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Biomedical subjects

Dale Bramley

Publications and source records attributed to Dale Bramley.

12 recordsLinked to original sources
PubMed2006

Will a web-based cardiovascular disease (CVD) risk assessment programme increase the assessment of CVD risk factors for Maori?

BACKGROUND: Maori suffer disproportionately from cardiovascular disease despite the national priority of reducing inequalities. National guidelines on the clinical management of CVD risk recommend a comprehensive risk assessment be completed as a prerequisite for identifying patients most likely to benefit from treatment. METHODS: A retrospective audit of GPs using PREDICT-CVD (an electronic risk assessment and management tool) was designed with adequate explanatory power for Maori to determine if it could increase CVD risk assessment without increasing inequalities. 1680 electronic medical records (EMRs) prior to implementation and 1884 after implementation of PREDICT were audited. RESULTS: Documentation of CVD risk increased from 3.2% of EMRs to 14.7% of EMRs in Maori, and from 2.8% to 10.5% in non-Maori. The documentation of individual CVD risk factors also increased post-implementation of the tool. CONCLUSIONS: The implementation of PREDICT-CVD was as likely to increase documentation of CVD risk assessment and risk factors in Maori as in non-Maori. However documentation was still low in Maori despite known high prevalence of CVD risk factors. A comprehensive quality-driven implementation programme is recommended, including targeting risk assessment for those most in need.

Adult↗
PubMed2006

Cardiovascular risk factors and their associations with alcohol consumption: are there differences between Maori and non-Maori in Aotearoa (New Zealand)?

AIMS: To describe the relationship between indicators of alcohol consumption and major known cardiovascular risk factors, and to test whether these relationships are different for Maori and non-Maori. METHODS: Data from five New Zealand studies (national and population specific) conducted since 1988 were made available to the investigators and were re-analysed by Maori and non-Maori classification using multivariate modelling adjusting for sex and age. Three indicators of alcohol consumption were used: frequency of drinking, volume drunk on a typical or usual occasion, and average daily consumption. Interaction terms were used to test for differences between Maori and non-Maori in the associations between alcohol consumption and cardiovascular risk factors (tobacco smoking, systolic and diastolic blood pressure, high density lipoprotein (HDL), the ratio of total cholesterol to HDL, serum glucose, reported diagnosis of diabetes, and body mass index). RESULTS: There were a total of 44,830 people in the combined study populations of whom 6926 (15.4%) were Maori. For the risk factors examined, in general Maori had higher levels of risk compared to non-Maori. The pattern of associations between each of the three indicators of alcohol consumption and lipid factors, diabetes, serum glucose level, and obesity were not shown to be different in Maori and non-Maori. However for systolic blood pressure and tobacco smoking, the patterns of association were different. CONCLUSION: There are clear associations for most of the cardiovascular risk factors examined and alcohol consumption. These associations are consistent for Maori and non-Maori, except for blood pressure and cigarette smoking. As the study is hypothesis-generating, further investigation is required for confirmation.

Adolescent↗
PubMed2006

Coronary artery bypass graft surgery in New Zealand's Auckland region: a comparison between the clinical priority assessment criteria score and the actual clinical priority assigned.

AIMS: To describe the cohort of patients waiting for Coronary Artery Bypass Graft (CABG) surgery in the Auckland region; compare the Clinical Priority Assessment Criteria (CPAC) score with the actual priority assigned; and to assess the impact of a patient's demographic characteristics on the CPAC score and the assigned priority. METHODS: An electronic register was developed to capture all patients who had a CPAC form completed for isolated CABG surgery during the period June 2002 to September 2004 in the Auckland region. CPAC scores and clinical priority assigned were collected from the CABG booking form. Demographic characteristics came from the booking form (age, gender) or linkage via the National Health Index (NHI) number (ethnicity, deprivation score). RESULTS: The cohort displayed severe coronary artery disease and symptoms: 70% had class 3 or class 4 angina; 89% had their ability to work, live independently, or care for dependents threatened; 65% had three-vessel coronary disease; and 26% had left-main coronary disease. The CPAC score correlated only modestly with the actual clinical priority assigned, with an extremely wide range of scores for any given clinical priority. The mean CPAC score varied by the age of the patient, level of deprivation, and ethnicity--with higher mean scores among male patients who were Maori, Pacific, or more socioeconomically deprived. Clinical priority varied less by demographic characteristics than did the CPAC score, except more women than men were assigned the 'emergency' category. Despite higher CPAC scores for Maori and Pacific men, these did not translate to greater urgency in clinical priority. CONCLUSIONS: The CPAC scoring system is used to limit access onto the CABG surgery waiting list in Auckland, but is not used to prioritise patients as to the urgency of surgery once on the list. The challenge is to determine why clinicians do not consider that the CPAC score is adequate to prioritise the urgency of surgery and to build in a process whereby any such score can be continuously evaluated and improved. We have demonstrated that the establishment of an electronic register of such patients can provide timely analysis of patterns of practice and could be used on a national scale to improve future CPAC scoring systems.

Activities of Daily Living↗
PubMed2005

Smoking cessation using mobile phone text messaging is as effective in Maori as non-Maori.

AIMS: To determine whether a smoking cessation service using mobile phone text messaging is as effective for Maori as non-Maori. METHODS: A single-blind randomised controlled trial was undertaken with recruitment targeted to maximise the participation of young Maori. The intervention included regular, personalised text messages providing smoking cessation advice, support, and distraction. Maori text messages related to Maori language, support messages (in Maori and English) and information on Maori traditions. Text messaging was free for 1 month. After 6 weeks, the number of messages reduced from 5 per day to 3 per week until the 26-week follow-up. RESULTS: Participants included 355 Maori and 1350 non-Maori. Maori in the intervention group were more likely to report quitting (no smoking in the past week) at 6 weeks (26.1%) than those in the control group (11.2%) RR 2.34, 95% CI: 1.44-3.79. There was no significant difference between the RR for Maori and that for non-Maori (RR: 2.16, 95%CI: 1.72-2.71). CONCLUSIONS: A mobile phone-based cessation programme was successful in recruiting young Maori, and was shown to be as effective for Maori as non-Maori at increasing short-term self-reported quit rates. This shows clear potential as a new public health initiative.

Adult↗
PubMed2005

Disparities in indigenous health: a cross-country comparison between New Zealand and the United States.

OBJECTIVES: We compared the health statuses of the indigenous populations of New Zealand and the United States with those of the numerically dominant populations of these countries. METHODS: Health indicators compared included health outcome measures, preventive care measures, modifiable risk factor prevalence, and treatment measures. RESULTS: In the case of nearly every health status indicator assessed, disparities (both absolute and relative) were more pronounced for Maoris than for American Indians/Alaska Natives. Both indigenous populations suffered from disparities across a range of health indicators. However, no disparities were observed for American Indians/Alaska Natives in regard to immunization coverage. CONCLUSIONS: Ethnic health disparities appear to be more pronounced in New Zealand than in the United States. These disparities are not necessarily intractable. Although differences in national health sector responses exist, New Zealand may be well placed in the future to evaluate the effectiveness of new strategies to reduce these disparities given the extent and quality of Maori-specific health information available.

Adult↗
PubMed2004

Indigenous disparities in disease-specific mortality, a cross-country comparison: New Zealand, Australia, Canada, and the United States.

AIMS: To compare the disease-specific mortality rates of the indigenous populations of New Zealand, Australia, Canada, and the United States with the non-indigenous populations in each country. METHODS: For New Zealand, Australia, Canada, and the United States, we compiled and calculated (from crude data) ethnic-specific mortality rates by primary cause of death in 1999 for the indigenous and non-indigenous populations in each country. We calculated age-adjusted mortality rates, using direct standardisation and weights based on the World Health Organization world population. RESULTS: Australia experienced the largest relative and absolute disparities in life expectancy between indigenous and non-indigenous populations. For specific causes of death, New Zealand Maori, and Australian Aboriginals and Torres Strait Islanders experienced the highest levels of disparities when compared to their respective non-indigenous population group. Large disparities exist for indigenous peoples in all four countries for diabetes mortality. CONCLUSION The indigenous peoples of New Zealand and Australia suffer from high disease-specific mortality rates. The relative size of indigenous/non-indigenous mortality disparities are highest in New Zealand and Australia. There appears to be a number of common issues that adversely affect the quality of the mortality data that is available in the four countries. Action is required to address indigenous health disparities and to improve the quality of indigenous mortality data.

Australia↗
PubMed2003

Differences in patterns of alcohol consumption between Maori and non-Maori in Aotearoa (New Zealand).

AIM: To describe relative differences in alcohol consumption patterns in Maori and non-Maori from all available large-scale New Zealand surveys. METHODS: Data from five New Zealand surveys (national and population specific) conducted since 1988 were made available to the investigators and were re-analysed by sex and age group in Maori and non-Maori using multivariate modelling. RESULTS: There was a total of 44 830 people in the combined study populations, of whom 6926 (15.4%) were Maori. There was significant variation in the populations sampled and instruments used for measuring alcohol; however, the relative differences in consumption patterns between Maori and non-Maori were similar across all studies. In all age groups, and in men and women, non-Maori were more likely to be drinkers. The strength of this relationship increased with age. In all age groups, frequency of alcohol consumption (days a year) was higher for non-Maori, though the relative volume drunk on a usual drinking occasion was consistently around 40% less than for Maori. The averaged daily volume of alcohol consumed was similar between Maori and non-Maori. CONCLUSIONS: Maori have markedly different alcohol consumption patterns from non-Maori, which are not apparent when averaged daily alcohol consumption is compared. Frequency of drinking and amount consumed on a typical drinking occasion should be considered when determining the relationship between Maori alcohol consumption and health-related problems.

Adolescent↗
PubMed2003

The cost effectiveness of universal antenatal screening for HIV in New Zealand.

OBJECTIVE: To model the incremental costs and benefits of a universal antenatal HIV screening programme in New Zealand (NZ). DESIGN: Cost effectiveness analysis, including only health service costs, using secondary data sources and expert opinion. Uncertainty assessed in multi-way sensitivity analyses. SETTING: The NZ Health Care System. SUBJECTS: Antenatal population of NZ. INTERVENTION: Universal antenatal HIV screening programme. MAIN OUTCOME MEASURES: Incremental cost per true-positive HIV case detected in mothers; incremental cost per HIV case avoided in babies; and incremental cost per discounted life-year gained, for mothers and babies, due to screening. RESULTS: Using base case values the application of universal screening would cost an additional $NZ 723 607 ($US 307 917) and would lead to the identification of an additional 6.25 true-positive women. After terminations have been excluded, the screening programme would detect five HIV exposed babies. There would be 1.15 avoided cases of HIV infection in babies and a net gain of 41.97 discounted life-years, for mothers and babies combined. The cost per incremental HIV-positive woman detected was $NZ 115 859 ($US 49 301), HIV infected baby avoided $NZ 629 669 ($US 267 944) and discounted life-year gained $NZ 17 241 ($US 7336). CONCLUSION: The discounted cost per life gained in NZ compares favourably to estimates reported in studies of similar interventions in other developed countries and other health care interventions in NZ. The decision of whether to implement universal screening in NZ would be clarified if the prevalence of antenatal HIV infection was known and policy makers identified their willingness to pay for an additional life-year gained.

Cost-Benefit Analysis↗
PubMed2003

The acceptability of chronic disease management programmes to patients, general practitioners and practice nurses.

AIM: To evaluate the perceived effectiveness and acceptability of a disease management programme for patients with congestive heart failure (CHF) in South Auckland. METHODS: Focus groups were held with patients, and practice nurses (PNs) and general practitioners (GPs) interviewed to develop the questionnaires. Questionnaires were posted to the 150 patients, 14 GPs and 6 PNs involved in the programme. RESULTS: The programme was reported as changing patient lifestyle behaviours and patient understanding of medications and CHF. GP management was also seen as having improved. All aspects of the programme were seen as important: clinical review with a GP, educational sessions with a PN, patient-held care plan and educational material. The main issues were lack of time for practice staff to be involved, and payment for their time. CONCLUSIONS: Disease management programmes such as this are of value and are acceptable to both patients and providers.

Attitude of Health Personnel↗