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INTRODUCTION: The usual drivers of health care provision, namely efficacy and cost, might be expected to drive down the use of Complementary and Alternative Medicines (CAMs), given the relative paucity of evidence of efficacy for many CAMs. Usage of CAMs remains extensive and little attention has been given to explaining this paradox. This paper explores how patients integrate acupuncture, as a CAMs exemplar, within their personal schemes of health care. METHODS: An interpretive phenomenological approach underpinned the inquiry, which gathered data from in-depth interviews with 12 participants who had recently consulted acupuncturists. Thematic analysis was conducted using a constant comparison methodology. FINDINGS: Participants mostly accessed acupuncture for musculoskeletal and pain-related conditions. Usage was often initially motivated by dissatisfaction with conventional health care, perceptions that the source of the problem had not been addressed, and sometimes was due to negative experiences with medical professionals. Previous positive outcomes with acupuncture motivated more extensive use, as did personal health ideologies. Acupuncture was viewed to be appropriate for treating chronic and quality of life health issues, while treatment-associated cost was identified as a barrier to access. CONCLUSIONS: CAMs usage has been explained variously by 'push' and 'pull' factors; however, this study has shown that reasons for patient use of acupuncture may be complex and change overtime. This qualitative study suggests that acupuncture fulfils specific health needs unmet in conventional health care, but also that patients view CAMs treatment as part of a broader and more pluralistic scheme of health care. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The Medicines (Standing Order) Amendment Regulations 2011 allow medicines to be supplied or administered to a patient by a nurse in the absence of a medical practitioner and without a prescription. Regulations have been in place since 2002, but no substantive research has occurred in New Zealand concerning their use. AIM: This paper reports a survey of registered nurses (RNs) who work in primary health care (PHC) settings and explores aspects of their practice relating to their use of standing orders. METHODS: A self-reported survey using a non-probability sample of RNs working in PHC who use standing orders in their practice (n=231). Data were analysed descriptively. RESULTS: The sample were experienced RNs (mean 24 years since registration) and 53% have a post-graduate qualification. Some nurses' understanding of a standing order included provision of a prescription to a patient. Standing orders were used frequently (42% reported use 1 to >5 times/day) for a wide variety of conditions. There is a significant relationship between undertaking the stated professional development requirements and confidence in the clinical decisions made (p=0.025). Over half (52%) would like to use standing orders more often. DISCUSSION: Standing orders are used extensively in PHC settings. The conditions nurses are involved in treating are usually already differentiated or have a high degree of diagnostic certainty. Nurses can effectively provide medicines under standing orders when doctors support their use, issue evidence-based orders, and have confidence in nurses with advanced skills. Doctors need to meet their responsibilities under the Regulations. [ABSTRACT FROM AUTHOR]

Introduction. Community-based primary care physiotherapy has developed through private practice, fee-for-service model in Aotearoa New Zealand where independent businesses operate in competition. Aim. We aimed to explore how the private practice model of physiotherapy impacts patient care, physiotherapists, and professional behaviour. Methods. Six physiotherapists managing musculoskeletal conditions in a primary care private practice in Aotearoa New Zealand were recruited using maximum variation purposive sampling. In-depth individual face-toface semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using Interpretive Description. Inductive data analysis synthesised and contextualised data, creating a thematic framework that developed across interviews. Results. All physiotherapy participants discussed concerns about culture and professionalism in private practice physiotherapy despite not being asked about these. Three themes were identified. 'Competitive business model and lack of collaboration' - participants thought that competition between practices resulted in a lack of trust, collegiality, and collaboration, and pressure on clinicians to maintain income. '(Un)professional behaviour' - participants thought that physiotherapists were defensive and averse to scrutiny, resulting in reluctance to admit when they needed help, or to undertake peer review or seek second opinions. 'Lack of support and mentoring' - the professional culture in private practice was perceived to reduce support and mentoring, with negative impacts that affected physiotherapists at all stages of career. Conclusion. This exploratory qualitative study suggests that competition dominates communication and collaboration in private practice physiotherapy and may have wider implications for professionalism and the quality of patient care. Competitive business models and an aversion to scrutiny may reduce collegial interaction and professional behaviour. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Diabetes mellitus is common in primary care, yet little has been reported of its primary care prevalence or the clinical characteristics of patients with Type 2 diabetes mellitus (T2DM). AIM: To determine the prevalence of diabetes mellitus and clinical characteristics of diabetes patients in primary care in the Waikato region. METHODS: Primary care data were extracted from the electronic records of 15 general practices for patients aged >20 years with current diabetes mellitus at 20 June 2017. Diabetes mellitus was defined as having a glycated haemoglobin (HbA1c) of ≥50 mmol/mol (6.7%) or having being dispensed two or more anti-diabetic medications in the previous 12 months. Additional data collected included patients' ethnicity, age, sex and years since diagnosis. RESULTS: The overall prevalence of diabetes mellitus was 5.7% and was higher for Māori (8.6%), Asian (7.0%) and Pacific peoples (9.1%) than Europeans (5.0%; all P < 0.001). For patients with T2DM for whom current diabetes annual review data were available (n = 2227) the mean body mass index (BMI) was 32.8 ± 0.2 kg/m2, but BMI was higher in Māori, younger patients, females and patients diagnosed <2 years previously (all P < 0.001). Similarly, HbA1c levels were highest in Māori and younger patients (both P < 0.001), with 40% of patients overall having a HbA1c of ≤53 mmol/mol (7.0%). Approximately 70% of all patients had at least one measure of hypertension (systolic ≥130 or diastolic ≥80 mmHg), or dyslipidaemia. More than 85% of patients had completed a recent retinal screen and foot check. DISCUSSION: We found that management of T2DM was suboptimal, with measures for many patients not meeting clinical targets. Support should be provided to improve weight and glycaemic management, particularly for Māori, females and younger patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: There is increasing concern worldwide at the steady growth in acute inpatient admissions and emergency department (ED) attendances. AIM: To develop measures of variation in acute hospital use between populations enrolled at different general practices that are independent of the sociodemographic characteristics of those populations. METHODS: Two consecutive years of hospital discharge and ED attendance data were combined with primary health organisation (PHO) registers from 385 practices of over 1.5 million people to develop and test two measures of unplanned hospital use: the standardised acute hospital admission ratio (SAAR) and the standardised ED attendance ratio (SEAR). Disease-specific measures were also produced for inpatient events. RESULTS: The enrolled populations of a high proportion of practices had significantly higher or lower than expected acute use of hospitals and this was consistent over both years studied. Practices whose population made unexpectedly high use of acute hospital care for one condition tended to do so for others. Differences in health needs between practice populations as measured by clinical complexity, comorbidities and length of stay did not explain a significant portion of the overall variation in hospital admissions. The enrolled population's average travelling time to a 24-hour ED accounted for some of the practice variation in unplanned utilisation of hospital services. DISCUSSION: This study confirms that there is considerable unexplained practice variation in acute hospital use. Further development of the SAAR and SEAR measures may be possible to use these to identify modifiable practice-level factors associated with high unplanned hospital use. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The ageing population means prescribing for chronic illnesses in older people is expected to rise. Comorbidities and compromised organ function may complicate prescribing and increase medication-related risks. Comorbid depression in older people is highly prevalent and complicates medication prescribing decisions. AIM: To determine the prevalence of potentially inappropriate medication use in a community-dwelling population of older adults with depressive symptoms. METHODS: The medications of 191 community-dwelling older people selected because of depressive symptoms for a randomised trial were reviewed and assessed using the modified version of the Beers' Criteria. The association between inappropriate medication use and various population characteristics was assessed using Chi-square statistics and logistic regression analyses. RESULTS: The mean age was 81 (±4.3) years and 59% were women. The median number of medications used was 6 (range 1-21 medications). The most commonly prescribed potentially inappropriate medications were amitriptyline, dextropropoxyphene, quinine and benzodiazepines. Almost half (49%) of the participants were prescribed at least one potentially inappropriate medication; 2996 were considered to suffer significant depressive symptoms (Geriatric Depression Scale >5) and no differences were found in the number of inappropriate medications used between those with and without significant depressive symptoms (Chi-square 0.005 p=0.54). DISCUSSION: Potentially inappropriate medication use, as per the modified Beers' Criteria, is very common among community-dwelling older people with depressive symptoms. However, the utility of the Beers' Criteria is lessened by lack of clinical correlation. Ongoing research to examine outcomes related to apparent inappropriate medication use is needed. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Outreach Immunisation Services (OIS) enable children who have not been immunised on time at general practice to be immunised in the community, thereby improving immunisation coverage and reducing equity gaps. AIM: To identify the most effective service delivery models and make recommendations for more effective and cost-efficient OIS delivery in New Zealand. METHODS: Data collection and thematic analysis through a detailed review of OIS contracts and service specifications, an online survey and in-depth interviews with stakeholders and providers, and an analysis of cost data was conducted. RESULTS: In total, 28 OIS providers completed survey questionnaires, 28 OIS staff were interviewed, and cost effectiveness data were obtained from 11 providers. The surveys and interviews identified key themes around identifying clients with the highest needs, effective engagement strategies, staffing requirements, and service challenges. On average, each OIS referral costs NZ$361 (median NZ$257), and each vaccination event costs NZ$636, ranging from NZ$145 to NZ$2403. Characteristics for two separate models of service delivery were identified based on provider size. CONCLUSION: There is considerable range in costs and style of OIS delivery, and efficiencies can be gained. Models need to fit with locality needs and include adequate resourcing, staff with good local knowledge, close relationships with other key child health services and preferably co-location, sustainable funding, and regular service reviews. OIS are part of an effective integrated service that relies on accurate data, positive relationships and a rapid response when children fail to present for vaccination in a timely fashion. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Māori are overrepresented in cardiovascular disease (CVD) mortality and morbidity statistics in New Zealand (NZ). AIM: To examine cardiovascular risk (CVR) assessment and management for Māori, utilising Caring Does Matter (CDM) initiative data. METHODS: Using 16 general practices' electronic medical records--which include ethnicity data--the rate o f CVR screening, CVD medication treatment and adherence levels, and physiological measures for Māori patients at high CVR (≥15% five-year risk o f a cardiovascular event) were compared to findings for Pacific and non-Māori/non-Pacific patients. RESULTS: Records for 72 351 adults (10 358 Māori; 14%) showed that Māori patients have a poorer CVR assessment rate (46% at guideline-indicated age) than Pacific and non-Māori/non-Pacific groups; when assessed, a greater proportion o f Māori patients (38%) were at high CVR. The proportion o f high-CVR Māori patients being treated with oral antidiabetic medication (42%) was lower than for Pacific patients but higher than for non-Māori/non-Pacific patients. Lower rates o f antihypertensive adherence were found for high-CVR Māori patients than for non-Māori/non-Pacific patients (although higher than for Pacific patients). The high-CVR Māori patients who adhered to CVD medications had lower blood pressure, total- to-HDL cholesterol ratio and HbA1c than non-adherers. DISCUSSION: The association between higher medication adherence and better control o f risk factors suggests that adherence should be further promoted by clinicians. More active CVR assessment, treatment and support o f medication adherence in Māori attending general practices is justified, given their high mortality rate from CVD in comparison to the overall NZ population. [ABSTRACT FROM AUTHOR]

INTRODUCTION; Pacific New Zealanders have a high prevalence of smoking, with many first smoking in their pre-adolescent years. AIM: To identify risk factors for tobacco smoking among Pacific pre-adolescent intermediate school children. METHODS: A cross-sectional survey of 2208 Pacific students aged between 10 and 13 years from four South Auckland intermediate schools who were asked about their smoking behaviour between the years 2007 and 2009. RESULTS: The prevalence of Pacific ever-smokers (for 2007) in Year 7 was 15.0% (95% Confidence Interval [Cl] 12.0%-18.3%) and Year 8, 23.0% (95% Cl 19.5%-26.7%). Multivariate modelling showed the risk factors for ever-smoking were Cook Island ethnic group (OR 1.72; 95% Cl 1.26-2.36, ref=Samoan), boys (OR 1.47; 95% Cl 1.14-1.89), age (OR 1.65; 95% Cl 1.36-2.00), exposure to smoking in a car within the previous seven days (OR 2.24; 95% Cl 1.67-3.01), anyone smoking at home within the previous seven days (OR 1.52; 95% Cl 1.12-2.04) and receiving more than $NZ20 per week as pocket money/allowance (OR=1.91,95% Cl 1.23-2.96). DISCUSSION: Parents control and therefore can modify identified risk factors for Pacific children's smoking initiation: exposure to smoking at home or in the car and the amount of weekly pocket money the child receives. Primary health care professionals should advise Pacific parents to make their homes and cars smokefree and to monitor their children's spending. This study also suggests a particular need for specific Cook Island smokefree promotion and cessation resources. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Most exercise studies for older adults have been university- or hospital-based. Little is known about the benefits and factors influencing long-term participation in community-based exercise programmes, especially in New Zealand. AIM: To quantify the objective benefits, participant perceptions and retention rates of a New Zealand community-based exercise programme for adults (60 years or older). METHODS: Study 1 involved assessing the benefits of 12 weeks' training on a convenience sample of 62 older adults commencing the never2old Active Ageing programme. Study 2 assessed the perceptions of 150 current participants on a variety of programme components that could act as barriers or facilitators to continued engagement. Study 3 assessed the retention rates of 264 participants in the programme over a two-year period. RESULTS: Significant improvements in many physical functional scores were observed in Study 1 (5-30 percentile points; p<0.05). Questionnaire responses from participants in Study 2 indicated many perceived benefits (positive responses from 67-95% on various questions) and that core components of the programme were rated very highly (64-99% on various components). Retention rates were high, with Study 3 finding 57% of participants still engaging in the programme at the end of the two-year period. DISCUSSION: A community-based exercise programme for older adults can improve many objective and subjective measures of physical fitness and functional performance and have good retention rates. General practitioners and other allied health professionals in New Zealand should consider promoting programmes, such as the never2old Active Ageing programme, to their older patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Doctors are increasingly involved in the management of chronic disease and counsel patients about their lifestyle behaviours, including nutrition, to improve their health outcomes. AIM: This study aimed to assess the impact of a medical undergraduate course containing nutrition content on medical students' self-perceived nutrition intake and self-efficacy to improve their health behaviours and counselling practices. METHODS: A total of 239 medical students enrolled in a 12-week nutrition-related course at The University of Auckland were invited to complete an anonymous questionnaire before and after the course. The questionnaire was adapted from a previous evaluation of a preventive medicine and nutrition course at Harvard Medical School. RESULTS: Sixty-one medical students completed both pre- and post-course questionnaires (25.5%). At baseline, medical students described their eating habits to be more healthy than non-medical students (p=0.0261). Post-course, medical students reported a higher frequency of wholegrain food intake (p=0.0229). Medical students also reported being less comfortable making nutrition recommendations to family and friends post-course (p=0.008). Most medical students (63.9%) perceived increased awareness of their own dietary choices, and some (15.3%) reported an increased likelihood to counsel patients on lifestyle behaviour post-course. DISCUSSION: Students can increase awareness of their own nutrition behaviour after undertaking a course that includes nutrition in the initial phase of their medical degree. Further investigation of how medical students' confidence to provide nutrition advice evolves throughout their training and in future practice is required. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Recognition of pulmonary involvement in extra-pulmonary tuberculosis (TB) may be an important public health issue, as smear-negative pulmonary TB is responsible for about 17% of new infections. Pulmonary TB can be present despite a normal chest x-ray (CXR), even in human immunodeficiency virus (HlV)-negative patients. In this retrospective clinical audit, we reviewed a case series of HIV-negative patients with extra-pulmonary tuberculosis to identify the proportion with concurrent pulmonary TB despite an unremarkable CXR. METHODS: Clinical notes, microbiology results and CXR reports were reviewed from consecutive patients treated at Auckland City Hospital for extra-pulmonary TB from January 2007 to July 2010. RESULTS: Of the sample of 103 patients with extra-pulmonary TB, the majority of patients were born in an Asian country (n=70; 68%). The commonest presentation of extra-pulmonary TB was lymphadenopa-thy (n=51; 50%), followed by pleural (n=24; 23%) and bone (n=6; 6%) disease. Extra-pulmonary TB was diagnosed by biopsy or excision of the extra-pulmonary site in the majority (n=74; 72%), and by sputum testing alone in 26 (25%). The majority had CXR abnormalities (n=76; 74%). In the group with a normal CXR (n=27), 55% (n=15) had sputum cultures performed. In total, 18% (n=5) of patients with extra-pulmonary TB and a normal CXR had pulmonary TB, of whom two were smear positive. DISCUSSION: In patients with extra-pulmonary TB, sputum testing should be considered to detect concurrent pulmonary TB even if a CXR is normal, especially in immunosuppressed or symptomatic patients. This may aid diagnosis and determine infectivity and consequent public health action. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Literature suggests that good quality health care access can have a positive impact on the health of people with serious mental illness (SMI), but literature relating to patterns of access by this group is equivocal. AIM: This study was designed to explore health care access patterns in a group of people with SMI and to compare them with a general New Zealand population group, in order for health providers to understand how they might contribute to positive health outcomes for this group. METHODS: The study surveyed 404 mental health consumers aged 18-65 years receiving care from one district health board in Auckland about their patterns of health care access. Results were compared with those from the New Zealand Health Survey of the general population. RESULTS: Findings suggest that the SMI consumer respondents had poorer physical health than the general population respondents, accessed health care services in more complex ways and were more particular about who they accessed for their care than the general population respondents. There was some concern from SMI consumers around discrimination from health care providers. The study also suggested that some proactive management with SMI consumers for conditions such as metabolic syndrome was occurring within the health care community. DISCUSSION: The first point of access for SMI consumers with general health problems is not always the family general practitioner and so other health professionals may sometimes need to consider the mental and physical health of such consumers in a wider context than their own specialism. [ABSTRACT FROM AUTHOR]

INTRODUCTION: An improved understanding of prognostic factors associated with low back pain (LBP) outcomes will refine expectations for patients, clinicians and funders alike and improve allocation of health resources to treat the condition. AIM: To establish the link between a range of clinical and sociodemographic prognostic variables for LBP against three separate, clinically relevant outcome measures. METHODS: This was a retrospective, non-experimental study of 1076 consecutive LBP cases treated during a three-year period. Multivariate logistic regression analysis was used to determine the association between potential prognostic variables and outcome measures: clinically relevant reduction in pain, improvement in perceived function, and successful return to work six months after rehabilitation. RESULTS: Patients with clinically relevant improvements in LBP were more likely to have a shorter duration of pain (odds ratio [OR] 1.89), lower baseline pain (OR 1.19), a directional preference for extension activities (OR 1.45) and a history of spine surgery (OR 1.38). Clinically relevant gains in perceived function were observed in patients who were younger (OR 0.98) or those with shorter symptom duration (OR 1.74). Prognostic variables associated with a successful return to work included being female (OR 1.79), having a job available (OR 2.36), intermittent pain (OR 1.48) or a directional preference for extension activities (OR 1.78). DISCUSSION: This study demonstrated that there are a variety of prognostic variables to consider when determining outcome for an individual with LBP. The relative importance of each variable may differ depending on the outcome measured. [ABSTRACT FROM AUTHOR]

INTRODUCTION: General practitioners (GPs) play an important role in the management of patients who are overweight or obese. Previous research suggests that GPs' physical characteristics may influence patients' perceptions of health care received during consultations, mediating the likelihood of patients following health advice provided by GPs. This study aimed to explore patients' perceptions of their GP's health status and its influence on patients' perceptions of healthy eating and exercise advice. METHODS: An interpretive approach to phenomenology underpinned the qualitative inquiry and study design. Twenty-one participants (aged 55.9 ± 6.5 years; 14 females, 7 males) who had previously received healthy eating and/or exercise advice from a GP participated in an individual semi-structured interview. A constant comparison approach to thematic analysis was conducted. FINDINGS: Participants identified three key indicators of perceived health of their GP. These included the GP's physical appearance, particularly weight status; perceived absence of ill health; and disclosure of a GP's health behaviours. Participants expressed favourable perceptions of the weight status of their GP. Participants expected their GP to be a healthy role model and often, but not always, felt more confident receiving advice from a GP that they perceived as healthy. CONCLUSION: The findings highlight that a GP's perceived health status influences patients' perceptions of the health advice received during consultations. These findings provide a foundation for future research that may allow GPs to modify patients' perceptions of their health status in order to facilitate behaviour change in overweight or obese patients. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Obesity is disproportionately prevalent among Pacific population groups in New Zealand. Lifestyle behaviours of excessive consumption of high energy, unhealthy foods and inadequate physical activity are risk factors for obesity that can be modified. AIM: To identify and describe the risk factors for and protective factors against obesity among Pacific Is- land (PI) adolescents who attend church and compare them with PI adolescents who do not attend church. METHODS: We investigated the lifestyle behaviours of 2495 PI adolescents at six secondary schools in Auckland, New Zealand (NZ), 77% of whom attend a church or other place of worship. The cross-sectional survey was undertaken in 2005. Structured individual interviews and anthropometric measurements were undertaken. RESULTS: Church attendees had a higher mean body mass index (BMI) compared with non-attendees (BMI 27.4 vs BMI 26.6), adjusted for age, gender and PI ethnicity (p=0.01). The weight status of attendees was associated with less healthy breakfast and lunch sources, lower levels of physical activity, and limited knowledge of the risk factors for obesity (p<0.05) DISCUSSION: Culturally appropriate and ethnic-specific weight management interventions, including monitoring and policy development programmes, are needed urgently to change pro-obesity lifestyle behaviours in PI adolescents and to avoid the burgeoning future obesity-related illnesses that would otherwise result. The church may be an important venue and change agent in the prevention of obesity for this population. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Adolescents are known to have high risk factors for sleep disorders, yet the youth rates of sleep disturbances are unknown. AIM: This study aimed to determine the prevalence of sleep disorders among New Zealand high school students. METHODS: The Auckland Sleep Questionnaire (ASQ) was administered to high school students at six schools in the North Island. Schools were chosen to reflect a range of ethnicities and school deciles, which identify the socioeconomic status of households in the school catchment area. RESULTS: A total of 1388 students completed the ASQ. The median age was 17 years (range 14-23) and females represented 43.5% (n=604) of the total group. A total of 37.2% of the students surveyed reported having significant sleep symptoms lasting longer than one month. Depression and anxiety were present in 51.7% and 44.8% of students reporting a sleep problem, respectively. A moderate correlation was observed between sleep problems and depression (r=0.34, p<0.01), and sleep problems and anxiety (r=0.31, p<0.01). Problem alcohol use and other substance use were more common in students with sleep symptoms (12.2% and 5.5% respectively). No difference was found in the rate of sleep problems reported by different ethnic groups. DISCUSSION: A considerable proportion of students surveyed reported significant sleep symptoms. This study has the potential to aid physicians within New Zealand in better appreciating the burden of sleep disorders faced by young people and in effectively assessing and managing different causes of sleep symptoms in this demographic. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Medical school selection is a first step in developing a general practice workforce. AIM: To determine the relationship between medical school selection scores and intention to pursue a career in general practice. METHODS: A longitudinal cohort study of students selected in 2006 and 2007 for The University of Auckland medical programme, who completed an exit survey on career intentions. Students are ranked for selection into year 2 of a six-year programme by combining grade point average from prior university achievement (60%), interview (25%) and Undergraduate Medicine and Health Sciences Admission Test (UMAT) scores (15%). The main outcome measure was level of interest in general practice at exit. Logistic regression assessed whether any demographic variables or admission scores predicted a 'strong' interest in general practice. RESULTS: None of interview scores, grade point average, age, gender, or entry pathway predicted a 'strong' interest in general practice. Only UMAT scores differentiated between those with a 'strong' interest versus those with 'some' or 'no' interest, but in an inverse fashion. The best predictor of a 'strong' interest in general practice was a low UMAT score of between 45 and 55 on all three UMAT sections (OR 3.37, p=0.020). Yet, the academic scores at entry of students with these UMAT scores were not lower than those of their classmates. DISCUSSION: Setting inappropriately high cut-points for medical school selection may exclude applicants with a propensity for general practice. These findings support the use of a wider lens through which to view medical school selection tools. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Many qualitative studies examine older people's attitudes towards their medicines. Often these studies focus on the topic of medicines adherence. In contrast, this study aims to explore the attitudes of older people, aged 75 years and older, towards their regular prescription and non-prescription medicines. METHODS: This study comprised two investigations of people aged 75 years and older. In the first investigation, 20 people were purposefully selected and interviewed, using an oral history approach, about their experiences of medicines over a lifetime. In the second investigation, 40 people were recruited from two internal medicine wards. Semi-structured interviews were undertaken with participants about their experiences of medicine changes after discharge from hospital. All 60 interviews were digitally recorded, transcribed verbatim, coded using NVivo and analysed thematically. FINDINGS: Participants disliked having to take prescription medicines, but the majority believed they were necessary. They also trusted their doctor's expertise regarding medicines. Most participants believed it was important to take their prescription medicines regularly, even if they sometimes forgot to take them. They were not anxious about possible side effects. Most participants aimed to limit the use of analgesics and non-prescription medicines which they perceived as unnecessary. CONCLUSION: Even taking into account participants' dislike of having to take prescription medicines, they were willing to accept medicines as part of their everyday routine, as they believed they were necessary. This suggests that many older people may be more willing to take their medicines than some studies on adherence in the wider population have indicated. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Internationally, non-medical practitioners are increasingly involved in tasks traditionally undertaken by general practitioners (GPs), such as medication review and prescribing. This study aims to evaluate GPs' perceptions of pharmacists' contributions to those services. METHODS: Semi-structured interviews were carried out in two localities with GPs whose patients had and had not undergone a pharmacist-led adherence support Medication Use Review (MUR). GPs were asked their opinions of pharmacists' provision of MUR, clinical medication review and prescribing. Data were analysed thematically using NVivo 8 and grouped by strengths, weaknesses, opportunities and threats (SWOT) category. FINDINGS: Eighteen GPs were interviewed. GPs mentioned their own skills, training and knowledge of clinical conditions. These were considered GPs' major strengths. GPs' perceived weaknesses were their time constraints and heavy workloads. GPs thought pharmacists' strengths were their knowledge of pharmacology and having more time for in-depth medication review than GPs. Nevertheless, GPs felt pharmacist-led medication reviews might confuse patients, and increase GP workloads. GPs were concerned that pharmacist prescribing might include pharmacists making a diagnosis. This is not the proposed model for New Zealand. In general, GPs were more accepting of pharmacists providing medication reviews than of pharmacist prescribing, unless appropriate controls, close collaboration and co-location of services took place. CONCLUSION: GPs perceived their own skills were well suited to reviewing medication and prescribing, but thought pharmacists might also have strengths and skills in these areas. In future, GPs thought that working together with pharmacists in these services might be possible in a collaborative setting. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Effective communication is fundamental to successful health care service delivery, and has a positive impact on access, quality of care, health outcomes, and patient satisfaction. Although there are a growing number of New Zealanders who do not speak English proficiently, underutilisation of trained interpreter services appears to be common in primary health care settings. AIMS: To describe the pattern of interpreter service need and utilisation by general practice services, and to identify key barriers and enabling factors to the use of trained interpreters. METHODS: A mixed methods study was employed. Census and Partnership Health Canterbury Te Kei o Te Waka (PHC) databases were combined, and quantitative analysis used to derive interpreter service need and utilisation patterns. Transcripts of focus groups and interviews from general practitioners, practice nurses and practice administration staff within the PHC were analysed, using qualitative methods to identify barriers and enablers to interpreter service use. RESULTS: For the years 2008-2010, approximately 10 742 consultations per year involved a non-English- speaking patient, yet in only approximately 74.8 (0.7%) consultations per year were interpreter services utilised. Analysis of focus groups and interviews identified four global themes that represented barriers for interpreter service utilisation; namely, practicalities, expectations, knowledge of service, and systems. DISCUSSION: The current use of interpreter services in PHC general practice appears to be significantly less than the need. In order to maximise health outcomes and reduce risk, strategies must be initiated to counter the barriers currently inhibiting interpreter service use, including adopting best practice policies. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Despite more than 10 years of the diabetes annual review (DAR) programme, ensuring the annual return of diabetic patients for review remains a challenge for primary care. Regardless of future arrangements for diabetes review programmes, regular review of patients remains clinically important. AIM: To investigate the effect of patient and practice characteristics on the retention of patients continuously enrolled with the same practice in the DAR programme. METHODS: We undertook a retrospective, observational study of a cohort of enrolled diabetic patients who had a DAR in the July 2006 - June 2007 reporting year and remained enrolled with the same practice for the following three years. Controlling for death and migration, retention rates were calculated for age, gender, ethnicity, rurality, practice fundingtype and practice nurse (PN) to general practitioner (GP) ratio. RESULTS: The study included data from 78 practices and 6610 patients with Type 2 diabetes. Non-Maori and those aged 60 years and over were more likely to be retained in the programme. For practice factors, those with a higher PN to GP ratio had a significant retention advantage. Rurality and funding type was not shown to have a significant role in retention. DISCUSSION: Results support the view that both patient and practice factors influence a patient's retention within the DAR programme. The PN to GP ratio may be an important factor in the retention of patients in a DAR programme and warrants further research and consideration when planning future primary care models. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Multiple medications are recommended for the management of ischaemic heart disease. Unfortunately, increasing the number of medicines reduces adherence to medicines therapy. The concept of a polypill with a ixed dose combination of the common cardiovascular medicines (aspirin, statin, two blood pressure-lowering medicines) has been promoted. Patient perceptions about this con- cept have not been explored. METHODS: People taking at least three cardiovascular medicines were interviewed using a semi-struc- tured interview about their views on a polypill that could reduce the number of tablets they would need to take. FINDINGS: The participants considered that the polypill would be very convenient, especially when travelling and would reduce the pill burden. If the polypill was subsidised by the government, they would have reduced dispensing fee costs. There were concerns around the inlexibility of dosing of individual components of the polypill, and some concerns about safety and eficacy. Medical practitioners were identiied as having an important role in inluencing participants about the acceptability of the polypill. CONCLUSION: Generally the concept of the polypill was acceptable to participants, primarily because of the convenience and reduced number of tablets required daily. There were concerns about whether the polypill would be as effective and safe as the individual medicines. [ABSTRACT FROM AUTHOR]

INTRODUCTION: There is a worldwide trend for diabetes care to be undertaken in primary care. Nurses are expected to take a leading role in diabetes management, but their roles in primary care are unclear in New Zealand, as are the systems of care they work in as well as their training. AIM: To describe and compare demographic details, education and diabetes experience, practice set- ting and facilities available for the three main groups of primary health care nurses working in the largest urban area in New Zealand. METHOD: Of the total number of practice nurses, district nurses and specialist nurses working in Auckland (n=1091), 31% were randomly selected to undertake a self-administered questionnaire and telephone interview in 2006-2008. RESULTS: Overall response was 86% (n=284 self-administered questionnaires, n=287 telephone interviews). Almost half (43%) of primary care nurses were aged over 50 years. A greater proportion of specialist nurses (89%) and practice nurses (84%) had post-registration diabetes education compared with district nurses (65%, p=0.005), from a range of educational settings including workshops, workplaces, conferences and tertiary institutions. More district nurses (35%) and practice nurses (32%) had worked in their current workplace for >10 years compared with specialist nurses (14%, p=0.004). Over 20% of practice nurses and district nurses lacked access to the internet, and the latter group had the least administrative facilities and felt least valued. DISCUSSION: These findings highlight an ageing primary health care nursing workforce, lack of a national primary health care post-registration qualification and a lack of internet access. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Perceived lack of confidential health care is an important barrier for young people accessing health care services in New Zealand (NZ). AIM: To determine the prevalence of forgone health care among a nationally representative sample of NZ secondary school students and to describe the health concerns and specific health issues for which young people had difficulty accessing health care. METHODS: Random sample of 9107 NZ secondary school students participated in a 2007 health survey using internet tablets. Questions about access to health care included whether there had been a time when they had not accessed health care when needed, reasons for difficulty in accessing health care, current health concerns and health risk behaviours. RESULTS: One in six students (17%) had not seen a doctor or nurse when needed in the last 12 months. Female Maori and Pacific students and those living in neighbourhoods with high levels of deprivation were more likely to report forgone health care. Students with chronic health problems, those engaging in health risk behaviours or experiencing symptoms of depression were more likely to report being unable to access health care when needed. Students reporting privacy concerns were more likely to report difficulty accessing health care for sensitive health issues, such as sexual health, emotional problems, pregnancy-related issues, stopping cigarette smoking, or alcohol or drug use. DISCUSSION: NZ secondary school students who forgo health care are at increased risk of physical and mental health problems and in need of accessible and confidential health services. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Various methods of delivering specialist palliative care to rural areas have been discussed in the literature, but published evaluations of these models are sparse. This study surveyed the stakeholders of a rural specialist palliative care service (SPCS) to help identify potential gaps and inform planning regarding the future vision. METHODS: A survey was sent to all relevant stakeholders across the West Coast of New Zealand, including staff in primary care, aged residential care and the hospital. It focused on understanding the local model of palliative care, the quality of the current service and perceived gaps. RESULTS: Thirty-three per cent of the surveys were returned, from a cross-section of healthcare providers. The medical respondents rated the quality of the service higher than nursing and allied health participants. All of the groups reported feeling the specialist palliative care team (SPCT) was under-resourced. Additional educational opportunities were considered essential. DISCUSSION: Stakeholders found the service easy to access, but improvements in communication, educational opportunities and forward planning were identified as being needed. This information helps the West Coast SPCT plan its future direction and develop a higher-quality service that meets the needs of all stakeholders. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Although people with serious mental illness (SMI) have a high prevalence of physical illness, health-related quality of life (HQoL) has not been sufficiently explored. AIM: To explore the self-reported HQoL of mental health service users in New Zealand. METHODS: Responses on the Medical Outcomes Study 36 Item Short Form (SF-36) measure of HQoL from 404 adult mental health service users in a metropolitan district health board area in New Zealand were analysed and compared to a representative sample of the general population. RESULTS: Mental health service users scored significantly lower on all eight domains of the SF-36 than the general population, the largest difference being in the role limitation--emotional domain. DISCUSSION: Being female, younger than 25, obese or overweight, or of New Zealand European/Other ethnicity were associated with poorer funct ioning on multiple HQoL domains. Future studies should seek to understand the factors contribut ing to perceptions of HQoL of mental health service users in New Zealand. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Domestic violence in its myriad shapes and forms is a crime affecting every level of society. Gaining a true understanding of intimate partner violence (IPV) victimology allows for the meaningful provision of intervention services. AIM: To explore the prevalence of IPV disclosure during routine screening in a large general practice in provincial New Zealand. METHODS: Data were collected from 13 October 2008 to 30 June 2014 from 6827 individuals screened for IPV on 10 062 occasions and were analysed relative to age, ethnicity, gender, screening outcome, screener and health centre enrolled status. RESULTS: Analysis indicated an overall ever-positive disclosure rate of IPV of 11.1%, lower than New Zealand studies that place ever-positive prevalence as high as 78%. Maori women disclosed an ever-positive rate of 21.6%, Pacific women 13.2%, compared to 8.9% for NZ European/Other women. Casual patients positively disclosed in 13.7% of instances as opposed to enrolled patients in 10.5%. Disclosure of past abuse was made 1.3 times more often than that of a current abusive situation. Those aged between 16 and 65 years disclosed an ever-positive rate >10%. While nurses screened 5.5 times more patients than doctors, the doctors facilitated a higher percentage of positive disclosures than the nurses. DISCUSSION: Disclosure rates from a general practice setting do not mirror those of population studies or administrative datasets due to differences in samples and data collection methods. Routine annual screening is effective, with both doctors and nurses providing support for approximately equal numbers of patients in immediate danger. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Several methods of reducing the cost barrier to primary health care have been implemented in New Zealand, but research about free primary health care and the patients who use such services is scarce. AIM: To compare the characteristics of patients at Dunedin's free clinic with those at a traditional general practice clinic. METHODS: A written survey was distributed to waiting room patients at the Free Clinic and a fee-charging clinic in close proximity. Patient records were accessed to determine health services utilisation rates at both clinics and the discounting rate at the traditional clinic. RESULTS: There were 126 patient surveys returned at the Traditional Clinic and 65 at the Free Clinic. There was a significantly greater proportion of Maori respondents at the Free Clinic than at the Traditional Clinic (24.1% versus 9.2%, p=0.011). The difference in deprivation profiles of Free Clinic and Traditional Clinic respondents was more marked for the individual deprivation measure (five or more NZiDep deprivation characteristics: 65.5% versus 13.3%, p<0.001) than for residential area deprivation (NZDep2006 quintile 5: 41.4% versus 15.8%, p<0.001). Emergency department presentation rates were high for Free Clinic patients, despite free primary care access and high general practitioner consultation rates. Among Traditional Clinic respondents, 31.7% reported deferring health care because of cost in the previous 12 months. The equivalent figure for Free Clinic respondents was 63.8%. DISCUSSION: This survey suggests that Dunedin's Free Clinic serves a vulnerable population, in whom levels of unmet health need and health service usage are high. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Obesity and low levels of physical activity are increasing among Pacific and Maori adolescents in New Zealand. AIM: To assess the feasibility of an after-school exercise and lifestyle programme to improve cardio-respiratory fitness, health and usual activity in less-active Pacific and Maori adolescents over six weeks. METHODS: Eighteen less-active secondary school students participated. The six-week programme included 3 x 1.5 hour exercise and healthy lifestyle sessions per week. Outcomes included estimated cardiorespiratory fitness (VO2max), insulin resistance (Homeostasis Model Assessment), physical activity, glycated haemoglobin (HbA1c), fasting plasma glucose, blood pressure, waist circumference and fasting lipids, measured at baseline and six weeks. Programme attendance and qualitative comments were also recorded. Student's f-tests were used. RESULTS: Of the 18 students enrolled, 16(89%) completed six-week follow-up, 14(78%) were female, 13 (72%) were Pacific ethnicity and 5 (28%) were Māori. At baseline, mean age was 16.3 (standard deviation [SD] 1.0) years, body mass index (BMI) 35.2 (SD 6.7) kg/m², VO2 max 31.5 (SD4.3) mL/kg/min, systolic blood pressure 125.0 (SD 12.9) mm Hg, HbA1c 39.9 (SD 3.8) mmol/mol, fasting serum insulin 28.3 (SD 27.8) µU/mL. At follow-up, improvements had occurred in VO2max (3.2 mL/kg/min; p = 0.02), systolic blood pressure (-10.6 mm Hg; p = 0.003), HbA1c (-1.1 mmol/mol; p = 0.03) and weekly vigorous (4 hours, p = 0.002) and moderate (2 hours, p = 0.006) physical activity, although waist circumference increased (p = 0.005). Programme attendance was over 50%. Comments were mostly positive. DISCUSSION: The after-school exercise and lifestyle programme and study methods were feasible. Such programmes have the potential to improve health outcomes for Pacific and Maori adolescents. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The increasing prevalence of diabetes has led to expanded roles for primary health care nurses in diabetes management. AIM: To describe and compare anthropometric and glycaemic characteristics of patients with diabetes and their management by practice nurses, district nurses and specialist nurses. METHODS: Primary health care nurses in Auckland randomly sampled in a cross-sectional survey, completed a postal self-administered questionnaire (n=284) and telephone interview (n=287) between 2006 and 2008. Biographical and diabetes management details were collected for 265 (86%) of the total 308 patients with diabetes seen by participants on a randomly selected day. RESULTS: Nurses were able to access key clinical information for only a proportion of their patients: weight for 68%; BMI for 16%; HbA1c for 76% and serum glucose levels for 34% (for either measure 82%); although most (96%) records were available about whether patients self-monitored blood glucose levels. Most nursing management activities focused on giving advice on dietary intake (70%) and physical activity (66%), weighing patients (58%), and testing or discussing blood glucose levels (42% and 43%, respectively). These proportions varied by nurse group (p<0.05), generally being highest for specialist nurses and lowest for district nurses. DISCUSSION: Most practice and specialist nurses could access patients' weight and HbA1c levels and focused their clinical management on health education to decrease these if indicated. Communication and organisational systems and contracts that allow district nurses to work across both primary and secondary health services are necessary to improve community-based nursing services for patients with diabetes. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Several methods of reducing the cost barrier to primary health care have been implemented in New Zealand, but research about free primary health care and the patients who use such services is scarce. AIM: To compare the characteristics of patients at Dunedin's free clinic with those at a traditional general practice clinic. METHODS: A written survey was distributed to waiting room patients at the Free Clinic and a fee-charging clinic in close proximity. Patient records were accessed to determine health services utilisation rates at both clinics and the discounting rate at the traditional clinic. RESULTS: There were 126 patient surveys returned at the Traditional Clinic and 65 at the Free Clinic. There was a significantly greater proportion of Maori respondents at the Free Clinic than at the Traditional Clinic (24.1% versus 9.2%, p=0.011). The difference in deprivation profiles of Free Clinic and Traditional Clinic respondents was more marked for the individual deprivation measure (five or more NZiDep deprivation characteristics: 65.5% versus 13.3%, p<0.001) than for residential area deprivation (NZDep2006 quintile 5: 41.4% versus 15.8%, p<0.001). Emergency department presentation rates were high for Free Clinic patients, despite free primary care access and high general practitioner consultation rates. Among Traditional Clinic respondents, 31.7% reported deferring health care because of cost in the previous 12 months. The equivalent figure for Free Clinic respondents was 63.8%. DISCUSSION: This survey suggests that Dunedin's Free Clinic serves a vulnerable population, in whom levels of unmet health need and health service usage are high. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Heart failure education contributes to effective self-management. New Zealand primary health care nurses' contributions to heart failure educational activities have not been researched. AIM: To identify primary health care nurses' heart failure educational activities in terms of duration and frequency, topics covered, resources used and strategies for Maori and other ethnic groups. METHODS: A cross-sectional survey of a random sample of 961 primary health care nurses using a postal questionnaire. RESULTS: Of 630 respondents (65.5%), 369 worked with patients with heart failure and 339 provided heart failure education. One-third of respondents providing education (33.3%; n=113) delivered sessions from 16 to 60 minutes. The main educational topics covered were on the physical aspects of heart failure; prognosis, spiritual/existential and psychosocial topics were least often addressed. One-quarter of the group providing education did not use educational resources (n=86). The majority of respondents reported they would find more education about heart failure useful or very useful (80.2%; n=292), along with nurse practitioner support (64.7%; n=229). Maori-centred services and resources and involving whanau/family in education were the most frequently mentioned Maori-specific education strategies. DISCUSSION: A consistent approach to heart failure education is important to address knowledge gaps in a timely manner. This study affirms the contribution made by primary health care nurses in chronic illness education and highlights the need for further development and investment in ongoing heart failure nursing education and specialist nursing support. [ABSTRACT FROM AUTHOR]

BACKGROUND AND CONTEXT: Giving Asthma Support to Patients (GASP) is a unique online tool developed to provide asthma education at point of care, and to provide health care professionals in primary care with skills and knowledge to undertake a structured asthma assessment. ASSESSMENT OF PROBLEM: A retrospective cohort study was undertaken to evaluate the effectiveness of GASP. Data for patients aged 5-64 years seen in primary care (Waitemata region of Auckland) with uncontrolled asthma who had completed a minimum of two GASP assessments between 1 November 2008 and 17 April 2011 were extracted from a secure, self-populating database. Outcome measures were compared between each patient's visit 1 and 2 assessments. RESULTS: A total of 761 patients provided data using GASP. There was a significant reduction between GASP assessments in the risk of exacerbations, hospital admissions, emergency department presentations, requirement for corticosteroids, and bronchodilator reliance. STRATEGIES FOR IMPROVEMENT: Results from this retrospective cohort study are promising. A randomised controlled trial of the use of GASP in primary care is warranted to confirm these findings. The effectiveness of the GASP tool also needs to be further investigated in Maori and Pacific populations. LESSONS: The findings of this study of GASP show its potential and support its use in the primary care setting. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Patient-centred care has proven to be cost-effective, with a positive impact on health outcomes. A patient-centred approach is recognised as a desirable component of diabetes care. AIM: The aim of this audit was to determine if the specific patient-centred intervention offered by a clinical service (CPSI Diabetes service) improves diabetes care, as measured by changes in glycosylated haemoglobin (HbA1c). METHODS: The CPSI Diabetes service is a community-based service, run by a general practitioner with a specific interest (CPSI) in diabetes, and a practice nurse. Adults with diabetes are referred to the service by their general practitioner (GP) and care is provided using a set of loosely structured diabetes-specific patient-centred approaches. Following a series of visits, patients are discharged back to their CP. Baseline HbAlc was recorded at intake and for two years after discharge from the service. Patient and CP satisfaction questionnaires were also completed. RESULTS: New Zealand (NZ) Europeans and Maori with Type 2 diabetes and Type 1 diabetes experienced immediate and sustained (two-year) improvements in HbA1c. At intake, baseline HbAlc for Maori was higher than that of NZ Europeans. However, following this patient-centred intervention, this difference was reduced. None of the returned CP or patient questionnaires contained negative feedback, although the patient response rate was low. DISCUSSION: A patient-centred clinical approach to diabetes can contribute to significant and sustained reductions in HbA1c. This clinical approach is potentially reproducible in other clinical settings and could also be applied to the management of other chronic conditions. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Reducing the rate of acute rheumatic fever nationally by two-thirds by 2017 is a New Zealand Ministry of Health priority. Northland District Health Board (DHB) has high rates of rheumatic fever, disproportionately impacting on Maori children and young people. School-based programmes and general practice both contribute to rheumatic fever prevention in detecting and appropriately treating group A streptococcal (GAS) pharyngitis. AIM: The aim of this study was to assess adherence by general practitioners and school-based sore throat programmes to national guidelines for the management of GAS pharyngitis in Northland. METHODS: Laboratory and pharmaceutical data were obtained for children and young people aged 3-20 years who had GAS positive throat swabs in Northland laboratory services between 1 April and 31 July 2012. Data were analysed separately for general practice and the school programmes for rheumatic fever prevention. RESULTS: One in five of those children presenting to general practice with a positive throat swab and complete prescription data did not receive treatment according to national guidelines, while appropriate treatment was offered to more than 98% of children accessing school-based programmes. A significant proportion of those seen in general practice received antibiotics not recommended by guidelines, an inadequate length of treatment or no prescription. There were no significant differences in the management of Maori and non-Maori children. DISCUSSION: There is room for improvement in general practice management of GAS pharyngitis in Northland. School-based management of sore throat provides high-quality management for children at high risk of rheumatic fever. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Measles that develops in previously vaccinated cases has been reported to be associated with modified disease, although severity has usually been assessed by the presence or absence of symptoms. To date no studies have attempted to subjectively grade the severity of the clinical features. AIM: To investigate both the objective and subjective severity of measles in vaccinated and unvaccinated cases in the context of a community outbreak. METHODS: A retrospective observational cohort study conducted in Christchurch in 2009 using notified data compared the presentation of measles in 14 confirmed cases that had received at least one MMR (measles, mumps, rubella) vaccination and 14 age-matched unvaccinated confirmed cases. Additional details on the subjective and objective severity of the illness were obtained from parents/guardians using a standardised telephone questionnaire. RESULTS: The vaccinated group had significantly fewer clinical features on presentation (p=0.01, RR=I.3, 95% CI 1.1-1.6) and a less severe illness objectively, as measured by height and duration of fever, the number of days needing medication other than paracetamol and days required in bed. Unvaccinated cases were 2.8 times more likely to have more severe clinical features than vaccinated cases (OR=2.8, 95% CI 1.5-5.0). Unvaccinated cases were 3.0 times more likely to develop IgM antibody (RR=3.0, 95% CI 0.9-9.3). DISCUSSION: Previously vaccinated children who develop measles are likely to have less severe disease and serology results that may be inconclusive, particularly for IgM antibody if tested in the first few days after the rash onset. [ABSTRACT FROM AUTHOR]