A repeat audit of primary care management of group A streptococcal pharyngitis in Northland, New Zealand 2016
Anil Shetty 1 , Clair Mills 1 , Kyle Eggleton 21 Public and Population Health, Northland District Health Board, Whangarei, New Zealand
2 Department of General Practice and Primary Health Care, The University of Auckland, Auckland, New Zealand
Correspondence to: Anil Shetty, Public and Population Health Unit, Northland District Health Board, PB 9742, Whangarei 0148, New Zealand. Email: anil.shetty@northlanddhb.org.nz
Journal of Primary Health Care 10(1) 18-24 https://doi.org/10.1071/HC17056
Published: 29 March 2018
Journal Compilation © Royal New Zealand College of General Practitioners 2018.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: One of the New Zealand Government’s Better Public Services targets was to reduce the rate of acute rheumatic fever (ARF) nationally by two-thirds by 2017. Māori children and young people are disproportionately affected by ARF in the Northland District Health Board region. General practice contributes to ARF prevention in detecting and appropriately treating group A streptococcal (GAS) pharyngitis. An audit in 2012 suggested improvements in adherence to national guidelines were needed.
AIM: The aim was to reassess general practice adherence to national guidelines for the management of GAS pharyngitis in Northland, New Zealand, following implementation of the national Rheumatic Fever Prevention Programme.
METHODS: Throat swab and dispensing data were obtained and analysed for children and young people aged 3–20 years who attended general practice in Northland between 1 April and 31 July 2016 and had laboratory-proven GAS pharyngitis.
RESULTS: Between 2012 and 2016, the number of throat swabs carried out in general practice more than doubled, and amoxicillin was more commonly prescribed. The proportion of GAS pharyngitis patients in general practice not receiving recommended antibiotics, or receiving an inadequate length of treatment or no prescription, has not reduced. There are significant differences in the management of care for Māori and non-Māori patients, with much higher risk of ARF for Māori.
Discussion: The management of GAS pharyngitis by general practice in Northland remains substandard. Implicit bias may contribute to inequity. Focused engagement with identified subgroups of general practices and practitioners who disproportionately contribute to non-guideline prescribing should be further investigated.
KEYWORDS: Pharyngitis; prevention and control; primary health care; rheumatic fever; school health services; Streptococcus pyogenes
References
[1] Ministry of Health, New Zealand. Progress on the better public services rheumatic fever target. Wellington: Ministry of Health. [cited 2017 April 14]. Available from: http://www.health.govt.nz/about-ministry/what-we-do/strategic-direction/better-public-services/progress-better-public-services-rheumatic-fever-target[2] Statistics New Zealand. Population projections prepared for Ministry of Health - Northland DHB projected population aged 0–20 years by sex at 30 June 2014–43 (2013-Base). Wellington: Statistics New Zealand; 2015.
[3] Robin A, Mills C, Lennon D, Tuck R. The epidemiology of rheumatic fever in Northland, 2002 to 2011. N Z Med J. 2013; 126 46–52.
[4] Ministry of Health. Previous BPS target: reduce rheumatic fever. Wellington: Ministry of Health; 2017. (Updated 09 June). [cited 2017 November 22]. Available from: https://www.health.govt.nz/about-ministry/what-we-do/strategic-direction/better-public-services/previous-bps-target-reduce-rheumatic-fever
[5] Heart Foundation of New Zealand. Group A Streptococcal Sore Throat Management Guideline. 2014 Update. Auckland: Heart Foundation of New Zealand; 2014.
[6] New Zealand Guidelines Group. New Zealand Primary Care Handbook 2012. 3rd ed. Wellington: Ministry of Health; 2012. [cited 2017 January 30]. Available from: www.health.govt.nz/publication/new-zealand-primary-care-handbook-2012
[7] Shetty A, Mills C, Eggleton K. Primary care management of group A streptococcal pharyngitis in Northland. J Prim Health Care. 2014; 6 189–94.
[8] Lennon D, Kerdemelidis M, Arroll B, Sharpe N. Once-daily amoxicillin for group A streptococcal (GAS) sore throat as the other first-line option: a clarification of the NZ sore throat guidelines. N Z Med J. 2011; 124 116–9.
[9] Ministry of Health. Rheumatic fever. Wellington: Ministry of Health; 2017. [cited 2017 November 22]. Available from: https://www.health.govt.nz/our-work/diseases-and-conditions/rheumatic-fever
[10] Ministry of Health. New Zealand. Rheumatic fever resources for health professionals. Wellington: Ministry of Health. [cited 2017 April 14]. Available from: http://www.health.govt.nz/our-work/diseases-and-conditions/rheumatic-fever/rheumatic-fever-resources/rheumatic-fever-resources-health-professionals.
[11] Ministry of Health. New Zealand. Pharmaceutical collection. Updated 24/06/15. Wellington: Ministry of Health. [cited 2017 April 14]. Available from: http://www.health.govt.nz/nz-health-statistics/national-collections-and-surveys/collections/pharmaceutical-collection
[12] Atkinson J, Salmond C, Crampton P. NZDep2013 Index of Deprivation. Wellington: Department of Public Health, University of Otago; 2014.
[13] Kljakovic M, Crampton P. Sore throat management in New Zealand general practice. N Z Med J. 2005; 118 U1609.
[14] Shetty A, Mills C. Primary care utilisation by 6 to 12 year old children in Northland: pre- and post-implementation of zero-fee visits. Whangarei, Northland: Public and Population Health Unit, Northland DHB; 2016.
[15] Mardani J, Calder L, Haydon-Carr J, et al. Throat swabbing for the primary prevention of rheumatic fever following health information. N Z Med J. 2011; 124 46–51.
[16] Norris P, Horsburgh S, Keown S, et al. Too much and too little? Prevalence and extent of antibiotic use in a New Zealand region. J Antimicrob Chemother. 2011; 66 1921–6.
| Too much and too little? Prevalence and extent of antibiotic use in a New Zealand region.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BC3MXptFClsr0%3D&md5=59d5c82f02b53c89fe2d07eacc76975bCAS |
[17] Ministry of Health. New Zealand. Annual update of Key Results 2015/16. New Zealand Health Survey. Wellington: Ministry of Health. [cited 2017 April 14]. Available from: http://www.health.govt.nz/ publications/annual-update-key-results-2015–16-new-zealand-health-survey
[18] Jatrana S, Crampton P, Norris P. Ethnic differences in access to prescription medication because of cost in New Zealand. J Epidemiol Community Health. 2011; 65 454–60.
| Ethnic differences in access to prescription medication because of cost in New Zealand.Crossref | GoogleScholarGoogle Scholar |
[19] Bhattacharyya O, Reeves S, Zwarenstein M. What is implementation research? Rationale, concepts, and practices. Res Soc Work Pract. 2009; 19 491–502.
| What is implementation research? Rationale, concepts, and practices.Crossref | GoogleScholarGoogle Scholar |
[20] Ministry of Health. Using Practitioner Supply Orders and Standing Orders in the Rheumatic Fever Prevention Programme. Published online 17 February 2015. Wellington: Ministry of Health, 2015. [cited 2017 April 14]. Available from: http://www.health.govt.nz/publication/using- practitioner-supply-orders-and-standing-orders- rheumatic-fever-prevention-programme
[21] Anderson A, Mills C, Eggleton K, et al. Northland District Health Board Research Report: Whanau experiences of the diagnosis and management of Acute Rheumatic Fever for tamariki in Te Tai Tokerau, Aotearoa. Te Kupenga Hauora Māori. Auckland: University of Auckland; 2015.
[22] Hokomau CA. What you can’t see can hurt you: how do stereotyping, implicit bias and stereotype threat affect Māori health? MAI J. 2016; 5 124–136.
| What you can’t see can hurt you: how do stereotyping, implicit bias and stereotype threat affect Māori health?Crossref | GoogleScholarGoogle Scholar |
