118 results for Kenealy, Timothy, Journal article

  • Should we embed randomized controlled trials within action research: arguing from a case study of telemonitoring

    Day, Karen; Kenealy, Timothy; Sheridan, Nicolette (2016-06-08)

    Journal article
    The University of Auckland Library

    Background: Action research (AR) and randomized controlled trials (RCTs) are usually considered to be theoretically and practically incompatible. However, we argue that their respective strengths and weaknesses can be complementary. We illustrate our argument from a recent study assessing the effect of telemonitoring on health-related quality of life, self-care, hospital use, costs and the experiences of patients, informal carers and health care professionals in two urban hospital services and one remote rural primary care service in New Zealand. Methods: Data came from authors' observations and field notes of discussions with three groups: the healthcare providers and healthcare consumers who participated in the research, and a group of 17 researchers and collaborators. The consumers had heart failure (Site A, urban), airways disease (Site B, urban), and diabetes (Site C, rural). The research ran from 2008 (project inception) until 2012 (project close-off). Researchers came from a wide range of disciplines. Both RCT and AR methods were recognised from early in the process but often worked in parallel rather than together. In retrospect, we have mapped our observed research processes to the AR cycle characteristics (creation of communicative space, democracy and participation, iterative learning and improvement, emergence, and accommodation of different ways of knowing). Results: We describe the context, conduct and outcomes of the telemonitoring trial, framing the overall process in the language of AR. Although not fully articulated at the time, AR processes made the RCT sensitive to important context, e.g. clinical processes. They resulted in substantive changes to the design and conduct of the RCT, and to interpretation and uptake of findings, e.g. a simpler technology procurement process emerged. Creating a communicative space enabled co-design between the researcher group and collaborators from the provider participant group, and a stronger RCT design. Conclusions: It appears possible to enhance the utility of RCTs by explicitly embedding them in an AR framework to shape stronger RCT design. The AR process and characteristics may enable researchers to evaluate telehealth while enhancing rather than compromising the quality of an RCT, where research results are returned to practice as part of the research process. Trial registration: Australian New Zealand Clinical Trials Registry, reference ACTRN12610000269033 .

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  • Geography matters: the prevalence of diabetes in the Auckland Region by age, gender and ethnicity

    Warin, B; Exeter, Daniel; Zhao, Jinfeng; Kenealy, Timothy; Wells, Linda (2016-01-10)

    Journal article
    The University of Auckland Library

    Aim: To determine whether the prevalence of diagnosed diabetes in the greater Auckland Region varies by General Electoral District (GED). Method: Using encrypted National Health Identifiers and record linkage of routine health datasets, we identified a regional cohort of people with diagnosed diabetes in 2011 from inpatient records and medication dispensing. The geographical unit of a person's residence (meshblock) was used to determine the GED of residence. We calculated prevalence estimates and 95% confidence intervals and used binary logistic regression to map geographical variations in diabetes. Results: An estimated 63,014 people had diagnosed diabetes in Auckland in 2011, a prevalence of 8.5% of the adult population ≥30 years of age. We found significant variation in diabetes prevalence by age, gender, ethnicity and GED. There was a more than five-fold difference in the unadjusted prevalence of diabetes by GED, ranging from 3.2% (3.1 to 3.4%) in the North Shore to 17.3% (16.8 to 17.7%) in Mangere. Such variations remained after binary logistic regression adjusting for socio-demographic variables. Compared to New Zealand Europeans, Indian people had the highest odds of having diabetes at 3.85 (3.73 to 3.97), while the odds of people living in the most deprived areas having diabetes was nearly twice that of those living in least deprived areas (OR 1.93, [1.87 to 1.99]). Geographic variations in diabetes remained after adjusting for socio-demographic circumstances: people living in GEDs in south-west Auckland were at least 60% more likely than people living in the North Shore GED to have diabetes. Conclusion: There is significant variation in the prevalence of diabetes by GED in Auckland that persists across strata of age group, gender and ethnicity, and persists after controlling for these same variables. These inequities should prompt action by politicians, policymakers, funders, health providers and communities for interventions aimed at reducing such inequities. Geography and its implications on access to and availability of health resources appears to be a key driver of inequity in diabetes rates, supporting an argument for interventions based on geography, especially a public health rather than an individual risk approach.

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  • Do primary health care nurses address cardiovascular risk in diabetes patients?

    Daly, Barbara; Kenealy, Timothy; Arroll, Bruce; Sheridan, Nicolette; Scragg, Robert (2014-11)

    Journal article
    The University of Auckland Library

    AIMS: To identify factors associated with assessment and nursing management of blood pressure, smoking and other major cardiovascular risk factors by primary health care nurses in Auckland, New Zealand. METHODS: Primary health care nurses (n = 287) were randomly sampled from the total (n=1091) identified throughout the Auckland region and completed a self-administered questionnaire (n = 284) and telephone interview. Nurses provided details for 86% (n =265) of all diabetes patients they consulted on a randomly selected day. RESULTS: The response rate for nurses was 86%. Of the patients sampled, 183 (69%) patients had their blood pressure measured, particularly if consulted by specialist (83%) and practice (77%) nurses compared with district (23%, p = 0.0003). After controlling for demographic variables, multivariate analyses showed patients consulted by nurses who had identified stroke as a major diabetes-related complication were more likely to have their blood pressure measured, and those consulted by district nurses less likely. Sixteen percent of patients were current smokers. Patients consulted by district nurses were more likely to smoke while, those >66 years less likely. Of those who wished to stop, only 50% were offered nicotine replacement therapy. Patients were significantly more likely to be advised on diet and physical activity if they had their blood pressure measured (p < 0.0001). CONCLUSIONS: Measurement of blood pressure and advice on diet or physical activity were not related to patient's cardiovascular risk profile and management of smoking cessation was far from ideal. Education of the community-based nursing workforce is essential to ensure cardiovascular risk management becomes integrated into diabetes management.

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  • Health Research Systems in Six Pacific Island Countries and Territories

    Ekeroma, Alec; Biribo, S; Herman, Josephine; Hill, A; Kenealy, Timothy (2016-03)

    Journal article
    The University of Auckland Library

    Background: Evaluating national health research systems (NHRS) in six Paci c Island states - Fiji, Solomon Islands, Vanuatu, Samoa, Tonga and the Cook Islands - is a key step in determining whether their systems, infrastructure and processes are in place to e ectively manage health research resources and facilitate conduct of research and its implementation. Methods The COHRED questionnaire used in a 2007 mapping of the Paci c Islands was utilised to survey informants from the six countries. Results: Fiji had a more developed NHRS followed by the Cook Islands and the Solomon Islands. ere was no correlation between the degree of NHRS development and population size, level of GDP or SCImago ranking for research output. All the six countries had a research structure accompanied by a satisfactory level of coordination. However, there was not always dedicated personnel assigned and there was a lack of research policies and legislation in all jurisdictions. With the exception of Fiji and the Solomon Islands, the countries had weak ethics processes and there were no monitoring and evaluation systems with the exception of Samoa. Conclusions: The NHRS in six Paci c Island states vary from less developed in Vanuatu to more developed in Fiji. e development of the various components of a NHRS in small Island states is sensitive to political, funding and human resource pressures. ere is room for improvement; nevertheless, there is no need in developing all the components of a NHRS in a resource-constrained setting as long as the various countries develop a Paci c solution that includes research collaborations and resource sharing with other Paci c and Paci c-rim countries.

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  • Gems of New Zealand Primary Health Care Research: COPD self-management in New Zealand: patient attitudes and behaviours

    Sheridan, Nicolette; Kenealy, Timothy; Salmon, E; Rea, Harold; Raphael, Deborah; Schmidt-Busby, J (2011)

    Journal article
    The University of Auckland Library

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  • 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

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  • 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.

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  • 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

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  • 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

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  • Quantification of diabetes consultations by the main primary health care nurse groups in Auckland, New Zealand

    Daly, Barbara; Arroll, Bruce; Sheridan, Nicolette; Kenealy, Timothy; Scragg, Robert (2016-09)

    Journal article
    The University of Auckland Library

    Diabetes prevalence continues to increase, with most diabetes patients managed in primary care.This report quantifies the number of diabetes consultations undertaken by primary healthcare nurses in Auckland, New Zealand.Of 335 primary healthcare nurses randomly selected, 287 (86%) completed a telephone interview in 2006-2008.On a randomly sampled day (from the past seven) for each nurse, 42% of the nurses surveyed (n=120) consulted 308 diabetes patients. From the proportion of nurses sampled in the study, it is calculated that the number of diabetes patients consulted by primary healthcare nurses per week in Auckland between September 2006 and February 2008 was 4210, with 61% consulted by practice, 23% by specialist and 16% by district nurses. These findings show that practice nurses carry out the largest number of community diabetes consultations by nurses. Their major contribution needs to be incorporated into future planning of the community management of diabetes.

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  • 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.

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  • 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

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  • Intensive primary care treatment reduced cardiovascular risk factors at 1 year in screen-detected type 2 diabetes

    Elley, CR; Kenealy, Timothy (2009)

    Journal article
    The University of Auckland Library

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  • Gems of New Zealand Primary Health Care Research: Including type 2 diabetes in cardiovascular risk equations

    Elley, C; Robinson, E; Kenealy, Timothy; Bramley, D; Drury, L (2010-06)

    Journal article
    The University of Auckland Library

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  • Sore Throat

    Kenealy, Timothy (2007)

    Journal article
    The University of Auckland Library

    Introduction About 10-30% of people present to primary healthcare services with sore throat each year. The causative organisms of sore throat may be bacteria (most commonly Streptococcus) or viruses (typically rhinovirus), although it is difficult to distinguish bacterial from viral infections clinically. Methods and outcomes We conducted a systematic review and aimed to answer the following clinical questions: What are the effects of interventions to reduce symptoms of acute infective sore throat? What are the effects of interventions to prevent complications of acute infective sore throat? We searched: Medline, Embase, The Cochrane Library and other important databases up to May 2006 (BMJ Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). Results We found eight systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. Conclusions In this systematic review we present information relating to the effectiveness and safety of the following interventions: antibiotics, corticosteroids, non-steroidal anti-inflammatory drugs, paracetamol, and probiotics.

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  • 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.

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  • Patient error: A preliminary taxonomy

    Buetow, Stephen; Kiata, L; Liew, T; Kenealy, Timothy; Dovey, S; Elwyn, G (2009-05-01)

    Journal article
    The University of Auckland Library

    PURPOSE: Current research on errors in health care focuses almost exclusively on system and clinician error. It tends to exclude how patients may create errors that influence their health. We aimed to identify the types of errors that patients can contribute and help manage, especially in primary care. METHODS: Eleven nominal group interviews of patients and primary health care professionals were held in Auckland, New Zealand, during late 2007. Group members reported and helped to classify types of potential error by patients. We synthesized the ideas that emerged from the nominal groups into a taxonomy of patient error. RESULTS: Our taxonomy is a 3-level system encompassing 70 potential types of patient error. The first level classifies 8 categories of error into 2 main groups: action errors and mental errors. The action errors, which result in part or whole from patient behavior, are attendance errors, assertion errors, and adherence errors. The mental errors, which are errors in patient thought processes, comprise memory errors, mindfulness errors, misjudgments, and—more distally—knowledge deficits and attitudes not conducive to health. CONCLUSION: The taxonomy is an early attempt to understand and recognize how patients may err and what clinicians should aim to influence so they can help patients act safely. This approach begins to balance perspectives on error but requires further research. There is a need to move beyond seeing patient, clinician, and system errors as separate categories of error. An important next step may be research that attempts to understand how patients, clinicians, and systems interact to cocreate and reduce errors.

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  • What Can Primary Care Prescribing Data Tell Us about Individual Adherence to Long-Term Medication? - Comparison to Pharmacy Dispensing Data

    Mabotuwana, Thusitha; Warren, James; Harrison, Jeffrey; Kenealy, Timothy (2009)

    Journal article
    The University of Auckland Library

    Purpose To assess the predictive value of general practice electronic prescribing records with respect to adherence to long-term medications as compared to claims-based pharmacy dispensing data. Methods A total of 29772 electronic prescribing records relating to 2713 patients attending a New Zealand general medical practice were linked by national health identifier to 63 833 dispensing records used for community pharmacy reimbursement. Individual possession ratios—prescription possession ratio (PPR) for prescribing and medication possession ratio (MPR) for dispensing—were calculated for the 15-month period from 1 January 2006 to 30 March 2007 based on each data source for the common long-term medications simvastatin, metoprolol succinate, bendrofluazide, felodipine, cilazapril and metformin. Results Out of 646 patients prescribed at least one of the six medications by the practice during the 15-month period, 50% of patients maintained high adherence (MPR ≥ 80%) to all (out of the 6) medications that they were prescribed over the period, with rates of high adherence to individual medications ranging from 68 (felodopine) to 55% (metformin). In 93% of 4043 cases where there was a prescription in the general practice data, a subsequent dispensing record for the same patient and drug was present with a time-stamp no more than seven days later. PPR < 80%. Conclusion There is potential for general practices to identify substantial levels of long-term medication adherence problems through their electronic prescribing records. Significant further adherence problems could be detected if an e-pharmacy network allowed practices to match dispensing against prescriptions.

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  • General practice changes in South Auckland from 1990 to 1999: a threat to continuity of care?

    Kenealy, Timothy; Arroll, Bruce; Kenealy, H; Scott, DJ; Scragg, Robert; Simmons, David (2002)

    Journal article
    The University of Auckland Library

    Aims To compare composition and organisation of general practices in South Auckland between 1990 and 1999 and consider implications for continuity of care. Methods Mail questionnaires were sent to all general practitioners in South Auckland in 1990 and in 1999. Results The response rates were 88% in 1990 and 76% in 1999 (p 0.3). The mean practice size increased from 2.8 to 3.7 doctors (p 0.003), the number of GPs in solo practice halved from 31.9% to 16.7% (p 0.009), and the mean number of part-time GPs per practice doubled from 0.7 to 1.3 (p 0.0004). There was no statistically significant difference in the country of origin of the doctors between 1990 and 1999. Women in 1999, compared with the men practitioners, were more likely to work fewer than eight ‘tenths’ (53.3% vs 8.1%, p 0.001), were fewer years since graduation (16.1 vs 20.4, p 0.004), had worked fewer years in South Auckland (7.9 vs 12.7, p<0.0001). Conclusion Through the 1990s there have been changes in the organisation of general practice, some of which may help and others hinder provision of continuity of care. Given that patients, practitioners and politicians value continuity of care, it is an important topic that warrants New Zealand research.

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  • Helplessness, self blame and faith may impact on self management in COPD: a qualitative study

    Sheridan, Nicolette; Kenealy, Timothy; Salmon, E; Rea, Harold; Raphael, Deborah; Schmidt-Busby, J (2011-12-01)

    Journal article
    The University of Auckland Library

    Aims: To explore how patients with COPD experience helplessness. Methods: In-depth interviews with 29 patients with moderate to very severe COPD. Data were analysed using a general inductive approach. Results: All patients focused on acute symptoms and expressed feelings of helplessness in the management of their condition; little attention was paid to longer-term strategies. For one group of patients, mostly European, self blame appeared to intensify feelings of helplessness. For a second group, mostly Pacific, a focus on faith in God, Church and family provided a more positive affect and existed alongside helplessness. Conclusions: Clinicians seeking to support patients to include longer term strategies in their self management will need to coach patients to experiences of short-term success, and be aware of the ways that patients experience and interpret their helplessness. Clinicians need to address self blame, and recognise patients' priorities of faith and family.

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