Ministry of Health Library

Health Improvement and Innovation Digest

Issue 220 - 22 October 2020

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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Article access

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Quality Improvement (International)

Advancing understanding and identifying strategies for sustaining evidence-based practices: a review of reviews
Implementation science has focused mainly on the initial uptake and use of evidence-based practices (EBPs), with less attention to sustainment—i.e., continuous use of these practices, as intended, over time in ongoing operations, often involving adaptation to dynamic contexts. Declining EBP use following implementation is well-documented yet poorly understood. Using theories, models, and frameworks (TMFs) to conceptualise sustainment could advance understanding. This study, published in Implementation Science, consolidated knowledge from published reviews of sustainment studies to identify TMFs with the potential to conceptualize sustainment, evaluate past uses of TMFs in sustainment studies, and assess the TMFs’ potential contribution to developing sustainment strategies.

Antibiotic stewardship: Improving patient-centered right care in urgent care using a shared decision aid and 5 Ds tool
Overuse of antibiotics leads to antibiotic resistance, costing $35 billion and causing approximately 23,000 deaths in the United States annually. Antibiotic stewardship is important in urgent care centers to prevent antibiotic resistance.  The aim of this quality improvement (QI) project, published in the Journal of the American Association of Nurse Practitioners, was to improve right care for patients of 65 years and younger with upper respiratory infections and/or head, ears, nose, or throat viral illnesses presenting to urgent care.

Hospital Productivity (International)

The role and contribution of nurses to patient flow management in acute hospitals: A systematic review of mixed methods studies
Increased overcrowding in the emergency department is a potential threat to the quality and safety of patient care. Innovative ways are needed to explore overcrowding, the variables affecting patient flow and interventions necessary for future flow improvement. The aim of this review, published in the International Journal of Nursing Studies, is to explore nurses’ role(s) and their contribution to maintaining patient flow in acute hospitals through emergency departments.

Cancer Services (New Zealand)

Characteristics and survival of de novo and recurrent metastatic breast cancer in New Zealand
This study, published in Breast Cancer, aims to examine the characteristics and survival of patients with de novo metastatic breast cancer (dnMBC) and recurrent metastatic breast cancer (rMBC) in New Zealand.

Cancer Services (International)

Healthcare delivery interventions to reduce cancer disparities worldwide
Globally, cancer care delivery is marked by inequalities, where some economic, demographic, and sociocultural groups have worse outcomes than others. This review, published in World Journal of Clinical Oncology, sought to identify patient-facing interventions designed to reduce disparities in cancer care in both high- and low-income countries.

Colour Coding Navigation: “Triage” Techniques to Improve Compliance in Breast Cancer Patients Requiring Primary Chemotherapy
This pilot study, published in the European Journal of Breast Health, assessed whether a file-colour-coded triage navigation system for patients on primary chemotherapy improves compliance and adherence and if it decreases defaulting.

Cardiovascular Disease and Diabetes (International)

Implementation interventions to promote the uptake of evidence‐based practices in stroke rehabilitation
Rehabilitation based upon research evidence gives stroke survivors the best chance of recovery. There is substantial research to guide practice in stroke rehabilitation, yet uptake of evidence by healthcare professionals is typically slow and patients often do not receive evidence‐based care. The objective of this Cochrane Review was to assess the effects of implementation interventions to promote the uptake of evidence‐based practices (including clinical assessments and treatments recommended in evidence‐based guidelines) in stroke rehabilitation and to assess the effects of implementation interventions tailored to address identified barriers to change compared to non‐tailored interventions in stroke rehabilitation.

Primary Health Care (New Zealand)

A survey of the NP workforce in primary healthcare settings in New Zealand
The aim of this survey, published in the New Zealand Medical Journal, was to describe the demographics, distribution, clinical settings and employment arrangements of the New Zealand nurse practitioner workforce in primary healthcare settings; and organisational factors limiting their practice.

Turning on a dime—pre- and post-COVID-19 consultation patterns in an urban general practice
The aim of this study, published in the New Zealand Medical Journal, was to investigate changes in general practice consultation patterns in response to reduced face-to-face patient contact during the COVID-19 pandemic.

Primary Mental Health (International)

Interventions to improve return to work in depressed people
Work disability such as sickness absence is common in people with depression. The objective of this Cochrane Review was to evaluate the effectiveness of interventions aimed at reducing work disability in employees with depressive disorders.

Reducing the Impacts of Mental Health Stigma Through Integrated Primary Care: An Examination of the Evidence
The reduction of mental health stigma (MHS) was an expected benefit of integrating behavioral health in primary care (IPC). However, unlike other barriers discussed in agency reports on IPC, discussions of MHS lack research support. The authors of this paper, which was published in the Journal of Clinical Psychology in Medical Settings, conducted a literature review identifying seven studies to fill this gap.

Better Help for smokers to Quit (International)

Electronic cigarettes for smoking cessation
Electronic cigarettes (ECs) are handheld electronic vaping devices which produce an aerosol formed by heating an e‐liquid. People who smoke report using ECs to stop or reduce smoking, but some organisations, advocacy groups and policymakers have discouraged this, citing lack of evidence of efficacy and safety. People who smoke, healthcare providers and regulators want to know if ECs can help people quit and if they are safe to use for this purpose. The objective of this Cochrane Review was to evaluate the effect and safety of using electronic cigarettes (ECs) to help people who smoke achieve long‐term smoking abstinence.

Childhood Obesity (New Zealand)

Interventions to prevent or treat childhood obesity in Māori & Pacific Islanders: a systematic review
Māori and Pacific Islander children exhibit greater risk of obesity and associated morbidities compared to children of other descent, secondary to unique cultural practices and socioeconomic disadvantage. Despite these known risk factors, there is limited synthesised evidence for preventing and treating childhood obesity in this unique population. The objective of this systematic review, published in BMC Public Health, was to identify and evaluate global prevention or treatment interventions for overweight or obesity that targeted Māori and Pacific Islander children and adolescents (aged 2–17 years).

Childhood Obesity (International)

Long-term outcomes (2 and 3.5 years post-intervention) of the INFANT early childhood intervention to improve health behaviors and reduce obesity: cluster randomised controlled trial follow-up
The few health behavior interventions commencing in infancy have shown promising effects. Greater insight into their longer-term benefits is required. This study, published in the International Journal of Behavioral Nutrition and Physical Activity, aimed to assess post-intervention effects of the Melbourne INFANT Program to child aged five on diet, movement and adiposity.

Motivational Interviewing for Overweight Children: A Systematic Review
Motivational interviewing (MI) is a communication method to help facilitate adherence to health behaviors through a series of person-centered strategies. MI’s evidence base supports its use as a potential intervention strategy at the parental decision-maker level to impact young children’s lifestyle behaviors to address childhood obesity; however, clarity is needed on the literature. The purpose of this systematic review, published in Pediatrics, is to synthesize the literature examining the use of MI at the parental level to impact young children’s weight status.

Oral Health (New Zealand)

Use of traditional medicine for dental care by different ethnic groups in New Zealand
There is an increasing public interest in the use of TM internationally, yet there is a paucity of research on the use of TM by the public in the dental setting. This study, published in BMC Oral Health, aimed to explore the views, use of and access to TM in dentistry among different ethnic groups residing in New Zealand.

Oral Health (International)

Recall intervals for oral health in primary care patients
There is ongoing debate about the frequency with which patients should attend for a dental check‐up and the effects on oral health of the interval between check‐ups. Recommendations regarding optimal recall intervals vary between countries and dental healthcare systems, but 6‐month dental check‐ups have traditionally been advocated by general dental practitioners in many high‐income countries. The objective of this Cochrane Review was to determine the optimal recall interval of dental check‐up for oral health in a primary care setting.

Effect of oral health intervention on cognitive decline in community-dwelling older adults: A randomized controlled trial
The incidence of dementia is rapidly increasing worldwide, especially in developed countries. Little is known regarding the effectiveness of dental intervention to prevent dementia or a decline in cognitive functions among community-dwelling older adults, but a few studies have reported a correlation between the lack of regular dental checkups and dementia. This study, published in Archives of Gerontology and Geriatrics, aimed to investigate the effects of oral health intervention on cognitive functions in community-dwelling subjects with a mild cognitive decline via a randomized controlled trial.

Key Ministry of Health Publications

COVID-19 in Health Care and Support Workers in Aotearoa New Zealand
Health care and support workers are an essential and valuable workforce. The nature of their occupation or workplace means they may be at increased risk of contracting COVID-19 during a time of community transmission. The report gives an overview of the occupation and demographics of health care and support workers diagnosed with COVID-19 with a focus on transmission pathways in the workplace.

Summary of Feedback: Kia Kaha, Kia Māia, Kia Ora Aotearoa: COVID-19 Psychosocial and Mental Wellbeing Recovery Plan
The Kia Kaha, Kia Māia, Kia Ora Aotearoa: COVID-19 Psychosocial and Mental Wellbeing Recovery Plan provides a national approach to supporting the mental and social wellbeing of New Zealanders in the COVID-19 recovery period. The Ministry sought and received feedback on the plan from a wide range of organisations via. The feedback is summarised in this report.

District Health Board Initiative

Waikato District Health Board (DHB) strengthens ties with Raukawa iwi for a better health future
Waikato DHB and Raukawa Charitable Trust leaders have signed a Mahi Tahi agreement recognising a shared commitment to improving the hauora (health and wellbeing) of Raukawa iwi and the South Waikato community.

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