Children and adolescents with type 1 diabetes in Aotearoa New Zealand: An online survey of workforce and outcomes 2021.

AIMS: To survey the national workforce that manages children and adolescents with type 1 diabetes (T1D) in Aotearoa New Zealand and compare with glycaemic outcomes for 2021. METHODS: A representative from each tertiary and regional diabetes service in Aotearoa New Zealand was asked to participate in an online survey assessing health-care professional (HCP) workforce numbers operating for the 2021 calendar year. Regional full-time-equivalent (FTE), glycaemic outcomes and population demographics were compared to a previously reported workforce surveys (2015 and 2019). RESULTS: Seventeen sites responded - including all four large tertiary centres - serving >99% of children and adolescents with T1D in Aotearoa New Zealand. HCP resourcing varied across sites, with median (range) HCP/100 patient ratios of: doctors: 0.40 (0.16-1.11), nurses: 1.19 (0.29-5.56), dietitians: 0.25 (0-1.11) and psychologist/social workers: 0 (0-0.26). No site met all of the International Society of Paediatric and Adolescent Diabetes (ISPAD) recommendations of HCP/100 patient ratios. Measures of socio-economic deprivation predicted HbA1c, rather than the diabetes clinic attended. Overall, only 15.1% (240/1585) of patients had an HbA1c less than the recommended 53 mmol/mol. CONCLUSIONS: The Aotearoa New Zealand workforce for children and adolescents with T1D is under-resourced and no site meets the ISPAD recommendations. There has been no significant increase in HCP/100 patient ratios compared to previous workforce surveys over the last decade. Few children and adolescents with T1D meet the recommended HbA1c. Resourcing according to recommended clinical need is required if equity in outcomes for young people with T1D is to be addressed.

Review of Maori equity in surgical trainee selection.

BACKGROUND: The Royal Australasian College of Surgeons (RACS) aims to achieve Maori health equity and cultural safety within the surgical workforce. The RACS Maori Health Strategy and Action Plans encourage Surgical Education and Training (SET) selection criteria that recognizes and credit applicants who identify as Maori or demonstrate competence in Maori health issues. This study investigates the current SET selection criteria for Maori entering surgical specialties. METHODS: The selection criteria for each surgical speciality for the proposed 2024 intake were examined through a documentary analysis. Criteria were reviewed for applicability to Maori identification and/or cultural competency. RESULTS: Criteria related to Maori identification and/or cultural competency make up 6%, 2%, and 1.5% of Otolaryngology and Head and Neck, General, and Vascular Surgery total SET selection score respectively. Criteria related to Maori identification and/or cultural competency make up 9% and 0.1% of Orthopaedic and Plastics and Reconstructive Surgery ranking scores for interview eligibility respectively. Cardiothoracic Surgery, Paediatric Surgery, Neurosurgery and Urology specialties do not incorporate any criteria appertaining to Maori. Allocation of research-related points determined by authorship may disincentivize Maori trainees. CONCLUSIONS: Some surgical specialties fail to recognize or credit Maori identification and cultural competency in SET selection criteria. There is a need for regular auditing to ensure SET criteria align with the RACS aspirations for Maori health equity and cultural safety within the surgical workforce.

A retrospective observational study of the management of non-traumatic dental presentations at a tertiary centre in New Zealand: a Choosing Wisely approach.

AIMS: Non-traumatic dental presentations (NTDPs) commonly present to emergency departments (EDs) and may receive orthopantomograms (OPGs, plain X-rays), opiates and antibiotics. "Choosing Wisely" is an international healthcare campaign that aims to reduce unnecessary and low-value patient care. This study aims to identify low-value management of NTDPs. METHODS: Presentations to the Christchurch Hospital ED with dental pain or dental abscess in 2020 were included. Data collected included patient demographics, management and discharge medications. Descriptive statistics were calculated. RESULTS: There were 931 NTDPs during the study period, with over-representation of young adults, Maori, Pacific Peoples and those living in high-deprivation areas. Of these, 343 (37%) received an OPG, of which 24% (83) were considered low value. Of patients managed by ED staff who were not referred to specialist dental services, 258 (42%) were prescribed antibiotics, of whom only half had facial swelling, and 71% received a script for analgesia, of which 78% included an opiate. Seventy-three percent of patients presented outside of normal working hours. Fewer than one in five NTDPs received definitive treatment. CONCLUSIONS: NTDPs may receive non-optimal management in EDs. Continuing to care for NTDPs in this environment may add to increased healthcare costs, access block and poor opioid and antimicrobial stewardship.