Journal of primary health care最新文献

Introduction Adverse drug reactions (ADRs) represent a significant public health burden, accounting for 3-6% of hospital admissions internationally and costing New Zealand taxpayers $280 million between 2015/16 and 2017/18. Community pharmacists are uniquely positioned to identify and report ADRs, yet their contribution to ADR reporting in New Zealand remains understudied. Aim This study aimed to investigate factors influencing ADR reporting by New Zealand community pharmacists, including current practices, barriers, facilitators, and potential improvements. Methods A descriptive qualitative study using semi-structured interviews was conducted with 12 registered community pharmacists across New Zealand. Participants were recruited through purposive and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analysed using thematic analysis. Results The study resulted in three main themes: workplace environment, education/training, and patient information access. All themes were underpinned by insufficient time and resources, resulting in ADR reporting not being viewed as integral to pharmacy practice. Key barriers included a lack of workplace reporting culture, inadequate education/training, and incomplete patient information access. The COVID-19 pandemic paradoxically served as the primary facilitator by increasing system visibility. Most participants had previously submitted ADR reports, with online submission being preferred. Discussion: Despite understanding the importance of ADR reporting, New Zealand community pharmacists face systemic barriers preventing optimal reporting practices. Addressing these requires comprehensive solutions, including integration of reporting tools into dispensing software, enhanced education/training programs, improved patient information access, and adequate professional recognition and compensation. These findings provide a foundation for targeted interventions to improve pharmacovigilance in community pharmacy settings.

Osteoarthritis (OA) affects one in ten adults in Aotearoa New Zealand, yet care remains fragmented and under-prioritised. The 2025 Aotearoa Osteoarthritis Summit explored re-framing OA through a lifespan, equity-focused lens. Summit attendees contribution to a collaborative workshop at the event highlighted misconceptions, harmful "wear and tear" narratives, and inconsistent information. Attendees called for empowering, strengths-based messaging, culturally responsive care, and early, lifelong joint-health strategies. Recommendations included myth-busting, accessible education, community support, and integrated non-surgical management. Equity for Māori, Pasifika, rural, and low-income communities was emphasised. Changing the OA narrative requires collaboration, consistent messaging, and scalable frameworks to improve outcomes nationwide.

Introduction: Rural whānau (families) in Aotearoa New Zealand face persistent barriers to timely healthcare, contributing to inequities - particularly for Māori. Point-of-care testing offers a potential solution by bringing diagnostic services closer to communities. To investigate this potential, the study 'He Tapu te Whare Tangata: A Model for Empowering Rural Solutions for Cervical Cancer Prevention' used human papillomavirus-based screening to examine how point-of-care testing could strengthen cervical screening pathways for rural women. The study combined a cluster-randomised crossover trial with qualitative research to compare two screening pathways, one of which utilised molecular point-of-care testing with direct access to specialist colposcopy appointments.

Aim: This paper explores the acceptability and feasibility of point-of-care testing for human papillomavirus in rural primary care from the perspective of healthcare professionals.

Methods: This paper draws on 11 interviews with rural primary healthcare professionals who spoke to the implementation and delivery of point-of-care testing. Guided by a Kaupapa Māori approach, semi-structured interviews were conducted between 2021 and 2023. Reflexive thematic analysis guided data interpretation.

Results: Interviewees considered point-of-care testing valuable for enabling faster results, timelier care, and more co-ordinated pathways. Community control was perceived to enhance rural service resilience - particularly during extreme weather when access to central laboratories was disrupted. Successful implementation was considered dependent on sufficient resourcing, workforce training, and sustained support.

Conclusion: Point-of-care testing for cervical screening was acceptable and, with adequate support, feasible in rural general practice. Point-of-care testing offers an equity-enhancing model for improving access and outcomes for rural Māori communities.

Introduction Cardiovascular disease (CVD) is the leading cause of mortality and morbidity globally and a significant contributor to health inequities for Pacific peoples in Aotearoa New Zealand. Addressing these inequities requires a multidisciplinary approach, where community pharmacists (CPs) have the potential to play a critical role. CPs' accessibility, medication expertise, and ability to engage with underserved populations position them uniquely within the healthcare system. However, their contribution to equitable heart health outcomes remains under-explored. Aim The aim was to explore the experiences and views of general practitioners (GPs) on CPs' roles in supporting heart health equity for Pacific peoples and to examine how GPs currently work with CPs. Methods This research employed interpretive description with Pacific principles and conducted semi-structured interviews with GPs. Analysis was conducted using template analysis and the Lili Health Model data interpretation tool. Results Nine interviews were conducted, from which five themes were generated: (1) Optimising CPs' roles beyond supporting GPs, (2) GPs and Pacific peoples' ability to engage with CPs, (3) Increasing Pacific representation and cultural responsiveness, (4) (Mis)perceptions of pharmacy, and (5) Control in a constrained healthcare system. Discussion Interviewed GPs believed that CPs play a pivotal role in addressing heart health equity for Pacific peoples. This role could be enhanced by expanding CPs' clinical responsibilities, enhancing cultural safety, increasing the numbers of Pacific pharmacy staff, and addressing systemic barriers.

Introduction: Aotearoa New Zealand has wide disparities in health outcomes between indigenous and non-indigenous groups, which are strongly associated with inequitable access to determinants of health by ethnicity. Experiences of health determinants culminate in higher rates of diabetes, asthma, kidney disease and other chronic diseases and worse outcomes for Māori.

Aim: This paper explores the relationships between health determinants and chronic disease from the perspectives of Māori patients and healthcare providers.

Methods: Using a Kaupapa Māori methodology and qualitative methods, six semi-structured focus groups with 21 Māori living with chronic disease and semi-structured consultations with 130 healthcare providers across the Waikato region were undertaken between 2021 and 2023.

Results: Participants identified five key health determinants shaping the everyday experience and management of chronic disease, including employment, welfare support, income, access to information and racism. Access to economic resources had significant impacts. Those in situations of economic insecurity experienced significant complications to everyday disease management and had fewer resources to mediate their effects. Chronic disease also reduced access to economic resources through increased health costs, reduced earning power and the impacts of dealing with the welfare and health systems. Comparatively, stable access to economic resources, such as health insurance, enabled disease management.

Discussion: Everyday experiences of health determinants are shaped considerably by economic circumstances. Claiming welfare support continues to be difficult for eligible participants, and welfare payment inadequate. The health system needs to re-design healthcare delivery so people with poor access to economic resources are actively supported to access health determinants.

Introduction: Lung cancer survival is worse for Māori in Aotearoa New Zealand (NZ) than non-Māori. Our previous work identified that Māori are more likely to have their lung cancer diagnosed following an emergency presentation and face additional barriers in accessing secondary diagnostic services.

Aim: To inform improvements in lung cancer services, we aimed to collect key informant views on the extent to which these disparities were modifiable and how they might be modified by the healthcare system.

Methods: We interviewed 18 key informants from across the cancer sector, including clinicians, academics, policy experts, community workers and advocates. Analysis of collected views was conducted utilising a previously published conceptual framework to help organise and describe key issues and recommended actions.

Results: Key themes emerging from the interviews included the value of lung cancer screening; the importance of health promotion; the need for an overhaul to primary care to improve access to clinical symptom recognition and early detection; the importance of improving geographic access to diagnostic/secondary services; the need to ensure the expansion of and improvements in a culturally-safe and competent workforce; the value and importance of good data to enable quality improvement; and the crucial importance of high-quality leadership and political buy-in.

Discussion: Our interviews revealed some of the potential drivers of barriers to early detection experienced by Māori and the recommendations for action to address these barriers. The majority of these recommendations require system-level resourcing and change.

Introduction: Long-term conditions data for Pacific people show unchanged outcomes over several decades. Research suggests that models of care that recognise diverse understandings of health and wellbeing have benefits for people with long-term conditions and their families and help address longstanding health disparities.

Aim: To explore Pacific people's understandings of health and wellbeing and, within this context, to examine concepts related to long-term conditions models of care.

Methods: A narrative review was conducted using broad search terms in key clinical and social science databases and manual searches of Pacific-focused publications to ensure extensive coverage of topics of interest. The methods were well suited to exploring experiential, conceptual themes often underrepresented in systematic reviews.

Results: Eighteen studies produced over a more than 25-year period (1997-2024) were included. The studies describe values and beliefs that form holistic conceptualisations of Pacific health, centred around family and grounded in a collective sense of wellbeing. They provide insights about how these understandings intersect with socioeconomic and environmental factors to shape context-specific experiences of care for Pacific peoples.

Discussion: The reviewed studies highlight the 'lived with' effects of long-term conditions that Pacific people and their families experience. They illustrate how the goals of long-term condition models of care, however desirable, may not seem beneficial or feasible for Pacific families if they neglect other dimensions of wellbeing, or fail to consider constraining contextual factors. Literature that challenges conventional concepts in long-term conditions models of care potentially support appropriate approaches for Pacific people and their families.

Introduction: Pacific health providers have worked to improve access to care and outcomes for Pacific communities in Aotearoa New Zealand since the 1980s. Although now an integral part of the health system (their role exemplified during the COVID-19 pandemic), providers' characteristics and service models are poorly understood and under theorised.

Aim: This study aimed to strengthen evidence about Pacific health providers for policy development by examining the evolution of the sector, identifying key provider organisational features and service delivery patterns, and developing a framework to categorise providers.

Methods: A stocktake was conducted to collect descriptive data on 43 Pacific health providers identified using specific criteria. Public material about providers was reviewed, and all providers were invited to complete an online survey and phone interview.

Results: Four categories were established representing the range of services delivered by Pacific health providers across general practice, primary health care, health promotion and support, and non-frontline 'enabler' settings. These providers operated in 88 different locations nationwide. Revenue data indicated significant growth from 2019 to 2023, partly due to COVID-19 funding. Survey results showed that most providers managed multiple, short-term contracts. Providers reported that 83% of their workforce was of Pacific ethnicity, highlighting their role as significant employers of Pacific health workers.

Discussion: This comprehensive stocktake provides insights about the contributions of Pacific health providers, while also highlighting the data gaps that have constrained understanding of their development. The proposed categorisation framework reflects the diverse activities of Pacific health providers, offering a foundation for ongoing assessment of their impact on Pacific health outcomes.

Introduction: Type 2 diabetes mellitus is a major health burden in Fiji (19.3% prevalence). Evidence suggests increased physical activity improves glycaemic control and health outcomes; however, this remains unstudied in Fiji's population.

Aim: This study aimed to assess physical activity levels and explore its relationship with glycaemic control among diabetic patients.

Methods: A quantitative, cross-sectional pilot study was conducted at Samabula Health Center, Fiji, from September to November 2022 using convenience sampling for 174 adults with diabetes. The International Physical Activity Questionnaire, short form, assessed physical activity, whereas capillary fasting and random blood sugar assessed glycaemic control targets. Logistic regression analysed associations.

Results: The study found 64% of participants were physically inactive, with females significantly less active than males (odds ratio (OR) = 0.49, 95% confidence interval (CI) = 0.25-0.98). Poor glycaemic control was common (75%), although adherence to lifestyle and pharmacological management plans were significantly associated with good control (OR = 2.37, 95% CI: 1.05-5.37). Increased physical activity levels were not significantly associated with meeting glycaemic control targets.

Discussion: Despite clinic attendance, patients with diabetes remained inactive, had poor glycaemic control and were non-adherent to lifestyle and drug treatment. Contradicting previous evidence, physical activity was not associated with meeting glycaemic control targets, possibly reflecting point-of-care glucose variability compared to the gold-standard glycated hemoglobin measure (HbA1c), and cross-sectional study design limiting causal interpretation. Future research should investigate glycaemic control and physical activity barriers, especially among women, physician practices and test culturally adapted interventions. Fiji's National Wellness Policy and Non-Communicable Disease (NCD) Strategic Plan must consider strengthening diabetes management guidelines, clinician training and patient support to address systemic gaps.