13 results for Arroll, B.

  • "Just say no" - Reducing the use of antibiotics for colds, bronchitis and sinusitis

    Thomas, M.G.; Arroll, B. (2000)

    Journal article
    The University of Auckland Library

    An open access copy of this article is available and complies with the copyright holder/publisher conditions. The use of antibiotics to treat infection can be miraculously beneficial or foolish and wasteful. Antibiotics save lives when used to treat endocarditis, meningitis and pneumonia, and restore health and prevent complications in many other infections (Figure 1).

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  • Evidence databases, the Internet, and general practitioners: The New Zealand story

    Kerse, N.; Arroll, B.; Lloyd, T.; Young, J.; Ward, J. (2001)

    Journal article
    The University of Auckland Library

    An open access copy of this article is available and complies with the copyright holder/publisher conditions. To determine self-reported access to and use of the Internet and the Cochrane Library by general practitioners (GPs) in New Zealand. Methods. A national cross sectional postal and fax survey of randomly selected GPs. Results. A total of 381 of 459 eligible GPs returned completed questionnaires (83%). The mean age of this sample was 45.7 years (SD 8.6) and average years in general practice was 15.7 years (SD 8.8 years). 74% (277) were male and 77% (289) in full-time practice. Internet access was present in 40% (95% CI 36-46%) of practices and 76% (72- 81%) of GP’s homes. The majority, 56% (51-61%), of GPs had used the Internet with regard to a patient. Younger GPs (<35 years old OR = 2.69, 95% CI 1.10-6.60) and male GPs (OR 1.72, 95% CI 1.02-2.90) were significantly more likely to report use of the Internet with respect to patients. 42% (95% CI 37-47%) of GPs were aware of the Cochrane Library but only 15% (11-19%) had used it. Those in group practice were more likely to be aware of the Cochrane database (adjusted OR 1.85, CI 1.09-3.12). Conclusions. Internet use is prevalent among GPs. Solo practitioners, older GPs and female GPs are least likely to avail themselves of this resource. Although half of GPs knew about Cochrane, a minority used it. Access and use of evidence databases can be improved in New Zealand. Strategies to assist those least likely already to use Cochrane may help our collective efforts towards evidence based practice.

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  • Problem gamblers: Do GPs want to intervene?

    Sullivan, Sean; Arroll, B.; Coster, G.; Abbott, M.; Adams, P. (2000)

    Journal article
    The University of Auckland Library

    An open access copy of this article is available and complies with the copyright holder/publisher conditions. Aim. To survey GPs' attitudes towards problem gamblers and knowledge to successfully intervene. Methods. 100 GPs, randomly selected for gender and geographical distribution, were anonymously surveyed by questionnaire through the Royal New Zealand College of General Practitioners. Results. 80 GPs responded (80% of those surveyed). There was strong support (85%) for problem gambling being within a GP's mandate, for involvement in treatment of problem gambling (72%) and for their having a role in supporting a family where a member has a gambling problem (80%). There was less confidence in raising the issue of gambling with patients (53%), in knowledge of resources (38%) and in having the necessary training to intervene (19%). Conclusions. GPs see problem gambling as a legitimate role for their intervention, however, they have concerns around their competency and knowledge of resources. The provision of undergraduate and postgraduate training may assist to remove barriers to an accepted role in primary health.

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  • High rates of chlamydia in patients referred for termination of pregnancy: Treatment, contact tracing, and implications for screening

    Rose, S.; Lawton, B.; Brown, S.; Goodyear-Smith, F.; Arroll, B. (2005)

    Journal article
    The University of Auckland Library

    An open access copy of this article is available and complies with the copyright holder/publisher conditions. Aims: To determine the rate of chlamydia and other sexually transmitted infections (STIs), and to describe treatment and factors associated with chlamydia in patients presenting for a termination of pregnancy (TOP). Methods: A retrospective audit of patients attending one of two TOP clinics from 1 February 2003. (Clinic A, n=500; Clinic B, n=501). Age, ethnicity, marital status, previous pregnancies, contraception, STIs, and treatment were recorded. Results: Ten percent of patients tested positive for an STI. Chlamydia was most commonly detected, in 7.7% of all patients. Higher rates of chlamydia were observed at clinic B (10.2% vs 5.2%, p=0.005) and in under 25 year olds (11.2% vs 3.6%, p<0.001). Rates of chlamydia in Pacific women were 18.6%, in Maori 12.9%, in Asian 7.3% and 4.4% in New Zealand European women. All patients testing positive for chlamydia were treated prior to TOP but only 41% of partners were treated. Other infections detected included 18 cases of human papillomavirus (HPV), three cases of trichomoniasis, one case of gonorrhoea, and one case of syphilis. Conclusions: There is a high rate of chlamydia in women presenting for TOP, particularly in under 25 year olds, Pacific, and Maori women. There is an immediate need for policymakers to respond to this increasing burden of chlamydia by instigating targeted education, guidelines, and mandatory chlamydia screening and contact tracing for pregnant women.

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  • Ethnic differences in mental health and lifestyle issues: Results from multi-item general practice screening

    Goodyear-Smith, F.; Arroll, B.; Coupe, N.; Buetow, S. (2005)

    Journal article
    The University of Auckland Library

    An open access copy of this article is available and complies with the copyright holder/publisher conditions. Aim: To determine ethnic differences in response, acceptance and desire to address problems identified by the multi-item screening tool (MIST). Methods: Patients were assessed using the MIST in urban Auckland. Fifty consecutive adult patients from 20 randomly selected practices completed the MIST and evaluation sheet before their consultation. All patients and general practitioners (GPs) completed feedback forms. Analysis adjusted for the clustered nature of the data. Results: Participants were 1000 patients and 20 urban GPs. The participation rate was 87% of GPs and 97.75% of patients. Compared with New Zealand Europeans, Pacific Island people were significantly more likely to be concerned about abuse and anger control. Maori were significantly more likely to want help with cutting down their alcohol use. The screening tool was accepted by all patients ( response to screening on lifestyle behaviours and mental health issues.

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  • Diabetes care by general practitioners in South Auckland: Changes from 1990 to 1999

    Kenealy, H.; Arroll, B.; Scott, D.; Scragg, R.; Simmons, D.; Kenealy, T. (2002)

    Journal article
    The University of Auckland Library

    An open access copy of this article is available and complies with the copyright holder/publisher conditions. Aim: To compare self-reported practices and preferences for diabetes care by general practitioners (GPs) in South Auckland between 1990 and 1999. Methods: Mail questionnaires were sent to all GPs in South Auckland in 1990, and again in 1999. Results: The response rate was 88% (163/185) in 1990 and 76% (186/245) in 1999 (p = 0.3). In 1999, compared with 1990, GPs had more diabetic patients (median 33 vs 20, p for ongoing care (74.7% vs 58.7%, p = 0.007). Conclusions: There have been large changes in GP diabetes care in South Auckland from 1990 to 1999. GPs in 1999 seem more confident to care for larger numbers of diabetes patients. Significant differences in practice style exist between male and female GPs.

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  • Depression in patients in an Auckland general practice

    Goodyear-Smith, F.; Lloyd, T.; Arroll, B. (2002)

    Journal article
    The University of Auckland Library

    An open access copy of this article is available and complies with the copyright holder/publisher conditions. Aim. To measure the rate of detected and undetected depression in patients attending an Auckland generalpractice. Method. At their consultation conclusion, general practitioners (GPs) asked all consecutive patients oversixteen years attending for consultation to participate in ahealth and mood questionnaire. A researcher administeredthe Beck Depression Inventory (BDI) to consentingparticipants. The GPs previously recorded whether theyconsidered these patients depressed. Results. Response rate among patients was 81% (253/314). The BDI found a 13.8% (35/253) 95% CI (9.6-18.5)depression prevalence among patients. GPs picked up 51%of cases (sensitivity 0.51 and specificity 0.91). Mäoripatients were no more likely to be depressed than non-Mäori but they were less likely to be receiving or havereceived treatment with antidepressants. Conclusion. The rate of depression in this practice was higher than an earlier study suggesting the true rate may be>10%. GPs see more depressed patients than other healthprofessionals, therefore improvement in detection andmanagement of depression in primary care is important.More work is needed on the difference between Mäori andnon-Mäori in the use of antidepressants

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  • Prostate cancer screening: Knowledge, experiences and attitudes of men aged 40-79 years

    Arroll, B.; Pandit, S.; Buetow, S. (2003)

    Journal article
    The University of Auckland Library

    An open access copy of this article is available and complies with the copyright holder/publisher conditions. Aim: The purpose of this study was to explore the knowledge, experiences and attitudes of men aged 40-79 years regarding screening for prostate cancer. Methods: This study was a cross-sectional telephone survey of men aged 40-79 years whose names were randomly selected from the Auckland telephone directory. The study was undertaken in the summers of 2000/2001 and 2001/2002. Results: The response rate was 77% (120/156). Of the men surveyed, 81% (91/113) stated that it was necessary to test for prostate cancer in men without concerns or symptoms. The majority were not aware of complications of treatment. Conclusions: Misconceptions surround prostate cancer screening. We recommend that doctors inform their patients that prostate cancer screening is controversial, and that the effectiveness of treatment for screen-detected prostate cancer is unknown. Individual patients would then be an improved position to decide about participation in screening.

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  • General practitioner management of upper respiratory tract infections: When are antibiotics prescribed?

    Arroll, B.; Goodyear-Smith, Felicity (2000)

    Journal article
    The University of Auckland Library

    An open access copy of this article is available and complies with the copyright holder/publisher conditions. Aim. To assess General Practice (GP) description and management of upper respiratory tract infections (URTI), including conditions under which they prescribe antibiotics. Method. A telephone survey of a randomised sample of Auckland GPs. Results. There was a 61% response rate. 82 of the 100 GPs interviewed agreed that most patients presenting with URTI expected antibiotics. Persistent symptoms and indication of specific infection (tonsillitis, otitis media, sinusitis, pharyngitis, purulent sputum) were common reasons for prescribing. Patients travelling overseas, expecting or requesting antibiotics and prior use of overthe-counter (OTC) medications increased antibiotic prescribing-rates. Most GPs (95%) issued as-needed prescriptions on occasion; 13% did this often. Amoxicillin and amoxicillin/clavulanic acid were most commonly used. Despite wide-ranging antibiotic use for URTI (0 to 90%), only 6% of GPs felt they prescribed more antibiotics than others. Conclusions. The results suggest over-prescription is common-place, but use of as-needed prescriptions to reduce antibiotic use is encouraging. Exploration of patient expectations in the consultation may assist in decreasing prescribing rates.

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  • Lifestyle screening: Development of an acceptable multi-item general practice tool

    Goodyear-Smith, F.; Arroll, B.; Sullivan, S.; Elley, C.R.; Docherty, B.; Janes, R. (2004)

    Journal article
    The University of Auckland Library

    An open access copy of this article is available and complies with the copyright holder/publisher conditions. Aims: To develop a short screening tool for lifestyle and mental-health risk factors that adults can self-administer, and to determine acceptability and feasibility of use of this tool in primary care settings. Methods: The multi-item tool was designed to screen patients in rural and urban New Zealand general practices for smoking, alcohol and drug misuse, problem gambling, depression, anxiety, abuse, anger, sedentary lifestyle, and weight issues. Patients were offered help for identified risk factors. Fifty consecutive adult patients per practice (n=2,543) were recruited to participate from 20 randomly-selected urban general practitioners; 20 general practice nurses and 11 rural general practitioners. Results: Patients came from diverse ethnic, geographical, and socioeconomic backgrounds. The sample prevalence of positive responses identified ranged from 2.8% (gambling) to 42.7% (depression). The number of patients requesting immediate assistance with these responses (0.5 to 13.5%) did not overwhelm clinicians. The tool was well accepted by patients, with few objections to specific questions (0.1-0.8%). Most practitioners stated they will use the screening tool once available. Conclusions: Screening for lifestyle and mental health risk factors is becoming increasingly important in primary health care. This screening tool was acceptable to patients and was not considered overly burdensome by practitioners.

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  • Few rural general practitioners use the Internet frequently in regard to patient care

    Janes, R.; Arroll, B.; Buetow, S.; Coster, G.; McCormick, R.; Hague, I. (2005)

    Journal article
    The University of Auckland Library

    An open access copy of this article is available and complies with the copyright holder/publisher conditions. Aims: To benchmark North Island rural general practitioner (GP) access to computers and the Internet, both at work and home, and assess whether rural GPs are using the Internet in regard to patient care. Methods: Cross-sectional postal survey of all North Island rural GPs in mid-2003. Results: 175 of 289 GPs (60.6%) returned useable questionnaires. Most (89.0%) reported computer availability at work when consulting, but even more had access to a computer at home (97.1%, p<0.05) reported ever using the Internet at work in regard to patients (56.5%) than at home (71.9%). Less than 10% of all GPs used the Internet three or more times a week at work (6.9%) or home (8.6%) in regard to patients. Of those with Internet access at work, 27.0% had broadband (fast Internet) access. Predictors of having (versus not having) work Internet access were computer availability in consultations (p=0.04). Conclusions: Few North Island rural GPs use the Internet frequently in regard to patient care, despite increasing access to computers and the Internet, both at work and home.

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  • Cost-effectiveness of physical activity counselling in general practice

    Elley, C.R.; Kerse, N.; Arroll, B.; Swinburn, B.; Ashton, T.; Robinson, E. (2004)

    Journal article
    The University of Auckland Library

    An open access copy of this article is available and complies with the copyright holder/publisher conditions. Aim: To assess the cost-effectiveness of the 'Green Prescription' physical activity counselling programme in general practice. Method: Prospective cost-effectiveness study undertaken as part of a cluster randomised controlled trial with 12-month follow-up of 878 'less-active' patients aged 40-79 years in 42 general practices in the Waikato. The intervention was verbal advice and a written exercise prescription given by general practitioners, with telephone exercise specialist follow-up compared with usual care. Main outcome measures included cost per total and leisure-time physical activity gain from health-funders' and societal perspectives. Results: Significant increases in physical activity were found in the randomised controlled trial. Programme-cost per patient was NZ$170 from a funder's perspective. The monthly cost-effectiveness ratio for total energy expenditure achieved was $11 per kcal/kg/day. The incremental cost of converting one additional 'sedentary' adult to an 'active' state over a twelve-month period was NZ$1,756 in programme costs. Conclusion: Verbal and written physical activity advice given in general practice with telephone follow-up is an inexpensive way of increasing activity for sedentary people, and has the potential to have significant economic impact through reduction in cardiovascular and other morbidity and mortality.

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  • Contraception before and after termination of pregnancy: Can we do it better?

    Goodyear-Smith, F.A.; Arroll, B. (2003)

    Journal article
    The University of Auckland Library

    An open access copy of this article is available and complies with the copyright holder/publisher conditions. Aim: To compare contraceptive use pre- and post-therapeutic abortion in 1995, 1999 and 2002 in a New Zealand clinic. Methods: Retrospective, consecutive case review of women presenting for therapeutic abortion. Anonymous data included demographic details, contraception used at conception, and post-termination contraception. Results: Pre-conception contraceptive use is significantly declining, with post-termination condom choice increasing. This is predominantly due to increasing numbers of Asian women presenting for abortion. In 2002, 97% of Asian women used no contraception or only condoms pre-conception, and 62% chose condoms or abstinence post-termination. Oral contraceptives are used significantly less by Asian than European women both pre-termination (p = 0.0002) and post-termination (p = 0.00001). Other ethnic groups showed little change in contraceptive use over the study periods. Conclusions: It is speculated that ethnic Chinese women lack adequate contraceptive education, demonstrate distrust of non-barrier methods, believe men should provide the prophylactic, and mistakenly believe contraception unnecessary for the first week following menstruation. Abortion may be used for family planning rather than as back up for contraceptive failure. Young Chinese arriving in New Zealand require immediate sexual health education including accurate contraceptive information. Liaison between primary healthcare sectors and policy makers of immigration and other services assisting overseas students is recommended to provide culturally appropriate education.

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