Issue 171 - 2 August 2018

Welcome to the fortnightly Health Improvement and Innovation Digest (formerly the HIIRC digest). The Digest has links to key evidence of interest, with access to new content arranged by topic.

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Have you heard about Grey Matter?

We'd like to introduce you to another newsletter that the Ministry of Health Library prepares.  The Grey Matter newsletter provides monthly access to a selection of recent NGO, Think Tank, and International Government reports related to health. Information is arranged by topic, allowing readers to quickly find their areas of interest.  If you'd like to subscribe to Grey Matter, email library@moh.govt.nz

Article access

For articles that aren't open access, contact your DHB library, or organisational or local library for assistance in accessing the full text. If your organisation has a subscription, you may be able to use the icon under full text links in PubMed to access the full article.

Quality Improvement (New Zealand)

The New Zealand Surgical Site Infection Improvement (SSII) Programme: a national quality improvement programme reducing orthopaedic surgical site infections
Published in the New Zealand Medical Journal, the authors describe the introduction of a nationwide SSI reduction programme for hip and knee arthroplasties.  They report an increase in compliance across the country with best practice that was associated with a reduction in incidence of SSI since June 2015 from the baseline period of April 2013 to March 2014, sustained to June 2017.

Quality Improvement (International)

Characteristics of healthcare organisations struggling to improve quality: results from a systematic review of qualitative studies
Identifying characteristics associated with struggling healthcare organisations may help inform improvement.  The authors of this article, published in BMJ Quality & Safety, systematically reviewed the literature to: (1) Identify organisational factors associated with struggling healthcare organisations and (2) Summarise these factors into actionable domains.

Engaging patients to improve quality of care: a systematic review
The purpose of this research, published in Implementation Science, was to identify the strategies and contextual factors that enable optimal engagement of patients in the design, delivery, and evaluation of health services.

Shorter Stays In Emergency Departments (International)

Mapping workforce configuration and operational models in Australian emergency departments: a national survey
Hospital emergency departments (ED) in Australia and internationally have been experiencing increased demand, resulting in reduced hospital quality, impaired access and adverse health outcomes. Effective evaluation of new ED service models and their effect on outcomes is reliant on baseline measures of the staffing configuration and organisational characteristics of the EDs being studied. Published in the Australian Health Review, the aim of the present study was to comprehensively measure these variables in Australian EDs.

Cardiovascular Disease and Diabetes (New Zealand)

Epidemiology and Outcomes of Abdominal Aortic Aneurysms in New Zealand: A 15-Year Experience at a Regional Hospital
Abdominal aortic aneurysms (AAA) account for approximately 400 deaths per year in New Zealand (NZ). Waikato Hospital caters to a diverse population comprising a high proportion of the indigenous Māori ethnic group considered to be at higher risk of mortality and morbidity. The aim of this study, published in the Annals of Vascular Surgery, was to further define the epidemiology and outcomes of AAA repairs in NZ.

Performance of a Framingham cardiovascular risk model among Indians and Europeans in New Zealand and the role of body mass index and social deprivation
Published in Open Heart, the purpose of this article was to evaluate a Framingham 5-year cardiovascular disease (CVD) risk score in Indians and Europeans in New Zealand, and determine whether body mass index (BMI) and socioeconomic deprivation were independent predictors of CVD risk.

Cardiovascular Disease and Diabetes (International)

Blood pressure targets for the treatment of people with hypertension and cardiovascular disease
The objective of this Cochrane Review was to determine if 'lower' blood pressure targets (≤ 135/85 mmHg) are associated with reduction in mortality and morbidity as compared with 'standard' blood pressure targets (≤ 140 to 160/90 to 100 mmHg) in the treatment of people with hypertension and a history of cardiovascular disease (myocardial infarction, angina, stroke, peripheral vascular occlusive disease).

Nontraditional risk factors in cardiovascular disease risk assessment: Updated evidence report and systematic review for the US Preventive Services Task Force
The objective of this research, published in JAMA, was to systematically review evidence for the US Preventive Services Task Force on the benefits and harms of 3 nontraditional risk factors in cardiovascular risk assessment: the ankle-brachial index (ABI), high-sensitivity C-reactive protein (hsCRP) level, and coronary artery calcium (CAC) score.

How are health-related behaviours influenced by a diagnosis of pre-diabetes? A meta-narrative review
Several countries, including England, have recently introduced lifestyle-focused diabetes prevention programmes. These aim to reduce the risk of individuals with pre-diabetes developing type 2 diabetes. The authors of this research, published in BMC Medicine, sought to summarise research on how socio-cultural influences and risk perception affect people’s behaviour (such as engagement in lifestyle interventions) after being told that they have pre-diabetes.

Primary Health Care (New Zealand)

General practice and patients’ views of the social networks of patients with multimorbidity
For patients with multimorbidity to live well, they need the support of not only health professionals but family, friends and organisations. These social networks provide support, potentially enabling the formation of a Community of Clinical Practice approach to multimorbidity care.  This study, published in the Journal of Primary Health Care, aimed to explore general practice knowledge of the social networks of patients with multimorbidity.

The complexity of food for people with multiple long-term health conditions
The prevalence of long-term health conditions (LTCs) continues to increase and it is normal for people to have several. Lifestyle is a core feature of the self-management support given to people with LTCs, yet it seems to fail to meet their needs. Published in the Journal of Primary Health Care, this paper reports on the role of food and mealtimes, and the effect of the nutritional advice on the lives of people with several LTCs.

Primary Health Care (International)

Nurses as substitutes for doctors in primary care
The aim of this Cochrane Review was to investigate the impact of nurses working as substitutes for primary care doctors on: patient outcomes; processes of care; and utilisation, including volume and cost.

Interventions for increasing the use of shared decision making by healthcare professionals
The objective of this Cochrane Review was to determine the effectiveness of interventions for increasing the use of shared decision making by healthcare professionals. The authors considered interventions targeting patients, interventions targeting healthcare professionals, and interventions targeting both.

Medications that reduce emergency hospital admissions: an overview of systematic reviews and prioritisation of treatments
Rates of emergency hospitalisations are increasing in many countries, leading to disruption in the quality of care and increases in cost. Therefore, identifying strategies to reduce emergency admission rates is a key priority. There have been large-scale evidence reviews to address this issue; however, there have been no reviews of medication therapies, which have the potential to reduce the use of emergency health-care services. The objectives of this study, published in BMC Medicine, were to review systematically the evidence to identify medications that affect emergency hospital admissions and prioritise therapies for quality measurement and improvement.

Impact of clinical pharmacist services delivered via telemedicine in the outpatient or ambulatory care setting: A systematic review
Utilization of telemedicine allows pharmacists to extend the reach of clinical interventions, connecting them with patients and providers, but the overall impact of these services is under-studied. Published in Research in Social and Administrative Pharmacy, the aim of this research was to assess the impact of clinical pharmacist telemedicine interventions on clinical outcomes, subsequently defined as clinical disease management, patient self-management, and adherence, in outpatient or ambulatory settings.

Frameworks for self-management support for chronic disease: a cross-country comparative document analysis
In a number of countries, frameworks have been developed to improve self-management support (SMS) in order to reduce the impact of chronic disease. The frameworks potentially provide direction for system-wide change in the provision of SMS by healthcare systems. Although policy formulation sets a foundation for health service reform, little is currently known about the processes which underpin SMS framework development as well as the respective implementation and evaluation plans. Published in BMC Health Services Research, the aim of this study was to conduct a cross-country comparative document analysis of frameworks on SMS for chronic diseases in member countries of the Organisation for Economic Cooperation and Development.

Primary Mental Health (International)

Screening for Depression in Pediatric Primary Care
Published in Current Psychiatry Reports, this article reviews the clinical practice guideline landscape for depression screening in pediatric primary care and identifies current gaps in knowledge.

Better Help for Smokers to Quit (New Zealand)

Just ask Siri? A pilot study comparing smartphone digital assistants and laptop Google searches for smoking cessation advice
The objective of this research, published in PLOS One, was to compare voice-activated internet searches by smartphone (two digital assistants) with laptop ones for information and advice related to smoking cessation.

Childhood Obesity (International)

Consequences of short sleep duration on the dietary intake in children: A systematic review and metanalysis
During the last years, a decline in the amount of hours of sleep has been observed in children. Sleep deficiency has been linked to an increase in calories, snacks, and fat intake. The objective of this study, published in Sleep Medicine Reviews, was to review the evidence between sleep duration and eating habits in children.

Key Ministry of Health Publications

Health and Independence Report 2017
The Health and Independence Report is the Director-General of Health’s annual report on the state of public health in New Zealand. The 2017 report presents an overview of the health of New Zealanders drawing on a range of sources.

Draft National Ethical Standards for Health and Disability Research: Consultation document
The National Ethics Advisory Committee (NEAC) is an independent advisor to the Minister of Health. NEAC was established in 2001 under section 16 of the New Zealand Public Health and Disability Act 2000.  The Draft National Ethics Standards for Health and Disability Research sets out the established ethical standards that apply to all health and disability research in New Zealand.  The draft standards are mostly targeted at individual researchers but are also useful to ethics committees, research sponsors and for training and educating researchers. NEAC has reviewed the draft standards and now seeks the views and feedback of the public.

Healthy Homes Initiative Evaluation: Final Report
The purpose of the evaluation of the Healthy Homes Initiative (HHI) is to inform and improve the delivery of the services. The evaluation included: assessing HHI processes, structure, model, management, implementation and delivery; identifying what worked well at the regional and national levels, and what could be improved; and identifying lessons to inform development and delivery of the extended programme to at-risk children aged 0–5 years.

The information available on or through this newsletter does not represent Ministry of Health policy. It is intended to provide general information to the health sector and the public, and is not intended to address specific circumstances of any particular individual or entity.