Cost and resource implications of introducing intensive nodal surveillance for sentinel node positive melanoma in provincial New Zealand
Patients with melanoma skin cancer which has spread to their lymph glands are normally advised to have a further operation to remove these diseased glands. In the future, this will change because the second operation doesn’t make you live any longer. Instead, health boards will need to follow these patients with regular scans and clinic visits. Here we have calculated the financial cost of this change. It looks to be affordable for the average provincial health board in New Zealand.
How much rehabilitation are our patients with stroke receiving?
New Zealand community stroke rehabilitation guidelines identify how often and how soon after hospital discharge community rehabilitation should start. This service audit looked at how quickly after hospital discharge patients with stroke were seen by a Wellington-based community rehabilitation team, and how much rehabilitation they received in the first four weeks and three months after discharge. We compared this to the guidelines and have made suggestions to improve the service.
An audit of patients with a diagnosis of idiopathic pulmonary fibrosis (IPF) in Canterbury, New Zealand
Idiopathic pulmonary fibrosis is a condition of unknown cause which results in progressive reduction in lung function causing breathlessness and often resulting in death. Historically, treatments have been ineffective, but newer agents have shown some promise. This paper highlights the estimated number of patients living with this condition and highlights ways in which resources could be better utilised to help them. Hopefully this may result in better overall care for patients living with this condition.
Unplanned pregnancies of women with chronic health conditions in New Zealand
Unplanned pregnancies can be a health risk for those with chronic health conditions such as diabetes, asthma and depression. In a study of about 7,000 pregnant women in New Zealand, I found that 15% had been diagnosed with a chronic health condition. Nearly half of the pregnancies of these women with chronic health conditions were unplanned. This was higher than the number of unplanned pregnancies among women without chronic health conditions.
Subsequent injuries experienced by Māori: results from a 24-month prospective study in New Zealand
Māori, the indigenous population of New Zealand, experience a disproportionate burden of injury compared to non-Māori. The impact of injury can be exacerbated by subsequent injuries, ie, injuries that occur after, but not necessarily because of, an earlier injury. Using interview, ACC and hospital discharge data, this study aimed to describe subsequent injuries experienced by Māori to determine: the number and timing of subsequent injury claims reported to ACC in the 24 months following an earlier injury; the proportions of Māori experiencing subsequent injuries; and the nature of subsequent injuries. Findings show that 62% of Māori participants who had already experienced a profound injury went on to experience a subsequent injury that reported to ACC within a 24-month period. This suggests that the subsequent injury burden for Māori is considerable, and that preventive opportunities are potentially being missed.
Three-month use of idarucizumab at Christchurch Hospital through the emergency department and MedChartTM
Idarucizumab is a high-cost medicine used to reverse the anticoagulant (anti-clotting) medicine dabigatran. We examined the use of idarucizumab from the emergency department and via the prescribing programme MedChart™. We looked at why it was being used and compared this to the national guidelines from PHARMAC and our own guidelines in Hospital HealthPathways. From 12 patients who received idarucizumab, all but one patient had idarucizumab prescribed for them according to both PHARMAC and local guidelines. The one exception had been a patient who had accumulated dabigatran in their body so there was high risk for the patient to have a bleed that could not be controlled.
Doctors’ rights to conscientiously object to refer patients to abortion service providers
Our paper critiques the current legal situation and standards of practice in New Zealand regarding doctors’ rights to refuse to refer patients for abortions and/or refuse to arrange for the patient to be seen by a colleague who will process the referral. Allowing providers to object to direct referrals, when one of their core professional obligations is to navigate patients through the health system, is one thing. But when providers object to making indirect referrals, and thereby fail to ensure the safe transfer of the patient to the care of a colleague, this amounts to abandoning the patient. We consider this ethical issue in the context of proposed abortion law reform in New Zealand.
Point-of-care testing governance in New Zealand through the lens of quality: an update on a national regulatory framework
Point of care testing (POCT) is testing outside of the main laboratory, like urine pregnancy testing at home and blood glucose testing at home for people with diabetes. These tests can be done by the patient or by a caregiver. The numerous POCT devices in the market means that without suitable advice and guidance, patients and healthcare workers who are not trained in laboratory medicine are at risk of purchasing devices that are not accurate or would not deliver what is medically (clinically) needed. Guidance should be provided at several levels, including: the government (Ministry of Health and Medsafe in New Zealand) through adequate regulation should provide devices that are safe and that are clinically fit-for-purpose; funders should support government by ensuring that devices they fund are defensible and safe; healthcare providers, eg, pharmacists and doctors, should receive comprehensive training on all aspects of using the device and testing, then ensure that when they provide a device to a patient, the patient has been fully informed about all technical intricacies of testing, what a result means, possible sources of erroneous results and who to contact for help if needed; and finally patients should know their rights, ask questions and take responsibility for their health, devices they use and tests that they undergo. New Zealand is updating its laws that govern medical devices. The Therapeutics Products Bill 2014 was released for consultation by the Minister of Health in December 2018. It is expected that the Bill will ensure that the new laws will be aligned with International Standards but should consider the uniqueness of individual populations, the New Zealand population. The authors propose a vision that is consistent with the aims of the Bill and also supports safe and fit-for-purpose POCT devices and tests are provided in New Zealand.