Cost savings of the rural accelerated chest pain pathway

Thursday, December 22nd, 2022 | claly44p | No Comments

The cost savings of the rural accelerated chest pain pathway for low-risk chest pain in rural general practice: a cost minimisation analysis.

Rory Miller, Garry Nixon, Tim Stokes, Michelle Smith, John W. Pickering, Talis Liepins and Martin Than. Journal of Primary Health Care 2022 doi:10.1071/HC22117

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With a rural accelerated chest pain pathway developed and shown to be equivalent to accelerated diagnostic chest pain pathways in urban EDs for patients with low-risk cardiac events, the team has now surveyed patients to evaluate the potential cost savings to both individuals and the health system.  Despite the low response rate, it is evident that savings can be made at many levels.  This pathway will  now be evaluated across Aotearoa NZ



Introduction. The rural accelerated chest pain pathway (RACPP) has been shown to safely reduce the number of transfers to hospital for patients who present with chest pain to rural general practice. Aim. This study aimed to estimate the costs associated with assessing patients with low-risk chest pain using the RACPP in rural general practice compared with transporting such patients to a distant emergency department (ED). Methods. This was a retrospective cost minimisation analysis. All patients with low-risk chest pain that were assessed in New Zealand (NZ) rural general practice using the RACPP between 1 June 2018 and 31 December 2019 were asked to participate. The costs incurred by patients were determined by an online survey. Patients were also asked to estimate the costs if they would have been transferred to ED. System costs were obtained from the relevant healthcare organisations. The main outcome measure was the total cost for patients who present with low-risk chest pain. Results. In total, 15 patients (22.7% response rate) responded to the survey. Using the RACPP in general practice resulted in a median cost saving of NZ$1184 (95% CI: $1111 to $1468) compared with transferring the same patient to ED. Discussion. Although limited by low enrolment, this study suggests that there are significant savings if the RACPP is used to assess patients with low-risk chest pain in rural NZ general practice.

Time to take a bow, Professor!

Friday, December 16th, 2022 | claly44p | No Comments

Congratulations to Professor Garry Nixon on his well-deserved promotion! We are proud of the Prof’s achievements! An awesome clinician, researcher and leader as well as an all round good bloke!

Garry continues to live and practice as a rural doctor in the same Central Otago community he has always worked in.

His research focuses on health outcomes and improving health services for rural communities like his own. His earlier research centred on point-of-care diagnostic technologies, including ultrasound and laboratory testing, examining their safety and impact on patient care.

In more recent times he has led a team of researchers who have developed and validated a new urban rural classification for health and are using it to compare urban and rural health outcomes and access to services.

He has collaborated closely with rural researchers in other parts of the country including the Far North and Waikato.

He has PhD students researching rural chest pain assessment pathways, the scopes of practice of rural allied health professionals, healthcare consumption across the urban rural spectrum and the workforce outcomes of rural interventions in the undergraduate medical programme.


New chest pain test for rural hospitals and general practices

Tuesday, December 13th, 2022 | claly44p | No Comments

Congratulations to Rory and the team with their successful pilot study, supported by the Heart Foundation, evaluating the safety and effectiveness of an accelerated chest pain pathway, including a troponin test performed in rural settings.  Read more:

A message from Rory:

A sincere and huge thank you to all sites that contributed to this project and made it a success. The primary findings have been published here as an open access article: and covered here in LOFP:

The project is discussed here on the podcast:

We have subsequently been awarded a research grant to implement a high sensitivity point-of-care troponin in 30 rural health facilities across Aotearoa. If you are currently using a point-of-care troponin and are interested in being part of this project then please reach out to:

New Zealand’s rural hospitals in 2021: findings from an exploratory questionnaire survey

Monday, August 22nd, 2022 | claly44p | No Comments

Katharina Blattner, Lynne Clay, Rory Miller, Garry Nixon, Sue Crengle, Lauralie Richard, Ray Anton, Tim Stokes

OPEN ACCESS Journal of Primary Health Care Published online: 18 August 2022

In 2021 I had the opportunity to work with Dr Kati Blattner on a project to explore the place of rural hospitals in Aotearoa, NZ.  My eyes were opened to the uniqueness of each and everyone of our rural hospitals and the challenges faced to provide equitable healthcare.  This short report presents one aspect of the research – a snapshot of how rural hospital leaders perceived the role of their hospital in a time of coronavirus and upcoming major change in the national health system. (L.C)


Introduction. There is a gap in our knowledge of the place and contribution of rural hospitals in the New Zealand health system. There is no current description of rural hospital services, no national policies and little published research regarding their value. Aim. To explore rural hospital leader perspectives of the role of rural hospitals. Methods. An on-line survey of rural hospital leaders conducted to capture perspectives on areas including facility nomenclature; access and equity; funding and the health reforms. Results. Fifty-five rural hospital leaders representing 19/24 rural hospitals responded. ‘Rural Hospital’ was the most common term used to describe facilities with 80% of respondents indicating this as their preferred term. Other descriptive terms varied widely from primary through to secondary care. Respondents indicated that the loss of rural hospital in-patient beds would be unacceptable to communities (median 0, IQR 0, 1). Scores on questions about ‘range of services’ (median 7, IQR 6, 8), ‘accessibility’ (median 7, IQR 6, 8) and how rural hospitals were addressing health equity (median 6, IQR 5, 7) were variable. The process for allocating funds to rural hospitals was perceived as lacking transparency (median 3, IQR 2, 5). National strategy and ‘local governance and control’ were both rated as important (median 9, IQR 7, 10 and median 9, IQR, 8, 10) for a rural hospital’s future. Discussion. By capturing a collective national rural hospital leadership voice, this study facilitates the understanding of the rural hospital concept. The findings inform subsequent research needed to gain a clearer picture of New Zealand rural hospital provision.

Rural Recognition at 2022 RNZCGP: Awards and Honorary Fellowships

Thursday, July 28th, 2022 | claly44p | No Comments


Ma pango ma whero, ka oti te mahi (by black and red together the work is done).

Congratulations to Marara Koroheke-Rogers and Hone Taimona recognised with Honorary Fellowships to the Royal New Zealand College of General Practitioners. Ngā mihi nui ki a koe – huge gratitude to you on behalf of your Otago colleagues and the numerous rural medicine trainees and experienced doctors who have learned from you through our rural postgraduate papers, in partnership with Hauora Hokianga (@hokiangahealth).

In 2006, the Dunedin School of Medicine shifted the teaching of the rural context and Hauora Māori components of our rural postgraduate programme out of a Dunedin classroom and onto the Pa-te-Aroha Marae at Whirinaki in the South Hokianga. This was not just a change in location but a change in direction for the entire programme.

Marara and Hone, with Hauora Hokianga, have been partners since those early days. They occupy crucial roles that link the local health service, the community and the teaching.  Marara and Hone have also been active members of research teams and co-authors on publications.

“Marara and Hone are pioneers in delivering this type of postgraduate medical education. The knowledge they bring needs to be at the centre of all our rural health teaching and research” Associate Professor Garry Nixon, Department of General Practice and Rural Health.



Congratulations to Dr Jeremy Webber and Dr Sean Hanna who were honoured with Distinguished Fellowship awards. The Fellowship is awarded to GPs who have demonstrated sustained contributions to general practice, medicine, or the health and wellbeing of the community.

The next generation steps up. Dr Jeremy Webber was the first person to get a Fellowship in Rural Hospital Medicine the proper way, that is by doing the training programme and he has now turned that into a FDRHMNZ (Dist.)  Jeremy expanded his world view by spending time working in Australia before returning home and almost immediately taking on some important leadership roles, at Taupō hospital, in the Division of Rural Hospital Medicine as Chair of the Board of Studies and the first Clinical Director Rural Health for Hauora Taiwhenua. Thanks for your efforts Jeremy and the great way you approach the people and issues you deal with.  Jeremy is also the packhorse in any Godzone Team and the powerhouse in any packraft. Ngā mihi


Dr Sean Hanna is a Wellington-based general practitioner, who has been the medical educator for Otago’s Rural Medical Immersion Programme since its early days. He is highly respected for his work as a specialist general practitioner in Takapūwāhia Porirua, his commitment to delivering health care to young people, his advocacy for equity in healthcare and his contribution to education. He has also made a significant contribution to rural health both in his RMIP role and as a rural doctor in the Hokianga.




The Eric Elder Medal is awarded in honour of Dr Eric Elder, who was an inspired rural GP affectionately known as the grandfather of vocational training in New Zealand. The medal is generally awarded to a rural general practitioner.  This year the award has gone to Dr Nina Stupples – congratulations Nina!

Dr Nina Stupples has worked in her Westport community for 13 years, providing consistent and quality care to her patients and ensuring they have access to high quality hospital care when required. She has been instrumental in the developing Rural Hospital Medicine in New Zealand, being the Chair of the Rural Hospital Division from 2010 until 2014, laying the foundation for the first truly generalist training programme in the country. The key feature of this programme was combining both Rural Hospital Medicine and Rural General Practice into a single training programme, with dual fellowship being an option in both vocational scopes of practice.

Nina has mentored many registrars in Westport, alongside her day-to-day practice and involvement with the Division, and she also teaches students in the Rural postgraduate programme and Rural Medical Immersion Programme at the University of Otago.  New Zealand rural health has benefitted from Nina’s hard work and dedication to the profession.

Congratulations to Rural Health Researchers!

Friday, July 1st, 2022 | claly44p | No Comments

Our shining stars, Dr Rory Miller and Assoc Prof Garry Nixon are among 22 University of Otago researchers to receive Health Research Council funding in the latest round.  Check out the full report. – well worth it for the photos! 

Awesome to see rural health research being supported!

“Dr Rory Miller, of the Department of General Practice and Rural Health, will assess a pathway to allow patients who develop chest pain to remain closer to their communities and whanau by accessing blood testing technology which is as accurate as those available in urban emergency departments.”

“Associate Professor Garry Nixon, of the Department of General Practice and Rural Health, is seeking to better understand the impact of rurality on health outcomes and healthcare delivery.  Aotearoa has not undertaken much research into the health status of rural communities, so he wants to find out how rurality, ethnicity and socioeconomic status interact to impact on health outcomes and access to health services for New Zealanders, how people move between urban and rural areas when they become unwell, and how much public healthcare rural New Zealanders consume, in dollar terms, compared to their urban compatriots.”


Dr Branko Sijnja named as 2022 recipient of Peter Snow Memorial Award

Friday, June 10th, 2022 | claly44p | No Comments

Influential GP Dr Branko Sijnja has been named as the recipient of the Peter Snow Memorial Award for 2022.

Branko was nominated for his service and dedication to rural health for over 40 years.

He is well known in the South Otago town of Balclutha and by many students at the University of Otago (UoO) for his leadership, commitment and inspiration.

Branko began his health career as a medical officer in 1974 and moved overseas for a couple of years to work in Scotland in the orthopaedic unit at Bridge of Earn Hospital and in Obstetrics and Gynaecology in Perth Royal Infirmary.

In 1980, Branko moved into working in General Practice. He became involved in the forming of Clutha Health First, a bespoke healthcare provider offering hospital, community and general practice services in Balclutha.

Clutha Health First opened in December 1998 and transformed the healthcare delivery to the Balclutha community.

To this day, Branko is still involved in the governance of Clutha Health First and sits on the Board of the Clutha Community Health Company Limited. Alongside this, he worked every Monday in the clinic for 12 hours.

Over his career, Branko has become well-known for delivering hundreds of babies in Balclutha. His wife says he is known throughout the community for his unwavering dedication which has often seen him work incredibly long hours doing home visits, followed by night shifts and then running a full clinic the next day.

In 2009, Branko’s career transformed when he became the Director of the Rural Medical Immersion Programme at UoO. Through this programme, Branko mentors fifth year medical students as they spend a year working and studying in rural New Zealand.

Since stepping into this role, Branko has taken advantage of the opportunity to share his passion for rural health and his wealth of experience. He is a natural teacher, and this has meant he often goes above and beyond to ensure his students succeed.

New Zealand Rural General Practice Chair Dr Fiona Bolden says Branko has always supported the Network.

“Whenever he comes to the conferences you can always spot him as he’s the one with the crowd of young doctors around him who know him through the training scheme- he’s usually telling them tales and there’s always lots of laughter,” she says.

It is no surprise that Branko has become a well-known and respected leader during his time as the Director. His commitment to encouraging and empowering the next generation of rural doctors is reflected through his work to expand the programme and produce educational outcomes that are equivalent to urban centres in New Zealand.

In 2021, Branko was awarded Distinguished Fellowship of the Royal New Zealand College of General Practitioners, which recognises Fellows of the College who have made sustained contributions to general practice, medicine, or the health and wellbeing of the community.

Branko currently works part time at the University and will be retiring from his role as Director at the end of June 2022. He plans to continue working at Clutha Health First for three days a week.

Reflecting on his time at the University Branko says, “I have really enjoyed working with the students, it’s been good for me too and I will miss them.”

The New Zealand Rural General Practice Network believes that Branko’s dedication to inspiring the future health workforce is what make him a deserving recipient of the 2022 Peter Snow Memorial Award.

About the award

The Peter Snow Memorial Award was set up to honour the life and work of Dr Peter Snow who passed away in March 2006.  Dr Snow was a rural general practitioner based in Tapanui. As well as caring for his patients, Peter was Past-President of the Royal New Zealand College of General Practitioners and was a member of the Otago Hospital Board and District Health Board. He was enthusiastic and active in seeking knowledge to improve the health and safety of rural communities. His work contributed to the identification of the chronic fatigue syndrome and he was influential in raising safety awareness on issues related to farming accidents.

Previous winners include:

Inaugural winner Dr Ron Janes (2007)
Nurse Jean Ross and Dr Pat Farry (2008 – jointly awarded)
Dr Garry Nixon (2009)
Dr Tim Malloy (2010)
Dr Martin London (2011)
Nurse Kirsty Murrell-McMillan (2012)
Dr Graeme Fenton and NZIRH CE Robin Steed (2013)
Kim Gosman and Dr Janne Bills (2014)
Dr Katharina Blattner (2015)
Dr Ivan and Leonie (RNS) Howie (2016)
Drs Chris Henry and Andrea Judd (2017)
Dr Keith Buswell (2018)
Dr John Burton (2019)
Mātanga Tapuhi (Nurse Practitioner) Tania Kemp (2020)
Dr Grahame Jelley (2021)



New Zealand postgraduate medical training by distance for Pacific Island country-based general practitioners: a qualitative study

Wednesday, April 27th, 2022 | claly44p | No Comments

Blattner K et al. Journal of Primary Health Care 2022; 14(1): 74–79.

Open Access

“Enrolling at the University of Otago distance-taught Rural Postgraduate programme allowed me the flexibility to study, work, and not have to relocate my young family to NZ. The registration process was simple and the content of the papers were applicable to the Cook Islands context especially the challenges faced in rural/remote settings with very little resources. It created a career pathway for upskilling which formed an important academic component for the Cook Islands GP Fellowship Programme which I’ve been blessed as a recipient.” Dr Teariki Puni

This study explores student experiences of the now established partnership between the University of Otago rural postgraduate programme and Pacific Island country-based doctors. While successful in meeting clinical relevance and professional connections, there needs to be better access to University resources and academic support akin to those based on campus. The lead author, Kati Blattner, is a tremendous advocate and support for these students who have achieved highly. See previous posts:  and and


Introduction. New Zealand health training institutions have an important role in supporting health workforce training programmes in the Pacific Region. Aim. To explore the experience of Pacific Island country-based doctors from the Cook Islands, Niue, and Samoa, studying in New Zealand’s University of Otago distance-taught Rural Postgraduate programme. Methods. Document analysis (16 documents) was undertaken. Eight semi-structured interviews were conducted with Pacific Island country-based students. Thematic analysis of the interviews was undertaken using the framework method. The two data sources were analysed separately, followed by a process to converge and corroborate findings. Results. For Pacific Island countries with no previous option for formal general practice training, access to a recognised academic programme represented a milestone. Immediate clinical relevance and applicability of a generalist medical curriculum with rural remote emphasis, delivered mainly at a distance, was identified as a major strength. Although technologies posed some issues, these were generally easily solved. The main challenges identified related to the provision of academic and other support. Traditional university support services and resources were campus focused and not always easily accessed by this group of students who cross educational pedagogies, health systems and national borders to study in a New Zealand programme. Study for individuals worked best when it was part of a recognised and supported Pacific in-country training pathway. Discussion. The University of Otago’s Rural Postgraduate programme is accessible, relevant and achievable for Pacific Island country-based doctors. The programme offers a partial solution for training in general practice for the Pacific region. Student experience could be improved by tailoring and strengthening support services and ensuring their effective delivery.

College drives improvements for rural registrars

Monday, April 11th, 2022 | claly44p | No Comments

Registrars in the first year of the General Practice Education Programme (GPEP) who choose to relocate and work in a rural community will now benefit from a sensible accommodation allowance thanks to College negotiations with the Ministry of Health.

From 1 April 2022, registrars living within 30 kilometres of a rural practice in which they work will receive $350 a week towards accommodation.

The College proactively approached the Ministry to substantially increase the existing allowance as a way to make working in rural locations more attractive to registrars. The approach, and ask, was recently ratified by the Resident Doctor’s Association (RDA) members.


Rural matters

About 20 percent of College-employed GPEP year 1 registrars do one rural attachment a year. Encouraging registrars to live closer to their rural practice means better understanding the culture and community they work in but also ensuring the health and safety of our people by cutting down long commutes at the start and end of busy days.

Encouraging our registrars to work in rural communities helps address some of the shortfall in some of New Zealand’s most remote locations, that really benefit from community doctors. We know more registrars would like the opportunity to work in rural communities but the financial barriers hinder many in making the move.



Any College-employed GPEP year 1 registrar who relocates to live within 30 kilometres of the rural practice they are attached to is eligible. With College pre-agreement it may also be possible in future to remain in a single rural practice for the whole of a first GPEP year.

Rural (or urban) practices wanting to sign up to become a teaching practice can do that on the College website.


Our voice is important for making change

The College is constantly advocating to make improvements to the workforce and conditions for registrars and Fellows. We do this through relationships, surveys to the membership, meetings with politicians, media messages, and direct advocacy to the Ministry of Health.


We believe this initiative will entice more GPEP year 1 registrars to live and work rurally and that will benefit both our members and our rural communities.

Nāku noa, nā

Lynne Hayman

Chief Executive

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

Wednesday, April 6th, 2022 | claly44p | No Comments

Rory Miller, Garry Nixon, John W. Pickering, Tim Stokes, Robin M. Turner, Joanna Young, Marc Gutenstein, Michelle Smith, Tim Norman, Antony Watson, Peter George, Gerald Devlin, Stephen Du Toit, Martin Than. 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, European Heart Journal. Acute Cardiovascular Care, 2022; 


It’s great to see a significant piece of rural clinical research from NZ published in an international journal. I know many of you contributed to this study.

This has important clinical implications. We now know that we don’t disadvantage our patients when using point of care troponins, as long as we use them as part of the Rural Accelerated Chest Pain Pathway. We also have a clearly defined group of chest pain patients we can assess without admitting to hospital. If the DHBs (or what follows them) can get the funding streams right, there is the potential to manage many of these patients in rural GP, resulting in savings to both patients and the health system.

Well done Rory. This is excellent work!