Clinical Indicators

Inhaled Corticosteroids 

• Why is the NZMC number used in this indicator while other indicators use the NHI number? The NHI levels within the pharmaceutical data warehouse are not consistently high enough for the programme to use, therefore, we use the NZMC number as the key identifier. The aim for the referred services related indicators is to eventually use NHI as a match rather than NZMC.

• Total days prescribed or dispensed? The inhaled corticosteroid indicator is based on date dispensed. This is because this is the date that the pharmacist enters into their records and which is recorded in the pharmaceutical data warehouse.  The date on which the prescription is written is not recorded.

• Why is the national goal to be under 1000mcg? Clinical advice is that in the majority of instances people can have their asthma well controlled by doses of less than 1000mcg per day and that additional increases in dosage provide no additional benefit.

• An inhaler has 200 doses while other medications have different dosage levels. How is this taken into account? The numerator for this indicator is ‘beclomethasone equivalent doses of inhaled corticosteroids’.  A table provided by PHARMAC shown in Appendix 4 of the Technical data definitions document shows both the list of Inhaled Corticosteroid types included in this indicator as well as the constants applied to convert the different types into beclomethasone equivalents.

Acute Phase Response

• Why does this indicator require a decrease for improvement, which is different to all the others? Why not just switch it round? This decision was made by the Advisory Group as to the indicator definition. There is an intention to make the indicators consistent i.e. that all improvements required an increase in movement, which we aim to address when the 2nd phase indicators for the Programme are agreed.

• Will you be able to differentiate between primary and secondary care ordering? Yes, as only primary and community information is provided in the laboratory data warehouse. Also, the Programme matches against NZMC numbers of the practitioners working within each PHO.

 

Influenza Vaccine

• Which year’s flu data is the baseline and targets derived from? The numbers are based on the previous year’s flu campaign. Please find the table below which will provide you with confirmation on which flu seasons data will be used for which reporting period and subsequently which Programme Report (i.e. Baseline, Quarterly, and Performance).

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• How is the data collection process defined? Information is provided by the PHO on the Immunisation Report (which is a component of the Service Utilisation Report (SUR)) loaded into the Ministry of Health Contract Management System (CMS). The Programme is provided with an extract from the CMS system, where the SUR has been confirmed as complete (i.e. 100% of practices have submitted their information.).

• What is the difference in the definition for High Need for this indicator? The difference for the definition for this indicator is that it only includes Maori and Pacific ethnicities.  The NZ Deprivation level quintiles are excluded. The different definitions can be found in the utilisation by high needs section and can also be found in the Data Definitions document at www.dhbnz.org.nz 

• Some PHOs have found it hard to track each individual child’s data. Will there be a more efficient data collection method implemented in the future? The NIR should be able to provide this monitoring tool for PHOs overtime. The Programme has no ability to provide patient level information.

 

Breast Screening

• What happens when patients opt for private screening services? We take NHI number associated with a screen recorded in the NSU data and match it back to the PHO.  There is no ability currently for private screens to be included in the NSU database or any alternative national data collection.

• Is the Programme going to take into account the new age band released for breast screening? At this point in time the Programme is unable to extend the age bands included in the data definition for this indicator. This will be reviewed once sufficient baseline data is available in the NSU. 

 

NHI Numbers

A large number of the population may have mismatched NHI numbers due to differences related to misunderstandings about names.

• Has the Programme accounted for this? E.g. Chinese people with English equivalent names may have a different NHI number assigned to each name.
  This is a general issue that not only impacts the programme, but also other health sector programmes that use NHI as a unique identifier. The Programme will work with NZHIS to see if there are improved processes that can be implemented to minimise this risk of this issue on the Programme.  At this point in time the data that matches the NHI on the PHOs patient register is the data that will be included in the Programme’s indicators.

 

Simultaneous Testing of Accute Phase Response

• Is the aim of this indicator to move away from ordering ESR to ordering CRP? For many conditions CRP is a better test to use than ESR, however, in some instances ESR is preferable to CRP.  BPAC NZ has provided an education pack to all general practitioners and PHOs on ESR and CRP testing.

 

Multiple Practice Logic

• What is the Multiple Practice Logic? During a reporting period a practitioner may join or leave a practice or PHO, they may work for multiple practices within a PHO or multiple PHOs, and they may also work outside PHOs i.e. hospice or family planning clinic.

• What is the calculation?Initially the split between practices is that 50% of costs are allocated to permanent practices and the remaining 50% allocated across all practices (permanent and non permanent).

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Scenario One: If a GP works in one practice and is recorded as a full-time practitioner, then 100% of their expenditure/claims will be assigned to that practice.

Scenario Two: If a GP works in two practices and recorded as a full-time practitioner in both practices, 50% of their expenditure/claims will be assigned to Practice A and 50% of the expenditure/claims will be assigned to Practice B.

Scenario Three: If a GP is working in two practices and recorded as a full-time practitioner in Practice A and a Locum in Practice B, then 75% of their expenditure/claims will be assigned to Practice A and 25% of the expenditure/claims will be assigned to Practice B.

Scenario Four: If a GP is working in three practices and recorded as a full-time practitioner in Practice A and a Locum in Practice B & Practice C, then 62.5% (50% + (50%/3)) of their expenditure/claims will be assigned to Practice A and 16% (50%/3) of the expenditure/claims will be assigned to Practice B and Practice C.

Scenario Five: If a GP works in one practice and is recorded as a Locum practitioner, then 75% of their expenditure/claims will be assigned to that practice.

 

• What is the definition of a locum? A locum means a Medical Practitioner (with a current practising certificate) who provides the Services in place of another Practitioner during that Practitioner’s normal working hours. A Locum may:
  a) work providing consultation Services to the patients of the Practitioner during those working hours if the Practitioner is performing work other than providing ordinary Services to patients or is on temporary leave (for whatever reason);
  b) provide Services in place of more than one Practitioner during any period of time;
  c) not consult with patients of the Practitioner at the same times as the Practitioner; and
  d) not be used to extend the normal working hours of the Practitioner.
  The definition is sourced from the PHO Agreement.
  What if a GP works for a practice that is not part of a PHO?
  This information is not provided to us, so we are not able to identify when a provider works in both a PHO practice and non-PHO practice.

• Does the amount of time a GP spends as a locum in a practice influence the split of funding? Yes and No.  As long as the GP is recorded as a locum at that practice then that is the calculated logic that will be applied.  The split is only applied for the date period that the GP is shown as working in the PHO.

• What portion percent would be allocated to a locum at two or more practices?Depending on the number of practices they work in, and the locum flag, the 75% is split.

• If a Locum is not with a PHO at all will they be counted? No.

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