Evaluation of the prescribing decision support system Synonyms in a primary care setting: a mixed-method study.

BACKGROUND: Primary care prescribers must cope with an increasing number and complexity of considerations. Prescribing decision support systems (DSS) have therefore been developed to assist prescribers. Previous studies have shown that although there is wide variance in the different DSS available within primary care, barriers and facilitators to uptake remain. The Drug Synonyms function ('Synonyms') is a DSS inherent in the commercial electronic medical record system EMIS. Synonyms functionality has been further developed by the NHS Greater Glasgow and Clyde (GG&C) Central Prescribing Team to promote safe and cost-effective prescribing; however, it does not support the collection of usage data. As there is no knowledge on the uptake nor on the perceived effect of using Synonyms on prescribing, quantitative and qualitative analyses of Synonyms usage are required to ascertain the impact Synonyms has on primary care prescribers, which will influence the continued maintenance and/or future development of this prescribing DSS. AIM: To determine the uptake of Synonyms and explore users' perceptions of its usefulness and future development. DESIGN AND SETTING: An exploratory sequential mixed-method observational study using quantitative questionnaires, followed by semi-structured interviews with primary care prescribers within NHS GG&C. METHOD: An electronic questionnaire (Questionnaire 1) accessible across 218 EMIS-compliant NHS GG&C GP practices ascertained Synonyms uptake by determining whether prescribers were aware of the DSS, whether they were aware of it and whether they used it. Prescribers who were aware of and used Synonyms were asked to opt in to participating further. This involved answering a second electronic questionnaire (Questionnaire 2), with the option of taking part in an additional one-to-one interview, to investigate their use and perceptions of Synonyms. RESULTS: Questionnaire 1 was completed by 201 respondents from 43.1% of eligible GP practices: 186 (92.5%) respondents were aware of Synonyms, of whom 163 (87.6%) had used it and 155 (83.3%) continued to use it. Questionnaire 2 was completed by 104 respondents: 90 (86.5%) indicated that Synonyms informed or influenced their choice of drug prescribed; 94 (90.4%) reported that Synonyms changed their prescribing choice towards medication on NHS GG&C formulary, and 104 (100%) reported that they trust Synonyms. Six interviews generated suggestions for improvements, mainly extending the clinical conditions listed. CONCLUSION: Most respondents were aware of and continued to use Synonyms. Respondents perceived Synonyms to influence prescribing choices towards local formulary medicines and improve adherence to local prescribing guidelines. Respondents trusted the DSS, but there is potential to increase awareness and training amongst non-users to encourage usage. Potentially, the NHS GG&C Synonyms function could be utilised by other health boards with supportive clinical systems.

An Analysis of E-Cigarette Marketing in New Zealand Tobacco Retail Outlets Prior to Legislative Change.

INTRODUCTION: In 2017, the New Zealand (NZ) Government announced its intention to liberalize the sale and promotion of electronic nicotine delivery systems (ENDS), including permitting any outlet to sell ENDS. This research estimated the proportion of tobacco outlets selling ENDS prior to legislative change, documented ENDS point-of-sale (POS) marketing, and examined associations between ENDS availability and outlet type, area-level deprivation, study region, and proximity to a secondary school. AIMS AND METHODS: After drawing a proportional random sample of 281 tobacco outlets from two NZ regions that included convenience stores, supermarkets, and petrol stations, we conducted observational in-store assessments to record ENDS product ranges and promotions. Data were collected between October and December 2017 and analyzed using descriptive statistics and regression modeling. RESULTS: Of tobacco outlets sampled, 22% sold ENDS; these were typically convenience stores (85%) and located in high deprivation areas (53%). Of stores selling ENDS, products were visible at POS in 89% of stores, including 15% with self-service displays and 15% with displays adjacent to children's products. ENDS advertising was present in 31% of the outlets and generally promoted ENDS as cheaper than smoked cigarettes. CONCLUSIONS: Liberalizing access to ENDS could reduce harms caused by smoking; however, extensive use of POS promotions will reach children and young people as well as smokers. While reducing harm among smokers is important, policy makers also need to ensure that regulations protect children from ENDS promotions. IMPLICATIONS: Careful regulation is required to ensure increases in ENDS availability are not accompanied by an increase in young people's exposure to ENDS marketing at the POS.

Smoke-free policies in New Zealand public tertiary education institutions.

The Framework Convention on Tobacco Control mandates the creation of smoke-free environments to protect non-smokers from second-hand smoke and reduce demand for tobacco. We aimed to examine the extent and nature of smoke-free campus policies at tertiary education institutions throughout New Zealand, and examine the policy development process. Stage one comprised an audit and content analysis of smoke-free policies. In stage two, semi-structured telephone interviews were conducted to investigate the process of developing and implementing policies. Qualitative content analysis was undertaken on interview notes. Policies were identified for most institutions (n = 26/29), though varied widely in nature. Only nine mandated 100% smoke-free campuses without exceptions and few prohibited the sale of tobacco on campus, or connections with the tobacco industry. During interviews (n = 22/29), cited barriers to developing a 100% smoke-free policy included enforcement challenges and anticipated opposition from staff and students. However, participants from institutions with 100% smoke-free policies reported having encountered few challenges. Varying levels of compliance with 100% smoke-free policies were reported yet, overall, these policies were viewed as being effective. Smoke-free campus policies could be strengthened to better reflect a completely tobacco-free organization. Other institutions and workplaces could use these findings to develop 100% smoke-free policies.

Progression of varicose veins and chronic venous insufficiency in the general population in the Edinburgh Vein Study.

OBJECTIVE: The natural history in the general population of chronic venous disease in the legs is not well understood. This has limited our ability to predict which patients will deteriorate and to assign clinical priorities. The aims of this study were to describe the progression of trunk varicose veins and chronic venous insufficiency (CVI) in the general population, to identify important lifestyle and clinical prognostic factors, and to determine the relationship between venous reflux and progression. METHODS: The Edinburgh Vein Study is a population-based cohort study in which randomly selected adults aged 18 to 64 years had an examination at baseline. This included a questionnaire on lifestyle and clinical factors, standardized assessment and classification of venous disease in the legs, and duplex scan to detect venous reflux in eight segments of each leg. A follow-up examination 13 years later included a reclassification of venous disease to ascertain progression in the development or increase in severity of varicose veins and CVI. RESULTS: Among 1566 adults seen at baseline, 880 had a follow-up examination, of whom 334 had trunk varicose veins or CVI at baseline and composed the study sample. The mean (standard deviation) duration of follow-up was 13.4 (0.4) years. Progression was found in 193 (57.8%), equivalent to 4.3% (95% confidence interval [CI], 3.7-4.9) annually. In 270 subjects with only varicose veins at baseline, 86 (31.9%) developed CVI, with the rate increasing consistently with age (P = .04). Almost all subjects (98%) with both varicose veins and CVI at baseline deteriorated. Progression of chronic venous disease did not differ by gender or leg, but a family history of varicose veins and history of deep venous thrombosis increased risk (odds ratio [OR], 1.85 [95% CI, 1.14-1.30] and 4.10 [95% CI, 1.07-15.71], respectively). Overweight was associated with increased risk of CVI in those with varicose veins (OR, 1.85; 95% CI, 1.10-3.12). Reflux in the superficial system increased the likelihood of progression, especially in combination with deep reflux (OR, 2.57; 95% CI, 1.55-4.25) and when located in the small saphenous vein (OR, 4.73; 95% CI, 1.37-16.39). CONCLUSIONS: Nearly half of the general population with chronic venous disease deteriorated during 13 years, and almost one third with varicose veins developed skin changes of CVI, increasing their risk of ulceration. Age, family history of varicose veins, history of deep venous thrombosis, overweight, and superficial reflux, especially in the small saphenous vein and with deep reflux, might influence the risk of progression.

Attitudes towards smokefree campus policies in New Zealand.

AIM: This study examines the level of support for a completely smokefree campus policy and other smokefree policy initiatives amongst staff and students at a New Zealand University. METHODS: Attitudes to smoking on campus, smokefree campus policies, implementation and enforcement of smokefree policies were assessed using an online survey of 332 staff and 268 students; giving a response rate of 51% from staff and 41% from students. RESULTS: Most participants had never smoked, or were past smokers; few reported being current smokers. Participants agreed that exposure to second-hand smoke is harmful, disliked being exposed to second-hand smoke on campus, and felt the university should promote a healthy work and study environment. Results indicated strong support for smokefree policies, and participants made several recommendations regarding smokefree policies. Most disagreed that compliance with a smokefree policy should be voluntary, but felt that campus security should warn people who breach the policy. CONCLUSIONS: These results provide a sound basis for university administrators to implement smokefree policies. While around half of the tertiary education institutions in New Zealand already have a completely smokefree campus policy, greater adoption of this policy by tertiary education institutions would foster realisation of the government's goal that New Zealand become a smokefree nation by 2025. A potential barrier preventing tertiary education institutions working towards a smokefree campus is a perceived risk of opposition from staff and students. Our study found strong support for smokefree campus policies; these findings should encourage other universities, polytechnics and other tertiary education providers to adopt full campus smokefree policies.

Smokefree outdoor areas in New Zealand: how far have we come?

AIM: This research examined 1) the extent and nature of smokefree outdoor area (SFOA) policies in New Zealand, and 2) the process of developing, implementing and promoting compliance with a SFOA policy. METHOD: An online survey was carried out with 43 of the 67 Local and District Councils, supplemented by other means. The survey assessed whether the council had a smokefree policy and if so, what locations the policy covered, the process of developing, implementing and promoting compliance with a smokefree policy, the challenges associated with policy development, and plans for future policies. RESULTS: SFOA policies had been enacted by a total of 47 councils, 31 of which responded to the survey, covering a combination of playgrounds, sports grounds, parks, and council run events. Lack of public health priorities, and resources were common issues preventing other councils from developing a policy. Letters from health advocacy groups strongly influenced councils to introduce SFOA policies. The biggest barriers to implementation of SFOA policy were time and resource commitment required from staff, and the financial cost for signage. Voluntary compliance was used to ensure compliance with the policies; no councils used active enforcement. Few councils have evaluated their policies, but most felt that it had been successful. CONCLUSION: Health groups can take heart that their advocacy is resulting in policy change within local government. However, continued efforts are required to undertake evaluations of current SFOA policies which may provide evidence to extend SFOAs, to assist those councils without a SFOA policy to develop one, and to increase funding for implementation.

Characteristics of tobacco retailers in New Zealand.

Using data on known tobacco outlets throughout NZ, GIS was used to map outlets, deprivation and secondary schools. A total of 5008 tobacco outlets were identified, giving a density of one outlet per 617 people or one outlet per 129 smokers. One-half of secondary schools had an outlet within 500 m. Tobacco outlets were more densely located in areas of higher socioeconomic deprivation. One third of all tobacco outlets had a licence to sell alcohol. This study indicates the widespread retail availability of tobacco and the need for a mandatory system of registration for better enforcement of smokefree legislation.

Childhood and adolescent television viewing and antisocial behavior in early adulthood.

OBJECTIVE: To investigate whether excessive television viewing throughout childhood and adolescence is associated with increased antisocial behavior in early adulthood. METHODS: We assessed a birth cohort of 1037 individuals born in Dunedin, New Zealand, in 1972-1973, at regular intervals from birth to age 26 years. We used regression analysis to investigate the associations between television viewing hours from ages 5 to 15 years and criminal convictions, violent convictions, diagnosis of antisocial personality disorder, and aggressive personality traits in early adulthood. RESULTS: Young adults who had spent more time watching television during childhood and adolescence were significantly more likely to have a criminal conviction, a diagnosis of antisocial personality disorder, and more aggressive personality traits compared with those who viewed less television. The associations were statistically significant after controlling for sex IQ, socioeconomic status, previous antisocial behavior, and parental control. The associations were similar for both sexes, indicating that the relationship between television viewing and antisocial behavior is similar for male and female viewers. CONCLUSIONS: Excessive television viewing in childhood and adolescence is associated with increased antisocial behavior in early adulthood. The findings are consistent with a causal association and support the American Academy of Pediatrics recommendation that children should watch no more than 1 to 2 hours of television each day.