Journal of primary health care最新文献

Introduction: Management of type 2 diabetes (T2D) occurs predominantly in primary health care in Aotearoa New Zealand. Optimising the delivery of clinical diabetes management by upskilling healthcare professionals can reduce the strain on the healthcare system and improve patient care.

Aim: This study aimed to qualitatively evaluate the importance of an education programme delivered by a non-physician diabetes specialist on nurses' knowledge and confidence of T2D management in primary care.

Methods: Semi-structured interviews with nurses enrolled in the programme for at least 6 months and their nurse leads across two clinics in the Waikato region were conducted to assess their confidence and knowledge in T2D management, as well as the acceptability of the programme. Transcripts were analysed using quantitative content analysis.

Results: Four nurses and two nurse leads were interviewed, lasting between 15 and 60 min. Nurses reported improved knowledge of diabetes medications and interpreting clinical measures. Nurses also felt more confident in their communication skills with patients, advocating for their patients, and improved patient engagement. Further education was needed on administering diabetes medication, knowledge of medical devices such as continuous glucose monitoring, and understanding the pathophysiology of diabetes.

Discussion: Self-efficacy and self-reported skills of nurses in T2D management improved following the diabetes mentoring programme. Further research is needed to assess quantitative clinical measures and whether the programme is effective in improving patient health outcomes.

Introduction: There is a knowledge gap around the experiences of New Zealand (NZ) primary health care (PHC) registered nurses and nurse practitioners when working with children whom they suspect are being abused or neglected.

Aim: This study aimed to explore what PHC nurses experience when building and nurturing family and interdisciplinary relationships amidst a suspicion that a child is being abused or neglected.

Methods: Using contacts and snowballing to recruit participants, 13 PHC nurses working in the Auckland region were interviewed using semi-structured interviews. Gadamerian hermeneutics guided the analysis, with other philosophers drawn on to deepen the analysis.

Results: Relationship building is precarious due to trust issues, tensions around reporting, and complex power relations. Nurses are central to coordinating interprofessional care.

Discussion: Building relationships with families, children, and colleagues is fundamental to child protection. It is only by knowing what building and nurturing relationships is like amidst suspicion of child abuse or neglect that those whom nurses work with can understand what this work is like.

Introduction Integrating oral health into primary health care (PHC) is recommended, thereby ensuring comprehensive patient care. Primary care teams are well placed to promote and protect patients' oral health, and frequently see oral health-related complaints, and so need to be sufficiently knowledgeable to manage such presentations. There is limited local evidence to inform acceptable and feasible ways of integrating oral health into PHC in Aotearoa New Zealand. Aim To explore the views of doctors and nurses on the place of oral health, and how to improve its inclusion, in PHC. Methods Focus groups with nurses and doctors from six practices were conducted. Data were analysed thematically. Results Several factors influenced the inclusion of oral health in PHC and management of oral health presentations, at individual, professional and system levels: low oral health knowledge, skill and confidence in managing presentations, and lack of communication with local dental services (individual level); considering oral health as out-of-scope of practice, competing priorities, time constraints and ethical considerations (professional level); and lack of affordable and timely definitive oral health care and referral pathways (systems level). Suggestions to facilitate integration of oral health in PHC included information sessions on oral health, developing relationships with local dental professionals, and health system changes. Discussion Primary care practitioners are open to incorporating oral health into their practice; however, several barriers exist to do so sustainably. For effective integration, a series of individual-, professional- and system-level changes are likely required.

Introduction Rural Māori experience inequities in heart health outcomes compared to rural non-Māori and urban Māori. Access to health care is a significant contributor to these inequities. There is a wealth of literature that explores Māori access to health care; however, the voice of rural Māori within the literature is limited. Under Te Tiriti o Waitangi (The Treaty of Waitangi), Māori have legislative rights to access, engage, and participate in the health care system equitably. Aim This study aimed to investigate the barriers and facilitators of accessing heart health care for rural Māori. Methods The study was informed by Kaupapa Māori Theory, which centres on Māori worldviews and epistemologies. Rural Māori (n =11) with lived experience of (or who had supported their whānau (family) member with) acute coronary syndrome, heart failure or cardiovascular risk assessment were interviewed, and reflective thematic analysis of the data was undertaken. Results Three overarching themes were generated: rural Māori desires and expectations of heart health care; how the system engages with rural Māori; and knowing what is important to rural Māori when it comes to heart health. Discussion Participants experienced many barriers to accessing quality heart health care, some of which were unique to rural settings. Participants sought heart health care that was close to home, culturally responsive, included a representative Māori workforce, involved their whānau, and valued partnership. System-level action is needed to adequately address inequities in health care access and outcomes in rural Māori and to meet obligations under Te Tiriti o Waitangi.

Introduction Interprofessional communication between health care professionals is crucial to deliver quality health outcomes and enhance patients' quality of life. Aim This study aimed to investigate the perspectives and contents of the interprofessional communication between general dental practitioners (GDPs) and general medical practitioners (GPs), and to explore the barriers and strategies that could bridge the gap between these health care professionals from their perspectives. Methods A qualitative study approach was undertaken, with semi-structured interviews conducted with GDPs and GPs from Dunedin and Auckland, New Zealand. Transcripts were analysed using a thematic approach to identify patterns and main themes. Results Three major themes emerged from the interviews with GDPs (n =10) and GPs (n =6): (1) experiences of communication, (2) the content of communication and (3) barriers and suggestions to improve communication. Most GDP and GP participants reported that there was a lack of communication between these two specialties. Complex medical conditions and polypharmacy were the topics perceived as essential for interprofessional communication between GDPs and GPs. The barriers of communication included time constraints, insufficient knowledge of the dental field among most GPs, inadequate understanding of referral among GDPs, and the absence of a common means of communication. Discussion Both GDPs and GPs reported a lack of efficient interprofessional communication. They suggested implementing interprofessional education, integrating health record systems, scheduling regular face-to-face meetings, and developing effective referral guidelines.

Introduction Type 2 diabetes disproportionately affects Indigenous Māori in New Zealand. The reasons for this are multifactorial but include a history of colonialism, barriers to health care access and a lack of culturally appropriate interactions/relationships with health care providers. There is currently a need to develop models of health care delivery that are tailored to the needs of this population. Aim This pilot study evaluates the use of technology, education and culturally-informed wrap-around care (including medication optimisation) to improve type 2 diabetes biomarkers and self-management in a high-needs, majority Indigenous population. Methods Twenty-three participants with HbA1c >80mmol/L received 2-4weeks of continuous glucose monitor (CGM) wear at baseline and at 3months alongside culturally-informed type 2 diabetes education and clinical care. Clinical biomarkers and psychometric measures were recorded at 0, 3, 6 and 12months and 0 and 3months respectively. Medication changes were recorded throughout the study. Results Mean (± s.d.) HbA1c significantly decreased from 93.4±15.7mmol/mol at baseline to 76.5±14.8mmol/mol at 3months, with reductions maintained at 6 and 12months by approximately three-quarters of participants (all P Discussion CGM informed, culturally-appropriate care has the potential to lead to sustained improvements in glycaemia in high-risk, Indigenous populations managed in primary care.

Introduction Fundus examination by direct ophthalmoscopy is widely used in general practice; however, it offers limited field of view, requires close approximation to the patient, has a steep learning curve and is a difficult skill to master and maintain. Non-mydriatic fundus photography (NMFP) offers an alternative with a wider field of view, ability for image analysis and transmission, and is able to be conducted by allied healthcare staff. Aim This study aimed to compare the use of direct ophthalmoscopy with smart-phone NMFP in a large rural general practice. It also aimed to analyse the number of adequate views and positive findings achieved with each instrument and the impact of NMFP on ophthalmology referral decisions. Methods Patients aged ≥16 years presenting to Dargaville Medical Centre (Dargaville, New Zealand) with visual disturbance, headache, hypertensive urgency (systolic blood pressure (BP) >200 mmHg or diastolic BP >120 mmHg), transient ischemic attack (TIA) or stroke were enrolled prospectively into an observational study of visualisation, diagnosis and management impact for a 1-year period (n = 152, 304 eyes). Direct ophthalmoscopy findings and management plans were documented by the attending general practitioner (GP), and then again following assessment of the NMFP. Results NMFP significantly improved visualisation of the fundal structures with an increase in adequate views achieved of both the optic disc and the retina. Inter-rater agreement between the referring GP and ophthalmologist was good. Discussion The use of NMFP in general practice might result in greater accuracy in diagnosing retina and optic disc disease. Routine transmission of NMFP images to specialist eye clinics as part of the referral might improve management and result in health system efficiencies.