Ministry of Health Library

Health Improvement and Innovation Digest

Issue 165 - 12 April 2018

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

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Have you heard about Grey Matter?

We'd like to introduce you to another newsletter that the Ministry of Health Library prepares.  The Grey Matter newsletter provides monthly access to a selection of recent NGO, Think Tank, and International Government reports related to health. Information is arranged by topic, allowing readers to quickly find their areas of interest.  If you'd like to subscribe to Grey Matter, email library@moh.govt.nz

Article access

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

Quality Improvement (International)

A systematic review to evaluate the evidence base for the World Health Organization's adopted hand hygiene technique for reducing the microbial load on the hands of healthcare workers
Effective hand hygiene prevents healthcare-associated infections. This systematic review, published in the American Journal of Infection Control, evaluates the evidence for the World Health Organization's (WHO) technique in reducing the microbial load on the hands of healthcare workers (HCWs).

Shorter Waits for Cancer Treatment (New Zealand)

A fast track clinic improves diagnosis and treatment times for those investigated for lung cancer in Northland District Health Board
In 2009, a Respiratory Fast Track Clinic (RFTC) was introduced successfully by Southern District Health Board. Advancing on this model by incorporating further biopsy methods, the authors of this study, published in the New Zealand Medical Journal, aimed to streamline their investigative cancer pathway.

Shorter Stays In Emergency Departments (International)

Why do 'fast track' patients stay more than four hours in the emergency department? An investigation of factors that predict length of stay
Low-acuity 'fast track' patients represent a large portion of Australian EDs' workload and must be managed efficiently to meet the National Emergency Access Target. The current study, published in Emergency Medicine Australasia, determined the relative importance and estimated marginal effects of patient and system-related variables in predicting ED fast track patients who stayed longer than 4 hours in the ED.

Primary Health Care (New Zealand)

A repeat audit of primary care management of group A streptococcal pharyngitis in Northland, New Zealand 2016
One of the New Zealand Government’s Better Public Services targets was to reduce the rate of acute rheumatic fever (ARF) nationally by two-thirds by 2017. Māori children and young people are disproportionately affected by ARF in the Northland District Health Board region. General practice contributes to ARF prevention in detecting and appropriately treating group A streptococcal (GAS) pharyngitis. An audit in 2012 suggested improvements in adherence to national guidelines were needed. The aim of this audit, published in the Journal of Primary Health Care, was to reassess general practice adherence to national guidelines for the management of GAS pharyngitis in Northland, New Zealand, following implementation of the national Rheumatic Fever Prevention Programme.

Effect of multimorbidity on health service utilisation and health care experiences
Multimorbidity, the co-existence of two or more long-term conditions, is associated with poor quality of life, high health care costs and contributes to ethnic health inequality in New Zealand (NZ). Health care delivery remains largely focused on management of single diseases, creating major challenges for patients and clinicians. The aim of this study, published in the Journal of Primary Health Care, was to understand the experiences of people with multimorbidity in the NZ health care system.

Caregiver experiences of racism and child healthcare utilisation: cross-sectional analysis from New Zealand
Children's exposure to racism via caregiver experience (vicarious racism) is associated with poorer health and development. However, the relationship with child healthcare utilisation is unknown. This study, published in the Archives of Disease in Childhood, aimed to investigate: the prevalence of vicarious racism by child ethnicity; the association between caregiver experiences of racism and child healthcare utilisation; and the contribution of caregiver socioeconomic position and psychological distress to this association.

Primary Mental Health (New Zealand)

Primary healthcare utilisation among adults with mood and anxiety disorders: an analysis of the New Zealand Health Survey
In New Zealand, as in other OECD countries, there is a high and growing prevalence of mental health problems, particularly anxiety and depression. These conditions are associated with a range of physical illnesses, and as a result this population have high and often complex needs for healthcare services, particularly through primary care. The aim of this study, published in the Journal of Primary Health Care, was to use data from the New Zealand Health Survey (NZHS) to examine the associations between internalising disorders (including anxiety, depression and bipolar disorder) and measures related to the utilisation of primary healthcare services.

Increased Immunisation (New Zealand)

Factors influencing women’s decisions about having the pertussis-containing vaccine during pregnancy
New Zealand experienced a major epidemic of pertussis from September 2011 to January 2014. In response to this epidemic, a pertussis-containing tetanus, diphtheria and acellular pertussis (Tdap) vaccine was funded for pregnant women of 28–38 weeks’ gestation. The aim of this study, published in the Journal of Primary Health Care, was to investigate the factors influencing women’s decisions regarding having the Tdap vaccine during pregnancy.

Increased Immunisation (International)

Motors of influenza vaccination uptake and vaccination advocacy in healthcare workers: A comparative study in six European countries
Annual vaccination is the most effective way to prevent and control the health and economic burden caused by seasonal influenza. Healthcare workers (HCWs) play a crucial role in vaccine acceptance and advocacy for their patients. This study, published in Vaccine, explored the drivers of HCWs’ vaccine acceptance and advocacy in six European countries.

Better Help for smokers to Quit (New Zealand)

Addressing ethnic disparities in adolescent smoking: Is reducing exposure to smoking in the home a key?
Smoking among New Zealand (NZ) adolescents has declined since 2000, but ethnic disparities remain pronounced. This study, published in Nicotine & Tobacco Research, investigated exposure to and relative importance of known predictors of adolescent smoking and how these have changed over time, for Māori and adolescents overall.

Prevalence of electronic nicotine delivery systems (ENDS) use among youth globally: a systematic review and meta‐analysis of country level data
The objective of this study, published in the Australian and New Zealand Journal of Public Health, was to describe the prevalence and change in prevalence of electronic nicotine delivery systems (ENDS) use in youth by country and combustible smoking status.

Weight Management (New Zealand)

Childhood predictors of adult adiposity: findings from a longitudinal study
The increasing prevalence of overweight and obesity has become a key challenge for New Zealand. The purpose of this study, published in the New Zealand Medical Journal, was to examine childhood risk factors for adult adiposity in a longitudinal birth cohort.

Childhood Obesity (International)

Understanding a successful obesity prevention initiative in children under 5 from a systems perspective
Systems thinking represents an innovative and logical approach to understanding complexity in community-based obesity prevention interventions. This study, published in PLoS One, reports on an approach to apply systems thinking to understand the complexity of a successful obesity prevention intervention in early childhood (children aged up to 5 years) conducted in a regional city in Victoria, Australia.

Effectiveness of school food environment policies on children's dietary behaviors: A systematic review and meta-analysis
School food environment policies may be a critical tool to promote healthy diets in children, yet their effectiveness remains unclear. The objective of this study, published in PLoS One, was to systematically review and quantify the impact of school food environment policies on dietary habits, adiposity, and metabolic risk in children.

Skipping breakfast, overconsumption of soft drinks and screen media: longitudinal analysis of the combined influence on weight development in primary schoolchildren
Regular breakfast and well-balanced soft drink, and screen media consumption are associated with a lower risk of overweight and obesity in schoolchildren. The aim of this research, published in BMC Public Health, was to examine these three parameters as influencing factors for longitudinal weight development in schoolchildren in order to adapt targeted preventive measures.

Oral Health (New Zealand)

Structural Determinants and Children's Oral Health: A Cross-National Study
Much research on children's oral health has focused on proximal determinants at the expense of distal (upstream) factors. Yet, such upstream factors-the so-called structural determinants of health-play a crucial role. Children's lives, and in turn their health, are shaped by politics, economic forces, and social and public policies. The aim of this study, published in the Journal of Dental Research, was to examine the relationship between children's clinical (number of decayed, missing, and filled teeth) and self-reported oral health (oral health-related quality of life) and 4 key structural determinants (governance, macroeconomic policy, public policy, and social policy) as outlined in the World Health Organization's Commission for Social Determinants of Health framework.

Reducing Indigenous Oral Health Inequalities: A Review from 5 Nations
Indigenous populations around the world experience a disproportionate burden in terms of oral diseases and conditions. These inequalities are likely due to a complex web of social determinants that includes poverty, historical consequences of colonialism, social exclusion, government policies of assimilation, cultural annihilation, and racism in all its forms (societal, institutional). Despite documented oral health disparities, prevention interventions have been scarce in Indigenous communities. This review, published in the Journal of Dental Research, describes oral health interventions and their outcomes conducted for Indigenous populations of the United States, Canada, Brazil, Australia, and New Zealand.

Māori Innovation

Ngātiwai Whakapakari Tinana: strengthening bodies through a Kaupapa Māori fitness and exercise programme
Activity based weight loss programmes may result in modest reductions in weight. Despite the small successes demonstrated by these interventions, there are few examples that specifically address the disparity of obesity for Māori compared to non-Māori. This research, published in the Journal of Primary Health Care, highlights the results of a Kaupapa Māori fitness and exercise programme that aimed to assist mainly Māori adults, to lose weight. The programme was designed to support participants by using Māori cultural values.

Achieving health equity in Aotearoa New Zealand: the contribution of medicines optimisation
This paper, published in the Journal of Primary Health Care, 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.

Key Ministry of Health Publications

Whāia Te Ao Mārama 2018 to 2022: The Māori Disability Action Plan
Whāia Te Ao Mārama is a culturally anchored approach to supporting Māori with disabilities (tāngata whaikaha) and their whānau because Māori are more likely to be disabled than the general population. Whāia Te Ao Mārama recognises that everyone must work together to achieve the vision – tāngata whaikaha pursue a good life with support. It outlines what the Ministry is committing to do from 2018 to 2022 and provides examples of actions tāngata whaikaha, whānau, health and disability providers, iwi and other organisations can take.

Where I Live; How I Live – Disability Support Services Community Residential Support Services Strategy 2018 to 2020
Where I Live; How I Live is about optimising the independence and self-determination of disabled people. It is in line with the Enabling Good Lives (EGL) principles that support people with a disability to make decisions about the kind of life they want.

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