Counties Manukau Research Articles

Optimisation of hospital resource use: A rapid review of the literature

Project System Wide Integration for Transformation (SWIFT) is a programme of work supported by developments in technology that aims to improve the health of people in Counties Manukau through initiatives focused on community-based care and improving hospital systems. A “rapid review” of literature focussing optimisation of resource use in hospitals was carried out to support this programme. In total, 36 articles were considered in detail for inclusion in this rapid review, with many other articles considered briefly from title or abstract alone. Of the 36 articles, 24 (66.7%) were ultimately deemed relevant, and included. The review found reasonable evidence that patient length of stay can be reduced by using: (1) collaborative physician/nurse multidisciplinary care management of medical patients with expedited discharge, and assessment following discharge; (2) perioperative anaesthetic and pain management strategies for primary total hip (THA) and total knee arthroplasty (TKA); (3) the use of specialist nurses across a variety of roles, and team midwives who provide care for pregnant women from the beginning of care to the end of the post-natal period. It also found that there is potential for a reduction in adverse cardiac outcomes in hospitals through: (1) prescribing guideline discharge therapies in acute cardiac care, and (2) remote management of heart failure patients implanted with cardioverter defibrillators. The review also suggested that appointment cancellations or instances of non-attendance can be reduced by: (1) the establishment of pre-operative assessment and consultation clinics; (2) distributed access to scheduling systems; (3) preferentially loading appointments onto high-attendance days; and (4) the use of text messaging or automated phone calls to remind patients about appointments.

Child-care nutrition environments: results from a survey of policy and practice in New Zealand early childhood education services.

To describe nutrition environments in formal child care for 3- and 4-year-olds. Cross-sectional online survey of nutrition-related child-care policy and practice. Written nutrition policies were analysed using the Wellness Child Care Assessment Tool. Licensed child-care services in the Auckland, Counties Manukau and Waikato regions of New Zealand. Eight hundred and forty-seven services (private and community day care, kindergartens and playcentres). Managers/head teachers of 257 child-care services completed the survey. Of services, 82·4 % had a written food, nutrition or wellness policy. Most policies did not refer to the national Food and Nutrition Guidelines and lacked directives for staff regarding recommended behaviours to promote healthy eating. Food was provided daily to children in 56·4 % of child-care services, including 33·5 % that provided lunch and at least two other meals/snacks every day. Teachers talked to children about food, and cooked with children, at least weekly in 60 % of child-care services. Nearly all services had an edible garden (89·5 %). Foods/beverages were sold for fundraising in the past 12 months by 37·2 % of services. The most commonly reported barrier to promoting nutrition was a lack of support from families (20·6 %). Although the majority of child-care services had a written nutrition policy, these were not comprehensive and contained weak statements that could be difficult to action. Foods served at celebrations and for fundraising were largely high in sugar, salt and/or saturated fat. Most services promoted some healthy eating behaviours but other widespread practices encouraged children to overeat or form unhealthy food preferences.

Coordination of care in hospitals: A rapid review of the literature

PProject SWIFT (System Wide Integration for Transformation) is a programme of work supported by developments in technology, that aims to improve the health of people in Counties Manukau through initiatives focused on community-based care and improving hospital systems. A “rapid review” of literature focussing on coordination of care in hospitals was carried out to support this project. Rapid review is a literature review methodology that is “streamlined” by limiting: the number of databases searched, the types of study design included, the languages that articles are written in, the dates when articles were written, and the level of inclusion of “grey” literature. In total, 30 articles were considered in detail for inclusion in this rapid review, with many other articles considered briefly from title or abstract alone. Of the 30 articles, 12 (40%) were ultimately deemed relevant, and included. In total, 112 unique articles contributed to the literature review, if all of the articles considered by three systematic reviews that contributed to this rapid review are included. The review found reasonable evidence that implementation of patient care delivery models focussing on coordination of care and efficiency can contribute to reductions in length of stay for hospital patients. In addition, reasonable evidence was found indicating that that the use of preoperative briefings and surgical safety checklists by operating teams can improve patient safety outcomes. However, it was not possible to draw firm conclusions from many of the other articles that were reviewed: these tended not to describe measurable improvements to patient outcomes or efficiency, and instead focussed on results that were process rather than outcome oriented, subjective, reported improvements that were not compared against any other measure, or were non-significant.

Postoperative Systolic Blood Pressure as a risk factor for haematoma following thyroid surgery.

To examine potential factors that may predict development of postoperative haematoma following thyroid surgery, with particular attention to postoperative systolic blood pressure. Retrospective, observational case-control study of patients undergoing thyroid surgery. Secondary General Hospital. Patients attending Counties Manukau District Health Board (CMDHB) between 2002 and 2012. Post-operative Haematoma formation that required re-exploration of the wound. The overall rate of postoperative haematoma was 2.57% (16/621). Three patients bled immediately (i.e. after wound closure but while still on the operating table); 10 patients (1.6%) bled in the early postoperative period; and three others bled 24h or more after surgery. The principal independent risk factor for postoperative haemorrhage that remained after multivariable regression was postoperative systolic blood pressure level. There was a 39% increase in risk of bleeding for every 10 points rise of highest blood pressure recordings in our patient population (OR 1.39; 95% CI=1.09-1.8). This study identifies postoperative hypertension as significantly related to development of early postoperative haematoma. Cause for late post-thyroidectomy bleeding remains speculative.

'Goes to church'.

Australasian Journal on AgeingVolume 34, Issue 3 p. 189-190 Reflection ‘Goes to church’ Berta Nicoll, Berta Nicoll Counties Manukau District Health BoardSearch for more papers by this author Berta Nicoll, Berta Nicoll Counties Manukau District Health BoardSearch for more papers by this author First published: 03 September 2015 https://doi.org/10.1111/ajag.12229 This address opened a conference on Spirituality and Ageing at Selwyn Village in Auckland, 28 August 2014. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume34, Issue3September 2015Pages 189-190 RelatedInformation

An innovative community organizing campaign to improve mental health and wellbeing among Pacific Island youth in South Auckland, New Zealand.

To examine whether being an organizer in a community organizing program improves personal agency and self-reported mental health outcomes among low-income Pacific Island youth in Auckland, New Zealand. Counties Manukau Health initiated a community organizing campaign led and run by Pacific Island youth. We used interviews, focus groups and pre- and post-campaign surveys to examine changes among 30 youths as a result of the campaign. Ten youths completed both pre- and post-campaign surveys. Eleven youths participated in focus groups, and four in interviews. Overall, youths reported an increased sense of agency and improvements to their mental health. Community organizing has potential as a preventive approach to improving mental health and developing agency over health among disempowered populations.

A change framework for physical therapy in a fluid healthcare environment

Background: Counties Manukau Health (CMH) has responsibility to provide for the health and wellbeing of its 500,000 resident population in South Auckland, New Zealand. It is a diverse population both in demographics and socioeconomic status leading to an increased demand for services. To meet this demand, there has been a drive towards a locality based healthcare model whereby healthcare is delivered in a more targeted way for its local population. This has bought into focus the need to understand the Models of Care to enable this service delivery including the workforce of which Physical Therapy is a key component.

Patient and caregiver preferences for home dialysis—the home first study: a protocol for qualitative interviews and discrete choice experiments

IntroductionThe number of patients requiring dialysis continues to increase worldwide imposing a substantial social and economic burden on patients, their families and healthcare systems. Compared with facility-based dialysis, dialysis performed...

Vaginal mesh for prolapse: a long-term prospective study of 218 mesh kits from a single centre.

The aim was to assess the long-term surgical outcomes and complications in patients undergoing mesh-augmented vaginal repair of pelvic organ prolapse. This is a report of a prospective long-term follow-up experience from the Urogynaecological Service, Counties Manukau District Health Board (CMDHB), Auckland, New Zealand. The subjects were 158 symptomatic women undergoing mesh-augmented prolapse repair (218 kits, Feb 2005 to July 2013) using the Apogee and/or Perigee kits (with IntePro mesh until November 2009, and IntePro Lite mesh thereafter). A dedicated electronic database was used. The median follow-up times were 138 and 105 weeks for the Apogee and Perigee kits, respectively; 56.6% and 48.8% of these kits, respectively, were inserted for recurrent prolapse. Cure rates for prolapse using mesh kits in patients with a history of native tissue POP repair in the same compartment were 90.91% for the anterior compartment (60 of 66) and 95.74% for the posterior compartment (45 of 47). The cumulative mesh extrusion/exposure rate was 15.8% of patients (11.5% of mesh kits) and was significantly higher with the Apogee kit than with the Perigee kit (P = 0.03). The rate of extrusion/exposure was significantly lower with IntePro Lite than with IntePro (P = 0.04 for Perigee and P = 0.0001 for Apogee). There was a significantly higher rate of extrusion/exposure with the Perigee kit in women with previous anterior compartment native tissue repair than with the Apogee kit in women with previous posterior compartment native tissue repair (21.2% versus 6.4%; P = 0.03). Only 8% of extrusions/exposures needed revision of the mesh. A set of significant predictors of mesh extrusion/exposure was identified. Overall success rates were 81.4% (110/135) for the Perigee kit and 74.7% (62/83) for the Apogee kit. This is one of the longest prospective mesh follow-up studies to date from a single centre and highlights the need for continuing surveillance despite high overall success rates.

Fatu Ola - an innovative home-based service to increase CR uptake and engagement for Pacific people in Counties Manukau

calculators integrated into computer systems and the active use of data/audit feedback to providers Innovative approaches to accessing patients Conclusion: The gains, while largely positive, have not been without debate. For example, many assessments have been non-face-to-face, and some wonder about the level of follow-up given the target’s focus on assessment rather than management. Guidelines were also updated to better reflect contemporary evidence and practice. The key focus for 2015 and beyond is to shift from an adapted Framingham based risk equation to a New Zealand specific equation. This presentation will review these success factors, progress to date with CVD Risk and potential next steps.

Audit of Maori uptake of cardiac rehabilitation in Counties Manukau

Audit of Maori uptake of cardiac rehabilitation in Counties Manukau

An open‐source practical manual for home hemodialysis: A catalyst for change!

Hemodialysis InternationalVolume 18, Issue 4 p. 716-719 EDITORIAL An open-source practical manual for home hemodialysis: A catalyst for change! Mark R. Marshall, Mark R. Marshall Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand Department of Renal Medicine, Counties Manukau District Health Board, Auckland, New ZealandSearch for more papers by this authorChristopher T. Chan, Corresponding Author Christopher T. Chan Division of Nephrology, University Health Network, Toronto, Ontario, CanadaCorrespondence to: C. T. Chan, MD, Toronto General Hospital, University Health Network, 200 Elizabeth Street, 8N Room 846, Toronto, ON M5G 2C4, Canada. E-mail: [email protected]Search for more papers by this authoron behalf of The Global Forum for Home Hemodialysis, Global Forum for Home HemodialysisSearch for more papers by this author Mark R. Marshall, Mark R. Marshall Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand Department of Renal Medicine, Counties Manukau District Health Board, Auckland, New ZealandSearch for more papers by this authorChristopher T. Chan, Corresponding Author Christopher T. Chan Division of Nephrology, University Health Network, Toronto, Ontario, CanadaCorrespondence to: C. T. Chan, MD, Toronto General Hospital, University Health Network, 200 Elizabeth Street, 8N Room 846, Toronto, ON M5G 2C4, Canada. E-mail: [email protected]Search for more papers by this authoron behalf of The Global Forum for Home Hemodialysis, Global Forum for Home HemodialysisSearch for more papers by this author First published: 17 October 2014 https://doi.org/10.1111/hdi.12235Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume18, Issue4October 2014Pages 716-719 RelatedInformation

Effects of pre-hospital ECG transmission for ST-elevation myocardial infarction in Counties Manukau

Effects of pre-hospital ECG transmission for ST-elevation myocardial infarction in Counties Manukau

Management of gout in a South Auckland general practice

In New Zealand, the highest prevalence of gout is in Maori and Pacific people. Counties Manukau District Health Board (CMDHB) has the highest Maori and Pacific population of any New Zealand District Health Board. A CMDHB study found that a high proportion of patients with gout were also at increased risk of cardiovascular disease. The primary objective was to examine whether the control of gout had changed over time at one clinic. The secondary objective was to assess the management of cardiovascular risk factors in patients with gout at that clinic. The mean serum uric acid level of patients with gout in the practice had risen in comparison with a similar audit carried out in March 2009. This indicates that the control of gout for patients at the practice has worsened over time. Many patients had not had an annual serum uric acid test. A repeat uric acid level was scheduled for all patients with gout in the practice, with follow-up appointments to be arranged if the result was abnormal. Gout is often suboptimally managed. Serum uric acid levels may only be tested when a patient presents with an acute attack of gout. Consideration should be given to a minimum of annual serum uric acid levels. Appropriate management of modifiable cardiovascular risk factors in this particular cohort is important and should be a particular focus of care.

Reducing the pain of intramuscular benzathine penicillin injections in the rheumatic fever population of Counties Manukau District Health Board

To evaluate the effectiveness of lignocaine and a vibrating device with cold pack (Buzzy) for pain management of intramuscular (IM) benzathine penicillin injections in the rheumatic fever (RF) population of Counties Manukau District Health Board (CMDHB). Four hundred and five RF patients receiving four weekly injections in the CMDHB region were offered 0.25 mL of lignocaine 2% and Buzzy for pain management of their injections. The lignocaine was mixed in with the benzathine penicillin prior to administration. A pre and post survey assessed pain scores during, 2-min and 1-h post administration and the following day. Questions assessing fear were also included. In total 49% of patients responded to the survey. There were 118 surveys paired pre and post intervention. Pain at injection delivery and fear scores were higher for participants ≤13 years of age. Overall pain scores were significantly reduced over all four time points. There was also a significant reduction in fear of the injections. Lignocaine and Buzzy resulted in a greater reduction in pain than lignocaine alone, only when the injection was being administered to those ≤13 years. After five months, a file audit showed that 66% of all RF patients of CMDHB were choosing to use lignocaine and 43% were choosing to use Buzzy. In total, 71% of all RF patients were choosing one or both of these analgesic interventions. This study demonstrates a clinically important reduction in the subjective experience of pain when two analgesic interventions were offered with IM delivery of benzathine penicillin. These pain reduction strategies have been popular in the RF population of CMDHB with a 71% uptake and a corresponding reduction in pain and fear.

Relationship Between Central Arterial Pressure, Exercise and Fitness Level in Stable Coronary Artery Disease

Background: An implantable cardioverter-defibrillator (ICD) is a treatment associated with significant cost and risk of morbidity. Elderly patients (arbitrarily defined as age≥ 75 years old) were under-represented in large clinical trials (e.g. MADIT-II and SCD-HeFT) which showed a mortality benefit with ICD implantation in patients with reduced left ventricular function. Thenetmortality benefit for this age group is unclear and there is no New Zealand data available. Aim: The aim of this study was to ascertain survival in elderly patients who have had ICDs implanted. The secondary objective was to document device related morbidity. Methods: This was a descriptive study with retrospective data collection on 41 patients age≥ 75 years old living in the Auckland region who received ICDs between 1st January 2000 to 31st December 2010. Demographic, clinical and survival data were collected retrospectively from Auckland District Health Board (DHB), Counties Manukau DHB, Waitamata DHB and regional ICD databases. Results: The total number of deaths was 15 (37%), eight cardiac and seven non cardiac. One and two year mortality rates were 2.4% (1/41) and 14.6% (6/41) respectively. Twenty patients (48.8%) received appropriate therapy while fivepatients (12.2%) received inappropriate therapy. Other device relatedmorbidity includes five implant complications (12.2%), five generator complications (12.2%) and one lead complication (2.4%) during follow up. Conclusions:While the total numberofpatients is small, our data support the value of ICD implantation in carefully selected elderly patients. Device related morbidity is acceptable.

A ‘whole of system’ approach to compare options for CVD interventions in Counties Manukau

To assess the usefulness of a national and a local system dynamics model of cardiovascular disease to planning and funding decision makers. In an iterative process, an existing national model was populated with local data and presented to stakeholders in Counties Manukau, New Zealand. They explored the model's plausibility, usefulness and implications. Data were collected from 30 people using questionnaires, and from field notes and interviews; both were thematically analysed. Potential users readily understood the model and actively engaged in discussing it. None disputed the overall model structure, but most wanted extensions to elaborate areas of specific interest to them. Local data made little qualitative difference to data interpretation but were nevertheless considered a necessary step to support confident local decisions. Some limitations to the model and its use were recognised, but users could allow for these and still derive use from the model to qualitatively compare decision options. The system dynamics modelling process is useful in complex systems and is likely to become established as part of the routinely used suite of tools used to support complex decisions in Counties Manukau District Health Board.

The Green Prescription programme and the experiences of Pacific women in Auckland

Extensive research has shown the effectiveness and cost-effectiveness of the Green Prescription (GRx) but none has focused on the experiences of Pacific women who have been through the GRx programme. The research aim was to investigate the experiences of the GRx programme for Pacific women in Auckland, New Zealand. Qualitative data from in-depth interviews with 20 Pacific women aged 40 years and older, who had been members of a GRx programme in Auckland City and Counties Manukau and had been discharged as independently active. Pacific women had positive experiences of the GRx programme and identified an improvement in their physical activity, lifestyle behaviours and consequent health improvements. Positive experiences can be attributable to the social and friendly atmosphere created by their peers and staff, exercise options, and education workshop components. The social aspect of the GRx programme was the primary reason the women enjoyed and completed the programme. Pacific women reported health improvements from participation in the GRx programme. Further research is indicated to explore the health impact of the GRx for Pacific people and the benefits and acceptability of the programme for Pacific ethnic groups.

New Zealand health leadership

PurposeThis article aims to provide an overview of what is occurring within two large District Health Boards in New Zealand: Counties Manukau DHB, ranking number three in relative population size, and Canterbury DHB, number two. The conclusions provide a comparison of these approaches and draw on some of the new developments which are being driven by and through these District Health Boards.Design/methodology/approachCanterbury DHB have embraced a capability/competency framework while Counties Manukau DHB have chosen an alternative approach, enacting “leadership as a practice approach”. CMDHB have developed a range of development intervention across management and leadership levels while CDHB have chosen a path of HR practices aligned to a capability framework.FindingsThe approaches taken by Counties Manukau DHB and Canterbury DHB, while different, are driven by many of the same elements both internally and externally, indeed they might even be considered complementary. A focus on quality and patient safety, the changing dynamics of clinicians and managers, the integration of primary and secondary care and the increasing move to multi‐disciplinary teams who focus on care systems in an environment of increased demand alongside proportionally decreasing resources feature in both and require an adaptation of leadership in a health context.Originality/valueThe approaches taken by the two DHBs are unique to their organisations and the sector, yet provide exemplars of practice for other large health providers. The outcomes will reflect their differences in approach and the specific workforce challenges each faces.

Partnership—Evaluation—Recovery (PER) Team — consumer evaluation of mental health services in Counties Manukau, New Zealand

Partnership—Evaluation—Recovery (PER) Team — consumer evaluation of mental health services in Counties Manukau, New Zealand