Issue 276 - 11 May 2023

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)

Equity of Cancer and Diabetes Co-Occurrence: A National Study With 44 Million Person-Years of Follow-Up
The co-occurrence of diabetes and cancer is becoming increasingly common, and this is likely to compound existing inequities in outcomes from both conditions within populations. This study, published in JCO Global Oncology, investigated the co-occurrence of cancer and diabetes by ethnic groups in New Zealand.

Is there equity of patient health outcomes across models of general practice in Aotearoa New Zealand? A national cross-sectional study
Primary care in Aotearoa New Zealand is largely delivered by general practices, heavily subsidised by government. Te Tiriti o Waitangi (1840) guarantees equal health outcomes for Māori and non-Māori, but differences are stark and longstanding. Seven models of primary care have evolved. The authors of this study, which was published in the International Journal for Equity in Health, hypothesised that patient health outcomes would differ between models of care; and that Māori, Pacific peoples and those living in material deprivation would have poorer outcomes from primary care.

Hospital Productivity (New Zealand)

Te Whatu Ora Capital, Coast and Hutt Valley case study: Improving inpatient rehabilitation services for patients following major trauma 
This project, published by the Health Quality & Safety Commission, aimed to understand allied health input into the care of major trauma patients and investigate opportunities to improve trauma rehabilitation and enhance patient experiences at Wellington Regional Hospital.

Cancer Services (International)

Implementation of electronic prospective surveillance models in cancer care: a scoping review
Electronic prospective surveillance models (ePSMs) for cancer rehabilitation include routine monitoring of the development of treatment toxicities and impairments via electronic patient-reported outcomes. Implementing ePSMs to address the knowledge-to-practice gap between the high incidence of impairments and low uptake of rehabilitation services is a top priority in cancer care. This scoping review, published in Implementation Science, aimed to understand the state of the evidence concerning the implementation of ePSMs in oncology.

Implementation of a Cancer Rehabilitation Navigation Program: a qualitative analysis of implementation determinants and strategies
Cancer rehabilitation navigation (CRNav) is a care delivery model that expedites identification and management of symptom-related functional morbidity for individuals undergoing cancer treatment. A CRNav program is unique in that it embeds a cancer rehabilitation professional in the cancer center for patient screening and assessment. This study, published in Journal of Cancer Survivorship: Research and Practice, explored the implementation of CRNav programs.

Digital Transformation of Cancer Care in the Era of Big Data, Artificial Intelligence and Data-Driven Interventions: Navigating the Field
The objective of this study, published in Seminars in Oncology Nursing, was to navigate the field of digital cancer care and define and discuss key aspects and applications of big data analytics, artificial intelligence (AI), and data-driven interventions.

Interactive or tailored digital interventions to increase uptake in cervical, breast, and colorectal cancer screening to reduce health inequity: a systematic review
Significant health inequities exist in screening uptake for certain types of cancer. The aim of this systematic review, published in the European Journal of Cancer Prevention, was to identify and describe interactive, tailored digital, computer, and web-based interventions to reduce health inequity in cancer screening and review the effectiveness of such interventions in increasing screening rates versus usual care.

Cardiovascular Disease and Diabetes (New Zealand)

A multiple case study of pre-diabetes care undertaken by general practice in Aotearoa/New Zealand: de-incentivised and de-prioritised work
In Aotearoa/New Zealand (NZ) general practices diagnose and manage pre-diabetes. This work is important as it has the potential to delay or prevent the onset of Type 2 Diabetes (T2DM), reduce NZ's health inequities, and the burden that T2DM places on health care services. This study, published in BMC Primary Care, examined how this work routinely occurs in NZ.

Cardiovascular Disease and Diabetes (International)

A critical realist exploration of factors influencing engagement in diabetes prevention programs in rural settings
Diabetes prevention programs are intended to reduce progression to type 2 diabetes but are underutilised. This study, published in the Australian Journal of Primary Health, aimed to explore people with prediabetes’ knowledge and attitudes about prediabetes, and their perceptions about engagement in preventive programs in a rural setting.

Primary Health Care (New Zealand)

Health workforce governance and professions: a re-analysis of New Zealand's primary care workforce policy actors
This article, published in BMC Health Services Research, contributes to the health workforce planning literature by exploring the dynamics of health professions in New Zealand's Primary Care sector and deriving broad lessons for an international audience.

Primary Health Care (International)

Sustainable general practice
Climate change is a health emergency, and general practitioners have an important role in both mitigation and adaptation to the effects of climate change. Climate change is already impacting health in a myriad of ways, including death and illness from increasingly frequent extreme weather events, disruptions to food systems and changes in vector-borne diseases. General practice can demonstrate leadership by embracing sustainability as part of a primary care ethos aligning it with quality care. The aim of this article, published in the Australian Journal of General Practice, is to outline the steps required to achieve and promote sustainability from practice operations through to clinical care and advocacy.

Primary Mental Health (New Zealand)

Indigenous suicide rates in the United States, Australia and New Zealand between 2006 and 2019
Indigenous suicide prevention is an important focus for national health policies. Indigenous suicide rates in formerly colonial English-speaking countries such as the United States, Australia and New Zealand are considerably higher than the general population, particularly in young males. This study, published in The Australian and New Zealand Journal of Psychiatry, conducted a time series analysis to assess recent sex and age trends of suicide in the Indigenous and general populations in the United States, Australia and New Zealand.

Exploring the Acceptability, Feasibility, and Effectiveness of a Digital Parenting Program to Improve Parental Well-being After the Christchurch Earthquakes: Cluster-Randomized Trial
Up to 6 years after the 2011 Christchurch earthquakes, approximately one-third of parents in the Christchurch region reported difficulties managing the continuously high levels of distress their children were experiencing. In response, an app named Kākano was co-designed with parents to help them better support their children's mental health. The objective of this study, published in JMIR Formative Research, was to evaluate the acceptability, feasibility, and effectiveness of Kākano, a mobile parenting app to increase parental confidence in supporting children struggling with their mental health.

Interventions to reduce alcohol’s harms to health: A modelling study
This research project, published by Te Whatu Ora - Health Promotion, used modelling techniques to estimate the health impacts of alcohol interventions and their contribution towards health equity in the Aotearoa context.

Primary Mental Health (International)

The impact of technology systems and level of support in digital mental health interventions: a secondary meta-analysis
Most people with a chronic disease (e.g., diabetes, hypertension, COPD) have more than one concurrent condition and are also at higher risk for developing comorbidities in mental health, including anxiety and depression. The aim of this study, published in Systematic Reviews, was to conduct a meta-analysis of the digital mental health interventions for people with comorbid physical and mental chronic diseases to compare the effect of technology systems and level of support.

Oral Health (New Zealand)

The life course and oral health in old age
Alongside a marked increase in the population of older New Zealanders has been an increase in tooth retention: more and more older adults now have at least some of their own teeth. Understanding their oral health demands consideration of their journey along the life course. The common clinical oral conditions – dental caries (‘tooth decay’) and periodontitis (‘gum disease’) – are both chronic and cumulative, and highly socially patterned in their occurrence, being more prevalent and severe in those of lower socio-economic position. Those who have ended up with ‘good oral health’ in old age are those who have had the wherewithal to adapt successfully to their oral disease burden as it has accumulated over the years. In this paper, published in the Journal of the Royal Society of New Zealand, the author considers the utility of the life course approach for interpreting and understanding data, and applies its principles to several important observations on older people’s oral health.

Oral Health (International)

Oral health promotion in acute hospital setting: a quality improvement programme
Tooth extraction is the most common hospital procedure for children aged 6-10 years in England. Tooth decay is almost entirely preventable and is inequitably distributed across the population: it can cause pain, infection, school absences and undermine overall health status. This study, published in BMJ Open Quality, explored an oral health programme (OHP) that was delivered in a hospital setting, which comprised of health promotion activities, targeted supervised toothbrushing, and staff training.

Disability Services (New Zealand)

Knowledge, attitudes, and practices towards fetal alcohol spectrum disorder in the New Zealand social and community sector: An online survey
Fetal Alcohol Spectrum Disorder (FASD) is a common neurodevelopmental disorder but may be underrecognised and misunderstood by people who provide health and social support services. The aim of the research, published in Journal of Intellectual Disabilities, is to understand the FASD knowledge, attitudes, and practices among people employed by the social and community sector in New Zealand.

Key Ministry of Health Publications

Oranga Hinengaro System and Service Framework
This publication sets direction of the future mental health and addiction system and services over the next 10 years. It provides guidance for those responsible for publicly funded health system policy, design, service commissioning, and delivery. 

COVID-19 winter surge package 2022 - rapid review
On 14 July 2022, the Government rolled out the COVID-19 Winter Surge Package (the Winter Surge Package), which put in place a series of health measures to reduce the impact of COVID-19 and other seasonal illnesses on the health system. Manatū Hauora – the Ministry’s of Health commissioned Allen + Clarke to complete an independent rapid review of the Winter Surge Package with a focus on identifying lessons learned for winter 2023.

Health Sector Initiative

Student chooses Māori midwifery for career in health
Participating in a recent Kia Ora Hauora Pathways programme has given a Year 13 student confirmation that Māori midwifery is the way forward. Amelia Ward, who attends Wellington East Girls College, took part in a one-week Rangatahi ki te Ao (Work Observation Week) run by national Māori health workforce development programme Kia Ora Hauora (KOH).

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.