scholarly journals General practitioners’ views of pharmacists’ current and potential contributions to medication review and prescribing in New Zealand

2013 ◽  
Vol 5 (3) ◽  
pp. 223 ◽  
Author(s):  
Ernieda Hatah ◽  
Rhiannon Braund ◽  
Stephen Duffull ◽  
June Tordoff
Keyword(s):  
New Zealand ◽  
General Practitioners ◽  
Medication Review ◽  
Skills Training ◽  
Structured Interviews ◽  
Medical Practitioners ◽  
Pharmacist Prescribing ◽  
Adherence Support ◽  
Primary Health Care Professional ◽  
Medication Reviews

INTRODUCTION: Internationally, non-medical practitioners are increasingly involved in tasks traditionally undertaken by general practitioners (GPs), such as medication review and prescribing. This study aims to evaluate GPs’ perceptions of pharmacists’ contributions to those services. METHODS: Semi-structured interviews were carried out in two localities with GPs whose patients had and had not undergone a pharmacist-led adherence support Medication Use Review (MUR). GPs were asked their opinions of pharmacists’ provision of MUR, clinical medication review and prescribing. Data were analysed thematically using NVivo 8 and grouped by strengths, weaknesses, opportunities and threats (SWOT) category. FINDINGS: Eighteen GPs were interviewed. GPs mentioned their own skills, training and knowledge of clinical conditions. These were considered GPs’ major strengths. GPs’ perceived weaknesses were their time constraints and heavy workloads. GPs thought pharmacists’ strengths were their knowledge of pharmacology and having more time for in-depth medication review than GPs. Nevertheless, GPs felt pharmacist-led medication reviews might confuse patients, and increase GP workloads. GPs were concerned that pharmacist prescribing might include pharmacists making a diagnosis. This is not the proposed model for New Zealand. In general, GPs were more accepting of pharmacists providing medication reviews than of pharmacist prescribing, unless appropriate controls, close collaboration and co-location of services took place. CONCLUSION: GPs perceived their own skills were well suited to reviewing medication and prescribing, but thought pharmacists might also have strengths and skills in these areas. In future, GPs thought that working together with pharmacists in these services might be possible in a collaborative setting. KEYWORDS: Community pharmacy services; general practitioners; New Zealand; primary health care; professional role

General Practitioners’ Roles in Disaster Health Management: Perspectives of Disaster Managers

2021 ◽  
pp. 1-8
Author(s):  
Penelope L. Burns ◽  
Gerard J. FitzGerald ◽  
Wendy C. Hu ◽  
Peter Aitken ◽  
Kirsty A. Douglas
Keyword(s):  
Health Care ◽  
New Zealand ◽  
General Practitioners ◽  
Health Management ◽  
Health Care Systems ◽  
Health Resources ◽  
Local Health ◽  
Structured Interviews ◽  
Care Needs ◽  
Study Objective

Abstract Introduction: General Practitioners (GPs) are inevitably involved when disaster strikes their communities. Evidence of health care needs in disasters increasingly suggests benefits from greater involvement of GPs, and recent research has clarified key roles. Despite this, GPs continue to be disconnected from disaster health management (DHM) in most countries. Study Objective: The aim of this study was to explore the perspectives of disaster management professionals in two countries, across a range of all-hazard disasters, regarding the roles and contributions of GPs to DHM, and to identify barriers to, and benefits of, more active engagement of GPs in disaster health care systems. Methods: A qualitative research methodology using semi-structured interviews was conducted with a purposive sample of Disaster Managers (DMs) to explore their perspectives arising from experiences and observations of GPs during disasters from 2009 through 2016 in Australia or New Zealand. These involved all-hazard disasters including natural, man-made, and pandemic disasters. Responses were analyzed using thematic analysis. Results: These findings document support from DM participants for greater integration of GPs into DHM with New Zealand DMs reporting GPs as already a valuable integrated contributor. In contrast, Australian DMs reported barriers to inclusion that needed to be addressed before sustained integration could occur. The two most strongly expressed barriers were universally expressed by Australian DMs: (1) limited understanding of the work GPs undertake, restricting DMs’ ability to facilitate GP integration; and (2) DMs’ difficulty engaging with GPs as a single group. Other considerations included GPs’ limited DHM knowledge, limited preparedness, and their heightened vulnerability. Strategies identified to facilitate greater integration of GPs into DHM where it is lacking, such as Australia, included enhanced communication, awareness, and understanding between GPs and DMs. Conclusion: Experience from New Zealand shows systematic, sustained integration of GPs into DHM systems is achievable and valuable. Findings suggest key factors are collaboration between DMs and GPs at local, state, and national levels of DHM in planning and preparedness for the next disaster. A resilient health care system that maximizes capacity of all available local health resources in disasters and sustains them into the recovery should include General Practice.

scholarly journals Electronic transmission of prescriptions in primary care: transformation, timing and teamwork

2021 ◽  
Vol 13 (4) ◽  
pp. 340
Author(s):  
Chloë Campbell ◽  
Caroline Morris ◽  
Lynn McBain
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
General Practitioners ◽  
Community Pharmacists ◽  
Unintended Consequences ◽  
Structured Interviews ◽  
Interprofessional Communication ◽  
Potential Benefits ◽  
Handwritten Signature ◽  
Purposive Sample

ABSTRACTINTRODUCTIONDuring the coronavirus disease 2019 (COVID-19) pandemic lockdown in New Zealand in March 2020, there was a rapid shift to virtual consultations in primary care. This change was supported by system adjustments to enable electronic transmission of prescriptions without a handwritten signature if they met certain security criteria. International research suggests potential for unintended consequences with such changes, so it is important to understand the effect on professional practice in New Zealand general practice and community pharmacy.AIMThe purpose of this study was to undertake a preliminary exploration of the experiences of New Zealand general practitioners and community pharmacists when prescriptions are transmitted electronically directly from prescriber to pharmacy.METHODSSemi-structured interviews with a purposive sample of four pharmacists and four general practitioners gathered qualitative data about their experiences of the shift to electronic transmission of prescriptions. Participants’ perceptions of effect on professional workflow, interprofessional interactions between general practitioners and pharmacists, and interactions with patients were explored. Interviews were audio-recorded, and the data analysed thematically using an inductive approach.RESULTSFour themes were identified: workflow transformation; mixed impact on interactions with patients; juggling timing and expectations; and new avenues for interprofessional communication (with some cul-de-sacs).DISCUSSIONBoth general practitioners and pharmacists experienced transformational changes to workflow. This was positive for general practitioners due to saved time and increased work flexibility. Pharmacists noted potential benefits but also some challenges. To fully reap teamwork benefits, more work is needed on managing the timing issues and patient expectations, and to refine the new modes of communication between health-care practitioners.

scholarly journals A Qualitative Exploration to Understand Access to Pharmacy Medication Reviews: Views from Marginalized Patient Groups

Pharmacy ◽  
2020 ◽  
Vol 8 (2) ◽  
pp. 73
Author(s):  
Asam Latif ◽  
Baguiasri Mandane ◽  
Abid Ali ◽  
Sabina Ghumra ◽  
Nargis Gulzar
Keyword(s):  
Conceptual Framework ◽  
Medication Review ◽  
Pharmacy Services ◽  
Structured Interviews ◽  
Healthcare Provision ◽  
Pharmacy Staff ◽  
Engagement Strategies ◽  
Marginalized Groups ◽  
Health And Social Care ◽  
Medication Reviews

Background: Vulnerable patients from marginalized groups (e.g., people with disabilities, people experiencing homelessness, black and minority ethnic communities) experience higher rates of ill-health, inequitable access to healthcare and low engagement with screening services. Addressing these disparities and ensuring healthcare provision is impartial and fair is a priority for the United Kingdom (UK) healthcare system. Aim: Using Levesque’s access conceptual framework, this study explored the views of patients from marginalized groups, specifically on how access to pharmacy services could be improved and their experiences of receiving a medication review service. Method: Qualitative data were collected via semi-structured interviews on patient experiences of pharmacy services and how access to these could be improved (n = 10). Interviews of patients who had received a medication review from their pharmacist were also conducted (n = 10). Using an interpretivist approach, five ‘demand-side’ dimensions of Levesque’s access conceptual framework were explored (ability to perceive a need for medication support, their ability to seek this support, ability to reach the pharmacy, ability to pay and engage). Results: The findings exposed the medicine, health and social care challenges of vulnerable people and how these are often not being adequately managed or met. Using the access formwork, we unpack and demonstrate the significant challenges patients face accessing pharmacy support. Discussion: Pharmacy organizations need to pay attention to how patients perceive the need for pharmacy support and their ability to seek, reach and engage with this. Further training may be needed for community pharmacy staff to ensure services are made accessible, inclusive and culturally sensitive. Effective engagement strategies are needed to enable the provision of a flexible and adaptable service that delivers patient-centred care. Policy makers should seek to find ways to reconfigure services to ensure people from diverse backgrounds can access such services.

General practitioners and decision-making capacity assessment: the experiences and educational needs of New Zealand general practitioners

2020 ◽  
Vol 37 (4) ◽  
pp. 535-540
Author(s):  
Alisha Vara ◽  
Greg Young ◽  
Alison Douglass ◽  
Frederick Sundram ◽  
Marcus Henning ◽  
...  
Keyword(s):  
Decision Making ◽  
New Zealand ◽  
General Practitioners ◽  
Clinical Skills ◽  
Structured Interviews ◽  
Convenience Sample ◽  
Roles And Responsibilities ◽  
Decision Making Capacity ◽  
Training Resources ◽  
And Training

Abstract Background Assessing decision-making capacity to health care is within the scope of practice for all doctors, yet the experience of GPs in this area is unknown. Objective To explore the experiences, perspectives, approaches and challenges for GPs in New Zealand when conducting decision-making capacity assessments. Methods Qualitative study design comprising individual in-depth semi-structured interviews conducted with a convenience sample of GPs. Interview transcripts were transcribed verbatim and analysed using a thematic analysis approach. Results Twelve participants were recruited. The following themes emerged: (i) GPs’ roles and responsibilities in decision-making capacity assessments; (ii) GPs lack formal training, knowledge, and confidence in decision-making capacity assessments; (iii) the legal interface of decision-making capacity assessments; (iv) GPs’ relationships with specialists and the resulting impact on their confidence in decision-making capacity assessments; and (v) opportunities to improve GPs’ knowledge and confidence in decision-making capacity assessments. Conclusions GPs take responsibility for decision-making capacity assessments; however, assessments can be complex. There is a need to develop specific curriculum and training resources for GPs to improve their clinical skills and legal knowledge in decision-making capacity assessments.

Provision of palliative and end-of-life care in New Zealand residential aged care facilities: general practitioners' perspectives

2020 ◽  
Vol 26 (2) ◽  
pp. 124 ◽  
Author(s):  
Deborah Balmer ◽  
Rosemary Frey ◽  
Merryn Gott ◽  
Jackie Robinson ◽  
Michal Boyd
Keyword(s):  
New Zealand ◽  
End Of Life ◽  
General Practitioners ◽  
End Of Life Care ◽  
Aged Care ◽  
Residential Aged Care ◽  
Life Care ◽  
Structured Interviews ◽  
Care Facilities ◽  
Aged Care Facilities

This exploratory study examined general practitioners’ (GPs) perspectives on delivering end-of-life care in the New Zealand residential aged care context. A general inductive approach to the data collected from semi-structured interviews with 17 GPs from 15 different New Zealand general practices was taken. Findings examine: (1) GPs’ life experience; (2) the GP relationship with the facilities and provision of end-of-life care; (3) the GP interaction with families of dying residents; and (4) GP relationship with hospice. The nature of the GP relationship with the facility influenced GP involvement in end-of-life care in aged care facilities, with GPs not always able to direct a facility’s end-of-life care decisions for specific residents. GP participation in end-of-life care was constrained by GP time availability and the costs to the facilities for that time. GPs reported seldom using hospice services for residents, but did use the reputation (cachet) associated with hospice practices to provide an authoritative buffer for their end-of-life clinical decisions when talking with families and residents. GP training in end-of-life care, especially for those with dementia, was reported as ad hoc and done through informal mentoring between GPs.

Navigating the path: a qualitative exploration of New Zealand general practitioners’ views on integration of care with acupuncturists

2020 ◽  
pp. 096452842092934
Author(s):  
Kate Roberts ◽  
Debra Betts ◽  
Jing-Bao Nie ◽  
Anthony Dowell
Keyword(s):  
Health Care ◽  
New Zealand ◽  
General Practitioners ◽  
Conventional Medicine ◽  
Well Being ◽  
The Body ◽  
Patient Choice ◽  
Structured Interviews ◽  
Integration Of Care ◽  
Interprofessional Communication

Background Increasingly, many patients believe that a combined approach of complementary and alternative medicine (CAM), including acupuncture, and conventional medicine is better than either on its own, and more patients now have the desire to discuss CAM with well-informed general practitioners (GPs). However, to our knowledge, the interaction and collaboration between GPs and acupuncturists specifically in relation to shared care have not been investigated. This research explored interprofessional communication between GPs and acupuncturists in New Zealand. This article specifically reports the GPs’ viewpoints. Methods This study was part of a larger mixed-methods research project. Semi-structured interviews of 14 purposively sampled GP participants were conducted and analysed using thematic analysis. Results The data analysis identified both facilitators of and barriers to integrative health care . Facilitators included the willingness of GPs to engage in communication and a recognition of the importance of patient choice. Barriers included the limited opportunities for sharing information and the lack of current established pathways for communication or direct referrals. GPs also highlighted the confusion around scopes of practice in terms of the different styles of and approaches to acupuncture. Conclusion This research contributes to the body of knowledge concerning interprofessional communication and collaboration between GPs and acupuncturists and suggests that while there are significant barriers to collaboration, there is also the potential to impact provider satisfaction and patient well-being. It provides context within a New Zealand health care setting and also provides additional insights regarding acupuncture, specifically through the disaggregation of specific CAM modalities.

scholarly journals Efficiency versus thoroughness in medication review: a qualitative interview study in UK primary care

2019 ◽  
Vol 69 (680) ◽  
pp. e190-e198 ◽  
Author(s):  
Polly Duncan ◽  
Christie Cabral ◽  
Deborah McCahon ◽  
Bruce Guthrie ◽  
Matthew J Ridd
Keyword(s):  
Medication Review ◽  
Resource Constraints ◽  
Structured Interviews ◽  
Qualitative Interview Study ◽  
Important Barrier ◽  
High Workload ◽  
Data Saturation ◽  
Nice Guidance ◽  
Medication Reviews ◽  
The Uk

BackgroundMedication reviews may improve the safety of prescribing and the National Institute for Health and Care Excellence (NICE) highlights the importance of involving patients in this process.AimTo explore GP and pharmacist perspectives on how medication reviews were conducted in general practice in the UK.Design and settingAnalysis of semi-structured interviews with GPs and pharmacists working in the South West of England, Northern England, and Scotland, sampled for heterogeneity. Interviews took place between January and October 2017.MethodInterviews focused on experience of medication review. Data saturation was achieved when no new insights arose from later interviews. Interviews were analysed thematically.ResultsIn total, 13 GPs and 10 pharmacists were interviewed. GPs and pharmacists perceived medication review as an opportunity to improve prescribing safety. Although interviewees thought patients should be involved in decisions about their medicines, high workload pressures meant that most medication reviews were conducted with limited or no patient input. For some GPs, a medication review was done ‘in the quickest way possible to say that it was done’. Pharmacists were perceived by both professions as being more thorough but less time efficient than GPs, and few pharmacists were routinely involved in medication reviews even in practices employing a pharmacist. Interviewees argued that it was easier to continue medicines than it was to stop them, particularly because stopping medicines required involving the patient and this generated extra work.ConclusionPractices tended to prioritise being efficient (getting the work done) rather than being thorough (doing it well), so that most medication reviews were carried out with little or no patient involvement, and medicines were rarely stopped or reduced. Time and resource constraints are an important barrier to implementing NICE guidance.

Cytisine as an alternative smoking cessation product for Pacific smokers in New Zealand

2018 ◽  
Vol 21 (2) ◽  
pp. 89-95
Author(s):  
Vili Nosa ◽  
Kotalo Leau ◽  
Natalie Walker
Keyword(s):  
Smoking Cessation ◽  
New Zealand ◽  
Nicotinic Acetylcholine Receptors ◽  
Cultural Practices ◽  
Partial Agonist ◽  
Snowball Sampling ◽  
Structured Interviews ◽  
Liquid Form ◽  
Pacific People ◽  
The Pacific

ABSTRACT Introduction: Pacific people in New Zealand have one of the highest rates of smoking.  Cytisine is a plant-based alkaloid that has proven efficacy, effectiveness and safety compared to a placebo and nicotine replacement therapy (NRT) for smoking cessation.  Cytisine, like varenicline, is a partial agonist of nicotinic acetylcholine receptors, and blocks the rewarding effects of nicotine. Cytisine is naturally found in some plants in the Pacific region, and so may appeal to Pacific smokers wanting to quit. This paper investigates the acceptability of cytisine as a smoking cessation product for Pacific smokers in New Zealand, using a qualitative study design. Methods: In December 2015, advertisements and snowball sampling was used to recruit four Pacific smokers and three Pacific smoking cessation specialists in Auckland, New Zealand. Semi-structured interviews where undertaken, whereby participants were asked about motivations to quit and their views on smoking cessation products, including cytisine (which is currently unavailable in New Zealand). Interviews were recorded and transcribed verbatim, with thematic analysis conducted manually. Findings: Pacific smokers reported wanting to quit for loved ones and family, but did not find currently available smoking cessation products effective. Almost all participants had not previously heard of cytisine, but many of the Pacific smokers were keen to try it. Participants identified with cytisine on a cultural basis (given its natural status), but noted that their use would be determined by the efficacy of the medicine, its cost, side-effects, and accessibility. They were particularly interested in cytisine being made available in liquid form, which could be added to a “smoothie” or drunk as a “traditional tea”.  Participants thought cytisine should be promoted in a culturally-appropriate way, with packaging and advertising designed to appeal to Pacific smokers. Conclusions: Cytisine is more acceptable to Pacific smokers than other smoking cessation products, because of their cultural practices of traditional medicine and the natural product status of cytisine.

Pemanfaatan Tumbuhan Obat Tradisional oleh Etnis Sangihe di Kepulauan Sangihe Bagian Selatan, Sulawesi Utara (The Usage of Traditional Medicinal Plants by Sangihe Ethnic in the Southern Sangihe Islands, North Sulawesi)

2018 ◽  
Vol 8 (2) ◽  
pp. 45
Author(s):  
Chrisye Yustitia Pelokang ◽  
Roni Koneri ◽  
Deidy Katili
Keyword(s):  
Medicinal Plants ◽  
Traditional Medicine ◽  
Plant Species ◽  
Structured Interviews ◽  
Active Components ◽  
Plant Materials ◽  
Medical Practitioners ◽  
North Sulawesi ◽  
Traditional Medicinal Plants ◽  
Plant Families

Abstrak Tumbuhan obat merupakan tumbuhan yang menghasilkan satu atau lebih komponen aktif yang dipercaya oleh penduduk berkhasiat obat sehingga dimanfaatkan dalam pengobatan tradisional. Penelitian ini bertujuan untuk mengidentifikasi dan mengkaji spesies tumbuhan yang digunakan sebagai obat tradisional oleh Etnis Sangihe di Kepulauan Sangihe bagian Selatan, Sulawesi Utara. Pengambilan data dilakukan melalui wawancara terstruktur  yang diajukan kepada pengobat tradisional. Hasil penelitian menunjukkan adanya 38 spesies dari 25 famili tumbuhan yang dimanfaatkan sebagai tumbuhan obat oleh Etnis Sangihe bagian Selatan. Herba merupakan habitus tumbuhan yang banyak dimanfaatkan untuk bahan pengobatan. Bagian tumbuhan yang paling banyak digunakan sebagai obat yaitu daun. Cara pengolahan yang paling banyak digunakan adalah direbus. Jenis penyakit yang dapat diobati dengan tumbuhan obat sebanyak 22 jenis penyakit. Kata kunci: tumbuhan obat, obat tradisional, habitus, Kepulauan Sangihe Bagian Selatan Abstract             Medicinal plants are plants that produce one or more active components that are believed by local people as medicinal plants for traditional medicine practices. This study aimed to identify and to assess the plant species that used as traditional medicine by the Sangihe Ethnic in the Southern Sangihe Islands, North Sulawesi. Data collection was conducted by structured interviews to the indigenous medical practitioners. The results showed that 38 plant species from 25 plant families were used as medicinal plants by the Southern Sangihe Ethnic people. Herbs were plant habitus that were widely used for medicinal ingredients. The leaves were widely used as medicinal plant materials. Boiling was the most processing method for preparing medicinal herbs. There were 22 types of diseases that could be treated using medicinal plants. Keywords: medicinal plants, traditional medicine, habitus, Southern Sangihe Islands

Meeting the Needs of Gifted Learners Who Just Don’t ‘Fit’: Parent Perspectives

2019 ◽  
pp. 6-16
Author(s):  
Nadine Ballam ◽  
Anne Sturgess
Keyword(s):  
New Zealand ◽  
Gifted Education ◽  
Support Staff ◽  
Learning Approach ◽  
Full Time ◽  
Parent Perspectives ◽  
Structured Interviews ◽  
Gifted Learners ◽  
Initial Cohort ◽  
Data Informed

In February 2018, a full-time provider of gifted education opened in New Zealand with its initial cohort of children. This provider catered for learners from ages 1-15 years who did not ‘fit’ in mainstream education settings. This paper reports on a research project that focused on the effectiveness of the learning approach at this school in its inaugural year. Two sources of data informed this research, including semi-structured interviews with parents and learning and support staff, and an analysis of documents related to the philosophy, curriculum, and learning approach. This paper reports on benefits and limitations of the learning approach identified by the parent participants in the study.

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