Kia ora,

Welcome to the rural research blog – brought to you by the Section of Rural Health.

The postcards from the edge series has come to an end. However, if you have something to contribute then please be in touch.

These are archived here.


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Reminder: Diabetes CME - Acute problems & COVID study

Go to otago.ac.nz/cme-diabetes to register.


‘Exploring the response to the Covid-19 pandemic at the rural hospital – base hospital interface:  experiences of rural hospital doctors’ 

We are seeking rural hospital senior medical officers to undertake a short interview about their experiences working clinically during COVID-19 pandemic/lockdown. Ideally we are seeking doctors who were working clinically in NZ rural hospitals. If you are interested please click on the following link to read the information sheet and consent form.

https://otago.au1.qualtrics.com/jfe/form/SV_07J6JG4SXKiHK9T

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COVID-19 pandemic response

‘Exploring the response to the Covid-19 pandemic at the rural hospital – base hospital interface:  experiences of rural hospital doctors’ 

We are seeking rural hospital senior medical officers to undertake a short interview about their experiences working clinically during COVID-19 pandemic/lockdown. Ideally we are seeking doctors who were working clinically in NZ rural hospitals. If you are interested please click on the following link to read the information sheet and consent form.

https://otago.au1.qualtrics.com/jfe/form/SV_07J6JG4SXKiHK9T

 

 

 

Information:

There have been variations in the way in which different DHBs have managed the pandemic preparations for rural hospitals. There may be important lessons to be learnt from this. 

  We are undertaking a small qualitative study to explore, from the perspective of senior rural hospital doctors, clinical advice and arrangements for patient management put in place during the pandemic period. We are interested in identifying strategies that have and have not worked.  

To do this we are seeking one representative from each rural hospital to participate in a Zoom interviewThe participants should be senior rural doctors who take ultimate clinical responsibility for patients and organising inter-hospital transfers.  

 The total time commitment will be 30 minutes.    

We would really like to hear from a member of your frontline rural hospital medical team.  

We would be grateful if you could ask around your medical staff, and if someone is willing and able to participate, they should enrol by going to  

https://otago.au1.qualtrics.com/jfe/form/SV_07J6JG4SXKiHK9T 

If anyone has  questions prior to enrolling they should feel free to contact one of us.  

 

Garry Nixon           garry.nixon@otago.ac.nz 

Kati Blattner          katharina.blattner@otago.ac.nz 

Rory Miller            rory.miller@otago.ac.nz 

Steve Withington   stephen.withington@otago.ac.nz 

 

 

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CME webinar: Diabetes

Go to otago.ac.nz/cme-diabetes to register.

 

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Technology-facilitated care coordination in rural areas: What is needed?

Gill E, Dykes PC, Rudin RS, Storm M, McGrath K, Bates DW. Technology-facilitated care coordination in rural areas: What is needed? International Journal of Medical Informatics. 2020 May;137:104102.

 

Comments by the lead author – Dr. Emily Gill from Opōtiki

Take-away

People who live in rural areas have poorer health than their urban counterparts, and for those with multiple, complex medical needs, this is impacted by health IT systems.  This research suggests US rural settings may contend with more unaffiliated electronic health records (EHRs a.k.a. PMSs), than urban settings.  The equivalent in NZ is that rural areas that border between DHBs are more likely to see patients from outside their own DHB, and this poses challenges of accessing and exchanging electronic information (e.g., electronic referrals) with unaffiliated DHBs.  Policy regulations should require that health information be exchanged between all health services, from pharmacy to private hospital to allied health providers, in a way that is ‘useable’ (e.g., user-friendly; without the need to login to multiple other platforms).  An important way to evaluate whether health IT systems are improving health is to focus on care coordination activities: for patients who see multiple health providers due to their complex, chronic needs, how easily can the patient and all the health providers involved access and know pertinent health information, especially when changes are occurring frequently? 

More details:

To provide coordinated care, health information needs to be frequently transferred across settings such as primary care clinics, acute care hospitals, and community health services. The U.S. government made a major financial investment in health information technology with the aim of improving improve care coordination and provided incentives for healthcare organizations to electronically exchange information in a more efficient and accurate process.  Given the increased health needs of the rural population, this research project sought to understand the experiences of healthcare providers in exchanging information during or in response to a transfer of care.

 

The interviews and surveys conducted through this research described numerous gaps between the necessary care coordination activities for patients with complex needs and the capacity for technology to facilitate the process. Healthcare professionals described low confidence in the integrity of the information they receive, and the effort required to gather needed information, including challenges with arranging real-time communication with other providers caring for the same patient.  Providers described care plans, a potentially useful tool in care coordination, as being regulated to such an extent that they are not used in routine decision making. In exchanging information between organizations using different Electronic Health Records (EHRs), most systems could not automatically incorporate the new information into the existing patient record. This lack of interoperability explains the large quantities of information the providers described faxing and scanning in.  Finally, rural healthcare professionals described the compounding impact of poverty on coordinating care for their patients. Not having transportation to specialist appointments; being geographically located between multiple larger health systems, which amplifies the number of external EHR systems in use; and the lack of access to specialty services all accentuate the challenges of information exchange during care transitions.

Both the U.S. and New Zealand should continue to focus on policy that drives the development of technology standards for how health information is exchanged.  In addition to promoting EHR systems that can receive and incorporate information automatically, standards should guide the usability of digital health data, and how it is aggregated across settings to create useful longitudinal care plans. Policy in both countries should encourage further research to define meaningful measures of how coordination technology tools impact population health.

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Dealing with chest pain - a pathway protocol.

Miller R, Young J, Nixon G, Pickering JW, Stokes T, Turner R, et al. Study protocol for an observational study to evaluate an accelerated chest pain pathway using point-of-care troponin in New Zealand rural and primary care populations. Journal of Primary Health Care. 2020;12(2):129.
open access link

The study protocol for an observational study examining the safety a novel chest pain pathway that uses point-of-care troponin.

Chest pain pathway’s are used throughout the country but largely rely on laboratory based troponin assays, which are not available for a considerable proportion of the rural population.[1] This will be the first large study that examines a rural and/or primary care population.

Enrolment has been more difficult (and slower) than anticipated, but in more than 300 low risk patients (and preliminary analysis), there have been no missed Major Adverse Cardiac Events in the first 30 days after presentation. This is in line with other chest pain pathways that use the new high-sensitivity assays.

very preliminary analysis of the primary end-point 

If you have access to point-of-care troponin and aren’t involved as a study site then please get in touch with me, and if you are already contributing – thank you!! and think of entering patients with chest pain into the data collection tool!

 


  1. Miller R, Stokes T, Nixon G. Point-of-care troponin use in New Zealand rural hospitals: a national survey. New Zealand Medical Journal. 2019;132(1493):13.  ↩
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Any views or opinion represented in this site belong solely to the authors and do not necessarily represent those of the University of Otago. Any view or opinion represented in the comments are personal and are those of the respective commentator/contributor to this site.

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