Issue 229 - 1 April 2021

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

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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.

Māori Innovation

Te Ipu Aronui
This new website focuses on Māori end of life experiences. Short films showcasing whānau care of kaumātua as they approach death serve as a key focal point. The site is a response to concerns that Māori are losing knowledge of traditional end of life caregiving tikanga (customs). It is an outcome of the Health Research Council funded study, Pae Herenga. Led by Dr Tess Moeke-Maxwell (Ngāi Tai ki Tamaki & Ngāti Porou), the project was initiated by the Kāhui Kaumātua of the Te Ārai Palliative Care and End of Life Research Group at the School of Nursing, University of Auckland. 
 

Health Equity (New Zealand)

Stakeholder perspectives on the implementation and impact of Indigenous health interventions: A systematic review of qualitative studies 
Evaluations of health interventions for Indigenous peoples rarely report outcomes that reflect participant and community perspectives of their experiences. Inclusion of such data may provide a fuller picture of the impact of health programmes and improve the usefulness of evaluation assessments. The aim of this study, published in Health Expectations, was to describe stakeholder perspectives and experiences of the implementation and impact of Indigenous health programmes.

Indigenous peoples’ experiences and preferences in aged residential care: a systematic review
Although the demand for aged residential care increases, low use of aged residential care by Indigenous people raises questions about unrecognised barriers to health care. The objectives of this systematic literature review, published in AlterNative, were to examine current scientific literature that reports older Indigenous people’s experiences in aged residential care and describe critical factors that shape Indigenous people’s preferences in aged residential care settings.

Māori and Pasifika language, identity, and wellbeing in Aotearoa New Zealand
For Māori and Pasifika living in Aotearoa New Zealand, language, identity, and wellbeing are inter-linked and multifaceted. However, as English is the most widely spoken language in Aotearoa New Zealand, some Māori and Pasifika peoples will not be able to speak their community language. In this study, published in Kōtuitui, ratings of ethnic identity centrality, self-esteem, life satisfaction and the Personal Wellbeing Index of monolingual (English only) and bilingual Māori and Pasifika peoples were compared using New Zealand Attitudes and Values Study data.

Health Equity (International)

Health equity and virtual care: A narrative review of recommendations arising from the COVID-19 pandemic
The COVID-19 health crisis has disproportionately impacted populations who have been historically marginalised in health care and public health, including low-income and racial and ethnic minority groups. Members of marginalized communities experience undue barriers to accessing health care through virtual care technologies, which have become the primary mode of ambulatory health care delivery during the COVID-19 pandemic. Insights generated during the COVID-19 pandemic can inform strategies to promote health equity in virtual care now and in the future. The objective of this review, published in JMIR Formative Research, was to generate insights arising from literature that was published in direct response to the widespread use of virtual care during the COVID-19 pandemic, and had a primary focus on providing recommendations for promoting health equity in the delivery of virtual care. 

Quality Improvement (International)

Reduction of in-hospital cardiac arrest rates in intensive care-equipped New South Wales hospitals in association with implementation of Between the Flags rapid response system
The NSW Clinical Excellence commission introduced the 'Between the Flags' programme, in response to the death of a young patient, as a system-wide approach for early detection and management of the deteriorating patient in all NSW hospitals. The impact of BTF implementation on the 35 larger hospitals with intensive care units (ICU) has not been reported previously. They aim of this study, published in the Internal Medicine Journal, was to assess the impact of 'Between the Flags' (BTF), a two-tier rapid response system across 35 hospitals with an ICU in NSW, on the incidence of in-hospital cardiac arrests and the incidence and outcome of patients admitted to an ICU following cardiac arrest and rapid response team activation.

Emergency Department Services (International)

The effectiveness of nurse-initiated interventions in the Emergency Department: A systematic review
Nurse-initiated interventions potentially provide an opportunity for earlier response for time sensitive presentations to the Emergency Department, and may improve time-to-treatment, symptomatic relief and patient flow through the department. The objective of this study, published in Australasian Emergency Care, was to determine the effectiveness of nurse-initiated interventions on patient outcomes in the Emergency Department

Review article: Emergency department crowding measures associations with quality of care: A systematic review
Emergency Department crowding has been reported to reduce the quality of care. There are many proposed crowding metrics, but the metric most strongly associated with care quality remains unknown. The present study, published in Emergency Medicine Australasia, aims to determine the crowding metric with the strongest links with processes and outcomes of care linked to the Institute of Medicine quality domains. 

Cardiovascular Disease and Diabetes (International)

Mobile phone‐based interventions for improving adherence to medication prescribed for the primary prevention of cardiovascular disease in adults
Cardiovascular disease (CVD) is a major cause of disability and mortality globally. Premature fatal and non‐fatal CVD is considered to be largely preventable through the control of risk factors by lifestyle modifications and preventive medication. Lipid‐lowering and antihypertensive drug therapies for primary prevention are cost‐effective in reducing CVD morbidity and mortality among high‐risk people and are recommended by international guidelines. However, adherence to medication prescribed for the prevention of CVD can be poor. The objective of this Cochrane Review was to establish the effectiveness of interventions delivered by mobile phone to improve adherence to medication prescribed for the primary prevention of CVD in adults. 

Primary Health Care (International)

Different antibiotic treatments for group A streptococcal pharyngitis
Antibiotics provide only modest benefit in treating sore throat, although their effectiveness increases in people with positive throat swabs for group A beta‐haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated. The objective of this Cochrane Review was to assess the comparative efficacy of different antibiotics in: alleviating symptoms (pain, fever); shortening the duration of the illness; preventing clinical relapse (i.e. recurrence of symptoms after initial resolution); and preventing complications (suppurative complications, acute rheumatic fever, post‐streptococcal glomerulonephritis). 

Nursing Care Coordination for Patients with Complex Needs in Primary Healthcare: A Scoping Review
Millions of people worldwide have complex health and social care needs. Care coordination for these patients is a core dimension of integrated care and a key responsibility for primary healthcare. Registered nurses play a substantial role in care coordination. This review, published in International Journal of Integrated Care, draws on previous theoretical work and provides a synthesis of care coordination interventions as operationalized by nurses for complex patient populations in primary healthcare.

Hospital at home: home‐based end‐of‐life care
The policy of several countries is to provide people with a terminal illness the choice of dying at home; this is supported by surveys that indicate that the general public and people with a terminal illness would prefer to receive end‐of‐life care at home. The objective of this Cochrane Review was to determine if providing home‐based end‐of‐life care reduces the likelihood of dying in hospital and what effect this has on patients' symptoms, quality of life, health service costs and caregivers compared with inpatient hospital or hospice care. 

Primary Mental Health (New Zealand)

Involuntary Cultural Change and Mental Health Status Among Indigenous Groups: A Synthesis of Existing Literature
Indigenous groups throughout the world have experienced social exclusion and have been subjected to marginalisation. Globalisation has resulted in significant changes in traditional lifestyles and developmental programs have not been successful in integrating Indigenous people into communities with non-Indigenous people. Although there is substantial research on acculturation and adaptation within the field of cross-cultural psychology, there are few narrative reviews of this literature. The present paper, published in the Community Mental Health Journal, provides such a review and examines the mental health concerns of Indigenous groups undergoing acculturation.

Primary Mental Health (International)

Effectiveness of psychosocial interventions for reducing parental substance misuse
Parental substance use is a substantial public health and safeguarding concern. There have been a number of trials of interventions relating to substance‐using parents that have sought to address this risk factor, with potential outcomes for parent and child. The objective of this Cochrane Review was to assess the effectiveness of psychosocial interventions in reducing parental substance use.

Weight Management (International)

School-based interventions for the treatment of childhood obesity: a systematic review, meta-analysis and meta-regression of cluster randomised controlled trials
Schools offer an ideal setting for childhood obesity interventions due to their access to children and adolescents. This review, published in Public Health Nutrition, aimed to systematically review the impact of school-based intervention for the treatment of childhood obesity. 

Key Ministry of Health Publications

COVID-19 Māori Vaccine and Immunisation Plan: Supplementary to the Updated COVID-19 Māori Health Response Plan
The COVID-19 Māori Vaccine and Immunisation Plan builds on the Updated COVID-19 Māori Health Response Plan by outlining key initiatives that will be undertaken to ensure the COVID-19 Vaccine and Immunisation Programme addresses its obligations under Te Tiriti o Waitangi and supports Māori health and equity.

District Health Board Initiative

Rongoā Māori – Northland District Health Board funded pilot services
Northland DHB welcomed Te Hiku ō Te Ika Rongoā Māori practitioners into the fold of Kaitaia Hospital to deliver their traditional Rongoā Māori services. This is one of three recently funded Rongoā Māori pilot programmes across Te Tai Tokerau. The impetus to establish a funded Rongoā Māori service came from an overwhelming call from whānau and the community. While Rongoā Māori is not new, and in fact, a well-practised and well-used kaupapa, having it as an integral, funded health service pathway is new.  

Opportunity to make a difference

Board vacancies at all levels
We have a strong tradition in New Zealand of public service and giving back to the community. One way of contributing is by serving on a statutory board or authority. This provides a unique opportunity to make a real and lasting difference for New Zealanders. The Ministry of Health is currently looking for people to fill a number of current and upcoming vacancies. Some roles are specifically for health practitioners, but others are for laypeople who may be working in other fields. We’re keen to see applications from a wide range of people so we can ensure our boards reflect the diversity of New Zealand's population. Whatever your background, your focus as a board member will be on adding value and driving performance. You’ll be involved in setting strategic direction, managing risks and monitoring performance. Follow the link above, for more information and to register your interest by 9 April 2021.

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.