NEW ZEALAND MEDICAL JOURNAL最新文献

Aim: The aim of this study was to follow the instruments' pathways and cost each segment to calculate whether reusable or disposable ophthalmic instruments offer better value for money for intravitreal injections.

Methods: The cycles and costs of reusable and single-use disposable instruments used for intravitreal injections were mapped out, including purchase costs, transport to and from the place of use, opening and disposal, sterilisation, replacement, salary costs of staff involved, etc. results: The cost of using reusable instruments for intravitreal injections (NZ$29.00) was lower than the cost of using disposable instruments ($30.51) by $1.51 per patient.

Conclusions: Intravitreal injections performed with reusable instruments offer better value for money than when performed with disposable instruments. This equates to a beneficial financial saving just for this one low-complexity case. Such savings can multiply significantly when considering the instruments used in a wider variety of ophthalmic procedures. There are of course trade-offs between safety, quality, cost and sustainability.

Heart failure is a major healthcare problem in New Zealand. The Acute Decompensated Heart Failure (ADHF) Registry was introduced in 2015, and has identified the need for quality improvement strategies to improve care of patients hospitalised with heart failure. In this paper, we describe the implementation of the revised ANZACS-QI Heart Failure Registry, which has a primary aim to support evidence-based management of and quality improvement measures for patients who are hospitalised with heart failure in New Zealand. Taking the learnings from the initial experience with the ADHF Registry, the revised ANZACS-QI Heart Failure Registry i) utilises age-stratified sampling of hospital discharge coding to identify a representative heart failure cohort, ii) utilises existing ANZACS-QI infrastructure for data-linkage to reduce the burden of manual data entry, iii) receives governance from the Heart Failure Working Group, and iv) focusses on established quality improvement indicators for heart failure management.

Aim: To document and assess acute and preventive medication use in people with migraine disease in Aotearoa New Zealand.

Methods: Online survey of people with migraine in Aotearoa New Zealand (n=530), run from 22 August to 7 October 2022, including questions on current and previous acute and preventive medication use, reasons for medication discontinuation and use of new migraine medications.

Results: Most respondents had used simple analgesics for acute treatment; 55% were currently using a triptan; 27% were currently using an opioid. Overall, 27% of survey respondents had over-used at least one acute medication in the last month. Half of respondents were taking at least one preventive medication but only 57% of those eligible for preventive treatment were currently taking it. In those who had previously tried preventives, side effects and lack of efficacy were common reasons for stopping. Cost, lack of knowledge and awareness were the main barriers to use of new migraine medications.

Conclusion: Many people with migraine in Aotearoa New Zealand are not receiving optimal treatment, which increases the burden and cost of migraine disease. More effective and tolerable acute and preventive medications are needed that are affordable and available in Aotearoa New Zealand. Greater awareness of best practice prescribing is also needed.

Aim: To describe the incidence, characteristics, outcomes and hospital costs of patients admitted to hospital following trauma in a health region in Aotearoa New Zealand over a 10-year period.

Methods: A retrospective, observational study used data from the Te Manawa Taki (TMT) regional trauma registry to identify patients of all ages and injury severities that were admitted to hospital following injuries from 2013 to 2022, inclusive. This study reports on incidence of injuries with regard to age, gender, ethnicity, injury severity score (ISS), injury characteristics and direct cost to TMT facilities.

Results: Searches identified 60,753 trauma events leading to patient admission to hospitals in the TMT region. Of these, 81.9% were low-severity trauma, 10.2% were moderate-severity trauma and 7.9% were high-severity trauma. There were statistically significant relationships between gender, ethnicity and ISS category. Males were more likely to be hospitalised for any traumatic injuries. High-severity trauma is dominated by road traffic injuries and low-severity trauma is dominated by falls. Advanced age was associated with higher injury severity. The direct cost of trauma care to TMT hospitals increased by 122% during the 10-year period.

Conclusions: The study has identified the incidence, demographic features, severity, costs and outcomes for trauma patients admitted to hospitals in the TMT region of Aotearoa New Zealand over a continuous 10-year period. The volumes and costs of injury represent a significant burden on the health system, individuals and communities. Detailed understanding of the causes and costs of injuries of all severities will inform prevention activities, clinical quality improvement and health service planning.