A kaupapa Māori approach to cardiovascular risk reduction: A controlled trial

Project code:  MHS015

Department

General Practice and Primary Health Care

Location

Tauranga

Supervisor

Anna Rolleston

Māori are disproportionately affected by cardiovascular disease and innovative, Maori-centric approaches are required to address this inequity. The purpose of this project is to determine the effects of an exercise and lifestyle-management programme for cardiac risk reduction that is embedded within a kaupapa Māori approach. This project is a Heart Foundation funded controlled trial using kaupapa Maori methods, with a cluster wait-list design. Participants assigned to the intervention are able to redevelop a usual-care cardiac risk reduction programme to embed a Māori worldview. The aims of the summer studentship project are to perform a case study analysis of 2 participant clusters for dissemination back to the community and for formal peer-reviewed publication. In addition, an aim of the project is to understand how kaupapa Māori principles can be applied at the same time as western medical principles in both research and practice.

Skills

  • Community engagement and consultation
  • Kaupapa Māori theory in practice
  • Some clinical work if the applicant has the requisite skills (clinical assessments of participants)
  • Data management within a clinical trial environment

Screening for maternal depression: systematic review

Project code:  MHS043

Department

General Practice and Primary Health Care

Location

Auckland

Suicide is now the leading cause of maternal death in NZ, with the rate significantly higher than in comparable countries such as the UK. The aim is to conduct a systematic review on screening for maternal depression. This will be part of a project that is looking at developing an electronic tablet-based tool for midwives to integrate maternal screening, treatment guidelines and e-referrals to support women’s better access to treatment and integrated care. It is also anticipated that the systematic review will be published in a peer-reviewed journal.

Skills

You will be taught how to:

  • search databases
  • use bibliography software
  • analyse/ synthesise research findings
  • write for publication

You will join the group of summer students at the School of Population Health, Tamaki Campus, and have the opportunity to participate in the academic and social programme provided.

Activating older people for medication review: the effect of a practice mail-out

Project code:  MHS049

Department

General Practice and Primary Health Care

Location

Auckland

Supervisor

Katharine Wallis

Older people sometimes continue to take long-term medications when the benefit: harm ratio is no longer favourable. Deprescribing (tapering and withdrawing) long-term medications can be difficult. Older people may be reluctant to change and fearful of stopping medicines they have been on for a long time, and busy general practitioners may not consider reviewing and stopping long-term medicines for a multitude of reasons including fear of upsetting the patient.

To facilitate medication review and the possibility of deprescribing medicines that may no longer be indicated, we are exploring patient activation as part of a broader project to encourage medication review and improve the safety of prescribing for older people in general practice. Patient activation entails practice audit to identify patients with high-risk prescribing, and sending these at-risk patients a mail-out from the practice containing an information brochure about the medication issue and a letter encouraging the patients to discuss their medicines when they next see their doctor.

This student project is to interview older patients who have received a mail-out to discover the effect of the mail-out. We do not know whether older people will be interested in such a mail-out, or whether they will be upset by it or concerned about their medicines, or whether they will find it helpful and appreciate the encouragement to prompt their doctor to review their medicines, and whether it will help prepare them for possible medication change. 

The project is based in Auckland. The project will have ethical approval before the studentship starts. The interviews can be by phone or in person. 

Skills

  1. Being part of a research team
  2. Literature review – effect on older people of mail-out highlighting potential medication issue and encouraging discussion with their doctor
  3. Assisting with the design and implementation of a semi-structured interview questionnaire
  4. Arranging, conducting, audiotaping, and transcribing patient interviews
  5. Initial thematic analysis and interpretation of qualitative data
  6. Report writing

What data and research do we need to help decide if it is worth funding the Herpes zoster vaccine in New Zealand?

Project code:  MHS155

Department

General Practice and Primary Health Care

Location

Auckland

Supervisor

Dr Katharine Wallis

There is minimal information available on the burden of Herpes zoster (shingles) in New Zealand (http://www.immune.org.nz/sites/default/files/research_articles/Ebook%20Varicella.pdf). The United Kingdom began funding a vaccine for Herpes zoster for adults aged 70 years and over in 2013 and Australia will begin funding the Herpes zoster vaccine for adults (>70 years) this year. Should we be funding this vaccine in New Zealand? This project will help to guide an answer to this question by

1) Conducting a systematic review of recent literature available on Herpes zoster

2) Investigate the potential of the current national data collections to help assess the burden of Herpes zoster in New Zealand.

3) Conduct interviews with key informants about shingles.

4) Use outcomes from the review, investigation of data and interviews to write a research protocol for investigating the burden of Herpes zoster (shingles) in New Zealand.

Skills

  • Literature review and analysis
  • Qualitative research
  • Research planning
  • Familiarity with National data collections

The costly end

Project code:  MHS168

Department

General Practice and Primary Health Care

Location

Auckland

Supervisor

Prof Ngaire Kerse

To establish costs in the last year of life for Maori and non Maori octogenerians: LiLACS NZ

This project will use data from those who have passed away during the Lilacs NZ 5 year follow up and identify health costs in the last year of life. These will be compared with those still in the study for the same time period and between groups. Characteristics of persons with low cost last year's will be identified. 

Skills

  • Data analysis
  • Health system economics
  • Ageing
  • Manuscript preparation

Super Study

Project code:  MHS169

Department

General Practice and Primary Health Care

Location

Auckland

Supervisor

Ruth Teh

Those in need of daily care will increase by 200% for Maori and 75% for non-Maori by 2026. Frailty is a precursor to functional loss and results in increased health care needs.  Up to 51% of community-dwelling older people may be pre-frail, and over 60% in LiLACS NZ.

The SUPER Study is a randomised controlled trial to examine the effectiveness of a complex intervention in reducing frailty and falls and among pre-frail elderly.  The study aims to answer this question “Does eating well and moving about more make life happier and easier by reducing frailty and decreasing falls?”

What is the effect of nutrition and physical activity on functional status in pre-frail older people (75+ non-Maori and 60+ Maori): A pilot study

Skills taught: Data analysis. Health system economics. Ageing. Manuscript preparation. 

Skills

  • Literature Review,
  • Data analysis
  • Report writing and preparing a paper for publication

Innovative case management study of gout patients

Project code:  MHS083

Department

General Practice and Primary Health Care

Location

Auckland

Supervisor

Bruce Arroll

This project is part of an innovative programme to case manage patients with gout to enable them to get on to medication to prevent their gout. Gout is an issue that impacts Maori and Pacific men and there is evidence that they are undertreated. There are many barriers to getting a patient with gout started on preventive medicines. One of these is getting to a GP clinic to get a prescription and then getting the medication and laboratory tests. Our project will aim to make getting gout treated as easy as possible with phone calls, posting out prescriptions and laboratory tests. Patients will not be required to come to the clinic unless absolutely necessary. The study design is essentially a before –after study with the aim to see how many patients can be well controlled according to their blood tests and regular collection of prescriptions. We have two new graduate nurses who will be doing the case management and will follow each patient for 2 years. The role of the summer student will be to help with this process of contacting the 258 patients identified as well as managing and analysing the data set as it develops. The project will be conducted at Greenstone Clinic in Manurewa which is a national leader in innovation with the best control rates for patients with diabetes and 100% immunisation status for under one year olds.  The project is being supported by Counties Manukau DHB who will be providing a point of care testing machine for uric acid the chemical being measured in gout patients. We aim to get the best control rate for gout in the country and to estimate what are the barriers to optimal care and how we can surmount them.

Skills

The student will learn how to conduct a before-after trial and to do multiple audits on a sample of patients and to tease out the barriers to good treatment as well as conducting a literature on how best to treat gout. We will publish a paper on the findings of this study as there is national interest in the topic.