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In this pilot study, the primary aim was to compare four potential methods for undertaking a national survey of unmet secondary healthcare need in New Zealand (one collecting data from GPs, and three from community surveys). The secondary aim was to obtain an estimate of the prevalence of unmet secondary healthcare need, to inform sample size calculations for a national survey.An electronic system was set up for GPs in Christchurch (Pegasus PHO) and Auckland (Auckland PHO) to record cases of unmet need as encountered in clinics. For the community surveys, a questionnaire developed by the authors was administered to people from the same electoral wards as the GP clinics. Three modes of questionnaire administration were trialled: online, telephone and face-to-face interview. Random population sampling from the Māori and General Electoral Rolls was used to identify eligible survey participants until there were approximately 200 respondents for each method in each city. Data collection took place from November 2015 to February 2016.GP reports: Pegasus PHO: 8/78 eligible practices recorded 28 cases of unmet secondary healthcare need in 10 weeks. Auckland PHO: 3/26 practices participated and recorded no cases in three weeks. Surveys: 1,277 interviews were completed (online 428, telephone 447, face-to-face 402). For primary healthcare, 211/1,277 (16.5%) had missed a GP visit because of cost (online 25.0%, telephone 11.6%, face-to-face 12.9%). For secondary healthcare, 119/1,277 (9.3%) reported unmet healthcare need that had been identified by a health professional (online 11.2%; telephone 9.2%; face-to-face 7.5%). Of these, 75/119 (63.0%) required a consultation, and 47/119 (39.5%) required a procedure. Completed interview rates as a percentage of names on the Electoral Roll were low (online 8.8%, telephone 15.4%, face-to-face 13.9%), affected by changed addresses and lack of listed telephone numbers. The response rate for those with valid phone numbers was 47.6%, and for those with valid addresses was 31.5%.Using the Electoral Rolls to identify respondents is problematic. For a national survey, random population sampling by address, similar to the method employed for the New Zealand Health Survey, but giving respondents a choice between face-to-face and phone interviews, is proposed. Asking GPs to record data on unmet need for secondary care was not successful. Our pilot study suggests there is sufficient unmet secondary healthcare need in New Zealand to merit a national survey.

An analysis of the cost-effectiveness of interventions to control Campylobacter in the New Zealand poultry supply examined a series of interventions. Effectiveness was evaluated in terms of reduced health burden measured by disability-adjusted life years (DALYs). Costs of implementation were estimated from the value of cost elements, determined by discussions with industry. Benefits were estimated by changing the inputs to a poultry food chain quantitative risk model. Proportional reductions in the number of predicted Campylobacter infections were converted into reductions in the burden of disease measured in DALYs. Cost-effectiveness ratios were calculated for each intervention, as cost per DALY reduction and the ratios compared. The results suggest that the most cost-effective interventions (lowest ratios) are at the primary processing stage. Potential phage-based controls in broiler houses were also highly cost-effective. This study is limited by the ability to quantify costs of implementation and assumptions required to estimate health benefits, but it supports the implementation of interventions at the primary processing stage as providing the greatest quantum of benefit and lowest cost-effectiveness ratios.

This paper introduces the idea of the perceived curriculum from the student's viewpoint. Based on this, students' perception of opportunity to learn is measured and a process indicator developed for use in school effectiveness research and school evaluation. The Essential Skills of the New Zealand Curriculum are used as the foundation for the development of an instrument to measure opportunity to learn. The instrument measures students' perceptions of opportunity to learn from activities within the school environment. Some illustrative results from a baseline study of 1,300 pupils from 20 schools are presented. Potential uses for an instrument are proposed.

To estimate volumes and costs of health services required for new cases of colorectal cancers in New Zealand from 2014 to 2026 in the absence of population screening.Annual incidence of colorectal cancer, by stage, location and age was estimated for 2006-2026 based on NZ cancer registry data for 2001-2005. Treatment protocols were determined based on current best practice. An economics forecasting model was developed to estimate annual volumes and costs of health services to treat new cases of colorectal cancer expected to present each year from 2014 to 2026. Survival rates and other model parameters were drawn from the literature. Costs are presented at 2011 prices.Annual health service costs of new colorectal cancer presentations in New Zealand are estimated to increase from approximately $83.6 million in 2014 to $100.2 million by 2026, if no systematic screening programme is introduced. The majority of these costs will be for surgery and colonoscopies.These results provide a baseline against which to compare the level of resources required if a population screening programme is introduced. Planning is necessary to manage costs and services for colorectal cancer, even without a systematic population screening programme.

This paper estimates future health service costs of the current practice in New Zealand of not funding treatment of hepatitis C virus (HCV) infections. Costs are estimated separately for Māori and non-Māori, male and female IDUs. Markov modelling is used to track the infection and progression of HCV to severe liver disease and death, and accumulated costs are estimated for the life of the cohort. Upper and lower estimates of costs are calculated based on different assumptions of the rate of progression of HCV to more severe liver disease. Costs are estimated at dollars 24.6 million per 1000 non-Māori men IDUs (discounted at 3%), under progression assumptions based on liver clinic studies, compared with dollars 10.3 million per 1000 using lower rates of progression based on community studies. Similarly, corresponding costs for non-Māori women are estimated at dollars 27.6 million and $11.2 million per 1000 IDUs. Costs for women are higher because their greater life expectancy is associated with more cases of liver cirrhosis (LC) at older ages. Future costs for Māori are lower than non-Māori, because Māori are more likely to die at younger ages and hence fewer progress to more advanced liver disease. The current situation in New Zealand of not treating HCV infections will result in considerable future costs as some people with HCV progress to more severe liver disease. Provisional estimates are that the accumulated costs of HCV-related liver disease for all IDUs currently infected will be between dollars 166 million at lower rates of disease progression (discounted at 3%) to dollars 400 million at upper rates. Some of the associated morbidity and mortality could have been avoided if the HCV infections had been treated.

To estimate the colonoscopy burden of introducing population screening for colorectal cancer in New Zealand.Screening for colorectal cancer using biennial immunochemical faecal occult blood tests offered to people aged 50-74 years of age was modelled using population estimates from Statistics New Zealand for 2011-2031. Modelling to determine colonoscopy requirements was based on participation and test positivity rates from published results of screening programmes. Estimates of the number of procedures required for ongoing adenoma surveillance were calculated using screening literature results of adenoma yield, and New Zealand Guidelines for Adenoma Surveillance. Sensitivity analysis was undertaken on key parameters.For a test positivity of 6.4%, biennial screening using immunochemical faecal occult blood testing with a 60% participation rate, would require 18,000 colonoscopies nationally, increasing to 28,000 by 2031. The majority of procedures are direct referrals from a positive FOBT, with surveillance colonoscopy numbers building over time.Colonoscopy requirements for immunochemical faecal occult blood based population screening for colorectal cancer are high. Significant expansion of services is required and careful management of surveillance procedures to ensure timely delivery of initial colonoscopies whilst maintaining symptomatic services. A model re-run informed by data from the screening pilot will allow improved estimates for the New Zealand setting.

In 2005 the National Screening Unit of the Ministry of Health appointed a Colorectal Screening Advisory Group to provide independent strategic advice and recommendations on population screening for colorectal cancer (CRC) in New Zealand.Evidence-based review of relevant literature and assessment of CRC screening using the New Zealand Criteria to Assess Screening Programmes.Guaiac faecal occult blood test (FOBTg), immunochemical FOBT (FOBTi), flexible sigmoidoscopy, colonoscopy, and CT colonography were considered. FOBTg is the only test supported by high quality evidence from randomised controlled trials but has limited sensitivity and achieves modest CRC mortality reduction over time. FOBTi has higher analytical sensitivity than FOBTg and would be assumed to achieve greater mortality reduction. A CRC screening programme requires substantial planning and resources. Currently public hospitals cannot deliver timely diagnostic or surveillance colonoscopy.The Advisory Group recommends that a feasibility study of CRC screening using FOBTi be undertaken. This would help determine the performance of the FOBTi in the New Zealand population and whether the New Zealand health system could support an acceptable, effective and economically efficient CRC screening programme. To optimise the diagnosis and treatment of colorectal cancer there is an immediate need to expand colonoscopy services and to ensure that throughout New Zealand the treatment outcomes for CRC, both surgical and oncological, meet international standards.

In a retrospective review of 74 tibial osteotomies performed for Blount disease, the patients were divided into three groups based on age and treatment. Group A (26 osteotomies), 4 years old or younger, and group B (34 osteotomies), older than 4 years, were treated the same with osteotomy and crossed pins. Group C (14 osteotomies), older than 4 years, was treated with osteotomy and external fixator. At 6 years of follow-up, the recurrence of varus deformity was 46%, 94%, and 72% in groups A, B, and C, respectively. There was no correlation between recurrence of varus deformity and preoperative deformity angle or degree of surgical correction. Fixation with crossed pins or external fixator was not a factor. Surgery at 4 years old or younger and correction of the postoperative deformity angle in valgus may obviate recurrence of varus deformity in Blount disease at long-term follow-up.

Tibial osteotomies in children have been associated with a number of complications. A retrospective review of 116 children who had 129 tibial osteotomies was performed to assess these complications at our institution. Results showed that there were 35 cases of wound problems, 6 cases of recurrence/reoperation, 5 cases of delayed union, 2 cases with transient peroneal nerve palsy, 1 case of nonunion, and 1 case of mal-union. Patients having certain comorbidities had a higher frequency of complications. There were no significant differences between the location of the tibial osteotomy (proximal or distal) and the incidence of complication. External fixation was associated with a lower incidence of complications than the use of pins and casting. Although our results demonstrate an overall low complication rate, there is a significant association between complications and comorbid conditions. This highlights the need to recognize comorbidities preoperatively and the potential of increased postoperative complications.

This study is part of a larger project to determine the resources used by, and the costs of care of, the dependent elderly in different care environments, including hospital. A major aim is to establish the variation in the consumption of resources by different patients. Nursing care is the major input of hospital care of the elderly. Nurses’ time can be divided into that spent on individual patients’ needs, e.g. bathing (termed direct care), and that spent on a group of patients, e.g. night supervision (termed indirect). The wide variation in the amount of direct nursing time consumed by different patients has been well documented and has been linked to various patient characteristics (Magid and Rhys Hearn, 1981; Scottish Home and Health Department, 1969). Many studies of the relationship between care times and patient characteristics have classified patients into care groups and estimated a mean care time for each group (for example, Chagnon et al., 1978; Oxford Regional Hospital Board, 1967; Scottish Home and Health Department, 1969; Connor et al., 1961). The process of aggregation into classes may cause valuable information to be lost: the variation within each group is suppressed. Using the results in further calculations, e.g. for estimating ward workloads, relies on the population size (number of patients in the ward) being sufficiently large to absorb the within-group variation. Some studies have taken steps to overcome this problem. For example, one study (Rhys Hearn and Potts, 1978) introduced weights which contained a component for the number of dependency factors an individual patient had. The presence of each factor (e.g. uncooperative, confused) increased the time taken for nursing tasks above the average for the care group. The predictive ability of this model for an individual patient was not stated. However, the model was developed to determine ward staffing levels and was probably not intended to be an accurate predictor of care time for the individual patient. Barr (Oxford Regional Hospital Board, 1967) developed a multiple regression model to

(1984). Comparative costs of alternative forms of care for the elderly: A comment. New Zealand Economic Papers: Vol. 18, No. 1, pp. 141-143.