In the latest issue (attached below):

Ten reviews covering chronic patients (eg, diabetes and hypertension) and primary care patients, as well as health care providers were found but eight were included for the analysis of outcome measures.

The authors found mixed outcomes across both patient and health care providers groups, with approximately half of the reviews showing positive changes with record access. Patients believe that record access increases their perception of control; however, outcome measures thought to create psychological concerns (such as patient anxiety as a result of seeing their medical record) are still unanswered. Nurses are more likely than physicians to gain time efficiencies by using a patient accessible electronic health records (PAEHRs) system with the main concern from physicians being the security of the PAEHRs.

The authors conclude that there is a lack of rigorous empirical testing that separates the effect of record access from other existing disease management programs. Current research is too targeted within certain clinical groups’ needs, and although there are positive signs for the adoption of PAEHRs, there is currently insufficient evidence about the effect of PAEHRs on health outcomes for patients or health care providers.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.2196/jmir.4446

Jilka, S.R., et al. (2015). “Nothing about me without me”: An interpretative review of patient accessible electronic health records. Journal of Medical Internet Research, 17(6), e161.

A number of government policies that come into effect tomorrow will deliver real benefits to families, Prime Minister John Key says.

From tomorrow all children under 13 will have access to free GP visits and prescriptions.  

It is estimated that over 400,000 children will benefit from the scheme, taking the total number of children who are benefitting from free GP visits and prescriptions to over 750,000.

“We’re committed to giving kids the best start in life and that means ensuring they are able to go to the doctor any time of the day or night without their parents worrying about the cost,” says Mr Key.

“Doctor’s visits and prescriptions are already free for children under the age of six and thanks to our careful management of the government’s books we have been able to extend this policy to all children under 13.”

Other changes that come into effect tomorrow include:

• The average ACC motor vehicle levy, including the annual licence levy and petrol levy, will fall from around $330 to $195 per year.
• Paid parental leave payments will increase with the maximum weekly rate for eligible employees and self-employed parents going from $504.10 to $516.85 gross.
• More assistance for solo parents who are studying
• Additional checks for people working with young New Zealanders
• More funding will also be made available to hospices to help them expand their community palliative services to better support terminally ill people at home and in aged-care facilities.

“These changes show how a growing and vibrant economy is delivering New Zealanders more money in their back pockets.”

• Upfront: Time to reduce antibiotic prescribing – NOW
• Debate: Do you prescribe antibiotics for respiratory tract infections? An everyday conundrum in general practice
• Is it ok to stop antibiotics when symptoms resolve?
• Delayed antibiotic prescriptions for respiratory tract infections: does the strategy work?
• Should I prescribe a topical antiseptic cream instead of a topical antibiotic for minor skin infections?
• Is point-of-care CRP testing useful in guiding antibiotic prescribing in patients with respiratory tract infections?
• Do probiotics provide effective and safe protection against antibiotic-associated adverse effects?
• When is an allergy to an antibiotic really an allergy?
• The role of prophylactic antibiotics for preventing infective endocarditis in people undergoing dental or other minor procedures
• Cellulitis: skin deep and spreading across New Zealand

To read the issue in full text, go to:  http://www.bpac.org.nz/BPJ/2015/June/contents.aspx

To read the article in full text, go to: http://www.bpac.org.nz/BPJ/2015/June/tips.aspx

The three core outcomes for the medicines system as set out in the Strategy are:

• access
• optimal use
• quality, safety and efficacy.

Implementing Medicines New Zealand is about the changes required to deliver on Medicines New Zealand. This action plan supports the achievement of the Strategy’s outcomes by:

• making the most of every point of care
• enabling shared care through an integrated health care team
• optimal use of antimicrobials
• empowering individuals and families/whānau to manage their own medicines and health
• optimal medicines use in older people and those with long-term conditions
• competent and responsive prescribers
• removing barriers to access.

This will be done by harnessing the collective efforts of all health professionals, including those working in community organisations, primary health care, pharmacies, hospitals, rest homes and end-of-life care.

Implementing Medicines New Zealand 2015 to 2020 can be downloaded at:  http://www.health.govt.nz/publication/implementing-medicines-new-zealand-2015-2020

Ministry of Health (2015). Implementing Medicines New Zealand 2015 to 2020. Wellington: Miistry of Health

In this issue:

Among 134 respondents, "... geriatricians rated limited life expectancy and cognitive impairment very important in driving deprescribing practices. Geriatricians more often deprescribed multiple medications in the setting of advancing dependency and cognitive impairment, driven by dementia severity and pill burden concerns. Physician characteristics also influence deprescribing practices". The authors describe a need for further research.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1093/ageing/afv028 or contact your DHB library, or organisational or local library for assistance.

Ní Chróinín, D., et al. (2015). Factors influencing deprescribing habits among geriatricians. Age and Ageing, 44(4), 704-708.

Health and Social Care Information Centre media release, 23 June 2015

Community pharmacists across England will be given the opportunity to access the Summary Care Record (SCR), in new plans announced today.

In the latest issue (attached below):

In a change to its 2005 predecessor, the updated guideline uses a new approach – focusing on the symptoms that a patient might experience and go to their doctor with - to make its recommendations easier for GPs to use. It sets out clear tables linking signs and symptoms to possible cancers and includes simple recommendations about which tests to perform and the type of referral to specialist services that should be made".

To read the full story on the NICE website, go to:  http://www.nice.org.uk/news/article/nice%E2%80%99s-new-symptom%E2%80%93based-approach-will-help-to-save-thousands-of-lives-from-cancer

Three Dennis Pickup Clinical Educator Awards and five Butland Teaching Excellence awards were presented at a ceremony in the Faculty of Medical and Health Sciences this week.

The Dennis Pickup Clinical Educator Awards are made to clinical teachers who are judged by staff and students to have made an outstanding contribution to medical, nursing, optometry or pharmacy education.

“This is by virtue of their qualities as role models in clinical practice and their contribution to the relationship between the health professions and the Faculty of Medical and Health Sciences,” said Deputy Dean, Distinguished Professor, Ian Reid.

“These awards recognise clinicians and practitioners who give their time to assist in the education of health professionals,” he said.

Dennis Pickup is a previous CEO of Auckland City Hospital, and in that role he played a crucial part in establishing the enduring partnership between the University of Auckland and the hospital.  These awards were presented by Dennis Pickup.

Professional Teaching Fellow and GP, Dr Chris Wong from the Department of General Practice and Primary Healthcare at the School of Population Health was awarded the Dennis Pickup Award for his contribution to general practice in the medical programme.

“Dr Chris Wong is a GP in West Auckland and is employed to teach medical students one day a week,” said Director of the Teaching Programme, Associate Professor Warwick Bagg. “The contribution he makes to general practice in the medical programme is immense.”

Dr Wong co-ordinates and teaches in the Year 4 General Practice Observed Patient Simulations for a full week, six times a year, and in 2014 redesigned the week and arranged for it to be delivered in Hamilton .

He is actively involved in all aspects of the general practice teaching, including facilitating Year 5 and Year 6 symposium days, marking written assignments from them as well as Year 2 assignments. He attends team meetings; contributes to protocols and visits practices to accredit them as community-based teaching sites.

He has also contributed to the medical programme by assessing clinical scenarios and progress test questions for general practice relevance, interviewing candidates for medical school admission and assisting with the inaugural Year 5 Clinical Skills Assessment examination.

“Chris is an excellent clinician who serves as a wonderful role model to inspire students to consider general practice as a career option,” said Dr Bagg.  “As a GP working four days in clinical practice, he brings a grassroots general practice perspective to his teaching and serves as a great bridge between clinical practice and academia.”

“He is an extremely innovative teacher,” he said. “His involvement in so many aspects of the curriculum means his input has a huge impact on student learning. The passion and time he gives to so many components of general practice teaching far exceeds the expectations for someone employed on this basis and is very deserving of a clinical educator award.”

Clinical Director of the Paediatric Service in Rotorua for Lakes DHB, Dr Stephen Bradley, also received a Dennis Pickup award that acknowledged his sustained and wide ranging contribution to the medical programme.

“Dr Bradley is an Honorary Clinical Senior Lecturer in the Department of Paediatrics: Child and Youth Health and has demonstrated his commitment to undergraduate and postgraduate education throughout his career as a consultant paediatrician at Lakes DHB,” said Dr Bagg.

Dr Bradley now holds a Postgraduate Diploma in Clinical Education and is currently undertaking his Masters in Clinical Education. He is an instructor for the Advanced Paediatric Life Support.

“Steve has, for many years, played a key role in the ongoing development of Rotorua as a teaching site for undergraduate students,” said Dr Bagg.  “He is held in high esteem by his colleagues in New Zealand, but carries that prestige with great humility.   He is a very hard worker and has actively engaged in reinvigoration of our curriculum.”

Dr Bradley’s active participation in the changes within the paediatrics discipline was highly valued, he said.

“He draws on a wealth of experience and understanding of educational principles in his teaching and is a highly regarded teacher, said Dr Bagg.

In 2012 his team received two teaching awards; 'The Lakes DHB Clinical Teaching Award, and Rotorua Paediatrics the 'Most Supportive Clinical Team'   (voted by students of MBChB 5 class).

“That year Steve himself received a 'Distinguished Clinical Teacher Award' from the School of Medicine.  In 2014 he volunteered to be filmed for the crucial Mini CEX calibration videos, a role few other academics would put their hands up for. This is a further illustration of how Steve is a wonderful role model to other academics, clinical teachers and students,” he said.

The final Dennis Pickup Award recipient for 2015 was the Director of Nursing at Waikato District Health Board, Sue Hayward for her extraordinary leadership in nursing education and she was introduced by the acting Head of the School of Nursing, Associate Professor Nici Sheridan.

“Sue is a Registered Nurse with a Postgraduate Diploma in Health Management and Masters in Health Sciences who has, since 2008, been the Director of Nursing and Midwifery at the Waikato District Health Board.  She is also the executive sponsor of the Bachelor of Nursing Honours programme within the DHB.”

In 2013, Waikato DHB, recognising the need to focus on investing in our future nursing leaders, started working with the University of Auckland on a programme that would allow newly graduated nurses to not only complete an Honours degree, but also participate in a high level supervision and mentoring programme.  

“This programme has, from day one benefitted from Sue’s exceptional oversight,” said Dr Sheridan. “There is no doubt that the programme would not have been possible without her guidance, commitment and sponsorship.”

“To redirect education funds away from experienced nurses to new graduates was a brave call and one which she undertook willingly. Sue continues to provide one-on-one and group sessions with the students and is heavily involved in the development and selection of their research topics.”

“For many years Sue has been very active in nursing education across the DHB particularly in relation to leadership and clinical nursing practice,” she said.  “Sue’s interaction with the University and this programme in particular, has led to the programme being seen as a Waikato DHB initiative.”

Professor Reid introduced the Butland Awards with some background to the history of the award.

In 1964, four years before our first medical class started at the University of Auckland, the University received an endowment of 40,000 pounds from food manufacturer and philanthropist, Sir Jack Richard Butland.

The aim of this endowment was to establish a Medical Foundation to advance medicine on a broad spectrum within New Zealand and in a specific sense to ensure the planned medical school had the best teaching talent it could attract.

Jack Butland was a self-made millionaire who developed the iconic Chesdale brand and pioneered the small packaging and retailing of dairy products in New Zealand.  Jack Butland was a leading public benefactor of his day and in today’s terms his endowment would be the equivalent of many millions of dollars.

“This evening we acknowledge those who have been identified as providing exemplary teaching and support to their students within the Faculty of Medical and Health Sciences with the Butland Teaching Excellence Awards, said Professor Reid.

The 2015 Butland Award for Early Career Excellence in Teaching was made to Dr Max Petrov from the School of Medicine and recognized his teaching excellence and innovation in the Faculty.  These awards were attended by Debbie and Grant Cathrow from the Butland Family and made by Trustee Dr Jock Carnachan.

“Max joined the Department of Surgery in 2011 as a Senior Lecturer and since his appointment he has been an enthusiastic and willing participant in a wide range of activities within the Department,” said Professor Reid.

“Despite a relatively short period of teaching, Max has achieved record of excellence in teaching, research supervision, and leadership.  His innovative approaches to inducting PhD students caught the attention of the awards committee.”

“Soon after his appointment, he proposed the introduction of a research induction seminar for new PhD and Masters Students in the Department of Surgery,” he said. “Max was given responsibility for developing and introducing this course and it has grown over the last three years, rapidly becoming a whole School of Medicine programme that continues to grow in numbers and in the maturity of content.  The programme has received excellent reviews from attendees.”

This year Dr Petrov brought in further innovation with the introduction of the Science Café, where postgraduate students can develop relationships with more senior researchers in the Faculty. More than 40 students attend not only from the School of Medicine, but also from Liggins and the Schools of Medical Sciences, Population Health, and Nursing. The initiative has been an outstanding success.

“Max is deeply committed to postgraduate and undergraduate supervision,” said Professor Reid. “In just over three years since he was appointed he has supervised or is supervising more than 10 PhD, Masters, and Honours students.”

“ His skill in this endeavour is already evident with several high quality publications from his students and many winning awards for their endeavours. Four out of the five of his Masters and Honours students have graduated with First Class Honours,” he said.  “ Max has shown that he teaches to an excellent standard and he has shown huge promise as an emerging leader within the School of Medicine.  He is a worthy recipient of this 2015 award.”

The Butland Award for Excellence in Teaching Innovation was awarded to Senior Lecturer, Dr Phillipa Malpas from the School of Medicine.

“Phillipa has made an outstanding contribution to the innovative teaching of ethics to our medical students following her appointment to the Department of Psychological Medicine,” said Professor Reid.  “Phillipa has innovated through curriculum and assessment development to achieve truly novel teaching and course design in the areas of ethics and medical humanities.”

“Her approach to teaching ethics engages medical student's right from the early years, capturing their curiosity and excitement about the ethical dimension of medicine,” he said.  “Content draws on clinicians' experiences and knowledge, case studies, student's own experiences, and topical issues within society.”  “Recognising that ethical thinking can be confounding for many students, she has developed an innovative ethical 'toolkit' to help students reason their way through ethical and medico-legal challenges.”

Building on the early teaching in the medical programme Phillipa turned her attention to the year five curriculum and developed an "Ethics Report” that is completed by senior students.  In the report students are encouraged to reflect critically on ethical aspects arising from their clinical experiences.  

“The feedback from students demonstrates how profoundly doing this work affects many of them,” said Dr Reid. “Phillipa has taken students’ work in these reports an important step further.  She recognized a number of common themes emerging in student writing, in particular in the broad area of consent.”

“This led Phillipa to work with a range of stakeholders including chief medical officers, the Health and Disability commissioner, medical student groups and her colleagues in Auckland and Otago to develop a national consensus document on medical students and informed consent – the first such document in the world.”

“The novelty and reach of Phillipa’s innovations make her a very worthy recipient of this award,” said Professor Reid.

The Butland Award for Excellence in Research Supervision recognises and rewards a long-term, consistent or broad contribution to research supervision at the Faculty, and this year went to Professor Paul Donaldson from the School of Medical Sciences.

“Through his excellent supervisory practices Paul has played a significant and influential role in shaping the careers of many emerging scientists,” said Professor Reid.  “Paul has directed a large, successful research group based at FMHS since 1996 when he was appointed to the Department of Physiology.”

“Over the 19 years since then he has enjoyed many successes, attributable to his forward-thinking approach to research, and his ability to build and maintain a strong research group,” he said.  “He has been able to maintain this research group in part due to the excellence of his supervision and mentorship. It is a hallmark of Paul’s research group that several of his students have worked with him over extended periods of time.”

The awards panel was impressed by the ‘joined up’ strategic thinking that underpins Paul’s recruitment and development of future research students.  From his earliest interactions with undergraduates, summer students and the like Professor Donaldson fosters strong, positive relationships, welcoming and encouraging new members of the group to become ‘part of the team’, recognising and celebrating their achievements and successes.

“Paul learns about his students and tailors his supervision to get the best out of each of them,” said Professor Reid.  “Like winners of this award in the past, Paul always has the student’s career development at the forefront of his supervision style and provides networking and conference opportunities to all his lab members, including students.”

“Paul’s approach ensures that research students work in an inclusive lab environment of fun, friendship and research excellence,” he said.  “He is an inspirational teacher to his students, a role model to younger scientists and a natural leader. The positive impact he has had on many students over the years, both personally and professionally make him a worthy recipient of this award,”

Associate Professor Mark Barrow, said the Butland Award for Sustained Teaching Excellence recognizes and rewards a long term, consistent or broad contribution to teaching excellence in the Faculty.

“This year two nominations exemplified the excellence we seek,” said Associate Professor Peter Barrow.  “After a lot of deliberation the panel approached the Dean who agreed that two awards be made and I’m sure you will agree that both are well deserved.”

The first Butland Award for Sustained Teaching Excellence went to Peter Riordan from the School of Medical Sciences.

“Peter was appointed in 2000 to help support the growth in Biomedical Science teaching,” said Dr Barrow. “He arrived with an outstanding command of IT technologies and this expertise (alongside a broad portfolio of skills) has been a major contributor to the success of the very large classes that are a feature of Medical Science teaching.”

“Managing student numbers in the thousands is a real art as one needs to make sure that the students not only have all the information they need, but that they still feel important as individuals and can approach their lecturers. Peter achieves this with ease.”

“In 2005 Peter stepped up and took on additional teaching for both MEDSCI 201 students and Year II MBChB student”, he said. “It was in this role that Peter really stood out as a superb teacher - it was as if ‘he had found his true calling’”

“Since that time Peter has expanded and advanced his teaching and involvement in gross anatomy and when the opportunity arose, he took on the role of Laboratory Manager of the Human Anatomy Laboratory and has overseen the entire refurbishment of this unique and highly specialised facility.”

“The panel was impressed by Peter’s humble approach, deriving satisfaction from working alongside students to enhance their learning, providing additional assistance and opportunities for further learning wherever he can.  His students value Peter highly, and this shone through in the nomination,” said Dr Barrow.

The second Sustained Teaching Excellence Award was made to Associate Professor Warwick Bagg.

“Since his appointment in 2000 Warwick has been a leader in the development and delivery of the medical programme; his contribution to teaching has been sustained, consistent and broad,” said Dr Barrow. “Warwick stepped up quickly from the core teaching role to lead the Year six Medicine attachment, then Phase three as a whole.”

“During this time Warwick led the development of the Year Five Pūkawakawa programme,” he said. “Despite time-pressured development, this programme has run like clockwork from the start and has become an exemplar for immersion programmes in Australasia, with tangible workforce benefits.”

“We all know Warwick as the Head of the Medical Programme.  His exemplary leadership of the programme, through a recent period of redevelopment is recognised here.  Of Warwick’s multiple roles in the reinvigoration of the MBChB, perhaps the most outstanding example of his leadership was the introduction of Progress Testing.”

“This was a radical idea for Auckland and Auckland is the first programme in Australasia to use it,” said Dr Barrow. “Warwick steered the introduction with considerable patience and persistence working to gain acceptance by staff and students drawing on the experience of other institutions and the evidence in the literature to assist him.”

“Despite his role as Head of the Medical Programme Warwick continues to lecture the fourth and fifth year medical students, supervises senior medical students, and does ‘beside tutorials’ with medical students completing clinical attachments at Auckland City Hospital,” he said.  “He shows a genuine interest and curiosity in his students’ approach to learning and in the development of every individual medical student.”

“Warwick is seen by his students as excellent and empathetic teacher, communicator, mediator, and by the staff in the programme as an inspirational leader of change,” said Dr Barrow.

The Commission invites patients and interested health professionals to give feedback on the draft survey by 24 June 2015. All feedback is anonymous.

To find out more, go to:  http://www.hqsc.govt.nz/news-and-events/news/2196/

Living with chronic heart damage is not something many of us associate with children but for many children in the Waikato this is still the case.

Rheumatic fever is caused by group A streptococcus – a simple throat infection. If not treated approximately 3 per cent of strep patients could develop rheumatic fever which can lead to irreversible damage to the heart valves. In the Waikato the disease disproportionately affects Maori and Pacific children and is associated with social deprivation and poor living conditions.

But North Waikato has a plan. This winter local schools, pharmacies and health providers have joined together to fight rheumatic fever as part of the national push to end the disease.

Raukura Hauora o Tainui rheumatic fever prevention coordinator Melissa Epiha with Lyn King of Waikato DHB’s Population Health have spearheaded the winter campaign with a hope to reduce the number of cases found in Huntly and Ngaruawahia.

“It’s about raising the awareness and education of rheumatic fever in the home, school and community and providing the support for whanau to access services that can swab a sore throat – anytime and anywhere,” said Melissa.

Misty Blue, 13, from Huntly was diagnosed with rheumatic fever when she was 11. For her and her family, the experience of spending months in hospital and now going through the ongoing treatment has completely changed the course of her young life. As a result, Misty wants others in her community to be aware of what a simple sore throat can lead to. She will be the local face of the community campaign and share her story with peers and families in the area.

Misty’s story is really about acknowledging the core of the campaign, said Melissa.

“Our focus is addressing a community problem with a community solution.  A strong community sense of belonging and pride is a key factor in having a successful campaign.”

The collaborative approach is about promoting awareness of rheumatic fever and the importance of getting a sore throat swabbed every time. The campaign will use several strategies including media, school newsletters, posters and community events.

In addition 13 schools that are on the rheumatic fever prevention programme will be provided with teaching units which will enable teachers to talk every student who attends that school during these winter months when colds and coughing are prevalent.

The Waikato has some of the highest rates of rheumatic fever in the country and data shows that between 2004 to 2012 a quarter of the new cases diagnosed in the DHB catchment came from Waikato District Council’s catchment which encompasses Huntly and Ngaruawahia.

New Zealand has 160 cases a year, with the cost of hospital admissions for rheumatic fever and rheumatic heart disease totalling $12 million a year.

The West Coast District Health Board has announced plans to strengthen and enhance home-based services for older people and shift away from the provision of aged residential care facilities in Buller.

At a public meeting and in discussions with residents, their families and staff yesterday, Chief Executive David Meates says the direction of travel has been set after nine months of conversations with the Buller community. 

“We wanted to understand the range of views about how best to care for and support Buller’s older population.  Throughout this engagement process, we’ve been clear about the opportunities and realities that we collectively face.  Older people have been telling us they want to remain in their own homes for as long as they possibly can.  We’re responding to that and supporting a greater number of people to remain well and supported in their own homes.  As a consequence, DHB-owned rest home occupancy is dropping,” he says.

“Our DHB aged care facilities are in a poor state of repair and there’s no further government funding available to fix them or build new facilities. We also know that O’Conor Home plans to progressively expand its capacity into the future.

“It’s in this context that it’s not viable to continue to maintain the DHB’s Kynnersley Home or Dunsford Ward.  Therefore, our intention is to consult with staff on the proposed closure of Kynnersley Home and the further strengthening of our community-based services. It is expected that this formal consultation will begin in July, with decisions in mid-August 2015.”

Following these steps, and as O’Conor Home expands its capacity, the DHB expects to undertake a further formal consultation process on the proposed closure of Dunsford Ward.

“We’ll be engaging closely with residents, their families, and staff over the coming weeks and months.  Our aim is to respond to the needs and priorities of the community by continuing to increase the range of community-delivered services that enable people to be supported to live well in their own homes”.

“We also want to continue to improve after-hours services, as well as working with other organisations to tackle the key issues identified through the community engagement process of the last nine months — including housing, transport and social isolation,” Mr Meates says.

Mr Meates reiterated that it was a priority for the DHB to ensure there were sufficient beds and appropriate services to meet the needs of all current residents of DHB-owned facilities and those requiring care and support into the future. 

To find out more about this event, go to:  http://www.kingsfund.org.uk/events/integrated-care-summit-2015

Nineteen papers were identified as relevant for this review (3 randomised control trials; 4 cross-sectional, 5 cohort and 3 qualitative studies, and 3 systematic reviews). "The reviewed studies indicated that providing general practitioner-led supportive interventions for post-treatment care of cancer patients is feasible and acceptable to patients. General practitioner involvement resulted in improved physical and psychosocial well-being of patients and continuity of care, especially for patients with concomitant health conditions".

The authors discuss the implications of these findings.

This article is available to read in free full text at:  http://www.ijic.org/index.php/ijic/article/view/1987/2983

Ngune, I., et al. (2015). Do patients with long-term side effects of cancer treatment benefit from general practitioner support? A literature review. International Journal of Integrated Care, 8 June.

Further to an update from Dr Graham Scott, Chair of the Integrated Performance and Incentive Framework Expert Advisory Group, please find attached the draft framework and measures for your input and further development.  Attached are five draft documents as follows:

• Draft Integrated Performance and Incentive Framework
• IPIF Measures and Outline – Summary Document V2
• Description and outline of potential measures
• How to have your say
• Update from Graham Scott on the Integrated Performance and Incentive Framework 30 September 2013.

Please note that the consultation period is now over. The Expert Advisory Group (EAG) Report on the Integrated Performance and Incentive Framework (IPIF) is available to read at:  http://www.hiirc.org.nz/page/45527/

For further information please contact Kanchan Sharma at

The Congress is a partnership between The International Foundation of Integrated Care (IFIC), the Inter-ministerial Health and Social Care and Interaction Plan of the Government of Catalonia and Hospital Clínic Barcelona.

To find out more about this event, go to:  http://integratedcarefoundation.org/events/icic16-16th-international-conference-on-integrated-care

Topics covered in this conference and workshops include: paediatric eczema management; gastroenterology; fertility; ophthalmology; ECG interpretation; diabetes management; musculoskeletal examinations;  and joint injections.

To find out more, including registration details, go to:  http://acma.org.nz/acma-conference-2015/

To find out more, go to:  http://www.nzno.org.nz/groups/sections/respiratory_nurses/conferences

Clinical psychologist and PhD researcher Sarah Malthus works with people who have serious complications of diabetes, such as amputations, kidney failure, and blindness.

She says it can be “heart-breaking” work, but it prompted her interest in developing and evaluating interventions for people at the pre-diabetes stage, so they can avoid these complications in the future.

“Diabetes is a potentially debilitating long-term health condition that comes with substantial physical and psycho-social cost, and unless more is done at a prevention level the impact on the health system is likely to be substantial,” she says.

Ms Malthus, who is based at Massey University’s Psychology Clinic in Palmerston North, is seeking 150 people with prediabetes who live in the MidCentral district to take part in her intervention study.

In the study, funded by the MidCentral District Health Board, participants will receive information about their condition, along with practical changes they can make to their lifestyle to reduce their risk of progressing to diabetes. Involvement requires approximately three to seven hours over six months.

People interested in the study will need to meet criteria for pre-diabetes, which is based on a blood test result. They can be referred into the study by their GP or practice nurse, or contact her directly to discuss a referral. Haemoglobin A1c (HbA1c) is the recommended screening test for Type 2 diabetes and prediabetes. Those with HbA1c levels in the range 41–49 mmol/mol are considered to have prediabetes, otherwise known as ‘intermediate hyperglycaemia’.

Study participants will be randomly assigned to research groups, which will be provided with different types of lifestyle interventions relating to diet and physical activity. The interventions have been informed by international approaches in line with prediabetes advice provided by the Ministry of Health They have been developed in collaboration with the Diabetes Trust along with input from nurse practitioners, dieticians and other health professionals with extensive experience in diabetes prevention and research.

Ms Malthus said Type 2 diabetes is referred to as a ‘silent killer’, because in the early stages people may not have any symptoms or symptoms are very subtle. Symptoms that can indicate a shift from prediabetes to Type 2 diabetes include; feeling tired, increased thirst, increased urination, blurred vision and frequent infections.

Currently, about 25 per cent of New Zealanders meet the criteria for pre-diabetes, which means they are at high risk of developing Type 2 diabetes.

“These rising rates are partly related to changes in lifestyle, such as what we eat, our weight and how physically active we are,” she says.

Rising rates of both prediabetes and diabetes within New Zealand and globally has made diabetes prevention a central focus of health research. International research has demonstrated that the risk of developing Type 2 diabetes can be substantially reduced by almost 60 per cent by providing lifestyle interventions for people with prediabetes.

Ms Malthus was motivated to pursue her doctoral research as a result of her work as a psychologist for the Massey Health Conditions Psychology Service. Her role with this service involves helping people to cope with emotional distress related to living with diabetes, and supporting them to make changes to their lifestyle to manage their diabetes.

She hopes her study will ultimately help those who are at high risk of developing diabetes take steps towards a healthier future, and prevent them from developing serious health problems down the track. She is optimistic that diabetes prevention approaches, such as these, will reduce pressure on the health system that is already overwhelmed with managing diabetes and its complications.

To find out more about the study, or register to take part, contact Sarah Malthus on (06) 350 5180.

Massey University researchers in the College of Health have been awarded almost $4 million in the 2015 Health Research Council’s Funding round.

Pro Vice-Chancellor Paul McDonald says the funding will go towards four diverse research projects tackling some of the most pressing health challenges facing New Zealand and the world.

Investigating gut microbiomes in women:
Chair in Nutrition Professor Bernhard Breier has been awarded almost $1.2 million over three years to investigate the gut microbiome – the mass of bacteria residing in the human gut - in women of Pasifika and New Zealand European descent in the fight against obesity. 

Tantalising new evidence suggests that microbial complexity and functionality in the gut may play a crucial role in obesity. Professor Breier and a team from Massey University, and the Universities of Auckland and Otago, will test whether diet, taste perception, sleep and physical activity can modify the gut microbiome and its impact on obesity.

Enabling participation for children with disabilities:
Professor Karen Witten has been awarded almost $800,000 over three years for research into how built environments, amenities and social environments create barriers for children and young people with disabilities. 

In association with non-governmental organisations in the disability sector, Professor Witten will work with children and young people with motor and sensory impairments and their families to understand their experiences in the public realm using a range of methods across diverse Auckland neighbourhoods.

How airway micro-organisms affect children with asthma:
Childhood asthma is a complex condition which could lead to more severe asthma or other conditions in later life. Professor Jeroen Douwes has been awarded nearly $1.2 million over four years to investigate which airway micro-organisms are associated with lung function deficits and non-allergic inflammation in childhood asthma in 240 New Zealand children. It is the fifth consecutive project Professor Douwes has had funded by the Health Research Council.

Improving outcomes for injured New Zealanders:
Last year the Accident Compensation Corporation (ACC) spent $1.8 billion and received 1.8 million injury claims. Of those claims, 28 per cent have been identified as subsequent injury claims. Associate Professor Sarah Derrett has been awarded almost $600,000 over two years for a Subsequent Injury Study to identify if interventions can be developed for people who suffer a re-injury or identify as being “accident prone”.

“These projects are representative of the cutting edge, applied science we are conducting across the College of Health at Massey University,” said Pro Vice-Chancellor Paul McDonald.

“Our top scientists and students are using their talents and novel ideas to solve the 21st century’s biggest health challenges such as obesity, asthma and disability. Winning such a high proportion of the HRC project grants shows our growing strength and ability to look at issues in groundbreaking ways.”

Thirty-three researchers from across New Zealand received a combined total of more than $34.5 million in project funding in the Health Research Council’s 2015 funding round.

Health Minister Jonathan Coleman says good progress is being made towards accurately measuring patient flow from GPs to hospital based specialists and the outcome of those referrals.

“The Government is focused on delivering better and faster access to health services, including more elective surgeries,” says Dr Coleman.

“We’ve backed that up in Budget 2015 with a further $98 million for increased access to elective surgery. This comes on top of the $110 million committed in Budget 2014.

“The number of patients receiving surgical first specialist assessments has significantly increased over the last six years, from around 260,000 patients a year, to over 315,000 patients assessed each year.

“However there have always been an uncounted percentage of patients who are returned to the care of their GPs.”

The previous Government in 2006 estimated around 25 percent of all GP referrals to specialists were returned to GP care. This would mean that of the 260,000 patients seen each year under Labour, at least 65,000 patients were being referred back to their GPs for care.

“Generally we know that patients can be referred back to their GP for a variety of reasons in addition to not meeting the threshold,” says Dr Coleman. 

“These may be cases where management in primary care is more appropriate such as if the patient has been referred for tests that primary care can access. Patients may also have been referred with incomplete information or to the wrong DHB.

“We are keen to better understand the exact outcomes of GP referrals.

“It is a significant undertaking to standardise the way this data is recorded by different DHBs and to understand referral outcomes. New Zealand will be one of a few countries to be collecting information of this kind at a national level.

“The Ministry of Health is working with DHBs to collect data in a comparable way.

“Ultimately this data will provide more comprehensive information for primary care on their patients.”

The project is on track to release the first set of reliable information in early to mid-2016.

Notes:

The National Patient Flow project has a three year implementation plan, with preliminary data expected to be available in early to mid-2016

The first phase being the collection of information on referrals received by DHBs for first surgical assessments. This has been underway since July 2014.

The second phase will commence in October 2015 and will include information on referrals for elective surgery, and some other procedures, including colonoscopy.

The third phase of the collection will commence in July 2016, and will include the full scope of the collection.  This will encompass a wider range of services, including diagnostics, and will allow linking of related referrals, and capture of a clinical classification of referral reason. This will allow more defined understanding of outcomes for patients

The initial phase of the application process will be hosted by the Ministry of Business, Innovation & Employment (MBIE). Interested applicants will be required to register an Expression of Interest via the MBIE application portal.

To find out more, go to:  http://www.hrc.govt.nz/news-and-media/news/nz-china-non-communicable-diseases-collaborations

Studies in this issue (attached below):

In the latest issue (attached below): 

"Twenty-two PNs and 15 GPs participated in interviews. The Quit with PN intervention was viewed positively. Most PNs were satisfied with the training and the materials provided. Some challenges in managing patient data and follow-up were identified".

The authors discuss the implications of these findings. 

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1093/fampra/cmv041 or contact your DHB library, or organisational or local library for assistance.

Halcomb, E., et al. (2015). Process evaluation of a practice nurse-led smoking cessation trial in Australian general practice: Views of general practitioners and practice nurses. Family Practice, 29 May [Epub before print].

The approach combined systematic review with logic modelling synthesis techniques to develop an evidence-based framework of factors influencing the pathway between interventions and system-wide changes. A narrative synthesis and logic model summary of the data was completed.

This report is available to read in free full text at:  http://dx.doi.org/10.3310/hsdr03240

Blank L, Baxter S, Woods HB, Goyder E, Lee A, Payne N, et al. (2015). What is the evidence on interventions to manage referral from primary to specialist non-emergency care? A systematic review and logic model synthesis. Health Services and Delivery Research, 3(24).

Eighteen studies (6 randomised trials, 2 quasi-experimental studies, 8 with historical controls and 3 with retrospective comparators) were included from primary, secondary, community and managed care settings serving a total estimated asthma population of 800,000 people in six countries.

In these studies, targeting professionals (n=2) improved process, but had no clinically significant effect on clinical outcomes. Targeting patients (n=6) improved some process measures, but had an inconsistent impact on clinical outcomes. Targeting the organisation (n=3) improved process measures, but had little/no effect on clinical outcomes.

Interventions that explicitly addressed patient, professional and organisational factors (n=7) showed the most consistent improvement in both process and clinical outcomes. Authors highlighted the importance of health system commitment, skills training for professionals, patient education programmes supported by regular reviews, and on-going evaluation of implementation effectiveness.

The authors conclude that effective interventions combined active engagement of patients, with training and motivation of professionals embedded within an organisation in which self-management is valued. They go on to say that healthcare managers should consider how they can promote a culture of actively supporting self-management as a normal, expected, monitored and remunerated aspect of the provision of care.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1186/s12916-015-0361-0

Pinnock, H., et al. (2015). Implementing supported self-management for asthma: A systematic review and suggested hierarchy of evidence of implementation studies. BMC Medicine, 13:127.

Twenty studies, including 81,746 patients, were analysed in this review, with the authors noting that, overall the studies were of moderate to low methodological quality.

They conclude from their analysis that "chronic disease management programmes for adults with asthma probably improve patients' quality of life, reduce the severity of the asthma, and improve breathing as demonstrated by improved performance in lung function tests after 12 months. It is unclear whether chronic disease management programmes improve the patients' abilities to manage their own asthma or decrease the number of hospitalisations or emergency visits.".

This article is available to read in free full text at: http://dx.doi.org/10.1002/14651858.CD007988.pub2

Peytremann-Bridevaux I, Arditi C, Gex G, Bridevaux PO, Burnand B. (2015). Chronic disease management programmes for adults with asthma. Cochrane Database of Systematic Reviews, 5, CD007988. 

The NPHCC will host leading international and national speakers providing a platform to engage, challenge and exchange ideas, where pivotal issues for the future of primary health care in Australia will be discussed and where delegates will learn from the experience, opinions and perspectives of sector leaders and their peers. 

To find out more, go to:  https://phaa.eventsair.com/QuickEventWebsitePortal/nphcc/info

To find out more, go to:  http://www.tsanzsrs2016.com/

Primary health workers throughout the Whanganui District Health Board (WDHB) area have reason to celebrate as the Minister of Health’s national health targets results show primary care achieving the Better help for smokers to quit target for the first time with a 91 percent result. 
 
The results released today report the performance of DHBs against the six national health targets over the 2014/15 Quarter Three period of January to March 2015. Whanganui GP and national primary care tobacco target champion John McMenamin says he’s delighted to see the primary care Better help for smokers to quittarget reached in Whanganui.
 
“Whanganui health workers have every reason to celebrate. This result reflects the determination of primary health workers to encourage people to quit smoking,” Dr McMenamin says. “It’s a result that is very deserving as well as timely, with World Smokefree Day coming up on 31 May.”
 
While the WDHB narrowly missed out by one percent on achieving the 95 percent smoking target set for hospitals, the consistent results achieved for this target each quarter are a credit to the hospital staff offering advice and support for patients to quit smoking, says WDHB chief executive Julie Patterson.

Emergency Department clinical director Athol Steward is delighted that the WDHB’s hospital-wide efforts to admit, discharge or transfer 95 percent of patients from ED within the six-hour target, have been sustained. Dr Steward says it’s interesting to see the WDHB once again achieving 96 percent. “It shows consistency by the Whanganui Hospital’s entire clinical team and management.”
 
The 2014/15 Quarter Three national health target results show Whanganui district residents continue to enjoy a high access rate to elective surgical procedures with the DHB achieving 103 percent for the 100 percentImproved access to elective surgery.
 
But disappointingly, Whanganui’s result for the 95 percent Increased immunisation target has dropped to 86 percent. Whanganui Regional Health Network chief executive Judith McDonald says in addition to the 181 children who were immunised in this quarter, there were a further 19 children who did not receive their immunisation on time. “And given that the target performance includes families who have made an informed decision to decline immunisations, and, families who despite being offered support have not met the target timeline, the result is not surprising,” Mrs McDonald says.

Meanwhile, Mrs McDonald is delighted that for a third quarter in a row, Whanganui exceeded the 90 percent national target for More heart and diabetes checks by one percent. She says this is down to the dedicated efforts of general practice teams and the Whanganui Regional Health Network’s success in targeting patients who have not had a completed cardiovascular disease risk assessment.
 
Mrs Patterson is pleased with the steady progress being made on the new 85 percent Faster cancer treatmenttarget. This quarter’s 67 percent result is a five percent improvement on the 62 percent result achieved in the October to December quarter. The target asks that 85 percent of patients will receive their first cancer treatment (or other management) within 62 days of being referred as having a high suspicion of cancer. The target will increase to 90 percent by June 2017.

Click here for the full National Health Targets results table for 2014/15 Quarter 3.

In the latest issue (attached below):

Access to the full text of the articles is free but registration is required on the Lancet site. 

Constructs of depression and distress in diabetes: Time for an appraisal
Frank J Snoek, Marijke A Bremmer, Norbert Hermanns

The link between depression and diabetes: The search for shared mechanisms
Calum D Moulton, John C Pickup, Khalida Ismail

Depression and diabetes: Treatment and health-care delivery
Frank Petrak, Harald Baumeister, Timothy C Skinner, Alex Brown, Richard I G Holt

"Audit and feedback, computerised advice, point-of-care reminders, practice facilitation, educational outreach and processes for patient review and follow-up all demonstrated evidence of a quality improvement effect. Evidence of an improvement effect was higher where baseline performance was low and was particularly demonstrated across process measures and measures related to prescribing. Evidence was not sufficient to suggest that multifaceted approaches were more effective than single interventions".

The authors discuss the implications of these findings.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1017/S1463423615000274 or contact your DHB library, or organisational or local library for assistance.

Irwin, R., et al. (2015). Practice-level quality improvement interventions in primary care: A review of systematic reviews . Primary Health Care Research & Development, 25 May [Epub before print]

Nearly 500 more people were admitted, discharged or transferred within six hours of presenting to Wellington Hospital’s emergency department between January and March this year, an increase of three percent from the previous three months.

Latest health target results released today show that despite another record increase in the number of presentations to the emergency department in the first quarter of 2015, Capital & Coast District Health Board (CCDHB) has improved its performance against the shorter stays in emergency departments target, and three of the five other targets.

“These results reflect the improvements we’ve made to change how we care for people in hospital and the community, and the tremendous efforts made by our staff to provide high-quality healthcare for our patients,” says chief operating officer Chris Lowry.

“Elective surgery performance has improved and we are on track to meet the target this year as we have done in previous years,” she says.

The DHB is also providing more people with help to quit smoking, rising from 80% in the last quarter to 92% of patients provided with brief advice and support to quit this quarter.

“Quitting smoking is the single best thing a person can do for their health. While we have some more work to do in this area to achieve the target, it is promising to see we are supporting more of our patients to do this, especially at the primary care level,” she says.

CCDHB continues to lead the country in the new Faster Cancer Treatment target, and achieved the national immunisation target as second-highest performer.

“Our goal is to achieve all six targets. These latest results are very promising and reflect the amount of time and effort put in by our staff put in to date,” Ms Lowry says.

The results of the six national health targets across all 20 District Health Boards (DHBs) have been released today for the January to March 2015 quarter.  We sustained our improvements to achieve the goals again this quarter for Shorter Stays in the Emergency Department, and Better Help for Smokers to Quit for patients admitted to hospital.  A summary of our results for all the national health targets this quarter is provided below.

Just under 96% (9520) of 9961 people were admitted, discharged or transferred from the Emergency Department (ED) within six hours of presenting – A small improvement on last quarter and again achieving the national target.  Compared to the same quarter last year when we had a similar number of people presenting to the Emergency Department, 559 more people had shorter stays in ED this quarter – a sizeable improvement that reflects the concerted effort of a large number of staff to ensure better patient flow processes, and, together with our general practice teams, better manage the demand for acute health care services.

We continue to be ahead of target for the number of people discharged following their elective surgery.  Over this quarter, another 1701 patients were discharged following their elective surgery bringing the total number to 5377 patients who have had their elective surgical procedure over the last nine months – delivering 110% of our planned target year to date.  About 11% of our patients have their planned surgery at other hospitals that provide specialist surgery to residents of the wider region, like Wellington for heart surgery, and Hutt Valley for plastic and burns surgery.

The new national target for faster cancer treatment was published for the first time last quarter.  The target is that by July 2016, 85 percent of patients receive their first cancer treatment (or other management) within 62 days of being referred with a high suspicion of cancer and a need to be seen within two weeks.  Our result this quarter, at 67%, is consistent with last quarter and the same as the national average for this period (results cover those patients who received their first treatment between October 2014 and March 2015).  This target focuses on a sub-set of patients who are referred through a managed, outpatient pathway.  Our aim is to make steady improvements toward this target by examining referral guidelines and pathways to earlier diagnosis and treatment that will ultimately benefit all cancer patients.

The hospital component of the national health target for offering advice and support to quit smoking was achieved for the second consecutive quarter, with a result of 97.0%.  This was a small improvement on the result last quarter and just above the national average (96%).  Of the adult patients admitted to hospital who smoke (about 15% of all admissions), 1111 patients have been offered brief advice and support to quit smoking over the last nine months.

The result for providing better help for smokers to quit in the primary healthcare setting could not be reported in time for publishing this quarter.  This was disappointing, especially as the targeted ‘quit smoking’ campaign that was undertaken over the last few months by our primary health organisation (CentralPHO) and general practice teams is likely to have contributed to a big improvement on our previous results.  We are currently verifying the data and expect that updated data will be published on the health targets website within the next week or so.

Our result for eight-month-old infants being fully immunised on time fell slightly this quarter to 94.4% - just short of the 95% target, which we attained last quarter.  A drop in the rate this quarter is similar to the pattern last year, with the summer holiday period making it a bit more difficult to reach families with infants due for their immunisation.  Our immunisation team, including general practices and outreach services, continue to work together with families to ensure the vast majority of our children are immunised against vaccine preventable diseases.

The proportion of our eligible enrolled population that have had their risk for cardiovascular disease assessed in the last five years was much the same as last quarter.  Although there were another 367 heart and diabetes checks undertaken between January and March, the proportion of the total expected number to have had a risk assessment over the last 12 months fell short of the 90% target, at 85% of the 47,260 eligible enrolled adults.  CentralPHO is continuing to support general practice teams and our Maori and Pacific health providers to enable more people to have a heart and diabetes check to minimise the risk of them having a heart attack or stroke in the next five years.

Chief executive officer Kathryn Cook has thanked staff for their continued efforts to improve on our performance against these targets.

For more details and FAQs about the Health Targets go to: www.health.govt.nz/healthtargets and the 'MyDHB' website.

Health Minister Jonathan Coleman says the latest quarterly health target results show the shorter stays in emergency departments target has been met for the first time.

“DHBs are continuing to improve their performance on the Government’s health targets,” says Dr Coleman.

“Across the country over 250,000 New Zealanders were admitted, discharged or transferred from an emergency department within six hours. Achieving the 95 per cent target for the first time is a significant achievement.

“The number of patients presenting to emergency departments continues to increase. In quarter three, 4,481 more people attended an emergency department compared to the last quarter.

“Reaching the target is a tribute to all the staff working within emergency departments and DHBs. We know that emergency departments only work well when the rest of the hospital is working well too.”

The improved access to elective surgery and the hospital component of the better help for smokers to quit targets were also met:

• 96 per cent of smokers in hospitals were offered advice on how to quit.
• DHBs delivered 7,997 more elective surgical discharges than planned.

“DHBs remain focused on reducing waiting times for elective first specialist assessments and treatment,” says Dr Coleman.

“The extra $98 million for elective surgery in Budget 2015 will provide more New Zealanders with timely surgery. The Government is committed to continuing to deliver increases in elective surgery.”

The results also show good progress on other targets, including:

• The more heart and diabetes checks target increased to 88 per cent.
• The primary care component of the better help for smokers to quit target increased to 89 per cent.
• The new faster cancer treatment health target increased to 67 per cent – this is the second time this target has been reported.

The quarter three (January-March 2015) results can be found at www.health.govt.nz.

The results of district health board performance against six health targets for the third quarter 2014/15 has been released.

The results are available at:  http://www.health.govt.nz/new-zealand-health-system/health-targets/how-my-dhb-performing/how-my-dhb-performing-2014-15

In the latest issue (attached below): 

Studies were included if they described an intervention for one or more of six chronic conditions that was delivered in a primary health care setting in Australia, New Zealand, Canada or the United States. Attitudes, beliefs, expectations, understandings and knowledge of patients, their families, Indigenous communities, providers and policy makers were of interest. Published and unpublished qualitative and quantitative studies from 1998 to 2013 were considered. Qualitative findings were pooled using a meta-aggregative approach, and quantitative data were presented as a narrative summary.

Twenty three studies were included. Meta-aggregation of qualitative data revealed five synthesised findings, related to issues within the design and planning phase of interventions, the chronic disease workforce, partnerships between service providers and patients, clinical care pathways and patient access to services. The available quantitative data supported the qualitative findings. Three key features of enablers and barriers emerged from the findings: (1) they are not fixed concepts but can be positively or negatively influenced, (2) the degree to which the work of an intervention can influence an enabler or barrier varies depending on their source and (3) they are inter-related whereby a change in one may effect a change in another.

The authors conclude that future interventions should consider the findings of this review as it provides an evidence-base that contributes to the successful design, implementation and sustainability of chronic disease interventions in primary health care settings intended for Indigenous people.

This is an open access article and can be read in free full text at:  http://dx.doi.org/10.1186/s13012-015-0261-x

Gibson, O., et al. (2015). Enablers and barriers to the implementation of primary health care interventions for Indigenous people with chronic diseases: A systematic review. Implementation Science, 10:71.

The module will support knowledge of the human papilloma virus (HPV) and the HPV vaccine. It will assist you with knowing when to order an HPV test as part of regular cervical screening, and discussing the results of those tests with women.

To find out more on the LearnOnline website, go to:  http://learnonline.health.nz/course/category.php?id=83

The brochure is an initiative between Home and Community Health Association and Carers New Zealand, funded by Accident Compensation Corporation.

http://www.acc.co.nz/publications/index.htm?ssUserText=acc7116

Topics covered include: Epidemiology of paediatric diabetes: a growing problem? New insights into pathophysiology; Making the diagnosis: effect of correct diagnosis and action; Management of type 1 diabetes; Controversies; Management of type 2 diabetes: limited evidence leads to limited options; Can paediatric diabetes be prevented? Future directions: closing the loop?

Access to the full text of the article is free but registration is required on the Lancet site. To read the full abstract and for information on how to access the full text, go to: http://dx.doi.org/10.1016/S0140-6736(15)60971-0 or contact your local, DHB or organisational library for assistance.

Cameron, F.J. & Wherrett, D.K. (2015). Care of diabetes in children and adolescents: Controversies, changes, and consensus. The Lancet, 385(9982), 2096-2106.

University of Otago researchers have gained nearly $2.2M in funding from the Lottery Grants Board to support studies aimed at improving the health status of New Zealanders.

The grants support the purchase of research equipment, scholarships, and the pursuit of research projects aimed to translate into meaningful health outcomes and community benefit.

Researchers from across the University’s three main campuses in Dunedin, Christchurch and Wellington have received 19 translational research grants, 10 equipment grants, two postdoctoral scholarships and two PhD scholarships. A full list appears below.

Nationally, around $3.8M, comprising 64 grants, was distributed in the Lottery Health Research 2014/2015 funding round.

Otago’s translational projects involve a wide variety of health-related topics ranging from using whole-genome sequencing to rapidly diagnose drug-resistant tuberculosis strains to investigating whether improving homes could prevent children from suffering strep throat and rheumatic fever.

Also among the projects are studies on topics such as New Zealand’s non-Hodgkin’s lymphoma epidemic, improving prediction of cardiovascular risk in the general populations. Others focus on areas including searching for a signature of aggressiveness in prostate cancer, and biomarkers that may predict Alzheimer’s disease progression.

Otago’s Lottery Health grants 2014/2015

Translational Research Projects:

Understanding the determinants of cerebral perfusion stability for improved neurocritical care
Mr Philip Allan (Surgery, University of Otago, Wellington)
$7,000

Benefits of nuts and seeds in the diets of postmenopausal women with type 2 diabetes. The NuSeD Trial
Dr Alexander Chisholm (Human Nutrition)
$100,000

Whole genome sequencing of Mycobacterium tuberculosis isolates for rapid diagnosis and genotyping
Professor Greg Cook (Microbiology & Immunology)
$86,218

Epidemiological risk and epigenetics of non-Hodgkin lymphoma and chronic lymphocytic leukaemia
Associate Professor Brian Cox (Preventive & Social Medicine)
$78,000

Improving the breast cancer journey for women with experience of mental illness
Dr Ruth Cunningham (Public Health, University of Otago, Wellington) 
$86,618

The effectiveness of a feedback device in changing occupational postural behaviour: a randomised controlled trial
Dr Daniel Cury-Rubiero (Physiotherapy)
$29,000

First steps towards non-invasive antenatal screening in New Zealand
Dr Sara Filoche (Primary Health Care & General Practice, University of Otago, Wellington)
$92,825

Search for a signature indicative of aggressive prostate cancer in tissue biopsies 
Dr Elspeth Gold (Anatomy)
$50,222

Measurement of mitochondrial dysfunction in human disease
Professor Mark Hampton (Pathology, University of Otago, Christchurch)
$59,166

Clozapine Therapy: Are dose adjustments required for Māori patients?
Dr Noelyn Hung (Pathology)
$30,000

Identification of persons with early signs of hip and knee osteoarthritis and the effect of intervention
Dr Prasath Jayakaran (Physiotherapy)
$37,110

Longitudinal investigation of sedentary behaviour patterns and its predictors among New Zealanders with high risk of developing chronic diseases
Mr Ramakrishnan Mani (Physiotherapy)
$7,709

Incidence and prevalence of anterior cruciate ligament (ACL) injuries in female netball players in New Zealand and identification of factors in which they occur.
Dr Meredith Perry (Physiotherapy)
$18,712

Improving cardiovascular risk prediction in the general population
Dr Anna Pilbrow (Medicine, University of Otago, Christchurch)
$96,221

Youth health interagency collaboration: identifying the best ways to work together to provide effective and accessible health care to young people in New Zealand
Associate Professor Susan Pullon (Primary Health Care & General Practice, University of Otago, Wellington)
$58,884

Acceptability and feasibility of a collaborative approach to improving partner notification and STI retesting rates in primary care
Dr Sally Rose (Primary Health Care & General Practice, University of Otago, Wellington)
$60,000

How food literate are New Zealand children?
Professor Murray Skeaff (Human Nutrition)
$35,000

Rapid detection of antibiotic resistance through LC-MS
Dr James Ussher (Microbiology & Immunology)
$41,008

The prognostic value of a novel Alzheimer’s disease-related composite biomarker signature
Dr Joanna Williams (Anatomy)
$120,000

Research Equipment grants:

Shared equipment for automated high throughput cell imaging
Dr Augustine Chen (Biochemistry)
$50,000

3dMDtrio Imaging System and software (for 3D imaging of the face)
Professor Mauro Farella (Oral Sciences)
$90,000

Automated Histology Autostainer Bond Max – Leica Biosystems or Biocare IntelliPATH Stainer 
Ms Amanda Fisher (Pathology, Dunedin)
$100,000

Ultracentrifuge rotor and PCII hood
Associate Professor Merilyn Hibma (Pathology, Dunedin)
$14,050

Proto-Tech Thermocycler Unit
Ms Wendy-Ann Jansen van Vuuren (Oral Rehabilitation)
$15,417

High speed, high sensitivity camera, (sCMOS), CoolLED UV LED-based light source
Dr Peter Jones (Physiology)
$50,000

Automated Protein Crystallography incubation and imaging facility
Professor Kurt Krause (Biochemistry)
$79,054

Lecia EM PACT2 high pressure freezer with a rapid transfer system
Associate Professor Dorothy Oorschot (Anatomy)
$100,000

Advanced Human Environmental Chamber
Dr Shieak Tzeng (Surgery, University of Otago, Wellington)
$40,754

Integrated preparative high pressure liquid chromatography (prep-HPCL0) system consisting of a binary pump, autosampler, column oven, variable wavelength UV-Vis detector and associated software
Dr Andrea Vernall (Pharmacy)
$19,275

Postdoctoral Fellowships:

The influence of systemic infection on post-stroke functional recovery
Dr Silke Neumann (Pathology, Dunedin)
$150,000

Cool? The insights and experiences of New Zealand youths living in, or at risk of, fuel poverty
Dr Kimberley O’Sullivan (Public Health, University of Otago, Wellington)
$150,000

PhD Scholarship:

Could improving homes prevent children developing GAS pharyngitis and rheumatic fever?
Ms Jane Oliver (Public Health, University of Otago, Wellington)
$120,000

Understanding how the host immune response improves patient prognosis in colorectal cancer
Ms Kirsten Ward-Hartstonge (Microbiology & Immunology)
$120,000

1. Managing menopause 
2. Polycystic ovarian syndrome 
3. Abnormal uterine bleeding 
4. Incontinence: an update 
5. Older women who want to conceive 
6. Sexual Health 
7. Update on smear taking and colposcopy 
8. The new diabetes in pregnancy guidelines 

For registration details, go to:  https://womenshealthupdate2015.lilregie.com/step1

Original Health Navigator NZ material is produced and updated by a team of medical writers and subject experts.

The Health Navigator NZ website is a non-profit community initiative combining the efforts of a wide range of partner and supporter organisations overseen by the Health Navigator Charitable Trust.

Content includes:

• Checklist: patient presenting with acute chest pain in primary care
• Investigate all patients with suspected cardiac chest pain
• Treatment for all patients with acute coronary syndromes
• If the patient cannot be transported to hospital immediately

bpac (NZ) is an independent organisation that promotes health care interventions which meet patients’ needs and are evidence based, cost effective and suitable for the New Zealand context.

They develop and distribute evidence-based resources which describe, facilitate and help overcome the barriers to best practice.

The guide is available to read in full text at: http://www.bpac.org.nz/BPJ/2015/April/coronary.aspx

The Health Research Council of New Zealand (HRC) is gearing up to announce its 2015 funding results in early June. The HRC’s Chief Executive Dr Kathryn McPherson says that the really important news to note is the difference that funding awarded in previous years has achieved for New Zealand. 

“We recently undertook a survey of all the health-related research published by New Zealand researchers between 2005 and 2009,” says Dr McPherson. “The survey shows that New Zealand research is punching above its weight,” she says.

“The results of the survey identified that health research funded by the HRC has a significant impact around the world,” she says. HRC publications were cited at or above the world average for citation impact in every field.

“In a number of fields, research undertaken by HRC-funded researchers achieved double the world average for scientific influence - measured by the number of other studies which reference New Zealand research. For example in paediatrics and reproductive medicine, immunology, genetics and clinical sciences, with our articles achieving double the world average for citation impact.” The HRC’s health research achieved an impressive 20 per cent of publications ranked in the top 20th percentile worldwide, and one or more publication ranked in the top 1 per cent worldwide in a number of fields.

“Our findings indicate that our assessment processes result in exceptionally high quality work that makes a difference. The fact that our researchers are amongst the very best internationally is great for New Zealand for all sorts of reasons. Perhaps the most important one is because where there is high quality health research, all international data indicates there is better health for the population,” says Dr McPherson. 

Since our establishment in 1990 the quality of life for all New Zealanders, and the number of years we can expect to live free from disease and disability has improved significantly – New Zealand’s infant mortality rate has declined by 30 per cent, the disability among over 65 year olds has decreased by 13 per cent, life expectancy has increased by six years for males and three years for females, and survival rates from cancer have doubled since the 1970s. Our research and research teams have made many of these health gains possible.

“As we move towards celebrating 25 years of serving New Zealand this year, it is timely to recognise some of the world-first breakthroughs and significant health and economic impacts HRC-funded research has achieved, says Dr McPherson.

• We have had a tangible impact on the health of our homes and environment. The work of Professor Philippa Howden-Chapman and her team proved the link between meningococcal disease and household overcrowding, while Professor David Fergusson as part of the Christchurch Longitudinal study established the link between passive smoking and respiratory illness, and the negative health impact of lead. Each of these findings has resulted in real changes to housing policy and the health of our homes; the regulation of smoking and the introduction of smokefree environments; and the removal of lead from our petrol.
• We have made world first discoveries with the identification of the mechanism causing kidney cancer in children (Professors Anthony Reeve and Parry Guilford); the discovery of stem cells in the brain and evidence that the human brain can repair itself by generating new brain cells (Professor Richard Faull and his team at the Centre for Brain Research); the identification of the gene associated with antisocial behaviour in males and the gene-environment interaction that predisposes adolescents smoking cannabis to develop adult psychosis (Professors Richie Poulton and David Fergusson and their teams at the Dunedin Multidisciplinary health and Development study and the Christchurch Health and Development Longitudinal study); and a novel peptide that identifies heart-failure at the earliest stage – this discovery has saved thousands of lives and led to the development of new treatment standards that are used the world-over (Professor Mark Richards and his team at the Christchurch Heart Institute).
• Our research has saved the lives of thousands of our babies and young people. Three babies in every 1000 live births survive each year because of HRC-funded research – 20 years ago these babies would have died from sudden unexplained death in infancy. At current birth rates, that’s 200 babies a year (Professor Ed Mitchell). The recent identification of target levels of oxygen for pre-term babies has also greatly improved survival rates of vulnerable babies (Professor Brian Darlow and his team), and HRC research leading to the national and subsequently international withdrawal of the high dose fenoterol inhaler medication to treat asthma in children, has saved tens of thousands of lives globally (Professors Neil Pearce and Richard Beasley).
• We have made valuable savings for the New Zealand taxpayer by identifying the right and most cost-effective treatments. HRC-funded research identified that prescribing calcium supplements to prevent osteoporosis increased the rate of cardiovascular events in older women which resulted not only in better health outcomes, but a 66 per cent reduction in calcium supplements prescribed, saving $3.9 million over 5 years, with annual savings likely to accrue into the foreseeable future (Professor Ian Reid). PREDICT software, an electronic decision-support tool for the prediction of cardiovascular risk has led to a significant reduction in health care costs, with District Health Boards estimating the cost-savings to our health system at $300 million a year (Professor Rod Jackson).
• Our research also generates direct economic returns through the development of innovative commercial products, where we have taken early discoveries all the way from patent to patient. These innovative products and treatments include a wireless heart-pump (Professor Simon Malpas); a cooling cap to prevent brain damage in pre-term babies (Professor Alistair Gunn); an award winning e-therapy for youth coping with depression (Professor Sally Merry); a new fast-track cardiac diagnostic tool which has halved unnecessary hospital admissions (Dr Martin Than); a new effective and low-cost treatment for neo-natal hypoglycaemia (Professor Jane Harding); a world-first vaccine for rotavirus; a diagnostic tool for bladder cancer (Professor Parry Guilford); and a new treatment for osteoporosis that is 10,000 times stronger than previously available drugs (Professor Ian Reid).

Dr McPherson says that “whilst there is more to be done, and important questions remain about how best to maintain health and get better outcomes for people with illness or injury, New Zealand has every reason to be proud of what its health researchers are achieving.”  

People who smoke cannabis as little as once a week are more likely to suffer respiratory symptoms such as morning cough, bringing up phlegm, and wheezing, according to University of Otago research.

However, the researchers’ study into the long-term respiratory effects of smoking cannabis found that after reducing or quitting cannabis smoking, these symptoms reduced to levels similar to those found in non-users.

In New Zealand, cannabis use is almost as widespread as tobacco with about half of young adults admitting to have used it in the previous year.

Associate Professor Bob Hancox, who led the study, says “Even people who only used cannabis once per week were likely to have a cough, bring up phlegm from the chest, and get wheezy. The good news is that if they stop smoking cannabis, these symptoms usually improve, although there was evidence that cough and wheeze may persist in those who have been long-term heavy users.”

The effect of quitting cannabis use was studied in the Dunedin Multidisciplinary Health and Development Study, which continues to follow the progress of 1037 people born in Dunedin between April 1972 and March 1973. Cannabis and tobacco smoking histories were obtained at ages 18, 21, 26, 32 and 38 years. At each assessment, participants were asked how many times they had used the drug in the previous year.

Many cannabis users already had symptoms of bronchitis (cough, sputum production, and wheeze) by the age of 21 years. These symptoms persisted or got worse at ages 26, 32, and 38 years if people continued to use cannabis weekly or more. The association between cannabis use and bronchitis symptoms remained even after tobacco smoking, asthma, and other factors were taken into account.

Dr Kyle Perrin, medical director at the Asthma Foundation says “Any form of smoking is going to affect your lungs. People who smoke marijuana, even if it is only once a week, need to realise that it will adversely affect their health.”

“The findings indicate that cannabis users are likely to develop bronchitis but that this often gets better on quitting” says Associate Professor Hancox. “However, some people who had been heavy cannabis users had a persistent cough and wheeze even after they cut down or quit. This suggests that long-term heavy cannabis smoking may have lasting effects on the airways.”

The findings appear in the European Respiratory Journal and the study was supported by the Asthma Foundation.

The report is available to read in full text at:  http://www.phcris.org.au/phplib/filedownload.php?file=/elib/lib/downloaded_files/publications/pdfs/phcris_pub_8441.pdf

Erny-Albrecht K, Bywood P, Oliver-Baxter J. (2015). The role of primary care in primary and secondary prevention of diabetes and related complications. PHCRIS Policy Issue Review. Adelaide: Primary Health Care Research & Information Service.

HIIRC identified this research via the Ministry of Health Library's Grey Matter newsletter.

These guidelines provide a systematic approach to the investigation of clusters of non-communicable disease. Public health units (PHUs) can follow this approach to carry out an organised and coordinated response to reports of alleged clusters.

The guidelines can be downloaded in full text at:  http://www.health.govt.nz/publication/investigating-clusters-non-communicable-disease-guidelines-public-health-units

Ministry of Health (2015). Investigating Clusters of Non-communicable Disease: Guidelines for public health units. Wellington: Ministry of Health.

This evidence briefing, Supporting self-management: Helping people manage long-term conditions, has been produced by the Centre for Reviews and Dissemination.

This evidence briefing on the commissioning of social prescribing has been produced by the Centre for Reviews and Dissemination. 

The briefing is available to download and read in free full text at:  http://www.york.ac.uk/media/crd/Ev%20briefing_care%20planning.pdf

University of York Centre for Reviews and Dissemination (2015). Promoting patient-centred care planning consultations. York: Centre for Reviews and Dissemination.

The workshop aims to:

• Set out the key characteristics of effective and successful leaders in complex health systems.
• Demonstrate through case studies the impact of successful leadership, and draws on examples of significant problems in health organisation due to poor or lack of leadership.
• Relate the above to your own role and clinical practice setting or work setting to allow you to bring and apply the key leadership characteristics.

To find out more, go to:  http://www.nzno.org.nz/petercarter

"The study focuses in on the content of these new models, which are frequently applied from different disciplinary and professional perspectives and associated with different goals and does so through analyzing approaches to self-management support, service delivery design and decision-support strategies, financing, availability and access. Significantly, it also illustrates the challenges faced by individual patients as they pass through the system".

The book is free to download at:  http://www.euro.who.int/en/about-us/partners/observatory/publications/studies/assessing-chronic-disease-management-in-european-health-systems-country-reports

Nolte, E. & Knai, C. (2015). Assessing chronic disease management in European health systems: Country reports. Brussels: European Observatory on Health Systems and Policies.

These case studies establish the context of primary care in each country; the key governance and economic conditions; the development of the primary care workforce; how primary care services are delivered; and an assessment of the quality and efficiency of the primary-care system.

The report is available to download and read in free full text at:  http://www.euro.who.int/en/about-us/partners/observatory/publications/studies/building-primary-care-in-a-changing-europe-case-studies

Kringos, D., et al. (2015). Building primary care in a changing Europe: Case studies. Brussels: European Observatory on Health Systems and Policies.