Journal of primary health care最新文献

Introduction: Delivery of interprofessional education (IPE) in rural settings can support pre-registration health sciences students to achieve interprofessional collaborative practice (teamwork) competencies. It can also grow the rural workforce with previous students recommending the programme to their peers and some choosing to work in a rural workplace as graduates. Launching and implementing a rural IPE programme in a new location is challenging, even when comparable IPE models exist in other settings.

Aim: We aimed to evaluate the implementation of a new rural IPE programme in Greymouth, New Zealand.

Methods: Qualitative evaluation data were collected through several rounds of interviews during the first 2 years of the programme. The interviews included students, stakeholders (Education Operations Group - the tertiary education providers who sent students, clinical placement providers, community stakeholders), and local programme staff. Focus group and interview data were explored using thematic analysis.

Results: Three themes were identified, each with subthemes: (1) allow sufficient lead-in time, (2) ensure there is time to bed down, and (3) undertake location-specific quality improvement. These themes pointed to aspects that were important when implementing a new IPE programme, particularly to enable development of a local flavour.

Discussion: Rural IPE programmes are complex, expensive to establish, and difficult to sustain, but such programmes may be key to increasing the rural workforce. It is critical to have local staff who can work effectively with all the stakeholder groups, all of whom are important to continuing the programme.

Introduction: Genitourinary symptoms of menopause (GSM) affect a large proportion of women and can worsen over time if left untreated. In New Zealand, effective treatment with low-dose vaginal oestrogen is available only by prescription, limiting timely access. Internationally, such treatments have been reclassified for supply by pharmacists, but there are no studies examining New Zealand pharmacists' perspectives on this.

Aim: This study aimed to determine pharmacists' confidence in treating GSM and their perspectives on supplying an over-the-counter (OTC) vaginal oestrogen.

Methods: A cross-sectional survey was distributed by the research team to 2762 registered pharmacists. The survey explored confidence in GSM management, opinions on OTC vaginal oestrogen supply, perceptions of patient preferences, and barriers and facilitators to service delivery. Quantitative data were analysed descriptively, and open-ended responses were reviewed using descriptive thematic analysis.

Results: A total of 299 pharmacists responded (response rate 10.8%). While only 46.8% felt confident in recommending currently available OTC products for GSM, 61.2% reported they would be confident supplying low-dose vaginal oestrogen OTC. Pharmacists believed that supplying OTC oestrogen would improve accessibility, reduce the burden on general practice, and support patient-centred care. Key barriers included cost to patients, lack of specific knowledge of GSM, and limited time or resources in the pharmacy setting.

Discussion: Pharmacists in New Zealand support expanding their role to supply low-dose OTC vaginal oestrogen for GSM, provided that appropriate tools and training are implemented. This service could improve access, address health disparities, and significantly enhance menopause care in New Zealand.

Introduction: Disparities in maternal health outcomes in Aotearoa New Zealand are well documented, with Māori and Pacific women experiencing disproportionately poorer outcomes. Early pregnancy care delivered through general practice offers an opportunity to reduce these inequities. The Best Start early pregnancy assessment tool, developed by the National Hauora Coalition, was implemented across four general practices in Whanganui to support timely, culturally safe care.

Aim: To implement and evaluate an equity-focused model of early pregnancy care in general practice using the Best Start assessment tool, with the goal of improving timely, culturally responsive support for pregnant Māori and Pacific women.

Methods: An iterative, co-designed implementation was carried out across a Very Low Cost Access clinic, an iwi health provider, and two general practices. The project was structured in three modules: (1) co-design with hapū māmā (pregnant Māori women), (2) clinical implementation, and (3) integration of wrap-around services. Mixed methods were used, including practice management data queries, clinical audits, and qualitative insights from community hui.

Results: In the lead practice, 85% of estimated pregnancies were identified, with 84% identified in the first trimester. Of these, 79% received a Best Start assessment (74% of Māori pregnancies). Mental health concerns were the most common referral need (18%), while low attendance at external stop smoking services highlighted persistent barriers. Community feedback led to system improvements, including warm handovers (in-person referrals) and protected appointment slots.

Discussion: The Best Start model demonstrates that early pregnancy care in general practice can be redesigned to better support equity, provided it is culturally responsive, co-designed with māmā, and supported by systemic change. Ongoing investment is needed to sustain and scale the model, especially for Māori and Pacific women.

Introduction: Comprehensiveness in primary care is defined as managing most medical needs in a population while integrating the context of patient's values, preferences, and beliefs. This study aims to synthesise validated measures for measuring comprehensiveness in primary care to facilitate its practical application.

Aim: The objective of this study was to synthesise validated measures for measuring comprehensiveness in primary care, facilitating its practical application.

Methods: A narrative-style literature review was employed to conduct a hierarchical review of relevant literature. The process involved several stages: initial term filtering, separation of primary care from specialist care using medical subject heading (MeSH) terms, incorporation of non-MeSH terminology, and a manual review of titles, abstracts, and full articles. Articles were included if they discussed the measurement, assessment, or application of comprehensiveness in primary care and were relevant to primary care and methodologically sound. A multistage PubMed search of 'comprehensiveness' (MeSH) with hierarchical sub-term filtering and snowball method gleaning of additional articles from literature-described terminology was conducted.

Results: Thirteen studies met the inclusion criteria. Methodological strategies varied from claims-based approaches for cost and utilisation to surveys assessing the scope of clinical services and patient experience.

Discussion: Thoroughly measuring comprehensiveness in primary care integrates methods that evaluate the effect of physician ranges of clinical services on the cost and utilisation of health care, and the impact on patient outcomes within the context of the patient experience. Implementing these methods pragmatically can assist communities and health systems in implementing, measuring, and capturing comprehensiveness in primary care.

Introduction: Despite being a common and disabling neurological disease, migraine is often underdiagnosed and undertreated. Although most patients with migraine can be effectively managed in primary care, people with migraine in Aotearoa New Zealand (NZ) report multiple barriers to care and negative impacts of migraine on physical and mental health, work and quality of life.

Aim: This study aimed to describe the experience of primary care clinicians with managing migraine disease in NZ and identify enablers and barriers to effective care.

Methods: Clinicians were recruited through advertisements in an online newsletter and a regional email network. Semi-structured interviews were completed via phone or Zoom. Inductive thematic analysis was undertaken to identify key themes.

Results: Five general practitioners and three nurse practitioners were interviewed. Themes related to the clinician, healthcare system and societal factors were identified across the patient journey of seeking health care (cultural safety, primary care accessibility, awareness and health literacy), diagnosis (diagnostic knowledge, secondary care and diagnostic test accessibility and diagnostic overshadowing) and management (treatment knowledge, communication and patient education, access to ongoing care, role of other health professionals and stigma of chronic disease).

Discussion: Significant barriers to migraine health care related to accessibility of primary care, particularly cost, wait times and availability. Advice from neurology was a valued resource, but access to in-person consultations for patients with migraine was limited. Clinician knowledge about migraine diagnosis and treatment was well supported by online and educational resources. Involving the wider primary care team in migraine management could help improve care.

Background and context: The National Bowel Screening Programme (NBSP) in Aotearoa New Zealand aims to reduce bowel cancer mortality through early detection. Despite this, participation remains lower among Māori and Pacific peoples. In 2023 and 2024, primary care-led campaigns were introduced to support general practices to engage eligible patients in screening discussions.

Assessment of the problem: General practices had varied levels of engagement with reminder systems and resources, and many lacked consistent processes for incorporating screening into routine consultations. To address this, tailored materials and practice support tools were provided.

Results: Campaign participation included a substantial number of New Zealand practices, including engagement of Very Low-Cost Access (VLCA) clinics. Overall, the volume of faecal immunochemical test (FIT) kit requests more than doubled over 2 years; however, return rates remained modest, highlighting the need for additional follow-up strategies.

Strategies for improvement: Future efforts should focus on expanding reminder systems, enhancing practice workflows, and incorporating outreach support to increase kit completion rates.

Lessons learnt: Structured primary care interventions can boost screening uptake, particularly among equity priority groups. Sustained improvements in screening participation will depend on system integration and continued support for practices and communities.

Introduction: Antibiotic misuse and overuse, among other factors, are the main drivers of increased antimicrobial resistance. Although cefalexin is generally recommended as a second-line agent, recent trends in Aotearoa New Zealand (NZ) indicate increased community use, highlighting the need for closer scrutiny.

Aim: This preliminary study aimed to assess the appropriateness and guideline compliance of cefalexin prescribing.

Methods: We conducted a cross-sectional study reviewing all cefalexin prescriptions issued at a single urban medical centre in Ōtautahi Christchurch, NZ, during July-August 2023. Retrieved prescriptions were assessed for guideline compliance and clinical appropriateness using a modified audit survey based on national and regional guidelines.

Results: We identified 27 cefalexin prescriptions provided to 25 patients (16 female, 20 NZ European; median age 48.9 years, IQR 49.7). Soft tissue (n = 11, 42.3%) and genito-urinary infections (n = 10, 38.5%) were the most common indications. Of the assessable prescriptions (n = 26), 14 (53.8%) were guideline compliant, and 15 (57.7%) were clinically appropriate. Indications were documented in 22 cases (84.6%) - 6 on the prescription and 19 in the clinical record.

Discussion: This exploratory study identifies areas for targeted antimicrobial stewardship interventions in general practice to promote improved prescribing practices. A larger multicentre study is planned to further investigate prescribing patterns and appropriateness.

Introduction: The New Zealand Primary Health Care Strategy (2001) and subsequent government health policy have aimed to improve access to and expand the role of nurses in primary health care. Measuring primary healthcare utilisation is one way to assess the success of such policies.

Aim: This study aimed to describe trends from 2008 to 2023 in average annual general practitioner (GP) and nurse consultations, by gender, age, ethnicity, and area-level deprivation.

Methods: Primary health care service utilisation data were obtained from the Ministry of Health.

Results: Average GP consultations per enrolled patient per year showed little change over the study period, with increases from 2.9 in 2008 to 3.1 in 2022, and a dip in 2020 and 2021 during the COVID-19 pandemic. In 2023, GP consultations were the lowest in the study period (2.8). Nurse consultations rose steadily from 0.4 in 2008 to 1.0 in 2023 and did not show a marked COVID-19-related dip. Māori had consistently lower rates of GP consultations and higher rates of nurse consultations than New Zealand Europeans. Utilisation of primary health care, particularly that provided by GPs, was low in 2023.

Discussion: Possible reasons for Māori and older people consulting with nurses at higher rates should be investigated. These may be artefactual, due to our inability to age-standardise the data. Other possible reasons include nurse management of chronic conditions and barriers to accessing GP care. The fall in primary healthcare utilisation in 2023 will likely increase secondary care need.

Introduction: Research in primary care (PC) is essential for improving patient outcomes and healthcare systems. However, family physicians often face barriers to conducting research, including limited training, time constraints, and lack of institutional support. Identifying effective strategies to build research capacity can help integrate research into PC practice.

Aim: This scoping review identifies and synthesises strategies that strengthen family physicians' research capacity in PC.

Methods: The review followed the PRISMA-ScR methodology. We included studies published up to 2023 in English, Portuguese, or Spanish that described relevant research capacity building (RCB) strategies for family physicians in PC, with no restrictions on study design. A comprehensive search in PubMed, Scopus, Web of Science, and the Cochrane Library was conducted. This review protocol was registered in the Open Science Framework (1).

Results: We included 19 studies and identified five key strategic approaches to RCB in PC: (1) Training and mentoring programmes - Structured educational initiatives and mentorship developed research skills. (2) Networking - Collaborative research networks fostered engagement. (3) Blueprint development - Frameworks guided research initiatives. (4) Strategic communication interventions - Awareness campaigns promoted a research culture. (5) Knowledge transfer and exchange - Mechanisms facilitated the application and dissemination of research findings.

Discussion: Implementing multifaceted strategies enhances family physicians' involvement in research and strengthens the research culture in PC. Combining structured training programmes, professional networking, and strategic communication fosters a more research-friendly environment. Future studies should assess how adaptable these strategies are to different PC settings, evaluate their long-term impact, and integrate other professional groups within PC.