Men calling healthline.

OBJECTIVE: To compare data for men who call Healthline for themselves with data from women callers and to use those pilot data to inform strategies to encourage men to use Healthline. SUBJECTS AND METHODS: This was a study examining retrospective data for people calling Healthline in a week in October 2010. Calls from 487 men were compared with those from 487 women. Geocoded data provided deprivation levels. RESULTS: There were fewer men calling than women in all age groups, although younger men were overrepresented. Young men were more acutely unwell than young women or older men. Men called at all times of the day, and call duration was similar to that of women callers. Most men callers were European; men of other ethnic groups were underrepresented compared with women and compared with their representation in the New Zealand population. Men from higher deprivation areas were more likely to call than those from lower deprivation areas. CONCLUSIONS: Compared with women, men underuse Healthline as they do other primary care services. Overall, men are more symptomatic than women; of interest is our observation that among men, the users are likely to be younger, of lower socioeconomic status, and European. Healthline may be an acceptable source of health advice for these men, and it should be considered central in any future initiative addressing men's health.

How safe is telenursing from home?

OBJECTIVE: To compare the work of telenurses working from home with that of their colleagues working in a health call centre. DESIGN: A retrospective review of existing clinical and other data. SETTING: NURSE-ON-CALL, the telephone triage and advice line operated for the Department of Human Services, Victoria by McKesson Asia Pacific. SUBJECTS: Nurses employed by McKesson Asia Pacific, Victoria, Australia working in their call centre and from home. MAIN OUTCOME MEASURES: Comparison between nurses working from home with those working in the centre: demographics and dispositions of callers, management of mystery callers, frequency of risk incidents, productivity, and satisfaction. RESULTS: Callers sought triage for the same range of symptoms and were triaged to similar dispositions; mystery callers were managed similarly; there were a similar number of risk incidents. Nurses working from home were more productive, took fewer days sick leave and had a lower attrition rate. Nurses working from home identified more flexible hours and less travel as advantages. No disadvantages were identified. CONCLUSIONS: Nurses who worked from home were provided with adequate education for their role, full technological facilities, decision support software, ready access to supervision and continuing education. They managed a similar range of cases as nurses working in a health call centre, did so as safety, were more productive and expressed high levels of satisfaction.

Universal telenursing triage in Australia and New Zealand - a new primary health service.

BACKGROUND: Most Australian and all New Zealand residents now have 24 hour access to free telephone advice and symptom triage. Australasia is following an international trend triggered by a perceived need for standardised advice, demand management (primary care and emergency department), and equity of access. A growing literature describes the impact of this new service on existing primary health services. OBJECTIVE: This article summarises the results of telephone triage projects in Australia and New Zealand to acquaint Australian general practitioners with nurse led telephone triage services that have health call centre technology. DISCUSSION: Australian and New Zealand services are similar with respect to the demographics of callers, when they call, and the issues on which they seek advice. Further study is needed in order to understand how telenursing can best be integrated with general practice and other primary care services.

Professional isolation and performance assessment in New Zealand.

INTRODUCTION: Solo and nonurban practice, nonmembership of a professional group, and aging are all associated with underperformance and may be indicators of professional isolation. Although it may lead to underperformance in physicians, there are no clear measures to assess professional isolation. METHODS: By mailed questionnaire, experienced performance assessors were asked to list markers of professional isolation. RESULTS: A set of criteria and descriptors for professional isolation was generated, and included personality; solo practice; poor colleague relationships; outlier practice; MOPS or CPD failure; specialist in only private practice; stress, no relief, complaints, job dissatisfaction; locum, itinerant or part-time practice; cultural barriers; male gender. DISCUSSION: The identification of physicians at risk for professional isolation may enable the prevention of poor performance.

Death certification and doctors' dilemmas: a qualitative study of GPs' perspectives.

BACKGROUND: Death certificate inaccuracies have implications for funding and planning public health services, health research and family settlements. Improved training has been identified as a way of reducing inaccuracies. Understanding the influences on certifying doctors should inform that training. AIM: To explore what factors influence GPs as they complete death certificates. DESIGN: Focus groups held by teleconference with 16 GPs. SETTING: New Zealand general practice. METHOD: Four teleconferenced focus groups were taped and transcribed. Transcripts were examined for emerging themes. Credibility, transferability and confirmability were underwritten by a clear audit trail. RESULTS: Participants identified two factors that influenced death certification: clinical uncertainty and the family. Other themes provided an understanding of the personal and professional concerns for GPs. CONCLUSION: Improving death certification accuracy is a complex issue and needs to take into consideration factors that influence certifiers.

Assessing the competence of practicing physicians in New Zealand, Canada, and the United Kingdom: progress and problems.

Members of the public expect practicing physicians to be competent. They expect poorly performing physicians to be identified and either helped or removed from practice. "Maintenance of professional standards" by continuing education does not identify the poorly performing physician; assessment of clinical performance is necessary for that. Assessment may be responsive-ie, following a complaint- or periodic, either for all physicians or for an identified high-risk group. A thorough review using a range of tools is appropriate for a responsive assessment but is not practical for periodic assessment for all. A single, valid, reliable, and practical screening tool has yet to be devised to identify physicians whose practice is suboptimal. Further, articulate commentators are concerned about the harm that too-intensive scrutiny of professional performance may cause. We conclude that high performance by all physicians throughout their careers cannot be fully ensured, but it is nonetheless the responsibility of licensing bodies to use reasonable methods to determine whether performance remains acceptable. Such methods should be shown scientifically to be accurate, valid, and reliable for practicing physicians. Such an approach is likely to encourage the agreement and cooperation of the profession. To do less risks losing the trust of the public.

Perceptions of migrant doctors joining the New Zealand medical workforce.

New Zealand, like many first World countries, has become increasingly dependent on overseas-trained doctors (OTDs). This qualitative study identifies and explores issues of concern to OTDs when first integrating into the New Zealand medical system through the New Zealand Registration Examination (NZREX) pathway. The data were collected using semistructured interviews and focus groups involving 10 OTDs who were working in a New Zealand hospital. The study identified four key issues: work issues which included difficulty finding employment and difficulty integrating into their work role; a bridging programme which improved the ability of OTDs to gain knowledge and experience of the New Zealand medical working environment; financial difficulties which were a major impediment to attaining registration and a career pathway in New Zealand; and bureaucratic barriers (including examinations and information availability), which were seen as necessary but unsympathetic processes in gaining registration. Sociocultural educational theory provides a useful framework for understanding the difficulties faced by OTDs integrating into a New Zealand medical workforce.

Healthline: do primary care doctors agree with the advice?

AIMS: To assess agreement between the advice to symptomatic callers to Healthline, and that advised by primary care doctors given the same clinical information, and thus to assess the safety of Healthline advice. METHODS: Ninety records of symptomatic calls to Healthline were examined by three primary care specialists, blinded to the actual advice given. They independently recorded what they would have advised, and their advice was compared with that actually given by the Healthline nurse guided by Care Enhance Call Centre software. RESULTS: Variation among the three doctors was greater than that between the median doctor and Healthline. In 82% of cases, the median doctor triaged to an endpoint close to (or lower than) Healthline. In all but one of the remainder, at least one doctor thought there was no risk to the patient (i.e. in 99% of cases). Review of that case indicated nurse error and the guideline itself was judged to be safe. CONCLUSION: New Zealand primary care specialists regarded the Care Enhance Call Centre decision support software used by Healthline as clinically safe.

Doctors whose competence has been reviewed under the Medical Practitioners Act 1995.

AIM: An analysis of referrals for competence reviews since the introduction of the Medical Practitioners Act 1995. METHODS: A retrospective file review at the Medical Council of New Zealand. RESULTS: In the six years to 1 July 2002, 258 doctors were referred. The characteristics of the referrals and the concerns, and the demographics of the doctors are presented. Competence reviews were ordered for 114 doctors and carried out for 92, of whom 23 did not meet the standard. The demographics of this group are also presented. CONCLUSIONS: Of the competence concerns received by the Council, less than half result in a decision to review the doctor's competence, and of these only one quarter led to the finding that the doctor did not to meet the required standard. The characteristics of this group appear to match overseas findings, but the numbers in New Zealand are small. The cost of uncovering this small group is significant.

A telephone advice line does not decrease the number of presentations to Christchurch Emergency Department, but does decrease the number of phone callers seeking advice.

AIM: To describe the effect of a pilot national telephone advice service (Healthline) on a public hospital emergency department. METHODS: We prospectively gathered information from the Christchurch Hospital Emergency Department (ED) computer- and non-computer-based information systems, for a six-month period during the operation of Healthline. We compared the data with five earlier periods when Healthline was not running. In addition, Healthline collected and analysed data from call log information. RESULTS: There was a small increase (1.1%) in ED attendance during the study period. Patients referred by Healthline had a similar triage distribution to the general ED population, but a lower admission rate (29% vs 47%). Telephone calls to the ED dropped dramatically during the study period. CONCLUSIONS: Healthline had little effect on overall ED census and appeared to refer patients with similar acuity to the general ED census. It decreased the workload for ED nursing staff charged with answering advice calls.