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Biomedical subjects

Murray Tilyard

Publications and source records attributed to Murray Tilyard.

11 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↗
PubMed2005

Opioid poisoning deaths in New Zealand (2001-2002).

AIM: To investigate the rates of opioid deaths in New Zealand relative to the utilisation of opioids. METHODS: Deaths from opioid poisonings for New Zealand from 1 January 2001 to 31 December 2002 were identified from chemical injury cases that are routinely collected for surveillance purposes by the Institute of Environmental Science and Research from the Coronial Services Office in Wellington. Prescriptions for medicines containing morphine, methadone, and dextropropoxyphene were identified from the PharmHouse database from 1 January 2001 to 31 December 2002. RESULTS: There were 92 poisoning deaths involving opioids: morphine in 33, methadone in 31, dextropropoxyphene in 16, and codeine/dihydrocodeine in 12. The rate (95% CI) of deaths per 100,000 prescriptions was 5.94 (4.09 to 8.34) for morphine, 1.34 (0.91 to 1.91) for methadone, and 2.5 (1.45 to 4.12) for dextropropoxyphene. The rate of deaths (95% CI) per 1,000,000 defined daily doses was 0.94 (0.65 to 1.32) for morphine, 0.40 (0.27 to 0.56) for methadone, and 0.14 (0.08 to 0.22) for dextropropoxyphene. CONCLUSIONS: Restrictions in the availability of dextropropoxyphene, and increased monitoring of prescription and dispensing of methadone, should be considered in order to reduce deaths due to opioids in New Zealand.

Adolescent↗
PubMed2005

Avoiding and fixing medical errors in general practice: prevention strategies reported in the Linnaeus Collaboration's Primary Care International Study of Medical Errors.

AIM: To report tactics for avoiding and remedying medical errors observed by general practitioners in New Zealand and five other countries. METHODS: The Primary Care International Study of Medical Errors collected 66 reports of medical errors in New Zealand and 363 reports from general practitioners in Australia, Canada, England, the Netherlands, and the United States. Strategies for avoiding and overcoming errors were grouped by themes, for New Zealand and the five other countries combined. RESULTS: In all New Zealand reports and 336 (92.6%) reports from other countries, doctors offered at least one error prevention idea. The largest category of suggestions was 'more diligence' (New Zealand: 69.7% of reports, other countries: 55.3%). Other strategies were: 'provide care differently' (New Zealand 22.7%, other countries 36.4%); 'improve communication' (19.7% and 17.8% of reports); 'education' (7.8% and 11.0% of reports); and 'more resources' (12.1% and 14.0% of reports). CONCLUSIONS: In general practitioners' medical errors reports, a culture of individual blame is more evident than recognised need for systems design. A minority of reports contained specific, pragmatic suggestions for changing healthcare systems to protect patients' safety. Error reporting systems may be a practical way to generate innovative solutions to potentially harmful problems facing general practice patients.

Australia↗
PubMed2003

Antidepressant poisoning deaths in New Zealand for 2001.

AIM: To compare the rates of death per volume of drug dispensed for antidepressants in New Zealand. METHODS: Deaths from antidepressant poisonings were identified from the reports of coronial inquiries for New Zealand in 2001. Prescriptions for antidepressant medications were identified from the PharmHouse database from 1 January 2001 to 31 December 2001. The rates of deaths (95% CI) per prescription, tablet/capsule or defined daily dose were calculated for individual antidepressants and classes of antidepressant. RESULTS: There were 200 poisoning deaths recorded in the database for New Zealand in 2001. Antidepressants were involved in 41 deaths, and death was attributed to an antidepressant in 23 cases. There were 5.52 (95% CI 3.85-7.68) deaths per 100 000 prescriptions for tricyclic antidepressants (TCAs) and 2.51 (1.57-3.79) deaths per 100 000 prescriptions for selective serotonin reuptake inhibitors (SSRIs). There was marked variability in rates of death per volume of drug dispensed between individual antidepressants. CONCLUSIONS: SSRIs have lower rates of death per volume of drug dispensed than TCAs and there is also variation in these rates within these classes of drugs. Toxicity in overdose should be considered when prescribing antidepressants.

Antidepressive Agents, Tricyclic↗
PubMed2003

Trends in the use of inhaled corticosteroids for childhood asthma in New Zealand.

OBJECTIVE: To compare the dispensed volumes and prescribed doses for inhaled corticosteroids (ICS) for children in New Zealand. DESIGN: Longitudinal analysis of prescribing trends using the Royal New Zealand College of General Practitioners Research Unit database and the Pharm Warehouse database of the New Zealand Health Information System. SETTING: New Zealand from 1993 to 2001. SUBJECTS: Children aged 0-5 years and 6-17 years. MAIN OUTCOME MEASURES: The ratio of potency-adjusted mean daily dose of fluticasone propionate (FP) to beclomethasone (BDP) and dispensed volumes of FP, BDP and budesonide. RESULTS: The ratio of potency-adjusted mean daily dose of FP to BDP prescribed to children aged 0-17 years ranged from 1.22 to 1.91. With the introduction of FP, the total amount of ICS dispensed to children aged 0-5 years in New Zealand nearly doubled, when adjusted for potency. CONCLUSIONS: The introduction of FP into New Zealand corresponds with an increase in the total amount of ICS dispensed and an increase in the adjusted daily dose prescribed.

Administration, Inhalation↗
PubMed2003

Comparison of the fatal toxicity index of zopiclone with benzodiazepines.

BACKGROUND: Zopiclone is a hypnosedative structurally unrelated to the benzodiazepines but operating at the same receptor complex. Although zopiclone has been used in clinical practice for many years, relatively little is known of its relative toxicity in comparison with other hypnosedatives. METHOD: Deaths, where hypnosedatives were implicated, in New Zealand (NZ) in 2001 were identified from a chemical injury database. Prescription and aggregate defined daily dose (DDD) data forNZ in 2001 were obtained from a national prescribing database. Rates of death per prescription and DDD, and relative rates between individual hypnosedatives and benzodiazepines, and their respective 95% CI were calculated. RESULTS: Of the 200 poisoning deaths in NZ for 2001, 39 involved hypnosedatives, and zopiclone was involved in 12. Hypnosedatives were the sole agents in only one death and were the primary agents in eight deaths. Zopiclone was the sixth most commonly involved agent in poisoning deaths in NZ in 2001. The relative rate of death per prescription (95% CI) and DDD (95% CI) of zopiclone compared with benzodiazepines were 1.04 (0.49-2.05) and 0.59 (0.28-1.16), respectively. The relative rates of death per DDD (95% CI) for alprazolam and chlormethiazole compared with the other sedatives/anxiolytics were 6.2 (1.6-17.0) and 20.9 (2.5-79.8) respectively. CONCLUSIONS: The fatal toxicity for zopiclone was not significantly different from that for benzodiazepines as a group when adjusted for usage, whereas alprazolam and chlormethiazole had greater toxicity. Hypnosedatives are contributory factors rather than primary substances in poisoning deaths.

Adolescent↗
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↗
PubMed2002

Impact of safety alerts upon prescribing of cisapride to children in New Zealand.

AIMS: To assess the volume of cisapride prescribed in New Zealand to children age 0-17 years and establish whether safety announcements on cisapride had an effect on prescription volumes. METHODS: The Pharm warehouse database, which includes prescribing data from the New Zealand Health Information Service, was searched for all prescriptions for cisapride, ranitidine and omeprazole to children age 0-5 and 6-17 years inclusive, from January 1993 to October 2001. The amount of cisapride prescribed, and subsequently dispensed, was tabulated by month, using ranitidine and omeprazole as comparison groups. The time-course of prescribing patterns were compared with the timing of Medsafe alerts regarding cisapride. RESULTS: There were a total of 27169 prescriptions for cisapride over the time-period studied. For both age groups cisapride prescription numbers increased through the mid 1990 s to reach a peak prior to 1998. The prescription volumes declined following the Medsafe alerts, with the peak in prescribing by paediatricians occurring twelve months prior to that for general practitioners. Ranitidine and omeprazole prescriptions continued to rise in the younger age group throughout the study. CONCLUSION: The volume of cisapride prescribed in children has decreased dramatically since 1998 following the Medsafe alerts but the trends indicated delay in the response to safety announcements.

Adolescent↗
PubMed2002

A qualitative comparative investigation of variation in general practitioners' prescribing patterns.

BACKGROUND: In New Zealand there is increasing interest in the variation in the prescribing behaviours of general practitioners (GPs). Research conducted to date hasfocused primarily on the quantifiable aspects of prescribing variation. AIM: To investigate the qualitative aspects that may help explain variations in prescribing behaviour between GPs. DESIGN OF STUDY: Qualitative and comparative interviews. SETTING: Thirty New Zealand GPs. METHOD: A sample of 60 GPs (comprising 20 low, 20 medium, and 20 high-cost prescribers) was selected. Half of this sample (10 GPs in each prescribing category) was recruited to the study. Responders participated in a 60-minute interview. RESULTS: Low-cost prescribers reported more experience in practice and appeared to have a more 'relaxed' attitude towards medicine. They were more comfortable with refusing patients and they responded to patient expectations with education and explanation. In addition, they viewed the prescription as a pragmatic means of delivering health care to patients. Low and medium-cost prescribers did moreformal counselling and emphasised the 'listening' aspects of general practice. High-cost prescribers appeared to be more highly motivated and to have a more 'serious' attitude toward medicine. They tended to view their obligations and responsibilities to the patient in terms of medical competence. They described their roles with patients in terms of service provision and suggested that patients viewed the prescription as a signifier of the GP's service to the patient. CONCLUSION: This study suggests that there are discernible, non-quantifiable differences between low, medium, and high-cost prescribers in the Otago and Southland areas of New Zealand.

Attitude of Health Personnel↗