Issue 234 - 10 June 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

Creating an Indigenous Māori-centred model of relational health: A literature review of Māori models of health
Improving health equity for Māori, similar to other colonised Indigenous peoples globally, requires urgent attention. Improving the quality of health practitioners' engagement with Indigenous Māori accessing health services is one area that could support improving Māori health equity. While the Fundamentals of Care framework offers a promising relational approach, it lacks consideration of culture, whānau or family, and spirituality, important for Indigenous health and wellbeing. This qualitative literature review on Māori models of health and wellbeing, published in the Journal of Clinical Nursing, yielded nine models to inform a Māori-centred relational model of care.

Health Equity (New Zealand)

Wellbeing of Indigenous Peoples in Canada, Aotearoa (New Zealand) the United States: A Systematic Review
Despite the health improvements afforded to non-Indigenous peoples in Canada, Aotearoa (New Zealand) and the United States, the Indigenous peoples in these countries continue to endure disproportionately high rates of mortality and morbidity. Indigenous peoples’ concepts and understanding of health and wellbeing are holistic; however, due to their diverse social, political, cultural, environmental and economic contexts within and across countries, wellbeing is not experienced uniformly across all Indigenous populations. The systematic review, published in the International Journal of Environmental Research and Public Health, aimed to identify aspects of wellbeing important to the Indigenous people in Canada, Aotearoa and the United States.

Health Equity (International)

Nature-Based Equity: An Assessment of the Public Health Impacts of Green Infrastructure in Ontario Canada
This study, published in the International Journal of Environmental Research and Public Health, explores the built environment as a physical determinant of health essential to the planning and development of a more equitable society. Communities face growing challenges due to environmental stressors such as climate change, with vulnerable communities experiencing a disproportionate burden of adverse health outcomes. The interdependencies between urban planning and public health outcomes are inextricable, with respect to improving access to healthier built environments for vulnerable and marginalized groups. Widespread implementation of nature-based solutions, such as green infrastructure, provides a multi-functional strategy to support sustainable development, increase climate resilience, enhance ecological connectivity, and create healthier communities.

Hospital Productivity (International)

AI in patient flow: applications of artificial intelligence to improve patient flow in NHS acute mental health inpatient units
Growing demand for mental health services, coupled with funding and resource limitations, creates an opportunity for novel technological solutions including artificial intelligence (AI). This study, published in Heliyon, aims to identify issues in patient flow on mental health units and align them with potential AI solutions, ultimately devising a model for their integration at service level.

Access to surgical care as an efficiency issue: using lean management in French and Australian operating theatres
Millions around the world still cannot access safe, timely and affordable surgery. Considering access as a function of efficiency, this paper, published in the Journal of Health Organization and Management, examines how the latter can be improved within the context of operating theatres. Carried out in France and Australia, this study reveals different types of waste in operating theatres and a series of successful tactics used to increase efficiency and eliminate wastefulness. 
 

Cancer Services (New Zealand)

What Is the Evidence Globally for Culturally Safe Strategies to Improve Breast Cancer Outcomes for Indigenous Women in High Income Countries? A Systematic Review
The aim of this review, published in the International Journal of Environmental Research and Public Health, was to systematically assess the evidence on whether cultural safety affects breast cancer outcomes with regards to care for Indigenous women in high income countries.

Interventions to improve cancer survivorship among Indigenous Peoples and communities: a systematic review with a narrative synthesis
The purpose of this systematic review, published in Supportive Care in Cancer,  is to synthesize the evidence on the types of interventions that have been utilized by Indigenous Peoples living with cancer, and report on their relevance to Indigenous communities and how they align with holistic wellness.

Cancer Services (International)

Incorporation of human papillomavirus self-sampling into the revised National Cervical Screening Program: a qualitative study of GP experiences and attitudes in rural New South Wales
Human papillomavirus self-sampling is part of the revised Australian National Cervical Screening Program for eligible under- or never-screened women. Although research demonstrates self-sampling as an acceptable method from the perspective of women, little is known about GP experiences and perspectives of this new screening alternative. This study, published in the Australian Journal of Primary Health, sought to explore the experiences and perspectives of rural GPs towards the revised National Cervical Screening Program and the new self-sampling option. 

Emergency Department Services (International)

Effectiveness of clinical criteria in directing patient flow from the emergency department to a medical assessment unit in Queensland, Australia: a retrospective chart review of hospital administrative data
Medical Assessment Units (MAUs) have become a popular model of acute medical care to improve patient flow through timely clinical assessment and patient management. The purpose of this study, published in BMC Health Services Research, was to determine the effectiveness of a consensus-derived set of clinical criteria for patient streaming from the Emergency Department (ED) to a 15-bed MAU within the highly capacity-constrained environment of a large quaternary hospital in Queensland, Australia. 

Cardiovascular Disease and Diabetes (New Zealand)

What helps and hinders metformin adherence and persistence: a qualitative study exploring the views of people with type 2 diabetes
The aim of this study, published in the New Zealand Medical Journal, was to explore the views of people with type 2 diabetes who had initiated metformin monotherapy about what influences adherence and persistence.

Traditional, complementary and integrative medicine use among Indigenous peoples with diabetes in Australia, Canada, New Zealand and the United States
This systematic review, published in the Australian and New Zealand Journal of Public Health, aimed to describe traditional, complementary and integrative medicine (TCIM) use among Indigenous peoples with diabetes from Australia, Canada, New Zealand and the United States (US).

Primary Health Care (New Zealand)

The characteristics of behaviour change interventions used among Pacific people: a systematic search and narrative synthesis
Pacific people living in New Zealand, Australia, United States, and the Pacific region continue to experience a disproportionately high burden of long-term conditions, making culturally contextualised behaviour change interventions a priority. The primary aim of this study, published in BMC Public Health, was to describe the characteristics of behaviour change interventions designed to improve health and effect health behaviour change among Pacific people. 

Primary Health Care (International)

Relational continuity of care in community pharmacy: A systematic review
Relational continuity of care (COC) is becoming an important concept related to improving healthcare quality, reducing medical costs and increasing patient satisfaction with primary care. While community pharmacy (CP) has a considerable role in primary care, there are few reports dedicated to the role of relational COC in CP. This study, published in Health & Social Care in the Community, reviewed the existing evidence of relational COC in CP and its effect on patients.

Training healthcare providers to respond to intimate partner violence against women
Intimate partner violence (IPV) includes any violence (physical, sexual or psychological/emotional) by a current or former partner. This review reflects the current understanding of IPV as a profoundly gendered issue, perpetrated most often by men against women. The objective of this Cochrane Review was to assess the effectiveness of training programmes that seek to improve healthcare providers identification of and response to IPV against women, compared to no intervention, wait‐list, placebo or training as usual.

Information meetings on end-of-life care for older people by the general practitioner to stimulate advance care planning: a pre-post evaluation study
To increase knowledge about options people have concerning end-of-life-care issues, General Practitioners (GPs) can organise meetings to inform their older patients. This study, published in BMC Family Practice, evaluated these meetings, using the following research questions: How did the attendees experience the information meeting? Was there a rise in Advance Care Planning (ACP) behaviour after the information meeting? Was there a change in trust people have that physicians will provide good care at the end of life and that they will follow their end-of-life wishes after the information meetings?

Formative evaluation of a community‐based approach to reduce the incidence of Strep A infections and acute rheumatic fever
The objective of this study, published in the Australian and New Zealand Journal of Public Health, was to explore the acceptability of a novel, outreached-based approach to improve primary and primordial prevention of Strep A skin sores, sore throats and acute rheumatic fever in remote Aboriginal communities.

Primary Mental Health (International)

Internet‐based cognitive and behavioural therapies for post‐traumatic stress disorder (PTSD) in adults
Therapist‐delivered trauma‐focused psychological therapies are effective for post‐traumatic stress disorder (PTSD) and have become the accepted first‐line treatments. Despite the established evidence‐base for these therapies, they are not always widely available or accessible. Many barriers limit treatment uptake, such as the number of qualified therapists available to deliver the interventions; cost; and compliance issues, such as time off work, childcare, and transportation, associated with the need to attend weekly appointments. Delivering Internet‐based cognitive and behavioural therapy (I‐C/BT) is an effective and acceptable alternative to therapist‐delivered treatments for anxiety and depression. The objective of this Cochrane Review was to assess the effects of I‐C/BT for PTSD in adults. 

Weight Management (International)

Behavioral Counseling Interventions for Healthy Weight and Weight Gain in Pregnancy: US Preventive Services Task Force Recommendation Statement
The prevalence of overweight and obesity is increasing among persons of childbearing age and pregnant persons. The USPSTF commissioned a systematic review to evaluate the benefits and harms of behavioural counselling interventions to prevent adverse health outcomes associated with obesity during pregnancy and to evaluate intermediate outcomes, including excess gestational weight gain. This is a new recommendation published in JAMA. 

Disability Services (New Zealand)

Māori and autism: A scoping review
Most current approaches to identifying, researching and managing autism are based on Western views and understandings. However, different cultural groups may understand and approach autism differently. This review, published in Autism, searched a wide range of websites, academic journals and other sources for published information related to autism and Māori, the indigenous people of Aotearoa/New Zealand. 
 

Key Ministry of Health Publications

Suicide data related to mental health service users
This publication outlines 2016 suicide data related to mental health service users.

District Health Board Initiative

Keeping our tamariki smiling
Once a month, a small group of tamariki visiting Gisborne Hospital for significant dental procedures receive a unique kind of awhi from the Hauora Tairāwhiti Oral Health Service. Dressed in a plush giraffe ‘onesie’ on the way to meet with our most recent group of tamariki, Oral Health Programme Support Bonita Mackey talks about the importance of making children feel as comfortable as possible on the day. 

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.