Vol 134 No 1546: 26 November 2021

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Issue Summary

Article

SUMMARY

Access to primary care services using public transport in Ōtautahi Christchurch

Molly Hartley, Angela Curl, Rose Crossin, Christina McKerchar

Public transport plays a vital role in improving access to healthcare, particularly for people who do not have access to a car. We mapped and analysed access to primary healthcare (general practitioners) using public transport in Greater Ōtautahi (Christchurch) and examined whether access varies across neighbourhoods and different population groups. Overall, public transport accessibility to primary healthcare across the city is poor, with almost 30% of the population in Greater Ōtautahi being more than 30 minutes from their nearest GP by public transport. In addition, the overall frequency of services was low, which is particularly problematic for those living in the most deprived deciles, who might be more likely to rely on public transport due to lower rates of household car ownership. Improving public transport access to primary healthcare may help meet health equity and sustainability objectives.

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Navigating the health system during COVID-19: primary care perspectives on delayed patient care | OPEN ACCESS

Geraldine Wilson, Zoe Windner, Susan Bidwell, Anthony Dowell, Les Toop, Ruth Savage, Ben Hudson

The study surveyed over 160 New Zealand general practitioners, practice nurses and nurse practitioners over a period of 16 weeks from May last year, examining how they dealt with the pandemic-induced change to healthcare delivery and, for this paper, their perceptions of delayed patient care. We found patients were noted to display different health-seeking behaviors and that there were health system contributors to delayed care, including difficulty referring patients to secondary (hospital-based) care. Certain medical conditions were more commonly impacted, with one general practitioner noting that “Covid did distract us from other diagnosis especially in early days.” These experiences have highlighted a number of ways to minimise future delayed care from pandemic disruption, including reducing barriers to patients seeking care and improving integration and relationships across the health system.

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Barriers and facilitators for Māori in accessing hospital services in Aotearoa New Zealand

Emma Espiner, Sarah-Jane Paine, Maree Weston, Elana Curtis

This paper reports the findings of a literature review to answer the research question, “What are the barriers and facilitators of access to hospital services for Māori?” Our review confirms existing knowledge about practical barriers and facilitators to healthcare access for Māori and contributes to an emerging body of evidence about the impact of racism and culturally unsafe services in preventing Māori from accessing healthcare services. The facilitators identified provide a potential roadmap for the redesign of services, so they are accessible and effective for Māori. Improving services in this way would support district health boards, the Ministry of Health and professional organisations to comply with their commitments to providing culturally safe services and health professionals.

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Cancellation of elective orthopaedic procedures is not a benign practice and is often preventable

Matthew McCall, Mike Peebles, N Amir Sandiford

Total joint arthroplasty, in particular hip and knee arthroplasty, are cost-effective procedures that significantly improve patients’ mobility, independence and quality of life. These operations are being cancelled for largely avoidable reasons, the majority of which are institutional (hospital related). Patients awaiting elective joint replacement, particularly hip replacements, are waiting significantly longer than other operations. The impact of these cancellations and subsequent delays in eventual surgery on patients has not been published in the literature. While awaiting surgery, these patients are at risk of having progression of symptoms and re-presenting to healthcare services with sequelae of their condition, for example pain falls or over-use of opioid analgaesia, not to mention the consequences for the mental health of patients and their families.

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Setting up the Prostate Cancer Outcomes Registry of New Zealand: reflecting and influencing clinical practice

Stephen Mark, Judith Clarke, Brett Shand, Jeremy Millar, Nathan Papa

The Prostate Cancer Outcomes Registry of Australia and New Zealand will collect relevant patient information on men with prostate cancer, allowing us to improve patient care and outcomes. We can compare our New Zealand care to those men in Australia with similar conditions, with a goal to deliver better care in Aotearoa New Zealand.

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How electronically available referral guidelines for primary medical practitioners can improve the timeliness of orchidopexy

Erika M Stark, Spencer W Beasley, Alison Campbell

This paper demonstrates a trend towards earlier referral and surgery for undescended testes that correlates with the introduction of Community HealthPathways website guidelines. Community HealthPathways appears to have led to substantial improvement in the quality of our regional child health services. A similar resource made available in other regions or countries also might be expected to reduce the age of referral for this condition, enabling orchidopexy to be performed more often at the optimal age for the procedure and allow the best long-term outcomes to be obtained.

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Frailty prevalence in Aotearoa New Zealand haemodialysis patients and its association with hospitalisations

Katherine Bloomfield, Zhenqiang Wu, Lai Chan, Janak R de Zoysa

Identification of frailty allows health professionals to focus clinical attention on those people at greater risk of health decline. This is the first Aotearoa New Zealand study of the prevalence of frailty in the haemodialysis population and illustrates that almost 40% of such patients screen positive for frailty. Results show that several factors are associated with the risk of being frail, many of which are unsurprising, such as increasing age. However, we also found that Pacific people had increased association with screening positive for frailty by one of the tools studied. Further larger studies are needed to assess the needs and experiences of people living with frailty in those with renal disease in Aotearoa New Zealand.

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Sensitivity and potential utility of SARS-CoV-2 rapid antigen and nucleic acid amplification tests in the context of an elimination approach | OPEN ACCESS

Jenna Beaumont, Mirsaed Miri Nargesi, Susan Smith, David Harte, Erasmus Smit, James Ussher, Gary McAuliffe

PCR is the current gold standard for detecting the COVID-19 virus. It is a type of nucleic acid amplification test (NAAT), which is a diagnostic technique that works by identifying the genetic material of the virus. Other testing methods include isothermal NAATs, which are similar to PCR tests but use a slightly different technology to identify the genetic material, and rapid antigen tests (RATs), which work by looking for proteins on the surface of the virus. RATs are less expensive than NAATs and operate in a manner similar to that of a home pregnancy test. Standard PCR tests within the laboratory take a number of hours to provide a result. Our study looked at the performance of three rapid NAATs (one rapid PCR and two rapid isothermal NAATs) and five brands of RAT, all of which can provide a result in less than an hour. We found that the rapid PCR test (the Cobas Liat) was just as sensitive at detecting the virus as our standard PCR tests. The rapid isothermal NAATs and the RATs were less sensitive than our standard PCR tests, limiting their utility.

Editorial