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Ngaire Kerse

Publications and source records attributed to Ngaire Kerse.

15 recordsLinked to original sources
PubMed2005

Quality of residential care for older people: does education for healthcare assistants make a difference?

AIM: To determine the impact of a healthcare assistant education programme on the quality of care for older people living in a residential home in Auckland, New Zealand. METHOD: A pre- and post-intervention evaluation study was undertaken within a residential home for older people. Quality of care was established by two periods of non-participant time-sampling observation of residents, separated by a programme of 10 interactive teaching sessions for healthcare assistants. Informed consent was gained from all observed residents and staff. RESULTS: Using the Quality Assessment Project (QAP) quality measure, the non-participant time-sampling observation data identified a 12.5% increase in resident care that was considered appropriate and adequate (chi-squared=12.05) and an 11.53% decrease in resident care that was considered inappropriate and inadequate (chi-squared=11.43). The intermediate grades did not alter significantly. Residents with low functional activity scores (Barthel Index) received better care after the education intervention (chi-squared=32.99), as did residents with moderate cognitive impairment (Abbreviated Mental Test Score [AMTS]<8/10). CONCLUSION: Healthcare assistant education can positively impact on the quality of care given to older people in residential care.

Adult↗
PubMed2005

Residential care workers and residents: the New Zealand story.

AIMS: To describe the nature and size of long-term residential care homes in New Zealand; funding of facilities; and the ethnic and gender composition of residents and residential care workers nationwide. METHODS: A postal, fax, and email survey of all long-term residential care homes in New Zealand. RESULTS: Completed surveys were received from an eligible 845 facilities (response rate: 55%). The majority of these (54%) facilities housed less than 30 residents. Of the 438 (94%) facilities completing the questions about residents' ethnicity, 432 (99%) housed residents from New Zealand European (Pakeha) descent, 156 (33%) housed at least 1 Maori resident, 71 (15%) at least 1 Pacific (Islands) resident, and 61 (13%) housed at least 1 Asian resident. Facilities employed a range of ethnically diverse staff, with 66% reporting Maori staff. Less than half of all facilities employed Pacific staff (43%) and Asian staff (33%). Registered nursing staff were mainly between 46 and 60 years (47%), and healthcare assistant staff were mostly between 25 and 45 years old (52%). Wide regional variation in the ethnic make up of staff was reported. About half of all staff were reported to have moved within the previous 2 years. CONCLUSIONS: The age and turnover of the residential care workforce suggests the industry continues to be under threat from staffing shortages. While few ethnic minority residents live in long-term care facilities, staff come from diverse backgrounds, especially in certain regions.

Adult↗
PubMed2004

Cost-effectiveness of physical activity counselling in general practice.

AIM: To assess the cost-effectiveness of the 'Green Prescription' physical activity counselling programme in general practice. METHOD: Prospective cost-effectiveness study undertaken as part of a cluster randomised controlled trial with 12-month follow-up of 878 'less-active' patients aged 40-79 years in 42 general practices in the Waikato. The intervention was verbal advice and a written exercise prescription given by general practitioners, with telephone exercise specialist follow-up compared with usual care. Main outcome measures included cost per total and leisure-time physical activity gain from health-funders' and societal perspectives. RESULTS: Significant increases in physical activity were found in the randomised controlled trial. Programme-cost per patient was NZ170 dollars from a funder's perspective. The monthly cost-effectiveness ratio for total energy expenditure achieved was 11 dollars per kcal/kg/day. The incremental cost of converting one additional 'sedentary' adult to an 'active' state over a twelve-month period was NZ1,756 dollars in programme costs. CONCLUSION: Verbal and written physical activity advice given in general practice with telephone follow-up is an inexpensive way of increasing activity for sedentary people, and has the potential to have significant economic impact through reduction in cardiovascular and other morbidity and mortality.

Adult↗
PubMed2004

Circumstances and consequences of falls in residential care: the New Zealand story.

AIMS: To describe the circumstances and consequences of falls in long-term residential care homes in New Zealand. METHODS: A study followed 14 residential care facilities over 18 months and recorded all falls experienced by 680 residents (97% participation rate). The number and characteristics of falls are described according to the timing, activities, direction, and severity of falls. Predictors of injury are examined using regression techniques. RESULTS: 271 residents sustained 954 falls, 63% of which resulted in injury. The rate of falls increased in the afternoons especially in rest homes. Environmental hazards were involved with 15% of falls. Falling in the dining room was associated with fewer injuries, and falling from a standing height, and to the side, were independently associated with major injury such as hip fracture. CONCLUSION: The timing and circumstances of observed falls and their subsequent injuries is useful information for healthcare planners, and staff involved in the care of older people living in long-term residential care settings.

Accidental Falls↗
PubMed2004

Wearing slippers, falls and injury in residential care.

BACKGROUND: Risk factor studies for falls in residential care have not included factors related to the facilities themselves. OBJECTIVE: To identify risk factors for falls and injury related to the individual and the facility. METHOD: Cohort study with 1 to 17 months of followup. SETTING: A random sample of 14 residential care homes in Auckland, New Zealand. SUBJECTS: All residents were approached and 606 (97%) participated, mean (SD) age was 83 (11) years. 114 (19%) residents died and 64 (11%) were transferred. MEASURES: Rate of falls and injurious falls per resident year were measured. RESULTS: The mean rate of falls and injurious falls was 2.75 and 1.75 per resident year respectively. Factors independently associated with increased falls included: increased mobility (IRR 1.25; 95% CI 1.14-1.37), and less problematic behaviours (IRR 1.09, 95% CI 1.02-1.17), while unexpectedly digoxin use (IRR 0.56, 95% CI 0.33-0.97) was associated with decreased falls. Factors associated with increased risk of injury included being born in the UK (IRR 2.89, 95% CI 1.24-7.19) and being more mobile (OR 1.15, 95% CI 1.06-1.25), whereas wearing soft-soled shoes compared with slippers (IRR 0.50, 95% CI 0.28-0.90) and unexpectedly visual impairment (IRR 0.52, 95% CI 0.33-0.80) was associated with decreased injury. No significant factors related to the facility were identified. CONCLUSION: Falls are frequent in residential care facilities and risk factors related to footwear are potentially reversible. IMPLICATIONS: Residents should be encouraged to wear shoes rather than slippers.

Accidental Falls↗
PubMed2004

Fall prevention in residential care: a cluster, randomized, controlled trial.

OBJECTIVES: To establish the effectiveness of a fall-prevention program in reducing falls and injurious falls in older residential care residents. DESIGN: Cluster, randomized, controlled trial. SETTING: Fourteen randomly selected residential care homes in Auckland, New Zealand. PARTICIPANTS: All older residents (n=628, 95% participation rate). INTERVENTION: Residential care staff, using existing resources, implemented systematic individualized fall-risk management for all residents using a fall-risk assessment tool, high-risk logo, and strategies to address identified risks. MEASUREMENTS: Number of residents sustaining a fall, falls, and injurious-falls incidence rates. RESULTS: During 12 months of follow-up, 103 (43%) residents in the control group and 173 (56%) residents in the intervention group fell (P<.018). There was a significantly higher incidence rate of falls in intervention homes than in control homes (incident rate ratio=1.34, 95% confidence interval=1.06-1.72) during the intervention period after adjusting for dependency level (type of home), baseline fall rate, and clustering. There was no difference in the injurious fall incidence rate or incidence of serious injuries. CONCLUSION: This fall-prevention intervention did not reduce falls or injury from falls. Low-intensity intervention may be worse than usual care.

Accident Prevention↗
PubMed2004

Intercultural residential care in New Zealand.

Along with other Organization for Economic Cooperation and Development (OECD) countries, New Zealand's society is aging such that an increase in the number of older people requiring residential care is predicted. What cannot be foreseen is how culturally defined health beliefs affect the care given to older people in residential care. In this article, the authors describe and discuss the culturally based health beliefs of some Pacific Islands caregivers and predominately European (Pakeha) older people resident at one long-term care facility in Auckland, New Zealand. The delivery of care is influenced by culturally related beliefs about "being old." Racism is evident in residential care, and the authors discuss the reactions of caregivers, residents, and management. This research extends the discussion of caregiving and receiving in to the cross-cultural setting, and the findings highlight a number of elements in cultural differences between carer and cared-for that might affect care practices at the residential facility studied.

Aged↗
PubMed2003

Screening for depression in primary care with two verbally asked questions: cross sectional study.

OBJECTIVE: To determine the diagnostic accuracy of two verbally asked questions for screening for depression. DESIGN: Cross sectional criterion standard validation study. SETTING: 15 general practices in New Zealand. PARTICIPANTS: 421 consecutive patients not taking psychotropic drugs. MAIN OUTCOME MEASURES: Sensitivity, specificity, and likelihood ratios of the two questions compared with the computerised composite international diagnostic interview. RESULTS: The two screening questions showed a sensitivity and specificity of 97% (95% confidence interval, 83% to 99%) and 67% (62% to 72%), respectively. The likelihood ratio for a positive test was 2.9 (2.5 to 3.4) and the likelihood ratio for a negative test was 0.05 (0.01 to 0.35). Overall, 37% (157/421) of the patients screened positive for depression. CONCLUSION: Two verbally asked questions for screening for depression would detect most cases of depression in general practice. The questions have the advantage of brevity. As treatment is more likely when doctors make the diagnosis, these questions may have even greater utility.

Adolescent↗
PubMed2003

Effectiveness of counselling patients on physical activity in general practice: cluster randomised controlled trial.

OBJECTIVE: To assess the long term effectiveness of the "green prescription" programme, a clinician based initiative in general practice that provides counselling on physical activity. DESIGN: Cluster randomised controlled trial. Practices were randomised before systematic screening and recruitment of patients. SETTING: 42 rural and urban general practices in one region of New Zealand. SUBJECTS: All sedentary 40-79 year old patients visiting their general practitioner during the study's recruitment period. INTERVENTION: General practitioners were prompted by the patient to give oral and written advice on physical activity during usual consultations. Exercise specialists continued support by telephone and post. Control patients received usual care. MAIN OUTCOME MEASURES: Change in physical activity, quality of life (as measured by the "short form 36" (SF-36) questionnaire), cardiovascular risk (Framingham and D'Agostino equations), and blood pressure over a 12 month period. RESULTS: 74% (117/159) of general practitioners and 66% (878/1322) of screened eligible patients participated in the study. The follow up rate was 85% (750/878). Mean total energy expenditure increased by 9.4 kcal/kg/week (P=0.001) and leisure exercise by 2.7 kcal/kg/week (P=0.02) or 34 minutes/week more in the intervention group than in the control group (P=0.04). The proportion of the intervention group undertaking 2.5 hours/week of leisure exercise increased by 9.72% (P=0.003) more than in the control group (number needed to treat=10.3). SF-36 measures of self rated "general health," "role physical," "vitality," and "bodily pain" improved significantly more in the intervention group (P<0.05). A trend towards decreasing blood pressure became apparent but no significant difference in four year risk of coronary heart disease. CONCLUSION: Counselling patients in general practice on exercise is effective in increasing physical activity and improving quality of life over 12 months.

Adult↗
PubMed2003

Do delayed prescriptions reduce antibiotic use in respiratory tract infections? A systematic review.

BACKGROUND: There is concern about the increasing resistance of antibiotics to common bacteria. Delayed prescribing for respiratory tract infections is a strategy that may reduce the use of antibiotics. AIM: To systematically review controlled trials of delayed prescriptions to establish their capacity to reduce antibiotic intake. DESIGN OF STUDY: A systematic review of the literature. SETTING: Four studies were conducted in the United Kingdom and one in New Zealand. METHODS: We searched MEDLINE from 1966 to April 2003, EMBASE, and the Cochrane Controlled Trials Register using the following terms: 'delayed', 'antibiotics', 'prescriptions', and 'back-up' (as in back-up prescription). We included controlled trials of studies in which the intervention was a delayed prescription compared to an immediate prescription for patients with upper respiratory tract infections. The studies were selected independently and the results compared. Disagreements were resolved by discussion. The data and quality of the studies were extracted and assessed independently by two of the authors. RESULTS: Four randomised controlled trials and one before-after controlled trial contributed to the review. The relative risk in the randomised trials for lower antibiotic usage when a delayed prescription was given ranged from 0.54 for the common cold to 0.25 for otitis media. CONCLUSION: The consistent reduction in antibiotic usage in the five controlled trials included in this review suggests that delayed prescription is an effective means of reducing antibiotic usage for acute respiratory infections. The duration of delay for prescriptions ranged widely, from 1 to 7 days.

Anti-Bacterial Agents↗
PubMed2002

Delayed antibiotic prescriptions: what are the experiences and attitudes of physicians and patients?

OBJECTIVE: To explore the experiences and opinions of family physicians and patients regarding the delay of antibiotic prescriptions, to be dispensed if symptoms persist or worsen over time, in treating upper respiratory tract infections. STUDY DESIGN: Qualitative study using semistructured interviews conducted in family practice in Auckland, New Zealand. POPULATION: Thirteen physicians recruited from a study of family physicians' reported antibiotic prescribing and 13 patients recruited from the intervention arm of a randomized controlled trial on delayed antibiotic prescribing. OUTCOMES MEASURED: Patients' and physicians' experiences of delayed antibiotic prescriptions for upper respiratory tract infections. RESULTS: The primary themes identified were value judgments of antibiotics, decreased antibiotic use, patient-centered factors, effects on the physician-patient relationship, patient convenience, adverse effects of delaying prescription, and selectivity for use of antibiotics. Many themes were common to both patients and physicians. Physicians valued empowering patients' decision making about their health care management more highly than did patients. Decreasing antibiotic use was not a key factor for most patients. Both groups acknowledged the value in saving patients time and money. Physicians viewed the strategy as giving patients reassurance and meeting their expectations for antibiotics. Negative implications included perception of physician incompetence and physician loss of management control. Opinions were mixed regarding which patients, under which conditions, were suitable for delayed antibiotic prescriptions. CONCLUSIONS: Although delayed antibiotic prescriptions are effective in decreasing antibiotic use for conditions not clinically warranting antibiotics, neither patients nor physicians universally endorsed this strategy. Research to establish formalized recommendations for patient suitability and instructions for use would be of value.

Adult↗
PubMedDate not supplied

Physician-patient relationship and medication compliance: a primary care investigation.

PURPOSE: We assessed the relationship between 4 attributes of the physician-patient relationship and medication compliance. METHODS: We conducted a waiting room survey of patients consulting 22 general practitioners in 14 randomly selected practices in Auckland, New Zealand (81% response rate). A total of 370 consecutive patients (75% response rate) completed survey instruments about 4 attributes of the physician-patient relationship. Continuity of care (assessed from use of a usual physician, length of continuity, and perceived importance of continuity) and trust in the physician were ascertained before the consultation. After the consultation the Patient Enablement Index measured the physician's ability to enable patients in self-care, and concordance between the patient and physician was measured by a 6-item inventory of perceived agreement about the presenting problem and management, were ascertained immediately after the consultation. Compliance with prescribed medication therapy was ascertained by telephone follow-up 4 days after the consultation. RESULTS: Overall, 220 patients (61%) received a prescription, and 79% of these patients were taking the medication at follow-up. In a univariate analysis adjusted for clustering, only trust and physician-patient concordance were significantly related to compliance. In analysis further adjusted for health and demographic factors, physician-patient concordance was independently related to compliance (odds ratio = 1.34, 95% confidence interval, 1.04-1.72). CONCLUSIONS: Primary care consultations with higher levels of patient-reported physician-patient concordance were associated with one-third greater medication compliance. An emphasis on understanding and facilitating agreement between physician and patient may benefit outcomes in primary care.

Adult↗