Measuring doctor appointment availability in Northland general practice.

INTRODUCTION Primary care access is associated with improved patient outcomes. Availability of appointments in general practice is one measure of access. Northland's demographics and high ambulatory sensitive hospitalisation rates may indicate constrained appointment availability. Our study aims were to determine appointment availability and establish the feasibility of measuring appointment availability through an automated process. METHODS An automated electronic query was created, run through a third party software programme that interrogated Northland general practice patient management systems. The time to third next available appointment (TNAA) was calculated for each general practitioner (GP) and a mean calculated for each practice and across the region. A research assistant telephone request for an urgent GP appointment captured the time to the urgent appointment and type of urgent appointment used to fit patients in. Regression analysis was used to determine the relationships between deprivation, patients per GP, and the use of walk-in clinics. RESULTS The mean TNAA was 2.5 days. 12% of practices offered walk-in clinics. There was a significant relationship between TNAA and increasing number of walk-in clinics. CONCLUSION The TNAA of 2.5 days indicates the possibility that routine appointments are constrained in Northland. However, TNAA may not give a reliable measure of urgent appointment availability and the measure needs to be interpreted by taking into account practice characteristics. Walk-in clinics, although increasing the availability of urgent appointments, may lead to more pressure on routine appointments. Using an electronic query is a feasible way to measure routine GP appointment availability.

The Northland emergency meningococcal C vaccination programme.

AIM: This paper describes an emergency meningococcal C vaccination programme implemented in Northland, New Zealand in 2011. The programme aimed to reduce the impact of a meningococcal group C outbreak on the Northland population, through vaccination of 85% of children and youth 12 months to <20 years with a meningococcal serogroup C conjugate vaccine. METHOD: The emergency vaccination programme targeted an estimated population of 44,000 children and youth. Vaccinations were promoted and delivered by Northland District Health Board Public Health Nursing Service, Primary Health Organisations, General Practice, and Maori provider services, at schools, general practice clinics, via community clinics and outreach home-based vaccination services. RESULTS: 32,410 children and youth were vaccinated. Overall coverage reached 73% (72% Maori, 75% non-Maori). Coverage differed across age, ethnic groups, school decile and geographic location. Vaccination coverage was highest for children 5 to <13 years at 84% for Maori and 81% for non-Maori. Coverage was lowest for the 17 to <20 year age group at 46% for Maori and 63% for non-Maori. In the pre-school population, 67% of Maori and 76% of non-Maori children 12 months to <5 years received vaccination. The 13 to <17 year age group reached 71% coverage for Maori and 70% for non-Maori. CONCLUSION: Equitable, high vaccination coverage is attainable in an emergency vaccination programme in New Zealand. However a range of service options, including community outreach, are necessary to reduce access barriers for some groups. The programme presented useful insights into what is possible with focussed attention to adapting services to meet diverse needs.

Kaupapa Maori Action Research to improve heart disease services in Aotearoa, New Zealand.

Action Research can be a powerful tool for change and improvement in health services for indigenous people when utilised within an appropriate framework. The project Maori Utilisation & Experience of Ischaemic Heart Disease Management illustrates this convergence in its use of Kaupapa Maori Action Research methods in its efforts to improve the health and well-being of Maori within the northern region of Aotearoa/New Zealand. We outline the research processes and outcomes obtained through the application of 'by Maori for Maori' approaches to understanding Maori pathways and barriers to care for ischaemic heart disease. Maori understandings of their illness and experiences of treatment, and healthcare providers' perspectives on care of Maori with ischaemic heart disease, were combined into Maori-led actions to improve service provision. The paper examines critical factors in an action research approach to health service innovations and implications for efforts to reduce entrenched health disparities.

From secondary prevention to primary prevention: a unique strategy that gives hope to a country ravaged by meningococcal disease.

New Zealand has been affected by an epidemic of group B meningococcal disease dominated by a strain defined as, B:4:P1.7b,4. Over 5550 cases and 222 deaths have been reported since 1991 in a population of 4 million people. Meningococcal disease cases notified on EpiServ database operated by Institute of Environmental Science and Research Limited through to 30 September 2004. Through the collaborative efforts of a government agency, vaccine company, university and laboratory institute, clinical trials of the Chiron produced outer membrane vesicle (OMV) strain-specific MeNZB vaccine were run in rapid succession. The delivery of MeNZB will be New Zealand's largest immunisation programme with three doses given at 6-week intervals to over 1 million people aged 6 weeks-19 year olds inclusive. Planning, co-ordinating and delivering the immunisation programme is a challenging project for the New Zealand Health Sector.