National variability in provision of health services for major long-term conditions in New Zealand (a report from the ABCC NZ study).
BACKGROUND
Chronic illness is the leading cause of morbidity, mortality, and inequitable health outcomes in New Zealand. The ABCCNZ Stocktake aimed to identify extent of long-term conditions management evidence-based practices in stroke, cardiovascular disease, chronic obstructive pulmonary disease and congestive heart failure in New Zealand's District Health Boards (DHBs).


METHODS
Eleven 'dimensions' of care for long-term conditions, identified by literature review and confirmed at workshops with long-term conditions professionals, formed the basis of the Stocktake of all 21 DHBs. It comprised two questionnaires: a generic component capturing perceptions of practice; and a disease-specific component assessing service provision.


RESULTS
Fifteen DHBs completed all or parts of the questionnaires. Data accrual was completed in July 2008. Although most DHBs had developed long-term conditions management strategies to a moderate degree, there was considerable variability of practice between DHBs. DHBs thought their PHOs had developed strategies in some areas to a low to moderate level, though cardiovascular disease provision rated more highly. Regarding disease-specific services, larger DHBs had greater long-term conditions management provision not only of tertiary services, but of standard care, leadership, self-management, case-management, and audit.


CONCLUSIONS
There is considerable variability in perceptions of long-term conditions management service provision across DHBs. In many instances variability in actual disease-specific service provision appears to relate to DHB size.
Geriatric Medicine, University of Auckland, Auckland, New Zealand. martin.connolly@waitematadhb.govt.nz
Martin J
MJ
Connolly
Timothy
T
Kenealy
P Alan
PA
Barber
Peter
P
Carswell
Janet
J
Clinton
Lorna
L
Dyall
Gerard
G
Devlin
Robert N
RN
Doughty
Ngaire
N
Kerse
John
J
Kolbe
Ross
R
Lawrenson
Allan
A
Moffitt
Nicolette
N
Sheridan
D002318:Cardiovascular Diseases / Q000628:therapy*; D002908:Chronic Disease; D019468:Disease Management; D019317:Evidence-Based Medicine; D019538:Health Care Surveys; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D009520:New Zealand; D011320:Primary Health Care / Q000458:organization & administration*; D029424:Pulmonary Disease, Chronic Obstructive / Q000628:therapy*; D012040:Regional Health Planning; D020521:Stroke / Q000628:therapy*