Journal of primary health care最新文献

Introduction: Globally, mental health problems are increasing, particularly among youth, women, Indigenous populations, and those facing socioeconomic disadvantage. Aotearoa New Zealand (NZ) mirrors these trends, raising concerns about the capacity of primary care to respond.

Aim: This study aimed to analyse psychological distress trends in NZ from 2011 to 2023 and assess implications for primary health care.

Methods: Data from the New Zealand Health Survey were used, focusing on Kessler 10 scores ≥12, classified as high or very high psychological distress. Results were stratified by age, gender, ethnicity, and deprivation.

Results: Overall rates of distress rose significantly. Among females aged 15-24 years, distress increased from 6 to 30%. Māori and Pacific peoples showed consistently higher distress rates, with widening disparities. The most socioeconomically deprived groups (Quintile 5) had the highest distress levels in all years of study data.

Discussion: The findings highlight an escalating mental health burden managed predominantly in primary care. Workforce shortages, limited continuity of care, and structural inequities restrict the sector's ability to respond. Urgent investment in culturally responsive, integrated, and equitable mental health services is required.

Introduction: An updated medical model for wholistic and patient-centred care that adds elements of prevention and management of long-term medical conditions to the old biomedical model is a necessary response to current understanding of health and wellbeing. The capacity to adapt and self-manage is central to health, and important domains or pillars to consider are physical, psychological, social/emotional, and spiritual. The challenge for this model is applying it in a resource-constrained primary care environment.

Assessment of problem: The value of an enhanced model of care in a general practice setting was tested. Elements of the model were relevance and applicability to New Zealand general practice, equity considerations, and validated tools for delivering messages and measuring outcomes. Components were facilitated group video modules to educate and support participants in self-efficacy within domains of physical, psychological, emotional, and spiritual wellbeing, followed by extended one-on-one consultations between participants and their GP at 6-monthly intervals for 1 year.

Results: Self-Efficacy and Patient Activation Measure scores increased throughout the study. Quality of Life scores and consideration of the four domains of wellbeing indicate patient ability for self-management and adaptability in the face of changing medical conditions, without decline in wellbeing.

Summary: A shift in locus of control favouring the patient, with use of validated tools to enhance a wholistic approach in patient-clinician interactions, results in meaningful health improvements. Such tools and education resources are accessible and can be incorporated into existing systems of care without substantial disruption and offers a realistic opportunity for positive change.

Introduction: Effective quality improvement (QI) is vital to improve healthcare quality and outcomes. The context surrounding QI has a dynamic relationship that impacts QI efforts over time. Developing an understanding of context may provide opportunities to address barriers to success. Most studies into contextual influences have been conducted in secondary care. Primary care is key to improving population health, equity and value. The Model for Understanding Success in Quality (MUSIQ) is a commonly used context assessment tool that was developed in large, mainly secondary care organisations, and questions have been raised as to its applicability in primary care.

Aim: This study aims to assess the applicability of the MUSIQ in primary care settings and suggest adaptations for primary care.

Methods: A multi-case mixed methods approach was followed with quantitative data from the MUSIQ survey tool, compared with qualitative data from Aotearoa New Zealand primary care interviews. The Consolidated Framework for Implementation Research (CFIR) guided qualitative data collection and analysis.

Results: Scores were duplicated between common microsystem and organisational factors. External motivation created mixed reactions and scores depending on interpretation, but consistent themes of community responsibility and network relationships were identified as strengths. A lack of QI infrastructure and triggering events were consistent findings.

Discussion: Total MUSIQ scores were impacted by scores given for factors at different MUSIQ levels that are combined in many primary care organisations. A primary care adaptation of MUSIQ is proposed that removes the duplicated levels and adds key primary care contextual factors not included in MUSIQ.

Introduction Adults aged 50 years and over are drinking more than ever but primary health care (PHC) professionals find it challenging to screen them for alcohol-related harm, despite being at greater risk for harm than younger drinkers. Aim This intervention aimed to enhance alcohol screening for this cohort by (a) introducing an algorithm in the patient management system to automate detection of alcohol risk in patients and (b) providing training to support health professionals' practice of, knowledge about, and comfort with alcohol screening in this cohort. Methods Eleven PHC practices in Aotearoa New Zealand took part in this intervention, including 41 PHC health professionals. Development and integration of the automated alcohol screening process within PHC patient management systems was undertaken in parallel with health professional training approaches. Results Screening rates increased substantially at intervention initiation but fell immediately with the onset of the New Zealand COVID-19 national lockdown. Two-thirds of health professionals identified the system screening prompts, over 40% felt this changed their screening practice, and 33% increased their awareness of - and felt more comfortable screening for - alcohol-related risk in those aged 50+. Discussion We illustrated an initial increase in alcohol screening rates in those aged 50+ as a result of this intervention, but this increase could not be sustained in part due to COVID-19 disruption. However, health professionals indicated that this intervention helped many change their practice and enhanced their awareness of such risk and comfort in screening for alcohol-related risk in those aged 50+.

Introduction In 2022-2023, a multi-region implementation study ('Let's test for HPV') was undertaken in New Zealand primary care to inform the National Cervical Screening Programme shift to human papillomavirus (HPV) primary screening in September 2023. Aim This study aimed to describe 'Let's test for HPV study participants' experiences with HPV primary screening. Method Implementation study participants were invited to complete an anonymous online survey in September 2023. Survey data were summarised using descriptive statistics. Free text comments were analysed using inductive thematic analysis. Results Forty-two percent of those invited began a survey (969/2302) and 921 were included in analyses. Respondents were aged 24-71, represented each of the three regions of New Zealand and different ethnic groups and included never and under-screened participants. Most people chose to self-test for comfort, convenience and privacy. Gaps were identified in participant understanding about HPV, how HPV testing differs from cervical cytology and the implications of HPV test results. Key topics requiring further explanation were identified by participants. Around 8% did not find self-testing easy or comfortable. Intent to screen again was high (92.4%), with greater preference for self-testing at home (48.2%) over the GP practice (33.5%). Discussion HPV primary screening incorporating the option to self-test was highly acceptable to primary care-based study participants. Despite having participated in the new pathway, knowledge gaps were evident. Clear communication from screen-takers will be key to support participant knowledge, understanding and confidence in the efficacy of HPV primary screening. Ongoing programme evaluation, including patients' perspectives, will be essential in the pursuit of equity and progress towards cervical cancer elimination.

Introduction YouthCHAT (Youth electronic Case-Finding and Help Assessment Tool) assesses lifestyle issues in young people in New Zealand (NZ) primary care settings, including questions on smoking and vaping. Aim This study aimed to assess adolescent vaping/smoking rates, reasons, and interest in help. Methods An analysis of a de-identified extract of adolescent smoking and vaping YouthCHAT responses with chi-squared testing of independence of reporting ever-smoking and ever-vaping was performed. Gender and gender-by-ethnicity differences were tested by chi-squared test for females versus males and Māori and Pacific versus NZ European. Bonferroni correction for multiple comparisons was applied by multiplying P -values by 10. Follow-up responses, including help questions, were tallied. Results Of 3462 completed YouthCHAT screens of adolescents aged ≤14 years, 753 (22%) reported ever-vaping and 427 (12%) ever-smoking (P P =0.001; 0.003, respectively). The rate of having ever-vaped and of vaping-never-smoked was higher in Māori (adjusted P P =0.005 for vaping; 0.001 for vaping-never-smoked) girls compared to NZ Europeans. For ever-vaped, 511 (68%) had felt the need to cut down. Of those who vaped in the past 3months, 120/558 (22%) wanted help. Discussion Vaping is more frequent than smoking among young NZ adolescents under 15years of age but many are open to receiving help. Relatively few adolescents are vaping to stop smoking. Tight controls of vaping products are needed to prevent e-cigarette marketing from attracting non-smoking adolescents, while ensuring access for those who wish to quit smoking.

Introduction Sexual and reproductive health (SRH) is important for well-being, yet Indigenous peoples, including Māori, have poorer SRH outcomes than non-Indigenous peoples. Healthcare providers (HCPs) play a critical role in enhancing patients' health literacy, directly impacting health outcomes by providing clear, accessible information and guidance. Therefore, it is important to explore the experiences that wāhine Māori (Māori women) have when interacting with HCPs and how they learn about SRH. Such research could guide interventions to improve dissemination of SRH knowledge to Māori. Aim This study aimed to explore the experiences wāhine Māori have of sexual health care and accessing SRH knowledge. Methods Wāhine were interviewed in this Kaupapa Māori study. Interviews were transcribed and coded, and thematic analysis was performed. Results Twelve wāhine were interviewed. An overarching theme, He mana tō te mātauranga (knowledge is power), was identified. There were four subthemes: being informed about contraceptive options is empowering, informed consent is important, high-stress situations call for better communication and improved dissemination of SRH knowledge is needed. The wāhine valued being well-informed about their health and options, however, their experiences of receiving information varied. Discussion Wāhine Māori want to be told more about their health and options when encountering HCPs regarding SRH. Being informed is empowering, while feeling uninformed results in a breakdown in trust in the healthcare system and inability to exercise mana motuhake (autonomy). Facilitating improved dissemination of knowledge about SRH may help improve SRH outcomes for Māori by supporting health literacy, so that Māori can make informed decisions about their health.

Introduction Aotearoa New Zealand's National Screening Unit (NSU) moved to use of human papillomavirus (HPV) primary screening in November 2023. Aims This study aimed to evaluate participants' views on favourable and unfavourable elements of HPV primary screening and to seek suggestions for potential improvements. Method Primary care participants in a multi-region HPV primary screening implementation study were invited to complete an online follow-up survey in September 2023. This paper reports on qualitatively analysed responses to open-ended questions asking participants what they liked, disliked or thought could be improved for future screening participants. Results Of 2361 invitations sent, 2302 were delivered, 969 people consented to participate and 921 were included in analyses (40%, 921/2302). Respondents were 24-71 years of age, from three regions, different ethnic groups and included under-screened participants. Most had chosen to self-test (92%) and 28.9% self-tested at home. Three quarters shared comments about what they liked, with themes related to ability to self-test, avoiding cervical tests, choice, communication and support. Twenty percent described unfavourable aspects, with themes related to inadequate information, self-testing issues, inappropriate physical space and process and programme-related factors. Seven key recommendations were identified from suggestions about potential improvements for future screening participants. Conclusion Survey participants' experience of HPV primary screening was overwhelmingly positive, with choice of a self-test a clear benefit for most. Inadequate information or communication contributed to suboptimal experiences for some. Participant recommendations highlight practical steps screen-takers (and the NSU) could take to ensure screening participants receive a well-informed, affirming experience that supports ongoing participation in cervical screening.