Characteristics of a stratified random sample of New Zealand general practices

Abstract

INTRODUCTION Practice size and location may affect the quality and safety of health care. Little is known about contemporary New Zealand general practice characteristics in terms of staffing, ownership and services. AIM To describe and compare the characteristics of small, medium and large general practices in rural and urban New Zealand. METHODS Seventy-two general practices were randomly selected from the 2014 Primary Health Organisation database and invited to participate in a records review study. Forty-five recruited practices located throughout New Zealand provided data on staff, health-care services and practice ownership. Chi-square and other non-parametric statistical analyses were used to compare practices. RESULTS The 45 study practices constituted 4.6% of New Zealand practices. Rural practices were located further from the nearest regional base hospital (rural median 65.0 km, urban 7.5 km (P < 0.001)), nearest local hospital (rural 25.7 km, urban 7.0 km (P = 0.002)) and nearest neighbouring general practitioner (GP) (rural 16.0 km, urban 1.0 km (P = 0.007)). In large practices, there were more enrolled patients per GP FTE than both medium-sized and small practices (mean 1827 compared to 1457 and 1120 respectively, P = 0.019). Nurses in large practices were more likely to insert intravenous lines (P = 0.026) and take blood (P = 0.049). There were no significant differences in practice ownership arrangements according to practice size or rurality. CONCLUSION Study practices were relatively homogenous. Unsurprisingly, rural practices were further away from hospitals. Larger practices had higher patient-to-doctor ratios and increased nursing scope. The study sample is small; findings need to be confirmed by specifically powered research.

Do people living in rural and urban locations experience differences in harm when admitted to hospital? A cross-sectional New Zealand general practice records review study

“…Analysis of the characteristics of the general practices of the original SHARP study showed that large practices had significantly higher numbers of patients enrolled per full-time-equivalent (FTE) general practitioner (GP) (mean 1827 patients per FTE GP) compared with medium-sized practices (mean 1457 patients/FTE GP) and small practices (mean 1120 patients/FTE GP) but similar practice nurse workloads. 24 International literature on the linkage between practice size, patient caseload for the general practice team and quality and continuity of primary care is mixed. An English study of over 230 000 patients showed that better continuity of care with one’s own GP was associated with reduced rates of preventable hospital admissions and that larger practices (>7 FTE GPs) had lower levels of continuity than smaller practices (1–3 FTE GPs).…”

Medication-related harm in New Zealand general practice: a retrospective records review

“…Twelve practices were randomly selected by from each strata and invited to participate; 44 study practices consented to participate (72.6% of the 62 eligible randomly selected practices with compatible practice software). 11…”

“…9 In this study we examine medication-related harm in general practice using a subset of data from a nation-wide retrospective cohort review of general practice electronic health records which was looking at all harms. 10,11 The primary aim of this paper was to estimate the incidence, preventability and severity of all harms attributable to medication prescribed in general practice in New Zealand.…”

Research using electronic health records: Balancing confidentiality and public good

“…18 We randomly selected 72 practices nationally and invited the 62 eligible practices to participate. 19 Forty-five practices agreed (73%). The most common reasons for non-participation were commitment to confidentiality, concern about secondary use of data for financial gain, and fear of accountability repercussions.…”