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Author Archives: Rory

Podcast: rural accelerated chest pain pathway – repost from the RNZCUC

Thursday, June 16th, 2022 | Rory | No Comments

 

 

 

 

 

Listen here

 

We are joined by Dr Rory Miller to discuss a recently published paper that looked at the use of point of care troponin alongside an accelerated chest pain pathway in New Zealand rural and primary care. 

https://academic.oup.com/ehjacc/advance-article/doi/10.1093/ehjacc/zuac037/6562963?login=false

Miller R, Nixon G, Pickering JW, Stokes T, Turner RM, Young J, Gutenstein M, Smith M, Norman T, Watson A, George P, Devlin G, Du Toit S, Than M. A prospective multi-centre study assessing the safety and effectiveness following the implementation of an accelerated chest pain pathway using point-of-care troponin for use in New Zealand rural hospital and primary care settings. Eur Heart J Acute Cardiovasc Care. 2022 Apr 4:zuac037. doi: 10.1093/ehjacc/zuac037. Epub ahead of print. PMID: 35373255.

 

Podcast: Our Rural Medley #1 Steve Withington- a conversation with Lucinda

Tuesday, May 31st, 2022 | Rory | No Comments

A new podcast series called Our Rural Medley. In this episode Lucinda talks with Steve.

Steve’s paper: https://blogs.otago.ac.nz/rural/changing-the-model-ashburtons-experience/

You can listen using the links below or directly here.

Available on iTunes or any other podcast apps

 

 

 

 

photo credit: https://newcomers.co.nz/ashburton-mid-canterbury

Paper conveners wanted

Tuesday, January 25th, 2022 | Rory | No Comments

Pointing the finger @ you!

Work from home (mainly) as a paper convener with the University of Otago’s rural post-graduate team. These are 0.1-0.15FTE positions. These roles would best suit those who have completed the Diploma of rural and provincial hospital medicine (or equivalent) and are currently working (or have prior experience) in a senior medical position in rural New Zealand.  Come and join our passionate team and help share your knowledge and experience with great students wanting to upskill to provide the best outcomes in rural medical settings!

 

Please contact rural.postgrad@otago.ac.nz email for further information.

Mandatory ultrasound training for rural general practitioners?

Friday, September 17th, 2021 | Rory | No Comments

A case for mandatory ultrasound training for rural general practitioners: a commentary

Arnold AC, Fleet R, Lim D.  A case for mandatory ultrasound training for rural general practitioners: a commentary . Rural and Remote Health 2021; 21:6328. Full text is open access:: https://doi.org/10.22605/RRH6328

Don’t disagree. Increasing access to cheaper devices (e.g. Butterfly) and multiple training opportunities including Postgraduate Certificate in Clinician-Performed Ultrasound (PGCertCPU)  will hopefully open up this diagnostic modality to more clinicians and patients. Multiple GPs and rural hospital docs have now done PGCertCPU.

Adequate peer-review and credentialing for clinicians, especially those in isolated practices/facilities, remains an issue.

ABSTRACT:

Context:  Point-of-care ultrasound is a rapidly evolving technology that enables rapid diagnostic imaging to be performed at a patient’s bedside, reducing time to diagnosis and minimising the need for patient transfers. This has significant applications for rural emergency and general practice, and could potentially prevent unnecessary transfers of patients from rural communities to more urban centres for the purpose of diagnostic imaging, reducing costs and preventing disruption to patients’ lives. Meta-analyses on point-of-care ultrasound have reported extremely high sensitivity and specificity when detecting lung pathology, and the potential applications of the technology are substantial. A significant application of the technology is in the care of rural paediatric patients, where acute lower respiratory pathology is the most common cause of preventable deaths, hospitalisations, and emergency medical retrievals from remote communities for children under five.

Issues:  Although widely available, point-of-care ultrasound technology is not widely utilised in Australian emergency departments and general practices. Issues with comprehensive training, maintenance of skills, upskilling and quality assurance programs prevent physicians from feeling confident when utilising the technology. In Canada, point-of-care ultrasound training is part of the core competency training in the Royal College of Physicians of Canada emergency medicine fellowship program. Point-of-care ultrasound is widely used in rural practice, although lack of training, funding, maintenance of skills and quality assurance were still listed as barriers to use.

Lessons learned:  Point-of-care ultrasound is a highly sensitive and specific technology with wide potential applications. Issues with quality control and maintenance of skills are preventing widespread use. Coupling point-of-care ultrasound with telemedicine could help increase the usability and accessibility of the technology by reducing the issues associated with maintenance of skills and quality assurance.

Keywords:

Australia, diagnostic imaging, paediatric diagnostic imaging, patient transfers, point-of-care ultrasound, rural medicine, telemedicine, training protocol.

 

Thanks to Fiona Doolan-Noble for forwarding this paper.

Equitable spatial accessibility of COVID-19 vaccine?

Thursday, September 16th, 2021 | Rory | No Comments

Spatial inequity in distribution of COVID-19 vaccination services in Aotearoa

 

Whitehead J, Atatoa P, Scott N, Lawrenson R. Spatial inequity in distribution of COVID-19 vaccination services in Aotearoa. Preprint on medRxiv. https://doi.org/10.1101/2021.08.26.21262647

 

This is a pre-print version. It has not been peer reviewed but is open access. The final publication (after peer review/editorial process) maybe (slightly) different and we will link to that when it is available.

From Jesse the lead author:

We examined the spatial accessibility of Covid-19 vaccination services across NZ at the start of the latest Covid-19 delta outbreak. We estimated access by looking at the number of vaccination services available to communities within a 30 minute drive, relative to the size of the local population. The locations of Covid-19 vaccinations services on the 18th August 2021 were distributed unevenly, and resulted in better spatial access for urban, wealthy, and European populations. Access was significantly worse for rural areas, Māori, older people, and areas of high socioeconomic deprivation. We also found significant variation in levels of access by DHB region. Furthermore, high access to Covid-19 vaccination services at the DHB level was associated with more equitable vaccination uptake for Māori. DHBs that provided the best access to vaccination services had the highest vaccination rate ratios for Māori.

Spatial accessibility to COVID-19 Vaccination Services

Are we surprised?

Abstract

Aim This research examines the spatial equity, and associated health equity implications, of the geographic distribution of Covid-19 vaccination services in Aotearoa New Zealand.

Method We mapped the distribution of Aotearoa’s population and used the enhanced-two-step-floating-catchment-method (E2SFCA) to estimate spatial access to vaccination services, taking into account service supply, population demand, and distance between populations and services. We used the Gini coefficient and both global and local measures of spatial autocorrelation to assess the spatial equity of vaccination services across Aotearoa. Additional statistics included an analysis of spatial accessibility for priority populations, including Māori (Indigenous people of Aotearoa), Pacific, over 65-year-olds, and people living in areas of high socioeconomic deprivation. We also examined vaccination service access according to rurality, and by District Health Board region.

Results Spatially accessibility to vaccination services varies across Aotearoa, and appears to be better in major cities than rural regions. A Gini coefficient of 0.426 confirms that spatial accessibility scores are not shared equally across the vaccine-eligible population. Furthermore, priority populations including Māori, older people, and residents of areas with socioeconomic constraint have, on average, statistically significantly lower spatial access to vaccination services. This is also true for people living in rural areas. Spatial access to vaccination services, also varies significantly by District Health Board (DHB) region as does equality of access, and the proportion of DHB priority population groups living in areas with poor access to vaccination services. A strong and significant positive correlation was identified between average spatial accessibility and the Māori vaccination rate ratio of DHBs.

Conclusion Covid-19 vaccination services in Aotearoa are not equitably distributed. Priority populations, with the most pressing need to receive Covid-19 vaccinations, have the worst access to vaccination services.

Congratulations! Eric Elder Medal winner; Honorary and distinguished fellows;

Tuesday, September 7th, 2021 | Rory | 1 Comment

Congratulations to the three members of the Section received wards at the RNZCGP conference.  Kati Blattner who was awarded the Eric Elder medal, Branko Sijnja was awarded a Distinguished Fellowship, Jill Muirhead and Wendy Finnie were awarded Honorary Fellowships.

Kati winning Eric Elder Medal

 

Branko the distinguished.

Jill and Wendy receiving their fellowships

The place of Rural Hospitals in New Zealand’s Health System: an exploratory study

Thursday, September 2nd, 2021 | Rory | No Comments

For those of you who are in leadership roles can you please fill in the below survey (it’s QUICK!). For those who are not – can you please forward within your workplaces!

You can cash in your chocolate fish in a time when we can talk again.

https://otago.au1.qualtrics.com/jfe/form/SV_3h2NCEQ1yM8TPqC

 

The place of Rural Hospitals in New Zealand’s Health System: an exploratory study

University of Otago Research Grant 2021; PI Kati Blattner, RF Lynne Clay,

CI’s Tim Stokes, Garry Nixon, Rory Miller, Sue Crengle, Lauralie Richard & Ray Anton  

Aims: To identify current and future priorities for NZ rural hospitals and gain a national picture of NZ rural hospital provision to provide a platform for further research through:stakeholder interviews, a national online survey & identification of key service characteristics.

Progress to date:

Interviews: Thank you to rural hospital leaders and key stakeholders who have participated

representing 18 RH (with 2 more IV scheduled), and 4 national stakeholder groups.

National Survey: For people in leadership roles (clinical & non-clinical), we have now launched our short survey. Please access today!

https://otago.au1.qualtrics.com/jfe/form/SV_3h2NCEQ1yM8TPqC

Service Characteristics: A worksheet of key service provision information populated from RH websites. We will be emailing these to RH leaders for assistance to verify and add missing details.