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ORIGINAL SCIENTIFIC PAPERS quantitative research ACKNOWLEDGEMENTS Thank you to the GPs who participated in the project. relevant and valid information at the point of care. Clinicians also need sources for rapid retrieval of this information to integrate it into their daily practice and their careers of lifelong learning.’ 4 The GPs in our sample certainly have ‘sources for rapid retrieval’ and are using ‘relevant’ information; they are probably also getting ‘valid’ information, given the resources they have nominated. Web resources have the potential to provide both immediate answers to clinical questions and contribute to lifelong learning. The possible change from textbooks to web resources has the additional advantages of providing clinicians with up-to-date information which is not possible with paper textbooks. Future research is needed and perhaps it would be worthwhile repeating the study of 2002 to see how answering clinical questions may have changed. 13 The issue of lifelong learning (knowledge for the future) needs more research. References 1. Glasziou P. Why is evidence-based medicine important? Evid Based Med. 2006 ;11(5):133–5. 2. Sackett DL, Rosenberg WMC, Gray JAM, Haynes RB, Richardson WS. Evidence based medicine: what it is and what it isn’t. BMJ. 1996;312:71–2. 3. Miller SH, Thompson JN, Mazmanian PE, Aparicio A, Davis DA, Spivey BE, et al. Continuing medical education, professional development, and requirements for medical licensure: a white paper of the Conjoint Committee on Continuing Medical Education. J Contin Educ Health Prof. 2008;28(2):95–8. 4. McConaghy JR. Evolving medical knowledge: moving toward efficiently answering questions and keeping current. Prim Care. 2006;33(4):831–7. 5. Duffy FD, Holmboe ES. Self-assessment in lifelong learning and improving performance in practice: physician know thyself. JAMA. 2006;296(9):1137. 6. Davis DA, Mazmanian PE, Fordis M, Van Harrison R, Thorpe KE, Perrier L. Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA. 2006;296(9):1094. 7. Tracey J, Arroll B, Barham P, Richmond D. The validity of general practitioners’ self assessment of knowledge: cross sectional study. BMJ.1997:1426–8. 8. Campion-Smith C, Smith H, White P, Baker E, Baker R, Holloway I. Learners’ experience of continuing medical education events: a qualitative study of GP principals in Dorset. Br J Gen Pract. 1998;48(434):1590. 9. Treweek S, Flottorp S, Fretheim A, Havelsrud K, Kristoffersen DT, Oxman A, et al. What do general practitioners do to keep themselves up to date? Tidsskr Nor Laegeforen. 2005;125(3):304–6. 10. Davis D, O’Brien MAT, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA. 1999;282(9):867–74. 11. Bloom BS. Effects of continuing medical education on improving physician clinical care and patient health: a review of systematic reviews. Int J Technol Assess Health Care. 2005;21(03):380–5. 12. Goodyear-Smith F, Kerse N, Warren J, Arroll B. Evaluation of e-textbooks. DynaMed, MD Consult and UpToDate. Aust Fam Phys. 2008;37(10):878. 13. Arroll B, Pandit S, Kerins D, Tracey J, Kerse N. Use of information sources among New Zealand family physicians with high access to computers. J Fam Pract. 2002;51(8):706. 14. Bennett NL, Casebeer LL, Kristofco R, Collins BC. Family physicians’ information seeking behaviors: a survey comparison with other specialties. BMC Med Inform Decis Mak. 2005;5:9. 15. Dovey SM, Fraser TJ, Tilyard MW, Ross SJ, Baldwin KE, Kane D. ‘Really simple, summary, bang! That’s what I need.’ –Clinical information needs of New Zealand general practitioners and the resources they use to meet them. N Z Fam Physician. 2006;33(1):18. 16. Ramos K, Linscheld R, Schafer S. Real-time informationseeking behavior of residency physicians. Fam Med. 2003;35(4):257–60. Funding This project was funded by a summer studentship in the Faculty of Medicine and Health Science, The University of Auckland. COMPETING INTERESTS None declared. Zac Gravatt conducted research through a summer studentship in the Department of General Practice and Primary Health Care at the end of his 2nd medical school year. He was such a popular and good researcher that he was welcomed back for a second summer studentship at the end of 3rd year. This paper is the result of his second studentship. In July 2009, halfway through his 4th medical school year, Zac died suddenly and tragically of meningococcal C septicaemia. We would like to honour the great doctor and researcher Zac could have been should he have survived. 104 VOLUME 2 • NUMBER 2 • JUNE 2010 J OURNAL OF PRIMARY HEALTH CARE
ORIGINAL SCIENTIFIC PAPErS quantitative research Causes of excess hospitalisations among Pacific peoples in New Zealand: implications for primary care Faafetai Sopoaga MBChB, FRNZCGP, FAFPHM; Ken Buckingham PhD (Aberdeen), MSc (York), BSc (Bath); Charlotte Paul MBChB, PhD, FAFPHM ABSTRACT introduction: Pacific people suffer disproportionately poorer health and reduced life expectancy at birth compared to the total New Zealand population. Department of Preventive and Social Medicine, University of Otago, New Zealand Aim: To assess causes of excess morbidity in the Pacific population, and identify lesser known or previously unknown causes which require further investigation. Methods: We obtained public hospital discharge data from July 2000 to December 2002. The population data were from the 2001 Census. Standardised discharge ratios were calculated to compare Pacific peoples with the total New Zealand population. Results: Pacific peoples were six times more likely to have a diagnosis of cardiomyopathy and gout, and four to five times of rheumatic fever, gastric ulcer, systemic lupus erythematosus (SLE), and diabetes. Respiratory diseases, skin abscesses, heart failure, cataracts, cerebral infarction and chronic renal failure were also significant causes of excess morbidity. Unexpected causes of excess morbidity included candidiasis, excess vomiting in pregnancy (hyperemesis gravidarum) and pterygium. discussion: The magnitude of established causes of excess morbidity among Pacific peoples were similar to our findings. Other causes of excess morbidity are less widely known, or are identified here for the first time. These are systemic lupus erythematosus, hyperemesis gravidarum, cardiomyopathy, gastric ulcer, candidiasis and pterygium. The findings draw attention to specific causes of excess morbidity in Pacific communities where effective interventions are available in primary care, and where further research may identify preventive or curative interventions. KEYWORDS: Pacific peoples; primary care; hyperemesis gravidarum; morbidity; hospitalizations Introduction The Pacific population makes up approximately 7% of the total New Zealand population from the 2006 Census. 1 Pacific people suffer disproportionately from poorer health and, in 2001, their life expectancy at birth was five years less compared to the total New Zealand population. 2,3 The focus of many health intervention programmes is on addressing this disparity in health status. To decrease disparities it is important to understand the range of health problems which disproportionately affect Pacific peoples. Some of these problems have already been identified from mortality and health survey data. 2–5 Nevertheless, there is limited information published on the occurrence of chronic conditions among Pacific peoples in New Zealand. This study was carried out as part of a health needs analysis for Pacific peoples commissioned by the Ministry of Health. Our aim was to determine the specific causes of hospital admissions which are significantly elevated in the Pacific population. This will provide information that may assist early diagnosis and treatment in primary care, and may result in better outcomes for Pacific peoples. J PRIMARY HEALTH CARE 2010;2(2):105–110. CORRESPONDENCE TO: Faafetai Sopoaga Department of Preventive and Social Medicine, University of Otago PO Box 913, Dunedin New Zealand tai.ventura@otago.ac.nz VOLUME 2 • NUMBER 2 • JUNE 2010 J OURNAL OF PRIMARY HEALTH CARE 105
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