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Biomedical subjects

B McAvoy

Publications and source records attributed to B McAvoy.

11 recordsLinked to original sources
PubMed1999

Practice nurses in the Waikato, 1991-1992, I: Occupational profile.

AIMS: To describe the personal characteristics, working conditions, clinical activities and professional development of a representative sample of practice nurses in the Waikato during the period 1991-1992. METHODS: The data are from a survey of practice nurses drawn from a larger study of general practice carried out in the Waikato (the WaiMedCa Study). Eighty-nine percent of the 107 practices in the region participated in the study. The practice nurse survey was carried out on the 189 nurses working in these practices. Of these 149 replied, representing a response rate of 79%. RESULTS: On average, there was one nurse for each solo practice and two in most other practices. Only two practices--both solo--did not employ a nurse. Practice nurses were female and aged between 30 and 50. While only one-third had received a postgraduate qualification, two-thirds had been to recent professional development courses. The majority had worked as a practice nurse for between one and ten years. Nurses averaged just under 15 telephone contacts a day and 28 face-to-face contacts a week. Nurses' workload comprised general measurements and assessments, monitoring and surveillance procedures (such as diabetes, asthma and child development), and counselling and women's health activities. CONCLUSION: Practice nurses are an accepted and essential part of primary health care in New Zealand. However, their potential is probably underdeveloped and they could be more fully utilised for a wider range of nursing functions.

Adult↗
PubMed1995

Geographical variations in the organisation of general practice.

AIMS: To describe organisational characteristics of New Zealand general practice and to investigate inter-regional variations in these characteristics. METHODS: Data were collected by standardised questionnaires from general practitioners in Auckland, Waikato and Taranaki. The Waikato data were collected in July-August 1991 by postal survey, the Taranaki data were collected May-June 1992 by postal survey and the Auckland data were collected December 1990 to January 1991 by face-to-face interview. RESULTS: The response rates were Auckland 98% (167/171), Waikato 84% (185/220) and Taranaki 79% (79/100). There were significantly more overseas trained graduates in rural areas than in urban areas. Average practice size was 2.3 full time equivalent doctors, with each 100 doctors employing 71 nurses and 77 receptionists. The number of patients seen per week ranged from 109-141. Almost all (95%) general practitioners operated appointment systems. One in five general practitioners had patients in private hospitals, and more than half (58%) had patients in rest homes. At the time of interview, 29% of Auckland general practitioners used computers in their practices compared with over 50% in Waikato and Taranaki (p < 0.05). A smaller proportion of Auckland general practitioners had access to age/sex registers and fewer Auckland general practitioners had a recall system. Of Auckland general practitioners with recall systems, a greater proportion used them for mammograms, blood pressure and lipid measurements compared with elsewhere. CONCLUSIONS: There are some significant regional variations in the functional characteristics of general practice in New Zealand which should be taken into account when planning primary care services in different regions. Should budget holding and managed care be introduced, computerised practices will be required. This will have significant resource implications.

Adult↗
PubMed1995

Adolescent health--a descriptive study of a school doctor clinic.

AIM: To describe a school doctor clinic at a New Zealand secondary school. METHODS: A three phase study was designed and conducted at a coeducational secondary school in Auckland. Firstly, a health questionnaire was developed to assess adolescents' perceptions of their health status and use of primary health care services. The second phase was descriptive study of a newly established school doctor clinic. The doctor clinic was run twice weekly over a 3 month period in 1993. The third phase of the study was a clinic-based satisfaction survey. RESULTS: A 75% response rate was achieved, with a total of 221 health questionnaires completed from 292. Although the majority of students (n = 184, 84%) considered themselves healthy, 16% (n = 36) described their health as only 'fair' or 'poor'. Seventy one percent (n = 157) of students had seen their general practitioner in the preceeding twelve months. Thirteen percent (n = 142) of the school population consulted the school doctor clinic. Significantly more female, Maori and European students attended the school doctor clinic compared with the school demography. The commonest diagnoses for the doctor clinic were respiratory, skin and musculoskeletal problems. Thirty one percent of the diagnoses related to recognised adolescent health needs such as contraception, sexual health, nutrition, and psychosocial problems. Over two thirds of students at the first consultation had not seen another health provider. Students perceived that the doctor clinic overcame barriers such as access, cost and confidentiality. CONCLUSION: The school doctor clinic was well utilised, overcame some barriers to access and addressed many recognised adolescent health needs.

Adolescent↗
PubMed1994

The Waikato Medical Care (WaiMedCa) Survey 1991-1992.

Objective. The main objective of this study is to provide a comprehensive description of general practice in the Waikato, an area which represents many aspects of New Zealand. Accurate, detailed and up to date information in this area is needed for future planning of medical education and the provision of health services. Survey method. The survey was conducted over one year, from September 1991 to August 1992. Participating general practitioners and practice nurses recorded details of a sample of patient encounters in the surgery or on home visits. Each participant was assigned four single weeks for data gathering over the course of the year. A one in five sub-sample of patients was also given questionnaires to complete immediately and two weeks after the consultations. This component of the study was reported elsewhere. Participants. A list of all active general practitioners working within the area covered by the Waikato Area Health board was constructed. All were contacted during May and June 1991 and asked to contribute to the study. During this initial, recruiting stage the practitioners and their practice nurses were asked to provide details of their professional background and to outline the structure, functions and size of their practices. Data collection. The variables studied included: provider characteristics (age, gender, qualifications, type of practice and services offered); patient attributes (age, gender, ethnicity, benefit category and occupation); patient reasons for encounter (up to four per encounter); doctor diagnoses (again up to four per encounter); drugs prescribed and or other treatments provided; tests and investigations ordered and referrals made; planned follow up and subjective view on the encounter. Data were centrally coded by trained staff. Patient reasons for encounter were coded according to NAMCS, practitioner diagnoses were classified into OXMIS, and drugs prescribed were allocated into the ATC classification system. Participation rate. 87% of practitioners (182/209), 89% of practices (95/107), and 80% of practice nurses (150/189) completed the initial recruitment survey. The participation rate at the first phase of the encounter survey was 80.5% (169/210), but this had dropped to 65.7% (136/207) by the fourth collection week. An overall response rate of 68.6% was achieved, representing successful collection of encounter data in 562 of 819 potential doctor recording weeks. On average, general practitioners recorded 109 encounters per week, from which they selected on average a sample of 23 patients for the survey. They described 141 problems per 100 encounters, of which 49 were new. On average general practitioners made less than three home visits per 100 encounters.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1994

Pathological gamblers--will they use a new telephone hotline?

AIMS: This paper reports on the preparedness of pathological gamblers to seek help through a new national toll-free telephone hotline and compares these callers, on some key dimensions, with a representative sample of pathological gamblers living in the community. METHODS: Callers were assessed using standard diagnostic screens. Sociodemographic data and reported symptoms of stress and depression were also recorded. Callers identified as pathological gamblers were compared with their counterparts in a recent nationwide epidemiological survey. RESULTS: During the first 3 months of operation, 1506 calls were received from 329 callers. Of these 167 were pathological gamblers, 117 were partners or family members and 45 were from various agencies. Pathological gamblers contacting the hotline resembled those from the community survey with respect to gender and age. Maori and Pacific Islanders were underrepresented. Suicidal ideation was reported by over 90% of pathological gambler callers. CONCLUSIONS: The new service provides a means to reach people with serious gambling-related problems and provides information to family members and helping agencies. High reported suicidal ideation was consistent with previous studies showing elevated rates of stress and depression among pathological gamblers. Underutilization by Maori, Pacific Islanders and people with less severe gambling disorders indicates the need to find better ways to engage these groups.

Gambling↗
PubMed1992

Cervical screening: what do Auckland general practitioners do?

AIMS: To assess the frequency of cervical screening; average age of screened women and adequacy of decontamination practices of vaginal specula by Auckland general practitioners. METHODS: A random sample of 96 Auckland general practitioners completed a questionnaire at the time of consultation describing the screening history and decontamination practices for vaginal specula from five consecutive patients having a cervical smear test. RESULTS: Of the 96 doctors 68 completed the questionnaire for the five consecutive patients. The majority of women were aged below 50 years and the median time since the last smear for women with a previously normal smear was 18 months. Although the majority of doctors adhered to Health Department guidelines for decontamination, deviations occurred by: reusing plastic specula; using only disinfection as a means of decontamination and not boiling specula for 30 minutes. CONCLUSIONS: The majority of women being screened are young and there is a high level of very frequent screening in women with previously normal smears. Closer adherence to the 1991 cervical screening recommendations and Health Department guidelines for decontamination of vaginal specula is required for some Auckland general practitioners.

Adolescent↗
PubMedDate not supplied

The impact of the new subsidy regime in general practice in New Zealand.

The first substantial change in the New Zealand health care reforms was the introduction in February 1992 of a new subsidy and charging regime in general practice. The paper reports on a comparison of data collected before and after the changes, drawing on GP-patient encounter information. Overall, seasonally adjusted levels of utilisation were maintained in the stage before the introduction of the new regime, declined 15% immediately following the changeover and stabilised thereafter. All patient groups were affected by the decline. Although the elderly were temporarily exempt from the changes, their consultations fell by 10%. Utilisation among beneficiaries--minor gainers from the changes--dropped by 30%. Children were more affected overall, adults less so. There was also some suggestion of greater falls for the lowest socio-economic groups. Activities under the direct control of the practitioner--prescribing and the ordering of tests--showed either little turbulence or no clear pattern of change. It is concluded that, although primary care subsidies and charges had been reshaped to favour poorer people, six months after the introduction of these changes there had been no corresponding redistribution of medical care consumed. Indeed, there is a suggestion that some of the groups ostensibly the target of increased assistance may have been adversely affected by the overall decline in utilisation.

Attitude to Health↗