title: Use of, and attitudes to, clinical priority assessment criteria in elective surgery in New Zealand.
abstract: OBJECTIVE
  To describe the ways patients access elective surgery in New Zealand, and to understand the use of, and attitudes to, clinical priority assessment criteria (CPAC) in determining access to publicly funded elective surgery.
  
  
  METHODS
  A qualitative study in selected New Zealand localities. A purposive sample of general practitioners, surgeons and administrators in publicly funded hospitals were interviewed. Data were analysed by a process of thematic analysis.
  
  
  RESULTS
  Sixty-five interviews were completed. General practitioners had a key role in determining which patients were seen in the public sector and, by utilising strategies to actively advocate for patients, influenced both waiting times for first assessment by surgeons and for surgery. CPAC had been developed as decision support guides with the intention that they would provide transparency and equity in determining access. However, there was variation in the way CPAC were being used both in score construction and in the influence of the score on access to surgery. The management of the hospital system also limited the extent to which CPAC could be used to prioritise patients for surgery.
  
  
  CONCLUSIONS
  Variability in the use of CPAC tools meant that at the time of the study they did not provide a transparent and equitable method of determining access to surgery. This highlights the difficulties in developing and implementing CPAC and suggests that further development is difficult in the absence of evidence to identify patients who will benefit the most from surgery.
authors.affiliation: Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand.
authors.forename: Deborah
authors.initials: D
authors.lastname: McLeod
authors.forename: Sonya
authors.initials: S
authors.lastname: Morgan
authors.forename: Eileen
authors.initials: E
authors.lastname: McKinlay
authors.forename: Kevin
authors.initials: K
authors.lastname: Dew
authors.forename: Jackie
authors.initials: J
authors.lastname: Cumming
authors.forename: Anthony
authors.initials: A
authors.lastname: Dowell
authors.forename: Tom
authors.initials: T
authors.lastname: Love
mesh_terms: D001291:Attitude of Health Personnel; D017558:Elective Surgical Procedures / Q000706:statistics & numerical data*; D015276:Health Care Rationing / Q000592:standards*; D006297:Health Services Accessibility; D006302:Health Services Research; D006740:Hospital Administrators / Q000523:psychology; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006801:Humans; D007407:Interviews as Topic; D008505:Medical Staff, Hospital / Q000523:psychology; D009520:New Zealand; D018579:Patient Selection; D010821:Physicians, Family / Q000523:psychology; D017064:Process Assessment, Health Care; D036301:Qualitative Research; D012017:Referral and Consultation / Q000706:statistics & numerical data