š Primary care outcomes; GP enrolment; cancer survival comparisons; AAA detection; new health targets; 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
How Do Different Models of Care Impact Health Outcomes for MÄori in Primary Care?
Sheridan N, Jansen RM, Harwood M, et al. Hauora MÄori ā MÄori health: a right to equal outcomes in primary care. International Journal for Equity in Health. 2024;23(1). doi:10.1186/s12939-023-02071-6
This study assessed whether six different health outcome measures differed for the MÄori population across seven different models of general practice for the year ending September 2018, drawing on data from more than 600,000 MÄori patients. When MÄori-owned clinics were compared with conventional GP-owned practices, there was no significant difference in annual HbA1c testing for those diagnosed with diabetes, emergency department attendance, and child or adult ambulatory sensitive hospitalisation rates. MÄori-owned clinics had less polypharmacy among those 55 and older, but had lower childhood immunisation at six months of age (13 percentage points less; 53.0 vs 66.4%). Overall, these results are positive, given that the MÄori-owned clinic population had higher medical needs and were more likely to live rurally and in high-deprivation areas; these results have been delivered in the context of prolonged underfunding of MÄori providers noted in the Wai 2575 inquiry. To improve health outcomes for MÄori patients, the study suggests increasing support for under-resourced MÄori practices to address unmet primary care needs. By understanding the impact of different care models, healthcare professionals and policymakers can work towards achieving equitable health outcomes.
Can Fairer Enrolment Methods in Primary Care Improve Access for MÄori?
Irurzun-Lopez, M., Pledger, M., Mohan, N., Jeffreys, M., McKenzie, F., & Cumming, J. (2024). āClosed booksā: restrictions to primary healthcare access in Aotearoa New Zealandāreporting results from a survey across general practices. New Zealand Medical Journal, 137(1591). doi.org/10.26635/6965.6347
This article examined 'closed books' in general practices, where new patient enrolments are either fully stopped or severely limited. 2019 data showed that 6% of the population was not enrolled in primary care. The practice of "closed books" has been increasing since the COVID-19 pandemic, exacerbating existing challenges in accessing primary healthcare; the proportion of clinics reporting āclosed booksā in the study group (~119 clinics) had increased over time from 7% in 2019 to 27% in 2022 (see Chart of the Week below); these limitations on enrolment disproportionately affect marginalised communities, including MÄori, young individuals, and those residing in areas of high deprivation. Interestingly, the research found a lower prevalence of closed books in practices serving higher proportions of MÄori and Pacific peoples, suggesting these practices may offer more equitable access to healthcare. The article advocates for exploring more equitable patient intake methods and adherence to national enrolment policies as solutions to mitigate inequities in enrolment. This study underscores the urgent need for systemic reforms to ensure equitable healthcare access in Aotearoa.
Cancer Care in Aotearoa: A Comparative Analysis with Australia
Elwood, M. (2024). Cancer outcomes in New Zealand and other countries: How are we doing? New Zealand Medical Journal, 137(1591), [1591]. https://doi.org/10.26635/6965.e1591
This editorial examined cancer outcomes in Aotearoa and Australia, revealing higher mortality here. The article mentions lower survival in the MÄori population but does not present data disaggregated by ethnicity. 2014-18 results highlighted an 11% higher overall cancer death rate in Aotearoa, with a notable 17% higher rate in women and a 5% higher rate in men compared with Australia. Despite similar cancer incidence rates, Aotearoa struggles with effective cancer treatment. The 5-year relative survival rates in Aotearoa are lower than in Australia for most cancer types, with widening gaps over time (see Chart of the Week below). Late cancer diagnosis in Aotearoa hampers successful treatment due to unfavourable stage distribution. Accelerating suspected cancer management in primary care is crucial for improving cancer care. Emulating Australia's success could potentially reduce deaths in Aotearoa by over 1,000 people per year, urging increased healthcare investment and system enhancements. Readers can advocate for improved access to diagnostic tests, specialist referrals, and cancer-specific drugs to enhance survival for MÄori and others in Aotearoa.
How prevalent are abdominal aortic aneurysms among MÄori in Te TairÄwhiti?
Kee, R., Clifford, K., Maloney, J., Mangu, A., Cain, J., Memon, S., & Rahiri, J.-L. (2024). A retrospective cohort study of incidental abdominal aortic aneurysms on routine abdominal computed tomography scans in Te TairÄwhiti (2018ā2019). New Zealand Medical Journal, 137(1591). https://doi.org/10.26635/6965.6365
In a recent study in Te TairÄwhiti region, researchers discovered a 5.2% prevalence of incidental abdominal aortic aneurysms (AAA) among patients aged 50 and above in a retrospective review of 811 CT scans. There was a higher prevalence among MÄori males (16.2% vs 8.1% for NZ European (NZE) males, p=0.052) and MÄori females (10.9% vs 8.1% for NZE, p=0.047). Without a formal screening program, this study highlights the potential for incidental detection of AAA from abdominal CT scans, especially in at-risk populations. To address this issue effectively, healthcare professionals and policymakers could consider implementing opportunistic screening for AAA for high-risk groups using abdominal scans, along with improving access to local vascular surgical services and referral to other centres. Proactively identifying and managing incidental AAA cases might improve health outcomes for the MÄori population in Te TairÄwhiti. However, this approach should be carefully weighed against the significant impacts of screening and intervention for this condition.
How can Culturally Responsive Pain Management Benefit MÄori Health?
Antunovich, D., Romana, J., Lewis, G. N., Morunga, E., & Bean, D. J. (2024). The lived experience of chronic pain for MÄori: How can this inform service delivery and clinical practice? A systematic review and qualitative synthesis. New Zealand Medical Journal, 137(1591). https://doi.org/10.26635/6965.6271
This article explored the experiences of MÄori individuals grappling with chronic pain in Aotearoa, emphasising the crucial need for culturally tailored approaches in pain management services. New Zealand Health Survey data indicated that MÄori were 1.39 times more likely to be experiencing chronic pain than non-MÄori. The article revealed the multidimensional nature of pain from a MÄori perspective, the significance of tikanga-informed care, and the desire for autonomy in pain management decisions. To improve health outcomes for those with chronic pain, it is vital to embrace culturally safe practices, foster therapeutic relationships grounded in whakawhanaungatanga, and support self-determination (tino rangatiratanga) in pain management choices. By incorporating traditional MÄori treatments, promoting anti-racist approaches, and prioritising whÄnau-centred care, healthcare providers can empower MÄori individuals to navigate chronic pain more effectively and holistically.
š Chart of the Week
Closed books - The study by Irurzun-Lopez mentioned above, found that the proportion of GP clinics with open books between 2019 and 2022 had decreased from 57% to 28% of the ~119 clinics in the study; and that those with fully closed books had increased from 7% to 27%. This makes it more difficult for high-needs groups to access primary care. āLimited enrolmentā denotes that the clinic is selective about who they choose to enrol.
Cancer survival - Elwood reported lower 5-year survival for selected cancers when comparing Aotearoa and Australia. The data were not disaggregated by ethnicity. There was no significant difference for cancers of the pancreas in females and males, or, for melanoma in males. While the article did not discuss lead-time bias, the WHOās SURVMARK-2 benchmarking programme corroborates the lower survival here.
š Achievements
Dr Rachelle Love, an otolaryngology, head and neck surgeon (NgÄpuhi, Te Arawa), has been elected Chair of the Medical Council. Rachelle trained at Auckland Medical School and has made significant contributions to MÄori health through her roles in various national boards and research groups, focusing on cultural competency and safety in surgical education and sleep surgery.
ā In Brief
šÆ New health targets announced - The Government has announced new health targets. The targets will be reported at the national and regional levels and, where feasible, by specific population groups. They will come into effect on 1 July 2024, and the first quarter of reporting will be for Quarter 1 of 2024/25 (July-September 2024). The targets are:
Faster cancer treatment ā 90% of patients receive cancer management within 31 days of the decision to treat.āÆĀ (Sep 2023 result = 84%)
Improved immunisation ā 95% of children fully immunised at 24-months of age.Ā (Sep 2023 result = 83%)
Shorter emergency departments stays ā 95% of patients admitted, discharged or transferred within 6 hours. (Sep 2023 result = 66%)Ā
Shorter first specialist assessment wait times ā 95% of patients wait less than 4 months for a first specialist assessment.Ā (Sep 2023 result = 66%)
Shorter elective treatment wait times ā 95% of patients wait less than 4 months for elective treatment. (Sep 2023 result = 62%)
š„ Health Sector Leads Job Growth and Earnings Surge - In the year ended December 2023, the āhealth care and social assistanceā industry had a 5.3% increase in filled jobs, and a 17% increase in total earnings. These increases were the largest of any industry measured.
šWaitangi Tribunal 101 - the background, capabilities, and limitations of the Waitangi Tribunal are summarised succinctly in this article from Stuff.
š Johns Hopkins has produced a playbook for dealing with misinformation in health. Health professionals can use the guidebook to prevent and mitigate misinformation about vaccinations and other health interventions. The Nobel Prize Summit 2023 is another good resource for understanding misinformation and how to counter it.
šļø City design influences implicit racial biases - This article in Nature found that implicit racial bias trended lower in larger, diverse cities where people frequently interacted with those from different backgrounds and cultures (ie. lower segregation).
šCameroon Becomes First Nation to Launch Malaria Vaccine - Cameroon has started providing vaccinations against malaria, aiming to curb the rising toll of cases and deaths. This initiative is part of a broader effort by WHO to deploy the vaccine across 20 African countries this year, marking a significant advancement in the global fight against malaria.
š¬ End Notes
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