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Issue

Vol 135 No 1565: 11 November 2022

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Issue Summary

Article

SUMMARY

Does support received for subsequent injuries differ between Māori and non-Māori? Findings from a cohort study of injured New Zealanders

Emma H Wyeth, Gabrielle Davie, Brett Maclennan, Michelle Lambert, Helen Harcombe, Trudy Sullivan, Sarah Derrett

Māori are less likely to access ACC support and services despite being more likely to experience serious injury than non-Māori. Māori that do receive ACC support are less likely to be referred for certain injury treatment interventions than non-Māori claimants. This paper explored whether there were differences between injured Māori and non-Māori in accessing and receiving support from ACC for treatment and rehabilitation of subsequent injuries (i.e., any injuries sustained in the year following a ‘sentinel’ injury which resulted in an ACC entitlement claim). Despite some limitations, our study found that Māori and non-Māori generally received equitable compensation from ACC for subsequent injuries. More detailed information on the specific needs of those injured is necessary—if the support required for subsequent injuries in truth differed between Māori and non-Māori, then similar levels of compensation would mean inequitable support relative to need.

Article

SUMMARY

Are they ready? A survey of postgraduate year 1 and 2 surgical house officers

Vanshay Bindra, Phillip Chao, Sanket Srinivasa, Jonathan Koea

Medical student teaching has moved away from experienced based teaching with real patients in real clinical situations to more didactic teaching models (lectures and tutorials). A survey of new medical graduates working in hospitals showed that only 50% of responders had ever attended a critical clinical event in their training and that specific teaching in mental and physical self care, managing extended hours of work, clinical prioritization, delegation and workload management is lacking. Given the extreme stress that the health system now finds itself operating under this assumes an even greater priority to prepare our medical graduates adequately to manage in conditions of resource limitation.

Article

SUMMARY

Analysis of deprivation distribution in New Zealand by ethnicity, 1991–2013

Belinda Loring, Sarah-Jane Paine, Bridget Robson, Papaarangi Reid

Since 1991, each neighbourhood in New Zealand has been given a score based on its level of socioeconomic deprivation. NZ European New Zealanders are much more likely to live in socioeconomically privileged areas, and Māori are much more likely to live in socioeconomically deprived areas. Our study found that between 1991 and 2013, there has been virtually no change in the pattern of inequity between Māori and NZ Europeans’ neighbourhood deprivation since 1991. This not only has serious impacts on Māori health, but suggests that government policy efforts over the last two decades have failed to make any difference to the relative inequity in deprivation between Māori and NZ Europeans. The ongoing structural racism maintaining this pattern needs to be named and explicitly addressed if real changes are to be made to the distribution of socio-economic resources, and health outcomes, in New Zealand.

Article

SUMMARY

Understanding the context of hospital transfers and away-from-home hospitalisations for Māori | OPEN ACCESS

Donna Cormack, Bridgette Masters-Awatere, Arier Lee, Arama Rata, Amohia Boulton

Many hospitalisation involve travel away from where a person usually lives. More than 10% of all routine hospitalisations for Māori in the period 2009–2014 involved an “away-from-home” hospitalisation (that is, a hospitalisation in a DHB that was different from the DHB where the person normally lived). These types of hospitalisations also increase as deprivation increases, with over half of Māori away-from-home admissions among people living in areas of high deprivation. Secondary care planning and resourcing should more explicitly consider the needs and costs for whānau for these types of hospitalisations. The current approach, which heavily relies on a reimbursement model, does not support whānau to be able to provide support and care for their whānau member during away-from-home hospitalisations.

Article

SUMMARY

Ethnicity data audit in a secondary care gastroenterology service

Jennifer Randle, Stephen Inns, Ricci Harris, Melissa McLeod

This was a study measuring how accurate ethnicity listed on the hospital record was for 200 patients attending gastroenterology appointments at Hutt Hospital. We found that for about 1 in 10 patients, the ethnicities listed on the hospital database were partially or completely different than what patients reported on gold-standard collection taken at the appointment. This inaccuracy appears to be worse for those who identify as Māori, which is consistent with previous studies and has important implications for the monitoring and provision of equitable healthcare. We also found that ethnicity data can appear to be accurate at the population level (i.e., the same size ethnic groups as expected), but be inaccurate at the individual level (i.e., the groups in each dataset contain different people). We therefore need to be measuring accuracy of ethnicity data at both population and individual levels when it will be used to target individuals for health services.

Viewpoint

SUMMARY

Understanding disparities in post-operative mortality for Indigenous patients

Jason K Gurney, Melissa McLeod, Courtney Thomas, Doug Campbell, Elizabeth Dennett, Sarah Jackson, Dick Ongley, Juliet Rumball-Smith, James Stanley, Diana Sarfati, Jonathan Koea

There is an urgent need for high-quality evidence regarding post-operative mortality among Indigenous peoples. In order to build on this evidence base, our group recently published a national audit of four million procedures conducted between 2005–2017, which found considerable disparities in post-operative mortality between Indigenous Māori and non-Māori New Zealanders. Understanding the things that drive these disparities—for Māori, but likely also other Indigenous populations worldwide—requires us to consider the multiple levels at which these drivers might arise. To that end, in this paper we breakdown these drivers in detail, and present a framework that can be used to begin to understand them—with a view to rousing action and inspiring intervention to address them.

Clinical Correspondence

SUMMARY

A rare case of penetrating intra-abdominal trauma by a fishing speargun

Sohil Pothiawala, Ian Civil

Spearfishing is a popular sport in New Zealand. Accidental speargun injuries while fishing can be life-threatening and there is no legislation regarding the use of spearguns. Users do not require a license despite the potential for severe penetrating trauma similar to that caused by firearms. Safety guidelines need to be published and widely available, and the potential risks of speargun injuries should be included in fishing rules. Introducing license requirement for possession and handling of this firearm-like weapon also needs to be considered.

Article

SUMMARY

Asian New Zealanders’ experiences of racism during the COVID-19 pandemic and its association with life satisfaction | OPEN ACCESSS

Rebekah Jaung, Lynne Soon-Chean Park, Joohyun J Park, David Mayeda, Changzoo Song

In Aotearoa and globally, the COVID-19 pandemic has highlighted racism in our society, including targeted anti-Asian hatred. Our study describes experiences of racism for Asian people in Aotearoa and the association between these experiences and life satisfaction during the first 18 months of the COVID-19 pandemic. Overall, 40% of participants had experienced racism since the start of the pandemic. We also identified three underrepresented subgroups, students/young people, those living in non-urban areas and temporary migrants, who experienced higher levels of racism. The study also revealed an association between COVID-era racism and life satisfaction. These findings inform us where anti-racism actions are most needed, and that such activities should be included in efforts to ensure the wellbeing of Asian communities in a pandemic context.

Article

SUMMARY

Socio-economic deprivation and healthcare service use of young people with type 1 and type 2 diabetes

Sasini M. Wijayaratna, Arier Lee, Emmanuel Jo, Hyun Young Park, Tim Cundy, Warwick Bagg

Young-onset type 2 diabetes is a growing health concern associated with a high risk of diabetes complication. Young people with type 2 diabetes living in more socio-economically deprived areas were more likely to have a delayed referral to specialist diabetes services and were less likely to attend diabetes clinic appointments, which was in turn associated with higher blood sugar levels. Socio-economic deprivation was also associated with a higher number of hospital admissions. Socio-economic deprivation needs to be addressed in developing a more equitable model of care for young people with type 2 diabetes.

Article

SUMMARY

Feasibility and acceptability of telehealth and contactless delivery of human papillomavirus (HPV) self-testing for cervical screening with Māori and Pacific women in a COVID-19 outbreak in Aotearoa New Zealand

Karen Bartholomew, Jane Grant, Anna Maxwell, Collette Bromhead, Fiona Gillett, Rajneeta Saraf, Kate Moodabe, Susan M Sherman, Georgina McPherson, Deralie Flower, Jyoti Kathuria, Sue Crengle, Richard Massey, Nina Scott, Pania Coote

A small proof-of-concept study was undertaken to determine the feasibility and acceptability of a telehealth offer and contactless delivery of HPV cervical screening self-test during the 2021 COVID-19 Level 4 lockdown in Auckland. One hundred and ninety-seven never-screened, due or overdue Māori and Pacific women enrolled in a local Primary Health Organisation (PHO) were invited to take part. Study invitation, active follow-up, nurse-led discussion, result notification and post-test questionnaire were all delivered through telehealth. Out the 197 invited women, 86 women were successfully contacted, 66 agreed to take part and 61 women returned the samples. Uptake of cervical self-test of all contactable women was 70.9%. Six of the 61 self-tests (9.8%) were positive for Human Papillomavirus (HPV), all for non 16/18 types, and were referred for cytology. Three had negative cytology and 3 with positive cytology results were referred for colposcopy. The current study shows that the offer of HPV self-testing during COVID-19 lockdown was both feasible and highly acceptable for Māori and Pacific women.

Editorial

SUMMARY

The long road to good care

Jason K Gurney

t is often more difficult for Māori to access good healthcare in Aotearoa New Zealand. Sometimes, this is because more Māori live in rural areas than non-Māori, and so have to travel further to access care than non-Māori. This is compounded by the fact that Māori are much more likely to live in deprivation, and so are less likely to be able to pay the up-front costs associated with travelling to access care. This editorial highlights the findings of recent research in the context of inequities in travel to access care for Māori in Aotearoa New Zealand, and offers some recommendations for a pathway forward.

Editorial