NEW ZEALAND MEDICAL JOURNAL最新文献

This article makes a case for Māori organisations to investigate developing hospitals in addition to hauora primary care services. Our programme of research on kaumātua hauora has involved ten noho wānanga in Te Tai Tokerau, Waikato and Tauranga Moana. During our wānanga and associated kānohi-ki-kānohi interviews, we heard from older Māori who experienced hospital stays as detrimental to their wellbeing. At a whakahoki kōrero with Waikato kaumātua, we were requested to investigate the rationale for a Māori hospital, a wish that has historical roots in Princess Te Puea Herangi's efforts to create a small hospital at Tūrangawaewae Marae. Her project was stymied by the health authorities of the time. Our observations are backed up by other research demonstrating adverse outcomes for Māori at New Zealand's public hospitals. A small international literature offers some pointers for success in developing hospitals for Indigenous populations. While there are many aspects that would need thorough investigation in a development process (e.g., tikanga, scope, sites, architecture, development finance, cost structures, staffing, clientele and accessibility), we argue that hospitals developed by and for Māori are a long-held dream that could well be enacted in today's health service environment.

Background: There is a lack of literature concerning dermatological conditions affecting patients of Pacific ethnicity.

Aim: To investigate dermatological conditions in patients of Pacific ethnicity referred to dermatology from 2016 to 2022.

Methods: Single-centre study of electronic referrals to dermatology from January 2016 to May 2022.

Results: Pacific ethnicity was recorded for 1.7% of 30,769 referrals to dermatology, under-representing census data for the local population (5.4%). Dermatological diagnoses were eczema in 36% of patients, benign skin lesions in 11% and skin infection in 8.3%.

Conclusion: Eczema was the most common reason for referral to dermatology in patients of Pacific ethnicity in the Waikato Region.

Aim: Quantitative faecal haemoglobin (fHb) measurement by faecal immunochemical test (FIT) is a powerful biomarker for colorectal cancer (CRC) and is incorporated in referral, prioritisation and triage protocols for symptomatic cases in other countries. We report our use of FIT to prioritise new patient symptomatic cases referred for colorectal investigation.

Method: Cases referred for investigation of new colorectal symptoms who were aged ≥50 years (≥40 years Māori/Pacific peoples), who would otherwise be triaged to non-urgent colonoscopy, were asked to provide a stool sample for FIT. Following FIT testing, cases were re-triaged to either urgent colonoscopy, non-urgent colonoscopy or computed tomography colonography (CTC) depending on fHb concentration (measured in micrograms haemoglobin per gram of stool [mcg/g]) and incorporating clinical judgement. At pathway initiation, cases already waiting for colonoscopy on the non-urgent new patient waiting list were approached first, and then new patient (NP) referrals for colonoscopy could be triaged to the pathway at the discretion of the triaging consultant.

Results: Out of 739 cases, 715 (97%) returned FIT samples, and 691 cases completed colorectal investigations. Overall FIT positivity ≥10mcg/g was 17.1%. Fifteen colorectal cancers (CRC) were detected (2.2%). The sensitivity and specificity of FIT ≥10mcg/g for CRC were 80.0% (54.0-93.7%) and 84.3 (81.4-86.9%) respectively. A total of 432 cases (62.5%) completed the pathway without recourse to colonoscopy, and the median time to CRC diagnosis for NP from referral was 25 days.

Conclusion: FIT based prioritisation of cases referred with symptoms concerning for CRC is feasible and reduces time to CRC diagnosis.

Aims: Ethnicity is an important variable, and in Aotearoa New Zealand it is used to monitor population health needs, health services outcomes and to allocate resources. However, there is a history of undercounting Māori. The aim of this study was to compare national and primary care ethnicity data to self-reported ethnicity from a Kaupapa Māori research cohort in the Waikato region.

Methods: Through individual record linkage, prospective self-reported ethnicity, collected using New Zealand Census and Ministry of Health - Manatū Hauora ethnicity protocol as a "gold standard", was compared to ethnicity in secondary and primary healthcare datasets. Logistic regression analyses were used to determine if demographic variables such as age, ethnicity and deprivation are associated with inaccuracies in ethnicity recording.

Results: Māori were undercounted in secondary NHI (32.5%) and primary care (31.3%) datasets compared to self-reported (34.6%). Between 9.5-11% of individuals had a different ethnicity recorded in health datasets than self-reported. Multiple ethnicities were less often recorded (secondary NHI [5.3%] and primary care [5.8%]) compared to self-reported (8.7%). Māori ethnicity (p=0.039) and multiple ethnicity (p<0.001) were associated with lower ethnicity data accuracy.

Conclusion: Routine health datasets fail to adequately collect ethnicity, particularly for those with multiple ethnicities. Inaccuracies disproportionately affect Māori and urgent efforts are needed to improve compliance with ethnicity data standards at all levels of the health system.

Aim: Endometrial cancer (EC) is increasing in incidence in women across Aotearoa New Zealand as risk factors such as obesity and diabetes become more prevalent. In 2022, a Rapid Access Clinic (RAC) for hysteroscopy was implemented at Te Whatu Ora Counties Manukau District to increase early detection of EC.

Method: Plan-Do-Study-Act (PDSA) cycles were used to test and implement RAC supported by a nurse pre-procedural phone consultation. Quantitative data was collected alongside patient experiences of the pre-procedural telephone call.

Results: A total of 207 women successfully completed RAC, which enabled one less visit to clinic per patient, subsequent travel cost savings (NZ$35,959) and a decrease in CO2 emissions (1,782kg). Lead time from first specialist appointment (FSA) to outpatient (OP) hysteroscopy, previously 25 days (SD: 21 days), was eliminated. Wait time from referral to provisional diagnosis increased from 26 days to 31 days; however, standard variation reduced from 30 days to 15 days. Clinician productivity increased by 25% per hysteroscopy session. Twenty-six out of 30 patients reported positive experiences of their pre-procedural RAC phone consultation. Twenty-seven out of 207 women were diagnosed with endometrial cancer from RAC.

Conclusion: RAC are patient-centric and have demonstrated valuable benefits for both clinicians and women with a high suspicion of EC.