Biomedical subjects

Andrew Tomlin

Publications and source records attributed to Andrew Tomlin.

6 recordsLinked to original sources

PubMed2006

Health status of New Zealand European, Maori, and Pacific patients with diabetes at 242 New Zealand general practices.

OBJECTIVE: To compare the care and health status of different ethnic groups attending general practices with diabetes. METHOD: We analysed information about 13,281 patients with any type of diabetes, collected by 242 general practices in the first visit of the Southlink Independent Practitioner Association's Get Checked program. These patients constituted about 60% of patients with diabetes in the South Island of New Zealand. RESULTS: 13,196 (99.4%) patients had Type 1 or Type 2 diabetes. Of these, 11,911 (90.3%) were Europeans, and 759 (5.8%) were Maori or Pacific Islanders (mostly of Samoan, Tongan, Niuean, or Cook Islands origin). There was no difference between ethnic groups in total cholesterol, proportions on oral therapy or statins, or having a foot check. Maori and Pacific Islanders had poorer glycaemic control (HbA1c > 8.0 for 41.5% of Maori or Pacific Islanders versus 23.8% of New Zealand Europeans; 95% confidence interval for the difference [CI]: 14.0, 21.1), and were less likely to have retinopathy screening (71.9% versus 77.9%; CI: -9.2, -2.6). In patients with Type 2 diabetes (and compared with Europeans) Maori and Pacific Islanders were younger, had higher mean body mass indices (males 33.9 versus 29.5; CI: 3.9, 5.0 and females - 34.6 versus 30.7; CI: 3.2, 4.6) and diastolic blood pressures 82.4 mmHg versus 78.7 mmHg (CI: 2.9, 4.5), and were more likely to smoke (27.5% versus 10.9%; CI: 13.3, 19.9). Overall, Maori and Pacific Islanders were more likely to be at high risk for microvascular complications (9.0% versus 4.4%; CI: 2.5, 6.6). CONCLUSIONS: In this study, Maori and Pacific Island patients had a demographic profile suggesting greater health vulnerability (especially for those with Type 2 diabetes) yet similar routine diabetes care (especially for those with Type 1 diabetes). Ethnic inequalities were noted in seven of nine health status measures. IMPLICATIONS: The Get Checked program aims to increase the health of all patients with diabetes but whether it accentuates or diminishes ethnic disparities is not yet known.

Adolescent↗

PubMed2004

Linking primary and secondary healthcare databases in New Zealand.

AIM: To investigate the effectiveness of linking primary and secondary care data using an encrypted national health index (ENHI). METHODS: Primary care patient registers from 106 practices collected by the Dunedin Research Unit of the Royal New Zealand College of General Practitioners (RNZCGP) for the year 2001 were linked to the entire National Minimum Data Set (NMDS) for 2001 using an ENHI. The success of matching using the ENHI was measured, and primary and secondary care populations were compared in terms of hospital utilisation (number of discharges, length of stay, major diagnostic category [MDC]). RESULTS: 86,608 unique general practice ENHIs were successfully linked to the NMDS for the study period. Date of birth was matched on ENHIs (96.6%), sex (99.1%), and ethnicity (84.0%). Hospital morbidity and hospital utilisation (in terms of number of discharges and length of stay) were similar for general practice patient admissions and the entire NMDS admission data set. CONCLUSIONS: Data collected in general practice linked well to secondary care data using the ENHI. Linked primary and secondary care data sets will provide a sound basis for research into publicly funded healthcare.

Databases as Topic↗

PubMed2003

Registered and unregistered patients in general practice: implications for primary health organisations.

AIMS: To describe differences between registered and unregistered patients in New Zealand general practice and assess patient registers prior to enrollment in primary health organisations (PHOs). METHODS: Patient records from 35 computerised general practices made up the study data set. Data were assessed for the year 1 July 2000 to 30 June 2001. Patient registers and consultation files were examined to determine levels of recording of demographic data, consulting rates and date of last contact with practice for registered and unregistered patients. Prescription medications were coded to therapeutic groups for both patient groups. RESULTS: Sixty seven per cent of patients were listed as not registered with their practice. Only 10% of unregistered patients consulted during the study year. At least 20% of all patients had no contact with their practice in the last three years. A high proportion of unregistered patients were aged 15-34 years. Unregistered patients were likely to be treated for minor ailments. CONCLUSIONS: Unregistered patients constitute a distinct patient sub-population, with fewer holders of community service cards and high user health cards than registered patients, and they have a different age/sex profile. A substantial number of patients, both registered and unregistered, have had no contact with their practice in the last three years. Patient registers will require considerable updating prior to PHO enrollment.

Adolescent↗

PubMed2003

The characteristics of doctors receiving medical complaints: a cross-sectional survey of doctors in New Zealand.

AIM: To analyse the incidence and characteristics of medical complaints received by doctors in New Zealand. METHODS: A cross-sectional survey of New Zealand doctors randomly selected from each of three groups from the New Zealand medical register: vocationally registered general practitioners; vocationally registered hospital-based specialists; and general registrants. RESULTS: Nine hundred and seventy one doctors (11% of registered New Zealand doctors) indicated that 34% had ever received a medical complaint, and 66% had never received one. The rate of complaint in New Zealand is rising. The annual rate of complaint in 2000 was 5.7%, with doctors in the 40-60 age group receiving 68% of complaints. Doctors who were male, vocationally registered general practitioners, and holding higher postgraduate qualifications were more likely to receive a complaint. Time to resolution of a complaint is long, with 74% of dismissed and 59% of upheld complaints being resolved within 12 months. CONCLUSIONS: This study finds a high incidence of complaint in New Zealand. It finds differences between doctors based on gender, qualification, and field of practice, and suggests that responsibility for patient care may be an important determinant of the risk of receiving a complaint.

Adult↗

PubMed2003

Differential prescribing of inhaled corticosteroids in New Zealand general practice.

AIM: To determine how inhaled budesonide, beclomethasone and fluticasone are prescribed by general practitioners in New Zealand. METHODS: Retrospective study of computerised clinical records from 42 general practices in New Zealand for the period 1 July 1997 to 30 June 1998. The study population comprised 174 929 consulting patients, of whom 9878 patients were prescribed budesonide, fluticasone, or beclomethasone with full dosing instructions. RESULTS: The mean daily prescribed dose was higher for patients receiving inhaled budesonide (886 microg) than beclomethasone (547 microg), a difference of 339 microg (95% CI 311 microg to 367 microg), and fluticasone (508 microg), a difference of 378 microg (95% CI 344-412). The difference between mean daily prescribed doses of beclomethasone and fluticasone was 39 microg (95% CI 15-63). The overall difference was consistent across age groups and with different types of inhalation device. Evidence of systematic prescribing of higher doses of budesonide to patients with more severe asthma was not found. Patients prescribed fluticasone were more likely to have been prescribed oral steroids in the preceding year. CONCLUSIONS: Conclusions about the relative potencies of inhaled corticosteroids cannot be made with the data presented. However, data presented show that inhaled corticosteroids have not been prescribed in line with their reported relative potencies. This study provides benchmark data for the prescribing of inhaled steroids in New Zealand general practice.

Administration, Inhalation↗

PubMed2002

A general practice minimum data set for New Zealand.

AIM: To assess the completeness of primary care data collected by the Royal New Zealand College of General Practitioners' (RNZCGP) Dunedin Research Unit, and assess the feasibility of creating a New Zealand national minimum data set for primary care. METHODS: Patients from 42 practices contributing data to the Dunedin Research Unit made up the study population. A six-month sample of data was evaluated for completeness, and compliance to a minimum data set structure. Rates of recording patient identifiers, sex, ethnicity, community services card status, consultation identifier and date, prescriptions and Read codes were calculated for each practice and registered patient. RESULTS: Patient demography, NHI and community services card status were all well recorded (date of birth 99.3%, sex 98.9%, NHI 94.8%, CSC 100.0%). Read codes and ethnicity were still poorly recorded, although there was wide variation between practices. CONCLUSIONS: The completeness of data collected by the Dunedin Research Unit appears to be improving, although there is wide variation between contributing practices. The capability to create a primary care national minimum data set exists, but this will not become a reality until suitable education programmes and support are supplied for general practitioners and other staff members who record patient information.

Data Collection↗