š Surgical training criteria; travel barriers; informed consent; rural-urban differences; and more
MÄori health research highlights from the past week
šš½ Kia ora, Iām George Gray, a public health physician doing my best to keep up with the latest health research that can help improve outcomes for MÄori. Hereās what Iāve learned this weekā¦
š¬ The Latest Research
Are RACS MÄori Health Goals Reflected in Surgical Training Criteria?
Fisher, C., Bird, P., McCombie, A., Huria, T., & Love, R. L. (2024). Review of MÄori equity in surgical trainee selection. ANZ Journal of Surgery. https://doi.org/10.1111/ans.18909 (š paywalled)
The Royal Australasian College of Surgeons (RACS) is striving for MÄori health equity and cultural safety within the surgical workforce through its MÄori Health Strategy and Action Plans. This study examined the selection criteria for MÄori trainees entering surgical specialties in Aotearoa. It found that while some surgical specialties incorporate criteria related to MÄori identification and cultural competency, others do not. Additionally, the allocation of research-related points may disincentivise MÄori trainees. Orthopaedics had the highest percentage of selection score related to MÄori workforce development (9% of selection weighting); in contrast, Cardiothoracic Surgery, Paediatric Surgery, Neurosurgery and Urology specialties did not incorporate any criteria. The article concludes that there is a need for regular auditing to ensure that the selection criteria align with the RACS goal of achieving MÄori health equity and cultural safety in the surgical workforce.
Are MÄori Patients Facing Unfair Travel Barriers for Lung Cancer Treatment?
Gurney, J., Davies, A., Stanley, J., Whitehead, J., Costello, S., Dawkins, P., Henare, K., Jackson, C., Lawrenson, R., Scott, N., & Koea, J. (2024). Equity of travel to access surgery and radiation therapy for lung cancer in New Zealand. Supportive Care in Cancer, 32(3). https://doi.org/10.1007/s00520-024-08375-9
This study found that MÄori patients with lung cancer in Aotearoa encounter longer travel distances and times to access surgery and radiation therapy compared to European patients. MÄori tend to need to travel further (with longer travel times) to access both surgery (median travel distance: MÄori 57Ā km, European 34Ā km) and radiation therapy (MÄori 75Ā km, European 35Ā km). MÄori have greater odds of living more than 200Ā km away from both surgery (adjusted odds ratio [aOR] 1.83, 95% CI 1.49ā2.25) and radiation therapy (aOR 1.41, 95% CI 1.25ā1.60). These differences in access may contribute to disparities in treatment outcomes. To address this, the study suggests providing up-front funding for travel costs, offering culturally appropriate support workers, and exploring decentralised treatment options such as telehealth. Additionally, expanding the number of MÄori cancer care navigators could help bridge the gap. These findings underscore the need to reevaluate healthcare accessibility and support for MÄori patients with lung cancer in Aotearoa.
How Effective is Informed Consent?
Wijohn, T. R., Newcombe, R. M., Reynolds, J., El-Jack, S., & Armstrong, G. P. (2024). Informed consentāpatientsā understanding of risk. Journal of Medical Ethics, 137(1590). https://doi.org/10.26635/6965.6303
This study examined patients' understanding of risk concepts relevant to informed consent for medical procedures, revealing that Asian patients scored lower than other ethnic groups. The comprehension of MÄori/Pasifika patients was lower than PÄkehÄ/Europeans, but not as low as Asian patients. Advancing age was also linked to lower scores. Disaggregating the scores for MÄori and Pasifika could have provided more nuanced insights.; nevertheless, the study emphasises the need for improved risk comprehension, particularly among older people, Asian patients, and those with English as a second language. To enhance health outcomes for the MÄori population, healthcare providers should consider tailored communication and ongoing discussion during the informed consent process. Strategies to improve risk comprehension include inviting whÄnau to appointments, providing benchmark risks for comparison, using multimedia, and avoiding overwhelming patients with excessive information. These efforts can empower patients to make informed decisions about their healthcare.
Exploring Rural-Urban Disparities in Healthcare Utilisation in Aotearoa: What Does the Data Reveal?
Nixon, G., Davie, G., Whitehead, J., Miller, R. M., de Graaf, B., Liepins, T., Lawrenson, R., & Crengle, S. (2024). Ruralāurban variation in the utilisation of publicly funded healthcare services: an age-stratified population-level observational study. New Zealand Medical Journal, 137(1590). https://doi.org/10.26635/6965.6274
This study explores the disparities in healthcare utilisation between rural and urban areas in Aotearoa. The findings reveal significant differences in hospitalisation rates, outpatient visits, and emergency department attendances, with rural areas generally exhibiting lower rates. Ambulatory sensitive hospitalisation (ASH) rates for MÄori across all rural strata were lower than the urban U1 group, with incidence rate ratios that are consistently less than 0.9. Lower ASH rates should not be attributed to healthier communities; rural areas have the countryās highest amenable mortality rates. Notably, the study uncovers higher mortality rates among younger rural residents and emphasises the pronounced health outcome inequity gap for MÄori and remote rural communities. The article underscores the need for further research to understand the causes of these differences and their implications for policy and service delivery. It also highlights the opportunity to address any health disadvantage for rural communities resulting from these disparities. Solutions suggested by the authors include: further exploration of rural-urban differences in healthcare utilisation, addressing geographic equity in health service design and delivery, monitoring rural-urban variation within regions, improved primary care data collection for a comprehensive understanding.
š Chart of the Week
In a recent Public Health Communications Centre (PHCC) briefing, the authors emphasised how our low childhood immunisation coverage makes us vulnerable to another measles epidemic. After peaking in 2014-2016, coverage dropped steadily and accelerated during the COVID pandemic. The authors of the PHCC article provide four specific recommendations to prevent a measles epidemic. A recent journal article we summarised identified some reasons for lower childhood coverage during the COVID pandemic.
ā In Brief
āļø The PHCC article above highlights our current measles outbreak vulnerability due to the intersection of low childhood coverage, overseas arrivals at pre-COVID levels, and rising measles incidence in the Western Pacific.
š« Another PHCC briefing summarised the unequivocal evidence for positive outcomes from denicotinisation of cigarettes, the lack of negative effects on smokers, and the lack of evidence for claims that denicotinsation leads to illicit tobacco supply.
š¢ Statistics NZ released its child poverty statistics fo the year ended June 2023. 17.5% of children lived in homes with less than 50% of the median equivalised disposable income after housing costs vs 14.4% a year earlier. āFor tamariki MÄori, Pacific children, and disabled children, there was no statistically significant difference from the previous year for any of the poverty measures.ā
š The Auditor General released a report on how government agencies can better understand and meet the mental health needs of young people aged 12-24 years. Nine recommendations are listed in the report to improve health service delivery.
š Te Whatu Ora released its first Health Status Report. The report summarises data on social determinants, risk factor exposure, and health outcomes.
š Pharmac will make an updated COVID vaccine targeted at the XBB 1.5 strain available from March 7th. After high COVID hospitalisations over the summer caused by the JN1 variant, viral wastewater levels have risen again over the past few weeks.
š¬ End Notes
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