Investigations and treatment after non-ST segment elevation acute coronary syndrome for patients presenting to rural or urban hospitals in Aotearoa New Zealand: ANZACS-QI 75. Rory Miller, Garry Nixon, Robin M Turner, Tim Stokes, Rawiri Keenan, Corina Grey, Yannan Jiang, Susan Wells, Wil Harrison, Andrew J Kerr. New Zealand Medical Journal (Friday 10 November 2023 edition)

Congratulations Rory and the team – the full article can be found here if you are a NZMJ subscriber.  Or, for an overview of the study check out the University of Otago Media Release https://www.otago.ac.nz/news/news/treatment-of-heart-attacks-at-rural-and-urban-hospitals 

There’s also an interview with Rory c/o RNZ Midday Rural News here

Abstract 

Aims: Compare the care patients with non-ST segment elevation acute coronary syndrome (NSTEACS) received in Aotearoa New Zealand depending on the rural–urban category of the hospital they are first admitted to. 

Methods: Patients with NSTEACS investigated with invasive coronary angiogram between 1 January 2014 and 31 December 2019 were included. There were three hospital categories (routine access to percutaneous coronary intervention [urban interventional], other urban [urban non-interventional] and rural) and three ethnicity categories (Māori, Pacific and non-Māori/non-Pacific). Clinical performance measures included: angiography ≤3 days, assessment of left ventricular ejection fraction (LVEF) and prescription of secondary prevention medication. 

Results: Of 26,779 patients, 66.2% presented to urban-interventional, 25.6% to urban non-interventional and 8.2% to rural hospitals. A smaller percentage of patients presenting to urban interventional than urban non-interventional and rural hospitals were Māori (8.1%, 17.0% and 13.0%). Patients presenting to urban interventional hospitals were more likely to receive timely angiography than urban non-interventional or rural hospitals (78.5%, 60.8% and 63.1%). They were also more likely to have a LVEF assessment (78.5%, 65.4% and 66.3%). In contrast, the use of secondary prevention medications at discharge was similar between hospital categories. 

Māori and Pacific patients presenting to urban interventional hospitals were less likely than non-Māori/non-Pacific to receive timely angiography but more likely to have LVEF assessed. However, LVEF assessment and timely angiography in urban non-interventional and rural hospitals were lower than in urban interventional hospitals for both Māori and non-Māori/non-Pacific. 

Conclusions: Patients presenting to urban hospitals without routine interventional access and rural hospitals were less likely to receive LVEF assessment or timely angiography. This disproportionately impacts Māori, who are more likely to live in these hospital catchments. 

Great work from Tāupo Hospital published this week in the NZMJ showing how a bubble CPAP protocol for neonates can be successfully introduced into a rural setting with positive impacts

Glenn A. Barker: The use of neonatal bubble Continuous Positive Airway Pressure in a rural hospital setting. NZMJ Oct 20; 136(1584). ISSN 1175-8716 https://journal.nzma.org.nz/journal-articles/the-use-of-neonatal-bubble-continuous-positive-airway-pressure-in-a-rural-hospital-setting

Abstract 

Aim: This retrospective review examined the introduction of bubble Continuous Positive Airway Pressure (bCPAP) in resuscitating neonates in a rural hospital environment. 

Methods: A retrospective audit of all emergent neonatal presentations to a rural emergency department (ED) over a 5-year period prior to (pre) and a 3.5-year period following the introduction of bCPAP (post). 

Results: Sixty-seven neonatal resuscitations (31 pre- and 36 post-introduction of bCPAP) were reviewed, having an average gestation of 37.4 weeks and birth weight of 3,110g, with no significant difference in characteristics between groups. Time in the ED was significantly longer post-bCPAP (202±93 vs 156±70 mins), but time applying T-piece assisted ventilation was significantly reduced (55±40 vs 94 ± 84 mins). There was an 11% reduction in the use of aeromedical retrieval and an 18% reduction in admissions to the regional level III neonatal intensive care unit (NICU) with a corresponding increase in admissions to local level II NICU. 

Conclusion: The introduction of bCPAP into a rural hospital setting is technically feasible and results in less time spent on technically demanding hand ventilation, fewer admissions to level III neonatal intensive care units and a reduction in the use of aeromedical retrieval assets. 

Media release

Rural students face educational barriers to medical training

Students applying to enter medical programmes in Aotearoa New Zealand, after attending rural and regional schools, are disadvantaged by lower exam marks at those schools.

A new study, published in the Journal of the Royal Society of New Zealand, compared NCEA and UE attainment rates across secondary schools from 2012 to 2021, finding rural high schools have lower pass rates and marks than urban ones.

“The lower UE attainment levels for rural schools means it is likely that rural students will have greater difficulty in entering medical programmes and this inequity is worse for rural Māori students,” says lead author Dr Kyle Eggleton, Associate Dean Rural at Waipapa Taumata Rau, University of Auckland.

Rural schools are more likely to be in socioeconomically deprived areas, have a greater proportion of Māori students and be poorly resourced compared with urban schools.

Māori students attending schools which had a Māori world view, such as kura kaupapa and Māori boarding schools had higher pass rates than those attending mainstream schools.

The authors emphasised the study’s findings were based on aggregate data, and did not necessarily reflect the experiences of all rural students. However, the research provides evidence of a systemic problem.

The findings are relevant to the Otago and Auckland medical schools’ rural and regional admission schemes, which currently earmark a number of places for rural and regional students.

The admission schemes have been established among many measures aimed at addressing a rural medical workforce crisis in New Zealand. Medical students from rural backgrounds are more likely to return and work rurally.

“The study’s findings have important implications for the future of medical education in Aotearoa New Zealand,” Dr Eggleton says.

Recommendations from the research include:

• Rural entry pathways need to have an equity focus, so students have additional support once entering medical programmes.
• Rural Māori students should be targeted in Māori admission pathways and additional support given to address educational disadvantage.
• There should be pre-programme preparatory courses and interventions in rural high schools.
• Importantly, rural high schools should have increased funding and resources.

Importantly, rural high schools should have increased funding and resources.

“It is clear that more needs to be done to address the educational attainment inequities faced by rural students, particularly rural Māori students,” Dr Eggleton says.

“This will require a fundamental shift in the way that medical programmes are designed and delivered, with a focus on equity as well as workforce needs,” he says.

Waipapa Taumata Rau, University of Auckland

Article details:

Lucy Mason, Hana Turner-Adams, Garry Nixon & Kyle Eggleton (2023) Rural secondary school leaver attainment inequities for students entering medical programmes in Aotearoa New Zealand, Journal of the Royal Society of New Zealand

Open Access DOI 10.1080/03036758.2023.2258072