Journal of primary health care最新文献

Introduction: Primary care is increasingly exposed to acutely unwell patients and there is an increasing responsibility of primary care physicians to be well-equipped to manage medical emergencies. One means of training primary care staff is through simulation training; however, emergency simulation training in primary care is not well established.

Aim: The objective of this study was to conduct a rapid literature review of studies looking at the use and impacts of emergency care simulation training in primary care.

Methods: A systematic literature search with pre-defined key terms was carried out in November 2023 using the databases of PubMed, ERIC, EmBase and PsychInfo. Studies between 2013 and 2023 that met the inclusion criteria were reviewed. Only journal articles in English with full texts that were available were reviewed. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, data extraction was systematically structured, and studies were appraised systematically.

Results: Of 523 initial studies found from the literature review, eight studies met the eligibility criteria. Seven of the eight studies evaluated the efficacy of simulation training for primary care providers; these were prospective cohort studies. One of the eight studies was a proof-of-concept study. One study specifically compared high-fidelity to low-fidelity simulations. No previous literature reviews on the use of emergency simulations in primary care were found in this literature search. All studies were consistent in terms of the significant benefits emergency care simulation has for primary care staff in improving confidence, clinical practice and emergency management systems. These changes applied to both clinical and non-clinical staff. There were specific benefits from in-clinic simulation.

Discussion: This review emphasises the significant benefits of emergency simulation training in primary care. There should be greater consideration of specifically incorporating such educational tools in primary care specialties such as general practice, rural general practice and urgent care.

Introduction: Degenerative cervical myelopathy (DCM) is the most common cause of spinal cord dysfunction in adults. Adequate condition awareness and the ability to recognise key clinical signs are crucial for timely referral and diagnostic imaging. However, the level of awareness and diagnostic confidence among New Zealand primary care clinicians remains unclear.

Aim: This study aimed to evaluate self-reported condition awareness, diagnostic confidence, and understanding of DCM signs, symptoms, and management pathways among New Zealand primary care clinicians.

Methods: A cross-sectional survey with two sections was developed, piloted, and distributed through professional associations. Participants included general practitioners, nurse practitioners, physiotherapists, osteopaths, and chiropractors. Section A (demographics, DCM education, and ratings of awareness and confidence) was completed by all respondents. Section B (knowledge-based items) was completed by respondents who reported being at least 'slightly' confident.

Results: The survey yielded 336 responses, of which there were 320 complete responses for Section A and 227 complete responses for Section B. Over half (57.2%) of respondents reported no prior DCM education, and 43.1 and 32.5% reported 'average' or 'limited' awareness respectively. Low diagnostic confidence was reported by 25.9 (slightly confident) and 22.2% (not at all confident). Symptoms such as upper limb paraesthesia/numbness and neck pain/stiffness were selected by 98 and 95% of respondents as being associated with DCM. The most recognised clinical sign, tandem gait disturbance, was noted by only 65%. Magnetic resonance imaging was identified as the key diagnostic investigation by 73.6%, and 64.8% selected referral to an orthopaedic surgeon, spine surgeon, or neurosurgeon.

Discussion: These findings reveal critical gaps in DCM awareness, diagnostic confidence, and knowledge among New Zealand primary care clinicians. It is possible that these gaps contribute to missed and delayed diagnosis for people living with DCM, who subsequently face irreversible neurological compromise resulting from delayed intervention. This study suggests that there is a need for improved education of primary healthcare professionals in regard to this condition and the development of standardised diagnostic criteria.

Background and context: Despite the large volume of health and administrative data collected every day in primary care, little is available for research in Aotearoa New Zealand (NZ). The Southern Primary Care Research Network (PCRN) was developed to enable access to primary care data through the establishment of a regional research database, and to create the supportive governance and infrastructure necessary for enabling a broader programme of research. This includes, but is not limited to, studies utilising linked data. This paper describes the formation of the Southern PCRN and the research undertaken so far. It aims to raise awareness about the Southern PCRN, the types of data available, and caveats associated with using primary care data for research.

Results: Research networks require organisational coherence for governance and oversight. Various linked groups take on different roles in the Southern PCRN and are described. Foundational research projects are described, including three data linkage projects, a scoping review, research prioritisation exercises, and the development of an ethical framework for data use.

Strategies for improvement: Securing ongoing funding will improve the capacity of the network to undertake primary care research and facilitate the unification of regional primary care networks to establish a national primary care research network.

Lessons learnt: Strategic investment in primary care research infrastructure is essential for NZ to fully realise the potential of routinely collected health data to inform equitable service delivery, policy, and innovation in population health. Establishing a regional primary care research network is demonstrably feasible.

Introduction: Aotearoa New Zealand (NZ) achieved abortion law reform in 2020, allowing people to choose abortion without legal restriction up to 20 weeks gestation. Abortion can now be provided by a range of health practitioners in a variety of settings. While some progress has been made, we are yet to see abortion care being provided within the full extent of the law.

Aim: To describe the journey of people accessing first-trimester abortion care in NZ to identify how abortion services can be developed to deliver optimal first-trimester abortion care.

Methods: This was a qualitative study informed by phenomenology. Participants were recruited via a separate national survey to participate in in-depth interviews. Analysis was undertaken using a reflexive inductive approach to identify themes.

Results: Seven people were recruited. Analysis revealed four themes: (1) decision making (to have an abortion, choice of method, and coercive contraceptive decision making); (2) barriers to access (abortion service navigation, lack of access in rural areas including requirement to travel, abortion requirements); (3) abortion as a societal issue (abortion is isolating, 'slut-shaming', abortion is the taking of a life); and (4) empathy and advocacy.

Discussion: Despite decriminalisation of abortion in NZ, barriers remain. Work is required to improve access to accurate and non-judgemental information to inform decision-making. People value kind, non-judgemental clinicians and supportive whanau/friends play a major role in optimising the experience. Abortion stigma persists and has a negative impact on the abortion experience. Abortion services need support to ensure they are responsive to the needs of health consumers and reduce barriers to care.

Introduction: Although paracetamol is the most widely used prescription and over-the-counter drug globally, it also has a higher toxicity than other common non-opioid analgesics and is a leading preventable cause of acute liver failure and liver transplants. International evidence suggests that the public may have inadequate knowledge about paracetamol; however, in Aotearoa New Zealand (NZ), paracetamol is relatively cheap and readily available in large quantities at pharmacy and non-pharmacy outlets.

Aim: To identify paracetamol-associated knowledge, attitudes and beliefs of the NZ public.

Methods: Using Horizon Research Limited, a NZ-based research panel, we explored paracetamol-associated knowledge, attitudes and practices using an online survey.

Results: A total of 1723 respondents completed the survey. High rates of unintentional misuse of paracetamol were identified, in addition to significant knowledge gaps, particularly those related to participants' ability to identify paracetamol-containing formulations. Participants were also supportive of introducing policies restricting the supply and sale of paracetamol, such as where paracetamol can be purchased.

Discussion: There appears to be a need to increase the NZ public's knowledge of the safe use of paracetamol. Given the current lack of policies restricting access to paracetamol, the substantial proportion of the NZ adult population exceeding paracetamol dosing guidelines, and the public's apparent support for introducing policies, our findings may have important implications. However, research is required to understand the potential impact of tightening current regulatory policies, including restricting where you can purchase paracetamol or reducing the amount of paracetamol you can purchase at once, before they are introduced.

Introduction: Low back pain is a leading cause of morbidity worldwide, but its cause is often non-specific. Imaging should not take place unless there are specific 'red flag' features present, as it does not improve patient outcomes.

Aim: To establish prevalence and factors associated with ordering of imaging for new onset non-specific low back pain (new onset NSLBP) by early-career GPs ('registrars').

Methods: Cross-sectional analysis from a subset of data from the ReCEnT study of GP registrars' clinical experiences (2010-2018). The outcome was whether imaging was ordered for a patient with new onset NSLBP. Analyses employed univariable and multivariable regression.

Results: A total of 2333 GP registrars (96.0% response rate) contributed data from 325,058 consultations, comprising 508,316 patient problems/diagnoses. A total of 3066 problems/diagnoses (0.6%) were new onset NSLBP. Of the 3066 new onset NSLBP problems/diagnoses, 450 (15%) had imaging ordered. In multivariable models, variables significantly associated with imaging for new onset NSLBP were patient age: 35-64 years (adjusted OR 1.55, P = 0.002) or over 65 years (OR 2.32, P < 0.001) compared to patients aged 15-34 years, 'seeking in-consultation help from a supervisor' (OR 1.74, P = 0.009), scheduling of follow-up with the registrar (OR 3.61, P < 0.001) or another GP (OR 2.01, P = 0.013), and 'generation of learning goals' (OR 1.96, P = <0.001). Imaging was negatively associated with referral (OR 0.48, P < 0.001) as was 'prescription of medication' (OR 0.63, P < 0.001).

Discussion: Although Australian GP registrars are taking a considered approach to imaging for NSLBP, the prevalence of imaging likely exceeds optimal levels, at significant cost and potentially poorer patient outcomes. Refinement in guidelines regarding appropriate 'red flags' for imaging may aid in the further reduction of unnecessary imaging.

Introduction: In Aotearoa New Zealand, prefilled syringes for patients receiving palliative care in the community can be prepared (compounded) by certain pharmacies. Currently, there is limited information regarding the scope of compounding these prefilled syringes.

Aim: The study aimed to explore the range of subcutaneous bolus-dose medications and the compounding processes used in community pharmacies in Tāmaki Makaurau Auckland when preparing prefilled syringes used for anticipatory needs in patients receiving palliative care.

Methods: A convenience sample of community pharmacies contracted to prepare prefilled syringes was invited to complete an online survey. Information was requested on the medications compounded for bolus-dose syringes over the previous 6-month period, including what medications and facilities were used, how expiration dates were determined, and the time spent preparing these syringes.

Results: Data were requested on compounding between 1 September 2022 and 28 February 2023 with complete responses received from 8 of the 40 pharmacies invited to participate. The top four medications compounded, in rank order, were midazolam, oxycodone, haloperidol, and morphine sulfate. All eight pharmacies compounded syringes in a still air box, and 'published guidance' was the most common source of expiration dates. Most respondents each reported spending 5-10 h per week preparing the compounded products.

Discussion: Community pharmacies in Tāmaki Makaurau Auckland compounded a range of medications as bolus-dose prefilled syringes for patients receiving palliative care. These results will inform future planned studies on the stability and sterility of these syringes.

Introduction: AI scribes have had a rapid uptake in primary care across New Zealand (NZ). The benefits of this new technology must be weighed against the potential risks they may pose.

Aim: This study provides a snapshot of AI scribes use in primary care to generate clinical notes. We aimed to understand emerging provider experiences, identify perceived clinical benefits and concerns, and flag potential ethical and legal issues as a basis for future research and policy development.

Methods: GPs and health providers working in primary care across NZ were invited to participate in an anonymous survey about their experience with AI scribes (February-March 2024).

Results: One hundred and ninety-seven respondents completed the survey, 88% (n = 164) of whom were GPs. Of these, 40% (n = 70) had experience with AI scribes. Reported benefits included: reduced multitasking (n = 46), saved time (n = 43), and improved rapport with patients (n = 43). Key concerns included: compliance with NZ legal and ethical frameworks (n = 108), data security (n = 98), errors or omissions (n = 93), and data leaving New Zealand (n = 91). Only 66% (n = 41) had read the terms and conditionss of the AI scribe tool, and 59% (n = 35) reported seeking patient consent. Most (80%, n = 50) found AI scribes helpful or very helpful, and 56% (n = 35) said the tool changed consultation dynamics.

Discussion: While there is strong uptake and enthusiasm for AI scribes in primary care in NZ, critical issues remain around legal and ethical oversight, patient consent, data security, and the broader impact on clinician-patient interactions. Health providers need clearer guidance and regulatory support for safe, ethical, and legal use of AI tools.