Issue 303 - 27 June 2024

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 Health NZ district 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 Matahouroa: a feasibility trial combining Rongoā Māori and Western medicine in a surgical outpatient setting
This feasibility study, published in The New Zealand Medical Journal, was undertaken to implement and assess a Rongoā Māori (traditional Māori healing)/Western medicine collaboration model in a general surgical outpatient setting.

Health Equity (New Zealand)

The glue that binds us: The positive relationships between whanaungatanga (belonging), the wellbeing, and identity pride for takatāpui who are trans and non-binary
This article, published in the Health Promotion Journal of Australia, explores how belonging can enhance well-being for takatāpui (a traditional Māori term that embraces all Māori with diverse genders, sexualities and sex characteristics) who are trans and non-binary across a range of contexts.

Nutrition & Physical Activity (International)

Umbrella review of international evidence for the effectiveness of school-based physical activity interventions
Obesity and physical inactivity among children and young people are public health concerns. Despite the wide variety of interventions available to promote physical activity, little is known about which interventions are most effective. This review, published in PloS One, aimed to evaluate the existing literature on school-based interventions that aim to increase physical activity among children and young people aged 6 to 18 years.

Effects of physical activity planning interventions on reducing sedentary behavior in parent-child dyads: A randomized controlled trial
Effects of parent-child dyad interventions on behaviour remain unclear. This randomised controlled trial, published in Applied Psychology, Health and Well-Being, investigated if, compared with a control condition, three types of physical activity (PA) planning interventions (individual "I-for-me," dyadic "we-for-me," and collaborative "we-for-us") would reduce sedentary behaviour (SB) time in parents and their children.

Effects of different types of exercise intensity on improving health-related physical fitness in children and adolescents: a systematic review
A substantial body of empirical evidence reveals that physical activity is associated with a wide range of positive physical and mental health outcomes. However, an absence of comprehensive syntheses is observed concerning the varying effects of different exercise intensities on the improvement of physical health among children and adolescents. The aim of this review, published in Scientific Reports, is to systematically investigate the effects of different exercise intensities on the physical fitness of children and adolescents, to analyses the optimal exercise intensities for improving physical fitness, and to provide a relevant theoretical basis for optimizing school physical education curricula.

Quality Improvement (New Zealand)

Beyond the numbers: Classifying contributory factors and potentially avoidable adverse events in the gynaecology service of National Women's Health at Auckland District Health Board
Adverse events (AEs) during health care are common and may have long-term consequences for patients. Although there is a tradition of reviewing morbidity and mortality in gynaecology, there is no recommended system for reporting contributory factors and potential avoidability. The aim of this study, published in The Australian & New Zealand Journal of Obstetrics & Gynaecology, was to identify factors that contributed to AEs in the gynaecology service at National Women's Health at Auckland District Health Board and to determine potential avoidability, with the use of a multidisciplinary morbidity review.

Quality Improvement (International)

Multidisciplinary, multicomponent interventions to reduce frailty among older persons in residents of residential care facilities: a scoping review
Frailty reduction and reversal have been addressed successfully among older populations within community settings. However, these findings may not be applicable to residential care settings, largely due to the complex and multidimensional nature of the condition. Relatively, few attempts at frailty prevention exist in residential settings. This review, published in Systematic Reviews, aims to identify and describe best practice models of care for addressing frailty among older populations in residential care settings.

Closing the gap on healthcare quality for equity-deserving groups: a scoping review of equity-focused quality improvement interventions in medicine
Quality improvement (QI) efforts are critical to promoting health equity and mitigating disparities in healthcare outcomes. Equity-focused QI (EF-QI) interventions address the unique needs of equity-deserving groups and the root causes of disparities. This scoping review, published in BMJ Quality & Safety, aims to identify themes from EF-QI interventions that improve the health of equity-deserving groups, to serve as a resource for researchers embarking on QI.

Understanding the enablers and barriers to implementing a patient-led escalation system: a qualitative study
The management of acute deterioration following surgery remains highly variable. Patients and families can play an important role in identifying early signs of deterioration but effective contribution to escalation of care can be practically difficult to achieve. This paper, published in BMJ Quality & Safety, reports the enablers and barriers to the implementation of patient-led escalation systems found during a process evaluation of a quality improvement programme.

Emergency Department Services (International)

Pharmacists in Trauma: a randomised controlled trial of emergency medicine pharmacists in trauma response teams
Analgesia is an important component for patient well-being, but commonly delayed during trauma resuscitation. The Pharmacists in Trauma trial assessed the effects of integrating pharmacists into trauma response teams to improve analgesia delivery and medication management. This unblinded randomised trial, published in the Emergency Medicine Journal, compared emergency medicine (EM) pharmacist involvement in trauma callouts versus standard care at an Australian level 1 trauma centre.

Cardiovascular Disease and Diabetes (New Zealand)

Management of type 2 diabetes in New Zealand: a scoping review of interventions with measurable clinical outcomes
This review, published in Public Health, aimed to assess the effectiveness of interventions for type 2 diabetes (T2D) management in New Zealand on clinical outcomes, and explore the factors impacting their feasibility and acceptability.

Cardiovascular Disease and Diabetes (International)

Impact of a multi-disciplinary team-based care model for patients living with diabetes on health outcomes: a mixed-methods study
Individuals facing socioeconomic hardship experience higher than average rates of chronic disease, such as diabetes, with less access to evidence-based treatment. One solution to address these inequities is a team-based care (TBC) model, defined as one in which at least two providers work collaboratively with a patient and their caregiver(s) to make healthcare decisions. This paper, published in BMC Health Services Research, seeks to describe the implementation of a TBC model within a safety-net healthcare setting and determine the extent to which it can be an effective, patient-centred approach to treating individuals with diabetes.

Optimising a clinical decision support tool to improve chronic kidney disease management in general practice
Early identification and treatment of chronic disease is associated with better clinical outcomes, lower costs, and reduced hospitalisation. Primary care is ideally placed to identify patients at risk of, or in the early stages of, chronic disease and to implement prevention and early intervention measures. This paper, published in BMC Primary Care, evaluates the implementation of a technological intervention called Future Health Today that integrates with general practice EMRs to identify patients at-risk of, or with undiagnosed or untreated, chronic kidney disease (CKD), and provide guideline concordant recommendations for patient care. The evaluation aimed to identify the barriers and facilitators to successful implementation.

Primary Health Care (International)

“She’s Been a Rock”: The Function and Importance of “Holding” by Social Prescribing Link Workers in Primary Care in England—Findings from a Realist Evaluation
Social prescribing link workers are recently introduced roles in English primary care. One of their intended functions is to support patients with conditions influenced by the wider, social determinants of health. Their main purpose is to connect people to community resources to meet their nonmedical needs. However, our research reveals that link workers provide not only connections but also what we have described as “holding” for individuals with complex needs, who lack informal networks of support or who are waiting to access services. This study, published in Health & Social Care in the Community, explores the concept of holding, its meaning and significance in this context, and consider its consequences.

Understanding the causes of missingness in primary care: a realist review
Although missed appointments in healthcare have been an area of concern for policy, practice and research, the primary focus has been on reducing single ‘situational’ missed appointments to the benefit of services. This review, published in BMC Medicine, explores the causes and consequences of more ‘enduring’ multiple missed appointments in primary care and the role this has in producing health inequalities.

Factors affecting communication during telephone triage in medical call centres: a mixed methods systematic review
Telephone triage is used to optimise patient flow in emergency primary healthcare. Poor communication can lead to misunderstandings and compromise patient safety. To improve quality, a comprehensive understanding of factors affecting communication in medical call centres in primary care is needed. The aim of this review, published in Systematic Reviews, was to identify such factors and to describe how they affect communication during telephone triage.

Primary Mental Health (New Zealand)

Let’s get real evaluation - Stage 2 Report, June 2024
Let’s get real is a framework that describes the values, attitudes, knowledge and skills required for working effectively with people and whānau experiencing mental health and addiction needs across health care settings. This evaluation, by Te Pou, explored the operation of the Let’s get real champions model, champions’ experiences of the Let’s get real programme, and opportunities for programme enhancement.

Experiences of physical healthcare services in Māori and non-Māori with mental health and substance use conditions
Inequities in physical health outcomes exist for people with mental health and substance use conditions and for Indigenous populations (Māori in Aotearoa New Zealand). These inequities may be partly explained by poorer quality of physical healthcare services, including discrimination at systemic and individual levels. This study, published in The Australian and New Zealand Journal of Psychiatry, investigated the experiences of people with mental health and substance use conditions accessing physical healthcare and differences in service quality for non-Māori relative to Māori.

Oral Health (New Zealand)

Evaluation of the Oral Health Toothbrush and Toothpaste Initiative
This is an evaluation report, prepared for Health New Zealand, of the first phase of the Oral Health Toothbrush and Toothpaste Initiative. It covers the range of time between December 2021 to August 2023. The primary goal of the Oral Health Toothbrush and Toothpaste Initiative (TTI) is to improve the oral health of preschool children who are most at risk of poor oral health outcomes.

Key Ministry of Health Publications

Independent Review of the Alcohol Levy – Stage 2
In 2023, the Ministry of Health, with the support of Health New Zealand, commissioned Allen + Clarke, working with the New Zealand Institute of Economic Research, to review the use of the alcohol levy and its function under the new Pae Ora (Healthy Futures) Act 2022.

Costs of alcohol harms in New Zealand: Updating the evidence with recent research
The Public Health Agency, within the Ministry of Health, commissioned the New Zealand Institute of Economic Research (NZIER) to conduct an updated analysis of the costs of alcohol related harm in New Zealand. This was to support an independent review of the alcohol levy, undertaken by Allen + Clarke.

International Approaches to Natural Health Product Regulations
This report outlines and compares regulatory approaches to natural health products (NHPs) in Australia, Canada, the EU, UK, USA and China.

Health Sector Initiative

Ngāpuhi trial evaluates effectiveness of rongoā Māori with western medicines
A Ngāpuhi initiative is exploring ways to integrate rongoā Māori as an option for medical treatment by production of products that are consistent and tested – offering complementary options to pharmaceuticals and providing economic opportunities across the region.

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.