Ian ST GEORGE - Academia.edu (original) (raw)
Papers by Ian ST GEORGE
New Zealand medical journal (Print), Feb 16, 2007
Aims To show the deprivation indices of the addresses of callers to Healthline. Methods A retrosp... more Aims To show the deprivation indices of the addresses of callers to Healthline. Methods A retrospective analysis of routinely collected addresses of callers to Healthline in two, one-week sample periods, geocoded and matched with the NZDep2001 Index of Deprivation. Results Call rates increased with increasing level of deprivation of caller address, except at the highest levels of deprivation, when there was a decrease.
The British journal of general practice : the journal of the Royal College of General Practitioners, 2005
BACKGROUND Death certificate inaccuracies have implications for funding and planning public healt... more 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 fa...
Members of the public expect practicing physicians to be competent. They expect poorly performing... more 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 n...
The New Zealand Medical Journal, 2003
AIM An analysis of referrals for competence reviews since the introduction of the Medical Practit... more 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.
Australian family physician, 2008
BACKGROUND Most Australian and all New Zealand residents now have 24 hour access to free telephon... more 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.
Background Death certificate inaccuracies have implications for funding and planning public healt... more 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.
Published by the Department of Conservation, Wellington Conservancy, New Zealand Paperback, 194 p... more Published by the Department of Conservation, Wellington Conservancy, New Zealand Paperback, 194 pages, 150 × 205 mm, NZ, 2007 ISBN 978-0-478-14222-8 NZ$20.00 Reviewed by Murray Dawson Comprising some 25,000 species worldwide, the Orchidaceae is one of the largest families of fl owering plants. Many hybrids and cultivars have distinctive and showy fl owers and constitute a major part of the horticultural and cut-fl ower trade. Indigenous species are also greatly regarded by enthusiasts and some have high conservation values. Most countries, including New Zealand, have devoted orchid groups and societies. For these reasons, the new fi eld guide Wild orchids of the lower North Island is sure to attract interest. This d book is published by the Department of Conservation (DOC), and three of the authors are well-known DOC staff: Peter de Lange is a leading plant conservation scientist based in Auckland, and the other two are based in Wellington; Jeremy Rolfe is a botanist and photographe...
The New Zealand medical journal, Jan 16, 2007
The New Zealand medical journal, Jan 17, 2006
New Zealand, like many first World countries, has become increasingly dependent on overseas-train... more 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 re...
The New Zealand medical journal, Jan 28, 2005
To assess agreement between the advice to symptomatic callers to Healthline, and that advised by ... more 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. 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. 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. New Zealand primary care specialists regarded the Care Enhance Call Cent...
The British journal of general practice : the journal of the Royal College of General Practitioners, 2005
Death certificate inaccuracies have implications for funding and planning public health services,... more 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. To explore what factors influence GPs as they complete death certificates. Focus groups held by teleconference with 16 GPs. New Zealand general practice. 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. 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. Improving death certification accuracy is a complex issue and needs to take into consideration factors that influence certifiers.
The New Zealand medical journal, Jan 6, 2003
An analysis of referrals for competence reviews since the introduction of the Medical Practitione... more An analysis of referrals for competence reviews since the introduction of the Medical Practitioners Act 1995. A retrospective file review at the Medical Council of New Zealand. 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. 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.
The New Zealand medical journal, Jan 28, 2001
To acquaint New Zealand doctorsabout nurse telephone triage using call centre technology, and to ... more To acquaint New Zealand doctorsabout nurse telephone triage using call centre technology, and to report the activities of Healthline, a pilot call centre telephone triage project in New Zealand. Data for the second quarter of Healthline's activities are reported. Healthline received about 100 calls a day, mostly after hours, and typically from symptomatic patients seeking health advice. Women and children were the most frequent users; Maori used the service in proportion to their representation in the population. Common symptoms were to those encountered in primary medical care. Requests for specific health information were usually about the health issues of the day Callers were more often directed to contact general practitioners than any other careproviders. The triage advice provided was often different from the caller's original intention about the timing and and ofcare they would have sought. Satisfaction with the service among Maori and non-Maori callers was high. Heal...
Australian family physician, 2008
Most Australian and all New Zealand residents now have 24 hour access to free telephone advice an... more 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. 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. 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.
Health Informatics, 2011
Primary care nurses have given advice and assessed the severity of symptoms by telephone since te... more Primary care nurses have given advice and assessed the severity of symptoms by telephone since telephones were introduced and in 1993 Tisdale29 reported a pilot service in four small New Zealand centers, with nurses answering telephone health queries using simple diagnostic software and health databases. While it was not popular enough to warrant continuing, Tisdale wrote that this type of
Aims To assess agreement between the advice to symptomatic callers to Healthline, and that advise... more 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
Aims To show the deprivation indices of the addresses of callers to Healthline. Methods A retrosp... more Aims To show the deprivation indices of the addresses of callers to Healthline. Methods A retrospective analysis of routinely collected addresses of callers to Healthline in two, one-week sample periods, geocoded and matched with the NZDep2001 Index of Deprivation. Results Call rates increased with increasing level of deprivation of caller address, except at the highest levels of depri- vation, when
New Zealand medical journal (Print), Feb 16, 2007
Aims To show the deprivation indices of the addresses of callers to Healthline. Methods A retrosp... more Aims To show the deprivation indices of the addresses of callers to Healthline. Methods A retrospective analysis of routinely collected addresses of callers to Healthline in two, one-week sample periods, geocoded and matched with the NZDep2001 Index of Deprivation. Results Call rates increased with increasing level of deprivation of caller address, except at the highest levels of deprivation, when there was a decrease.
The British journal of general practice : the journal of the Royal College of General Practitioners, 2005
BACKGROUND Death certificate inaccuracies have implications for funding and planning public healt... more 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 fa...
Members of the public expect practicing physicians to be competent. They expect poorly performing... more 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 n...
The New Zealand Medical Journal, 2003
AIM An analysis of referrals for competence reviews since the introduction of the Medical Practit... more 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.
Australian family physician, 2008
BACKGROUND Most Australian and all New Zealand residents now have 24 hour access to free telephon... more 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.
Background Death certificate inaccuracies have implications for funding and planning public healt... more 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.
Published by the Department of Conservation, Wellington Conservancy, New Zealand Paperback, 194 p... more Published by the Department of Conservation, Wellington Conservancy, New Zealand Paperback, 194 pages, 150 × 205 mm, NZ, 2007 ISBN 978-0-478-14222-8 NZ$20.00 Reviewed by Murray Dawson Comprising some 25,000 species worldwide, the Orchidaceae is one of the largest families of fl owering plants. Many hybrids and cultivars have distinctive and showy fl owers and constitute a major part of the horticultural and cut-fl ower trade. Indigenous species are also greatly regarded by enthusiasts and some have high conservation values. Most countries, including New Zealand, have devoted orchid groups and societies. For these reasons, the new fi eld guide Wild orchids of the lower North Island is sure to attract interest. This d book is published by the Department of Conservation (DOC), and three of the authors are well-known DOC staff: Peter de Lange is a leading plant conservation scientist based in Auckland, and the other two are based in Wellington; Jeremy Rolfe is a botanist and photographe...
The New Zealand medical journal, Jan 16, 2007
The New Zealand medical journal, Jan 17, 2006
New Zealand, like many first World countries, has become increasingly dependent on overseas-train... more 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 re...
The New Zealand medical journal, Jan 28, 2005
To assess agreement between the advice to symptomatic callers to Healthline, and that advised by ... more 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. 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. 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. New Zealand primary care specialists regarded the Care Enhance Call Cent...
The British journal of general practice : the journal of the Royal College of General Practitioners, 2005
Death certificate inaccuracies have implications for funding and planning public health services,... more 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. To explore what factors influence GPs as they complete death certificates. Focus groups held by teleconference with 16 GPs. New Zealand general practice. 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. 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. Improving death certification accuracy is a complex issue and needs to take into consideration factors that influence certifiers.
The New Zealand medical journal, Jan 6, 2003
An analysis of referrals for competence reviews since the introduction of the Medical Practitione... more An analysis of referrals for competence reviews since the introduction of the Medical Practitioners Act 1995. A retrospective file review at the Medical Council of New Zealand. 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. 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.
The New Zealand medical journal, Jan 28, 2001
To acquaint New Zealand doctorsabout nurse telephone triage using call centre technology, and to ... more To acquaint New Zealand doctorsabout nurse telephone triage using call centre technology, and to report the activities of Healthline, a pilot call centre telephone triage project in New Zealand. Data for the second quarter of Healthline's activities are reported. Healthline received about 100 calls a day, mostly after hours, and typically from symptomatic patients seeking health advice. Women and children were the most frequent users; Maori used the service in proportion to their representation in the population. Common symptoms were to those encountered in primary medical care. Requests for specific health information were usually about the health issues of the day Callers were more often directed to contact general practitioners than any other careproviders. The triage advice provided was often different from the caller's original intention about the timing and and ofcare they would have sought. Satisfaction with the service among Maori and non-Maori callers was high. Heal...
Australian family physician, 2008
Most Australian and all New Zealand residents now have 24 hour access to free telephone advice an... more 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. 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. 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.
Health Informatics, 2011
Primary care nurses have given advice and assessed the severity of symptoms by telephone since te... more Primary care nurses have given advice and assessed the severity of symptoms by telephone since telephones were introduced and in 1993 Tisdale29 reported a pilot service in four small New Zealand centers, with nurses answering telephone health queries using simple diagnostic software and health databases. While it was not popular enough to warrant continuing, Tisdale wrote that this type of
Aims To assess agreement between the advice to symptomatic callers to Healthline, and that advise... more 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
Aims To show the deprivation indices of the addresses of callers to Healthline. Methods A retrosp... more Aims To show the deprivation indices of the addresses of callers to Healthline. Methods A retrospective analysis of routinely collected addresses of callers to Healthline in two, one-week sample periods, geocoded and matched with the NZDep2001 Index of Deprivation. Results Call rates increased with increasing level of deprivation of caller address, except at the highest levels of depri- vation, when