Issue 254 - 9 June 2022

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

Indigenous Māori responses to COVID-19: He waka eke noa?
The COVID-19 pandemic of 2020 has had significant impacts on communities and infrastructures across the globe. Indigenous health experts have called for culturally responsive Government support to mitigate pre-existing inequities and vulnerabilities in Indigenous communities. In Aotearoa New Zealand, official responses to the pandemic typically reflect the worldviews of the settler majority, while Māori interests are treated as part of the national concern. Using autoethnographic, Indigenous voice and an Indigenous wellbeing model, Whiti te Rā, this article (published in the International Journal of Psychology) contributes insights into Māori cultural values as they were reported in online platforms during the Level 4 lockdown period of March-July, 2020. 

Health Equity (New Zealand)

Reflexive Practice as an Approach to Improve Healthcare Delivery for Indigenous Peoples: A Systematic Critical Synthesis and Exploration of the Cultural Safety Education Literature
Cultural safety is increasingly being taught in tertiary programmes of study for health professionals. Reflexivity is a key skill required to engage in culturally safe practice, however, there is currently limited literature examining how reflexivity is taught or assessed within cultural safety curricula. In this paper, published in the International Journal of Environmental Research and Public Health,  a systematic review of the literature up until November 2021 was conducted, examining educational interventions which aimed to produce culturally safe learners. Studies were limited to those with a focus on Indigenous health and delivered in Australia, Aotearoa New Zealand, Canada, and the United States.

Cancer Services (New Zealand)

Where Are We Dying? Ethnic Differences in Place of Death Among New Zealanders Dying of Cancer
Around a third of people with cancer will die outside of their preferred place of death, with substantial variation occurring between and within countries in terms of place of death. This paper, published in JCO Global Oncology, examines place of death within the New Zealand cancer context, with specific focus on differences between Indigenous Māori and other ethnic groups.

Cardiovascular Disease and Diabetes (International)

Effectiveness of Integrated Diabetes Care Interventions Involving Diabetes Specialists Working in Primary and Community Care Settings: A Systematic Review and Meta-Analysis
Evidence that integrated diabetes care interventions can substantially improve clinical outcomes is mixed. However, previous systematic reviews have not focussed on clinical effectiveness where the endocrinologist was actively involved in guiding diabetes management. This review paper, published in the International Journal of Integrated Care, concludes that Integrated interventions with an active endocrinologist involvement can result in modest improvements in HbA1c, blood pressure and weight management.

Primary Health Care (New Zealand)

Knee osteoarthritis and the knowledgeable, trustworthy pharmacist: Patient and pharmacist perceptions of community pharmacy-based education and support
Osteoarthritis (OA) clinical guidelines recommend self-management education, but education is often not included in primary care consultations. This study, published in Musculoskeletal Care, examines pharmacists' and patients' perceptions of a pharmacist-led model of service delivery for knee OA that was integrated within pharmacies' day-to-day workflow. Nineteen pharmacists across New Zealand and Australia were rectruited to take part in the study.

Primary Health Care (International)

Comprehensive Geriatric Assessment for older people in the community at risk of poor health outcomes
Comprehensive Geriatric Assessment (CGA) is a multidimensional interdisciplinary diagnostic process focused on determining an older person's medical, psychological and functional capability in order to develop a co-ordinated and integrated care plan. CGA is not limited simply to assessment, but also directs a holistic management plan for older people, which leads to tangible interventions. This article, published in the Cochrane Library, aimed to determine the effectiveness of CGA for community-dwelling, frail, older adults at risk of poor health outcomes in terms of mortality, nursing home admission, hospital admission, emergency department visits, serious adverse events, functional status, quality of life and resource use, when compared to usual care.

Educational interventions for health professionals managing chronic obstructive pulmonary disease in primary care
Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable health condition. COPD is associated with substantial burden on morbidity, mortality and healthcare resources. This 2022 review, published in the Cochrane Library, examines existing evidence for educational interventions delivered to health professionals managing COPD in the primary care setting.

Primary Mental Health (New Zealand)

Well-being app to support young people during the COVID-19 pandemic: randomised controlled trial
Developed during the COVID-19 pandemic, 'Whitu: seven ways in seven days' is a well-being app that, as its name suggests, contains seven modules to help young people (1) recognise and rate emotions, (2) learn relaxation and mindfulness, (3) practice self-compassion and (4) gratitude, (5) connect with others, (6) care for their physical health and (7) engage in goal-setting. It can be completed within a week or as desired. This paper, published in the BMJ Open, aims to evaluate the efficacy and acceptability of the 'Whitu: seven ways in seven days' app for young people.

Primary Mental Health (International)

Suicide Prevention Interventions and Their Linkages in Multilayered Approaches for Older Adults: A Review and Comparison
Multilayered approaches to suicide prevention combine universal, selective, and indicated prevention interventions. These approaches may be more successful in reducing suicide rates among older adults if they link these layers more systematically: that is, if the programs are designed so that interventions at a lower level facilitate involvement at a higher level when appropriate. This study, published in Frontiers in Public Health, aimed to examine the effect of the structure of multilayered approaches, and in particular the types of interventions and the connections or linkages between them, on suicide rates.

Supporting Individuals with Mental Health and/or Addictions Issues Through Patient Navigation: A Scoping Review
Pathways through the mental health care system can be complex and laden with barriers that prevent individuals from finding the most appropriate care. Navigation has been proposed as a solution for improving access to and transition through complex health care systems. This review, published in the Community Mental Health Journal, set out to fill a hole in the literature by exploring the core themes of MHA navigation. These findings may support evidence-based implementation of navigation services and point to a need for increased exploration and reporting of MHA navigation outcomes in the literature.

Community‐based interventions for improving mental health in refugee children and adolescents in high‐income countries
The purpose of this review, published in the Cochrane Library, is to assess the effectiveness and acceptability of community‐based interventions (RCTs only) in comparison with controls (no treatment, waiting list, alternative treatment) for preventing and treating mental health problems (major depression, anxiety, post‐traumatic stress disorder, psychological distress) and improving mental health in refugee children and adolescents in high‐income countries.

Smoking Cessation (International)

The effectiveness of smoking cessation interventions for socio-economically disadvantaged women: a systematic review and meta-analysis
Tobacco use is one of the most common preventable causes of premature death, killing more than eight million people a year globally. Smoking is a leading cause of cancer linked to increased risk of at least 12 different cancers, as well as non-malignant respiratory diseases, cardiovascular disease, reproductive issues, early menopause and many other chronic health conditions. This systematic review and meta-analysis, published in Systematic Reviews, assessed the effectiveness of smoking cessation interventions among women smokers in low socio-economic status (SES) groups or women living in disadvantaged areas who are historically underserved by smoking cessation services.

Weight Management (New Zealand)

Interventions to prevent or manage obesity in Māori and Pacific adults: a systematic review and narrative synthesis
Obesity and its sequelae are an increasing problem, disproportionally affecting Māori and Pacific peoples, secondary to multifactorial systemic causes, including the effects of colonisation and the impact of globalisation. There is limited synthesised evidence on interventions to address obesity in these populations. The objective of this review, published in Ethnicity & Health, is to identify evaluated interventions for prevention and management of obesity amongst Māori and Pacific adults, assess the effectiveness of these interventions, and identify enablers and barriers to their uptake.

Disability Services (International)

Interventions aimed at improving healthcare and health education equity for adult d/Deaf patients: a systematic review
d/Deaf people suffer from inequitable access to healthcare and health information. This results in worse health literacy and poorer mental and physical health compared to hearing populations. Various interventions aimed at improving health equity for d/Deaf people have been documented but not systematically analyzed. The purpose of this systematic review, published in the European Journal of Public Health, is to obtain a global overview of what we know about interventions aimed at improving health equity for d/Deaf people.

Key Ministry of Health Publications

National Credentialling Framework – Pelvic floor reconstructive, urogynaecological and mesh revision and removal procedures
The aim of this framework is to provide a national credentialling framework for pelvic floor reconstructive procedures, urogynaecological procedures and procedures for mesh revision and/or removal.The framework supports principles of holistic models of care, assessing not only the health professional’s technical ability but also their knowledge and judgement skills, the patient experience and the health team environment. Among other responsibilities, the framework aims to respond to the specific needs of Māori and acknowledges the government’s responsibility under Te Tiriti o Waitangi to work in partnership with Māori to improve health outcomes for our tangata whenua. Cultural safety is identified as a specific tenet of this framework.

Kia Puawai National SUDI Prevention Programme Evaluation: Final evaluation report
SUDI is the unexpected death of an infant under one year of age. SUDI is a collective term that is used when the death is initially unexplained but may be found to be caused by high-risk conditions after extensive investigations. The Ministry commissioned research in 2020 to better understand the reasons behind the number of babies dying from SUDI and identify improvements to the Ministry-led National SUDI Prevention Programme (NSPP). The NSPP is the latest iteration of SUDI-prevention initiatives.

Sudden Unexpected Death in Infancy: An analysis of coronial SUDI Liaison Reports from Sept 2018 to June 2020 with subsequent recommendations
This report sets out the background and findings from analysis of coronial Sudden Unexpected Death in Infancy Liaison Reports between September 2018 and June 2020. After receiving and reviewing the report, the Ministry formed a SUDI prevention Expert Advisory Group (EAG) to develop recommendations for change, based on data and information presented in the SUDI Report. In August 2021 the EAG delivered a report to the Ministry with recommendations for a way forward, SUDI Prevention in New Zealand: The Case for Hauora – a wellbeing approach.

HISO 10094:2022 Māori Descent and Iwi Affiliation Data Protocols
This document sets out standard protocols for collecting and recording Māori descent and iwi affiliation in the health and disability system. The information is to be collected in a way that is accessible, connected and relevant to Māori, addresses findings of the Waitangi Tribunal in Hauora: Report on Stage One of the Health Service and Outcome Kaupapa Inquiry (Wai 2575), supports delivery of Whakamaua: Māori Health Action Plan 2020-25, and follows recommendations of the Health and Disability System Review in terms of improving equity of health outcomes for Māori.

Ministry of Health Consultations & Events

Proposed addition to the Specified Prescription Schedule of Medicines Designated Registered Nurse Prescribers 2016 - New Zealand Ministry of Health - Citizen Space
The Ministry of Health (the Ministry) invites submissions on proposed additions to the Schedule of Specified Prescription Medicines for Designated Registered Nurse Prescribers 2016. The Ministry, on behalf of the Director-General, must consult with those people or organisations that may be affected by a change to the schedules before making a legal change by Gazette notice. The Nursing Council has agreed that these medicines are appropriate to be added to the list for designated registered nurses working in primary health and specialty team. Closes 4 Jul 2022

District Health Board Initiative

Whānau House a treasured place of respite for whānau supporting patients at Whangārei Hospital | Northland DHB
Supporting a whānau member who has been unexpectedly or suddenly admitted to hospital can be a very challenging time, especially if you’re not sure where you can stay or if you’ll be able to cook a meal for yourself. It’s natural to want to stay as close as possible to the person you are supporting. The Whānau House at Whangārei Hospital provides emergency accommodation for people who are in just that position. For $10 a night per person people who have a whānau member admitted on a ward at the hospital have a safe place on the hospital campus where they can unwind, cook kai, use a washing machine, and whakatau, restart, and replenish themselves so that they are better able to support and care for their loved one on the ward.

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.