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Background: For more than a century, Māori have experienced poorer health than non-Māori. In 2019 an independent Tribunal found the Government had breached Te Tiriti o Waitangi by "failing to design and administer the current primary health care system to actively address persistent Māori health inequities". Many Māori (44%) have unmet needs for primary care. Seven models of primary care were identified by the funders and the research team, including Māori-owned practices. We hypothesised patient health outcomes for Māori would differ between models of care. Methods: Cross-sectional primary care data were analysed at 30 September 2018. National datasets were linked to general practices at patient level, to measure associations between practice characteristics and patient health outcomes. Primary outcomes: polypharmacy (≥ 55 years), HbA1c testing, child immunisations, ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Regressions include only Māori patients, across all models of care. Results: A total of 660,752 Māori patients were enrolled in 924 practices with 124,854 in 65 Māori-owned practices. Māori practices had: no significant association with HbA1c testing, ambulatory sensitive hospitalisations or ED attendances, and a significant association with lower polypharmacy (3.7% points) and lower childhood immunisations (13.4% points). Māori practices had higher rates of cervical smear and cardiovascular risk assessment, lower rates of HbA1c tests, and more nurse (46%) and doctor (8%) time (FTE) with patients. The average Māori practice had 52% Māori patients compared to 12% across all practices. Māori practices enrolled a higher percentage of children and young people, five times more patients in high deprivation areas, and patients with more multimorbidity. More Māori patients lived rurally (21.5% vs 15%), with a greater distance to the nearest ED. Māori patients were more likely to be dispensed antibiotics or tramadol. Conclusions: Māori practices are an expression of autonomy in the face of enduring health system failure. Apart from lower immunisation rates, health outcomes were not different from other models of care, despite patients having higher health risk profiles. Across all models, primary care need was unmet for many Māori, despite increased clinical input. Funding must support under-resourced Māori practices and ensure accountability for the health outcomes of Māori patients in all models of general practice. [ABSTRACT FROM AUTHOR]

ObjectivesTo compare mix of patients, scope of practice, and duration of visit in primary care physicians in Australia, New Zealand, and the United States.DesignComparison of three comparable cross sectional surveys performed in 2001-2. Physicians completed a questionnaire on patients' demographics, diagnoses, and duration of visit.SettingPrimary care practice.Participants79,790 office visits in Australia, 10,064 in New Zealand, and 25,838 in the US.Main outcome measuresDiagnostic codes were mapped to the Johns Hopkins expanded diagnostic clusters. Scope of practice was defined as the number of expanded diagnostic clusters accounting for 75% of all managed problems related to morbidity. Exposure to primary care was calculated from duration of visits recorded by the physician, and reports on rates of visits to primary care for each country.ResultsIn each country, primary care physicians managed an average of 1.4 morbidity related problems per visit. In the US, 46 expanded diagnostic clusters accounted for 75% of problems managed compared with 52 in Australia, and 57 in New Zealand. Correlations in the frequencies of managed health problems between countries were high (0.87-0.97 for pairwise comparisons). Though primary care visits were longer in the US than in New Zealand and Australia, the per capita annual exposure to primary care physicians in the US (29.7 minutes) was about half of that in New Zealand (55.5 minutes) and about a third of that in Australia (83.4 minutes) because of higher rates of visits to primary care in these countries.ConclusionsDespite differences in the supply and financing of primary care across countries, many aspects of the clinical practice of primary care physicians are remarkably similar in Australia, New Zealand, and the US.

Background: Primary care in Aotearoa New Zealand is largely delivered by general practices, heavily subsidised by government. Te Tiriti o Waitangi (1840) guarantees equal health outcomes for Māori and non-Māori, but differences are stark and longstanding. Seven models of primary care have evolved. We hypothesised that patient health outcomes would differ between models of care; and that Māori, Pacific peoples and those living in material deprivation would have poorer outcomes from primary care. Methods: We conducted a cross-sectional study of patient-level data from national datasets and practices, at 30 September 2018, using multilevel mixed effects regression analyses (patients clustered within practices). Primary outcomes, considered to be measures of unmet need for primary care, were polypharmacy (≥ 65 years), HbA1c testing in adults with diabetes, childhood immunisations (6 months), ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Explanatory variables adjusted for patient and practice characteristics. Equity, by model of care, ethnicity and deprivation, was assumed if they showed no significant association with patient outcomes. Patient characteristics included: age, ethnicity, deprivation, multi-morbidity, first specialist assessments and practice continuity. Practice characteristics included: size, funding and doctor continuity. Clinical input (consultations and time with nurses and doctors) was considered a measure of practice response. Results: The study included 924 general practices with 4,491,964 enrolled patients. Traditional practices enrolled 73% of the population, but, on average, the proportion of Māori, Pacific and people living with material deprivation was low in any one Traditional practice. Patients with high health needs disproportionately enrolled in Māori, Pacific and Trust/NGO practices. There were multiple associations between models of care and patient health outcomes in fully adjusted regressions. No one model of care out-performed others across all outcomes. Patients with higher health need received more clinical input but this was insufficient to achieve equity in all outcomes. Being a Māori or Pacific patient, or living in material deprivation, across models of care, remained associated with poorer outcomes. Conclusions: Model-level associations with poor patient outcomes suggest inequity in measures that might be used to target investment in primary care. [ABSTRACT FROM AUTHOR]

Provides a perspective from New Zealand on the role of medical education in addressing racism in medicine. New Zealand nursing curricula have introduced the concept of cultural safety as a means of conveying the idea that cultural factors critically influence the relationship between carer and patient. Describes a cultural immersion program for third-year medical students in New Zealand and discusses some of the strengths and weaknesses of such an approach. (EV)

Introduction. The 2001 Primary Health Care Strategy provided significant new government funding for primary care (general practice and related services) via capitation funding formulas. However, there remain important unanswered questions about how capitation funding formulas should be redesigned to ensure equitable and sustainable service provision to all population groups. Aim. To compare levels of chronic illness, utilisation, and unmet need in patients categorised as ‘high-need’ with those categorised as non-‘high-need’ using the definitions that are used in the current funding context, in order to inform primary care funding formula design. Methods. Respondents of the New Zealand Health Survey (2018–19) were categorised into ‘high-need’ and non-‘high-need’, as defined in current funding formulas. We analysed: (i) presence, and number, of chronic diseases; (ii) self-reported primary care utilisation (previous 12 months); and (iii) self-reported unmet need for primary care (previous 12 months). Analyses used integrated survey weights to account for survey design. Results. In total, 29% of respondents were ‘high-need’, of whom 50.2% reported one or more chronic conditions (vs 47.8% of non-‘highneed’ respondents). ‘High-need’ respondents were more likely than non-‘high-need’ respondents to: report three or more chronic conditions (14.4% vs 13.7%); visit a general practitioner more often (seven or more visits per year: 9.9% vs 6.6%); and report barriers to care. Discussion. There is an urgent need for further quantification of the funding requirements of general practices serving high proportions of ‘high-need’ patients in order to ensure their viability, sustainability and the provision of quality of care. [ABSTRACT FROM AUTHOR]

In this article, we examined the effect of gender concordance on physicians' perception of their patients and of their medical condition, analyzing a data set of 8,258 visit questionnaires from the New Zealand National Primary Care Medical Care Survey conducted in 2001-2002. Multivariate analysis indicated that the concordant female patient/female physician dyad had a positive independent association with physicians' reporting high rapport and a negative independent association with reporting uncertainty about the diagnosis. The discordant female patient/male physician dyad had a positive independent association with physicians' perceptions of uncertainty of diagnosis and hidden agenda, and a negative independent association with rating the patient's condition of high severity. The findings suggest a need to raise male physicians' awareness to possible biases when treating female patients. The findings also suggest the need to empower female patients to take an active partnership role to improve their communication with male physicians. KEYWORDS. Gender concordance, primary care, physicians, perceptions, survey, New Zealand

The aim of this research was to identify a small set of indicators of an individual's deprivation that is appropriate for all ethnic groups and can be combined into a single and simple index of individual socioeconomic deprivation in New Zealand. The NZiDep index of socioeconomic deprivation was derived using the same theoretical basis as the national census-based small-area indices of relative socioeconomic deprivation. The index has been created and validated from the analysis of representative sample survey data obtained from approximately 300 Maori, 300 Pacific, and 300 non-Maori, non-Pacific adults. Twenty-eight deprivation-related characteristics, derived from New Zealand and overseas surveys, were analysed by standard statistical techniques (factor analysis, Cronbach's coefficient alpha, item-total correlations, principal component analysis). The index was validated using information on tobacco smoking, which is known to be strongly related to deprivation. The NZiDep index is based on eight simple questions which take 2-3 min to administer. The index is a significant new (non-occupational) tool for measuring socioeconomic position for individuals. We argue that the index has advantages over existing measures, including a specific focus on deficits, applicability to all adults (not just the economically active), and usefulness for all ethnic groups. Its strengths include focus, simplicity, utility, acceptability across ethnic groups, construct validity, statistical validity, criterion validity (measured with reference to tobacco smoking), and relevance to the current New Zealand context. The index is indicative of deprivation in general, and is designed for use as a variable in research, and for elucidating the relationships between socioeconomic position and health/social outcomes. Keywords: New Zealand; Deprivation; Index; Socioeconomic position; Income poverty; Living standards

Abstract NZDep96 is an index of deprivation for small areas. Originally designed for use in health research, resource allocation and advocacy, it has now become a widely used social research [...]

Abstract The purpose of this paper is to promote debate on the devolution of primary care services to the third sector. The paper first discusses definitions of the term 'third [...]

The article provides an overview of the new coalition government's initial health policies, with a focus on the commitment to implement the Sapere report on capitation funding for primary care. Topic include discusses the urgency for redesigning the capitation formula to address issues of inadequate funding and inequity, highlighting the innovative aspects of the Sapere report that could shape the new funding arrangements.

New Zealand's deprivation index (NZDep91) measures and evaluates socioeconomic disadvantage at a small community level. The index uses household income and occupancy variables, which are adjusted for composition and size to alleviate bias. Principal components analysis identifies linear variable combinations, which account for data variation and target redundancy.

Background: The lack of diversity in the health workforce is partly due to selection criteria for health professional programmes that have not selected students from a wide range of backgrounds. Consequently, health care professionals from minority groups and lower socio‐economic backgrounds are under‐represented in the workforce. Approach: The Socioeconomic Equity (EQ) support programme aims to increase the participation, retention and academic success of students from low socio‐economic communities studying in health professional programmes at the University of Otago. At the start of the academic year, students who had attended a secondary school from a low socio‐economic community were invited to take part in the EQ Programme. This includes group workshops on study skills, guidance from peer mentors, subject specific academic support, one‐on‐one course advice and pastoral support and activities to enhance self‐esteem and self‐efficacy. Evaluation: Comparing the first two years of the EQ project with the previous year, there was an increase in the percentage of students from schools in low socio‐economic communities that passed HSFY. It was also found that more EQ students were offered places in health professional programmes than in the previous year. Implications: The percentage of students passing HSFY has increased, and importantly, the percentage of students from low socio‐economic backgrounds entering professional health programmes has doubled. This is a small start to building a health workforce that fairly reflects people from all communities. [ABSTRACT FROM AUTHOR]