Laboratory tests for inflammatory response, thyroid function and infectious diarrhoea were not being ordered as recommended by clinical guidelines.
To measure changes in community laboratory-test ...ordering following marketing programmes promoting guidelines recommendations.
Controlled before-and-after study involving 2 years of national laboratory payment data before and after each intervention. Comparisons were with doctors ordering the same tests but not receiving interventions.
New Zealand primary care.
3161, 3140 and 3335 general practitioners and 2424, 2443 and 2766 Comparison doctors ordering inflammatory response, thyroid function and acute diarrhoea tests from community laboratories, July 2003 to March 2009.
Three separate marketing programmes to general practitioners, each comprising written material advising of guidelines recommendations, individual laboratory-test use feedback and professional development opportunities.
Number of tests, tests/doctor, patients having tests and tested patients/doctor/year before and after each intervention. Change in expenditure from before each intervention to after.
For Intervention doctors, erythrocyte sedimentation rate tests decreased 60.0% after the intervention; tests for C-reactive protein increased 63.1%; simultaneous erythrocyte sedimentation rate and C-reactive protein orders decreased 32.6%. Tests for free thyroxine and free triiodothyronine decreased 44.1% and 36.0%. The proportion of thyroid function tests where thyroid-stimulating hormone was the sole test ordered increased from 43.2% before the intervention to 65.2% afterwards (p<0.001; 95% CI 21.7% to 22.2%). Testing for faecal culture decreased 31.5%, giardia and cryptosporidium 31.5%, and ova and parasites 56.9%. Faecal culture as the sole initial test increased from 31.4% to 39.1% (p<0.001; 95% CI 7.2% to 8.2%). Testing by Comparison doctors changed in the same direction but with significantly less magnitude. The estimated reduction in expenditure for study tests was 23.5%.
Clear information marketed to general practitioners improved the quality of laboratory test ordering for patients in New Zealand.
Community‐based forestry management is emerging as an important component of forest policies in the developing world. Using the Philippines as a case‐study, this article critically examines the way ...in which community‐based forestry is constructed and understood among government policy makers. The author suggests that the new policy discourse of community‐based forestry policy in the Philippines is still shaped by efforts to maintain centralized control over forest management and a political economy orientated towards commercial timber production using the principles of ‘scientific management’. While timber production and the technical aspects of forest management are emphasized, social and environmental considerations remain neglected.
This book investigates the experiences of older people who remain at home with care. It examines the transition points for the important life changes faced by family members who take on a greater ...care-giving role. The book draws on demographic analyses and qualitative fieldwork to explore the shift from independence to increasing dependence, and suggests that this transition constitutes movement into a new stage of life, that of an Age of Supported Independence. Applying the anthropological concept of rites of passage in their analysis, the authors focus on the changes in everyday living within the spatial environment of the home, the temporal organization of daily life, and the reshaping of relationships. They suggest that many older people - as well as the family members who become carers - remain in a state of `liminality`: unable to make sense of their new situation and experience and, despite assumptions that ageing-in-place sustains social connectedness, excluded from their communities. TOC:Introduction: Stake in the Ground.- Chapter 1: The Demographic and Policy Context of Supported Independence in Later Life.- Chapter 2: The Move from Independence.- Chapter 3: Space and Liminality.- Chapter 4: Temporality and Liminality.- Chapter 5: Relational Transitions.- Chapter 6: Seperation, Liminality and the Potential for Reconnections at Home with Care.- Chapter 7: Care Work and Reconnections.- Chapter 8: Reconnections - Supported Independence and Agency in Frailty
In 2001, the New Zealand government launched an ambitious health care information management and technology strategy that seeks to integrate the health sector, facilitate electronic health records ...and information portability and give patients greater information access. This article looks at the prospects for the strategy, against a background of extensive public health system restructuring in the 1990s. It notes that through this period, health purchasers and providers developed information systems in isolation from one another and with minimal central oversight. The result is a highly complex and firmly established architecture and an array of problems that need rectifying. Combined with present decentralised health structures, government capacity to influence activities is limited. The article concludes by reviewing current developments noting that advancement on the government's goals is likely to be incremental, across a range of areas, sometimes driven by providers and sometimes by central agencies.
The district health board (DHB) system is New Zealand's present structure for the governance and delivery of publicly-funded health care. An aim of the DHB system is to democratise health care ...governance, and a key element of DHBs is elected membership of their governing boards. This article focuses on the electoral component of DHBs. It reports on the first DHB elections of 2001 and recent 2004 elections. The article presents and discusses data regarding candidates, the electoral process, voter behaviour and election results. It suggests that the extent to which the DHB elections are contributing to aims of democratisation is questionable. (author abstract)
The district health board (DHB) system is New Zealand's present structure for the governance and delivery of publicly-funded health care. An aim of the DHB system is to democratise health care ...governance, and a key element of DHBs is elected membership of their governing boards. This article focuses on the electoral component of DHBs. It reports on the first DHB elections of 2001 and recent 2004 elections. The article presents and discusses data regarding candidates, the electoral process, voter behaviour and election results. It suggests that the extent to which the DHB elections are contributing to aims of democratisation is questionable. (author abstract)
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