Issue 270 - 16 February 2023

Welcome to the fortnightly Health Improvement and Innovation Digest. The Digest has links to key evidence of interest, with access to new content arranged by topic.

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Article Access

For articles that aren't open access, contact your DHB library, or organisational or local library for assistance in accessing the full text. If your organisation has a subscription, you may be able to use the icon under full text links in PubMed to access the full article.

Māori Innovation

Indigenous Knowledge and the Microbiome-Bridging the Disconnect between Colonized Places, Peoples, and the Unseen Influences That Shape Our Health and Well-Being
This paper, published in mSystems, aims to explore an Indigenous perspective of the microbiome as an unseen influence on health and well-being by framing the importance of the natural environment, Indigenous knowledge and leadership, and future research directions that can contribute to this domain.

Te Maramataka-An Indigenous System of Attuning with the Environment, and Its Role in Modern Health and Well-Being
This conceptual paper, published in the International Journal of Environmental Research and Public Health, highlights a uniquely Indigenous way of understanding the environment (the maramataka) and its connection to health, discusses the connections between the maramataka and scientific research on health and the environment, and introduces current and potential applications of the maramataka in improving health and well-being.

Health Equity (New Zealand)

Effective and respectful interaction with Māori: How the regulators of health professionals are responding to the Health Practitioners Competence Assurance Amendment Act 2019
The aim of this study, published in the New Zealand Medical Journal, was to ascertain the response of registered health professional regulators to the legislated requirement under the Health Practitioners Competence Assurance Amendment Act 2019 (HPCA Amendement Act) that practitioners are culturally competent and, specifically, enabling "effective and respectful interaction with Māori".

Disrupted mana and systemic abdication: Māori qualitative experiences accessing healthcare in the 12 years post-injury
Māori have been found to experience marked health inequities compared to non-Māori, including for injury. Accessing healthcare services post-injury can improve outcomes; however, longer-term experiences of healthcare access for injured Māori are unknown. This paper, published in BMC Health Services Research, reports on data from the longitudinal Prospective Outcomes of Injury Study - 10 year follow up (POIS-10) Māori study in Aotearoa/New Zealand (NZ), to qualitatively understand Māori experiences of accessing injury-related healthcare services long-term.

Health Equity (International)

Population-based physical activity promotion with a focus on health equity: a review of reviews
The extent to which people are physically active is dependent upon social gradients. Numerous studies have shown that especially people with social disadvantages do not meet the physical activity (PA) recommendations. A promising strategy to alleviate this issue are approaches that promote PA in the general population. In addition, several researchers have raised concerns that population-based health interventions may increase health inequities. The aim of the current review of reviews, published in the International Journal for Equity in Health, was to identify successful population-based PA promotion approaches with a particular focus on health equity.

Quality Improvement (New Zealand)

Pou hihiri, Pou o te aroha (Healing and learning from harm)
This new film, published by the Health Quality & Safety Commission, features consumers, clinicians and researchers talking about the benefits of following a restorative approach after a harmful event occurs in health care.

Healing, learning and improving from harm: National adverse events policy 2023
The national adverse events policy 2023, published by the Health Quality & Safety Commission, takes effect from 1 July 2023.

Quality Improvement (International)

Medication review in hospitalised patients to reduce morbidity and mortality
A medication review can be defined as a structured evaluation of a patient's medication conducted by healthcare professionals with the aim of optimising medication use and improving health outcomes. Optimising medication therapy though medication reviews may benefit hospitalised patients. The objective of this Cochrane Review was to examine the effects of medication review interventions in hospitalised adult patients compared to standard care or to other types of medication reviews on all‐cause mortality, hospital readmissions, emergency department contacts and health‐related quality of life.

Strategies to implement multifactorial falls prevention interventions in community-dwelling older persons: a systematic review
One-third of the community-dwelling older persons fall annually. Guidelines recommend the use of multifactorial falls prevention interventions. However, these interventions are difficult to implement into the community. This systematic review, published in Implementation Science, aimed to explore strategies used to implement multifactorial falls prevention interventions into the community. 

Primary Health Care (New Zealand)

Association between enrolment with a Primary Health Care provider and amenable mortality: A national population-based analysis in Aotearoa New Zealand
In Aotearoa New Zealand, being enrolled with a Primary Health Care (PHC) provider furnishes opportunities for lower cost access to PHC, preventative care and secondary health care services, and provides better continuity of care. This study, published in PLoS One, examined the characteristics of populations not enrolled, and whether enrolment is associated with amenable mortality.

The acceptability and utility of Indigenous youth health assessments: a narrative systematic review
Indigenous youth are navigating the transition from childhood to adulthood while contending with challenges of ongoing colonisation and everyday lived experiences of racism. A comprehensive assessment of Indigenous youth’s health could enable early diagnosis and respond to health concerns. This narrative systematic review, published in the Australian Journal of Primary Health, synthesises evidence about the acceptability and utility of primary health care-based health assessments for improving the health and wellbeing of Indigenous youth.

Primary Health Care (International)

Health equity for trans and gender-diverse Australians: addressing the inverse care law through the provision of gender-affirming health care in the primary healthcare setting
Equitable access to gender-affirming hormone treatment (GAHT) for trans and gender-diverse people has been identified as a key factor in addressing rates of poor health outcomes in the trans and gender-diverse community. In Australia, GAHT is largely delivered via a medical model, and within acute care facilities. Medicalisation and pathologisation of gender-affirming care acts as a significant barrier to access for many trans and gender-diverse individuals. This project, published in the Australian Journal of Primary Health, incorporated a case study approach using multiple methods to investigate a recent community sponsored, co-designed program providing GAHT that included a peer navigator (PN) model of care in a primary healthcare (community health) setting.

The effectiveness and cost of integrating pharmacists within general practice to optimize prescribing and health outcomes in primary care patients with polypharmacy: a systematic review
Polypharmacy and associated potentially inappropriate prescribing (PIP) place a considerable burden on patients and represent a challenge for general practitioners (GPs). Integration of pharmacists within general practice (herein ‘pharmacist integration’) may improve medications management and patient outcomes. This systematic review, published in BMC Primary Care, assessed the effectiveness and costs of pharmacist integration.

Smoking Cessation (International)

Implementation strategies to increase smoking cessation treatment provision in primary care: a systematic review of observational studies
Internationally, there is an ‘evidence-practice gap’ in the rate healthcare professionals assess tobacco use and offer cessation support in clinical practice, including primary care. Evidence is needed for implementation strategies enacted in the ‘real-world’. The aim of this review, published in BMC Primary Care, was to identify implementation strategies aiming to increase smoking cessation treatment provision in primary care, their effectiveness, cost-effectiveness and any perceived facilitators and barriers for effectiveness.

Weight Management (International)

Emotional Eating Interventions for Adults Living with Overweight or Obesity: A Systematic Review and Meta-Analysis
Emotional eating (EE) may be defined as a tendency to eat in response to negative emotions and energy-dense and palatable foods, and is common amongst adults with overweight or obesity. There is limited evidence regarding the effectiveness of interventions that address EE. The objective of this study, published in the International Journal of Environmental Research and Public Health, was to synthesize evidence on the effectiveness of EE interventions for weight loss and EE in adults living with overweight or obesity.

Health Sector Initiative

Emergency Q programme helps people access care sooner
The introduction of the Emergency Q (EQ) system at Southland Hospital late last year has helped ease pressure in the Emergency Department by diverting some patients to be seen free of charge in general practice on the same day.

The information available on or through this newsletter does not represent Ministry of Health policy. It is intended to provide general information to the health sector and the public, and is not intended to address specific circumstances of any particular individual or entity.