Understanding weight management experiences from patient perspectives: qualitative exploration in general practice.

BACKGROUND: Obesity is a complex health issue affecting the quality of life of individuals and contributing to an unsustainable strain on healthcare professionals and national health systems. National policy guidelines indicate that general practice is best suited to deliver obesity healthcare, however, obesity rates continue to rise worldwide indicating interventions are ineffective in this space. The aim of this study was to explore the weight management experiences from patient perspectives. METHODS: This qualitative study used semi-structured interviews with 16 rural Waikato general practice patients. Interviews were analysed using reflexive thematic analysis. RESULTS: Four themes were identified: Inconsistent Information, Significance of Holistic Factors, Obesity Centre Need, and Education. Participants expressed frustration at contradictory health messages, commercial company and 'expert' definition distrust, and that 'holistic' aspects to health significant to the weight management journey were unable to be addressed in general practice. CONCLUSION: Whilst primary care is positioned as suitable for delivering obesity healthcare, this study found that participants do not perceive general practice to be equipped to deliver this care. Instead, participants argued for a specialist obesity centre capable of meeting all their obesity healthcare needs. Further, wider issues including on-line commodification of health and neo-liberal capitalism - factors that exploit people with a stigmatised health issue - can cause further harm to the participant. A radical modernisation of education, information, and resources from regulated, qualified and 'trusted' healthcare professionals who can provide safe, non-stigmatising supportive services is recommended to meet the unique and changing food climate, reduce obesity rates and improve health outcomes.

Metabolic screening in primary care for patients with schizophrenia or schizoaffective disorder and taking antipsychotic medication.

INTRODUCTION Life expectancy in patients with schizophrenia is 15-20 years less than the general population. A dominant cause of morbidity and mortality in these patients is cardiovascular disease. Adverse consequences of modifiable cardiovascular risk factors can be reduced by regular monitoring of metabolic outcomes and intervention if required. AIM To evaluate the metabolic screening in primary care for patients with schizoaffective disorders managed in primary care. To show the usefulness of combining simple practice audits in evaluating such areas of clinical practice. METHODS An audit was undertaken in eight general practices in the Waikato and Bay of Plenty regions of New Zealand. Specifically, the monitoring of patients with schizophrenia or schizoaffective disorder whose antipsychotic medication was prescribed by primary care doctors was audited. Patient monitoring was compared to the guideline recommendation of the Royal Australian and New Zealand College of Psychiatrists (RANZCP) and the Best Practice Advisory Centre (BPAC). RESULTS In total, 117 patients were included in the audit and none were fully monitored, as recommended by the RANZCP guidelines. Although two-thirds of patients had been evaluated for glycosylated haemoglobin (HbA1c), lipids, blood pressure, complete blood count and weight, <10% of patients had had prolactin, waist circumference or electrocardiogram measurements recorded. The proportion of patients having a HbA1c measured was also significantly higher in younger patients and patients who were non-Maori or enrolled with an urban practice (all P<0.05). When using the simplified BPAC guidelines, half of all patients were correctly monitored. DISCUSSION These findings show there is room for improvement in the monitoring of patients receiving antipsychotic medication in primary care. This may indicate the need for clear guidance and general practitioner education around the monitoring requirements of these patients. Alternatively, a more simplified monitoring protocol may need to be developed. This audit has also shown that there is value in several practices completing the same audit and providing a larger cohort of patients for pooled data analysis.

The impact of multimorbidity on people's lives: a cross-sectional survey.

AIMS: To describe the experiences of people living with multimorbidity in New Zealand. METHODS: We conducted a cross-sectional survey of adults with multimorbidity enrolled in two primary health organisations in New Zealand. Potential participants with multimorbidity were identified using retrospective hospital discharge data coded for long-term conditions. Sampling was stratified by ethnicity (Maori, Pacific and non-Maori/non-Pacific). Analysis was descriptive, with some responses compared to the general population estimates from the New Zealand Health Survey. RESULTS: A total of 234 participants completed the survey (mean age 65.2). Self-reported physical health was poor among the cohort: forty-one percent of participants reported only 'fair' or 'poor' general health, compared to 13.5% in the general population (age and sex standardised), with similar results for both self-reported mental health and physical health. Self-reported health was poorer for Maori and Pacific participants. The majority (70%) of those who were working reported their health had affected their productivity, while nearly 20% of participants reported financial difficulty in taking care of their health needs. CONCLUSIONS: These results emphasise the serious impact multimorbidity has on patients' health status compared to the general population. This research supports the development of holistic patient-centred care models designed to improve patient outcomes.

Quality-of-life outcomes for adult cochlear implant recipients in New Zealand.

AIM: There were two aims to this study: to investigate the effect of a cochlear implant (CI) on quality-of-life (QOL) for adult recipients in New Zealand; and to determine which aspects of life that these changes are most noticed. METHOD: There were two groups of participants: CI Group - 94 postlingually deafened adult CI recipients; and WL group - 70 postlingually deafened adults on the waiting list (WL) for a CI. Two questionnaires were developed for this study. RESULTS: The results showed that cochlear implantation had a significant positive impact on QOL for recipients. The CI group had significantly higher ratings in all areas of QOL and satisfaction compared to the WL group. CONCLUSION: Overall, high QOL and satisfaction ratings were obtained from CI recipients. The significantly lower ratings from those on the WL for an implant highlight the difficulties experienced by those with a significant hearing impairment. Assessment of CI outcomes should include QOL measures in order to provide a more holistic picture.

Epidemiology of thyroid disease in Hamilton (New Zealand) general practice.

OBJECTIVE: To retrospectively review health records in two general practices in Hamilton, New Zealand (NZ) linking three data sources to estimate the prevalence of diagnosed thyroid dysfunction (TD). METHODS: A record-linkage study using computerised searches to find cases of diagnosed TD by diagnostic codes, prescribing data, and laboratory data. Data was verified against computerised and written records. RESULTS: The prevalence of diagnosed TD was 3.1%. Overt hypothyroidism was diagnosed in 2.5%, overt hyperthyroidism in 0.2% and 'other' conditions such as goitres, nodules and thyroiditis in 0.4% of the study population. CONCLUSIONS: This study provides a representation of TD in the community prior to mandatory iodine fortification. Our prevalence data is similar to national and international literature with the burden of TD being greater in women and in the older population. IMPLICATIONS: A national study with a sufficient sample of Maori and Pacific patients is needed before supplementation with iodine is introduced.