šSurgical robots pro-equity; pandemic effects on childhood imms; maternal stress impacts tamariki; primary care barriers; 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
Insights on Pain Management for MÄori Patients
Tan, R., Coia, M., Tay, M. L., & Baker, J. F. (2024). An exploratory study of acute analgesia in tibial shaft fractures: a comparison between MÄori and Non-MÄori. ANZ journal of surgery, 10.1111/ans.18848.
This study explored the management of acute fracture pain in MÄori and non-MÄori populations at a regional trauma centre in Aotearoa. The retrospective review included 104 patients with isolated tibial shaft fractures, and the outcome measures reflected the patient journey, including the type of analgesia charted pre-hospital, in the ED, and on the ward. The study found differences in pre-hospital administration of analgesia between MÄori and non-MÄori patients, but there were no significant differences between the groups in analgesia prescribed in the ED or on the ward. Further exploration is needed to understand the reasons behind the differences in pre-hospital care and to develop robust analgesic guidelines.
Robot Uprising for Surgical Equity
Chao, P. P., Koea, J. B., Hill, A. G., Resoli, D., & Srinivasa, S. (2023). Robot-assisted general surgery in Aotearoa New Zealand. The New Zealand medical journal, 136(1587), 98ā107.
This study highlights the transformative potential of robot-assisted surgery (RAS) within Aotearoa's healthcare landscape. The findings revealed that RAS could significantly enhance surgical precision, reduce complications, and shorten patient recovery times, particularly in complex procedures like rectal and gastric cancer surgeries. However, until recently, RAS has only been available in private hospitals, leading to differences in access; 22% of MÄori have private health insurance, compared with 17% of Pacific peoples and 40% of NZ European/Other. The article advocates for integrating RAS into public health systems to improve equity in surgical care for MÄori and others lacking access to this option.
Impact of COVID-19 on Childhood Vaccination in MÄori and Pacific Communities
Charania, N. A., Tonumaipe'a, D., Barbarich-Unasa, T. W., Iusitini, L., Davis, G., Pacheco, G., & Wilson, D. (2024). Exploring the impact of the COVID-19 pandemic on perceptions of national scheduled childhood vaccines among MÄori and Pacific caregivers, whÄnau, and healthcare professionals in Aotearoa New Zealand. Human vaccines & immunotherapeutics, 20(1), 2301626.
This article explores the impact of the COVID-19 pandemic on perceptions of childhood vaccines among MÄori and Pacific caregivers and healthcare professionals. The study found a decrease in routine childhood vaccination rates since the pandemic began, particularly among MÄori and Pacific children. Participants expressed trust in routine childhood vaccines and believed they offered protection to children and vulnerable family members. However, the pandemic added challenges to accessing vaccines, and misinformation and confusion from various sources influenced their perceptions of vaccines. Participants encouraged a more culturally specific approach to vaccination efforts and emphasised the importance of informed parents.
The Impact of Maternal Stress on MÄori Child Health Outcomes
Paine, S. J., Walker, R., Lee, A., Loring, B., & Signal, T. L. (2023). Associations between maternal stressful life events and child health outcomes in indigenous and non-indigenous groups in New Zealand. _KÅtuitui: New Zealand Journal of Social Sciences Online.
This study assessed the relationship between maternal stress and child health. MÄori women encounter stressful life events (SLE) more frequently than their non-MÄori counterparts; this exposure correlates with a higher incidence of sleep disorders and developmental concerns in their children by age three. The research highlights the need for targeted support systems to alleviate stressors on MÄori mothers and improve health outcomes for tamariki. Actionable solutions include establishing culturally attuned prenatal and postnatal support programs and integrating stress-reduction resources within healthcare services for MÄori families.
The Impact of Racism on Healthcare
Harris, R., Cormack, D., Waa, A., Edwards, R., & Stanley, J. (2024). The impact of racism on subsequent healthcare use and experiences for adult New Zealanders: a prospective cohort study. BMC public health, 24(1), 136. https://doi.org/10.1186/s12889-023-17603-6.
This study examined the link between experiences of racism and subsequent healthcare use among adults in Aotearoa. Participants were drawn from the 2016/17 NZ Health Survey and followed up for two years. The findings revealed that individuals who reported experiencing racism were more likely to have unmet healthcare needs, lower satisfaction with their medical centre, and negative experiences with general practitioners. To address these issues, healthcare providers and organizations should actively work to prevent racism within their environments and understand and mitigate its negative effects on patient healthcare. By doing so, the healthcare system can contribute to broader efforts to eliminate societal racism.
Breaking Down Financial Barriers to Healthcare for MÄori
Jeffreys, M., Ellison-Loschmann, L., Irurzun-Lopez, M., Cumming, J., & McKenzie, F. (2023). Financial barriers to primary health care in Aotearoa New Zealand. Family practice, cmad096. Advance online publication.
This article examines the financial barriers to primary health care for MÄori. The study analysed data from the NZ Health Survey from 2011/12 to 2018/19 and found that 22% of MÄori (compared to 13% of non-MÄori) experienced a cost barrier to seeing a general practitioner (GP), and 14% of MÄori (compared to 5% of non-MÄori) reported a cost barrier to collecting a prescription. The study highlights the considerable inequity in access to primary health care for MÄori and emphasises the urgent need for system funding changes to eliminate financial barriers. These cost barriers to primary care contribute to higher preventable hospitalisations. The authors argue the Very Low Cost Access subsidy for primary care is insufficient and requires review.
š Chart of the Week
Te Whatu Ora published the July-September 2023 Clinical Performance Metrics report in late December. Page 9 presented age-standardised ambulatory-sensitive hospitalisation rates nationally (see chart below - a bigger bar means more hospital admissions). These hospitalisations are potentially preventable through interventions available in primary care. The barriers to primary care and prescriptions described above likely contribute to the higher rates among MÄori and Pacific Peoples.
ā In Brief
šš½ Massive mana wave to the Pasifika Medical Association - theyāve made the New Zealand Medical Journal completely free to read; subscribe to the journal (for free) and read all past and present issues in full.
š This Public Health Communications Centre article dismantled claims that fewer cigarette outlets lead to an illicit market. The researchers used different lines of evidence to show no growth in illicit trade despite significant excise tax increases over the past decade. Overall, the absolute size of the illicit market has shrunk.
š» Google tested its PaLM-2 large language model (LLM) in medical consultations in a randomised trial. Like other LLMs, this one could hold dialogue with patients in memory and apply step-by-step reasoning, eventually scoring higher on diagnostic accuracy and empathy than the human primary care physician controls. These models might make primary care more accessible, addressing the financial barriers raised in the research article above. This legal LLM, for example, led to a 99.97% reduction in the price of legal contract review.
š¢ The Royal Society just published a Data Sovereignty guide with a section on MÄori data sovereignty.
š Last week, we summarised a journal article about an innovative MÄori-led COVID-19 case management service in Auckland. The full article is now available.
š¬ End Note
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