Issue 230 - 15 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.

Health Equity (New Zealand)

Implementation effectiveness of health interventions with Māori communities: a cross-sectional survey of health professional perspectives
The objective of this study, published in the Australian and New Zealand Journal of Public Health, was to identify factors that New Zealand health professionals rate as important for implementation effectiveness for health interventions with Māori communities.

Implementing Anti-Racism Interventions in Healthcare Settings: A Scoping Review
Racism towards Black, Indigenous and people of colour continues to exist in the healthcare system. This leads to profound harm for people who use and work within these settings. This scoping review, published in the International Journal of Environmental Research and Public Health, aimed to identify anti-racism interventions in outpatient healthcare settings.

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, are 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. 

Quality Improvement (International)

Clinical handover and handoff in healthcare: a systematic review of systematic reviews
The purpose of this systematic review, published in the International Journal for Quality in Health Care, is to appraise and summarise existing literature on clinical handover.

Enabling clinician engagement in safety and quality improvement
The aim of this study, published in Australian Health Review, was to determine how individual, group and leadership factors influence clinician engagement in safety and quality improvement work.

Cancer Services (New Zealand)

The impact of the COVID-19 pandemic on cancer diagnosis and service access in New Zealand–a country pursuing COVID-19 elimination
The COVID-19 pandemic has disrupted cancer services globally. New Zealand has pursued an elimination strategy to COVID-19, reducing (but not eliminating) this disruption. Early in the pandemic, our national Cancer Control Agency (Te Aho o Te Kahu) began monitoring and reporting on service access to inform national and regional decision-making. In this manuscript, published in The Lancet Regional Health - Western Pacific, the authors use high-quality, national-level data to describe changes in cancer registrations, diagnosis and treatment over the course of New Zealand's response to COVID-19. 

Why does New Zealand have such poor outcomes from colorectal cancer?: the importance of the pre-diagnostic period
Over 3000 cases of colorectal cancer (CRC) are diagnosed annually in New Zealand. The proportion of late stage diagnoses is higher than in similar countries, and highest in Māori and Pacific patients. Survival outcomes are poorer than for people in Australia and poor for Māori and Pacific peoples. A regional screening programme is not yet available to the entire target population (60–74 years). This study, published in the Journal of Primary Health Care, reviews research investigating the pre-diagnostic pathway for CRC in New Zealand and how this may contribute to poorer outcomes.

Cardiovascular Disease and Diabetes (International)

Impact of diabetes specialist nurses on inpatient care: a systematic review
People with diabetes have longer hospital stays and poorer clinical outcomes. Diabetes inpatient specialist nurses have been introduced to improve care. The aim of this systematic review, published in Diabetic Medicine, was to assess the evidence for the benefit of diabetes specialist nurses in the inpatient setting.

Healthcare professional-led interventions on lifestyle modifications for hypertensive patients – a systematic review and meta-analysis
About 0.9 billion people in the world have hypertension. The mortality due to hypertension increased dramatically over the last decades. Healthcare professionals should support patients with hypertension to modify their lifestyle to decrease blood pressure, but an overview of effective lifestyle interventions is lacking. The aim of this study, published in BMC Family Practice, was to determine whether healthcare professional-led interventions on lifestyle modifications are effective in lowering blood pressure in patients with hypertension. 

Primary Health Care (New Zealand)

Primary care improvement case study: Turanga Health: Tu Mahi project
This case study, published by the Health Quality & Safety Commission, describes a Whakakotahi quality improvement project run by Turanga Health in the Tairāwhiti, Gisborne, region. Turanga's intent was to address the issues of poor access and introduce options to facilitate and increase participation of Māori in primary health care and so reduce the demand on secondary care. The result is a workplace wellness platform that transitions individuals with long-term conditions to whānau-centred care and responsibility in the whare.

Proactively providing contraception to New Zealand adolescents
High adolescent pregnancy rates in New Zealand (NZ) are influenced by limited access to contraception. This paper, published in the Australian and New Zealand Journal of Obstetrics and Gynaecology, discusses using a proactive contraception provision (PCP) model to overcome barriers that prevent effective contraceptive uptake. 

Point-of-Care Testing in Rural and Remote Settings to Improve Access and Improve Outcomes: A Snapshot of the New Zealand Experience
Three key guiding principles of rural and remote clinical services are to improve health access, improve outcomes, and reduce inequity. In New Zealand, as in other countries, point-of-care testing and technologies can assist in clinical decision-making for acute and chronic conditions and can help to achieve these key health principles for people living in rural and remote locations. The objective of this paper, published in the Archives of Pathology & Laboratory Medicine, was to provide readers with insights into where and how point-of-care testing devices and tests can be implemented to improve outcomes in New Zealand settings without on-site pathology laboratory support.

Compounding inequity: a qualitative study of gout management in an urban marae clinic in Auckland
Gout remains a health equity issue; Māori and Pacific peoples are disproportionately afflicted, with increased burden and loss of quality of life, yet are less likely to receive appropriate management, which mainly occurs in primary care. This study, published in the Journal of Primary Health Care, aims to understand the perspectives of the mainly Māori and Pacific clinicians and staff at an urban marae practice about barriers and challenges to delivering effective care to a Māori and Pacific community with high burden of gout. 

Primary Health Care (International)

A Systematic Review to Examine the Evidence in Developing Social Prescribing Interventions That Apply a Co-Productive, Co-Designed Approach to Improve Well-Being Outcomes in a Community Setting
This systematic review, published in the International Journal of Environmental Research and Public Health, aims to investigate the evidence in applying a co-design, co-productive approach to develop social prescribing interventions. 

Effectiveness of a medication adherence management intervention in a community pharmacy setting: a cluster randomised controlled trial
Non-adherence to medications continues to be a burden worldwide, with significant negative consequences. Community pharmacist interventions seem to be effective at improving medication adherence. However, more evidence is needed regarding their impact on disease-specific outcomes. The aim of this systematic review, published in BMJ Quality & Safety, was to evaluate the impact of a community pharmacist-led adherence management intervention on adherence and clinical outcomes in patients with hypertension, asthma and chronic obstructive pulmonary disease (COPD). 

Primary Mental Health (International)

Moving from “let’s fix them” to “actually listen”: the development of a primary care intervention for mental-physical multimorbidity
Effective person-centred interventions are needed to support people living with mental-physical multimorbidity to achieve better health and wellbeing outcomes. Depression is identified as the most common mental health condition co-occurring with a physical health condition and is the focus of this intervention development study. The aim of this study, published in BMC Health Services Research, is to identify the key components needed for an effective intervention based on a clear theoretical foundation, consideration of how motivational interviewing can inform the intervention, clinical guidelines to date, and the insights of primary care nurses. 

Weight Management (International)

Interventions for weight loss in people with chronic kidney disease who are overweight or obese
Obesity and chronic kidney disease (CKD) are highly prevalent worldwide and result in substantial health care costs. Obesity is a predictor of incident CKD and progression to kidney failure. Whether weight loss interventions are safe and effective to impact on disease progression and clinical outcomes, such as death remains unclear. The aim of this Cochrane Review was to evaluate the safety and efficacy of intentional weight loss interventions in overweight and obese adults with CKD; including those with end‐stage kidney disease (ESKD) being treated with dialysis, kidney transplantation, or supportive care. 

Family-based nutrition interventions for obesity prevention among school-aged children: a systematic review
Effective evidence-informed family-based nutrition interventions for childhood obesity management are needed. The aim of this systematic review, published in Translational Behavioral Medicine, was to assess the number and quality of published randomized controlled trials incorporating family-based nutrition interventions for childhood obesity (ages 5-18 years) management and to identify intervention attributes (e.g., contact time, nutrition curricula, and behavior change strategies) used in successful interventions. 

Addressing obesity in the first 1000 days in high risk infants: Systematic review
Early intervention is critical for addressing the challenge of childhood obesity. Yet many preventive interventions do not target infants most at risk of future overweight or obesity. This systematic review, published in Maternal & Child Nutrition, examines interventions delivered before 2 years that aim to ameliorate excess weight gain among infants at high risk of overweight or obesity, due to sociodemographic characteristics, parental weight or health status, infant feeding or health behaviours. 

Oral Health (New Zealand)

Recommendations for improving dental care for dentate home-based older people: A qualitative New Zealand study
A small number of national studies have explored the barriers to older people accessing dental care. This study, published in Gerodontology, investigated older people's recommendations for overcoming these barriers. 

Disability Services (International)

How can coproduction help to deliver culturally responsive disability support? A case study from Australia
How to improve access and quality of social services to respond to cultural diversity is receiving increased attention. Yet no approach to cultural responsiveness has been widely accepted. Coproduction has been championed in many service fields for better service outcomes and has the potential to inform practices for cultural responsiveness. This study, published in Health & Social Care in the Community, explored how coproduction can be used to deliver culturally responsive social services.

Key Ministry of Health Publications

Office of the Director of Mental Health and Addiction Services Annual Report 2018 and 2019
This is the fourteenth annual report of the Office of the Director of Mental Health and Addiction Services. It presents information and statistics that reflect activity under the Mental Health (Compulsory Assessment and Treatment) Act 1992, the Substance Addiction (Compulsory Assessment and Treatment) Act 2017.

National Gambling Study Data Explorer
The Gambling Data Explorer is an interactive tool for exploring data from the New Zealand National Gambling Study. It presents gambling participation and harm results by gender, age and ethnic group

District Health Board Initiative

A way forward for mental health and addictions support
Whānau and communities have helped shape a proposed way forward for mental health and addictions support in Te Tairāwhiti. The proposal is the result of a review of local mental health and addiction services ‘Kia Tōtika Te Tū’. The review looked for a more effective way to support whānau needing help in our communities.

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.