118 results for Kenealy, Timothy, Journal article

  • Are antibiotics effective for acute purulent rhinitis? Systematic review and meta-analysis of placebo controlled randomised trials.

    Arroll, Bruce; Kenealy, Timothy (2006-08-05)

    Journal article
    The University of Auckland Library

    To systematically review the evidence for the effectiveness of antibiotics in acute purulent rhinitis (many guidelines advise against their use on the basis of one study that showed no effect).

    View record details
  • The impact of New Zealand CVD risk chart adjustments for family history and ethnicity on eligibility for treatment (PREDICT CVD-5).

    Wells, Linda; Kerr, Andrew; Broad, Joanna; Riddell, Tania; Kenealy, Timothy; Jackson, Rodney (2007)

    Journal article
    The University of Auckland Library

    Aims Current New Zealand cardiovascular (CVD) risk management guidelines advocate targeting treatment to patients with a high 5-year CVD risk assessed using a calculator derived from the Framingham Heart Study. For some high-risk population subgroups, a 5% upward adjustment to their calculated 5-year CVD risk is recommended. We estimated the impact of these adjustments on eligibility for treatment in a primary care setting. Methods Between 2002 and 2006, 23,709 patients visting their primary care provider in Auckland, New Zealand had CVD risk assessments as part of an opportunistic screening programme using PREDICT, a web-based clinical decision support system. We calculated their baseline CVD risk with and without the 5% upward adjustment for family history of premature ischaemic CVD or for being of Māori, Pacific or Indian subcontinent ethnicity. Results A baseline CVD risk could be calculated for 23,693 (99.9%) patients of whom 90% were between ages 35 and 74 years. Unadjusted risk scores classified the majority (70%) below the 10% 5-year risk threshold for specific individualised treatment. A further 11% were between 10 to 15% risk (recommended to receive individualised lifestyle counselling in general practice) and 19% had a greater than 15% risk ( recommended for drug treatment and referral to a dietician in addition to individualised lifestyle counselling). Over a quarter of patients were recorded as having a premature family history of CVD; 21% were Māori, Pacific, or Indian subcontinent and thus met the criteria for a single 5% upward adjustment. This increased the number of people eligible for drug treatment, intensive lifestyle management, and dietician referral by approximately 20% and individualised lifestyle assessment and counselling by 50%. Conclusions The upward adjustments to the calculated CVD risk recommended by the New Zealand CVD risk management guidelines has the potential to substantially increase resource requirements for CVD preventive services in primary care. Moreover the true impact is likely to be underestimated given other adjustment factors related to diabetes risk that were not available in this dataset. Given the impact of these relatively small changes to the CVD risk calculator, locally developed and validated risk equations are urgently needed.

    View record details
  • Should we prescribe diuretics for patients with prediabetes and hypertension

    Arroll, Bruce; Kenealy, Timothy; Elley, Carolyn (2008-12-13)

    Journal article
    The University of Auckland Library

    View record details
  • Derivation and validation of a new cardiovascular risk score for people with type 2 diabetes: The New Zealand diabetes cohort study

    Elley, Carolyn; Robinson, Elizabeth; Kenealy, Timothy; Bramley, D; Drury, PL (2010)

    Journal article
    The University of Auckland Library

    OBJECTIVE--To derive a 5-year cardiovascular disease (CVD) risk equation from usual-care data that is appropriate for people with type 2 diabetes from a wide range of ethnic groups, variable glycemic control, and high rates of albuminuria in New Zealand. RESEARCH DESIGN AND METHODS--This prospective open-cohort study used primary-care data from 36,127 people with type 2 diabetes without previous CVD to derive a CVD equation using Cox proportional hazards regression models. Data from 12,626 people from a geographically different area were used for validation. Outcome measure was time to first fatal or nonfatal cardiovascular event, derived from national hospitalization and mortality records. Risk factors were age at diagnosis, diabetes duration, sex, systolic blood pressure, smoking status, total cholesterol-to-HDL ratio, ethnicity, glycated hemoglobin (A1C), and urine albumin-to-creatinine ratio. RESULTS--Baseline median age was 59 years, 51% were women, 55% were of non-European ethnicity, and 33% had micro- or macroalbuminuria. Median follow-up was 3.9 years (141,169 person-years), including 10,030 individuals followed for at least 5 years. At total of 6,479 first cardiovascular events occurred during follow-up. The 5-year observed risk was 20.8% (95% CI 20.3-21.3). Risk increased with each 1% A1C (adjusted hazard ratio 1.06 [95% CI 1.05-1.08]), when macroalbuminuria was present (2.04 [1.89-2.21]), and in Indo-Asians (1.29 [1.14-1.46]) and Maori (1.23 [1.14-1.32]) compared with Europeans. The derived risk equations performed well on the validation cohort compared with other risk equations. CONCLUSIONS--Renal function, ethnicity, and glycemic control contribute significantly to cardiovascular risk prediction. Population-appropriate risk equations can be derived from routinely collected data.

    View record details
  • Invisible care: do we need a Code of Rights to protect family and informal carers?

    Rea, Harold; Kenealy, Timothy; Sheridan, Nicolette; Gorman, Desmond (2010)

    Journal article
    The University of Auckland Library

    ‘Informal carers’ are the people who provide unpaid care and support for those who need it. Care can be personal, such as bathing and dressing; physical, such as housework, cooking and transport; social, such as companionship; and it might meet financial, spiritual or cultural needs, amongst others.

    View record details
  • Audit of health data captured routinely in primary healthcare for the clinical decision support system PREDICT (PREDICT CVD-4)

    Riddell, Tania; Kenealy, Timothy; Wells, Linda; Jackson, Rodney; Broad, Joanna (2008)

    Journal article
    The University of Auckland Library

    Computerised clinical decision support systems require health data to be captured in an explicit, structured way. However, traditional patient medical records contain data that is recorded in multiple ways using coding systems, free text, medical jargon and idiosyncratic abbreviations. To be meaningful, data transferred either automatically or manually from medical records to a clinical decision support program must accurately reflect data held in the patient medical record. Aims To assess the accuracy of health data captured routinely in primary care practice by PREDICT-CVD, a clinical decision support program for supporting the assessment and management of cardiovascular disease risk. Methods Data saved in the PREDICT clinical decision support system were audited against the same patients’ data held within an electronic patient management system. The audit was conducted in three general practices in Auckland, New Zealand. Within each practice the sample included all Maori patient records and a random sample of non-Maori patient records that made the total up to 100 per practice (n=300). Results We found good agreement between the data stored within PREDICT and that held within the patient management system. For 12 of the 27 variables examined there was perfect agreement. The most common disagreements, in order of frequency, were for smoking, diabetes and ethnicity recordings. Overall, there were 70 observations where data were recorded in PREDICT (but not in the patient management system), compared to 21 occurrences where data were recorded in the patient management system (but not in PREDICT). Conclusions Health data captured routinely in general practice by the clinical decision support system PREDICT were found to be highly consistent with data held in electronic patient records. However, the use of PREDICT-CVD improved the completeness of cardiovascular risk factor documentation.

    View record details
  • Painting a new picture for practice nurses in a capitated environment: who holds the brush?

    Docherty, B; Sheridan, Nicolette; Kenealy, Timothy (2008)

    Journal article
    The University of Auckland Library

    View record details
  • Contribution by primary health nurses and general practitioners to the Diabetes Annual Review (Get Checked) programme in Auckland, New Zealand

    Daly, B; Kenealy, Timothy; Arroll, Bruce; Sheridan, Nicolette; Scragg, Robert (2013-08-16)

    Journal article
    The University of Auckland Library

    The 'Get Checked' annual diabetes review programme was successful in engaging practice and community-based specialist nurses in the community management of diabetes and has revealed positive relationships between nurses and doctors, extended roles for nurses and the importance of engaging nurses in the design of health care programmes. Nurses involved in the programme undertake a large proportion of all patient annual reviews at their practice and major nursing roles include measuring blood pressure, weighing patients, undertaking foot examinations and giving health promotional advice. DHBs need to continue to acknowledge the valuable contribution made by the largest health professional workforce and ensure primary health care nurses are involved in developing an effective replacement ‘Get Checked’ programme.

    View record details
  • Thiazide diuretics 'justifiable' for hypertension in patients with pre-diabetes

    Arroll, Bruce; Kenealy, Timothy; Elley, CR (2009)

    Journal article
    The University of Auckland Library

    View record details
  • Book Review : How Universities Can Help Create a Wiser World: The Urgent Need for an Academic Revolution by N. Maxwell. Imprint Academic, Exeter, UK, 2014, $18, 156 pp. ISBN 978 1 845 40573 1.

    Kenealy, Timothy (2015-06)

    Journal article
    The University of Auckland Library

    Book Review : How Universities Can Help Create a Wiser World: The Urgent Need for an Academic Revolution by N. Maxwell. Imprint Academic, Exeter, UK, 2014, $18, 156 pp. ISBN 978 1 845 40573 1.

    View record details
  • Protocol-based nurse management of type 2 diabetes did not differ from usual GP care for HbA1c levels

    Kenealy, Timothy (2011-09)

    Journal article
    The University of Auckland Library

    View record details
  • Chronic care management evolves towards integrated care in Counties Manukau, New Zealand

    Rea, Harold; Kenealy, Timothy; Wellingham, John; Moffitt, A; Sinclair, G; Barker, Susan; Goodman, M; Arcus, K (2007)

    Journal article
    The University of Auckland Library

    Despite anecdotes of many chronic care management and integrated care projects around New Zealand, there is no formal process to collect and share relevant learning within (but especially between) District Health Boards (DHBs). We wish to share our experiences and hope to stimulate a productive exchange of ongoing learning. We define chronic care management and integrated care, then summarise current theory and evidence. We describe national policy development (relevant to integrated care, since 2000) including the New Zealand Health Strategy, the NZ Primary Care Strategy, the development of Primary Health Organisations (PHOs), capitation payments, Care Plus, and Services to Improve Access funding. We then describe chronic care management in Counties Manukau, which evolved both prior to and during the international refinement of theory and evidence and the national policy development and implementation. We reflect on local progress to date and opportunities for (and barriers to) future improvements, aided by comparative reflections on the United Kingdom (UK). Our most important messages are addressed as follows: To policymakers and funders—a fragile culture change towards teamwork in the health system is taking place in New Zealand; this change needs to be specifically and actively supported. To PHOs—general practices need help to align their internal (within-practice) financial signals with the new world of capitation and integrated care. To primary and secondary care doctors, nurses, and other carers—systematic chronic care management and integrated care can improve patient quality of life; and if healthcare structures and systems are properly managed to support integration, then healthcare provider professional and personal satisfaction will improve.

    View record details
  • Use of antidepressants for depression in primary care

    Arroll, Bruce; Elley, CR; Fishman, Tana; Goodyear-Smith, Felicity; Kenealy, Timothy; Blashki, G; Kerse, Ngaire; MacGillivray, S (2010)

    Journal article
    The University of Auckland Library

    View record details
  • Antibiotics and acute purulent rhinitis: Authors' reply

    Arroll, Bruce; Kenealy, Timothy (2006-08-17)

    Journal article
    The University of Auckland Library

    View record details
  • Practitioner perspectives from seven health professional groups on core competencies in the context of chronic care

    Fouche, Christa; Kenealy, Timothy; Mace, J; Shaw, John (2014-11)

    Journal article
    The University of Auckland Library

    The prevalence of chronic illness is growing worldwide and management is increasingly undertaken by interprofessional teams, yet education is still generally provided in separate professions. The aim of this study was to explore the perspectives of New Zealand healthcare practitioners from seven professional groups involved in chronic care (general practice medicine, nursing, occupational therapy, pharmacy, physiotherapy, social work, and speech language therapy) on the core competencies required of those working in this area. The study was set in the context of the chronic care and shared decision-making (SDM) models. The core competencies for chronic care practitioners proposed by the World Health Organisation were used to shape the research questions. Focus groups with expert clinicians (n = 20) and semi-structured interviews with practitioners (n = 32) were undertaken. Findings indicated a high level of agreement that the core competencies were appropriate and relevant for chronic care practitioners but that many educational and practice gaps existed and interprofessional education in New Zealand was not currently addressing these gaps. Among the key issues highlighted for attention by educators and policy-makers were the following: teams and teamwork, professional roles and responsibilities, interprofessional communication, cultural competence, better engagement with patients, families, and carers, and common systems, information sharing and confidentiality.

    View record details
  • Proposed changes to the Pharmacy Council of New Zealand Code of Ethics would undermine the trusted position of pharmacists in the delivery of science based health care

    Albert, Benjamin; Albert, OJ; Hofman, Paul; Gunn, AJ; Kenealy, Timothy; Cutfield, Wayne (2015-10-16)

    Journal article
    The University of Auckland Library

    View record details
  • HealthPathways website: making the right thing the easy thing to do?

    Kenealy, Timothy; Sheridan, Nicolette; Connolly, Martin (2015-01-30)

    Journal article
    The University of Auckland Library

    View record details
  • Trends in the management of risk of diabetes complications in different ethnic groups in New Zealand primary care

    Agban, H; Elley, Carolyn; Kenealy, Timothy; Robinson, Elizabeth (2008)

    Journal article
    The University of Auckland Library

    View record details
  • A whole of systems approach to compare options for CVD interventions in Counties Manukau

    Kenealy, Timothy; Rees, D; Sheridan, Nicolette; Moffitt, A; Tibby, S; Homer, J (2012-01-02)

    Journal article
    The University of Auckland Library

    Objective: To assess the usefulness of a national and a local system dynamics model of cardiovascular disease to planning and funding decision makers. Methods: In an iterative process, an existing national model was populated with local data and presented to stakeholders in Counties Manukau, New Zealand. They explored the model's plausibility, usefulness and implications. Data were collected from 30 people using questionnaires, and from field notes and interviews; both were thematically analysed. Results: Potential users readily understood the model and actively engaged in discussing it. None disputed the overall model structure, but most wanted extensions to elaborate areas of specific interest to them. Local data made little qualitative difference to data interpretation but were nevertheless considered a necessary step to support confident local decisions. Conclusion: Some limitations to the model and its use were recognised, but users could allow for these and still derive use from the model to qualitatively compare decision options. Implications: The system dynamics modelling process is useful in complex systems and is likely to become established as part of the routinely used suite of tools used to support complex decisions in Counties Manukau District Health Board.

    View record details
  • Antibiotics for acute bronchitis - Four reviews and still no answers: our clinical definitions are at fault

    Arroll, Bruce; Kenealy, Timothy (2001)

    Journal article
    The University of Auckland Library

    View record details