134 results for Kenealy, Timothy, Journal article

  • 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.

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  • Characteristics of nurses providing diabetes community and outpatient care in Auckland

    Daly, B; Arroll, B; Sheridan, N; Kenealy, Timothy; Scragg, R (2013-03)

    Journal article
    The University of Auckland Library

    INTRODUCTION: There is a worldwide trend for diabetes care to be undertaken in primary care. Nurses are expected to take a leading role in diabetes management, but their roles in primary care are unclear in New Zealand, as are the systems of care they work in as well as their training. AIM: To describe and compare demographic details, education and diabetes experience, practice setting and facilities available for the three main groups of primary health care nurses working in the largest urban area in New Zealand. METHOD: Of the total number of practice nurses, district nurses and specialist nurses working in Auckland (n=1091), 31% were randomly selected to undertake a self-administered questionnaire and telephone interview in 2006-2008. RESULTS: Overall response was 86% (n=284 self-administered questionnaires, n=287 telephone interviews). Almost half (43%) of primary care nurses were aged over 50 years. A greater proportion of specialist nurses (89%) and practice nurses (84%) had post-registration diabetes education compared with district nurses (65%, p=0.005), from a range of educational settings including workshops, workplaces, conferences and tertiary institutions. More district nurses (35%) and practice nurses (32%) had worked in their current workplace for >10 years compared with specialist nurses (14%, p=0.004). Over 20% of practice nurses and district nurses lacked access to the internet, and the latter group had the least administrative facilities and felt least valued. DISCUSSION: These findings highlight an ageing primary health care nursing workforce, lack of a national primary health care post-registration qualification and a lack of internet access.

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  • Characteristics of nurses providing diabetes community and outpatient care in Auckland

    Daly, Barbara; Arroll, Bruce; Sheridan, Nicolette; Kenealy, Timothy; Scragg, Robert (2013)

    Journal article
    The University of Auckland Library

    INTRODUCTION: There is a worldwide trend for diabetes care to be undertaken in primary care. Nurses are expected to take a leading role in diabetes management, but their roles in primary care are unclear in New Zealand, as are the systems of care they work in as well as their training. AIM: To describe and compare demographic details, education and diabetes experience, practice setting and facilities available for the three main groups of primary health care nurses working in the largest urban area in New Zealand. METHOD: Of the total number of practice nurses, district nurses and specialist nurses working in Auckland (n=1091), 31% were randomly selected to undertake a self-administered questionnaire and telephone interview in 2006-2008. RESULTS: Overall response was 86% (n=284 self-administered questionnaires, n=287 telephone interviews). Almost half (43%) of primary care nurses were aged over 50 years. A greater proportion of specialist nurses (89%) and practice nurses (84%) had post-registration diabetes education compared with district nurses (65%, p=0.005), from a range of educational settings including workshops, workplaces, conferences and tertiary institutions. More district nurses (35%) and practice nurses (32%) had worked in their current workplace for >10 years compared with specialist nurses (14%, p=0.004). Over 20% of practice nurses and district nurses lacked access to the internet, and the latter group had the least administrative facilities and felt least valued. DISCUSSION: These findings highlight an ageing primary health care nursing workforce, lack of a national primary health care post-registration qualification and a lack of internet access.

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  • Development and validation of a predictive risk model for all-cause mortality in type 2 diabetes

    Robinson, Thomas; Elley, Carolyn; Kenealy, Timothy; Drury, PL (2015-06)

    Journal article
    The University of Auckland Library

    Type 2 diabetes is common and is associated with an approximate 80% increase in the rate of mortality. Management decisions may be assisted by an estimate of the patient's absolute risk of adverse outcomes, including death. This study aimed to derive a predictive risk model for all-cause mortality in type 2 diabetes.We used primary care data from a large national multi-ethnic cohort of patients with type 2 diabetes in New Zealand and linked mortality records to develop a predictive risk model for 5-year risk of mortality. We then validated this model using information from a separate cohort of patients with type 2 diabetes.26,864 people were included in the development cohort with a median follow up time of 9.1 years. We developed three models initially using demographic information and then progressively more clinical detail. The final model, which also included markers of renal disease, proved to give best prediction of all-cause mortality with a C-statistic of 0.80 in the development cohort and 0.79 in the validation cohort (7610 people) and was well calibrated. Ethnicity was a major factor with hazard ratios of 1.37 for indigenous Maori, 0.41 for East Asian and 0.55 for Indo Asian compared with European (Ps risk of death. Results are similar to models previously published from smaller cohorts in other countries and apply to a wider range of patient ethnic groups.

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  • Ethnicity and risk of lower limb amputation in people with Type 2 diabetes: a prospective cohort study

    Robinson, Thomas; Kenealy, Timothy; Garrett, M; Bramley, D; Drury, PL; Elley, Carolyn (2016-01)

    Journal article
    The University of Auckland Library

    Lower limb amputation is a serious complication of diabetic foot disease and there are unexplained ethnic variations in incidence. This study investigates the risk of amputation among different ethnic groups after adjusting for demographic, socio-economic status and clinical variables.We used primary care data from a large national multi-ethnic cohort of patients with Type??2 diabetes in New Zealand and linked hospital records. The primary outcome was time from initial data collection to first lower limb amputation. Demographic variables included age of onset and duration since diabetes diagnosis, gender, ethnicity and socio-economic status. Clinical variables included smoking status, height and weight, blood pressure, HbA1c , total cholesterol/HDL ratio and albuminuria. Cox proportional hazards models were used.There were 892 lower limb amputations recorded among 62??002 patients (2.11 amputations per 1000??person-years), followed for a median of 7.14??years (422??357??person-years). After adjusting for demographic and socio-economic variables and compared with Europeans, M??ori had the highest risk [hazard ratio (HR) 1.84 (95%CI:1.54-2.19)], whereas East Asians [HR 0.18, (0.08-0.44)] and South Asians [HR 0.39 (0.22-0.67)] had the lowest??risk. Adjusting for available clinical variables reduced the differences but they remained substantial [HR 1.61 (1.35-1.93), 0.23 (0.10-0.56) and 0.48 (0.27-0.83), respectively].Ethnic groups had significantly different risk of lower limb amputation, even after adjusting for demographic and some major clinical risk factors. Barriers to care should be addressed and intensive prevention strategies known to reduce the incidence of lower limb amputations could be prioritized to those at greatest risk.

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  • Who are the successful reproductive health clinician-researchers?

    Ekeroma, Alec; Kenealy, Timothy; Latu, R; Hill, Andrew (2016-06)

    Journal article
    The University of Auckland Library

    Health research output from the Pacific Islands is low. Improving clinicians important role in generating and utilizing research evidence to improve patient care has been the aim of research collaborations, governments and funding agencies. Twenty-eight reproductive health clinicians from six Pacific countries participated in a research workshop and were provided mentors to complete identified research projects. Completion of research tasks were assessed 18 months later using a tool co-produced by a panel of research experts. Those with academic and specialist appointments did better than other medical officers and nurses/midwives.

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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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  • Six new studies about diabetes: What can we learn that might benefit M??ori and Pacific people?

    Kenealy, Timothy; Sheridan, Nicolette; Orr-Walker, BJ (2017-02-17)

    Journal article
    The University of Auckland Library

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  • Childhood immunisations in Northland, New Zealand: declining care and the journey through the immunisation pathway

    Rumball-Smith, J; Kenealy, Timothy (2016-07-15)

    Journal article
    The University of Auckland Library

    In a region with high rates of immunisation refusal, we examine whether refusing an immunisation at 6 weeks (the first scheduled immunisation) predicts the pattern for subsequent scheduled immunisations, and the characteristics of those who declined these immunisations.We used data from the National Immunisation Register to identify 11,972 children born between 1 January 2009 and 31 December 2013 (inclusive), and who had their first immunisation (due at 6 weeks age) in Northland, New Zealand. At each immunisation event, individual vaccines are recorded as being delivered or declined. This cohort was 'followed' to determine which of these children received or declined the scheduled 3-month and 5-month immunisations.Immunisation providers delivered a full immunisation programme to 10,828/11,927 (90%) of the cohort. Caregivers of 897 (7%) of children declined the 6-week vaccination. Of this group, 872 (97%) also declined the 3-month and 850 (95%) declined the 5-month immunisations, constituting 872/962 (91%) and 850/923 (92%) of all declined immunisations, respectively. In the decline group, there was variability with primary care practice, and differences according to ethnic group and deprivation profile.Increasing Northland's immunisation coverage may require primary care providers to more actively engage with declining caregivers prior to the 3-month and 5-month vaccinations. Immunisation information and decision-making programmes targeted at parents and providers in the antenatal and prenatal period may also be of benefit, in addition to considering regulatory and incentive strategies.

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  • When equity is central to research: implications for researchers and consumers in the research team

    Sheridan, Nicolette; Kenealy, Timothy; Stewart, L; Lampshire, Debra; Robust, Te Tuhi; Parsons, John; McKillop, Ann; Couturier, J; Denis, J-L; Connolly, Martin (2017-06-27)

    Journal article
    The University of Auckland Library

    This paper is a response to our recognition that approaches to equity and consumer involvement in research differed in emphasis between our researchers and jurisdictions. Whilst we shared common aspirations we varied in our priorities between equity groups and methods to represent consumer interests. New Zealand has a historical focus on equity for indigenous Maori and shares with Canada concern about enduring inequalities that affect people???s lives.

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  • Are patient and carer experiences mirrored in the practice reviews of Self-management Support (PRISMS) provider taxonomy?

    Sheridan, Nicolette; Kenealy, Timothy; Kuluski, K; McKillop, Ann; Parsons, John; Wong-Cornall, C (2017)

    Journal article
    The University of Auckland Library

    Introduction: Patient self-management support is central to care for long term conditions and for integrated care. Patients and their carers are the final arbiter of whether support for self-management has been effective. A new taxonomy lists 14 categories of provider activities that support patient self-management (Practical Reviews in Self-Management Support, PRISMS). We asked whether we could recognise these provider activities in narratives from patients and carers. We sought to extend the theoretical framework of the taxonomy to include the view from patient and carers. Methods: We interviewed 28 patients and family carers in a case study of primary health care in New Zealand in 2015 to determine which components of the taxonomy were visible. We drew on interviews with clinicians and organisation persons to explain case study context. Results: We found, within patient and carer data, evidence of all 14 components of provider self-management support. The overarching dimensions of the taxonomy helped reveal an intensity and consistency of provider behaviour that was not apparent considering the individual components. Conclusions: Patient and carer data mapped to provider activities. The taxonomy was not explicit on provider relationships and engagement with, or separate support needs of, patients and carers.

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  • An association between ethnicity and cardiovascular outcomes for people with Type 2 diabetes in New Zealand

    Kenealy, Timothy; Elley, Carolyn; Robinson, Elizabeth; Bramley, Dale; Drury, Paul; Kerse, Ngaire; Moyes, Simon; Arroll, Bruce (2008)

    Journal article
    The University of Auckland Library

    Aims To investigate the association between ethnicity and risk of first cardiovascular (CV) event for people with Type 2 diabetes in New Zealand. Methods A prospective cohort study using routinely collected data from a national primary health care diabetes annual review programme linked to national hospital admission and mortality data. Ethnicity was recorded as European, Maori, Pacific, Indo-Asian, East-Asian or Other. A Cox proportional hazards model was used to investigate factors associated with first CV event. Data was collected from 48 444 patients with Type 2 diabetes, with first data collected between 1 January 2000 and 20 December 2005, no previous cardiovascular event at entry and with complete measurements. Risk factors included ethnicity, gender, socio-economic status, body mass index, smoking, age at diagnosis, duration of diabetes, systolic blood pressure, serum lipids, glycated haemoglobin and urine albumin : creatinine ratio. The main outcome measures were time to first fatal or non-fatal CV event. Results Median follow-up was 2.4 years. Using combined European and Other ethnicities as a reference, hazard ratios for first CV event were 1.30 for Maori (95% confidence interval 1.19???1.41), 1.04 for Pacific (0.95???1.13), 1.06 for Indo-Asian (0.91???1.24) and 0.73 for East-Asian (0.62???0.85) after controlling for all other risk factors. Conclusions Ethnicity was independently associated with time to first CV event in people with Type 2 diabetes. Maori were at 30% higher risk of first CV event and East-Asian 27% lower risk compared with European/Other, with no significant difference in risk for Pacific and Indo-Asian peoples.

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  • Extending "Continuity of Care" to include the Contribution of Family Carers

    Wong-Cornall, C; Parsons, John; Sheridan, Nicolette; Kenealy, Timothy; Peckham, A (2017-06-27)

    Journal article
    The University of Auckland Library

    Family carers, as a "shadow workforce", are foundational to the day-to-day integration of health service delivery for older family members living with complex health needs. This paper utilises Haggerty's model of continuity of care to explore the contribution of family carers' to the provision of care and support for an older family member's chronic condition within the context of health service delivery.We analysed data from interviews of 13 family carers in a case study of primary health care in New Zealand - a Maori Provider Organisation - to determine the alignment of family caregiving with the three levels of continuity of care (relational continuity, informational continuity, and management continuity).We found alignment of family caregiving tasks, responsibilities, and relationships with the three levels of continuity of care. Family carers 1) partnered with providers to extend chronic care to the home; 2) transferred and contributed information from one provider/service to another; 3) supported consistent and flexible management of care.The Maori Provider Organisation supported family carer-provider partnership enabled by shared Maori cultural values and social mandate of building family-centred wellbeing. Relational continuity was the most important level of continuity of care; it sets precedence for family carers and providers to establish the other levels - informational and management - continuity of care for their family member cared for. Family carers need to be considered as active partners working alongside responsive primary health care providers and organisation in the implementation of chronic care.

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  • Access to diabetes drugs in New Zealand is inadequate

    Krebs, J; Coppell, KJ; Cresswell, P; Downie, M; Drury, P; Gregory, A; Kenealy, Timothy; McNamara, C; Miller, SC; Smallman, K (2016-06-10)

    Journal article
    The University of Auckland Library

    New Zealand is well behind the rest of the developed world in access to funded drugs for managing type 2 diabetes. Over the last 12 years three new classes of glucose-lowering drugs have come through clinical trials to market. The principal strengths of all three novel classes of medicine are their lack of hypoglycaemia (low blood sugar), their frequent acceptability in patients intolerant of or contraindicated for existing funded drugs, and avoidance of weight gain. International guidelines focus on individualization of treatment and avoidance of hypoglycaemia. This is extremely difficult for New Zealanders with type 2 diabetes when we do not have access to modern drug treatments.

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  • Patient resistance as a resource: candidate obstacles in diabetes consultations

    Barton, J; Dew, K; Dowell, A; Sheridan, Nicolette; Kenealy, Timothy; Macdonald, L; Docherty, B; Tester, R; Raphael, Deborah; Gray, L; Stubbe, M (2016-09)

    Journal article
    The University of Auckland Library

    This study uses conversation analysis to explore 'candidate obstacles', a practice observed in sequences of patient resistance to lifestyle advice within health professional consultations. This article presents illustrative analyses of selected data excerpts drawn from audio-visual recordings of 116 tracked consultations between health professionals and 34 patients newly diagnosed with type 2 diabetes mellitus in New Zealand. The analysis shows that in consultations where health promotion activities are central, patient resistance can provide space for patients to identify obstacles to their compliance with lifestyle advice. Identifying candidate obstacles provides opportunities for health professionals to align advice with concerns of patients and potentially improve patient outcomes.

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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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  • 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

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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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  • Antibiotics and acute purulent rhinitis: Authors' reply

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

    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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