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					CONCURRENT SESSION ABSTRACTS SUNDAY

Session E1: 1100 – 1200

DETECTING GLAUCOMA AND PREVENTING BLINDNESS: A WICKED ISSUE FOR GENERAL PRACTITIONERS TO
WINTER Helene, DONALDSON Mark
EastMED Doctors St Heliers, Auckland

Background
Glaucoma is a wasting disease of the optic nerve that leads to irreversible blindness. Glaucoma is slowly
progressive and asymptomatic in the early stages therefore many patients present late with visual field loss. This
The glaucoma prevalence is 2% in patients over 40 and 10% in those over 80. Known risk factors are positive
family history, myopia and steroid use.

Aim
To raise awareness of glaucoma and provide a quick, inexpensive test for our practice population.

Methods
Using a Zeiss Frequency Doubling Technology (FDT) Perimeter test, patients over the age of 40 were invited to
take part in the study on a fee basis. Our study was approved by the regional Ethics Committee.
Participants completed a questionnaire, and practice nurses supervised the FDT test. All participants with
abnormal results were referred to an Ophthalmologist, where a definitive diagnosis could be made. Participants

Results
The study ran for 5 years from Feb 2005. FDT tests were performed on 560 participants. 85 abnormal results
were obtained. Following ophthalmology assessment 22 were diagnosed and treated for glaucoma, 49 had other
eye or neurological diagnoses. 9 patients with abnormal FDT results had no pathology when examined by an

Conclusion
Our study demonstrates that the FDT method of detecting glaucoma is reliable, affordable and effective for
General Practice. The FDT test reaches many patients who do not see an Optometrist regularly. Participants
with abnormal results were willing to go for further testing for definitive diagnosis. Early detection of glaucoma
is invaluable for the patient in terms of preservation of vision and rewarding for the GP. Current technology

AGING WITH CEREBRAL PALSY – WHERE IS THE TEAM FOR A TEAM APPROACH?
1.    Juliet 1; Mcpherson Kathryn 2; Institute, AUT 1; MUDGE Suzie 1; STOTT Zealand3
  Health and Rehabilitation ResearchTAYLOR DeniseUniversity, Auckland, NewSusan , 2. Person Centred
ROSIE
Research Institute, AUT University, Auckland, New Zealand , 3. Department of Surgery, Auckland University,
Auckland, New Zealand

Background
The physiological changes occurring for adults with cerebral palsy (CP) as they age is increasingly a focus of
research. However, this literature is predominately from the standpoint of the medical team, and little is known
about the experience of aging from the perspective of the adult with CP.

Aims
Firstly, to identify the experiences of aging according to adults in New Zealand with CP. Secondly, to explore
participants’ experiences in encounters with health services. This presentation focuses on the results from the

Methods
A qualitative methodology using grounded theory was applied to capture, by way of semi-structured interviews,
adults’ views of aging with CP and interactions with health services, and to identify themes providing an

Results
Interviews were conducted with 28 adults (14 women) with CP, aged 37 to 70 years. Five themes emerged from
the data: aging as a process of change, exploring identity, the nature of help, concerns for the future and how

Interactions with health professionals worked well for adults with CP when they perceived they were treated like
any other client (rather than ‘a person with CP’), and the health professional was able to acknowledge and
address any additional needs. Due to health professionals not having expertise about CP, the occasions when the
latter occurred were infrequent and adults were placed in an uncomfortable dual role as patient and expert

Conclusion
Health professionals with specific interest and expertise in health care for adults with CP are needed. These
results highlight the importance of a collaborative relationship between the adult with experience and health
professionals with expertise for these encounters to be positive from the patient’s perspective and to address

THE FUTURE ROLE OF GPS IN MENTAL HEALTH CARE
Facilitated by Members of the Mental Health and Addictions Advanced Competency Module Working Group,
RNZCGP, RANZCP and Health Workforce New Zealand

RODENBURG Helen1, RAINGER William2, LACK Liza3, GOODYEAR-SMITH Felicity4, MOIR Fiona5, FERGUSON
William6, DOMANSKI Sue7, CODYRE David8, SHIEFF Rob9, HATCHER Simon10.
1
  Compass Health, Wellington, 2 Hygieia Consulting Ltd, Auckland, 3 RNZCGP, Wellington, 4 University of
Auckland, Auckland, 5 University of Auckland, Auckland, 6 Kumeu Medical Centre, Kumeu, 7 RNZCGP,
            8                        9                              10
Wellington, Procare Ltd, Auckland, Thinking Solutions, Auckland, University of Auckland, Auckland

Background
This workshop provides a background to some key developments in mental health care from both a national and
an international perspective. In developed countries globally, devolution of hospital-based services into the
community and horizontal with vertical integration involving a wider range of providers is seen as the key to
addressing the growing burden of health problems. With this blurring of the primary / secondary interface
offering more choices for patient care between home and hospital, increasingly mental health care is provided
by teamsincluding GPs and practice nurses, our secondary colleagues and a number of other community-based

The stepped care model with examples of case studies of new approaches used in Procare and Compass Primary
Care Network will be presented.

Interventions with a patient-centred approach which focus on increasing positive emotions and healthy
behaviours will have optimal health outcomes because these are vital components in enabling our patients to be
actively engaged in self-management. Primary mental health is core business and hence raising these
The aim is to have a facilitated discussion on the GP role and proposed advanced competency training, including
both the content and proposed career pathway. Workshop participants will have the opportunity to contribute
to the development of new roles that can provide professional development, an opportunity for leadership and
Session E2: 1100 – 1200

DELIVERING WHANAU ORA (TE PUNA PHO)
MARSDEN Lyvia

‘WHANAU ORA; PARALLEL JOURNEYS AND SHARED OPPORTUNITIES’
 Whanau Ora presents a significant and socially pivotal opportunity for the health and social services sectors to
work together in a more integrated and culturally informed way to help reverse current trends in the social and
 This is no quick fix or passing fad it is a multi sectorial, inter generational challenge for us all. This is about
‘draining swamps ‘ and not about finding smarter ways to ‘shoot crocodiles’
 There is nothing particularly new nor indeed threatening or mysterious about Whanau Ora. It is in fact a large
dollop of common sense mixed with cultural awareness and sensitivity, to create a delivery environment that plays
to the strengths of all those involved in the process and empowers .
 General Practice is an important component of a delivery chain that typically has both its genesis and ultimate
resolution in the social services sector. Many of the social problems manifest as health issues and present everyday
in the clinics of General Practitioners across the length and breadth of Aotearoa NZ.
 There are fewer more qualified to discuss this topic than Lyvia Marsden RN; QSM who has a track record of
successful Whanau Ora service delivery. She has developed robust processes to support the delivery of effective
 Lyvia will talk of the power and importance of strong alliances with providers across both the health and social
sectors to achieve demonstrable improvements in outcomes for her people and others impacted by inequalities.

PACIFIC PEOPLES’ USE OF Deborah,2 CARE – PATTERNS, TRENDS AND AREAS Mani,4 McMAHON Anna,2 LAWRENSON
KENEALY Timothy,1 RYAN PRIMARY SOUTHWICK Margaret,3 MANIPARATHY FOR CONCERN
Ross1
1: University of Auckland, 2: Pacific Perspectives, 3: Whitireia Community Polytechnic, 4: Bakker Maniparathy

Background
Pacific peoples have high health needs but, compared with other ethnic groups, they may have benefitted least from
reforms to primary care over the last decade.

Aim
To describe and explore health system views of Pacific peoples’ use of primary care.

Methods collated anonymous data from 6 DHBs covering 88% and from 14 PHOs covering 73% of the approximately
We have
298,000 Pacific people in New Zealand. Current patterns of use and time trends are described. We have interviewed
health system persons in primary care, secondary care, PHOs, DHBs and the Ministry of Health. The interviews have
been transcribed and subject to thematic analysis. Related interviews and analysis to give a Pacific view of primary
care is ongoing and not reported here.

Results
Preliminary results suggest that for some issues Pacific peoples are relatively high users of primary care
(immunisations and diabetes Get Checked). More generally their use of primary care is similar to that of other ethnic
groups, although may be less than expected given the high needs of children (especially with cellulitis and respiratory
condition) and of those with long term conditions (especially diabetes, cardiovascular disease and respiratory
conditions). Pacific peoples, more than other ethnic groups, choose to attend health care providers of the same
ethnic and language background as themselves. They also appear more likely to attend hospital emergency
departments and less likely to pick up prescribed medications even after adjusting for available measures of poverty.
Some mainstream provider have adapting their service to Pacific needs, especially with longer opening hours, flexible

Conclusion
It is likely that current measures of deprivation to not adequately measure Pacific peoples’ poverty. Some service
adaptations by mainstream providers appear to improve engagement with Pacific peoples.
BSC Pilot
HULME-MOIR Mike

BSC PILOT
HULME-MOIR Mike
BCS Medical Director, C olorectal Surgeon , WDHB
Waitemata DHB, working with primary care, will be delivering on the BSC pilot, with a start this October, and
hopefully a National role out in 2-4 years, subject to the evaluation. The pilot will offer screening to all patients who
are resident in the WDHB area, aged 50- 74. A new (for NZ) immunological occult blood test, the iFOB, will be
used. As the programme will go national it is of value for all GPs and practices to know about it – it is the first
population screening project that involves primary care.
Session E3: 1100 – 1200

EATING DISORDERS: WHEN TO INTERVENE AND WHAT TO DO
WEBSTER Louise

Eating disorders happen quite commonly and are usually not brought to your attention by the patient, rather the
people around the patient. This presentation outlines the epidemiology of the commonest eating disorders;
bulimia and anorexia, and suggests strategies in engaging and managing patients.

HEADACHE IN GENERAL PRACTICE
HILL Dr Rosamund

Many patients present with headache to general practitioners. Diagnosis and management can be tricky, and
there are often complex psychosocial dynamics. How do we know which patients need further investigation,
and which can be safely managed in general practice? Who should be referred for CT? How can refractory
Session E4: 1100 – 1200

SUCCESSFUL TEAM-BASED MIDWIFERY CARE WITHIN A PRIMARY CARE SERVICE
PULLON Sue1, STEINMETZ Monika2, GRAY Ben1
1
  Department of Primary Health Care and General Practice, University of Otago Wellington, P.O.Box 7343,
Wellington 6042 , 2 Newtown Union Health Service

Introduction
Maternity services in NZ are delivered via a unique and unusual case-load model of care. The majority of women
are cared for by independent midwives working as Lead Maternity Carers (LMCs), with referral to secondary
services when required. Services are generally not integrated with usual primary care/general practice providers.
The current LMC model provides for personalised care for individual women by individual midwives. Midwives
often work in small collectives but most maintain their own case-loads and work independently. Newtown Union
Health Service (NUHS) is a comprehensive primary care provider serving a high need population of mixed
ethnicity in Wellington. NUHS provides team based midwifery care, embedded in a primary care service.

Aim
We undertook a study to investigate this team-based model of midwifery care, and to ascertain consumer

Method
The structure and operation of the service was reviewed and comparisons made with models of maternity care
internationally. Data collation and analysis of routinely collected maternity consumer feedback was undertaken.
Other routinely collected maternity service data wasreviewed and considered.

Results
NZ maternity care is organized differently from other countries, making international comparison difficult.
Routinely collected data at NUHS about key maternity outcomes such as mode of delivery, and 6-week
breastfeeding and immunization rates are comparable with national figures. Consumer satisfaction with the
midwifery service at NUHS was high but response rate to written questionnaires was low. The questionnaires

Conclusions
Team-based maternity care, embedded in primary care, appeared very acceptable to consumers. Midwifery care
based within a primary care service has potential to provide improved primary care for women and their babies.

LEARNING SAFE PRESCRIBING: HOW TO TACKLE?
MURTON Samantha, PEARSON John
The Royal New Zealand College of General Practitioners

Background
There are many studies on the prevalence of prescribing errors1, how to reduce prescribing errors2, and learning
from prescribing errors.3 However, little is written or known about the learning needs of GP registrars in relation
to prescribing. In particular, what are the difficulties registrars experience in general practice prescribing away
from the hospital setting, with the appropriate use of medicines, and in achieving compliance and agreement

Aim
The aim of this study is to find out what GP registrars’ learning needs are, and how they are being addressed in
both the day-release seminar programme and on their practice attachment.

Methods
GP registrars’ learning needs are being investigated through a national survey of all registrars and their current
GP teachers at the end of June. Survey data will be analysed descriptively.
Focus groups have been held with two teacher groups with the view to gain their experience of registrar
prescribing. Focus groups will be held with registrars in July to follow up issues raised.

Some analysis of the usage of the online learning ‘scaffold’ on prescribing has been gathered with a full analysis
undertaken when all regions have covered this part of the curriculum.

Results
Brief data from the two focus groups indicates that generally registrars are well versed in writing scripts.
Teachers noted that in dealing with simple medication needs registrars are generally competent and prescribe
well. Difficulties do arise in prescribing with patients with co-morbidities needing a range of medications.

Conclusion
It is planned that the issues identified from the survey analysis and the direction from focus groups will lead to a
further development of the prescribing scaffold and extra teaching resources.

GMC (2009). EQUIP (Errors – questioning undergraduate impact on prescribing) see
The Lancet (2009). How to reduce prescribing errors. The Lancet Vol. 374 p.1945
Dean, D. (2002). Learning from prescribing errors. Qual.Saf.Health Care. 11;258-260

FOSTERING CURIOSITY, FOCUSING REFLECTION, FACILITATING REPETITION: PLAYING OUR ADVANTAGE
MURTON Samantha, PEARSON John, DOMANSKI Sue
The Royal New Zealand College of General Practitioners

Background
Increasing training places with a wider geographic delivery of the New Zealand GP Registrar training programme
has led to the part-time employment of a number of experienced GP Teachers to run regional day-release
seminars. Resources provided to them include some 40 nationally developed seminar ‘Scaffolds’, designed using
research from neuroscience and education, to “Foster curiosity, focus reflection, and facilitate repetition”.[1][2]

Aim
Each scaffold covers one content area. Scaffolds contain the pre-reading, seminar requirements, and cover the
Communication
Clinical expertise
Professionalism
Scholarship
The context of general practice

Scaffolds are in their third year of use and second iteration of development. The scaffolds are available to GP
Teachers and GP Registrars through a ‘Moodle’ Learning Management System. This study aims to identify the
aspects of the scaffolds that are regarded as useful and areas where further development is needed.
Methods
Reports on how each scaffold is used (October 2010 – March 2011) by GP registrars, GP Teachers, and GP
Medical Educators have been collated and analysed. Data from this will be followed up with survey
questionnaires sent to GP Registrars and GP Teachers. Focus groups will be undertaken with registrars and

Discussion
It is expected that the analysis will guide Medical Educators in further development of the scaffolds, including
scaffolds in advanced competencies to assist College Fellows meet their CPD requirements. Further work is
planned with Medical Educators identifying how their involvement with development work has influenced their

Virtue, J. L. (2009) Neurones Matter – developing a plastic training scaffold for delivering effective and efficient
vocational education. Paper presented at Annual Scientific Meeting, ASME, Edinburgh
Virtue, J. L. and Pearson, J.D. (2009). Seminars in step with the curriculum: Walking the curriculum talk.
Session E5: 1100 – 1200

EXTENDING THE ROLE OF NURSES THROUGH PROTOCOLS AND STANDING ORDERS
SCOTT-JONES Joseph
Church Street Surgery, Opotiki, New Zealand

Background
The role of the practice nurse is changing as workforce pressures and pressures of population and chronic

Protocols and standing orders are useful tools that are being increasingly utilised to support practice nurses in
extending the services they provide to patients, but there are a number of barriers to this, including a lack of
knowledge about standing order legislation, anxiety about medico-legal implications of standing order use, and a

Aim of workshop
At the end of the workshop participants will:
Understand the current legal framework supporting the use of standing orders and protocol care.
Have a guide to developing standing orders and protocols within their practices.
Have developed an exemplar standing order for provision of antibiotics to treat impetigo.
This will be acheived through the use of a brief presentation, hand-outs and small group work.

Facilitators
Joseph Scott-Jones (GP) Dorothy Keir (Practice Nurse)

The focus of knowledge or skills presented
Dr Scott-Jones is currently studying for a certificate in clinical education and his MMSc research was focused on
the use of standing orders in primary care.
Session E6: 1100 – 1200

SURVIVING THE CANCER VERSUS SURVIVING THE TREATMENT – A DOCTOR AS PATIENT PERSPECTIVE
ARROLL Prof Bruce
Professor and Head of Department and Elaine Gurr Chair in General Practice, Dept of General Practice and Primary
In early 2011 I was diagnosed with a lump on my tongue which turned out to be an acute myeloid leukaemia.
However my bone marrow was clear so they elected to give me three rather than four rounds of chemotherapy. The
lump disappeared in two days and the treatment continued in cycles for 3 months. In the talk I hope to explain some
of the issues around the treatment of acute myeloid leukaemia and some insights in to being on the receiving end of
some very toxic medications. The experience was very educational.

MOODIE Peter Dr
Medical Director, Pharmac
Dabigatrin has been fully funded since 1 July this year and, although this is a very important addition to the
Pharmaceutical Schedule, the fact that there are no funding restrictions on it has meant there has been real pressure
on primary care to understand how to use it, and what the risks are.
PHARMAC, in conjunction with haematologists, have been identifying and reporting adverse events. This
presentation goes through the major indications and contraindications and will highlight some of the things that
have gone wrong so far and the lessons to learned from them.
Session E7: 1100 – 1200

WHO TO TACKLE: PRIORITISING THE DEFENSIVE LINE
GELLATLY Dr Ros1, MCEWAN Mr Chris2
                                                                     1
GP Liaison Nelson Marlborough DHB, Clinical Advisor, Electives NHB , Plastic Surgeon, Waikato DHB, Clinical
Advisor, Electives NHB 2

Every day in general practice we confront the wicked problem of getting access for our patients to publicly
funded services when the resource is not infinite. This workshop presents a really clear way to tackle this
problem. At the end of the session you will have a useful tool that allows you to:

 balance competing needs in health care,
discuss this with patients
define what you need from secondary care to support you
join the movement to get primary care involved in prioritisation decisions i.e. support a primary care clinician led
health system

LEADING TRANSFORMATIONAL CHANGE
WRAIGHT Brenda1
1
    Director, Health Workforce New Zealand

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