Issue 291 - 21 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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Thank you for reading the Health Improvement and Innovation Digest this year. Our next issue will be sent on the 25th of January 2024. Wishing you all the best over the holidays!

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)

Associations between maternal stressful life events and child health outcomes in indigenous and non-indigenous groups in New Zealand
Exposure to stressful life events (SLE) around the time of pregnancy is associated with adverse health outcomes for mothers and children. Previous New Zealand research found Indigenous Māori women are more likely to be exposed to SLE than non-Māori, and are exposed to a higher number of SLE. The consequences of this for ethnic inequities in child health outcomes are unknown. This paper, published in Kōtuitui, examines the relationship between patterns of maternal SLE exposure with child health and development outcomes at age 3 years, for Indigenous and non-Indigenous children.

Health Equity (International)

Embedding Equity into the Hospital Incident Command System: A Narrative Review
Disasters exacerbate health inequities, with historically marginalised populations experiencing unjust differences in health care access and outcomes. Health systems plan and respond to disasters using the Hospital Incident Command System (HICS), an organisational structure that centralises communication and decision-making. The HICS does not have an equity role or considerations built into its standard structure. The authors of this paper, published in Joint Commission Journal on Quality and Patient Safety, conducted a narrative review to identify and summarise approaches to embedding equity into the HICS.

What impact do self-referral and direct access pathways for patients have on health inequalities?
There is increasing interest in self-referral and direct access as alternatives pathways to care to improve patient access to specialist services. The impact of these pathways on health inequalities is unknown. The purpose of this systematic review, published in Health Policy, is to explore the impact of self-referral and direct access pathways on inequalities in health care use.

Quality Improvement (International)

Quality and reporting of large-scale improvement programmes: a review of maternity initiatives in the English NHS, 2010–2023
Large-scale improvement programmes are a frequent response to quality and safety problems in health systems globally, but have mixed impact. The extent to which they meet criteria for programme quality, particularly in relation to transparency of reporting and evaluation, is unclear. The aim of this review, published in BMJ Quality & Safety, was to identify large-scale improvement programmes focused on intrapartum care implemented in English National Health Service maternity services in the period 2010–2023, and to conduct a structured quality assessment.

Emergency Department Services (International)

Interventions Intended to Alleviate Emergency Department Overcrowding: CADTH Horizon Scan
Emergency department (ED) overcrowding is a known issue in Canada that puts patients’ lives and health at risk when treatment needs within the ED exceed the resources required to address them. The causes and consequences of ED overcrowding are complex, varied, and extend beyond the ED.- Left unchecked, ED overcrowding contributes to a deteriorating standard of care as staff become overworked and burned out., This CADTH Horizon Scan of 87 new and emerging interventions intended to alleviated ED overcrowding complements CADTH’s Emergency Department Overcrowding: An Environmental Scan of Contributing Factors and a Summary of Systematic Review Evidence on Interventions.

ParallelED-A novel screening and referral intervention using emergency department wait times to identify and address unmet social needs
People arriving at the emergency department (ED) often have unmet health-related social needs (HRSN). This study, published in the Journal of the American College of Emergency Physicians Open, implemented an intervention that used undergraduate student volunteers to screen patients in the ED waiting room (WR) for unmet social drivers of health and subsequently referred patients to community resources.

Overcrowding in emergency departments: an overview of reviews describing global solutions and their outcomes
The problem of overcrowding in emergency departments has emerged as a global public health concern, and several healthcare agencies have addressed the issue and proposed possible solutions at each level of emergency care. There is no current literature summarising the extensive research on interventions and solutions, thus there is a need for data synthesis to inform policymakers in this field. The aim of this overview, published in Internal and Emergency Medicine, was to summarise the interventions at each level of emergency care: input, throughput, and output.

Primary Health Care (New Zealand)

Self-care in New Zealand: The role of the community pharmacy
Self-care is a growing area in community pharmacy globally. In a time where people are taking control over their own health care, the question of the degree of self-care available from community pharmacies is pertinent. This article, published in Exploratory Research in Clinical and Social Pharmacy, will highlight what is currently known about self-care in New Zealand, the gaps that exist and the current challenges in this area.

A realist evaluation of the development of extended pharmacist roles and services in community pharmacies
Internationally, community pharmacy models of care have been moving away from a focus on dispensing to extended, clinically-focused roles for pharmacists. The objective of this paper, published in Research in Social & Administrative Pharmacy, was to identify how community pharmacy strategies were being implemented in Aotearoa New Zealand; how changes were expected to influence health and health system outcomes; what extended services were being delivered; the responses of pharmacists, other health professionals and consumers to these developments; and the contexts and mechanisms supporting the successful implementation of new community pharmacy services.

Primary Health Care (International)

Interprofessional collaboration in primary care: what effect on patient health? A systematic literature review
In a period of change in the organisation of primary care, Interprofessional Collaboration (IPC) is presented as one of the solutions to health issues. Although the number of inter-professional interventions grounded in primary care increases in all developed countries, evidence on the effects of these collaborations on patient-centred outcomes is patchy. The objective of this study, published in BMC Primary Care, was to assess the effects of IPC grounded in the primary care setting on patient-centred outcomes.

Primary Mental Health (New Zealand)

Kua takoto te mānuka, mā wai e hiki ake? Advancing a Te Tiriti o Waitangi-led approach to mental health education in schools
This article, published in Kōtuitui, engages mātauranga Māori, social psychology and the sociology of education to argue that an individualistic approach to mental health education in schools is inadequate. This article discusses a recent national school curriculum policy that demonstrates the ways mental health education can be framed by Te Tiriti o Waitangi, informed by the determinants of health, and culturally located in worldviews representative of Te Ao Māori.

Primary Mental Health (International)

Motivational interviewing for substance use reduction
Substance use is a global issue, with around 30 to 35 million individuals estimated to have a substance‐use disorder. Motivational interviewing (MI) is a client‐centred method that aims to strengthen a person's motivation and commitment to a specific goal by exploring their reasons for change and resolving ambivalence, in an atmosphere of acceptance and compassion. This Cochrane Review assesses the effectiveness of motivational interviewing for substance use on the extent of substance use, readiness to change, and retention in treatment.

Weight Management (New Zealand)

Enhancing health outcomes for Māori elders through an intergenerational cultural exchange and physical activity programme: a cross-sectional baseline study
The study, published in Frontiers in Public Health, offers baseline data for a strengths-based approach emphasizing intergenerational cultural knowledge exchange and physical activity developed through a partnership with kaumātua (Māori elders) and kaumātua service providers.

Key Ministry of Health Publications

Annual Update of Key Results 2022/23: New Zealand Health Survey
The Annual Data Explorer presents results from the 2022/23 New Zealand Health Survey, with comparisons to earlier surveys where possible. Results are available by gender, age group, ethnic group, neighbourhood deprivation and disability status.

Interim High Vigilance Guideline for Non-Mesh Stress Urinary Incontinence Surgery
This guideline is to be used to mitigate and manage risk while a time-limited pause on the use of surgical mesh for the treatment of female stress urinary incontinence is in place.

Clinical Leadership in Manatū Hauora
This publication introduces clinical leadership as it applies to the work of the Ministry of Health/Manatū Hauora, including the definition and principles of clinical leadership in that context.

Shining a Light on Whānau Experiences of Coroners’ Investigations of Suspected Self-Inflicted Deaths
This publication provides the recommendations of a group of people bereaved by suicide based on their review of the Coroners’ investigations process for suspected self-inflicted deaths. This work was commissioned by the Suicide Prevention Office, Manatū Hauora.

Health Sector Initiative

Tu Kaha Sensory Room a First for Northland
Tu Kaha, the inpatient mental health facility in the Mid North, has the first sub-acute sensory room in Northland. A sensory room is a multipurpose area used by residents visiting whānau, Tu Kaha Community Support workers and mental health multidisciplinary team members. The area is intended to be used as a recovery-focused tool which allows practitioners to move away from using purely clinical treatments to using recovery focused treatments such as sensory modulation and cognitive behaviour therapy.

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.