare. Our study shows that approximately half of both trainee and non-trainee orthopaedic registrars are exhibiting signs of burnout. This is comparable to other developed nations with a similar healthcare system.

Article

SUMMARY

Presenting characteristics, length of stay and oxygen use among COVID-19 cases at a single tertiary hospital in Auckland, New Zealand, using retrospective medical recorded data | OPEN ACESS

Nicole Hotchkiss, Georgia Van Zantvoort, Christin Coomarasamy, Eunicia Tan, Andrew Brainard

Our study looked at the first wave of COVID-19 patients in Auckland, New Zealand. We recorded information from medical charts including details about the patient’s background, the symptoms that made them seek medical care, and their vital signs on arrival to hospital. We then assigned a clinical severity score, and looked at it in terms of oxygen use in the hospital and the patient’s hospital course. We found that the assigned clinical severity score was associated with need for oxygen, whether the patient was discharged or admitted to hospital and the duration of the hospital stay. Additionally, we found that when patients were admitted to the hospital, they spent nearly half their stay not using any oxygen at all.

Article

SUMMARY

Community specialist palliative care services in New Zealand: a survey of Aotearoa hospices

Salina Iupati, Rod MacLeod, James Stanley, Cheryl Davies, Richard Egan

This paper is comprehensive survey of services provided by hospice across Aotearoa. All hospices responded to the survey. The survey found all hospices provided care at home with 94% also provided care in aged residential care facilities. There are areas of inconsistency in afterhours access and cultural support for Māori. This survey also questions capacity of the present system to address current and future shortages of palliative medicine specialist.

Article

SUMMARY

A survey of adult respiratory and sleep services in Aotearoa New Zealand: inequities in the provision of adult respiratory and sleep services

Roland Meyer, Paul Dawkins, James Fingleton, Brett Shand, Elaine Yap

Our health system is undergoing a major transformation with the stated aims of the reforms of addressing long-standing inequities, improving access to health services, correcting geographic variation and ensuring services are in accordance with the principles of the Te Tiriti O Waitangi. We believe that our survey underpins the evidence for the need of this work now. The need to end a "postcode lottery" in the patients and whanau’s ability to receive key respiratory services is clearly demonstrated.

Article

SUMMARY

A health sector response to the commercial determinants of health

Sarah Sharpe, Karen McIlhone, Summer Hawke, Shanthi Ameratunga

This article describes the development and use of a framework for assessing a health organisation’s response to the commercial determinants of health (CDoH). CDoH are the “strategies and approaches used by the private sector to promote products and services that are detrimental to health”. The study was done at Counites Manukau Health in 2021. It involved reviews of published literature, review of policy documents at Counties Manukau Health, and interviews with 12 people about their thoughts and perspectives. The findings highlight: the power of companies that make harmful products (e.g. alcohol, tobacco, highly processed foods and beverages); the harmful impacts of these products on people, whānau/families, and communities; and the important role the health sector has in responding to the CDoH in order to protect and promote people’s health and wellbeing.

Viewpoint

SUMMARY

Beyond muddy waters: Three Waters reforms required to future-proof water service delivery and protect public health in Aotearoa New Zealand

Tim Chambers, Professor Nick Wilson, Professor Simon Hales, Marnie Prickett, Edward Ellison, Professor Michael G Baker

The current management of water services in Aotearoa is inadequate to protect public health and is economically inefficient. Three Waters reforms will facilitate better public health surveillance, water service provision and infrastructure upgrades. Concerns around co-governance, privatisation and loss of local control have varying degrees of legitimacy but do not provide a persuasive argument against the urgent need for reform.

Clinical Correspondence

SUMMARY

A diagnosis fifteen years in the making

Anthony R Brownson, David W Orr, Emily Carr-Boyd

This is a case report about a patient from Ethiopia who migrated to New Zealand and was found to have liver disease. For many years was thought to have non-alcoholic fatty liver disease. The correct diagnosis was not made until he had a liver biopsy to confirm whether he had cirrhosis. It turn out he had hepatic schistosomiasis, which is a chronic infection of a fluke worm endemic in certain tropic countries. New Zealand medical professionals should consider schistosomiasis in patients with liver disease from endemic areas.

Research Letter

SUMMARY

The Care Coordination Process: an opportunity to evaluate the impact of structural reform

Mariana Hudson, Emily A Gill

Care coordination is a process that happens most often when people who have many medical needs require services in different places (e.g., "settings"), and/or care from different health providers. This process is integral to high quality and fair healthcare and so should be evaluated. No evaluation of care coordination has occurred in primary care, so we describe an evidenced-based measurement framework using a clinical scenario. An aim of the Pae Ora (Health Futures) Bill is more coordinated care, but ‘care coordination’ is only mentioned once in the latest Budget 2022 Initiatives by Vote – Health as part of the ‘Comprehensive Primary Care Teams’ initiative. Evidenced-based research and evaluation are important approaches to ensure investment in care coordination will improve health.

Editorial