Journal of primary health care最新文献

In this viewpoint, we recommend that general practitioners and other primary care providers in Aotearoa New Zealand (NZ) discuss vitamin D supplementation with patients at high risk of developing type 2 diabetes, as part of a broader strategy for diabetes prevention, including weight loss and other lifestyle changes.

Introduction: General practitioners with special interests (GPwSIs) and extended roles (GPwERs) have been developed internationally to expand access to specialist expertise and relieve secondary care pressure, but their implementation and evaluation in Aotearoa New Zealand (NZ) remain unexplored.

Aim: This scoping review mapped the roles, service models, and clinical applications of GPwSIs/GPwERs in NZ.

Methods: An online search was conducted across PubMed, Scopus, CINAHL, and Google Scholar for literature published up to July 2025. The review followed PRISMA-ScR guidelines and included peer-reviewed publications focused on GPwSI/GPwER roles in NZ.

Results: Five studies met the inclusion criteria, all of which were retrospective clinical audits conducted between 2007 and 2019. Three were comparative studies, and two were single-practitioner audits. Two studies focused on skin cancer excision, while the remaining addressed diabetes care, varicose vein treatment, and public otolaryngology services. The skin cancer studies, conducted a decade apart (2007 and 2017), reported improved malignant lesion diagnosis by GPwSIs compared to other vocational specialists (general practitioners and surgeons). The GPwSI otolaryngology model demonstrated greater efficiency and effectiveness than standard hospital outpatient clinics. Diabetes and varicose vein audits, both single-practitioner audits, found improved effectiveness and safe clinical outcomes.

Conclusion: This review identified a limited body of literature describing GPwSI /GPwER roles in NZ. The findings highlight variation in role implementation, service models, and outcome reporting. Further research is needed to examine the breadth, consistency, sustainability, and potential benefits and unintended impacts of these extended general practice roles within the NZ health system.

Objective: This review investigates factors influencing baseline knowledge in patients with cardiovascular disease (CVD), with a focus on tools used to assess cardiac knowledge, demographic influences, and areas of patient understanding. Given the central role of primary care in chronic disease management, understanding these factors is essential for improving patient education and outcomes.

Methods: A systematic review of literature from January 2003 to December 2023 was conducted across databases including PubMed, CINAHL, Medline, ProQuest, ScienceDirect, and Google Scholar. Search terms targeted patient knowledge, assessment tools, and cardiovascular disease. Studies were included if they reported on demographic influences or specific knowledge domains in CVD, were published in English, and fell within the date range. Studies focusing solely on pre/post-intervention scores or non-cardiac populations were excluded.

Results: Thirty-three studies met inclusion criteria. The Coronary Artery Disease Education Questionnaire (CADE-Q) and its variants were the most used tools, appearing in 25 studies. Knowledge scores ranged from 40% to 89%, with most studies reporting scores between 60-79%. Higher education, income, and comorbidities were associated with better knowledge. Patients showed strong awareness of risk factors and dietary guidance, but limited understanding of psychosocial risks.

Discussion: This review highlights significant variability in CVD knowledge and the need for standardised assessment tools. In primary care, routine use of such tools during patient encounters can help identify knowledge gaps. Tailored education strategies that consider demographic and regional factors can enhance patient self-management and reduce cardiovascular risk.

Introduction Vaccination rates for Pasifika in Aotearoa New Zealand have fallen dramatically since the COVID-19 pandemic. While the decline in the South Island is not as great as in areas of greater Pasifika concentration such as Auckland, rural Pasifika are under-represented in research and it is important to investigate their perspectives. Aim The study aimed to explore knowledge of and perspectives on childhood vaccinations of a diverse rural Pasifika community in the South Island of New Zealand, and to identify underlying reasons for the recent decline in immunisation rates. Methods Interviews and focus groups, informed by a talanoa approach, were conducted with twelve female members of the Pasifika community in a rural NZ town with a large and growing Pasifika community. Transcripts were analysed using framework analysis followed by iterative, inductive thematic analysis. Results Five themes were identified that underlie vaccine uptake: (1) Established norms; (2) Knowledge about vaccination; (3) Experiences of vaccination or diseases; (4) Health professionals' communication; (5) Logistic and practical concerns. Each theme encompasses both barriers and facilitators of vaccination. Discussion Rural Pasifika communities are disadvantaged in terms of healthcare access both by rurality, and by their minority ethnic status. Empowering individuals and communities to access, understand, and use health information is vital, especially for Pasifika navigating an unfamiliar system in rural areas, and when there have been negative vaccination experiences. Every health interaction should aim to build literacy, address concerns, and foster relationships, trust and understanding.

Introduction: Parkinson's disease is a neurodegenerative disorder that affects patients' lives by deteriorating their motor and non-motor functions through the loss of dopaminergic neurons. Medications remain the preferred option to manage Parkinson's disease symptoms. In Australia, the Pharmaceutical Benefits Scheme (PBS) supports access to essential medicines by subsidising their cost, making long-term treatment more affordable.

Aim: This study analyses the dispensing patterns of Parkinson's medications in Australia from 2012 to 2024, focusing on utilisation trends over time and shifts in prescribing practices.

Methods: We conducted a quantitative analysis using concessional PBS data. Key variables included cumulative and annual prescription counts, defined daily dose (DDD), and DDD per 1000 concessional population per day, classified by medication type and Anatomical Therapeutic Chemical code. Time trends were examined using linear regression, and Pearson's correlation coefficients were assessed to understand the relationship between changes over the year and time.

Results: A total of 14 medications were assessed, with an accumulated dispensing count of 11,493,423. Levodopa combined with Benserazide had the highest prescription count at 3,663,722 and a mean DDD per 1000 concessional population of 1.81, followed by Levodopa combined with Carbidopa. Linear regression showed strong correlations (r > 0.9) between prescription volume and time for the majority of medications assessed.

Discussion: The findings highlighted a preference for Levodopa-based therapies, combined with Benserazide or Carbidopa, and suggest shifts in prescription patterns. By identifying the dispensing patterns of Parkinson's medication, the study contributes to developing treatment trends for further analysis of these medications' distribution and consumption.

Introduction: External Clinical Teaching Visits (ECTVs) are formative workplace-based assessments involving experienced general practitioners (GPs), acting as external clinical teaching visitors (ECT visitors), observing trainees ('registrars') in practice. ECTVs are a core element of Australian GP vocational training. Remote modalities of ECTVs, introduced in response to the COVID-19 pandemic, have continued alongside face-to-face ECTVs post-pandemic.

Aim: This study aimed to explore the characteristics and associations of ECTV content delivered by these different modalities.

Methods: From 2020 to 2021, GP registrars of three geographically defined regional training organisations were invited to complete a questionnaire after completing ECTVs. Outcomes included: (1) the frequency registrars were observed performing physical examination by an ECT visitor and (2) the frequency a physical examination was observed and discussed by the ECT visitor. Analyses employed univariable and multivariable logistic regressions.

Results: A total of 1394 questionnaires (for 44% of eligible ECTVs) were completed by 729 (58% of eligible) registrars. After exclusions, 1106 questionnaires were analysed. Eighty-two percent of visits were conducted by video. Overall, 87% of visits involved a registrar being observed performing a physical examination at least once, and 42% involved both observation and discussion of physical examination. On multivariable analysis, the odds of observation of physical examination were significantly less with video-conducted visits (OR: 0.16, 95% CI: 0.05-0.49, P = 0.001).

Discussion: Remote ECTVs are an attractive option to reduce resource usage and logistical burden. However, key differences in the content of ECTVs delivered by remote modalities compared to those conducted face-to-face were found. A hybrid model ECTV program may be appropriate to ensure the educational integrity of ECTVs is maintained.

Introduction: The healthcare sector accounts for 4-5% of global greenhouse gas emissions. Data regarding the environmental impact of general practice are lacking. Toitū Envirocare produced a report for the Carefirst Limited's general practice centres in Taranaki, concluding solid waste disposal to be their primary source of greenhouse gas emissions.

Aim: Considering the increasing need to address climate change, this study aimed to provide novel insight into waste and carbon emissions generated by general practice through audit data.

Method: A waste to landfill audit was conducted at four Taranaki general practices. Waste to landfill was collected for 3 days, then sorted to determine the amount which could have been diverted to recycling and composting.

Results: The potential diversion rate of audited landfilled rubbish ranged from 65 to 79.3%. Although Westown had a potential diversion rate of 68.3%, its existing recycling processes meant this equated to 25% of its total waste production. Of the other three practices, 59-65% of their total waste production could be diverted.

Discussion: It was recommended that all practices have recycling and composting bins, and to collect bottle caps, soft plastics, and batteries to further landfill diversion. These bins must be more available and visible. Ideally, each practice would have a 'waste champion' to educate staff and dispose of these recyclables at designated facilities. Recycling in a general practice setting can produce significant waste diversions from landfill, producing meaningful progress towards sustainable practice.

Introduction: There is limited literature on dementia care, support or services within the New Zealand Chinese community, despite the Chinese community is one of the largest Asian ethnic groups in New Zealand.

Aim: To explore Chinese general practitioners (GPs)' perspectives on dementia services for the Chinese population in New Zealand; their perceived barriers and shortfalls, as well as improvement opportunities.

Methods: A qualitative study investigating the perspectives of Chinese GPs across metropolitan Auckland, New Zealand. Semi-structured in-depth interviews were conducted in 2024. The interviews were recorded, transcribed and thematically analysed.

Results: Ten participants were interviewed. Thematic analysis of the interviews generated four main themes: (i) under-recognition of dementia and lack of dementia information; (ii) stigma and seeking help for dementia; (iii) lack of Chinese friendly dementia services and (iv) support for dementia, with the overarching theme of language and cultural barriers.

Discussion: There are significant barriers to accessing dementia services for the Chinese population in New Zealand, rooted in language and cultural differences, low awareness, stigma, and systemic inefficiencies. Addressing these barriers requires a multifaceted approach that includes culturally tailored services, public education, care coordination, and policy changes.

Introduction In Aotearoa New Zealand, the responsibility for management of long Covid sits with primary care. GPs are often the first point of contact for these patients in a system that is already overburdened. Globally, patient experiences of accessing support for long Covid are varied. To date, the perspectives of New Zealanders living with the condition, on how best to support their care, have not been sought. Aim The aim of this study is to explore what a long Covid service should offer from the perspectives of those living with the condition. Methods Participants were recruited via the New Zealand long haulers Facebook group and individual interviews and discussions were conducted using Zoom. These were semi-structured with a few loosely structured questions to encourage discussion. Data were analysed using Braun and Clarke's thematic analysis. Results Eighteen participants were recruited. Four themes were identified in the data: practical guidance to support the health care journey; training and collaboration between health professionals; personalised care; and opportunity for health system change. Discussion Overall, participants appeared to want interdisciplinary knowledge sharing; collaborative services with clear lines of communication and a person-centred approach to care. Many of these proposed suggestions for a long Covid clinic align with the Ministry of Health recommendations. However, to date, there is no addition support from Government to support these long Covid service recommendations.

Introduction: New approaches are needed to respond to increasing numbers of patients with type 2 diabetes and high HbA1c (glycated haemoglobin). This pilot supported additional care from five primary care nurses and community pharmacists for people with type 2 diabetes with high HbA1c.

Aim: To describe uptake, outcomes and experiences of a collaborative pharmacy and general practice diabetes programme.

Methods: Quantitative data from patients enrolled before 31 August 2022 included change in HbA1c and medication, and pharmacist activity. Interviews with seven patients, five pharmacists and four practice nurses were analysed thematically.

Results: The evaluation included 26 people with an average baseline HbA1c of 97.6 mmol/mol (range 69-136 mmol/mol), of whom 84.6% were Māori or Pacific peoples. HbA1c reduced by an average 25.2 mmol/mol; 20.7 mmol/mol for Māori and Pacific peoples. HbA1c reduced by ≥5 mmol/mol in 84.6% of service users, and 81.8% of Māori and Pacific peoples. HbA1c reductions were sustained an average 7.5 months after programme completion. Pharmacists tailored their actions to the individual. The programme was highly acceptable to patients, pharmacists and nurses, with generally good communication and trust between them. Understanding about diabetes and medication, and medication adherence improved. New, effective medicines and insulin were often introduced. Some participants described increased blood glucose testing and lifestyle changes. Diabetes distress and denial, goal setting, client understanding of HbA1c and dropouts need further attention. COVID-19, staffing changes and staff shortages impacted enrolments. Pharmacist mentoring may help enrolments.

Discussion: A collaborative pharmacy-general practice model has potential to improve HbA1c in patients with type 2 diabetes through relatively simple interventions.