Issue 241 - 4 November 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

Māori and Pacific peoples’ experiences of a Māori-led diabetes programme
Type 2 diabetes mellitus (T2DM) disproportionately affects Māori and Pacific peoples in Aotearoa (New Zealand). Despite this, the lived experiences of T2DM and its management by Māori and Pacific peoples are scarcely acknowledged in health literature. The present study, published in the New Zealand Medical Journal, examines the lived experiences of T2DM by Māori and Pacific participants in the Mana Tū diabetes programme.

Health Equity (New Zealand)

The inequity of access to health: a case study of patients with gout in one general practice
Gout is a health equity issue for Māori and Pacific peoples because disparities in quality of care exist. This study, published in the New Zealand Medical Journal, aims to describe domains of access that may contribute to the optimisation of gout care and, therefore, address health inequity.

Quality Improvement (New Zealand)

Using a randomised controlled trial to test the effectiveness of social norms feedback to reduce antibiotic prescribing without increasing inequities
Antibiotic overprescription is a key driver of antimicrobial resistance, and rates of community dispensing of antibiotics in New Zealand are high compared to other developed countries. This study, published in the New Zealand Medical Journal, described whether a social-norm-based intervention successful elsewhere would have an effect on GPs with high prescribing rates of antibiotics. The authors also aimed to assess the effects on prescribing for Māori and Pacific patients.

Quality Improvement (International)

Routine provision of feedback from patient‐reported outcome measurements to healthcare providers and patients in clinical practice
Patient‐reported outcomes measures (PROMs) assess a patient’s subjective appraisal of health outcomes from their own perspective. Despite hypothesised benefits that feedback on PROMs can support decision‐making in clinical practice and improve outcomes, there is uncertainty surrounding the effectiveness of PROMs feedback. The objective of this Cochrane Review was to assess the effects of PROMs feedback to patients, or healthcare workers, or both on patient‐reported health outcomes and processes of care.

Cancer Services (New Zealand)

Which demographic factors influence Pacific women’s attendance at colposcopy clinics in New Zealand?
The aim of this study, published in the New Zealand Medical Journal, was to examine the demographic factors associated with attendance at colposcopy clinics among Pacific women following a high-grade cytology in New Zealand.

Human Papillomavirus (HPV) Self-Sampling among Never-and Under-Screened Indigenous Māori, Pacific and Asian Women in Aotearoa New Zealand: A Feasibility Study
In Aotearoa, New Zealand, the majority of cervical cancer cases occur in women who have never been screened or are under-screened. Wāhine Māori, Pacific and Asian women have the lowest rate of cervical screening. Self-sampling for human papillomavirus (HPV-SS) has been shown to increase participation in cervical cancer screening. A whole-of-system approach, driven by evidence in the most effective delivery of HPV-SS, is required to mitigate further widening of the avoidable gap in cervical screening access and outcomes between groups of women in Aotearoa. This single-arm feasibility and acceptability study of HPV self-sampling, published in the International Journal of Environmental Research and Public Health, invited never- and under-screened 30–69-year-old women from general practices in Auckland, Aotearoa.

Cancer Services (International)

Music interventions for improving psychological and physical outcomes in people with cancer
Having cancer may result in extensive emotional, physical and social suffering. Music interventions have been used to alleviate symptoms and treatment side effects in people with cancer. This review includes music interventions defined as music therapy offered by trained music therapists, as well as music medicine, which was defined as listening to pre‐recorded music offered by medical staff. The objective of this Cochrane Review was to assess and compare the effects of music therapy and music medicine interventions for psychological and physical outcomes in people with cancer.

Interventions to Improve the Preparedness to Care for Family Caregivers of Cancer Patients: A Systematic Review and Meta-analysis
Preparedness for caregiving could balance the negative impacts of caregiving. The interventions aimed at increasing readiness among the caregivers are important during the illness period for both patients and their caregivers. The aims of this study, published in Cancer Nursing, were to review the interventions applied to the caregivers of cancer patients and to examine the effects of these interventions on the preparedness to care.

Emergency Department Services (International)

A framework to guide the implementation of lean management in emergency department
This paper, published in the Journal of Health Organization and Management, aims at enriching the knowledge of the application of lean management (LM) in emergency department (ED), structuring the methodology for implementing LM projects and summarizing the relevant dimensions of LM adoption in ED.

Cardiovascular Disease and Diabetes (New Zealand)

A survey of nurses prescribing in diabetes care: Practices, barriers and facilitators in New Zealand and the United Kingdom
The aim of this study, published in the Journal of Clinical Nursing, was to compare diabetes-related prescribing practices, barriers and facilitators amongst nurse prescribers in New Zealand and the United Kingdom.

Evaluating diabetes care quality improvement strategies used by clinical teams in five primary care practices in New Zealand
This study, published in the New Zealand Medical Journal, aims to describe the level of implementation of six QI strategies for improving primary care of diabetes (self-management support, team changes, case management, patient education, electronic patient registers and patient reminders).

Cardiovascular Disease and Diabetes (International)

Deconstructing type 2 diabetes self-management of Australian Pacific Islander women: Using a community participatory research and talanoa approach
This study, published in Health & Social Care in the Community, details community-based participatory research using culturally appropriate talanoa approaches provided the framework to explore diabetes self-management of Australian Pacific Islander (API) women living with type 2 diabetes in South-East Queensland.

Effectiveness of Text Messaging Interventions on Blood Pressure Control Among Patients With Hypertension: Systematic Review of Randomized Controlled Trials
Controlling blood pressure (BP) is an international health concern, and high BP is a major contributor to cardiovascular disease mortality. Evidence has shown that educational interventions directed at patients potentially improve BP control and adherence to medications and lifestyle modifications. In addition, a text messaging intervention has a potential effect on BP control; however, the dosage of a text messaging intervention has not been determined in previous reviews, resulting in difficult application in practice. This review, published in JMIR mHealth and uHealth, aimed to identify the effectiveness of a text messaging intervention on hypertension management with a specific focus on the dosage of text messaging and the type of additional interventions with text messaging.

Primary Health Care (New Zealand)

Primary case improvement case study: Improving eczema management and care at Hauora Heretaunga
This publication by the Health Quality & Safety Commission discusses a Whakakotahi quality improvement project, developed by Hauora Heretaunga, to improve the wellbeing of Māori children aged 0–4 years suffering physically and emotionally with eczema.

Qualitative experiences of primary health care and social care professionals with refugee-like migrants and former quota refugees in New Zealand
Former quota refugees are known to have higher health and social care needs than the general population in resettlement countries. However, migrants with a refugee-like background (refugee-like migrants) in New Zealand are not currently offered systematic government-sponsored induction or health services. This study, published in the Australian Journal of Primary Health, explored the experiences of New Zealand health and social care providers in general practice.

Primary Mental Health (New Zealand)

‘Really there because they care’: The importance of service users’ interpretations of staff motivations at a crisis intervention service in New Zealand
Crisis intervention services for people experiencing psychological distress and suicidal ideation are frequently described by the people accessing them as failing to meet their needs. This paper, published in Health & Social Care in the Community, reports a prominent finding from a realist evaluation of Taranaki Retreat—a charitable, non-clinical organisation in New Zealand, which offers free respite for people experiencing acute distress.

Primary Mental Health (International)

Specific content for collaborative care: a systematic review of collaborative care interventions for patients with multimorbidity involving depression and/or anxiety in primary care
In primary care (PC) many patients suffer from multimorbidity involving depression and/or anxiety. Collaborative care (CC) has shown promising results for patients with depression, anxiety, and multimorbidity involving depression. However, specific content in CC for patients with multimorbidity involving depression and/or anxiety is unknown. The objective of this review, published in Family Practice, was to examine the effect of Collaborative care interventions in patients with multimorbidity involving depression and/or anxiety compared with usual care; and to identify specific content of Collaborative care.

Weight Management (New Zealand)

Adult obesity management in New Zealand general practice: a review
Obesity is an important issue that leads to further health complications, increases the strain on the national health system and lowers quality of life. There is little available information on obesity management to guide best practice in general practice, despite 32% of New Zealand adults reported to be obese. The aim of this paper, published in the Journal of Primary Health Care, was to review obesity management in New Zealand general practice.

Weight Management (International)

Interventions for preventing weight gain after smoking cessation
Most people who stop smoking gain weight. This can discourage some people from making a quit attempt and risks offsetting some, but not all, of the health advantages of quitting. Interventions to prevent weight gain could improve health outcomes, but there is a concern that they may undermine quitting. The objective of this Cochrane Review was to systematically review the effects of interventions targeting post‐cessation weight gain on weight change and smoking cessation and  interventions designed to aid smoking cessation that plausibly affect post‐cessation weight gain.

Mindfulness-based programs for the prevention of childhood obesity: A systematic review
The prevalence of overweight and obesity has increased worldwide at an alarming rate in recent decades and has become a serious public health problem. The purpose of this study, published in Appetite, is to carry out a systematic review of scientific research on mindfulness-based programs for the prevention of childhood obesity carried out in the last 10 years.

Effects of programs and interventions related to the social environment on childhood and adolescent obesity: A systematic search for and scoping review of natural experiments
Given the potential importance of social environment on obesity and to better understand their causal relationship amongst children and adolescents, this scoping review, published in Health & Place, systematically searches for and evaluates programs and interventions using natural experiment designs.

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 the Health & Social Care in the Community, explored how coproduction can be used to deliver culturally responsive social services.

Key Ministry of Health Publications

Mortality web tool
The Mortality web tool presents mortality and demographic data for selected causes of deaths registered in New Zealand from 1948–2018.

Suicide web tool
The Suicide web tool presents data on confirmed suicides reported by the Ministry of Health, as well as data on suspected intentionally self-inflicted deaths reported by the Chief Coroner.

Virtual Diabetes Register web tool
This web tool presents both estimated numbers of people registered as having diabetes, as well as the estimated prevalence of diabetes per 1000 people, across different demographic groups in the population.

Standard of care: Administering assisted dying medication in New Zealand Aotearoa
This standard has been developed to ensure assisted dying services follow best
practice in administering medication in New Zealand Aotearoa. It covers the period of
service provision from when a service provider receives the medication from the
pharmacy through to the time that the person receiving the medication dies and the
service provider returns the medication kit. Contracted pharmacy services in-house
standard operating procedures and the Pharmacy Services Standard NZS 8134.7:2010
cover best practice in safely storing and transporting the medication. Other legal
requirements are outlined in Ngā whakaritenga ā-ture | Legal duties.

Health Consultations & Events

Transforming our Mental Health Law – a public discussion document
The Mental Health (Compulsory Assessment and Treatment) Act 1992 has not kept pace with the shift towards a recovery and wellbeing approach to care and has never been comprehensively reviewed. He Ara Oranga: Report of the Government Inquiry into Mental Health and Addiction highlighted these issues. Since 2019, we have been working on immediate, short-term improvements under the current legislation. This includes releasing new guidelines to improve people’s experiences under the current Mental Health Act and making amendments to the Act to eliminate indefinite treatment orders, better protect people’s rights and improve safety. We are now focusing on completely repealing and replacing the Mental Health Act and developing new mental health legislation for New Zealand. New legislation can support pae ora (healthy futures) by supporting self-determination and enhancing mana, encouraging whānau involvement, and strengthening recognition of Te Tiriti o Waitangi. Although the Mental Health Act is only used for a small proportion of people each year, it has significant impact on the lives of those who do experience it, and their family and whānau. We have heard why change is needed, and the next step is to get clear direction for what new mental health legislation in New Zealand should look like.

District Health Board Initiative

Counties Manukau Health celebrate a NZ first approach
CM Health announced a first in New Zealand approach that addresses barriers in a condition that can cause significant neonatal illness and even death. The “rhesus factor” is a protein on red blood cells and approximately 15% of the NZ population don’t have the protein. This can cause complications/issues during pregnancy some of which can be dire, even fatal. Recent work by a dedicated team has led to a treatment, a blood product, which can be delivered by community pharmacists free of charge on a Lead Maternity Carer prescription. This will help to address barriers such as cost and convenience, thereby reducing the risk of serious neonatal complications.

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.