PubMed Health⌕ Search

Biomedical subjects

Kevin Dew

Publications and source records attributed to Kevin Dew.

17 recordsLinked to original sources
PubMed2006

General practitioners' attitudes toward (and use of) complementary and alternative medicine: a New Zealand nationwide survey.

AIMS: This study aimed to update our understanding of how general practitioners view and use complementary and alternative medicine (CAM). METHOD: A nationwide cross-sectional postal questionnaire sent to 500 randomly selected general practitioners (GPs) of the 2358 who met the inclusion criteria of the study in December 2005. RESULTS: 300 completed questionnaires were returned thus giving a response rate of 60%. Twenty percent of the GP respondents practiced (and 95% referred patients to) one or more forms of complementary and alternative medicine. The most common CAM therapy practiced by GPs was acupuncture, and chiropractic manipulation was the most common GP-referred therapy for patients. Thirty-two percent of respondents had formal training and 29% had self education in one or more CAM therapies. Sixty-seven percent felt that an overview of CAM should be included in conventional medical education. CONCLUSIONS: The number of GPs practising CAM therapies has decreased over the past 15 years, although the number referring patients to CAM has increased. The finding 'that GPs feel information about CAM should be included in medical education' is consistent with earlier research and should be taken into account when developing the medical curriculum.

Acupuncture Therapy↗
PubMed2006

Smoking in film in New Zealand: measuring risk exposure.

BACKGROUND: Smoking in film is a risk factor for smoking uptake in adolescence. This study aimed to quantify exposure to smoking in film received by New Zealand audiences, and evaluate potential interventions to reduce the quantity and impact of this exposure. METHODS: The ten highest-grossing films in New Zealand for 2003 were each analysed independently by two viewers for smoking, smoking references and related imagery. Potential interventions were explored by reviewing relevant New Zealand legislation, and scientific literature. RESULTS: Seven of the ten films contained at least one tobacco reference, similar to larger film samples. The majority of the 38 tobacco references involved characters smoking, most of whom were male. Smoking was associated with positive character traits, notably rebellion (which may appeal to adolescents). There appeared to be a low threshold for including smoking in film. Legislative or censorship approaches to smoking in film are currently unlikely to succeed. Anti-smoking advertising before films has promise, but experimental research is required to demonstrate cost effectiveness. CONCLUSION: Smoking in film warrants concern from public health advocates. In New Zealand, pre-film anti-smoking advertising appears to be the most promising immediate policy response.

Adolescent↗
PubMed2006

Student debt amongst junior doctors in New Zealand; part 1: quantity, distribution, and psychosocial impact.

AIMS: To quantify student debt owed by first-year house officers at graduation, and to describe the effects of student debt on their lives. METHODS: A questionnaire was sent was to all 296 New Zealand-graduate first-year house officers practicing in New Zealand. The survey included questions on demographics, level of debt, student support received, repayment since graduation, psychosocial and financial impact of debt, and career intentions. RESULTS: The response rate was 53%. Ninety-two percent of respondents had some form of student debt, with 85% having a government student loan. The average total debt from all sources (excluding mortgages) at graduation was NZ65,206 dollars. Seventy-five percent of respondents owed more than 50,000 dollars and 13% had owed more than 100,000 dollars. Eighty-eight percent of respondents reported increased levels of stress as a result of their student loan, with 31% reporting that they worried about their student loan 'often' or 'always'. Eighty-three percent reported that their student loan had made it more difficult to save for their future, such as for a house deposit or for their retirement, and 42% stated that their student loan debt had influenced their decision whether to have children (or more children). CONCLUSION: Student debt has a major negative impact on the lives of house officers in New Zealand. These data provide a baseline for studying how changes in medical education affect junior doctors.

Education, Medical, Undergraduate↗
PubMed2006

Student debt amongst junior doctors in New Zealand; part 2: effects on intentions and workforce.

AIMS: To assess the effects of student debt on the intentions of first-year house officers in relation to location of practice and vocation, and to evaluate the relative importance of incentives to remain practising in New Zealand (NZ). METHODS: A questionnaire sent to all 296 New Zealand-graduate first-year house officers practicing in New Zealand. RESULTS: The response rate was 53%. Eighty percent of respondents intended to practice in New Zealand for the bulk of their careers; however, 65% of respondents intended to leave New Zealand within 3 years of graduating. The most important factors influencing the decision to leave NZ were overseas travel, financial opportunities, and job/training opportunities. Fifty-five percent of respondents had considered leaving the country, specifically because of the student loan debt. The most important factors influencing vocational intentions were interest, lifestyle, and intellectual challenge. Forty-three percent of respondents stated that their student debt had influenced their intended specialty, and only 9% of respondents indicated their intention to pursue a career in general practice. The highest rated incentives for staying in New Zealand were increased salaries, employer contributions towards student loans, and training opportunities within New Zealand. CONCLUSION: Student debt influences both emigration and specialty choice intentions of junior doctors in New Zealand. This effect is an unintended but important consequence of our current tertiary education system in New Zealand. These results paint a worrying picture for the junior doctor and general practitioner workforce in New Zealand's future.

Career Choice↗
PubMed2005

Documentary analysis in CAM research: Part 1.

The analysis of documents can provide insights into important social and political issues related to complementary and alternative medicine (CAM). This paper identifies some important sources of documents and outlines some of the advantages and disadvantages of using documents in social research. A number of analytic strategies are illustrated with examples to demonstrate the potential for documentary analysis to answer particular CAM-related research questions. These strategies are described as quantitative content analysis, qualitative descriptive analysis, qualitative interpretive analysis and semiotic analysis. It is argued that documents are a convenient source of data and that their analysis can enrich our understanding of CAM. Part 1 covers quantitative and qualitative strategies and Part 2 focuses on semiotic analysis.

Biomedical Research↗
PubMed2005

Documentary analysis in CAM research: Part 2.

The analysis of documents can provide insights into important social and political issues related to complementary and alternative medicine (CAM). This paper identifies some important sources of documents and outlines some of the advantages and disadvantages of using documents in social research. A number of analytic strategies are illustrated with examples to demonstrate the potential for documentary analysis to answer particular CAM-related research questions. These strategies are described as quantitative content analysis, qualitative descriptive analysis, qualitative interpretive analysis and semiotic analysis. It is argued that documents are a convenient source of data and that their analysis can enrich our understanding of CAM. Part 1 covered quantitative and qualitative strategies. Part 2 focuses on semiotic analysis and the methodological strengths and weaknesses of the different strategies.

Biomedical Research↗
PubMed2005

Assessing and developing community participation in primary health care in Aotearoa New Zealand: a national study.

AIMS: This study aimed to develop and test a framework and tool for assessing and developing community participation in Primary Health Organisations (PHOs) in New Zealand. METHODS: A qualitative study completed in three phases: semi-structured interviews with 42 key stakeholders in the primary care sector; development of and consultation on a draft toolkit, which included a PHO review process; and piloting the toolkit in four different types of PHOs. RESULTS: A toolkit entitled Community Participation: A Resource Kit and Self-Assessment Tool for PHOs (CP Toolkit for PHOs) was developed, which contains a set of resources for organisational self-review and a framework for community participation under the six headings: Organisational Structure, Maori Responsiveness, Governance and Management Processes, Use of Resources, Links to the Wider Community, and Consultation and Decision-Making. The pilot PHO sites found the CP Toolkit, and the review process contained within it, to be very relevant to the implementation of the Primary Health Care Strategy at a PHO level. CONCLUSIONS: The Community Participation Toolkit for PHOs complements existing quality tools available for clinical general practice and nursing, and supports the further development of primary health care in New Zealand.

Community Participation↗
PubMed2005

"This glorious twilight zone of uncertainty": mental health consultations in general practice in New Zealand.

General practitioners provide treatment for the majority of people diagnosed as having a mental disorder in New Zealand, but much research suggests that they fail to diagnose many common mental disorders. This paper explores the issue of GP recognition of mental health problems through four discussion groups with GPs from the lower half of the North Island of New Zealand. GPs were asked to consider what they thought their role was in relation to mental health, what facilitated discussion of mental health issues in consultations and what could influence patients to disclose mental health problems. The analysis of the data collected drew on thematic and discourse analysis. Four key domains that had an impact on the consultation were identified, which were categorised as practice pressures, socio-cultural factors, the medico-legal framework and the consultation process. GPs employ a number of strategies to respond to the systemic and social issues influencing the consultation. This research suggests that GPs do recognise mental health problems in patients, but that a number of important factors result in the consultations not being labeled as mental health ones. The paper concludes by offering a framework for the mental health consultation that illustrates the systemic issues that GPs consider when making decisions about mental health consultations.

Family Practice↗
PubMed2005

Explicit rationing of elective services: implementing the New Zealand reforms.

In an attempt to make rationing of elective surgery in the publicly funded health system more explicit, New Zealand has developed a booking system for surgery using clinical priority assessment criteria (CPAC). This paper is based on research undertaken to evaluate the use of CPAC. To explore whether the goals of explicit rationing were being met 69 interviews were undertaken with policy advisors, administrators and clinicians in six localities throughout New Zealand. The aims of reforming policy for access to elective surgery included improving equity, providing clarity for patients, and achieving a paradigm shift by relating likely benefit from surgery to the available resources. The research suggests that there have been changes in the way in which patients access elective surgery and that in many ways rationing has become more explicit. However, there is also some resistance to the use of CPAC, in part due to confusion over whether the tools are decision-aids or protocols, what role the tools play in achieving equity and differences between financial thresholds for access to surgery and clinical thresholds for benefit from surgery. For many surgical specialties implicit rationing will continue to play a major part in determining access to surgery unless validated and reliable CPAC tools can be developed.

Elective Surgical Procedures↗
PubMed2004

'Choosing' to work when sick: workplace presenteeism.

Presenteeism is a concept used to describe the phenomenon of working through illness and injury. This paper is based on interviews and focus groups undertaken at three different work sites in New Zealand: a small private hospital, a large public hospital and a small factory. The research suggests that presenteeism is a prominent phenomenon in the lives of workers at these different sites, but the way in which it is rationalised and the factors that foster presenteeism are quite distinct. Exploring the way in which presenteeism links to economic and social constraints and workplace cultures provides insights into these rationalisations. The powerful forces promoting presenteeism tempers the research community's concern with absenteeism. A presenteeism discourse needs to be more prominently articulated to oppose both the absenteeism discourse, and to moderate the views taken by some postmodernist theorists on choice in relation to health practices in workplace settings.

Absenteeism↗
PubMed2004

Clinicians' reported use of clinical priority assessment criteria and their attitudes to prioritization for elective surgery: a cross-sectional survey.

OBJECTIVES: To explore the attitudes of clinicians working in New Zealand publicly funded hospitals towards prioritizing patients for elective surgery, and their reported use of clinical priority assessment criteria (CPAC). DESIGN: A cross-sectional study using a postal questionnaire. The questionnaire drew on themes identified from an earlier qualitative study. Questions were closed and information was sought about perceptions of the need to prioritize patients, effective ways of doing so and the use of CPAC. SETTING: New Zealand. PARTICIPANTS: A national sample of cardiologists, cardiac, general and orthopaedic surgeons, and registrars. RESULTS: Three hundred and thirty-two clinicians responded to the survey (74.1%). Respondents generally agreed that a nationally consistent method of prioritizing patients for surgery was required but felt their clinical judgement was the most effective way of prioritizing patients. Current CPAC were considered to be administrative tools and there was marked variation in their reported use. Consistent use of CPAC using the constructs provided was more likely to be reported by cardiac specialists than general or orthopaedic surgeons. Other features of the hospital system in which surgeons worked also had a major impact on access to elective surgery. CONCLUSIONS: Clinicians recognized the need for a nationally consistent method of prioritizing patients. Although most did not consider current CPAC were effective in achieving this, many felt there was some potential in further development of tools. However, further development is problematic in the absence of objective measures of need and ability to benefit.

Attitude of Health Personnel↗
PubMed2004

Equity of access to elective surgery: reflections from NZ clinicians.

OBJECTIVES: To explore factors potentially influencing equitable access to elective surgery in New Zealand by describing clinicians' perceptions of equity and the factors they consider when prioritising patients for elective surgery. METHODS: A qualitative study in selected New Zealand localities. A purposive sample of 49 general practitioners, specialists and registrars were interviewed. Data were analysed thematically. RESULTS: General practitioners described unequal opportunities for patients to access primary and secondary care and, in particular, private sector elective surgery. They felt that socio-economically disadvantaged patients were less able to advocate for themselves and were more vulnerable to being lost to the elective surgical booking system as well as being less able to access private care. Both GPs and secondary care clinicians described situations where they would personally advocate for individual patients to improve their access. Advocacy was related to clinicians' perceptions of the 'value' that patients would receive from the surgery and patients' needs for public sector funding. CONCLUSIONS: The structure of the health system contributes to inequities in access to elective care in New Zealand. Subjective decision making by clinicians has the potential to advantage or disadvantage patients through the weighting clinicians place on socio-demographic factors when making rationing decisions. Review of the potential structural barriers to equitable access, further public debate and guidance for clinicians on the relative importance of socio-demographic factors in deciding access to rationed services are required for allocation of services to be fair.

Attitude of Health Personnel↗
PubMed2004

Use of, and attitudes to, clinical priority assessment criteria in elective surgery in New Zealand.

OBJECTIVES: To describe the ways patients access elective surgery in New Zealand, and to understand the use of, and attitudes to, clinical priority assessment criteria (CPAC) in determining access to publicly funded elective surgery. METHODS: A qualitative study in selected New Zealand localities. A purposive sample of general practitioners, surgeons and administrators in publicly funded hospitals were interviewed. Data were analysed by a process of thematic analysis. RESULTS: Sixty-five interviews were completed. General practitioners had a key role in determining which patients were seen in the public sector and, by utilising strategies to actively advocate for patients, influenced both waiting times for first assessment by surgeons and for surgery. CPAC had been developed as decision support guides with the intention that they would provide transparency and equity in determining access. However, there was variation in the way CPAC were being used both in score construction and in the influence of the score on access to surgery. The management of the hospital system also limited the extent to which CPAC could be used to prioritise patients for surgery. CONCLUSIONS: Variability in the use of CPAC tools meant that at the time of the study they did not provide a transparent and equitable method of determining access to surgery. This highlights the difficulties in developing and implementing CPAC and suggests that further development is difficult in the absence of evidence to identify patients who will benefit the most from surgery.

Attitude of Health Personnel↗
PubMed2002

A needs assessment of the potential users of a South Pacific telehealth service.

Qualitative methods such as focus groups, individual interviews, case studies and participant observation were used to complete a needs assessment for a telehealth service in the South Pacific. Participants from the Cook Islands and Fiji were able to identify extensive uses for a telehealth service, but also identified barriers to its implementation. These included the extremely limited telecommunications and electrical infrastructure found in South Pacific countries, the high cost of Internet access and staffing shortages. The effective implementation of a telehealth site will probably require the use of clinician drivers with an interest in telehealth to encourage colleagues less enthusiastic to change their work practices. Telehealth in the South Pacific would improve services across a wide geographical area, but initial and continuing costs would be high due to the lack of infrastructure.

Attitude of Health Personnel↗
PubMed2002

Accident insurance, sickness, and science: New Zealand's no-fault system.

This article explores the process of seeking compensation for occupational illness under a no-fault accident insurance scheme. The author uses two case studies--firefighters who attended a fire at a chemical storage depot and timbermill workers who worked with pentachlorophenol--to illustrate how science can be used to deny compensation to sick and dying workers. The results of the studies suggest that a no-fault accident compensation scheme, considered to be a victory for workers, offers no guarantee of just outcomes for working people. And science can be co-opted and used to support business and state interests against workers; this ideological support is increasingly hidden behind the development of "objective" systems of assessing compensation claims.

Capitalism↗