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Biomedical subjects

M W Tilyard

Publications and source records attributed to M W Tilyard.

14 recordsLinked to original sources
PubMed1992

General practitioners' views on the role of the community pharmacist.

AIM: to determine the views of general practitioners on the roles and activities of community pharmacists. METHOD: the views of 137 general practitioners in Otago and Southland were canvassed by postal questionnaire. RESULTS: one hundred and three completed questionnaires were returned. All of the general practitioners reported that their professional contact with pharmacists was useful. Seventy-five percent expressed a desire for greater cooperation. Nearly all respondents (99%) accepted that pharmacists have a role in screening prescriptions for possible problems and preparing and dispensing medicines. They also accepted that pharmacists were capable of treating and advising in the management of minor illnesses. Providing drug information to general practitioners, information about previously diagnosed conditions to patients, and advice on personal and home hygiene were less widely accepted activities. The majority indicated that they considered it inappropriate for pharmacists to undertake screening programmes (blood pressure (70.6%), cholesterol (70.6%), glucose (60.8%), haemoglobin (72.5%)). Younger general practitioners objected more often than older general practitioners to reclassification of Acetopt eye drops from prescription only to availability through pharmacies (p < 0.05). Female general practitioners were more often in favour of reclassification of Gyno-Daktarin than their male colleagues (p < 0.05). CONCLUSION: this study shows that general practitioners accept several aspects of the current role of pharmacists in providing primary health care. However, there is room for improved communication between general practitioners and pharmacists to ensure optimum patient care.

Adult↗
PubMed1992

The effect of employment status and household composition on health care utilisation in a general practice.

OBJECTIVE: to investigate the effect of employment status and family composition on general practice and secondary health care utilisation rates of a New Zealand general practice population. METHODS: the study practice's health care records were electronically interrogated and pooled data on utilisation rates was obtained for a 12 month period. Individual records were grouped according to the number of people in the family and families were further categorised according to the employment status of the adults in the family. Comparisons were made between family groups in rates of general practice and secondary care activities. Costs were attributed to each activity and a cost analysis undertaken. RESULTS: families of four or more people depending on government benefits had a lower primary care cost per person than equivalent families where an adult was in paid employment, but higher costs in secondary care resulted in a higher total health care cost. Overall, for the year reviewed, the mean cost per person for public health care was $365 for people in families where at least one person was in the paid workforce, $568 for those in families depending on government support, and $1438 for people over 60 years of age. CONCLUSION: in this practice the increased use of secondary care facilities by those who have lower rates of general practice activity resulted in a higher overall cost of health care to those patients. This study indicates the need for further analyses of activities by differing patient groupings to facilitate rational and equitable health care planning.

Adult↗
PubMed1992

Treatment of postmenopausal osteoporosis with calcitriol or calcium.

BACKGROUND AND METHODS: Osteoporosis is a common problem whose management is controversial. To evaluate the efficacy and safety of calcitriol (1,25-dihydroxyvitamin D3) in the treatment of postmenopausal osteoporosis, we conducted a three-year prospective, multicenter, single-blind study in 622 women who had one or more vertebral compression fractures. The women were randomly assigned to receive treatment with calcitriol (0.25 micrograms twice a day) or supplemental calcium (1 g of elemental calcium daily) for three years. New vertebral fractures were detected by means of lateral roentgenography of the spine each year, and calcium absorption was measured in 392 of the women. RESULTS: The women who received calcitriol had a significant reduction in the rate of new vertebral fractures during the second and third years of treatment, as compared with the women who received calcium (second year, 9.3 vs. 25.0 fractures per 100 patient-years; third year, 9.9 vs. 31.5 fractures per 100 patient-years; P less than 0.001). This effect was evident only in women who had had five or fewer vertebral fractures at base line (second year, 5.2 vs. 25.3 fractures per 100 patient-years; third year, 4.2 vs. 31.0 fractures per 100 patient-years; P less than 0.0001). The groups also differed significantly in the number of peripheral fractures; 11 such fractures occurred in 11 women in the calcitriol group, whereas 24 occurred in 22 women in the calcium group (P less than 0.05). There was no significant difference between the groups in the incidence of side effects requiring withdrawal of treatment (8.6 percent in the calcitriol group vs. 6.5 percent in the calcium group). CONCLUSIONS: Continuous treatment of postmenopausal osteoporosis with calcitriol for three years is safe and significantly reduces the rate of new vertebral fractures in women with this disorder.

Aged↗
PubMed1992

A comparison of tiaprofenic acid, mefenamic acid and placebo in the treatment of dysmenorrhoea in general practice.

The efficiency and side-effects of tiaprofenic acid, mefenamic acid and placebo were compared in the treatment of primary dysmenorrhoea. The trial was a double-blind prospective randomized 3-way crossover study during 6 successive menstrual cycles following a 2-cycle run-in period and involved 50 women with primary dysmenorrhoea selected from 96 volunteers between 16 and 35 years of age. Overall pain was significantly less (p less than 0.05) on treatment with tiaprofenic acid than on treatment with mefanemic acid, placebo, or the women's usual treatments. Both active treatments were well tolerated but more side-effects were reported during treatment with mefenamic acid.

Adolescent↗
PubMed1991

The health services utilisation of a general practice population.

OBJECTIVE: to establish a viable methodology for the linkage of patients information between general practice and the secondary health care sector. To demonstrate this by examining the activities and cost of health care to a general practice community. METHODS: the linkage of computerised records was achieved using a unique alpha numeric identifier (the National Master Patient Index number). Using this link all patient activities for one general practice were analysed. Consultations and their outcomes in terms of pathology and radiology requests, prescriptions, and referrals to other health care providers were recorded. Secondary care activities analysed were outpatient, inpatient, day care, and accident and emergency attendances. RESULTS: the study population of 3611 patients produced 15,453 contacts in general practice (4.3 contacts per person per annum) and 2804 contacts with the secondary care system (0.8 contacts per person per annum). The total government expenditure was $824,567 for general practice care and $1,410,198 for secondary care, ie, $2,234,765 in total or $619 per person. CONCLUSION: this methodology for information linkage provides the potential for comprehensive examination of publicly funded health care in both general practice and hospital settings, thereby promoting better coordinated and more rational planning of services.

Costs and Cost Analysis↗
PubMed1991

Evaluation of a rapid diagnostic test for group A beta-haemolytic streptococcus in general practice.

OBJECTIVE: to assess the efficacy of Abbott Testpack Strep A compared with throat culture for the diagnosis of group A beta-haemolytic streptococcus in general practice. METHODS: one hundred and fifty-four specimens were obtained from general practices in selected regions, and were tested for group A beta-haemolytic streptococcus using both Abbott Testpack Strep A and throat culture. RESULTS: sensitivity of the rapid diagnostic test was 79.4%, specificity 93.3%. The negative predictive value of the test was 94.1%; the positive predictive value 77.1%. CONCLUSION: maximum cost effectiveness is achieved, with respect to short term costs and benefits, by diagnosing and treating solely on the basis of Abbott Testpack Strep A results. When possible complications are taken into consideration, initial testing by Abbott Testpack Strep A, followed by confirmatory laboratory testing of negative Testpack results becomes a feasible alternative.

Bacteriological Techniques↗
PubMed1991

Fees charged to a consulting population in general practice.

OBJECTIVES: information generated by the computer systems of thirty-five general practitioners was examined to determine their fee structure during the study period. METHODS: copies of the general medical services (GMS) claims and patient fees were examined to determine whether patients had been charged the doctor's regular fee or an amount greater or less than this. RESULTS: information on 97,869 consultations was collected. A regular fee was charged to patients in 47% of cases, a greater or less than normal fee was charged in 7.5% of the consultations, and no fee to the patient was made in 22.5% of cases. Consultations charged to the Accident Compensation Corporation (ACC) comprised 17.5% of the study data. Maternity cases comprised the remaining 5.5%. Nineteen doctors provided information on 6511 out of hours or home visit consultations. In 44.3% of these cases no charge was made to the patient. This proportion was higher among beneficiaries (58.9%) than for any other group. CONCLUSION: all of the contributing doctors appear to exercise discretion in their charging policies rather than to maintain a rigid pricing structure for their services.

Adult↗
PubMed1991

The effect of the 1989 health benefits package on prescribing and consultation patterns in general practice.

OBJECTS: this study aims to assess the effect of the 1989 health benefits package on the prescribing and consultation rates of the contributing general practitioners. METHODS: following the introduction of the health benefits package in February 1989 information on the consultation rates and prescribing records of twenty-eight computerised general practitioners was obtained for the two three month periods of February, March and April 1988 and 1989. Analysis was undertaken both on the pooled data and by comparing consultations for adults, beneficiaries aged 60 or older, beneficiaries less than 60 years and children. RESULTS: the number of consultations increased from 57,209 in 1988 to 63,736 in 1989. The number of items prescribed decreased from 66,984 in 1988 to 62,284 in 1989 indicating a mean decrease in the number of prescription items per consultation from 1.02 in 1988 to 0.83 in 1989. Based on the 1988 figures provided by the study the actual percentage decrease in pharmaceutical use by the contributing doctors during the study time frame was 9.3% whereas the expected increase was 11.4%. CONCLUSIONS: there was an increase in consultation rates and a decrease in prescribing among the contributing general practitioners during the 1989 study period compared with the 1988 study period. These changes may be attributed to the introduction of the 1989 health benefits package.

Adult↗
PubMed1990

Evaluation of standards of practice for general practitioners using eight hypothetical cases.

Concerns about the quality of primary care in New Zealand have increased over recent years as the scarcity of research in this field has become more apparent. A survey was undertaken among 132 general practitioners in Otago and Southland to gauge the degree of consensus of care for eight hypothetical cases. An 87.3% response rate was obtained. The year of graduation of the respondents was a significant factor in determining the response to the choice of management options for the paediatric sore throat and the benign hypertension cases. A variation in treatment of a 65 year old with epigastric pain was seen between rural and urban practitioners, with the cluster containing the most rural practitioners being least likely to undertake detailed diagnostic procedures.

Chronic Disease↗
PubMed1990

General practitioners' views on generic medication and substitution.

The government proposal to allow pharmacists to substitute generic medication has caused concern among general practitioners and their patients. A survey of 200 general practitioners was undertaken to canvass their views on the use of generic medications and generic substitution. One hundred and eighty-two completed questionnaires were returned and included in the analysis. Sixty-seven percent of responders indicated that they actively prescribe generic medication. Fifty-two percent stated their opposition to generic substitution without the doctor's knowledge or approval. Fifty doctors provided information about 85 cases where they had identified problems which they associated with the use of generic medications.

Aged↗
PubMed1989

Is outcome for low risk obstetric patients influenced by parity and intervention?

Maternal and perinatal morbidity were examined to assess the influence of parity and intervention procedures among 1032 women considered low risk at commencement of labour. A diagnosis of fetal distress, failure to progress during labour, maternal problems after delivery and consultation with or transfer of the neonate to a paediatrician occurred more frequently amongst nulliparous women (p less than 0.001). Failure to progress in labour was found to be influenced by parity (primigravida), maternal age (less than 20 years) and also by the use of epidural anaesthetic for pain relief (p less than 0.001). Prevalence of abnormal delivery was found to be influenced by parity (primigravida), failure to progress in labour and diagnosis of fetal distress. The use of epidural anaesthesia for pain relief was also found to increase the rate of abnormal delivery (p less than 0.001). Statistically significant differences occurred between the groups of patients, with patients of private specialists having the highest rates for induction (34%), use of epidural for pain relief (40%) and abnormal delivery (46%).

Adult↗
PubMed1988

Is outcome for general practitioner obstetricians influenced by workload and locality?

Maternal and perinatal morbidity and transfer patterns were examined to assess the influence of the number of deliveries performed by each general practitioner obstetrician and the distance from specialist care. There were statistically significant differences in transfer patterns between urban and rural practitioners and between those practitioners delivering fewer than twenty per year and those delivering twenty or more per year. Antenatally, rural practitioners transferred more of their patients to the base hospital and those practitioners delivering fewer than twenty per year had higher transfer rates than those delivering twenty or more per year. During labour the transfer rate was lowest for rural practitioners delivering more than 20 babies per year. Urban practitioners in comparison to rural practitioners delivered a significantly greater proportion of women who were considered to have a moderate or high obstetric risk. No association was found between the number of deliveries undertaken by general practitioners both urban and rural and maternal and neonatal morbidity. The proportion of women and neonates who had a score which indicated a less favourable outcome for maternal and neonatal morbidity, was higher for urban practitioners than for rural practitioners.

Delivery, Obstetric↗
PubMedDate not supplied

A randomized double-blind controlled trial of roxithromycin and cefaclor in the treatment of acute lower respiratory tract infections in general practice.

A multicenter, randomized, double-blind, single-dummy placebo-controlled study is being undertaken by the Research Unit of the Royal New Zealand College of General Practitioners to compare the efficacy and tolerance of 150 mg twice daily roxithromycin with 250 mg three times daily cefaclor in the treatment of 250 general practice patients with acute lower respiratory tract infections (LRTIs). Interim analysis of 200 patients reveals no statistically significant differences in the study parameters. Of the patients on roxithromycin and cefaclor, 83% and 67%, respectively, had a moderate or severe illness. Based on efficacy criteria, 96% of roxithromycin recipients and 99% of cefaclor recipients had a satisfactory or improved response. On an intention-to-treat basis, this was reduced to 95% for both treatment groups. Sputum grading and semiquantitative culturing was performed according to NCCLS standards. The most common isolates in order were Haemophilus influenzae, Moraxella catarrhalis, and Streptococcus pneumoniae. Efficacy for bacteriologically evaluable cases was 87.5% for roxithromycin and 57% for cefaclor. Four patients on roxithromycin (3.9%) and 11 patients on cefaclor (11.3%) withdrew because of side effects probably or possibly related to the study treatment. The study is ongoing.

Acute Disease↗