Issue 290 - 7 December 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.

Māori Innovation

Te Ōranga Ō Te Roro: kaumātua perspectives on the development of a mobile app for mate wareware (dementia) awareness
Mate wareware (dementia) presents a significant social and economic burden for Māori in Aotearoa New Zealand. Previous literature has highlighted the need to improve health literacy for Māori regarding the causes and management of mate wareware, yet there is a lack of Māori-centred educational resources. It was determined that a mobile phone application (app) could meet this need and that early consultation with Māori was required to ensure the digital solution would be culturally safe and relevant.  This study, published in the New Zealand Medical Journal, explored the perspectives of kaumātua (Māori elders) regarding how to cater the mate wareware mobile app to Māori.

Health Equity (New Zealand)

It’s not in my head: a qualitative analysis of experiences of discrimination in people with mental health and substance use conditions seeking physical healthcare
Clinician bias contributes to lower quality healthcare and poorer health outcomes in people with mental health and substance use conditions (MHSUC). Discrimination can lead to physical conditions being overlooked (diagnostic overshadowing) or substandard treatment being offered to people with MHSUC. This research, published in Frontiers in Psychiatry, aimed to utilise experiences of people with MHSUC to identify discrimination by clinicians, including the role of clinician’s beliefs and assumptions in physical health service provision.

Rapua te kurahuna: an occupational perspective of internalised oppression
Internalised oppression can be tricky to recognise and hard to talk about. Described as the most devastating kind of racism, it remains poorly researched and understood. Nuanced and expansive ways of understanding internalised oppression are necessary for the work of being recognised and seeing each other as fully human. For many complex reasons, internalised oppression can be performed by targets of oppression in service of white supremacy, turning Indigenous spaces into new foci for racism via everyday occupations. This article, published in AlterNative, outlines our critical examinations and steps to grapple with internalised oppression as Indigenous occupational therapists who observe how racism is transmitted in daily tasks of life.

‘It’s about having that knowledge, tino rangatiratanga!’ Understanding structural barriers to accessing aged residential care services among older Māori in New Zealand
New Zealand’s older Indigenous people (Māori) are underserved and underrepresented as consumers of aged residential care services (ARC). This study, published in Kōtuitui, seeks to ascertain, from the perspectives of older Māori and whānau (family), the influence of structural factors that impact the process of seeking aged residential care.

Quality Improvement (New Zealand)

Maternal morbidity review toolkit for maternity services 
This document and attachments form the Te Tāhū Hauora/Health Quality and Safety Commission's maternal morbidity review toolkit.

Implementation and Adaptation of the Safewards Model in the New Zealand Context. Perspectives of Tāngata Whai Ora and Staff
The safety of service users and staff is paramount in cultivating a therapeutic environment within inpatient mental health units. The Safewards model, originating in the United Kingdom, aims to reduce conflict and containment rates through 10 interventions. This study, published in Issues in Mental Health Nursing, used participatory action research to explore the perspective of tāngata whai ora and staff regarding the adaptation of the Safewards model to the unique New Zealand context.

Quality Improvement (International)

Identifying behaviour change techniques in 287 randomized controlled trials of audit and feedback interventions targeting practice change among healthcare professionals
Audit and feedback (A&F) is among the most widely used implementation strategies, providing healthcare professionals with summaries of their practice performance to prompt behaviour change and optimise care. Wide variability in effectiveness of A&F has spurred efforts to explore why some A&F interventions are more effective than others. Unpacking the variability of the content of A&F interventions in terms of their component behaviours change techniques (BCTs) may help advance our understanding of how A&F works best. This study, published in Implementation Science, aimed to systematically specify BCTs in A&F interventions targeting healthcare professional practice change.

Hospital Productivity (New Zealand)

Intensive care utilisation after elective surgery in Australia and New Zealand: getting the balance right
Of the total intensive care unit (ICU) admissions in Australia and New Zealand, 36.6% occur following an elective surgical procedure. How best to use ICU services in this setting is not clear, despite this being an expensive and resource-intensive method of care delivery. The literature relating to this area has not demonstrated a clear association between improved outcomes and routine ICU utilisation. It has, however, demonstrated that methods of care delivery in this setting vary at the local, national and international level. There is now an increased interest in how we can offer safe, efficient care to patients who need ICU-level support after elective surgery, as well as where and when that care can be offered. The authors had previously performed a literature review relating to ICU utilisation in the elective surgical post-operative setting. This perspective piece, published in the Australian Health Review, arises from this literature review as well as extensive clinical experience from the authors.

Cancer Services (New Zealand)

Cancer incidence, mortality and survival for Pacific Peoples in Aotearoa New Zealand
Pacific Peoples comprise over 16 culturally diverse ethnic groups and experience a disproportionate burden of preventable cancers, attributable to infectious diseases and obesity. This study, published in the New Zealand Medical Journal, aims to provide updated evidence on cancer incidence, mortality and survival rates among Pacific Peoples in Aotearoa New Zealand.

Interval colorectal cancers after negative faecal immunochemical test in the New Zealand Bowel Screening Pilot
The objectives of this study, published in BMJ Open Gastroenterology, were to evaluate the diagnostic performance of faecal immunochemical test (FIT), identify risk factors for FIT-interval colorectal cancers (FIT-IC) and describe long-term outcomes of participants with colorectal cancers (CRC) in the New Zealand Bowel Screening Pilot.

Cancer Services (International)

A Systematic Review of the Effectiveness of Health Education Programs for Cervical Cancer Prevention in Rural Communities: Implications for Promoting Health Equity
Rural women face an increased risk of cervical cancer diagnosis in comparison to women living in metropolitan areas. This review, published in the Journal of Cancer Education, synthesised and critically evaluated cervical cancer screening interventions that target women living in rural communities in the USA.

Primary Health Care (New Zealand)

Funding Primary Care for Better Outcomes
This article, published in Policy Quarterly, reviews a recent report advocating transformational change in the funding and recruitment of staff for Aotearoa New Zealand’s primary care services, including taking a social investment approach to the funding of primary care.

Te Whare Pora a Hine-te-iwaiwa: weaving tradition into the lives of pregnant Māori women, new mothers and babies
This study, published in AlterNative, explores Te Whare Pora a Hine-te-iwaiwa (Te Whare Pora), a Māori approach to the prevention of sudden infant death, which posits that immersion in traditional knowledge and the weaving of the wahakura (woven flax bassinet) as a safe infant sleep space boosts the resilience of pregnant wāhine Māori (Māori women) and the post-neonatal safety of their infants.

Primary Health Care (International)

Different antibiotic treatments for group A streptococcal pharyngitis
Antibiotics provide only modest benefit in treating sore throat, although their effectiveness increases in people with positive throat swabs for group A beta‐haemolytic streptococci (GABHS). It is unclear which antibiotic is the best choice if antibiotics are indicated. This is an update of a Cochrane Review first published in 2010, and updated in 2013, 2016, and 2021.

Cognitive behavioural therapy (CBT) with and without exercise to reduce fear of falling in older people living in the community
Fear of falling (FoF) is a lasting concern about falling that leads to an individual avoiding activities that he/she remains capable of performing. It is a common condition amongst older adults and may occur independently of previous falls. Cognitive behavioural therapy (CBT), a talking therapy that helps change dysfunctional thoughts and behaviour, with and without exercise, may reduce FoF, for example, by reducing catastrophic thoughts related to falls, and modifying dysfunctional behaviour. The objective of this Cochrane Review was to assess the benefits and harms of CBT for reducing FoF in older people living in the community, and to assess the effects of interventions where CBT is used in combination with exercise.

Antibiotics for acute otitis media in children
Acute otitis media (AOM) is one of the most common diseases in childhood for which antibiotics are commonly prescribed; a systematic review reported a pooled prevalence of 85.6% in high‐income countries. This is an update of a Cochrane Review first published in the Cochrane Library in 1997 and updated in 1999, 2005, 2009, 2013 and 2015.

Smart Meds: Using Pharmacists to Address Health Literacy Disparities Among Medically- and Socially-Vulnerable Populations
Patients in historically underserved communities are most vulnerable to uncontrolled chronic conditions and report a lack of health knowledge to manage them. This report, published in Journal of Health Care for the Poor and Underserved, aims to describe the development of SMART MEDS, a pharmacy-led program implemented to address health literacy disparities among medically and socially vulnerable patients.

Reducing antibiotic prescribing in general practice in Australia: a cluster randomised controlled trial of a multimodal intervention
The health and economic burden of antimicrobial resistance is significant. Interventions that help guide and improve appropriate prescribing for acute respiratory tract infections in the community represent an opportunity to slow the spread of resistant bacteria. Clinicians who work in primary care are potentially the most influential health care professionals to address the problem of antimicrobial resistance, because this is where most antibiotics are prescribed. This cluster randomised trial, published in Australian Journal of Primary Health, compared two parallel groups of 27 urban general practices in Queensland, Australia: 13 intervention and 14 control practices, with 56 and 54 general practitioners (GPs), respectively.

Primary Mental Health (International)

Communication in refugee and migrant mental healthcare: A systematic rapid review on the needs, barriers and strategies of seekers and providers of mental health services
Migrants and refugees may not access mental health services due to linguistic and cultural discordance between them and health and social care professionals (HSCPs). The aim of this review, published in Health Policy, is to identify the communication needs and barriers experienced by third-country nationals (TCNs), their carers, and HSCPs, as well as the strategies they use and their preferences when accessing/providing mental health services and language barriers are present.

Health Sector Initiative

New rural after-hours telehealth service available across the motu 
A new rural after-hours telehealth service is now available, improving access to primary health care for almost 900,000 New Zealanders. Rural communities can access the service in two ways, by calling 0800 2 KA ORA (0800 252 672) directly or via referral from their rural healthcare provider.

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.