Issue 238 - 5 August 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 whare tapa whā: The impact of physical distancing on the health and well-being of kuia and koroheke
The effects of the COVID-19 lockdown and physical distancing were broad, impacting multiple sectors, particularly health, for Māori and Indigenous peoples. This situation report, published in MAI Journal, considers health and well-being using Te Whare Tapa Whā, and looks at the experiences and voices of kuia and koroheke—considered to be at high risk of contracting coronavirus—to better understand their health and well-being impacts from physical distancing.

Health Equity (New Zealand)

Reported sources of health inequities in Indigenous Peoples with chronic kidney disease: a systematic review of quantitative studies
The aim of this review, published in BMC Public Health, was to summarise the evidentiary basis related to causes of inequities in chronic kidney disease among Indigenous Peoples.

Inequities in people with gout: a focus on Māori (Indigenous People) of Aotearoa New Zealand
Health equity can be defined as the absence of systematic disparities in health between more and less advantaged social groups. Gout is one of the most common forms of arthritis and disproportionally affects Indigenous peoples, including Māori in Aotearoa New Zealand. Inequities in gout management are well documented and clearly evidenced in Indigenous populations. For example, while gout occurs at a younger age and is more severe in Māori, there is less regular dispensing of urate-lowering therapies. Indigenous peoples are also under-represented in clinical trials. This article, published in Therapeutic Advances in Musculoskeletal Disease, will review inequities in gout using Aoteoaroa New Zealand as an example.

Health Equity (International)

‘Dalarinji’: A flexible clinic, belonging to and for the Aboriginal people, in an Australian emergency department 
Equity and access to high-quality healthcare for Aboriginal and Torres Strait Islander (Aboriginal) people has remained refractory for complex and multifactorial reasons, and there are sound ethical arguments for addressing this urgently. In EDs all patients who ‘leave at own risk’ (LAOR) or ‘do not wait to be seen’ (DNW) are at increased risk of readmission, morbidity or death. This also incurs additional resource costs to the health system. Aboriginal patients have high rates of DNW and LAOR. This study, published in Emergency Medicine Australasia, explores the Flexiclinic model of care. It was co-designed to better support the needs of Aboriginal patients in the ED and to reduce the rates of DNW and LAOR.

Quality Improvement (New Zealand)

Impact of pharmacist involvement on medication safety in interprofessional transfer of care activity
Any transition of patient care is a high-risk time for communication error. This paper, published in the New Zealand Medical Journal, explores whether the presence of a pharmacist as part of an interprofessional group provides additional benefit and safety in transitions of care.

Connecting care: Improving service transitions – Top tips
The national mental health and addiction (MHA) quality improvement programme is working with Connecting care project teams from New Zealand district health boards to improve transitions between services for MHA consumers and support a change in reporting requirements. Some providers are making great progress but there is more to be done. To support those engaged in ongoing improvement work in service transitions, the Health Quality & Safety Commission has summarised some top tips and examples from provider project teams in this document.

Primary Health Care (New Zealand)

Early diagnosis of acute rheumatic fever and rheumatic heart disease as part of a secondary prevention strategy: Narrative review
Acute rheumatic fever (ARF) and its sequela rheumatic heart disease (RHD) remain significant causes of morbidity and mortality. In New Zealand, ARF almost exclusively affects Indigenous Māori and Pacific children. This narrative review, published in Journal of Paediatrics and Child Health, aims to present secondary interventions to improve early and accurate diagnosis of ARF and RHD, in order to minimise disease progression in New Zealand.

Primary Health Care (International)

Impact of an integrated community-based model of care for older people with complex conditions on hospital emergency presentations and admissions: a step-wedged cluster randomized trial
Health systems must reorient towards preventative and co-ordinated care to reduce hospital demand and achieve positive and fiscally responsible outcomes for older persons with complex needs. Integrated care models can improve outcomes by aligning primary practice with the specialist health and social services required to manage complex needs. This paper, published BMC Health Services Research, describes the impact of a community-facing program that integrates care at the primary-secondary interface on the rate of Emergency Department (ED) presentation and hospital admissions among older people with complex needs.

Decision‐support tools via mobile devices to improve quality of care in primary healthcare settings
The ubiquity of mobile devices has made it possible for clinical decision‐support systems (CDSS) to become available to healthcare providers on handheld devices at the point‐of‐care, including in low‐ and middle‐income countries. The use of CDSS by providers can potentially improve adherence to treatment protocols and patient outcomes. However, the evidence on the effect of the use of CDSS on mobile devices needs to be synthesized. The objective of this Cochrane Review was to assess the effects of digital clinical decision‐support systems (CDSS) accessible via mobile devices by primary healthcare providers in the context of primary care settings.

Tailored or adapted interventions for adults with chronic obstructive pulmonary disease and at least one other long‐term condition: a mixed methods review
Background Chronic obstructive pulmonary disease (COPD) is a chronic respiratory condition characterised by shortness of breath, cough and recurrent exacerbations. People with COPD often live with one or more co‐existing long‐term health conditions (comorbidities). People with more severe COPD often have a higher number of comorbidities, putting them at greater risk of morbidity and mortality. The objective of this Cochrane Review was to assess the effectiveness of any single intervention for COPD adapted or tailored to their comorbidity(s) compared to any other intervention for people with COPD and one or more common comorbidities (quantitative data, RCTs) in terms of the following outcomes: Quality of life, exacerbations, functional status, all‐cause and respiratory‐related hospital admissions, mortality, pain, and depression and anxiety.

Telehealth interventions: remote monitoring and consultations for people with chronic obstructive pulmonary disease (COPD)
Chronic obstructive pulmonary disease (COPD, including bronchitis and emphysema) is a chronic condition causing shortness of breath, cough, and exacerbations leading to poor health outcomes. Face‐to‐face visits with health professionals can be hindered by severity of COPD or frailty, and by people living at a distance from their healthcare provider and having limited access to services. Telehealth technologies aimed at providing health care remotely through monitoring and consultations could help to improve health outcomes of people with COPD. The objective of this Cochrane Review was to assess the effectiveness of telehealth interventions that allow remote monitoring and consultation and multi‐component interventions for reducing exacerbations and improving quality of life, while reducing dyspnoea symptoms, hospital service utilisation, and death among people with COPD.

Primary Mental Health (New Zealand)

A qualitative study of community pharmacists’ perceptions of their role in primary mental health care in New Zealand
Mental illness is an important public health issue internationally. As people with mild-to-moderate illness are usually cared for in primary health care, pharmacists are well placed to play an important role. The objectives of this study, published in the International Journal of Pharmacy Practice, were to explore community pharmacists’ perceptions of their role in primary mental health care and the barriers and facilitators to the provision of care in New Zealand.

Primary Mental Health (International)

An exploration into suicide prevention initiatives for mental health nurses: A systematic literature review
Mental health and suicide prevention are national health priorities in Australia, with research currently focussed towards the ZERO Suicide (ZS) initiative. The aim of this review, published in the International Journal of Mental Health Nursing, was to evaluate the impact of suicide prevention programmes, in particular the ZS prevention initiative.

Improving Suicide Prevention Through Evidence-Based Strategies: A Systematic Review
The authors of this review, published in The American Journal of Psychiatry, sought to identify scalable evidence-based suicide prevention strategies.

Increased Immunisation (International)

Healthcare workers’ perceptions and experiences of communicating with people over 50 years of age about vaccination: a qualitative evidence synthesis
Infectious diseases are a major cause of illness and death among older adults. Vaccines can prevent infectious diseases, including against seasonal influenza, pneumococcal diseases, herpes zoster and COVID‐19. However, the uptake of vaccination among older adults varies across settings and groups. The objective of this Cochrane Review was to explore healthcare workers' perceptions and experiences of communicating with older adults about vaccination.

Oral Health (International)

Healthy Smile, Happy Child: partnering with Manitoba First Nations and Metis communities for better early childhood oral health
Indigenous populations in Canada are disproportionately affected by early childhood caries. The Healthy Smile, Happy Child initiative utilizes a community development approach to encourage community uptake of evidence-based early childhood oral health promotion strategies. Sharing circles and focus groups elicited First Nations and Metis (Indigenous peoples of mixed Indigenous-European, primarily French, ancestry) views on the challenges of keeping children caries-free. This paper, published in AlterNative, share participants’ experiences and viewpoints on implementation research strategies, principles and protocols that are sensitive to Indigenous community-based contexts.

Key Ministry of Health Publications

National Hepatitis C Action Plan for Aotearoa New Zealand
This publication presents an action plan to guide the health sector and services working in hepatitis C prevention or treatment. It provides a framework for working towards the World Health Organization’s goal to eliminate viral hepatitis by 2030.

Induction of Labour in Aotearoa New Zealand: A Clinical Practice Guideline 2019
This publication provides best practice clinical guidance for health professionals on induction of labour in the Aotearoa New Zealand context.

Ministry of Health Consultations & Events

Assisted Dying Workforce Forum
Heath professionals are invited to register their interest in attending a workforce forum about assisted dying, being held in Wellington 29-30 September.  The workforce forum is part of the Ministry of Health’s work programme to implement the End of Life Choice Act 2019 (the Act).  Health practitioners who are considering providing parts of the assisted dying service may be particularly be interested in attending, with the second day of the forum providing practical training. It will be an opportunity to ask questions, establish networks with peers, and learn about the new service and roles within it. Register interest in attending the forum here. Find out more about the implementation of the Act on the Ministry of Health website. 

Submission on amendments to the schedule of the Medicines (Designated Pharmacist Prescribers) Regulations 2013 and Schedule 1B of the Misuse of Drugs Regulations 1977
The Ministry of Health invites submissions on proposed amendments to the schedule of specified prescription medicines for designated pharmacist prescribers. Please submit your feedback on the proposed amendments by 9 August 2021.

District Health Board Initiative

CM Health led initiative delivers first-ever New Zealand Hepatitis C ‘Test and Treat’ service
A Counties Manukau Health-led, New Zealand first ‘Test and Treat’ programme for New Zealanders with hepatitis C is being launched in selected community pharmacies across the Northern Region, including 17 in the Counties Manukau area.

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.