Aim: Gout is a health equity issue for Māori and Pacific peoples because disparities in quality o... more Aim: Gout is a health equity issue for Māori and Pacific peoples because disparities in quality of care exist. This study aims to describe domains of access that may contribute to the optimisation of gout care and, therefore, address health inequity. Methods: The practice management system at one general practice in Auckland was used to identify enrolled patients with gout, using disease codes and medication lists. Barriers to access for the cohort were investigated using staff knowledge and the practice management system. The general practice is uniquely situated within an urban marae (traditional meeting house) complex serving a predominantly Māori community. This enables a focus on domains of access other than cultural safety. Results: Of 3,095 people enrolled at the practice, 268 were identified as having gout. Of these, 94% had at least one other long-term health condition. The majority of people with gout enrolled at the practice have employment roles incongruent with the clinic's opening hours. Conclusions: Social circumstances, such as employment and availability of transport, should be actively discussed with all patients and recorded in the practice management system. Reorientation of health services, including hours of access, is evidentially required to ensure optimal management of gout and possibly other health conditions.
INTRODUCTION Gout remains a health equity issue; Māori and Pacific peoples are disproportionately... more INTRODUCTION Gout remains a health equity issue; Māori and Pacific peoples are disproportionately afflicted, with increased burden and loss of quality of life, yet are less likely to receive appropriate management, which mainly occurs in primary care. AIM This study aims to understand the perspectives of the mainly Māori and Pacific clinicians and staff at an urban marae practice about barriers and challenges to delivering effective care to a Māori and Pacific community with high burden of gout. METHODS Semi-structured interviews were conducted with 10 staff members delivering health care to a mostly Indigenous community. Interviews sought to ascertain staff views of enablers and barriers to optimal gout management and analyse them thematically. RESULTS Three themes were identified: community disadvantage; demands unique to Indigenous providers; and challenges and opportunities for optimising gout management. High prevalence and heavy impact of gout on wellbeing in the community was...
The type of bariatric surgery is important for whether medicines will be absorbed. A gastric bypa... more The type of bariatric surgery is important for whether medicines will be absorbed. A gastric bypass is the most common type of bariatric surgery, involving a restrictive process (reducing the size of the stomach) and a malabsorptive process (bypassing the duodenum, jejunum and much of the small intestine). This is usually the Roux-en-Y Gastric Bypass, but may also be a jejunoileal bypass or biliopancreatic diversion. Gastric banding or sleeving is a restrictive procedure only, reducing the stomach size and having less impact of the absorption of medicines and nutrients.1
CORRESPONDENCE TO: Linda Bryant Clinical Manager, Clinical Advisory Pharmacist, East Health Trust... more CORRESPONDENCE TO: Linda Bryant Clinical Manager, Clinical Advisory Pharmacist, East Health Trust PHO PO Box 38248, Howick Auckland, New Zealand l.bryant@auckland.ac.nz NUGGETS of KNOWLEDGE provides succinct summaries of pharmaceutical evidence about treatment of common conditions presenting in primary care and possible adverse drug reactions. J PRIM HEALTH CARE. 2015;7(1):78–80. Long-term antibiotics to reduce COPD exacerbations: pros and cons
In February 2012 the FDA Consumer Information website1 warned that statins may cause subtle cogni... more In February 2012 the FDA Consumer Information website1 warned that statins may cause subtle cognitive impairment such as mild memory loss or forgetfulness and ‘fuzzy’ or unfocused thinking. This uncommon adverse effect is reversible on stopping the statin. The mild cognitive impairment is not dementia. Statins do not prevent or treat dementia per se,2,3 but may help reduce risk of multi-infarct or vascular dementia. It is important for the patient to know that subtle changes in memory or cognitive function does not mean statin-induced dementia.
Rebound and hypersecretion after proton pump inhibitors treatment There is evidence of rebound hy... more Rebound and hypersecretion after proton pump inhibitors treatment There is evidence of rebound hypersecretion after PPI therapy, particularly longer term therapy.3–10 There is no evidence of rebound hypersecretion after one week of PPI treatment11,12 but it has been demonstrated after eight weeks8 and can last more than eight weeks, but less than six months after long-term proton pump inhibition.4
CORRESPONDENCE TO: Linda Bryant Clinical Manager, Clinical Advisory Pharmacist, East Health Trust... more CORRESPONDENCE TO: Linda Bryant Clinical Manager, Clinical Advisory Pharmacist, East Health Trust PHO PO Box 38248, Howick Auckland, New Zealand l.bryant@auckland.ac.nz NUGGETS of KNOWLEDGE provides succinct summaries of pharmaceutical evidence about treatment of common conditions presenting in primary care and possible adverse drug reactions. J PRIM HEALTH CARE 2014;6(4):336–337. Falls in older people are multifactorial and risk factors include muscle weakness. Statins are well known for causing muscle pain, but muscle weakness, particularly in the older person, appears to be less recognised in clinical practice. Unfortunately, the term myopathy is usually poorly defined in clinical trials of statins and it is difficult to determine the rate of muscle weakness, specifically, within this general term.
INTRODUCTION: The prevalence of gout among Maori is one of the highest in the world. This study e... more INTRODUCTION: The prevalence of gout among Maori is one of the highest in the world. This study explores the perceptions, understanding and treatment of gout among Maori. METHODS: A qualitative general inductive approach was used, guided by kaupapa Maori principles. Participants included 12 Maori aged 4879 years with gout. Semi-structured interviews were undertaken, taped and transcribed. Themes were identified from transcripts. FINDINGS: Participants described overwhelming sufferance due to gout, which was sometimes considered inevitable. All participants believed or had been informed that gout is caused by food and/or drink. This led to feelings of self-blame and blame from partners and employers. Whanau (family) were a resource for information and a support when independence was limited. Rongoa (traditional medicine) played a role in the lives of rural but not urban participants. Many reported stoicism, putting up with pain and putting others before themselves, as the Maori way...
Aim: Gout is a health equity issue for Māori and Pacific peoples because disparities in quality o... more Aim: Gout is a health equity issue for Māori and Pacific peoples because disparities in quality of care exist. This study aims to describe domains of access that may contribute to the optimisation of gout care and, therefore, address health inequity. Methods: The practice management system at one general practice in Auckland was used to identify enrolled patients with gout, using disease codes and medication lists. Barriers to access for the cohort were investigated using staff knowledge and the practice management system. The general practice is uniquely situated within an urban marae (traditional meeting house) complex serving a predominantly Māori community. This enables a focus on domains of access other than cultural safety. Results: Of 3,095 people enrolled at the practice, 268 were identified as having gout. Of these, 94% had at least one other long-term health condition. The majority of people with gout enrolled at the practice have employment roles incongruent with the clinic's opening hours. Conclusions: Social circumstances, such as employment and availability of transport, should be actively discussed with all patients and recorded in the practice management system. Reorientation of health services, including hours of access, is evidentially required to ensure optimal management of gout and possibly other health conditions.
INTRODUCTION Gout remains a health equity issue; Māori and Pacific peoples are disproportionately... more INTRODUCTION Gout remains a health equity issue; Māori and Pacific peoples are disproportionately afflicted, with increased burden and loss of quality of life, yet are less likely to receive appropriate management, which mainly occurs in primary care. AIM This study aims to understand the perspectives of the mainly Māori and Pacific clinicians and staff at an urban marae practice about barriers and challenges to delivering effective care to a Māori and Pacific community with high burden of gout. METHODS Semi-structured interviews were conducted with 10 staff members delivering health care to a mostly Indigenous community. Interviews sought to ascertain staff views of enablers and barriers to optimal gout management and analyse them thematically. RESULTS Three themes were identified: community disadvantage; demands unique to Indigenous providers; and challenges and opportunities for optimising gout management. High prevalence and heavy impact of gout on wellbeing in the community was...
The type of bariatric surgery is important for whether medicines will be absorbed. A gastric bypa... more The type of bariatric surgery is important for whether medicines will be absorbed. A gastric bypass is the most common type of bariatric surgery, involving a restrictive process (reducing the size of the stomach) and a malabsorptive process (bypassing the duodenum, jejunum and much of the small intestine). This is usually the Roux-en-Y Gastric Bypass, but may also be a jejunoileal bypass or biliopancreatic diversion. Gastric banding or sleeving is a restrictive procedure only, reducing the stomach size and having less impact of the absorption of medicines and nutrients.1
CORRESPONDENCE TO: Linda Bryant Clinical Manager, Clinical Advisory Pharmacist, East Health Trust... more CORRESPONDENCE TO: Linda Bryant Clinical Manager, Clinical Advisory Pharmacist, East Health Trust PHO PO Box 38248, Howick Auckland, New Zealand l.bryant@auckland.ac.nz NUGGETS of KNOWLEDGE provides succinct summaries of pharmaceutical evidence about treatment of common conditions presenting in primary care and possible adverse drug reactions. J PRIM HEALTH CARE. 2015;7(1):78–80. Long-term antibiotics to reduce COPD exacerbations: pros and cons
In February 2012 the FDA Consumer Information website1 warned that statins may cause subtle cogni... more In February 2012 the FDA Consumer Information website1 warned that statins may cause subtle cognitive impairment such as mild memory loss or forgetfulness and ‘fuzzy’ or unfocused thinking. This uncommon adverse effect is reversible on stopping the statin. The mild cognitive impairment is not dementia. Statins do not prevent or treat dementia per se,2,3 but may help reduce risk of multi-infarct or vascular dementia. It is important for the patient to know that subtle changes in memory or cognitive function does not mean statin-induced dementia.
Rebound and hypersecretion after proton pump inhibitors treatment There is evidence of rebound hy... more Rebound and hypersecretion after proton pump inhibitors treatment There is evidence of rebound hypersecretion after PPI therapy, particularly longer term therapy.3–10 There is no evidence of rebound hypersecretion after one week of PPI treatment11,12 but it has been demonstrated after eight weeks8 and can last more than eight weeks, but less than six months after long-term proton pump inhibition.4
CORRESPONDENCE TO: Linda Bryant Clinical Manager, Clinical Advisory Pharmacist, East Health Trust... more CORRESPONDENCE TO: Linda Bryant Clinical Manager, Clinical Advisory Pharmacist, East Health Trust PHO PO Box 38248, Howick Auckland, New Zealand l.bryant@auckland.ac.nz NUGGETS of KNOWLEDGE provides succinct summaries of pharmaceutical evidence about treatment of common conditions presenting in primary care and possible adverse drug reactions. J PRIM HEALTH CARE 2014;6(4):336–337. Falls in older people are multifactorial and risk factors include muscle weakness. Statins are well known for causing muscle pain, but muscle weakness, particularly in the older person, appears to be less recognised in clinical practice. Unfortunately, the term myopathy is usually poorly defined in clinical trials of statins and it is difficult to determine the rate of muscle weakness, specifically, within this general term.
INTRODUCTION: The prevalence of gout among Maori is one of the highest in the world. This study e... more INTRODUCTION: The prevalence of gout among Maori is one of the highest in the world. This study explores the perceptions, understanding and treatment of gout among Maori. METHODS: A qualitative general inductive approach was used, guided by kaupapa Maori principles. Participants included 12 Maori aged 4879 years with gout. Semi-structured interviews were undertaken, taped and transcribed. Themes were identified from transcripts. FINDINGS: Participants described overwhelming sufferance due to gout, which was sometimes considered inevitable. All participants believed or had been informed that gout is caused by food and/or drink. This led to feelings of self-blame and blame from partners and employers. Whanau (family) were a resource for information and a support when independence was limited. Rongoa (traditional medicine) played a role in the lives of rural but not urban participants. Many reported stoicism, putting up with pain and putting others before themselves, as the Maori way...
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