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INTRODUCTION: Clinical reminders have been shown to help general practice achieve an increase in some preventive care items, especially if they identify a patient's eligibility for the target item, prompt clinicians at the right time, provide a fast link to management tools and facilitate clinical recording. WRPHO has introduced the Patient Dashboard clinical reminder and monitored its impact on health targets. AIM: This paper reports the impact of a computerised colour-coded clinical reminder on achieving agreed health targets in Whanganui regional practices. METHODS: Patient was developed from previous versions in Auckland and northland and provided to Whanganui regional practices with Primary Health Organisation (PHO) support. The Dashboard was linked with existing and new clinical management tools which automatically updated clinical records. Data from practices was pooled by Whanganui Regional Primary Health Organisation and target achievement rates reported over 15 months. RESULTS: Over the initial 15 months of Patient Dashboard use, recording of smoking status increased from 74% to 82% and of alcohol use from 15% to 47%. Screening for diabetes increased from 62% to 74%, cardiovascular risk assessment from 20% to 43%, cervical screening from 71% to 79%, and breast screening from 60% to 80%. DISCUSSION: Patient Dashboard was associated with increased performance indicators both for those targets which were part of a PHO programme and for targets without additional support. [ABSTRACT FROM AUTHOR]

This paper addresses the systematics of the New Zealand spiders of the family Malkaridae. Malkarids are small araneoid spiders that live primarily in the leaf litter and mosses of temperate and tropical wet forests in Australia and New Zealand, with the exception of a single species in southern South America and another in New Caledonia. We treat the New Zealand species of Malkaridae that are not members of the subfamily Pararchaeinae, a monophyletic group of 11 new species that we classify in 2 new genera (Tingotingo , gen. nov. and Whakamoke , gen. nov.) and a new subfamily (Tingotinginae, subfam. nov.). We describe, diagnose, illustrate and map the distribution of specimen records of these 11 new species of New Zealand Malkaridae: Tingotingo porotiti , sp. nov., T. pouaru , sp. nov., T. tokorera , sp. nov., T. aho , sp. nov., Whakamoke orongorongo , sp. nov.; W. tarakina , sp. nov.; W. guacamole , sp. nov.; W. hunahuna , sp. nov.; W. paoka , sp. nov.; W. heru , sp. nov.; and W. rakiura , sp. nov. We also treat the phylogenetic relationships of Malkaridae and use the results of our previous work on the molecular phylogeny of Araneoidea as the bases for the classification of the family. Tingotingo , gen. nov. and Whakamoke , gen. nov. are sister clades. Tingotinginae, subfam. nov. is the sister group of the Malkarinae plus Pararchaeinae clade. We further hypothesise and discuss the morphological synapomorphies of Malkaridae, Tingotinginae, subfam. nov. and the two new genera. This study addresses the systematics of Malkaridae in New Zealand. We describe 2 new genera and 11 new species from New Zealand, and provide an overview of the systematics of the family. [ABSTRACT FROM AUTHOR]

Objectives: HealthPathways, pioneered in Canterbury, New Zealand, in 2008, is a web-based tool designed to promote health care integration and patient management in primary care and to reduce fragmentation in the delivery of health services. This cross-sectional study evaluated the utilisation and perceptions of this tool among health professionals in Australia and New Zealand. Methods: A cross-sectional survey was administered online through Research Electronic Data Capture (REDCap) to general practitioners (GPs), practice nurses and managers, nurse practitioners, specialist and community nurses, hospital clinicians, nurses, managers, and allied health professionals between April and September 2018. The frequency of HealthPathways use in the previous month was modelled as an ordered response using an ordered logistic regression model after adjusting for the possible effects of sex, age, years in clinical practice, location and time spent in practice. Results: Health professionals perceived HealthPathways to be useful in primary care management and referral, as well as in the prereferral treatment of patients. GPs in New Zealand, New South Wales and Victoria were 73%, 47% and 27% more likely to have used HealthPathways ≥10 times in the previous month respectively. Conclusion: The results suggest that HealthPathways is having a positive effect on healthcare systems in New Zealand and Australia. However, differences in uptake suggests the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change. What is known about the topic?: Early evaluations suggest that HealthPathways is a useful tool for health professionals, although uptake and utilisation may be limited. However, there is no comparative evidence regarding uptake and implementation of the tool. What does the paper add?: This study is among the first to provide a comparative narrative of the literature assessing the implementation and uptake of HealthPathways across Australia and New Zealand. It is also among the first to compare the perceptions of allied health professionals in the use of HealthPathways across Australia and New Zealand. What are the implications for practitioners?: The results of this study suggest the need for focused implementation, integration into eReferral software and expanding the tool to medical students, registrars, allied health professionals and potentially patients to encourage behavioural change. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore whether a relationship exists between the number of disasters a jurisdiction has experienced and the presence of disaster-specific pharmacy legislation. Methods: Pharmacy legislation specific to disasters was reviewed for five countries: Australia, Canada, UK, US and New Zealand. A binary logistic regression test using a generalised estimating equation was used to examine the association between the number of disasters experienced by a state, province, territory or country and whether they had disaster-specific pharmacy legislation. Results: Three of six models were statistically significant, suggesting that the odds of a jurisdiction having disaster-specific pharmacy legislation increased as the number of disasters increased for the period 2007–17 and 2013–17. There was an association between the everyday emergency supply legislation and the presence of the extended disaster-specific emergency supply legislation AH19093_IE1.gif. Conclusions: It is evident from this review that there are inconsistencies as to the level of assistance pharmacists can provide during times of crisis depending on their jurisdiction and location of practice. It is not a question of whether pharmacists have the skills and capabilities to assist, but rather what legislative barriers are preventing them from being able to contribute further to the disaster healthcare team. What is known about the topic?: The contributing factors to disaster-specific pharmacy legislation has not previously been explored in Australia. It can be postulated that the number of disasters experienced by a jurisdiction increases the likelihood of governments introducing disaster-specific pharmacy legislation based on other countries. What does this paper add?: This study compared five countries and their pharmacy legislation specific to disasters. It identified that as the number of disasters increases, the odds of a jurisdiction having disaster-specific emergency supply or disaster relocation or mobile pharmacy legislation increases. However, this is likely to be only one of many factors affecting the political decisions of when and what legislation is passed in relation to pharmacists' roles in disasters. What are the implications for practitioners?: Pharmacists are well situated in the community to be of assistance during disasters. However, their ability to help patients with chronic disease management or providing necessary vaccinations in disasters is limited by the legislation in their jurisdiction. Releasing pharmacists' full potential in disasters could alleviate the burden of low-acuity patients on other healthcare services. This could subsequently free up other healthcare professionals to treat high-acuity patients and emergencies. [ABSTRACT FROM AUTHOR]

Objective: This study reports on the characteristics of individuals conducting health service research (HSR) in Australia and New Zealand, the perceived accessibility of resources for HSR, the self-reported impact of HSR projects and perceived barriers to conducting HSR. Methods: A sampling frame was compiled from funding announcements, trial registers and HSR organisation membership. Listed researchers were invited to complete online surveys. Close-ended survey items were analysed using basic descriptive statistics. Goodness of fit tests determined potential associations between researcher affiliation and access to resources for HSR. Open-ended survey items were analysed using thematic analysis. Results: In all, 424 researchers participated in the study (22% response rate). Respondents held roles as health service researchers (76%), educators (34%) and health professionals (19%). Most were employed by a university (64%), and 57% held a permanent contract. Although 63% reported network support for HSR, smaller proportions reported executive (48%) or financial (26%) support. The least accessible resources were economists (52%), consumers (49%) and practice change experts (34%); researchers affiliated with health services were less likely to report access to statisticians (P < 0.001), economists (P < 0.001), librarians (P = 0.02) and practice change experts (P = 0.02) than university-affiliated researchers. Common impacts included conference presentations (94%), publication of peer-reviewed articles (87%) and health professional benefits (77%). Qualitative data emphasised barriers such as embedding research culture within services and engaging with policy makers. Conclusions: The data highlight opportunities to sustain the HSR community through dedicated funding, improved access to methodological expertise and greater engagement with end-users. What is known about the topic?: HSR faces several challenges, such as inequitable funding allocation and difficulties in quantifying the effects of HSR on changing health policy or practice. What does this paper add?: Despite a vibrant and experienced HSR community, this study highlights some key barriers to realising a greater effect on the health and well-being of Australian and New Zealand communities through HSR. These barriers include limited financial resources, methodological expertise, organisational support and opportunities to engage with potential collaborators. What are the implications for practitioners?: Funding is required to develop HSR infrastructure, support collaboration between health services and universities and combine knowledge of the system with research experience and expertise. Formal training programs for health service staff and researchers, from short courses to PhD programs, will support broader interest and involvement in HSR. [ABSTRACT FROM AUTHOR]

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]

The concept of commissioning is starting to gain traction in the Australian health system. Primary Care Networks began operations in July 2015 with a remit around commissioning health services. Despite the centrality of this concept, we know relatively little about commissioning in Australia. Other systems have experimented with it for some time, and this paper reviews the evidence and lessons inherent within the international literature. The study defines commissioning, and explores experiences of others who have adopted commissioning approaches and the evidence concerning the outcomes of these experiments. Commissioning is a difficult topic in many senses and its application to a complex area such as health reform can make it even more challenging. Ultimately, this evidence suggests that commissioning is more than simply a technical or operational process, but one that is value-based and relational. This is not to downplay the technical aspects, which in many jurisdictions have resulted in explicit and evidenced-based approaches to planning and priority setting. However, if new commissioning organisations, such as Primary Health Networks, are to have an impact, they need to balance the operational and relational elements of commissioning. [ABSTRACT FROM AUTHOR]

Introduction. Rural hospitals provide secondary care for much of the rural New Zealand population. Little is known about community perspectives of the health and social contribution. Aim. This descriptive qualitative study aimed to explore community views on the role of their rural hospital in a low socioeconomic rural district with a high Māori and Pacific population. Methods. Semi-structured individual and focus group interviews were conducted with rural community members about the perceived role of their rural hospital. Iterative thematic analysis was undertaken. Results. In total, 22 participants were interviewed. Thematic analysis yielded four themes: (i) rural hospitals as a safety net – providing access to emergency care and mitigating limited primary care access; (ii) providing personalised, culturally aware care; (iii) facilitating family/whanau support; and (iv) doing the best with limited resources. The latter included pragmatism about resource constraints, but a preference for the hospital to remain open. Discussion. Rural hospitals contribute to community safety by enhancing access to emergency care and mitigating difficulties in access to primary care. The local contextual knowledge of rural hospital providers allows personalised, family-centred and culturally-responsive care. Despite service centralisation, rural hospitals are wanted by their communities. Rural health planners should consider how to maximise the breadth of locally-provided services to reduce the impacts of travel and transfer for care [ABSTRACT FROM AUTHOR]

Introduction. Evaluating digital health services from an ethical perspective remains one of the more difficult challenges in telemedicine and health technology assessment. We have previously developed a practical ethical checklist comprising 25 questions covering six ethical themes: privacy, security, and confidentiality; equity; autonomy and informed consent; quality and standards of care; patient empowerment; and continuity of care. The checklist makes ethical analysis more easily accessible to a broader audience, including health care providers, technology developers, and patients. Aim. This project applies the previously developed practical ethical checklist to direct-to-consumer virtual primary care consultation services in Aotearoa New Zealand to conduct an ethical assessment. Method. We first mapped the available services. The ethical framework was then applied to assess these services based on publicly available information. Results. Our findings show that the examined virtual consultation services adequately address ethical considerations, particularly regarding patient data privacy and informed consent. We identified areas for improvement in equity, patient empowerment, and continuity of care. Discussion. The application of this framework raises fundamental questions on how continuity of care, equity, and comprehensive care can be protected when virtual care becomes more ubiquitous. The checklist can help virtual consultation services identify areas of improvement and ensure they meet ethical criteria, thus contributing to quality of care. The framework may be adapted to other digital health services and tools, providing ethical guidance to technology developers, clinicians, and patients and their whānau (family). [ABSTRACT FROM AUTHOR]

Introduction. The use of telephone and video consultations has vastly increased since the onset of the COVID-19 pandemic. Health care providers in traditional clinical practices have embraced these virtual consultations as an alternative to face-to-face consultations, but there has also been a simultaneous increase in services offered directly to consumers via commercial entities. One of the main challenges in telemedicine (and the broader field of digital health) is how to conduct a meaningful ethical assessment of such services. Aim. This article presents a novel framework for practical ethical analysis of direct-to-consumer virtual general practitioner consultation services in Aotearoa New Zealand. Methods. First, a scoping review of academic and policy documents identified the core ethical challenges arising from virtual consultations. Second, a qualitative analysis was conducted to translate the main ethical themes and subthemes into practical questions to assess virtual general practice services. Results. A total of 49 relevant documents were selected for review. The six key ethical themes related to telemedicine were: privacy, security, and confidentiality; equity; autonomy and informed consent; quality and standards of care; patient empowerment; and continuity of care. A practical ethical checklist consisting of 25 questions was developed from these themes and their subthemes. Discussion. The checklist provides an accessible way of incorporating ethics into technology assessment and can be used by all relevant stakeholders, including patients, health care providers, and developers. Application of the framework contributes to improving the quality of virtual consultation services with a specific focus on ethics. [ABSTRACT FROM AUTHOR]

Introduction. International research suggests free online postal self-sampling for sexually transmitted infection (STI) testing is an acceptable alternative to clinic-based testing. A userpays online STI testing service exists in Aotearoa New Zealand, but acceptability among priority populations is unknown. Aim. To explore Māori and Pacific young people’s perspectives on online postal self-sampling for STI testing (as prospective service users). Methods. Four wānanga (knowledge-sharing forum) were held between November 2022 and May 2023 with Māori and Pacific participants aged 15–24 years who were recruited via youth-focused community organisations. Three facilitators guided discussions about STI testing and use of an online service. Inductive thematic analysis was used to analyse data generated from audio-recorded discussions, group work notes and facilitator field notes. Results. None of the 38 participants were aware of online STI testing and all considered it cost-prohibitive. Perceptions of online testing were mixed, and discussion about concerns outweighed perceived benefits. Three themes were identified: (i) potential to support autonomy (perceived benefits and positive features of self-sample collection kits); (ii) barriers and process-related concerns; and (iii) tailoring online STI testing to young people’s needs (facilitating engagement with online testing). Discussion. For online STI testing to be an accessible alternative to clinic-based testing for priority populations, cost, low awareness and other barriers in the testing pathway need to be addressed. Clinician follow-up on positive results and free treatment would be critical to ensure the cycle of best practice care is completed. Regardless of where testing is accessed, investment is needed to support young people’s knowledge of when, why and how to access a sexual health check. [ABSTRACT FROM AUTHOR]

This paper highlights the importance of people as a central factor in improving health for Māori (Indigenous people of New Zealand). How whānau (family) relationships, connections, values and inspiration are integral to achieving Indigenous health goals is explained. Descriptions of how community researchers, healthcare staff, consumers and academics worked together to design interventions for two health services (in the Waikato and Bay of Plenty regions) is included. Through highlighting the experiences of health consumers, the potential for future interventions to reduce the advancement of pre-diabetes among whānau is described. Evidence from the study interviews reinforces the importance of whānau and whakapapa (heritage) as enabling factors for Indigenous people to improve health. Specifically, the positive effect of whānau enhancing activities that support peoples' aspirations of tino rangatiratanga (self-determination) in their lives when engaging with health care has been observed. This study highlights the many positives that have emerged, and offers an opportunity for taking primary health to the next level by placing whānau alongside Indigenous primary care providers at the centre of change strategies. [ABSTRACT FROM AUTHOR]

Critically reflecting on researcher–community partnerships is a key component in implementing chronic condition interventions in Indigenous communities. This paper draws on the results and learnings from a process evaluation that measures how well two research–community partnerships have followed the He Pikinga Waiora (HPW) Implementation Framework while co-designing chronic condition interventions in primary care. The HPW framework is centred on Indigenous self-determination and knowledge surrounded by community engagement, cultural centredness, systems thinking and integrated knowledge translation. The evaluation included in-depth interviews and online surveys with 10 team members. The findings demonstrate that the HPW framework was followed well, with strengths particularly in community engagement and relationship building. Areas for improvement included systems thinking and integrated knowledge translation to support sustainability of the interventions. The need for partnerships to use process evaluation results to support critical reflection is asserted, which helps build strong trust and synergy, power sharing and effective and sustainable implementation practices. It is concluded that the HPW framework is well suited to evaluating implementation of health interventions in primary care as it assists in the facilitation of better collaboration between researchers and Indigenous communities, and encourages the implementation team to reflect on power and privilege. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The health sector is facing considerable challenges to meet the health needs of rural communities. Nurse practitioners (NPs) deliver primary health care (PHC) services similar to general practitioner (GP) services, within a health equity and social justice paradigm. Despite GP workforce deficits, New Zealand has been slow to effectively utilise NPs. AIM: From a larger study exploring the establishment of NP services, this paper reports on the barriers and facilitators to becoming a NP in rural PHC. METHODS: Overall, 13 NPs and 4 NP candidates participated in individual or group interviews. Participants were employed in a variety of PHC settings from six district health boards across New Zealand. Using a scaffold map constructed to show the stages of the pathway from nurse to NP, data were analysed to identify experiences and events that facilitated or were barriers to progress. RESULTS: Experiences varied considerably between participants. Commitment to the development of the NP role in their local areas, including support, advanced clinical opportunities, supervision, funding and NP job opportunities, were critical to progression and success. Existing GP shortages and the desire to improve health outcomes for communities drove nurses to become NPs. DISCUSSION: Implementation of the NP workforce across New Zealand remains ad hoc and inconsistent. While there are pockets of great progress, overall, the health sector has failed to embrace the contribution that NPs can make to PHC service delivery. A national approach is required to develop the NP workforce as a mainstream PHC provider. [ABSTRACT FROM AUTHOR]

Objective: The aim of the present study was to evaluate the short-term outcomes of two health science academies established by a district health board in South Auckland, New Zealand, to create a health workforce pipeline for local Māori and Pasifika students. Methods: A mixed-methods approach was used, involving background discussions with key informants to generate an initial logic model of how the academies work, followed by secondary analysis of students' records relating to retention and academic achievement, a survey of senior academy students' interest in particular health careers and face-to-face interviews and focus groups with students, families and teachers. Results: Academy students are collectively achieving better academic results than their contemporaries, although selection decisions are likely to contribute to these results. Academies are retaining students, with over 70% of students transitioning from Year 11 to Years 12 and 13. Senior students are expressing long-term ambitions to work in the health sector. Conclusions: Health science academies show promise as an innovative approach to supporting Māori and Pasifika students prepare for a career in the health professions. Evaluating the long-term outcomes of the academies is required to determine their contribution to addressing inequities in the local health workforce. What is known about the topic?: Despite progress in health workforce participation for underrepresented indigenous and ethnic minority groups in New Zealand, significant disparities persist. Within this context, a workforce development pipeline that targets preparation of secondary school students is recommended to address identified barriers in the pursuit of health careers. What does this paper add?: We provide an evaluation of an innovative district health board initiative supporting high school students that is designed to ensure their future workforce is responsive to the needs of the local community. What are the implications for practitioners?: The findings have implications for decision makers in health workforce planning regarding the benefits of investing at an early stage of the workforce development pipeline in order to build an equitable and diverse health professions workforce. [ABSTRACT FROM AUTHOR]

Objective: To examine the impact and cost associated with mental illness. Methods: A rapid review of the literature from Australia, New Zealand, UK and Canada was undertaken. The review included literature pertaining to the cost-of-illness and impact of mental illness as well as any modelling studies. Included studies were categorised according to impact on education, labour force engagement, earlier retirement or welfare dependency. The well-accepted Drummond 10-point economic appraisal checklist was used to assess the quality of the studies. Results: A total of 45 methodologically diverse studies were included. The studies highlight the significant burden mental illness places on all facets of society, including individuals, families, workplaces and the wider economy. Mental illness results in a greater chance of leaving school early, a lower probability of gaining full-time employment and a reduced quality of life. Research from Canada suggests that the total economic costs associated with mental illness will increase six-fold over the next 30 years with costs likely to exceed A$2.8 trillion (based on 2015 Australian dollars). Conclusions: Mental illness is associated with a high economic burden. Further research is required to develop a better understanding of the trajectory and burden of mental illness so that resources can be directed towards cost-effective interventions. What is known about the topic?: Although mental illness continues to be one of the leading contributors to the burden of disease, there is limited information on the economic impact that mental illness imposes on individuals, families, workplaces and the wider economy. What does this paper add?: This review provides a summary of the economic impact and cost of mental illness. The included literature highlights the significant burden mental illness places on individuals, families, workplaces, society and the economy in general. The review identified several areas for improvement. For example, only limited information is available on the impact of attention deficit hyperactivity disorder, anxiety, cognitive function, conduct disorder, eating disorder and psychological distress. There was also a dearth of evidence on the intangible elements of pain and suffering of people and their families with depressive disorders. More research is required to better understand the full extent of the impact of mental illness and strategies that may be implemented to minimise this harm. What are the implications for practitioners?: Knowing the current and future impact of mental illness highlights the imperative to develop an effective policy response. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The Medicines (Standing Order) Amendment Regulations 2011 allow medicines to be supplied or administered to a patient by a nurse in the absence of a medical practitioner and without a prescription. Regulations have been in place since 2002, but no substantive research has occurred in New Zealand concerning their use. AIM: This paper reports a survey of registered nurses (RNs) who work in primary health care (PHC) settings and explores aspects of their practice relating to their use of standing orders. METHODS: A self-reported survey using a non-probability sample of RNs working in PHC who use standing orders in their practice (n=231). Data were analysed descriptively. RESULTS: The sample were experienced RNs (mean 24 years since registration) and 53% have a post-graduate qualification. Some nurses' understanding of a standing order included provision of a prescription to a patient. Standing orders were used frequently (42% reported use 1 to >5 times/day) for a wide variety of conditions. There is a significant relationship between undertaking the stated professional development requirements and confidence in the clinical decisions made (p=0.025). Over half (52%) would like to use standing orders more often. DISCUSSION: Standing orders are used extensively in PHC settings. The conditions nurses are involved in treating are usually already differentiated or have a high degree of diagnostic certainty. Nurses can effectively provide medicines under standing orders when doctors support their use, issue evidence-based orders, and have confidence in nurses with advanced skills. Doctors need to meet their responsibilities under the Regulations. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including Plan B group make an argument against lockdowns, and health policy.

INTRODUCTION: There is growing interest in increasing uptake of hepatitis C (HCV) treatment. HCV is strongly associated with injecting drug use and is a stigmatised illness. People with HCV may be reluctant to engage with health care services. A community-based, nurse-led integrated care clinic was established in Christchurch, New Zealand with the intention of bridging the health care gap for those unwilling or unable to access mainstream health care. This paper explores the experiences and perceptions of health professionals regarding the implementation of this clinic, with particular attention paid to the interprofessional relationships relevant to the clinic. METHODS: Qualitative, in-depth interviews were conducted with 24 stakeholders, including four staff of the clinic and other service providers with varying relationships to the clinic. FINDINGS: Participants generally endorsed the clinic model and described its operation as easy to access, non-judgmental and non-threatening, and, therefore, able to attract and engage 'hard-to-reach' clients. The clinic model was also thought to support more effective use of health resources. Some participants expressed concerns regarding the potential 'poaching' of patients from other services (particularly general practice) and indicated a preference for HCV treatment services to be restricted to hospital settings. CONCLUSION: The findings of this study suggest the need to address concerns of general practitioners regarding patient poaching. Key information to disseminate is the clinic's success in engaging with complex clients and contribution to more efficacious use of health service resources. These activities may require the advocacy of a key local opinion leader acting as 'knowledge broker'. [ABSTRACT FROM AUTHOR]

The author discusses the use of an area-based deprivation in New Zealand called NZDep index in quantitative sociological research, based on the paper "NZiDep: A New Zealand Index of Socioeconomic Deprivation for Individuals," by C. Salmond, P. Crampton and P. King et al. The paper compares the NZiDep they created and the ELSI measure of living standards adopted by the Ministry of Social Development. The author cites the limitation of the NZiDep in measuring health outcomes.

Objective. Patient navigation originated as an approach for reducing disparities in cancer care and consequent health outcomes. Over time navigator models have evolved and been used to address various health issues in differing contexts. This case study outlines the evolution, purpose and effects of a lay-led health navigator model in a deprived, sparsely populated, New Zealand rural setting, where primary care services are frequently understaffed and routinely overstretched. Methods. Routinely collected service utilisation data, survey results and health navigator interview data were utilised to illustrate the client group the service works with, why primary care refer to the service, as well as lessons learned from implementation to ongoing service provision. Results. Those referred to the navigator service generally represented the most vulnerable in the community. Survey respondents, overall, were highly satisfied with the service. Navigators identified barriers and facilitators to implementation, as well as ongoing obstacles and enablers to service provision. Conclusions. This lay-led navigator service provided support to a group of unwell individuals, with few resources and multiple barriers to negotiate, and has effectively engaged with health and social care services, while overcoming various barriers and obstacles to its establishment and ongoing operation. What is known about the topic? Patient navigation models of care were first employed in the 1990s, as a strategy to increase the uptake of cancer screening among disadvantaged women. They have since expanded across the cancer care continuum, but despite favourable findings, information regarding their potential in other settings is limited. What does this paper add? This paper provides a perspective on lay-led navigation services within a rural New Zealand primary care setting. The views of primary care professionals regarding the role and value of the service are provide, as is a summary of the key lessons learnt over the implementation, establishment and ongoing service delivery phases of the programme. What are the implications for practitioners? This case study proposes that lay-led navigation services can provide practical support to primary care; assisting it to meet the needs of patients living with multiple chronic conditions and social challenges. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The prevalence of long-term health conditions (LTCs) continues to increase and it is normal for people to have several. Lifestyle is a core feature of the self-management support given to people with LTCs, yet it seems to fail to meet their needs. From a larger study exploring the experiences of this group, this paper reports on the role of food and mealtimes, and the effect of the nutritional advice on the lives of people with several LTCs. METHODS: The experiences of 16 people with several advanced LTCs were explored using multiple qualitative case studies. Over an 18-month period, contact with participants included monthly conversations, two longer, semi-structured interviews and one interview with their primary care clinicians. The data were analysed inductively using thematic analysis. RESULTS: There was profound social, psychological and cultural significance of food to the participants. These aspects of food were then described using the Whare Tapa Wha model of health. The approach to food and nutrition participants experienced in health care was closely associated with conventional weight management. They found this advice largely irrelevant and therefore ineffective. DISCUSSION: The pressure people with several LTCs experience during clinical encounters has perverse effects on wellbeing and reinforces an overall sense of failure. This research challenges the assumption that all people have the will, agency and income to follow the advice they receive about nutrition and exercise. Considering people's needs using the Whare Tapa Wha model of health offers clinicians a framework to re-conceptualise the core features of self-management support and provide realistic, compassionate care that will optimise the quality of life for people with multiple LTCs. [ABSTRACT FROM AUTHOR]

This paper analyses biogeography and ecology in the grass Simplicia , endemic to New Zealand, with respect to tectonic geology and to distributions in other groups of plants and animals. There are disjunctions and phylogenetic breaks at the Oparara basin (north-west Nelson), the Western Province–Eastern Province tectonic boundary, the Alpine fault and the Waihemo fault zone (Otago). Distribution boundaries at these localities recur in many other taxa and coincide spatially with important fault zones. General aspects of distribution and evolution in Simplicia are addressed, using a set of critical questions posed by McGlone (2015) as a conceptual framework. The biogeographic evidence suggests that the divergence of Simplicia and of its species took place by vicariance, and that this was mediated by tectonics. All individual plants of Simplicia have dispersed to their present locality, but there is no evidence that chance dispersal with founder speciation has occurred in the genus. Trends in these grasses, such as spikelet reduction, are global and have evolved in many different environments over tens of millions of years. This suggests that non-random mutation has been more important than environment and natural selection in directing the course of evolution. [ABSTRACT FROM AUTHOR]

This paper aims to consider the various parts of what is required to achieve the best possible health outcomes from medicines in partnership with the person for whom they are prescribed. Specifically, it looks to highlight the process from an Indigenous view with respect to Māori in Aotearoa New Zealand, and claims a multi-dimensional approach is imperative. Attaining optimal use of medicines is necessary to help achieve health equity. There is an urgent need to understand and investigate models of care that achieve this optimal state. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Pastoral care is recognised as an important aspect of a mature primary care network. Pegasus Health is now in its 25th year and has had a formal Pastoral Care Programme for doctors since 2009. AIM: This study aimed to collect local data on the self-care of Canterbury (Christchurch, New Zealand) general practitioners (GPs), nurse practitioners (NPs), practice nurses (PNs) and community pharmacists (CPs). METHODS: The survey was open to all participants in the Pegasus Small Group Education Programme in Canterbury. From a survey circulated to approximately 1100 primary care professionals, 504 responses were collected either electronically or as hard copies. RESULTS: The themes that emerged were similar among all the health professional groups. A significant proportion of health professionals took minimal annual leave and even more worked while ill. CPs were the group with the highest rates in both these areas. Reasons given for this focused largely on a lack of locum cover. DISCUSSION: Locum cover is a significant issue in Canterbury for all health professional groups in the study. The issue of locums is now being reviewed in Canterbury partly as a result of this study. Consideration is also being given to how the Pastoral Care Programme can be made more widely available. [ABSTRACT FROM AUTHOR]

Galaxias maculatus is a declining amphidromous fish that supports New Zealand's culturally important whitebait fisheries targeting the migratory juvenile stage. Spawning ground protection and rehabilitation is required to reverse historical degradation and improve fisheries prospects alongside conservation goals. Although spawning habitat has been characterised in tidal rivers, there has been no previous study of spawning in non-tidal rivermouths that are open to the sea. We assessed seven non-tidal rivers over 4 months using census surveys to quantify spawning activity, identify environmental cues, and characterise fundamental aspects of the biogeography of spawning grounds. Results include the identification of compact spawning reaches near the rivermouths. Spawning events were triggered by periods of elevated water levels that were often of very short duration, suggesting that potential lunar cues were less important, and that rapid fish movements had likely occurred within the catchment prior to spawning events. Spawning grounds exhibited consistent vertical structuring above typical low-flow levels, with associated horizontal translation away from the river channel leading to increased exposure to anthropogenic stressors and associated management implications for protecting the areas concerned. These consistent patterns provide a sound basis for advancing protective management at non-tidal rivermouths. Attention to flood management, vegetation control, and bankside recreational activities is needed and may be assisted by elucidating the biogeography of spawning grounds. The identification of rapid responses to environmental cues deserves further research to assess floodplain connectivity aspects that enable fish movements in ephemeral flowpaths, and as a confounding factor in commonly used fish survey techniques. This paper provides a first assessment of the biogeography of Galaxias maculatus spawning grounds and amphidromous spawning behaviour at non-tidal rivermouths. Consistent patterns in catchment position, vertical structuring, and environmental cues were identified that provide a sound basis for protective management to assist the conservation of this culturally important fish, which is currently in decline. [ABSTRACT FROM AUTHOR]

Context: Data are lacking on the effects of selected endophytes of perennial ryegrass (Lolium perenne L.) on ryegrass persistence. Aim: We aimed to determine the impact of Epichloë endophyte on the persistence of mid- and late-heading perennial ryegrass cultivars. Method: Two mid-heading (Samson, Bronsyn) and two late-heading (One50, Rohan) cultivars, infected with selected endophytes (AR37, nea2/6) or with standard toxic endophyte, were established in a replicated plot study grazed by cattle in a subtropical environment of the upper North Island of New Zealand. Persistence characteristics were quantified at least five times per annum, over 4 years. Key results: Endophyte strain had an effect on persistence; infection with standard endophyte resulted in higher ryegrass ground cover percentage, ryegrass content in pasture dry matter and autumn yield than infection with nea2/6 on many occasions, and with AR37 on some occasions. There were negligible impacts on ryegrass tiller density or nutritive value. Trends were dominated by the main effect of endophyte; interactions with heading date were inconsistent. Conclusions: Cultivars were more persistent when infected with standard endophyte than with selected endophytes, although persistence declined over 4 years for all cultivars and irrespective of heading date. Implications: Reliance on selected endophyte is unlikely to prevent persistence decline of perennial ryegrass in a subtropical environment. Other strategies will be required to maintain the persistence of high-quality pastures based on perennial ryegrass. We determined the impact of endophyte strain (standard toxic endophyte, selected strains nea2/6 and AR37), on the persistence of four perennial ryegrass cultivars. Standard endophyte resulted in greater persistence than the selected endophytes, with higher ryegrass ground cover percentage and content in pasture dry matter by the end of the study, and higher herbage yields in autumn. Persistence declined over 4 years for all cultivars, regardless of endophyte. [ABSTRACT FROM AUTHOR]

Context: Data are lacking on the effects of heading date of perennial ryegrass (Lolium perenne L.) on ryegrass persistence. Aim: We aimed to determine the impact of heading date on perennial ryegrass persistence. Method: Two mid-heading (Samson, Bronsyn) and two late-heading (One50, Rohan) cultivars, infected with Epichloë endophytes (AR37, nea2/6 or standard toxic), were established in a replicated plot study grazed by cattle in a subtropical environment of the upper North Island of New Zealand. Persistence characteristics were quantified at least five times per annum, over 4 years. Key results: Late-heading cultivars had higher yield, nutritive value, perennial ryegrass content in pasture dry matter, ground cover and tiller density than mid-heading cultivars. There were large seasonal impacts on all ryegrass characteristics, with a major decline over summer and recovery during late autumn into early spring, with less recovery in the final year. Overall, there was a strong linear decline in ryegrass content measured during spring (2018–21). Conclusions: The two late-heading cultivars were more persistent than the two mid-heading cultivars, although persistence declined over 4 years for all cultivars. Implications: Results support industry recommendations of choosing late-heading cultivars for improved pasture quality and persistence. We determined the impact of heading date on persistence of perennial ryegrass cultivars infected with a range of endophytes, in a plot study grazed by cattle. The two late-heading cultivars were more persistent than the two mid-heading cultivars, with higher yield, nutritive value, perennial ryegrass content in pasture dry matter, ground cover and tiller density, although persistence declined over 4 years for all cultivars. [ABSTRACT FROM AUTHOR]

Background: Live fuel comprises a significant portion of the fuel consumed in forest and scrub crown fires. However, its flammability remains poorly understood. Although live fuel differs from dead fuel in moisture content, chemical composition, cellular structure and physiological characteristics, its higher moisture content masks the effect of other characteristics on its flammability. Aims: The aim of the study was to delineate and assess the effects of live/dead condition, moisture content and particle size on flammability of gorse (Ulex europaeus L.). Methods: Live and dead gorse material of three size classes (0–3, 3–6, and 6–10 mm in diameter) at six moisture contents (0, 10, 25, 50, 75 and 100%) was tested in a cone calorimeter to evaluate its flammability using new sample preparation and moisture conditioning techniques. Key results: On average, live fuel ignited 21% slower, reached 11% higher peak heat release rate, and had a 12% shorter burn duration than dead fuel of the same moisture content. These differences were most pronounced in coarser material. Conclusions: For gorse, fine dead fuels increase the likelihood of ignition, fine live fuels contribute to high burning intensities, and coarser live and dead fuels prolong combustion. Implications: These findings highlight the need to account for flammability differences between live and dead fuels in fire behaviour models beyond those driven by variations in moisture content. This study compares the flammability of live and dead vegetation at a range of moisture contents and particle sizes. Live fuel took longer to ignite but burned faster and more intensely than dead fuel of the same moisture content, emphasising the importance of live fuel flammability in fire prediction models. [ABSTRACT FROM AUTHOR]

Introduction. New Zealand's health care system faces significant shortages in health care workers. To address workforce challenges and meet the population's health needs, health care systems around the world have introduced new clinical roles, such as physician associates/assistants (PAs) into existing health care teams. Aim. This article aims to examine the benefits, challenges, and broader implications of regulating PAs in the context of New Zealand's primary care sector, with a specific emphasis on how it may impact general practice. Methods. A range of literature surrounding the role, impact, and perception of PAs were selected and included in this article. Results. The PA profession can significantly strengthen New Zealand's primary care workforce, improving patient access and continuity of care. However, the global deployment of PAs has faced scrutiny due to concerns about its potential risks to patient safety and the overall viability of such a role. Discussion. If regulated, the PA profession can reshape New Zealand's primary care, offering a partial solution to current medical staff shortages. Trained under a generalised medical model similar to doctors, PAs possess the necessary skills to perform both routine and non-routine medical tasks. This dual capability can significantly improve primary care service provision, reduce existing workloads, and allow for a more efficient deployment of doctor expertise. However, medico-legal issues and the supervisory burden can impede widespread integration into general practice. Despite challenges, the success of the PA role relies on mutual trust, respect, and support from other clinical team members within primary health care. [ABSTRACT FROM AUTHOR]

The article examines the solutions to Aotearoa New Zealand's general practitioner (GP) workforce crisis. Topics discussed include the current government's initiatives to increase the number of graduating doctors, the implementation of financial incentives for GPs in underserved areas, and the proposal for a bonding scheme to ensure long-term workforce distribution in high-need regions.

Introduction. From a coronavirus disease (COVID-19) pandemic perspective, Aotearoa New Zealand (NZ) rural residents formed an at-risk population, and disparities between rural and urban COVID-19 vaccination coverage have been found. Aim. To gain insight into factors contributing to the urban-rural COVID-19 vaccination disparity by exploring NZ rural health providers' experiences of the vaccine rollout and pandemic response in rural Māori and Pasifika communities. Methods. Rural health providers at four sites participated in individual or focus group semi-structured interviews exploring their views of the COVID-19 vaccine rollout. Thematic analysis was undertaken using a framework-guided rapid analysis method. Results. Twenty interviews with 42 participants were conducted. Five themes were identified: Pre COVID-19 rural situation, fragile yet resilient; Centrally imposed structures, policies and solutions - urban-centric and Pakehā focused; Multiple logistical challenges - poor/no consideration of rural context in planning stages resulting in wasted resource and time; Taking ownership - rural providers found geographically tailored, culturally anchored and locally driven solutions; Future directions - sustained investment in rural health services, including funding long-term integrated (rather than 'by activity') health services, would ensure success in future vaccine rollouts and other health initiatives for rural communities. Discussion. In providing rural health provider perspectives from rural areas serving Māori and Pasifika communities during the NZ COVID-19 vaccine rollout, the importance of the rural context is highlighted. Findings provide a platform on which to build further research regarding models of rural health care to ensure services are designed for rural NZ contexts and capable of meeting the needs of diverse rural communities. [ABSTRACT FROM AUTHOR]

Introduction. Few mandatory community-based attachments for postgraduate year two doctors (PGY2s) in Aotearoa New Zealand are hosted in general practices, due to space, time and remuneration barriers. Aim. This study aimed to explore the costs, barriers and enablers to general practices of hosting PGY2s. Methods. A cost analysis for four general practices beginning to host PGY2s was undertaken, including time spent supervising and supporting PGY2s, revenue impact including subsidies and cost of providing clinical space. Interviews with these practices and seven experienced PGY2 host practices were conducted and analysed thematically. Results. The estimated mean cost of hosting PGY2s excluding room cost was NZ$4907 per 13-week placement (range $890-$9183), increasing to $13 727 per placement (range $5750-$24 715) when room rental was included. Four themes were identified: working within a small business model; a new learning environment for PGY2s; providing positive experiences for the PGY2s; the relationship between practices and district hospitals that employed the PGY2s, including job sizing. Discussion. Tension exists between the small business model of general practice and providing positive experiences for PGY2s in a new learning environment. Guidance and support structures for PGY2 hosting should be developed nationally, and communication and cooperation between practices and employing hospitals needs improvement. Out-of-hours work should be included in community-based attachments so PGY2s' remuneration is consistent. General practice teams are willing to be part of creating a sustainable workforce. However, the time taken to host and costs of providing training in primary care are barriers. There is urgent need to increase funding to general practices for hosting PGY2s. [ABSTRACT FROM AUTHOR]

Introduction. Community-based primary care physiotherapy has developed through private practice, fee-for-service model in Aotearoa New Zealand where independent businesses operate in competition. Aim. We aimed to explore how the private practice model of physiotherapy impacts patient care, physiotherapists, and professional behaviour. Methods. Six physiotherapists managing musculoskeletal conditions in a primary care private practice in Aotearoa New Zealand were recruited using maximum variation purposive sampling. In-depth individual face-toface semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using Interpretive Description. Inductive data analysis synthesised and contextualised data, creating a thematic framework that developed across interviews. Results. All physiotherapy participants discussed concerns about culture and professionalism in private practice physiotherapy despite not being asked about these. Three themes were identified. 'Competitive business model and lack of collaboration' - participants thought that competition between practices resulted in a lack of trust, collegiality, and collaboration, and pressure on clinicians to maintain income. '(Un)professional behaviour' - participants thought that physiotherapists were defensive and averse to scrutiny, resulting in reluctance to admit when they needed help, or to undertake peer review or seek second opinions. 'Lack of support and mentoring' - the professional culture in private practice was perceived to reduce support and mentoring, with negative impacts that affected physiotherapists at all stages of career. Conclusion. This exploratory qualitative study suggests that competition dominates communication and collaboration in private practice physiotherapy and may have wider implications for professionalism and the quality of patient care. Competitive business models and an aversion to scrutiny may reduce collegial interaction and professional behaviour. [ABSTRACT FROM AUTHOR]

Introduction. Around 5% of the people in Aotearoa New Zealand (NZ) are not enrolled with a general practice. Aim. This study aimed to explore the utilisation of general practice by enrolment status and subsequent use of an emergency department. Methods. We compared a cohort of respondents from New Zealand Health Surveys (2013/14-2018/19) on self-reported general practice utilisation and their substitutes, according to their enrolment status (enrolled and not enrolled). They were then followed up to examine their subsequent use of an emergency department. Time to an emergency department presentation was modelled with proportional hazards regression models with enrolment status as the explanatory variable. Confounding variables used were sex, age group, prioritised ethnicity, the New Zealand Deprivation Index and self-rated health. Results. Those not enrolled were more likely to be young, male, Asian, more socioeconomically deprived and with better health status than those enrolled. Generally, those not enrolled utilised general practice services less. Those not enrolled who had used an emergency department were more likely to have used it as a substitute for general practice (40% vs 26%). Modelling showed that those not enrolled took longer to access an emergency department. Adjusting for confounding variables did not change that interpretation. Discussion. Those not enrolled were younger and healthier and may have a perception that enrolment isn't necessary. As a group, they were more likely to be socioeconomically deprived and to use an emergency department, which is free at a public hospital in NZ, as a substitute for primary care which suggests that cost may influence their choices. [ABSTRACT FROM AUTHOR]

Introduction. The inability to afford a consultation with a general practitioner may lead to delays in accessing care pathways. Aim. This study aimed to explore the characteristics of people by their unmet need for a general practitioner consultation because of cost, and the characteristics of subsequent inpatient hospitalisations. Methods. From the New Zealand Health Surveys (2013/14-2018/19), two groups were formed based on their unmet need for a general practitioner consultation due to cost. These groups were compared by socio-demographic factors and subsequent inpatient hospitalisation characteristics during follow-up. Time to an inpatient hospitalisation was the outcome in a proportional hazards regression model with need status as the key variable. The model was expanded to include confounding variables: sex, age group, ethnicity, the New Zealand Deprivation Index and self-rated health. Results. The need group, characterised by having a higher proportion of females, younger adults, Māori, increased socioeconomic deprivation and poorer self-rated health experienced a greater chance of hospitalisation, a similar number of visits during follow-up, shorter stays and a quicker time to hospitalisation compared to the no-need group. Proportional hazards survival models gave a 28% higher hazard rate for the time to an inpatient hospitalisation for the need group compared to the no-need group. The inclusion of all the confounders in the model gave a similar hazard ratio. Discussion. Although consultation fees vary across general practices, it is evident that this may not eliminate the cost barriers to accessing care for some groups. Needing multiple consultations may contribute to persistent unmet needs. [ABSTRACT FROM AUTHOR]

Introduction. The pursuit of health care equity is a fundamental objective for Aotearoa New Zealand, and patient co-payments in primary care challenge this goal. Aim. This study aimed to investigate the relationship between primary health care co-payments and the sociodemographic variables in areas where general practices provide health care. Methods. Using census data, facilities information from the Ministry of Health, and socioeconomic deprivation indices, linear regression models were used to explore the relationship between weighted average fees charged by general practices and various sociodemographic variables in statistical area 2 regions. Results. The study finds that areas with higher proportions of males and economically deprived individuals are associated with lower weighted average fees. Conversely, areas with higher proportions of retirement-aged and European individuals are linked with higher weighted average fees. The inclusion of the Very-Low-Cost-Access variable, indicating a subsidy scheme at the general practice level, made all the sociodemographic variables practically insignificant, suggesting Very- Low-Cost-Access practices are in the right geographical location to target high needs groups. Discussion. The findings affirm the complexity of health care inequities in Aotearoa New Zealand, influenced not only by financial factors but also by demographic variables as they play out geographically. While subsidy schemes like the Very-Low-Cost-Access scheme appear to reach groups with greater need, a high level of unmet need due to cost suggests that the fees are still too high. Policymakers need to consider disparities in the on-going health care reforms and make further changes to subsidy schemes to reduce unmet need. [ABSTRACT FROM AUTHOR]

Australia needs a new shared vision that the current trajectory of loss of natural heritage on its offshore islands is not acceptable and needs to change. This Special Issue brings together seven papers from leaders and practitioners with experience in offshore islands across the Australian and New Zealand context. The fundamentals for each paper are to suggest potential solutions or scenarios to move forward with island policy, and management. [ABSTRACT FROM AUTHOR]

INTRODUCTION: The New Zealand 2001 Primary Health Care strategy requires primary health organizations (PHOs) to involve communities in their governance and be responsive to communities' needs. it is less clear what the implications of this policy are for general practices. This paper presents key findings from a national study undertaken in the wake of the 2001 primary care reforms on the purpose and process of involving communities in primary health care. METHODS: A three-part qualitative process was employed. Initially, key informant interviews were undertaken with a diverse range of primary care policy makers, funders, practitioners and community stakeholders (n=42). A draft framework for involving communities in primary care was developed, and formed the basis of a consultation phase (n=26). The framework was further developed and then piloted in four PHOs around New Zealand. FINDINGS: Views on community participation varied among different stakeholder groups in the sector. Most described it as a complex process of relationship-building over time, and one that is quite distinct from consumer feedback processes in general practice. For community representatives, it was a process of trust-building and information-sharing between communities and health professionals. These relationships enabled people to feel comfortable seeking care, and professionals to mould services to people's needs. CONCLUSION: This research highlights that community is much more than a setting of care. As citizens, members of disadvantaged communities are partners with general practices and PHOs, working with them to improve health equity by ensuring that services are responsive to their needs. [ABSTRACT FROM AUTHOR]

BACKGROUND AND CONTEXT: Evidence has shown that non-attendance at clinics occurs for a variety of reasons and impacts negatively on client outcomes and effective use of clinic resources. This paper reports an audit of non-attendance at Care Plus and diabetes clinics undertaken between October 2007 and October 2008, in a large general practice in the Wellington region. ASSESSMENT OF PROBLEM: A retrospective and prospective audit of the non-attendance rate at nurse-led wellness clinics was completed using the Query Builder function in Medtech32, collecting data from 142 people who did not attend a scheduled appointment. RESULTS: Thirty-three people were unable to be contacted about their reason for not attending. Of those contacted, 68 did not attend because they were unaware of the appointment, confused regarding the appointment time, or simply forgot. Eighty-four people were aged between 18 and 65 years, yet of those contacted, only four cited work had prevented their attendance at the clinic. Only two people reported difficulty with transport. STRATEGIES FOR IMPROVEMENT: The audit highlighted the importance of administration processes for scheduling routine appointments and reminding patients about appointments. It provided evidence that administrative support for nurse-led clinics is necessary. LESSONS: Involvement in clinical audit was a new experience for many of the staff and the usefulness of the findings led to more positive views about how audit can be used. The importance of appropriate administrative support was highlighted. Lessons learned for future audits included the importance of a complete data set and consistent use of codes for data entry. [ABSTRACT FROM AUTHOR]

INTRODUCTION: General practitioners (GPs) working as clinical teachers are likely to influence medical students' level of community-based learning. This paper aimed to ascertain clinical teachers' views in relation to The University of Auckland about their clinical learning environment. METHOD: A total of 34 clinical teachers working in primary care contributed to this study. To gauge their level of involvement in teaching and learning, the clinical teachers were asked about issues such as their confidence, available time, sufficient clinical learning opportunities, clear learning objectives to teach students and what they would like changed. FINDINGS: The GPs appeared confident, felt there were sufficient learning opportunities for students and that their students were part of the team. Less experienced teachers expressed less confidence than more experienced peers. There was some hesitancy in terms of coping with time and feedback. Some clinical teachers were unclear about the learning objectives presented to students. CONCLUSION: Several issues that emerged--including available time and financial rewards--are difficult to resolve. Curriculum and selection are evolving issues requiring constant monitoring and alignment with increasing numbers of students studying medicine, increased ethical awareness, more diverse teaching systems and more advanced technologies. Non-faculty clinicians need adequate representation on curriculum committees and involvement in clinical education initiatives. Issues of cultural competency and professional development were raised, suggesting the need for more established links between university and GPs. [ABSTRACT FROM AUTHOR]

Family circumstances in infancy are persistent and powerful determinants of children's physical and mental health, influencing inequalities that trace from childhood through to adulthood. While the social factors that perpetuate patterns of inequality are more complex than can be addressed through single interventions, child and family health (CFH) services represent crucial sites where trajectories of inequality can be disrupted. In particular, approaches that foster opportunities for practitioner-parent engagement that challenge traditional hierarchical health care practice, such as the Family Partnership Model (FPM), are recommended as ways of addressing disadvantage. Little is known about how practitioners implement models of working in partnership with families and, consequently, there is a gap in understanding how best to develop and sustain these new CFH practices. This paper reports a research project that investigated the experiences of 25 health professionals working within a FPM framework with vulnerable families. Through discussion of four key themes - redefining expertise, changing practices, establishing new relationships with parents and the complexities of partnership practice - the paper offers first-hand accounts of reframing practices that recognise the needs, skills and expertise of parents and thus contribute to empowerment of families. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including issues relating to a wide range of primary health care providers such as pharmacists, physiotherapists, and social workers.

INTRODUCTION: During the coronavirus disease 2019 (COVID-19) pandemic lockdown in New Zealand in March 2020, there was a rapid shift to virtual consultations in primary care. This change was supported by system adjustments to enable electronic transmission of prescriptions without a handwritten signature if they met certain security criteria. International research suggests potential for unintended consequences with such changes, so it is important to understand the effect on professional practice in New Zealand general practice and community pharmacy. AIM: The purpose of this study was to undertake a preliminary exploration of the experiences of New Zealand general practitioners and community pharmacists when prescriptions are transmitted electronically directly from prescriber to pharmacy. METHODS: Semi-structured interviews with a purposive sample of four pharmacists and four general practitioners gathered qualitative data about their experiences of the shift to electronic transmission of prescriptions. Participants' perceptions of effect on professional workflow, interprofessional interactions between general practitioners and pharmacists, and interactions with patients were explored. Interviews were audio-recorded, and the data analysed thematically using an inductive approach. RESULTS: Four themes were identified: workflow transformation; mixed impact on interactions with patients; juggling timing and expectations; and new avenues for interprofessional communication (with some cul-de-sacs). DISCUSSION: Both general practitioners and pharmacists experienced transformational changes to workflow. This was positive for general practitioners due to saved time and increased work flexibility. Pharmacists noted potential benefits but also some challenges. To fully reap teamwork benefits, more work is needed on managing the timing issues and patient expectations, and to refine the new modes of communication between health-care practitioners. [ABSTRACT FROM AUTHOR]

Family members continue to be used as interpreters in medical consultations despite the well-known risks. This paper examines participant perceptions of this practice in three New Zealand clinics chosen for their frequent use of interpreters and their skill in using them. It is based on a detailed study of 17 video-recorded interpreted consultations and 48 post-consultation interviews with participants (5 doctors, 16 patients and 12 interpreters, including 6 family members). All participants expressed satisfaction with the communication. Analysis of the interviews explored what participants liked or valued about family member interpreters (FMIs). Key themes were the FMIs' personal relationship and knowledge, patient comfort, trust, cultural norms, time efficiency and continued help outside the consultation. General practitioners (GPs) expressed awareness of potential risks and how to manage them, in contrast to patients and FMIs. Although the use of professional interpreters needs to be strongly promoted, a well-informed decision to use a family member is appropriate in some situations. GPs need to be well trained in how to assess and manage the risks. Rather than striving for 'best practice' (i.e. universal use of professional interpreters), it is better to aim for 'good practice' where a considered judgement is made about each situation on an individual basis. [ABSTRACT FROM AUTHOR]

The article offers information that On July 1, 2022, the Aotearoa New Zealand health reforms went into force through a new national health system has been developed as a result of the Te Pae Ora (Healthy Futures) Act. incorporating Te Whatu Ora - Health New Zealand and Te Aka Whai Ora - Mori as two new organisations. Authority for Health.

INTRODUCTION: Youth health outcomes are poor in New Zealand and have a life-long impact on individuals, wha-nau (family) and society. Little is known about how young people view their experiences of general practice care despite it being the most common place to access health care. AIM: This study sought to explore young peoples' experiences of care in a selected, youth-friendly general practice. METHODS: In-depth individual interviews with six young people. RESULTS: Four themes were identified from young peoples' narratives in relation to their experiences of general practice care: going to the doctor is not easy for a young person; the attributes of staff make all the difference; specific youth-friendly consultation practices help young people; and a youth-friendly physical environment can help young people access services and feel safe. DISCUSSION: Even though the study general practice had explicitly instituted youth-friendly initiatives, including offering no-charge consultations and specialist staffmembers, young people still described considerable barriers to attendance. Many barriers are practice-based and could bemodified by staff training, provision of further youth care staff roles and consideration of environmental changes. Other barriers such as waiving prescription costs need government funding. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Routinely following an evidence-based clinical pathway of care for bacterial sexually transmitted infections (STIs) such as chlamydia or gonorrhoea is important to help reduce the spread of infections, prevent reinfections and avoid associated health complications. AIM: To develop an easy-to-use tool for routine use by primary care clinicians to ensure best practice management of patients tested for and diagnosed with chlamydia or gonorrhoea. METHODS: The tool (a MedTech Advanced Form) was developed in consultation with seven primary care clinicians and included different tabs for use during the STI care pathway (testing, treatment, advice, partner notification and follow up) with clickable links to relevant online resources. The tool was trialled over 3 months by 19 clinicians in three Wellington primary care clinics - two youth health and a student health service. Outcome measures were frequency of use, completeness of fields related to best practice care and clinician acceptance of the tool (from focus group feedback). RESULTS: The tool was used for approximately one in four patients who were tested during the trial period, with 'forgetting' reported as the mostcommonreason for non-use. Clinician views about the tool were favourable, with most indicating they would like to continue use and would recommend it to colleagues. Documentation of best practice care was excellent; fields to record reasons for testing, discussion of sexual history, provision of treatment and advice given were used for most patients for whom the form was completed. CONCLUSIONS: Inclusion of this STI management tool in the electronic patient records system appeared to improve primary care clinicians' delivery and documentation of best practice sexual health care at a practice level. Wider use of a modified version of this tool could facilitate more comprehensive best practice management of bacterial STIs. [ABSTRACT FROM AUTHOR]

Introduction. The global prevalence of diabetes is a pressing public health concern. Over 400 million individuals live with the effects of the disease, predominantly in low- and middleincome countries. In Aotearoa New Zealand (NZ), over 300 000 people have diabetes, resulting in a population rate of 43.1 per 1000. Enabling nurses to prescribe diabetes medications enhances accessibility and improves health outcomes for large sections of the population. Aim. This rapid review was undertaken to investigate the influence of nurse prescribing on health care delivery for individuals with diabetes in NZ, Australia, the United Kingdom, and Canada, countries sharing comparable health care systems and multicultural backgrounds. Methods. The review protocol was published on PROSPERO. In November 2022, a search was conducted across multiple databases to locate relevant literature and resources constrained to the last decade (from January 2012 to November 2022). Utilising the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, data extraction was systematically structured, while rigorous appraisal processes upheld selection quality. Results. Fifteen publications were identified as meeting predefined inclusion and exclusion criteria. The review of these articles revealed four main themes: the impact of nurse prescribing on clinical outcomes, levels of patient satisfaction, implications for health care service provisions, and identification of barriers and facilitators associated with nurse prescribing. Discussion. This report identifies outcomes of nurse prescribing, concluding it provides a potential avenue for enhancing access to and alleviating the burden on health care systems. [ABSTRACT FROM AUTHOR]

Introduction. The New Zealand population has one of the highest incidences of skin cancer in the world. Hospital waiting lists for surgical excision of keratinocytic skin cancers (basal cell carcinoma and squamous cell carcinoma) are lengthy, and increasingly, excisions are undertaken in primary care. Teledermatology, in response to general practitioners' electronic referrals (e-referrals), can improve clinical communication between general practitioners and dermatologists. Aim. The aim of this study was to evaluate an excision pathway for keratinocytic cancers diagnosed by teledermatology. Methods. A retrospective observational descriptive review of a 3-month cohort of primary care e-referrals was undertaken. Results. Three hundred and fifty eight suspected keratinocytic cancers (KCs) were diagnosed by teledermatology; histology reports confirmed KC in 201 of 267 excisions (75%). The majority (77.2%) were excised by general practitioners an average of 25 days after the dermatologist's recommendation. The rest were excised by plastic surgeons in private (3.4%) or at a public hospital (19.5%) after an average of 40 or 134 days, respectively. Discussion. E-referral pathways are now widely implemented. However, the ideal workflow for skin cancer management is unknown. We have demonstrated in New Zealand that surgery can be undertaken in primary care within a month of a teledermatology diagnosis and excision recommendation. Conclusion. This study reports prompt excision of KCs by general practitioners after an e-referral and a teledermatology response. [ABSTRACT FROM AUTHOR]