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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. Regular diabetic foot checks, at least annually, are important for early identification of risk factors and prevention of ulceration and amputation. To ensure this, most general practices in Aotearoa New Zealand (NZ) offer free annual diabetes reviews (ADRs) which include a comprehensive foot evaluation. However, attendance rates at these ADRs are low. Aim. To explore patients' perspectives on the barriers to attending ADRs and foot checks. Methods. Semi-structured interviews with people with type 2 diabetes who were overdue their ADR (n = 13; 7 women, 6 Māori) from two urban practices were conducted. Interviews were audio recorded and transcribed verbatim and then analysed using an inductive thematic analysis approach. Results. We identified three key themes demonstrating barriers to attendance: healthcareassociated factors (suboptimal clinician-patient relationship, not having a consistent general practitioner (GP)); patient-related factors (co-morbid health conditions, issues surrounding identity, and logistical issues); and systemic factors (COVID-19 pandemic, travel distance to the practice, unawareness of available foot care services). Participants' feedback focused on patient-centred approaches for improvements to service delivery, for example using online educational materials, and utilising culturally appropriate models of health including Te Whare Tapa Whā and Whānau Ora approach. Discussion. We identified several barriers to attendance, some of which are potentially modifiable. Addressing modifiable barriers and incorporating suggestions made by participants may improve access to the ADR and reduce non-attendance. Further participatory action research could explore these insights in ways that facilitate tino rangatiratanga (self-determination) and palpable action. [ABSTRACT FROM AUTHOR]

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: Primary health care is critical, particularly in rural areas distant from secondary care services. AIM: To describe the development of Coast to Coast Health Centre (CTCHC) at Wellsford, north of Auckland, New Zealand and reflect on its achievements and ongoing challenges. METHODS: Interviews were conducted with staff and management of CTCHC and with other health service providers. Surveys of staff and a sample of enrolled patients were undertaken. Numerical data on service utilisation were obtained from the practice and from national datasets. RESULTS: The CTCHC provides a wide range of services, including after-hours care, maternity and radiology, across a network of electronically connected sites, as well as interdisciplinary training for a range of health students. General practitioner (GP) recruitment is problematic and nursing roles have been expanded. Staff report positively on the work environment. Consultation rates are higher than in comparable practices, especially consultations with nurses. Rates of hospital admission are relatively low. The development of the CTCHC was assisted by formation of a local primary health organisation (PHO) and by recognition by the local district health board (DHB). Issues with poor coordination of local services, and less service provision than is characteristic in urban areas, remain. Contracting processes with the DHB were complex and time-consuming. The merging of the local PHO into a larger PHO within the Waitemata DHB catchment inhibited progression towards more complete locality planning. DISCUSSION: A dedicated and locally controlled provider was able to generate a more than usually complete community health service for Wellsford and area. [ABSTRACT FROM AUTHOR]

Introduction. Prediabetes is the asymptomatic precursor to type two diabetes mellitus, a significant and growing public health problem in New Zealand (NZ). Little is known about how general practitioners (GPs) and nurses view prediabetes care, and similarly little is known about how people with prediabetes view their condition and care. Aim. This study aimed to investigate the views of NZ GPs and nurses, and people with prediabetes about prediabetes and its management. Methods. This was a mixed qualitative methods study that is part of a randomised control trial of a prediabetes intervention. Results. Three key themes emerged from the health professional data (GPs and nurses) and another three themes emerged from people with prediabetes data. GPs and nurses were uncertain about the progression of prediabetes; they felt prediabetes was not a priority and they were unsure about what to advise. People with prediabetes were uncertain about the diagnosis and information given to them; they were unsure about what to do about prediabetes and they found lifestyle change hard. Discussion. GPs, nurses and people with prediabetes, expressed much uncertainty, but also some certainty about prediabetes. All were certain that prediabetes is common and increasing and that sustained lifestyle change was very difficult. But uncertainty prevailed about whether, in reality, prediabetes could be stopped, who would be most likely to benefit from lifestyle interventions and how best to achieve these. Older Māori and Pacific women were keen to promote lifestyle change and this appeared best done through Māori and Pacific peoples' organisations by means of co-designed interventions. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Obesity is disproportionately prevalent among Pacific population groups in New Zealand. Lifestyle behaviours of excessive consumption of high energy, unhealthy foods and inadequate physical activity are risk factors for obesity that can be modified. AIM: To identify and describe the risk factors for and protective factors against obesity among Pacific Is- land (PI) adolescents who attend church and compare them with PI adolescents who do not attend church. METHODS: We investigated the lifestyle behaviours of 2495 PI adolescents at six secondary schools in Auckland, New Zealand (NZ), 77% of whom attend a church or other place of worship. The cross-sectional survey was undertaken in 2005. Structured individual interviews and anthropometric measurements were undertaken. RESULTS: Church attendees had a higher mean body mass index (BMI) compared with non-attendees (BMI 27.4 vs BMI 26.6), adjusted for age, gender and PI ethnicity (p=0.01). The weight status of attendees was associated with less healthy breakfast and lunch sources, lower levels of physical activity, and limited knowledge of the risk factors for obesity (p<0.05) DISCUSSION: Culturally appropriate and ethnic-specific weight management interventions, including monitoring and policy development programmes, are needed urgently to change pro-obesity lifestyle behaviours in PI adolescents and to avoid the burgeoning future obesity-related illnesses that would otherwise result. The church may be an important venue and change agent in the prevention of obesity for this population. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Effective communication is fundamental to successful health care service delivery, and has a positive impact on access, quality of care, health outcomes, and patient satisfaction. Although there are a growing number of New Zealanders who do not speak English proficiently, underutilisation of trained interpreter services appears to be common in primary health care settings. AIMS: To describe the pattern of interpreter service need and utilisation by general practice services, and to identify key barriers and enabling factors to the use of trained interpreters. METHODS: A mixed methods study was employed. Census and Partnership Health Canterbury Te Kei o Te Waka (PHC) databases were combined, and quantitative analysis used to derive interpreter service need and utilisation patterns. Transcripts of focus groups and interviews from general practitioners, practice nurses and practice administration staff within the PHC were analysed, using qualitative methods to identify barriers and enablers to interpreter service use. RESULTS: For the years 2008-2010, approximately 10 742 consultations per year involved a non-English- speaking patient, yet in only approximately 74.8 (0.7%) consultations per year were interpreter services utilised. Analysis of focus groups and interviews identified four global themes that represented barriers for interpreter service utilisation; namely, practicalities, expectations, knowledge of service, and systems. DISCUSSION: The current use of interpreter services in PHC general practice appears to be significantly less than the need. In order to maximise health outcomes and reduce risk, strategies must be initiated to counter the barriers currently inhibiting interpreter service use, including adopting best practice policies. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Multiple medications are recommended for the management of ischaemic heart disease. Unfortunately, increasing the number of medicines reduces adherence to medicines therapy. The concept of a polypill with a ixed dose combination of the common cardiovascular medicines (aspirin, statin, two blood pressure-lowering medicines) has been promoted. Patient perceptions about this con- cept have not been explored. METHODS: People taking at least three cardiovascular medicines were interviewed using a semi-struc- tured interview about their views on a polypill that could reduce the number of tablets they would need to take. FINDINGS: The participants considered that the polypill would be very convenient, especially when travelling and would reduce the pill burden. If the polypill was subsidised by the government, they would have reduced dispensing fee costs. There were concerns around the inlexibility of dosing of individual components of the polypill, and some concerns about safety and eficacy. Medical practitioners were identiied as having an important role in inluencing participants about the acceptability of the polypill. CONCLUSION: Generally the concept of the polypill was acceptable to participants, primarily because of the convenience and reduced number of tablets required daily. There were concerns about whether the polypill would be as effective and safe as the individual medicines. [ABSTRACT FROM AUTHOR]

Background: "Hunger training", which aims to teach people to eat only when blood glucose is below a set target, appears promising as a weight loss strategy. As the ability of participants to adhere to the rigorous protocol has been insufficiently described, we sought to determine the feasibility of hunger training, in terms of retention in the study, adherence to measuring blood glucose, and eating only when blood glucose concentrations are below a set level of 4.7 mmol/L. Method: We undertook a two-week feasibility study, utilising an adaptive design approach where the specific blood glucose cut-off was the adaptive feature. A blood glucose cut-off of 4.7 mmol/L (protocol A) was used for the first 20 participants. A priori we decided that if interim analysis revealed that this cut-off did not meet our feasibility criteria, the remaining ten participants would use an individualised cut-off based on their fasting glucose concentrations (protocol B). Results: Retention of the participants in the study was 97 % (28/29 participants), achieving our criterion of 85 %. Participants measured their blood glucose before 94 % (95 % CI 91, 98) of eating occasions (criterion 80 %). However, participants following protocol A, which used a standard blood glucose cut-off of 4.7 mmol/L, were only able to adhere to eating when blood glucose was below the prescribed level 66 % of the time, below our within-person criterion of 75 %. By contrast, those participants following protocol B (individualised cut-off) adhered to the eating protocol 84 % of the time, a significant (p = 0.010) improvement over protocol A. Conclusion: Hunger training appears to be a feasible method, at least in the short-term, when an individualised fasting blood glucose is used to indicate that a meal can begin. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Obesity and low levels of physical activity are increasing among Pacific and Maori adolescents in New Zealand. AIM: To assess the feasibility of an after-school exercise and lifestyle programme to improve cardio-respiratory fitness, health and usual activity in less-active Pacific and Maori adolescents over six weeks. METHODS: Eighteen less-active secondary school students participated. The six-week programme included 3 x 1.5 hour exercise and healthy lifestyle sessions per week. Outcomes included estimated cardiorespiratory fitness (VO2max), insulin resistance (Homeostasis Model Assessment), physical activity, glycated haemoglobin (HbA1c), fasting plasma glucose, blood pressure, waist circumference and fasting lipids, measured at baseline and six weeks. Programme attendance and qualitative comments were also recorded. Student's f-tests were used. RESULTS: Of the 18 students enrolled, 16(89%) completed six-week follow-up, 14(78%) were female, 13 (72%) were Pacific ethnicity and 5 (28%) were Māori. At baseline, mean age was 16.3 (standard deviation [SD] 1.0) years, body mass index (BMI) 35.2 (SD 6.7) kg/m², VO2 max 31.5 (SD4.3) mL/kg/min, systolic blood pressure 125.0 (SD 12.9) mm Hg, HbA1c 39.9 (SD 3.8) mmol/mol, fasting serum insulin 28.3 (SD 27.8) µU/mL. At follow-up, improvements had occurred in VO2max (3.2 mL/kg/min; p = 0.02), systolic blood pressure (-10.6 mm Hg; p = 0.003), HbA1c (-1.1 mmol/mol; p = 0.03) and weekly vigorous (4 hours, p = 0.002) and moderate (2 hours, p = 0.006) physical activity, although waist circumference increased (p = 0.005). Programme attendance was over 50%. Comments were mostly positive. DISCUSSION: The after-school exercise and lifestyle programme and study methods were feasible. Such programmes have the potential to improve health outcomes for Pacific and Maori adolescents. [ABSTRACT FROM AUTHOR]