Pilot study of methods for assessing unmet secondary health care need in New Zealand.
OBJECTIVE
In this pilot study, the primary aim was to compare four potential methods for undertaking a national survey of unmet secondary healthcare need in New Zealand (one collecting data from GPs, and three from community surveys). The secondary aim was to obtain an estimate of the prevalence of unmet secondary healthcare need, to inform sample size calculations for a national survey.


METHODS
An electronic system was set up for GPs in Christchurch (Pegasus PHO) and Auckland (Auckland PHO) to record cases of unmet need as encountered in clinics. For the community surveys, a questionnaire developed by the authors was administered to people from the same electoral wards as the GP clinics. Three modes of questionnaire administration were trialled: online, telephone and face-to-face interview. Random population sampling from the Māori and General Electoral Rolls was used to identify eligible survey participants until there were approximately 200 respondents for each method in each city. Data collection took place from November 2015 to February 2016.


RESULTS
GP reports: Pegasus PHO: 8/78 eligible practices recorded 28 cases of unmet secondary healthcare need in 10 weeks. Auckland PHO: 3/26 practices participated and recorded no cases in three weeks. Surveys: 1,277 interviews were completed (online 428, telephone 447, face-to-face 402). For primary healthcare, 211/1,277 (16.5%) had missed a GP visit because of cost (online 25.0%, telephone 11.6%, face-to-face 12.9%). For secondary healthcare, 119/1,277 (9.3%) reported unmet healthcare need that had been identified by a health professional (online 11.2%; telephone 9.2%; face-to-face 7.5%). Of these, 75/119 (63.0%) required a consultation, and 47/119 (39.5%) required a procedure. Completed interview rates as a percentage of names on the Electoral Roll were low (online 8.8%, telephone 15.4%, face-to-face 13.9%), affected by changed addresses and lack of listed telephone numbers. The response rate for those with valid phone numbers was 47.6%, and for those with valid addresses was 31.5%.


CONCLUSIONS
Using the Electoral Rolls to identify respondents is problematic. For a national survey, random population sampling by address, similar to the method employed for the New Zealand Health Survey, but giving respondents a choice between face-to-face and phone interviews, is proposed. Asking GPs to record data on unmet need for secondary care was not successful. Our pilot study suggests there is sufficient unmet secondary healthcare need in New Zealand to merit a national survey.
Chair, Canterbury Charity Hospital Trust, Christchurch and Clinical Associate Professor, University of Otago, Christchurch.
Philip
P
Bagshaw
Senior Lecturer, Department of Paediatrics, University of Otago, Christchurch.
Susan
S
Bagshaw
Professor, Department of Medicine, University of Otago, Christchurch.
Christopher
C
Frampton
Professor and Head of Department of Preventive and Social Medicine, Director of Centre for Health Systems, Dunedin School of Medicine, Dunedin.
Robin
R
Gauld
Adjunct Senior Fellow, School of Health Sciences, University of Canterbury, Christchurch.
Terri
T
Green
Clinical Director, Auckland PHO, Auckland.
Charlotte
C
Harris
Emeritus Professor, University of Otago and Pegasus Health (Charitable) Ltd - Director and Chair, Community Board, Christchurch.
Andrew
A
Hornblow
Senior Lecturer, Department of General Practice, University of Otago, Christchurch.
Ben
B
Hudson
Independent Researcher, Auckland.
Antony
A
Raymont
Professor of Cancer Epidemiology, Wayne Francis Cancer Epidemiology Research Group, School of Health Sciences, University of Canterbury, Christchurch.
Ann
A
Richardson
Manager and Executive Officer, Canterbury Charity Hospital Trust, Christchurch.
Carl
C
Shaw
Professor and Head of Department of General Practice, University of Otago, Christchurch and Chair, Pegasus Health (Charitable) Ltd, Christchurch.
Les
L
Toop
D019643:Arthroplasty, Replacement; D002763:Cholecystectomy; D003113:Colonoscopy; D003376:Counseling; D003625:Data Collection / Q000379:methods*; D003729:Dental Care; D005260:Female; D005773:Gastroscopy; D058005:General Practitioners; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D059685:Herniorrhaphy; D006801:Humans; D020407:Internet; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009520:New Zealand; D010865:Pilot Projects; D063127:Secondary Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D013689:Telephone; D014648:Varicose Veins / Q000628:therapy