ORCID Profile
0000-0002-0312-3095
Current Organisation
The University of Auckland
Does something not look right? The information on this page has been harvested from data sources that may not be up to date. We continue to work with information providers to improve coverage and quality. To report an issue, use the Feedback Form.
Publisher: Informa UK Limited
Date: 09-2010
Publisher: Springer Science and Business Media LLC
Date: 14-05-2008
Publisher: Springer Science and Business Media LLC
Date: 11-10-2008
DOI: 10.1007/S11096-008-9257-9
Abstract: To explore consumer satisfaction with, and experiences of, a range of issues associated with the delivery of opioid substitution treatment at community pharmacies in New South Wales, Australia. 50 community pharmacies providing opioid substitution treatment in New South Wales. Self-completion survey completed by 508 clients during supervised dosing. Satisfaction with opioid substitution treatment delivery at community pharmacies. Sixty-one percent of participants reported being satisfied with their treatment programme. Participants expressed a high level of satisfaction with most aspects of opioid substitution treatment delivery at their pharmacy (aggregate mean = 8.1/10 10 = excellent). However, participants were less satisfied with the level of privacy afforded at the pharmacy. Thirty-four percent reported that they were made to wait longer than other customers, and 25% reported that the pharmacy staff did not treat them the same as other customers. However, 87% reported that they felt welcomed by the pharmacy staff. Twenty-three percent of clients were currently in debt to the pharmacy for nonpayment of dispensing fees. The mean amount of current debt was $71.75, equivalent to approximately 2 weeks of pharmacy dispensing fees. Community pharmacies providing opioid substitution treatment in New South Wales appear to be providing a level of service that is satisfactory to the clients of those services. However, many participants were concerned about a lack of privacy, the high cost of treatment, and being treated differently to other customers.
Publisher: Wiley
Date: 03-01-2013
DOI: 10.1111/ADD.12051
Publisher: SAGE Publications
Date: 06-12-2013
Abstract: To describe the self-reported mental health of New Zealand secondary school students in 2012 and to investigate changes between 2007 and 2012. Nationally representative health and wellbeing surveys of students were completed in 2007 ( n=9107) and 2012 ( n=8500). Logistic regressions were used to examine the associations between mental health and changes over time. Prevalence data and adjusted odds ratios are presented. In 2012, approximately three-quarters (76.2%, 95% CI 74.8–77.5) of students reported good overall wellbeing. By contrast (also in 2012), some students reported self-harming (24.0%, 95% CI 22.7–25.4), depressive symptoms (12.8%, 95% CI 11.6–13.9), 2 weeks of low mood (31%, 95% CI 29.7–32.5), suicidal ideation (15.7%, 95% 14.5–17.0), and suicide attempts (4.5%, 95% CI 3.8–5.2). Between 2007 and 2012, there appeared to be slight increases in the proportions of students reporting an episode of low mood (OR 1.14, 95% CI 1.06–1.23, p=0.0009), depressive symptoms (OR 1.16, 95% CI 1.03–1.30, p=0.011), and using the Strengths and Difficulties Questionnaire - emotional symptoms (OR 1.38, 95% CI 1.23–1.54, p .0001), hyperactivity (OR 1.16, 95% CI 1.05–1.29, p=0.0051), and peer problems (OR 1.27, 95% CI 1.09–1.49, p=0.0022). The proportion of students aged 16 years or older reporting self-harm increased slightly between surveys, but there was little change for students aged 15 years or less (OR 1.29, 95% CI 1.15–1.44 and OR 1.10, 95% 0.98–1.23, respectively, p=0.0078). There were no changes in reported suicidal ideation and suicide attempts between 2007 and 2012. However, there has been an improvement in self-reported conduct problems since 2007 (OR 0.78, 95% CI 0.70–0.87, p .0001). The findings suggest a slight decline in aspects of self-reported mental health amongst New Zealand secondary school students between 2007 and 2012. There is a need for ongoing monitoring and for evidence-based, accessible interventions that prevent mental ill health and promote psychological wellbeing.
Publisher: Informa UK Limited
Date: 05-02-2017
Publisher: Wiley
Date: 26-05-2009
DOI: 10.1111/J.1365-2753.2008.01032.X
Abstract: To examine the impact of audit and feedback on antipsychotic prescribing for schizophrenia outpatients over 4.5 years. Clinical files in three mental health services caring for outpatients in Auckland, New Zealand were reviewed at two time-points (March 2000, October 2004). After the first audit, feedback was provided to all three services. Baseline prescribing variations between services were found for antipsychotic combinations and second-generation antipsychotic (SGA) prescribing, in particular clozapine. In two services audit and feedback continued with two interim reviews (October 2001, March 2003). Specific feedback and interventions targeting clozapine use were introduced in both services. No further audit or feedback occurred in the third service until the final audit. Data were collected (patient characteristics, diagnosis, antipsychotic treatment) and analysed at each audit. Three prescribing variables (antipsychotic monotherapy, SGA and clozapine use) were consistent with practice recommendations at the final audit (85.7%, 82.7% and 34.5% respectively) and had changed in the desired direction for all three services over the 4.5 years. At baseline there were differences between the three services. One service had baseline prescribing variables closest to recommendations, was actively involved in audit, and improved further. The second service, also actively involved in audit had baseline prescribing variables further from recommendations but improved the most. The service not involved in continuing audit and feedback made smaller changes, and SGA and clozapine use at endpoint were significantly lower despite at baseline being comparable to the service which improved the most. This study found audit and feedback to be an effective intervention in closing the gap between recommended and routine clinical practice for antipsychotic prescribing in schizophrenia.
Publisher: Informa UK Limited
Date: 24-11-2009
Publisher: SAGE Publications
Date: 26-11-2012
Abstract: These findings are from a qualitative study examining clinician experiences of employing the AmpliChip® CYP450 test in psychiatric practice. One hundred tests were made available to secondary care mental health service clinicians commencing patient treatment with risperidone across three District Health Boards within New Zealand. Feedback was sought on clinicians’ ( n = 33) experiences of ordering the test and receiving results, utilization of results, and perceived advantages and disadvantages. Difficulties were reported regarding ordering the test and receiving the results however, real or perceived advantages of employing the test results in practice were widely reported. Analysis of the ways in which the test results were reportedly utilized revealed that they generally played a supporting role with regard to dosing decisions, rather than being the main influence on clinician behaviour. The test itself, and subsequent results, was viewed as potentially useful in facilitating the development of the doctor–patient relationship. Reported disadvantages of the test included potential over-reliance at the expense of clinical wisdom, cost, and challenges inherent in introducing a new clinical procedure into routine practice. These findings indicate that psychiatric clinicians are receptive to employing this test as a clinical support tool if its implementation is carefully considered and economically justifiable.
Publisher: Springer Science and Business Media LLC
Date: 11-12-2007
DOI: 10.1007/S10597-007-9116-5
Abstract: This study replicates a survey conducted in the 1980s that examined therapist attitudes and beliefs relevant to client dropout. A rev ed questionnaire modelled on the original was completed by 92% of therapists employed in the outpatient counselling arm of an alcohol and other drug treatment service. This questionnaire sought therapist perceptions of treatment length and client dropout as well as their preferred length of treatment engagement. Responses were then contrasted with known service attendance norms. As with the previous study, the results suggest therapists typically expect and prefer treatment of a considerably longer duration than the service mean and underestimate the rate of client dropout.
Publisher: Wiley
Date: 11-2013
DOI: 10.1111/JPC.12427
Abstract: To describe indicators of health and well‐being for N ew Z ealand secondary school students explore changes between 2001, 2007 and 2012 and compare these findings to international estimates. Three national health and well‐being surveys of randomly selected N ew Z ealand secondary school students were conducted. Data are presented as prevalence and variation over time (adjusted odds ratio ( aOR )). Comparisons with international estimates were made with subsets of the data. Between 2001 and 2012, students reported reductions in cigarette use ( aOR 0.27, 95% confidence interval ( CI ) 0.23–0.32), alcohol use ( aOR 0.39, 95% CI 0.33–0.46), marijuana use ( aOR 0.37, 95% CI 0.31–0.43), sexual abuse ( aOR 0.52, 95% CI 0.46–0.58), fighting ( aOR 0.63, 95% CI 0.55–0.73), seatbelt use ( aOR 1.47, 95% CI 1.31–1.65) and risky driving behaviours ( aOR 0.39, 95% CI 0.33–0.45). Positive connections to school (perception that the school cares, aOR 1.22, 95% CI 1.10–1.35 liking school, aOR 1.55, 95% CI 1.33–1.82) and family (good family relationship, aOR 1.83, 95% CI 1.70–1.97) also improved. Indicators that did not improve and compared poorly with international estimates were protected sex (condom use at last sexual intercourse, aOR 0.77, 95% CI 0.68–0.87) and healthy life‐style (daily physical activity, aOR 0.88, 95% CI 0.78–0.99 overweight/obese, aOR 1.09, 95% CI 0.92–1.31). Exposure to family violence ( aOR 1.37, 95% CI 1.11–1.68) and depressive symptoms ( aOR 1.03, 95% CI 0.91–1.17) also did not improve. There have been important improvements in the health and well‐being of N ew Z ealand adolescents over a relatively short period. These findings demonstrate that population rates of adolescent risk behaviours are amenable to change. Current policy efforts should not lose momentum, while identified priority areas must be adequately resourced to ensure young people have opportunities to thrive now and in the future.
Publisher: Springer Science and Business Media LLC
Date: 21-09-2007
Publisher: Wiley
Date: 07-2008
DOI: 10.1080/09595230802093760
Abstract: Screening and brief intervention (SBI) for alcohol consumption in primary care have been shown to be effective in reducing drinking. This role has not been taken up by community pharmacists. This study aimed to explore attitudes, knowledge, barriers and incentives towards involvement of community pharmacists in New Zealand with problem drinkers. A postal survey (three mailshots) of community pharmacies was undertaken in Auckland, New Zealand, followed by a 10% random s le non-responder-follow-up. A response rate of 39.1% to the postal survey was obtained. In general, knowledge of alcohol content of drinks and recommended safe drinking limits was poor. Respondents were generally well motivated towards undertaking this role, but lacked knowledge, skills and confidence. On follow-up, non-responders were found to be less knowledgeable, but had similar attitudes to respondents, indicating potential for extrapolation with regard to beliefs and views on this subject. This novel study has found that there is potential for involvement of community pharmacists in New Zealand in SBI for problem drinkers. Lack of knowledge can be remedied relatively easily greater hurdles such as lack of skills, and lack of confidence may be offset by the high level of motivation of this group. This is an area where community pharmacists can further their professional scope of practice by being in an essential position to provide this service.
Publisher: Elsevier BV
Date: 12-2008
DOI: 10.1016/J.DRUGPO.2007.03.002
Abstract: This study aimed to investigate the prevalence of ersion and injection of methadone and buprenorphine among clients receiving opioid pharmacotherapy treatment at community pharmacies in New South Wales (NSW), Australia. A multi-site cross-sectional survey design was utilised using a self-complete questionnaire. Participants were 508 clients receiving supervised methadone (n=442) and buprenorphine (n=66) at 50 community pharmacies. Participants were surveyed about whether they had erted their currently prescribed pharmacotherapy, whether they had injected methadone or buprenorphine, the frequency, desirability and duration of action of injecting, and the ease of availability of street-purchased pharmacotherapies. The prevalence of recent ersion was more than 10 times higher among those receiving buprenorphine compared to methadone, with 23.8% of buprenorphine-maintained participants reporting erting their dose in the preceding 12 months. Seventeen percent of methadone clients had injected methadone in the preceding 12 months compared with 9.1% of buprenorphine clients over the same time period. The higher prevalence of buprenorphine ersion compared to methadone ersion is likely to be due to its sublingual tablet formulation and difficulty associated with supervising its consumption compared to that of an oral liquid. Methadone ersion is also less prevalent likely due to the high levels of methadone take away provision, which also helps to explain the higher levels of recent methadone injecting compared to buprenorphine injecting. A clearer understanding of the motivations for ersion and injection of opioid pharmacotherapies, and the relationship between them is required.
Publisher: Informa UK Limited
Date: 08-12-2009
Publisher: Elsevier BV
Date: 09-2012
DOI: 10.1016/J.JADOHEALTH.2011.12.020
Abstract: Private and confidential health care is an important indicator of the quality of health care for adolescents. The objective of this study was to determine the prevalence of health care utilization and private and confidential health care among a nationally representative population of high school students. A two-stage cluster s le of 9,107 students (grades 8-12, response rate 73%) from 96 New Zealand high schools (response rate 84%) participated in a 2007 health survey using Internet tablets. Questions included when and where they had accessed health care, if their health care provider had explained that their health care was confidential, and if they had been seen in private by their health care provider. Although 83% of students had accessed health care in the previous 12 months, only 27% of students reported receiving private and confidential health care. Students who had accessed health care from a school-based health center (adjusted relative risk [95% confidence interval] 1.54 [1.42-1.66]) or family planning/sexual health clinics (adjusted relative risk = 2.1 [1.9-2.26]) were more likely to report receiving private and confidential health care compared with students who had not accessed health care from these settings. While most young people access health care from their family doctor or general practitioner's clinic, rates of private and confidential health care were low suggesting that opportunities to adequately explore and respond to important yet sensitive topics are compromised in primary care settings.
Publisher: Informa UK Limited
Date: 2006
DOI: 10.1080/10826080601025847
Abstract: This article highlights perceived weaknesses in the current understanding of unilateral client exit from alcohol and other drug psychosocial treatment. It is argued that unilateral client exit is typically interpreted as a "failure of retention" when it could equally be interpreted as a "failure of treatment fit" that is, the failure to deliver treatment optimally suited to actual client attendance. The results from an exploratory study conducted within a failure of treatment fit framework are presented. This study explored the possibility that short-term outpatient alcohol and other drug (AOD) treatment attendance may be an intentional service use strategy and that short-term attendees may exit AOD treatment as satisfied, successful, consumers. Standardized questionnaires were administered to clients (n = 109) starting a new treatment episode between June-August 2003 at admission and two-months post admission. Questionnaires explored the accuracy of client estimates of future appointment attendance, the reasons for short-term service exit, the satisfaction and outcome ratings of short-term clients, and the extent to which these compared with their longer-term peers. Findings suggest short-term treatment attendance is not an intentional service use strategy. However, despite attending fewer appointments than intended, most short-term participants reported significant levels of service satisfaction and problem improvement, and at a level comparable with their longer term peers. Problem-improvement was endorsed as the number one reason for short-term service exit. Implications for treatment delivery are discussed in light of these findings.
Publisher: Wiley
Date: 07-2008
DOI: 10.1080/09595230802093745
Abstract: Clients in opioid substitution therapy often have considerable unmet health-care needs. The current study aimed to explore health problems related to opioid substitution therapy among clients on methadone and buprenorphine treatment. A self-complete, cross-sectional survey conducted among 508 patients receiving methadone and buprenorphine treatment at community pharmacies in New South Wales (NSW), Australia. The most common problems for which participants had ever sought help were dental (29.9%), constipation (25.0%) and headache (24.0%). The most common problems for which participants would currently like help were dental (41.1%), sweating (26.4%) and reduced sexual enjoyment (24.2%). There were no significant differences between those currently on methadone and those currently on buprenorphine for any of the health problems explored, nor differences for gender or treatment duration. Participants on methadone doses 100 mg or above were significantly more likely to want help currently for sedation. The considerable unmet health care needs among participants in this study suggest that treatment providers should consider improving the detection and response to common health problems related to opioid substitution therapy.
Publisher: Wiley
Date: 03-2008
DOI: 10.1080/09595230701829538
Abstract: To explore barriers to, and incentives for, clients on methadone-maintenance treatment (MMT) in Auckland, New Zealand to transfer from secondary care to general practitioner (GP) care. Surveys (with free text response sections) of MMT secondary care staff, stabilised clinic clients, authorised GPs and GP patients. High response rates from secondary care staff (77%) and GPs (74%). Barriers to stable clients' transfer included financial cost and attitudes of secondary care staff and clients. Incentives for patient transfer included confidentiality, a holistic approach to their care, continuity of care, increased patient control, convenience and avoidance of contact with other opioid-dependent people. Distrust in the quality of care provided by authorised GPs was a major barrier for some secondary care staff and their clients, despite prerequisite training for authorisation. In contrast, patients rated primary better than secondary care with none stating a likelihood to return to the secondary service within 6 months. Progression from secondary to primary care should be incorporated in MMT planning from the outset, with secondary services staff reassured about the quality of primary care. An integrated transition period and exploration of funding options to assist transfer from largely publicly funded secondary to largely privately funded primary care are also recommended.
Publisher: Informa UK Limited
Date: 03-2009
DOI: 10.1080/02791072.2009.10400670
Abstract: Meth hetamine use has risen in many countries around the world in recent years, and New Zealand is no exception, with the substance having become well-established in the illicit drug market. While there is much published on the in idual and social harms of this drug, limited data are available on meth hetamine use initiation. Understanding early patterns of behavior is important, given the potential risks involved at this stage of use. This article presents findings from a qualitative study which was undertaken with meth hetamine users, most of whom were in treatment at the time of the research. While the research primarily sought to investigate patterns of meth hetamine use and associated harms, a key issue explored was the way in which respondents came to use the drug. Findings revealed that most were experienced users of other substances when trying the drug for the first time, but lacked specific knowledge of meth hetamine. The majority were introduced to meth hetamine in a social situation by a friend or partner, who also played a key role in preparing the drug for administration. Several reported risk-taking behaviors on the first occasion of use. The findings have important implications for potential interventions and harm reduction strategies at first use.
Publisher: Wiley
Date: 10-10-2007
DOI: 10.1111/J.1360-0443.2007.02016.X
Abstract: In England, the role of community pharmacy in service provision to drug misusers was studied in 1995. Extensive involvement was identified, and considerable underused capacity was noted. This study explores these and potential new roles 10 years on. Cross-sectional national study. Postal survey (three mailshots), plus a fourth telephone follow-up using a structured questionnaire based on the 1995 questionnaire. Community pharmacies in England. Involvement in opioid substitution therapy services (e.g. methadone, buprenorphine) and related activities. Attitudes towards service provision and novel services. A 95% response rate was obtained. This was higher than in 1995, due largely to the use of a telephone follow-up. There had been an increase in the proportion providing substitution therapy dispensing services from 51% to 63% and in the average current case-load (from 5.9 to 9.2) and consequently a large increase in the numbers being treated (approximately x 1.9). Similarly, supervised consumption of methadone and buprenorphine was being provided more widely (increasing from 0 to 59% of all responding pharmacists). Attitudes towards existing roles were more positive than in 1995, and providers tended to be more positive than non-providers. For newer roles (e.g. supervise medications for comorbidity provide hepatitis B vaccination), there was support from around one-quarter of respondents. Community pharmacy continues to play an important role in delivering treatment, including prescribing services, to drug misusers. There still appears to be untapped capacity, and moderate support for newer roles.
Publisher: Springer Science and Business Media LLC
Date: 29-03-2006
Abstract: This paper reviews the literature exploring issues around meth hetamine and injury. There was a paucity of peer reviewed quantitative research and a lack of large scale epidemiological studies. Further sources described cases and others described injury risk as part of an overall review of meth hetamine misuse. Thus, a number of limitations and potential biases exist within the literature. The main areas where associations were noted or extrapolated with meth hetamine use and injury were around driving and violence. Other associations with injury related to meth hetamine manufacture. There was also circumstantial evidence for third party injury (that is injury to those not specifically involved in drug use or drug manufacture) however, the available data are inadequate to confirm these associations/risks.
Publisher: Springer Science and Business Media LLC
Date: 13-11-2005
Abstract: In general the health of methadone clients has been found to be poorer than that of the general population. In New Zealand specialist drug services are not funded to provide primary healthcare services. Many health conditions could potentially be managed by community pharmacists who have frequent contact with this client group. This study sought to explore the health problems suffered by methadone clients, who they sought help from, and the potential for greater involvement of pharmacists. Self-completion questionnaire of methadone maintenance clients managed in specialist care in Auckland, New Zealand. The most common health problem experienced by these clients in the past three months was sweating (70.0%), and more than half of the respondents also reported experiencing headache, fatigue and depression. The least frequently experienced conditions were hay fever (12.9%) and abscesses (12.1%). Respondents indicated that the top three choices from whom they would seek help were GP (56.7%), the client's partner (31.6%) and community pharmacists (27.9%). Barriers to seeking help from pharmacists included issues around cost, perceptions of pharmacist knowledge and skills, privacy and confidentiality. Methadone clients in this study indicated that they suffered a number of general health problems, and in many cases were likely to seek help from a GP or their own partner, before seeking help from pharmacists. However, for over one quarter of respondents the pharmacist was in the top three from whom they would seek advice. Any barriers towards consulting pharmacists, in the main seem to be resolvable.
Publisher: Routledge
Date: 02-08-2004
Publisher: Informa UK Limited
Date: 2008
Publisher: Springer Science and Business Media LLC
Date: 22-05-2010
Publisher: Springer Science and Business Media LLC
Date: 12-05-2009
Publisher: Wiley
Date: 11-2009
DOI: 10.1111/J.1465-3362.2009.00066.X
Abstract: When a client exits an alcohol and other drug (AOD) treatment service against clinical advice, they and their service may incur significant disadvantage. The extent of awareness by both clients and clinicians that treatment would not continue has not been examined. Accordingly, this paper presents findings from a study that sought to identify whether clients and/or their respective clinicians were aware of pending service exit that occurred within the first 2 months of treatment admission. The study was set in an outpatient AOD treatment service located in Auckland, New Zealand. Data were obtained by structured questionnaire and were reported for a group of clients (n = 49), clinicians (n = 46) and matched client/clinician pairs (n = 36). Overall, clients and clinicians were no more likely to accurately identify pending service exit at a rate greater than would be expected by chance alone. However, clinicians were significantly more likely to identify pending service exit as compared with their respective clients (47% vs. 25%), although a large proportion of both groups expected treatment to continue beyond what proved to be the final treatment appointment (44% and 52%, respectively). These findings suggest that service exit that occurs within the first 2 months of treatment admission may be largely unpredictable and that, as a result of this unpredictability, the opportunities for a targeted response may be limited.
Publisher: Informa UK Limited
Date: 06-07-2009
DOI: 10.1080/10550880903028841
Abstract: This study aimed to identify the practices of community pharmacists regarding the provision of buprenorphine for opioid dependence and explore behaviors pharmacists considered indicative of buprenorphine ersion. A cross-sectional survey of 669 community pharmacists authorized to dispense buprenorphine or methadone was conducted in New South Wales and Victoria, Australia. There was wide variation between pharmacies in the level of supervision provided during supervised buprenorphine dosing and a lack of clarity between pharmacists regarding what behaviors are ex les of buprenorphine ersion. Compared to New South Wales, a higher proportion of Victorian pharmacists detected 1 or more episodes of buprenorphine ersion in the past year (65% vs. 28% p < .001) and in the past month (20% vs. 7% p < .001). Detection of buprenorphine ersion was associated with the administration of crushed tablets (odds ratio = 2.77), broken tablets (odds ratio = 2.69), and having more buprenorphine clients (odds ratio = 1.24). Future research investigating the prevalence of buprenorphine ersion should include a clear definition of what behaviors constitute ersion.
Publisher: Oxford University Press (OUP)
Date: 03-2007
Abstract: Objective This paper describes an evaluation of the impact of a concise, portable guideline for the medication management of acute behavioural disturbance in adult psychiatric inpatient units. Setting Waitemata District Health Board provides inpatient psychiatric care for an adult catchment population of about 800 000 at two units located in west and north Auckland, New Zealand with a total of 68 beds. Method A retrospective clinical audit of the first 72 hours' medication management for patients admitted in acute crisis was completed before and after formal guideline implementation. Key findings Benzodiazepines were the medication of choice. Total daily doses for both benzodiazepines and antipsychotics were within recommended ranges. Areas of practice that appeared to improve after guideline implementation included reduced use of antipsychotic and short-acting injectable medications and use of lorazepam as sole treatment, but differences were not statistically significant. Conclusion Pharmacological management was found to be consistent with best clinical practice before and after guideline implementation.
Publisher: Wiley
Date: 27-12-2013
DOI: 10.1111/JPC.12450
Abstract: The aims of this study are to provide a profile of sexual health behaviours of Māori youth and to identify factors associated with consistent condom and contraception use. Multivariable analyses were conducted to determine relationships between consistent contraception and condom use among all 2059 sexually active Māori participants in the 2007 New Zealand youth health and well-being survey of secondary school students. Forty per cent of Māori students were currently sexually active of these, 55.3% always used contraception, and 41.1% always used condoms. Risk factors for not using contraception were less than or equal to three sexual partners (males odds ratio (OR) 0.55, P = 0.04, females OR 0.35, P = 0.04) and regular cigarette use for females (OR 0.52, P = 0.02). Risk factors for not using condoms were 13- to 15-year-old females (OR 1.95, P < 0.01) and females who enjoyed sex (OR 0.52, P = 0.02). Family connection was associated with increased use of condoms among males (OR 1.07, P < 0.01). Reducing sexual risks, increasing opportunities for healthy youth development and family connectedness, alongside access to appropriate services, are required to improve the sexual health of Māori youth.
Publisher: Springer Science and Business Media LLC
Date: 24-04-2009
DOI: 10.1007/S10488-009-0223-1
Abstract: This paper presents findings from a Delphi survey of expert opinion asking participants (n = 18), all recruited from specialist alcohol and other drug treatment services, to identify the minimum level of clinical assessment information they would be willing to collect during a single treatment opportunity of 60-min in duration. The expert s le collectively identified 27 assessment items, 7 of which subsequently met the Delphi consensus criteria. All participants considered the resulting model (7 items) to be clinically appropriate under normal circumstances however, many stated they would be reluctant to strictly adhere to the model if it were implemented in practice. Participants suggested it would take them, on average, 40-min out of the 60-min intervention opportunity to collect the stated assessment information.
Publisher: Wiley
Date: 11-01-2010
DOI: 10.1111/J.1360-0443.2009.02774.X
Abstract: To explore service provision and the range of problems that New South Wales (NSW) and Victoria (VIC) community pharmacists providing opioid substitution treatment (OST) have experienced with clients and prescribers. ross-sectional postal survey. All community pharmacies providing OST in NSW (n = 593) and VIC (n = 393), Australia. Completed questionnaires were received from 669 pharmacists (68% response rate). The questionnaire addressed pharmacy characteristics, recent problems experienced with clients including refusal to dose, provision of credit for dispensing fees, termination of treatment, responses of pharmacists to problems experienced with clients, as well as problems experienced with OST prescribers. In the preceding month, 41% of pharmacists had refused to dose a client for any reason, due most commonly to expired prescriptions (29%), or > or issed doses (23%). Terminating a client's treatment in the past month was reported among 14% of respondents, due most commonly to inappropriate behaviour and missed doses. Treatment termination was reported by a significantly higher proportion of pharmacists in VIC (P < 0.001). Treatment termination in last month was predicted having more clients (P < 0.001), the provision of buprenorphine treatment (P = 0.008), having a separate dosing area (P = 0.021), and being a female pharmacist (P = 0.013). Past month refusal to dose was predicted by the pharmacy being in VIC (P < 0.001) and having more clients (P < 0.001). Problems experienced most commonly in the past month with prescribers were difficulty contacting prescriber (21%) and provision of takeaway doses to clients considered unstable by the pharmacist (19%) (higher in VIC: both P < 0.001). This study highlights the range of problems experienced by community pharmacists in the delivery of OST and the consequences for people in treatment. Particular attention should be focused upon considering number of clients per pharmacy and improving professional communication between pharmacists and prescribers.
Publisher: Wiley
Date: 09-08-2007
DOI: 10.1111/J.1360-0443.2007.01916.X
Abstract: To describe the development and evaluation of the Substances and Choices Scale (SACS), an adolescent alcohol and other drug (AOD) self-report instrument designed in a similar format to the Strengths and Difficulties Questionnaire (SDQ). A literature review, extensive consultation and discriminant analysis on a pilot s le (n = 61) of adolescents informed the development of the SACS. The psychometric properties of the SACS were then tested in a larger community and clinical s le. Three youth out-patient AOD treatment services and three secondary schools in Auckland, New Zealand. 13-18-year-old males and females attending the services (n = 120) or schools (n = 531). The SACS was administered with the CRAFFT, the Problem Oriented Screening Instrument for Teenagers (POSIT) and the Strengths and Difficulties Questionnaire (SDQ). Reliability of the SACS was sound, with coefficient alpha 0.91 and 3-week test-retest correlation 0.88. Congruent validity coefficients of the SACS versus the CRAFFT and the POSIT were 0.79 and 0.91, respectively. A ROC curve demonstrated the SACS as having a predictive value of 92%. Repeat SACS scores in a treatment s le indicated that the SACS had utility in measuring change. Feedback from participants indicated that the SACS was highly acceptable. The SACS is a simple AOD instrument that is reliable, valid and acceptable to young people. It has utility in screening and measuring outcome and should enhance the identification and treatment of AOD difficulties in adolescents across a range of health settings.
Publisher: Wiley
Date: 09-03-2007
DOI: 10.1111/J.1360-0443.2007.01762.X
Abstract: To assess changes in opiate prescribing (1995-2005) following a decade of national guidelines to address substandard opiate substitution prescribing for heroin addiction. A repeat national survey (1995 and 2005) using random one-in-four s les of all community pharmacies in England, achieving response rates of 75% (1847/2475) in 1995 and 95% (2349/2473) in 2005. Data were obtained on 3732 (1995 data) and 9620 (2005 data) prescriptions dispensed in the preceding month from the 936 and 1463 pharmacies who were currently dispensing. We have measured impact on practice for seven specific recommended changes. Between 1995 and 2005 the number of substitute opiate prescriptions doubled (x 2.03). By 2005, methadone still dominated (down from 97% to 83%), buprenorphine increased (from 1% to 16%) and other opiate medications virtually disappeared. Changes in the direction of national guidelines included: increased daily dose of methadone (from 47.3 mg to 56.3 mg), more frequent dispensing (from 38% to 60% as daily installments), more supervised consumption (from 0% to 36%) and fewer methadone tablets (from 10.9% to 1.8%). Nevertheless, despite the increased mean daily dose, only 41.0% of prescriptions for methadone were for daily doses in the recommended 60-120 mg dose range. Only one change was not in the direction of the national guidelines--the proportion of prescriptions from GPs fell from 41% to 30%, although this still represented an approximate 50% increase in the extent of GP prescribing. Doubling in provision of opiate substitute treatment has occurred, alongside significant improvements in the nature of this treatment. These positive changes have occurred in the direction of six out of seven of the UK national guidelines.
Publisher: Springer Science and Business Media LLC
Date: 03-2007
DOI: 10.1007/S11096-007-9096-0
Abstract: The aim of this study was to review treatment patterns of sedative-hypnotic agents within an acute adult inpatient psychiatric service, compare prescribing with best-practice recommendations for use and explore potential interventions. Two urban acute inpatient psychiatric units in the Waitemata community. A retrospective review of all consecutive admissions to these two adult psychiatric units was conducted during the period 1st January to 30th June 2002. Patient demographics, diagnosis and sedative-hypnotic treatment data were extracted from clinical files. Average benzodiazepine daily dose was calculated for each admission in diazepam equivalents (Diaz(e)). Sedative-hypnotic treatment administered, duration of treatment, average daily dose, and discharge treatment. Data from 257 patients and 293 admissions were analysed. Almost all admissions (86.7%) involved treatment with a sedative-hypnotic. A benzodiazepine was prescribed for 82.6% of admissions, of which 64.9% was administered on an "as-needed (prn)" basis. Zopiclone was used in 56.7% of admissions, of which 83.7% was "as-needed (prn)" treatment. Most benzodiazepine treatment was with a single agent (61.6%) and lorazepam was the most frequently prescribed (54.8%). Over two-thirds of admissions used benzodiazepine treatment for 50% or less of the admission duration. The duration of treatment was shortest in those with a diagnosis of schizophrenia/schizoaffective disorder. Almost two-thirds of admissions were discharged without any prescription for sedative-hypnotic treatment. The use of sedative-hypnotic treatment in the acute adult inpatient psychiatric environment compared favourably with best practice recommendations regarding dose, duration of treatment and discharge treatment. The study identified key areas for intervention by clinical pharmacists to ensure appropriate use of sedative-hypnotics including in-service education, regular review of all sedative-hypnotic treatment and discharge medication planning.
Publisher: BMJ
Date: 2012
No related grants have been discovered for Janie Sheridan.