Journal of primary health care最新文献

Introduction In 2001, Aotearoa New Zealand (NZ) launched a Primary Health Care (PHC) Strategy to improve access, reduce inequities, and shift care toward the community level. Those goals have remained in place since. Despite initial successes, multiple challenges indicate PHC remains underfunded. Aim This study aims to assess the extent to which PHC has been financially prioritised within public spending between 2009 and 2023. Methods We use Ministry of Health transfers to Primary Health Organisations (PHOs) as a proxy for PHC funding, including general practice capitation and PHC capacity investments. We analyse PHC funding trends relative to total government health funding, adjusted for inflation, in total and per capita terms, and examine changes in key funding streams. Results On average, NZ spent NZ$238 per person per year on PHC in 2023 prices, reflecting a slight 7% increase since 2009. Although PHO funding has diversified over time, it remains dominated by First Contact Funding, which accounted for 70% of total PHC funding. On average, NZ allocated 5.4% of its national health budget to PHC, a share that did not change throughout the study period. Discussion The findings highlight the need for greater financial prioritisation of PHC in NZ to fulfil the PHC Strategy. Despite nominal increases, the static share of PHC funding suggests that successive governments have not sufficiently prioritised PHC funding to align with their strategic PHC goals. We recommend routine monitoring of PHC funding relative to the total government health budget and setting a minimum allocation to help protect spending on PHC.

Introduction People are precluded from enrolling in primary health care at a general practice if it has 'Closed Books'. This creates barriers to accessing health care. Aim To examine which Health Districts had the greatest number and proportion of general practices with Closed Books and how this has changed since 2022. Methods Maps were used to display the distribution of Closed Books general practices and tables were used to compare changes in Health Districts over time. Results There were 373 (36%) general practices that had Closed Books in September 2024. Canterbury (n = 56), Southern (37) and Northland (32) Health Districts had the greatest number of Closed Books general practices, while Hutt Valley (73%), Lakes (70%) and Wairarapa (67%) Health Districts had the greatest percentage of general practices with Closed Books. Discussion The problem of Closed Books was felt across the country but has a larger impact in the middle-lower North Island and an increase in impact in Northland and the lower South Island. Improvements have been seen in the worst hit areas since 2022 but, overall, the percentage of general practices with Closed Books has not improved.

Introduction Despite government-funded dental care for children in New Zealand, dental caries was the leading cause of children's hospitalisations in 2019, with 10.4% of children aged Aim The review aims to map international literature on the use of silver diamine fluoride in preventing and managing dental caries, and to assess its contribution to achieving better and more equitable oral health outcomes for children aged 0-14years. Methods The scoping review adhered to the scoping review guideline from the Joanna Briggs Institute Manual for Evidence Synthesis. Six databases were searched for primary studies addressing the uses of silver diamine fluoride as a caries management tool in paediatric dentistry. Results Of 1185 records screened, 88 studieswere included. The results were categorised into five themes: (1) effectiveness; (2) enablers; (3) adverse effects and barriers; (4) cost-effectiveness; and (5) promotion of oral health equity. The capability of silver diamine fluoride to arrest dental caries is well-supported by evidence, offering benefits such as non-invasiveness and improved quality of life for children. However, aesthetic concerns post-treatment and limited public awareness pose challenges to its broader application. Discussion Silver diamine fluoride has the potential to significantly reduce caries rates among New Zealand children. Further research is needed to explore its role in promoting oral health equity, and tailored policies and protocols need to be developed to align with the local context.

Introduction In Aotearoa New Zealand (NZ), general practices are able to close their books, meaning that they do not enrol any new patients at all. This can increase the barriers that people face in accessing health care and may affect different groups disproportionately. Aim This study aimed to examine the link between the enrolling status of general practices and the characteristics of the population in areas served by these practices, ie the user base, across New Zealand. Methods Regression models, with bootstrapping, were used to explore the relationship between Open and Closed Books general practices and the variables: sex, median age, total count ethnicity, being born in New Zealand, median personal income, the New Zealand Deprivation Index 2023, health status, and the Urban Accessibility Index in the area surrounding the general practices. Results Being a Closed Books general practice was more likely when the user base had higher proportions of people born in New Zealand, had lower health status, were Māori or European, were female, and lived in a large or medium urban area. It was less likely when there were higher proportions of males and Asian peoples. After adjusting for Health Districts, only one variable, being born in New Zealand, remained significant. Discussion Characteristics of the user base were associated with a general practices' enrolling status and mediated by location. These findings contribute to a deeper understanding of the inequalities affecting access to primary health care and point to the potential of geographically tailored approaches to minimise disparities and promote healthcare equity.

Introduction Māori have poorer sexual and reproductive health (SRH) outcomes compared to non-Māori New Zealanders. Patient experiences of SRH services affect how they access, utilise, and benefit from services. Learning about how wāhine Māori (Māori women) experience care related to SRH could inform improvements in how services provide care for wāhine. Aim This study aimed to explore the experiences wāhine have when accessing SRH services. Methods This qualitative study utilised semi-structured interviews to explore the lived experiences of wāhine when accessing sexual healthcare. Inductive thematic analysis was performed to generate themes from the data. Results Twelve wāhine were interviewed. An overarching theme, Te Hāpai i te mana wāhine, te takahi i te mana wāhine (empowering women, disempowering women), was identified. This theme had four subthemes: creating comfortable spaces; manaakitanga (kindness and respect) overcomes barriers to care; patients are people, not numbers; and the importance of mana-enhancing care. The data showed that wāhine benefit from services and care that make them feel comfortable and respected and that dehumanising care can impact further engagement with services. Discussion Wāhine have variable experiences when accessing sexual healthcare, and although some of those experiences showed how positive interactions with healthcare staff facilitated effective care, many experiences demonstrated how dehumanising clinical care can sometimes be. Such care risks perpetuating health inequities indirectly by eroding the trust wāhine have in healthcare services, and directly by limiting the effectiveness of healthcare encounters. Recommendations are made to improve care provided to wāhine in sexual health settings.

Introduction Improvements in diagnostic test accuracy across multiple pathogens have resulted in multi-viral point-of-care testing (POCT) via a rapid antigen test (RAT). Aim This study aimed to describe general practice practitioners' reactions to a pilot respiratory virus surveillance programme during the SARS-CoV-2 pandemic, which enabled surveillance for influenza and other respiratory viruses alongside POCT for SARS-CoV-2. Methods Participating general practices collected viral swabs between May and December 2022. Nasopharyngeal swabs were taken for both an immediate COVID-19 RAT and a polymerase chain reaction (PCR) for testing SARS-CoV-2, influenza, respiratory syncytial virus (RSV) and other respiratory viruses. A questionnaire explored practitioners' experiences and perceptions, addressing project setup, swabbing process and perceived overall value. Results Of 4135 swabbed patients, 54% were positive for one of the tested viruses. Involved nurses and doctors reported high adaptability to the swabbing process. Clinicians valued obtaining rapid diagnostic information for patient management and patient communication. While no significant barriers were identified, practitioners acknowledged additional time requirements and potential challenges with swabbing young children. Discussion The study demonstrated the feasibility and clinical utility of using POCT swabbing for immediate RAT and subsequent PCR testing for respiratory viruses in general practices when managing a viral pandemic. The data assisted in identifying community transmission of respiratory viruses, provided information for patient management and reinforced positive health messages about viral illnesses. The study suggests potential benefits for both individual patient care and population-based surveillance. The study also identified the potential value of multi-viral POCT testing via a RAT.

Introduction Despite free dental care for children under 18 in New Zealand, children with disabilities face significant barriers to accessing these services, leading to disproportionately poorer oral health outcomes. A detailed understanding of the oral health status and service delivery for children with disabilities is essential to identify existing gaps and areas for improvement. Aim The study aims to examine the oral health status of children with disabilities in Auckland, New Zealand and explore the perspectives of clinicians and service managers working in the community dental service regarding oral health care for these children. Methods An explanatory sequential mixed-method design was utilised. The initial quantitative phase involved retrospective analysis of dental records of children with disabilities who received care through the community dental service. This was followed by the qualitative phase, which consisted of semi-structured interviews with clinicians and service managers. Results The study identified high caries rates and significant unmet dental care needs among children with disabilities. Clinicians and service managers recognised individual-level challenges, such as insufficient confidence and training. Additionally, broader systemic issues, including inadequate service design and barriers in service delivery, were also highlighted, contributing significantly to oral health disparities. Discussion This study highlights the urgent need for tailored dental services for children with disabilities in Auckland. It emphasises the importance of integrated care approaches and enhanced training for dental professionals to improve accessibility and outcomes in paediatric dental health care.

Introduction: Healthcare systems historically fail to deliver adequate and appropriate size- inclusive health care to the fat community with implications for fat people's health and human rights. The COVID-19 vaccination rollout was, and continues to be, an important part of Aotearoa New Zealand's (NZ) response to the COVID-19 pandemic. People with high body mass were identified as a priority group for early vaccination.

Aim: To investigate self-identified fat people's experiences of COVID-19 vaccination centres in NZ.

Methods: Qualitative descriptive analysis of free-text responses provided by self-identified fat people residing in NZ as part of a international online survey implemented during the COVID-19 pandemic.

Results: Of the 761 NZ survey respondents, 210 respondents provided open-ended and free-text comments about their first COVID-19 vaccination, 169 commented on their experiences of second or subsequent vaccination, and 198 commented on their overall experiences concerning COVID-19 vaccination. Two themes were identified: Navigating challenges in the vaccination centre environment and Advocating for the use of long needles.

Discussion: Findings highlighted healthcare inequities experienced by fat people when accessing COVID-19 vaccination centres and thin privilege at structural and interactional levels, despite identified priorities for vaccinating people with high body mass.

Introduction: Type 2 diabetes is a chronic condition predominantly managed through primary care in Aotearoa New Zealand. Primary care initiatives are being increasingly established to provide culturally safe and interprofessional care to optimise disease management.

Aim: This study aimed to qualitatively explore the 'Piki te Ora' (Ascending to Wellness) interprofessional primary care service of Te Korowai Hauora o Hauraki (a Māori general practice network) for supporting whānau (family) with type 2 diabetes.

Methods: Semi-structured interviews with patients with type 2 diabetes who were previously or currently enrolled in the Piki te Ora service between January 2021 and October 2023 were conducted between December 2023 and January 2024. Interviews were audio recorded, transcribed and thematically analysed.

Results: Nine participants were interviewed (six Māori and three NZ European; mean age 56 ± 16 years). Four overarching themes were identified: healthcare accessibility, care and support (manaakitanga), tailored holistic approach and patient empowerment. Most participants reported improved healthcare access through mobile clinics and telehealth, extended appointment times, approachable interactions with the Piki te Ora team, increased diabetes knowledge and management and a sense of empowerment from the staff. However, some participants were unaware of being enrolled in the Piki te Ora programme and found the written materials unclear, suggesting the need for clearer communication.

Discussion: The findings highlight the value of culturally safe, accessible healthcare services like Piki te Ora, particularly in addressing healthcare barriers in rural New Zealand. Further studies are needed to identify strategies for overcoming existing barriers to access and engagement, particularly in enhancing health equity for Māori.