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Introduction: Since 1991 the University of Otago, Dunedin, New Zealand has offered postgraduate qualifications specifically designed to educate general practitioners (GPs) about their unique work environment. Aim: To determine motivations and impacts of postgraduate education for practising GPs. Methods: Survey of the 100 graduates of the University of Otago, Dunedin postgraduate general practice programme. Ninety five living graduates were approached and 70 (73.7%) responded. Quantitative data about disposition of respondents before enrolling and after completion of the programme were analysed using chi-square and paired t-tests. Free text responses about motivations, impacts and outcomes of the program were thematically analysed. Results: 64 GPs graduated with a postgraduate diploma and 36 with a masters degree in general practice. Although the mean number of graduates was 3.5 and 2.0 (respectively), annual enrolments averaged 25.1. Most graduates (60.9%) were aged in their 40s when they started studying and most (94.3%) had a spouse and/or children at home. Intellectual stimulation and challenge motivated study. Outcomes included perceived improvement of medical care delivery; development of critical thinking about medical epistemology, education, and research; and personal growth. Graduates increased engagement in academic and advisory roles, published papers, and some completed doctoral studies. Respondents valued scholarship and enjoyed the learning environment, but felt their qualification had low perceived value within the profession. Cost and a perception of time commitment were important barriers to study. Di scussion: This voluntary postgraduate medical education complements traditional medical training but has low external value despite personal, practising and professional benefits. Graduates valued engagement above completion of a qualification. [ABSTRACT FROM AUTHOR]

INTRODUCTION: In 2013, the Nursing Council of New Zealand consulted on a proposal for introduction of registered nurse (RN) prescribing at two levels (specialist and community) within the designated class of prescriber. The proposal builds on the success of the diabetes nurse specialist prescribing project and the experience of other countries where RN prescribing is well established. AIM: To describe the views and intentions of nurses who work in primary health care (PHC) settings about the two levels of RN prescribing proposed. METHODS: The study involved a self-reported survey using a non-probability sample of RNs working in PHC settings (N=305). Quantitative and qualitative data were analysed descriptively. RESULTS: The respondents were experienced nurses. Overall, 82.3% expressed interest in becoming a community nurse prescriber, and 62.6% expressed interest in the specialist prescriber level. RN prescribing was expected to improve efficiency and access to medicines for high-needs populations, clarify accountability and improve nurses' autonomy. The education requirements for the specialist level were viewed as appropriate but too onerous for many. Requirements were viewed as inadequate for the community level. Concerns were raised about funding for education and support for RN prescribing roles. DISCUSSION: Nurses were positive about the proposals and see a potential to meet significant unmet health need. Nurses are already engaged in the provision of medicines to patients and prescribing authority would ensure they are suitably qualified to engage in these tasks. A clear policy platform will be needed if the proposed levels of RN prescribing are to be successfully implemented. [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. Aotearoa New Zealand has a range of community pharmacies; independent, corporate, hybrid, and mail-order, each with differing service delivery models. Corporate and hybrid pharmacies do not charge the NZ$5.00 co-payment on standard prescriptions; however, prescription co-payments were universally removed from 1 July 2023. Aim. This research aims to describe the consumer profiles of Aotearoa New Zealand's different types of community pharmacies prior to the removal of the prescription co-payment. Methods. A nationwide retrospective observational study linked 1-year of dispensing data (1 March 2022-28 February 2023) from the Pharmaceutical Collection to patient enrolment data using a National Health Index (NHI) number to identify the demographic details of people who use the different pharmacy types. People were assigned to a particular type of pharmacy if they collected at least 70% of their prescriptions from there; if they did not meet this threshold, they were defined as mixed users. Results. Independent pharmacies had an older customer base and fewer Asian users compared to other pharmacy types. Hybrid pharmacies served a greater proportion of Pacific peoples and those from areas of high deprivation. Māori made up relatively equal proportions of users across all pharmacy types. Areas without major cities had fewer corporate pharmacies and only four hybrid pharmacies were identified outside of Auckland. Discussion. There appears to be differences in the consumer profiles of the different pharmacy types. These results will serve as a comparison to how removing prescription co-payments shifts patients' behaviour. [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: Unmet needs are a key indicator of the success of a health system. Clinicians and funders in Christchurch, Canterbury, New Zealand were concerned that unmet health need was hidden. AIM: The aim of this survey was to estimate the proportion of patients attending general practice who were unable to access clinically indicated referred services. METHODS: The survey used a novel method to estimate unserviced health needs. General practitioners (GPs, n = 54) asked their patients (n = 2135) during a consultation about any health needs requiring a referred service. If both agreed that a service was potentially beneficial and not available, this was documented on an e-referral system for review. The outcomes of actual referrals were also reviewed. RESULTS: The patient group was broadly representative of the Canterbury population, but over-sampled female and middle-aged people and under-sampled Māori. Data adjusted to regional demographics showed that 3.6% of patients had a GP-confirmed unserviced health need. Elective orthopaedic surgery, general surgery and mental health were areas of greatest need. Unserviced health needs were significantly (P = 0.05) associated with greater deprivation, middle-age, and receiving high health-use subsidies. DISCUSSION: To our knowledge, this is the first survey of GP and patient agreement on unserviced referred health needs. Measuring unserviced health needs in this way is directly relevant to service planning because the gaps identified reflect clinically indicated services that patients want and need. The survey method is an improvement on declined referral rates as a measure of need. Key factors in the method were using a patient-initiated GP consultation and an e-referral system to collect data. [ABSTRACT FROM AUTHOR]

Introduction. Counties Manukau Health Otolaryngology programme for general practitioners with special interest (GPwSI) was developed to provide a group of GPs with tools to manage low complexity, secondary otolaryngology (ORL) problems in their local communities. After clinical triaging, the medical records were retrieved to assess patient outcomes from community (GPwSI) review. This programme provides an example of how the aims of the Health NZ reforms may work in practice, by bridging primary and secondary services. Aim. To assess whether the GPwSI programme provides patients with suitable specialty care in the community, compared to a specialised, hospital outpatient otolaryngology clinic (OPC). Methods. This is a retrospective study of patients with an assigned priority of three (non-urgent) referred to Middlemore Hospital for a first specialist assessment (FSA) during 2018-19. Results. Of the 6231 patients referred, one-fifth (22%) were directed to the GPwSI service, and the remainder (78%) were arranged to be seen in the OPC. GPwSI patients were more likely to be seen for their FSA earlier than OPC patients (RR 1.55, 95% CI 1.46-1.64, P < 0.05). Most patients (99%) referred for surgery by GPwSIs and about one-quarter (23%) of GPwSI patients (315/1345; 23%) were assigned to GPwSI follow up, of which almost all (95%) were managed within the GPwSI programme. Discussion. Patients being seen through the GPwSI programme are suitably managed in the community, more efficiently than if they were to be seen in an outpatient specialist clinic. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The efficacy and cost-effectiveness of exercise treadmill testing for patients with low cardiovascular risk is unclear. This is due to the low incidence of coronary artery disease in this population and the potential for false-positive results leading to additional invasive and expensive investigation. AIM: To investigate the value of exercise treadmill testing (ETT) as a predictor of coronary artery disease in patients with different levels of cardiovascular risk. METHODS: An observational study was completed on an outpatient population from a chest pain clinic (n = 529). Cross-tabulations and binary logistic regressions were used to examine relationships between variables. RESULTS: A negative ETT result was recorded for 72.5% of patients with low cardiovascular risk compared to 54.3% of those with moderate or high risk. Within the low cardiovascular risk group, patients with symptoms atypical for cardiac ischaemia were 11.1-fold more likely to have a negative ETT result. Of the patients with positive or equivocal ETT results, coronary artery disease was subsequently confirmed in only 23.1% of the low cardiovascular risk group compared to 77.2% of those with moderate or high cardiovascular risk. DISCUSSION: Results show low cardiovascular risk patients are significantly more likely to return negative ETT results, particularly when associated with atypical symptoms. Similarly, positive or equivocal ETTs in this group are significantly more likely to be false positives. This suggests the ETT is not efficacious in predicting coronary artery disease in patients with low cardiovascular risk. Is it therefore appropriate to offer exercise testing to this cohort or should alternative management strategies be considered? [ABSTRACT FROM AUTHOR]

INTRODUCTION: Prior New Zealand studies suggest that only approximately two-thirds of patients who present with an acute coronary syndrome (ACS) are maintained on a statin/aspirin post-discharge. This could be due to sub-optimal initiation or poor longer-term adherence. AIM: To identify the pattern of statin/aspirin maintenance following ACS from initial prescription to 3 years post-discharge. METHODS: All New Zealand Acute Coronary Syndrome Quality Improvement (ANZACS-QI) registry data for consecutive New Zealand residents (2007-2011), who were hospitalised with ACS, were anonymously linked to national datasets to derive a medication possession ratio (MPR) to assess medication maintenance. An MPR ⩾ 0.8 is considered adequate maintenance. RESULTS: Of the 1846 patients discharged alive, 95% were prescribed a statin at discharge and 92% were dispensed a statin within 3 months, but only 75% had a MPR ⩾ 0.8 in the first year, and 67% in year 3. In the same cohort, 98% were prescribed aspirin and 88% were dispensed aspirin within the 3 months of discharge. In the first year, 72% had an aspirin MPR ⩾ 0.8 and 71% maintained this in year 3. Fifty-nine percent were maintained on both aspirin and a statin in the third year, but 20% were maintained on neither. Regression analysis identified the independent predictors of inadequate maintenance in the third year as age < 45 years, no prior statin, and Mā ori and Pacific ethnicity. CONCLUSION: Longer-term maintenance of evidenced-based secondary prevention medications after ACS is suboptimal despite high levels of initial prescribing and dispensing. Understanding the barriers to longer-term maintenance is required to improve patient outcomes. [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: 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: 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: Intercalated degrees are one of the most focused undergraduate research training activities offered to medical students worldwide. The effect of intercalating on actual career choices has not been previously investigated. AIM: To examine the effect of obtaining an intercalated research degree on choosing general practice as a career. METHODS: This was a retrospective, matched cohort study of intercalating students at the University of Otago, New Zealand (1995–2008). Medical students who completed the intercalated Bachelor of Medical Sciences with Honours, BMedSc(Hons), degree were retrospectively identified. Gender- and graduation year-matched controls were identified from a publicly available graduate database in a 1:1 ratio. MEDLINE® and Google Scholar-indexed publications resulting from BMedSc(Hons) projects were determined using standardised search criteria. Speciality choice was obtained from online lists of registered doctors. RESULTS: Over the 14-year period, 99 (3.9%) students completed an intercalated degree with a publication rate of 36.4%. Of these, 42 (42.4%) were female and over two-thirds (68.7%) of projects were laboratory-based. The median follow-up period after graduation was 14 years (range 7.7–21.7 years). The congruence between students' BMedSc(Hons) research subject area and clinical speciality was 9.1%. Sixteen (16.2%) intercalating students chose general practice as a career, whereas 83 (83.8%) chose 19 different hospital-based specialties. Compared to controls, students who completed an intercalated degree were significantly less likely to pursue a career in general practice (odds ratio 0.37; 95% confidence interval = 0.18 – 0.77; P = 0.007). DISCUSSION: The present study findings suggest that completing an intercalated degree is associated with lower odds of pursuing a career in general practice. Future research should explore reasons for this observation to help develop strategies to promote primary care and general practice careers among medical graduates, including those interested in research careers. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Pacific women in New Zealand (NZ) have higher rates of antenatal depression than women from other ethnic groups. AIM: To identify factors that are significantly associated with depression symptoms in pregnant Pacific women living in NZ. METHODS: Data were collected from 5657 pregnant women, 727 of whom identified their ethnicity as Pacific Island. Antenatal depression symptoms were measured using the Edinburgh Depression Scale with scores above 12 indicating elevated antenatal depression symptoms (ADS). RESULTS: Pacific women had significantly higher rates of ADS than non-Pacific women, with 23% of pregnant Pacific women experiencing ADS. Factors associated with ADS for Pacific women included age <25 years, moderate to severe nausea during pregnancy, perceived stress, family stress and relationship conflict. Not seeing the importance of maintaining one's Pacific culture and traditions and negative feelings towards NZ culture were also significantly associated with ADS in Pacific women. One in three Pacific women aged <25 years experienced ADS. Pregnant Pacific women without a family general practitioner (GP) before their pregnancy were 4.5-fold more likely to experience ADS than non-Pacific women with a regular GP. DISCUSSION: Further attention is required to providing appropriate primary health care for Pacific women of child-bearing age in NZ. Better screening processes and a greater understanding of effective antenatal support for Pacific women is recommended to respond to the multiple risk factors for antenatal depression among Pacific women. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Interviews for selection into post graduate training courses are an accepted method of selection. There is the presumption that such interview processes are fair to both candidates and the training scheme. AIM: Due to concerns over unconscious bias and a desire to move to best practice, the Royal New Zealand College of General Practitioners introduced the Mini Multiple Interview (MMI) process as the selection process for doctors wishing to enter vocational training in general practice. METHODS: Aspects assessed during the interviews were developed through wide consultation and included: reason for wanting to undertake training, managing poor compliance, addressing issues of equity, managing complaints, insight and understanding the role of general practitioners in chronic care. There were 218 applicants who took the MMI. Demographic data as well as scores were collected. RESULTS: The MMI process has good reliability and performs well in several aspects of validity. All three interview venues had similar results. There was no gender difference in overall result or scores. New Zealand graduates scored higher than overseas graduates. Of the 218 candidates, 12 were considered not yet ready to enter training. DISCUSSION: The MMI process appears to have acceptable reliability and good validity. The structure of the MMI is likely to have reduced unconscious bias. Further research will study the predictive validity of the MMI for this cohort of candidates. [ABSTRACT FROM AUTHOR]

INTRODUCTION: New Zealand guidelines for cutaneous melanoma management recommend excision biopsy specimens of suspected lesions have a 2 mm horizontal margin, and a deep margin into upper subcutis. AIM: To assess guideline compliance of suspicious lesion biopsies taken in the community and in a hospital. METHODS: Patients admitted to Waikato Hospital, Hamilton, for diagnostic or treatment melanoma surgery during the year ending February 2016 were retrospectively identified, and their demographic and biopsy characteristics examined. RESULTS: In total, 140 patients had excision biopsies: 61.4% were performed outside the hospital. Biopsy data were available for 126 specimens. Mean horizontal margin was greater (P = 0.001) in hospital biopsies (4.8 mm, standard deviation (s.d.) 3.7 mm) than biopsies performed elsewhere (2.8 mm; s.d. 1.8 mm). Horizontal margins >2.0 mm occurred in 70.6% of specimens; 21.6% of ≤2.0 mm specimens had a tumour-positive margin. Subsequent wide local excision identified residual melanoma in 9.6% of specimens, which was not associated (P = 0.3) with primary horizontal margin ≤2.0 mm. Mean deep margin of hospital biopsies (6.5 mm; s.d. 2.7 mm) was greater (P < 0.001) than in other biopsies (4.1 mm; s.d. 2.7 mm). Horizontal margin >2.0 mm specimens had greater (P < 0.001) mean deep margin (5.9 mm; s.d. 2.7 mm) than specimens with horizontal margin ≤2.0 mm (mean deep margin 3.3 mm; s.d. 2.7 mm). Deep margin ≤2.0 mm (19.0%) was independently associated with the facility where biopsy was performed (P = 0.001) and horizontal margin (P < 0.001). DISCUSSION: The New Zealand biopsy deep margin recommendation does not lend itself to meaningful audit. Compliance with the horizontal margin recommendation was low, but of uncertain clinical significance. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Older people tend to take more medicines and prescription medicine costs may influence medicine adherence. AIM: The aim of this pilot study was to identify older people's perceptions of prescription medicine costs and related costs in four major cities across New Zealand. METHODS: A questionnaire was administered to people aged 65 years and older visiting pharmacies in Auckland, Wellington, Christchurch, and Dunedin to identify their perceptions of costs relating to prescription medicines and related pharmacy and general practice services. Data were compared between cities and examined for associations between participants' views on costs and age, sex, income, ethnicity, number of medicines, and monthly cost. RESULTS: Participants (N=107) received a median of five prescription medicines (range 1-15), at a median cost of NZ$8.00 (range 0-55.30). Median part-charges for medicines only partly funded by the government were NZ$6.25 (range 0.60-100.00), and GP consultations ranged from NZ$0-60.00. Of the participants, 89 (83.2%) thought medicine costs and 63 (58.9%) thought GP consultation costs were reasonable. Participants with median monthly medicine costs of NZ$8.33-87.00 more commonly perceived medicines as expensive or very expensive (p= 0.001, Fisher's exact test). DISCUSSION: Older people in this study mostly viewed their prescription medicines and related costs as reasonable; however, 17% and 41%, respectively, found medicines costs and GP consultation costs expensive. Larger, in-depth studies across New Zealand are needed to determine the sections of the population that find these costs expensive, and to explore how this might affect medicine adherence. [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]

Objective. To explore the practices of members of the Australian and New Zealand Society of Palliative Medicine (ANZSPM) in assessing and treating depression in palliative care patients. Methods. Semistructured questionnaires were forwarded to ANZSPM members in consecutive mail-outs to survey diagnostic and treatment practices for depression. Results. The response rate was 62.3%. The median prevalence of depression, as perceived by respondents, in the present respondent patient populations was 20% (range 0%-90%); 57.1% of respondents always assessed for depression, whereas 42.9% assessed for depression sometimes. The majority (98.9%) of respondents relied on clinical interviews to assess depression; non-somatic symptoms of the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria were more useful than somatic symptoms. The depression screening tools most frequently used were one- and two-item questions. Pharmacological and non-pharmacological methods were used to treat depression, with selective serotonin reuptake inhibitors the most frequently prescribed medications. Psycho-educational and supportive counselling were the most frequently used non-pharmacological interventions. Nominated measures to augment depression management included improving access to psychiatry, psychology and other allied health services, the development of a screening tool specific to palliative care patients and associated guidelines for depression management. Conclusions. This is the first Australasian study to explore the practice of medical practitioners regarding depression in palliative patients. Incorporation of screening tool questions into palliative care assessment interviews may warrant future research. [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]

A living donor kidney transplant (LDKT) is the preferred treatment for many people with end stage renal failure but there is a significant and growing gap between the number of people who might benefit from a transplant and those who receive one in New Zealand. International research suggests a range of barriers for patients in the journey to LDKT. One hundred and ninety-three patients on the New Zealand waiting list for a kidney transplant responded to a postal survey about live transplantation. While many patients are willing to discuss LDKT with family and friends, most are reluctant to go on to ask others directly to consider live donation. Patients who have not discussed LDKT with others are significantly less likely to have received even one offer from a potential donor. Pākehā and Māori are more likely to have received an offer to donate and to have had someone go on to be tested for compatibility than either Pacific or Other ethnic groups. Information gaps, ineffective donor recruitment strategies, donor incompatibility and donor medical unsuitability appear to be major barriers to LDKT. Many barriers are amenable to intervention and the implications for policy and practice are discussed. [ABSTRACT FROM AUTHOR]