NEW ZEALAND MEDICAL JOURNAL最新文献

Aim: The study explored whether the reported experience of primary healthcare differs for survey respondents in Aotearoa New Zealand who self-report having a mental health (MH) condition in comparison with those who do not.

Method: Responses to the New Zealand Health Quality & Safety Commission's adult primary care patient experience survey received from August 2020 to May 2022 were analysed. Comparative analysis of patient-reported experience measures were completed to contrast experiences reported by those with and without a MH condition, with results stratified by ethnicity (Māori/non-Māori), age group and gender. Age/gender-standardised estimates for proportions of positive responses to each question were developed for each group alongside standardised risk differences.

Results: Our sample comprised 201,650 responses, with 21% reporting a current diagnosed MH condition. While most respondents reported positive experiences of primary healthcare, we found a consistent pattern of fewer positive experiences for those with MH conditions across dimensions of care quality, age and gender groups. When responses were separated by ethnicity, this difference was amplified among Māori.

Conclusion: This analysis adds to the increasing body of evidence that experience of MH conditions is associated with worse healthcare experiences. It demonstrates that data are available in Aotearoa New Zealand to routinely monitor and report on primary care experiences for this group. Interventions to improve healthcare should focus on care for Māori with MH conditions as a priority.

This paper seeks to explore the current state of paediatric palliative care in Aotearoa New Zealand. The low priority afforded to paediatric palliative care for more than two decades has had a significant impact on service provision, education and research within this specialty. As a result, provision of specialist paediatric palliative care to children with serious illness and their whānau (family, including extended family) is inequitable and vastly inadequate. This paper considers the consequences of having limited access to specialist palliative care for children and whānau, and outlines what is required for both service development and current priorities for research.

Aim: A strict gluten-free (GF) diet is the current mainstay of treatment for coeliac disease (CD). A limited range of GF foods are available on prescription for those with CD. GF foods purchased in shops are typically more expensive than gluten-containing equivalents. This study sought to understand how New Zealanders with CD obtain GF products and the changes associated with this.

Method: Coeliac New Zealand members were asked to complete an anonymous electronic survey in June 2023.

Results: Although 24% of the 522 respondents had accessed GF foods on prescription in the past, only 2% currently used the service. One-third of the respondents were unaware of the service. Cost and limited product range were the key reasons for not accessing prescriptions. Most non-prescription GF foods were purchased from a supermarket, with 54% spending over $50 per week on GF foods. Most respondents (90%) would prefer a discount card to purchase GF products. Preferences regarding the prescription service would be to collect products from a local shop (84%) or a pharmacy (42%).

Conclusion: This study indicates a very low uptake of GF products on prescription, with awareness, cost, product range and convenience limiting use of the service. Most respondents would prefer financial support for discounted GF products.

Background and aims: Per-oral endoscopic myotomy (POEM) is an established treatment for achalasia. We aim to review outcomes of all POEM cases performed in New Zealand for achalasia.

Methods: A retrospective review of all POEM procedures performed in the five hospitals offering POEM between November 2015 and December 2022 was undertaken. The primary outcome was clinical success, defined as Eckardt score ≤3. Secondary outcomes included procedural complications.

Results: One hundred and sixty-six index and four redo POEM procedures were performed by seven clinicians. Ninety-six (58%) were male and mean age was 49.6 years (standard deviation [SD] 19.2 years). Eighty-three (50%) had a previous achalasia intervention. Median length of hospital stay was 1 day (interquartile range [IQR] 1-2 days). Median pre-POEM Eckardt score was 8 (IQR 6-9) and improved to 0 (IQR 0-2) at 6 months (p<0.001). Technical success was achieved in 164 (99%). Clinical success was achieved in 124 (93%) at 6 months and sustained to 12 months in 37/42 (88%) of these patients with follow-up data. Clinical success was achieved in 92% who underwent any prior intervention. There were five reported complications: tunnel leak (three), significant pain (one) and pneumothorax (one). One tunnel leak required thoracotomy for empyema debridement, all other complications were managed conservatively. Forty-seven (31%) reported symptomatic reflux after POEM.

Conclusions: This first review of all POEM procedures performed in New Zealand for achalasia demonstrates high 6-month clinical success and safety for the management of achalasia.

Background: Māori are less likely to survive their lung cancer once diagnosed, but it remains unclear whether this is partially driven by poorer access to best-practice diagnostic services.

Methods: We examined all lung cancer registrations in Aotearoa New Zealand between 2007-2019 (n=27,869) linked to national administrative health datasets and further stratified by ethnicity, tumour type and stage of disease. Using descriptive and regression analyses, we compared ethnic groups in terms of the basis of diagnosis (e.g., histology, cytology), receipt of bronchoscopy and travel distance and time to access bronchoscopy.

Results: We found no differences in access to a pathological diagnosis between ethnic groups regardless of cancer type or stage. We found that Māori within the cohort were marginally more likely to access bronchoscopy than the majority European group; however, we also found that Māori had lower odds of living close to the location of their bronchoscopy, and correspondingly higher odds of living 100-200km (adjusted odds ratio [adj. OR] 1.46, 95% confidence interval [CI] 1.26-1.69) or more than 200km away (1.36, 95% CI 1.15-1.61) than Europeans.

Conclusion: Interventions that aim to further support Māori to overcome the systematic and cumulative disadvantages in access to cancer care should be broadly supported and resourced.

Aim: To present selected key findings from a longitudinal analysis of the socio-demographic characteristics of students entering all courses at Ōtākou Whakaihu Waka (the University of Otago), all health professional programmes combined, and 11 individual health professional programmes between 1994 and 2023.

Method: Data sources: 1) university electronic collections of student data (programme details, demographics, schooling, home address), and 2) publicly available datasets (some socio-demographic variables). Analyses included counts and proportions of commencing students, disaggregated by time period and socio-demographic variables, and commencement rates per 100,000 population aged 18-29 years.

Results: During this 30-year period, there was a notable increase in the overall proportion of domestic health professional programme students who were Māori or Pacific, and an increase in enrolments of students from rural backgrounds. The socio-economic profile of incoming students remained unchanged, with students being highly skewed towards those from more socio-economically privileged backgrounds. The proportion of domestic health professional programme students who were female increased across all years, reaching nearly two-thirds by the study end.

Conclusion: While efforts to enhance health professional student diversity have had a positive impact, the university's vision of a health workforce that represents Māori and the diverse contexts of Aotearoa New Zealand's society will require long-term ongoing commitment.

Aim: We identified geographic distribution of Otorhinolaryngologist, Head and Neck surgeons in Aotearoa New Zealand. To identify the future workforce pipeline, we explored trainee intentions for specialist practice.

Method: A survey was distributed to all New Zealand Society of Otolaryngology, Head and Neck Surgery (NZSOHNS) members and all current New Zealand Otolaryngology, Head and Neck surgery trainees. Data were gathered on work location and patterns of work, including on-call commitments and full-time equivalent hours worked. Trainees were asked about future career plans.

Results: An 88% response rate was achieved encompassing senior medical officers (SMOs) and trainees. A total of 64.8% (68) of respondents reported primarily working in a metropolitan hospital and 26.7% (28) reported working in a regional centre. Rates of internationally trained surgeons were significantly higher in regional centres compared to metropolitan hospitals (64.3% vs 32.4%, p<0.05). Regional respondents had higher after hours on-call burden, a higher full-time equivalent (FTE) worked and higher average hours worked per week. Retirement intentions within the next 10 years were high in both groups (64% regional and 52.9% metropolitan, p<0.05).

Conclusions: The regional workforce in ORLHNS work longer hours, are older and are reliant on internationally trained surgeons. Current training of ORLHNS surgeons is unlikely to keep pace with expected retirements.

Aim: There is minimal evidence regarding predictors, preventative measures and treatments of new onset of post-operative atrial fibrillation (POAF) in patients undergoing valvular heart surgery. This study aimed to determine the incidence of new onset atrial fibrillation (AF) and its impact on outcomes and length of stay (LOS) for patients following valvular heart surgery.

Methods: A single-centre, retrospective study was conducted.

Results: New onset AF was observed in 51/120 (42.5%) patients. Baseline and surgical characteristics were similar between patients who did and did not develop AF, although suggestive older age may increase the risk of developing POAF (p=0.06). New onset AF was significantly associated with longer intensive care unit (ICU) LOS-median increase of 2 days (p=0.002)-and overall hospital LOS-median increase of 1.5 days (p=0.006). Patients who received double valve surgery spent 2.5 times longer in the ICU compared to patients who had an aortic valve replacement (AVR) (p=0.033).

Conclusion: The incidence of new onset AF following valvular heart surgery was high, with associated prolonged ICU and hospital LOS. Patients undergoing double valve surgery were more likely to have a longer ICU LOS compared with those who received an AVR.