Retrospective survey of colposcopy experience for wahine Maori across two time periods (2016 and 2021) in Waitemata and Auckland districts, New Zealand.

AIMS: To examine wahine Maori experiences of colposcopy services in New Zealand based on surveys conducted in 2016 and 2021. METHODS: The surveys included a total of 201 wahine Maori who had attended one of the three colposcopy clinics in the Waitemata and Auckland districts. Participants were retrospectively surveyed about their experience via telephone using a pre-tested questionnaire. Pre-defined responses were analysed quantitatively, and narrative comments were analysed thematically. RESULTS: Response rates were 27.6% in 2016 and 34.2% in 2021. Prior to their appointment, most women reported receiving the information leaflet and a reminder. At the clinic visit, overall interaction with staff, comfort, listening and explanation of the procedure all scored highly, with maintenance or improvements from 2016 to 2021. Wahine reported feeling culturally safe. Areas for improvement included content of information, access to Maori community liaison, appointment waiting time and delivery of colposcopy results. CONCLUSIONS: The findings indicated that wahine Maori had overall excellent experiences of colposcopy services, maintained over a five-year period with some suggested improvements to context of information and communication. This provides reassurance for wahine Maori in the diagnostic and treatment part of the cervical screening pathway ahead of the upcoming change to HPV primary screening.

Improving acute medical management: Junior Doctor Emergency Prescription Cards.

Doctors commencing Foundation Year (FY) training face many stresses and challenges. FY doctors are often the first point of contact for acutely unwell and deteriorating patients. Trust guidelines are used to aid acute medical management. Accessing guidelines is often fraught with barriers. Evidence suggests aide-memoire cards can provide easier access to guidelines and management pathways. We aimed to improve prescribing accuracy and efficiency of FY doctors for acute medical conditions within Gloucestershire trust by improving access to and usability of trust guidelines. Questionnaires were distributed to FY doctors to identify acute medical conditions to include on the emergency prescription cards (EPCs). Two small double-sided cards were created containing bullet pointed trust guidelines for: hyper/hypokalaemia, status epilepticus, diabetic emergencies, arrhythmias, myocardial infarction, acute asthma, pulmonary oedema, anaphylaxis and a ward-round checklist. Feedback was used to improve EPCs prior to distribution. Pre (N=53) and post-intervention (N=46) written questionnaires were completed by FY doctors. These assessed acute clinical management including use of guidance, confidence in management, speed of prescribing and EPC "usability". To assess prescribing accuracy, prescriptions for acute medical conditions were reviewed pre (N=8) and post-intervention (N=12). The EPCs were well received (80% quite/very useful) and found "easy to use" (83%). The introduction of EPCs increased guidance use (pre-intervention 58.8%, post-intervention 71.7%), increased confidence (pre-intervention 79%, post-intervention 89%) and significantly improved prescribing speed (p=0.05). There was a significant correlation with confidence and prescribing speed (p = 0.023). The accuracy of prescribed doses improved (pre-intervention 62.5%, post-intervention 87.5% accurate) as did details regarding route / additional required information (pre-intervention 75%, post-intervention 97.7%). The EPCs support the management of unwell patients, are relevant to the workload of modern doctors practice and may improve patient care. This improvement measure could be applied to other NHS trusts and medical specialties.