Vol 136 No 1582: 15 September 2023

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Issue Summary

Editorial

SUMMARY

State of general practice in New Zealand

Bryan Betty, Les Toop, Jo Scott-Jones

General practice plays a vital role in Aotearoa New Zealand’s health system, but we clearly have a problem. The system has not delivered equitable outcomes, especially for Māori and Pacific communities, and it is also struggling to provide population health outcomes that meet expectations. The workforce is under-resourced, under-valued, poorly distributed and increasingly burnt out. Traditional 15-minute consultations are no longer adequate to meet today’s increasingly complex demands, and the funding formula has long since passed its use by date. The way forward to a sustainable, equitable system involves rebuilding staffing levels in a way that reflects Aotearoa New Zealand, providing the capacity, capability and connections to deliver accessible, high-quality care.

Editorial

SUMMARY

Artificial intelligence in medicine: Promethean moment or Pandora’s box?

Tim Eglinton, Isaac Tranter-Entwistle, Saxon Connor

In recent years the use of artificial intelligence has increased dramatically in our daily lives and it is beginning to have an impact in healthcare. AI algorithms can already perform as well as doctors for a number of simple tasks and there is great potential for more complex problem solving. The exponential pace of development of AI will require clinician engagement and agility of regulators if its full transformative power is to be harnessed for the benefit of the health system.

Article

SUMMARY

A retrospective observational study of the management of non-traumatic dental presentations at a tertiary centre in New Zealand: a Choosing Wisely approach

Calum Fisher, Oliver Sutcliffe, Peter Coghlan, Andrew McCombie, Laura Joyce

New Zealand Emergency Departments continue to be utilised for dental conditions such as toothache or dental abscesses. Young adults, Māori, Pacific Peoples and those living in high deprivation areas are over-represented. These patients receive non-optimal care in the emergency department as they are ill-equipped and staffed by non-dentally trained health professionals. Treating these dental conditions in emergency departments may contribute to increased healthcare costs, overcrowding, unnecessary radiation exposure and inappropriate prescribing of opioids and antibiotics.

Article

SUMMARY

How young people in Aotearoa perceive vaping and the associated oral health risks

Hillary Hang, Rosie Dobson, Judith McCool

This study aimed to explore how young people in Aotearoa New Zealand perceive risks of vaping, including the risks to oral health. An online survey of 237 young people aged 16–24 years was undertaken. Although most participants understood that vaping posed risks to their general health, they reported lower levels of perceived risk of vaping on oral health. Participants who were current vapers held significantly lower perceptions of both the addictiveness and harms associated with vaping. Participants reported that oral health professionals seldom asked them about their vaping status. Most participants were open to discussing with oral health professionals about the effects of vaping on their oral health, suggesting that they would be less likely to vape if they knew it was bad for their oral health.

Article

SUMMARY

Non-attendance at diabetic retinal screening in Te Tai Tokerau, Northland, Aotearoa New Zealand

Laura E Wolpert, Christopher HJA Sadler, Andrew R Watts, David M Dalziel

Younger people, Māori and Pacific people, and people from areas of high socio-economic deprivation have higher rates of non-attendance at diabetic retinal screening.

Article

SUMMARY

Exploring the impact of e-learning modules and webinars on health professionals’ understanding of the End of Life Choice Act 2019: a secondary analysis of Manatū Hauora – Ministry of Health workforce survey

Aida Dehkhoda, Rosemary Frey, Melissa Carey, Xuepeng Jing, Jackie Robinson, Frederick Sundram, Nicholas R Hoeh, Susan Bull, David Benjamin Menkes, Gary Cheung

This paper explores the socio-demographic factors associated with health professionals’ completion of the e-learning module and attendance at the two webinars provided by the New Zealand Ministry of Health – Manatū Hauora, and whether completion of the e-learning module and webinars supported health professionals’ understanding of the End of Life Choices Act 2019. This association is determined by a secondary analysis of the Ministry of Health workforce surveys conducted in July 2021. Results show that health professionals who are older, of Pākehā/European ethnicity, and work in hospice settings are more likely to complete the e-learning module, while females are more likely to attend webinars. Despite low completion and attendance rates, the study highlights the positive association between training and health professionals’ overall understanding of the Act. These results emphasise the need for enhancing training programs to increase health professionals’ knowledge and competence with AD.

Article

SUMMARY

Exploring older peoples' attitudes and preferences around the use of their healthcare information

Cristian Andres Gonzalez-Prieto, Daniel Wilson, Gillian Dobbie, Claudia Rivera-Rodriguez, Susan Yates, Reshmi Rai-Bala, Tara Puspitarini Sani, Rosie Dobson, Sarah Jane Cullum

De-identified health data have been shown to be an important source of information for health research, but, under New Zealand Law, does not require individual consent for use. In this article we present the results of an online survey carried out among people who used Te Whatu Ora Counties Manukau health services, inquiring about their knowledge of the current use of de-identified health data and their comfort levels around its use. It was found that around 80% of the respondents understood how their de-identified data were used, and between 80 and 87% felt comfortable or very comfortable with the potential use of their health data. Some concerns about privacy and confidentiality were mentioned, as well as cultural concerns about the use of data after death.

Viewpoint

SUMMARY

Low and intermediate risk aortic dissection detection risk score and negative D-dimer: a word of caution

Steve Waqanivavalagi

Acute aortic syndrome (AAS) is a rare, vascular catastrophe with high mortality. In New Zealand, the incidence of AAS is higher than elsewhere in the world, especially for patients of Māori and Pacific Island descent. Ongoing work is being undertaken to determine whether novel rule-out strategies, such as the aortic dissection detection risk score and negative D-dimer, may be useful in excluding AAS without the requirement for advanced imaging. However, although its use has crept into the work-up of patients with suspected AAS, its use remains to be validated, especially in New Zealand.

Clinical Correspondence

SUMMARY

Recurrent Takotsubo syndrome with variable echocardiographic and electrocardiographic appearances

Aleisha Easton, Andrew J Kerr, Jen-Li Looi

Patients with recurrent Takotsubo syndrome may not represent with the same echo and ECG appearances as the first episode. Clinician should also be aware that recurrent Takotsubo syndrome may occur many years later after the first episode. The variation in ECG pattern we observed between recurrent events with differing echocardiographic variants is still not fully understood and should be further investigated.

Editorial