Ministry of Health Library

Health Improvement and Innovation Digest

Issue 193 - 20 June 2019

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@health.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 (New Zealand)

Towards quality improvement at scale in the New Zealand primary care setting: findings from consumer and health service engagement
The purpose of this document, commissioned by the Health Quality & Safety Commission, was to summarise the findings from consumer and health service engagement to inform the 2019/20 Primary Care programme planning on how to progress primary care quality improvement (QI) at scale.

DEFEAT-polypharmacy: deprescribing anticholinergic and sedative medicines feasibility trial in residential aged care facilities
Deprescribing is a proposed intervention that can help to minimise polypharmacy whilst potentially improving several health outcomes in older people. Published in the International Journal of Clinical Pharmacy, this study aimed to examine the feasibility of implementing a deprescribing intervention that utilises a patient-centred pharmacist-led intervention model, in order to address major deprescribing challenges such as general practitioner time constraints and lack of accessible deprescribing guidelines and processes.

Quality Improvement (International)

'They do not care how much you know until they know how much you care’: a qualitative meta-synthesis of patient experience in the emergency department
Patient experience is positively associated with both clinical effectiveness and patient safety and should be a priority for emergency care providers. While both quantitative and qualitative approaches can be used to evaluate patient experience in the emergency department (ED), the latter is well aligned to develop a detailed understanding of features influencing the lived experience of ED patients. This study, published in the Emergency Medicine Journal, aimed to systematically review the literature of qualitative studies to identify determinants of adult patient experience in the ED.

Interventions to address medication-related causes of hospital readmissions: a scoping review
Despite the availability of literature regarding hospital-level strategies to reduce readmissions, little has been written about strategies aimed at medication-related readmissions. Published in the Journal of Hospital Administration, this study sought to identify successful readmission reduction strategies by performing a scoping literature review of research published between 2000 and 2017.

Effect of a home-based exercise program on subsequent falls among community-dwelling high-risk older adults after a fall: a randomized clinical trial
Whether exercise reduces subsequent falls in high-risk older adults who have already experienced a fall is unknown. The objective of this study, published in JAMA, was to assess the effect of a home-based exercise program as a fall prevention strategy in older adults who were referred to a fall prevention clinic after an index fall.

Government policy interventions to reduce human antimicrobial use: a systematic review and evidence map
In this systematic review, published in PLoS Medicine, the authors assessed policy interventions intended to reduce antimicrobial overuse. They identified 17 unique policy options for governments to reduce the human use of antimicrobials.

Disability Sector Quality Improvement (New Zealand)

Proactive release of information - promoting the effective engagement of disabled people in policy development and service design
The Minister of Disability Issues has proactively released three documents detailing an Oral Cabinet Item. Dr Jonathan Godfrey as President of Blind Citizens along with the Social Investment Agency presented information on how disabled people had been engaged in consultation and the provision of advice to the Social Investment Agency in policy development. This was used as an exemplar to present ideas on the expectations for consulting disabled people, effective engagement and consultation processes, the benefits of doing this effectively and that engagement needs to respect the diversity of disabled people.

Shorter Waits for Cancer Treatment (New Zealand)

Predictors of non-attendance at outpatient endoscopy: a five-year multi-centre observational study from New Zealand
Missed and cancelled appointments for endoscopy lead to inefficient use of healthcare resources, increased financial costs, diagnostic and therapeutic delays, and longer wait times. The aims of this study, published in the New Zealand Medical Journal, were to evaluate non-attendance rates at outpatient endoscopy across two large public hospitals in New Zealand and identify any associated factors.

Shorter Stays In Emergency Departments (International)

Emergency department care for patients with mental health problems, a longitudinal registry study and a before and after intervention study
The objective of this study, published in International Emergency Nursing, was to describe the numbers and length of stay (LOS) of patients with mental health (MH) problems at a Dutch emergency department (ED) and the effect of a psychiatric intervention team (PIT) on patient flow.

Cardiovascular Disease and Diabetes (International)

The effectiveness of electronic health interventions on blood pressure control, self-care behavioural outcomes and psychosocial well-being in patients with hypertension: a systematic review and meta-analysis
Electronic health (eHealth) is a potential alternative for managing hypertension and modifying hypertension-related self-care set of behaviour. This review, published in the International Journal of Nursing Studies, aimed to identify the delivery mode and strategies used by current eHealth interventions and examine the effectiveness of eHealth on blood pressure control, self-care behavioural outcomes and psychosocial well-being.

Primary Health Care (New Zealand)

Mismatches between health service delivery and community expectations in the provision of secondary prophylaxis for rheumatic fever in New Zealand
Rheumatic fever (RF) recurrence prevention requires secondary prophylaxis for at least ten years. However, recurrences of rheumatic fever (RRF) persist disproportionately affecting Māori and Pacific youth. Reasons for recurrence rates are not well understood and commonly attributed to patient non-adherence. This research, published in the Australian & New Zealand Journal of Public Health, explored Māori and Pacific family experiences of RRF to better understand barriers to accessing secondary prophylaxis to inform health service improvements.

Identifying barriers to treatment of HCV in the primary care setting
The authors of this study, published in Hepatology International, conducted a survey of general practitioners in New Zealand to identify practice, attitudes, and potential barriers to treatment of Hepatitis C.

Primary Mental Health (International)

Psychiatric-related revisits to the emergency department following rapid expansion of community mental health services
Repeat visits (revisits) to Emergency Departments (EDs) for psychiatric care reflect poor continuity of care and impose a high financial cost. This study, published in Academic Emergency Medicine, tested whether rapid expansion of Community Health Centers (CHCs) - which provide regional, low-cost primary care - corresponded with fewer repeat psychiatric-related ED visits (PREDVs).

Better Help for Smokers to Quit (International)

Hypnotherapy for smoking cessation
Hypnotherapy is widely promoted as a method for aiding smoking cessation. It is intended to act on underlying impulses to weaken the desire to smoke, or strengthen the will to stop. Published in the Cochrane Database of Systematic Reviews, the objectives of this study were to evaluate the effect and safety of hypnotherapy for smoking cessation.

Weight Management (New Zealand)

Dissonance in naming adiposity: a quantitative survey of naming preferences from a convenience sample of health professional and lay population in Aotearoa New Zealand
Communication has an essential role in the therapeutic relationship between a patient and healthcare professionals (HCPs) with terminology playing an important role. The terminology used by HCPs can significantly impact on an individual's perceptions of weight and experience of stigma. Published in the New Zealand Medical Journal, this is the first quantitative research study in Aotearoa New Zealand to explore weight-related terminology.

Body size and weight, and the nutrition and activity behaviours of sexual and gender minority youth: findings and implications from New Zealand
Published in Public Health Nutrition, the objective of this study was to describe the body size and weight, and the nutrition and activity behaviours of sexual and gender minority (SGM) students and compare them with those of exclusively opposite-sex-attracted cisgender students. Male and female SGM students were also compared.

Weight Management (International)

Environmental interventions to reduce the consumption of sugar‐sweetened beverages and their effects on health
The objectives of this study, published in the Cochrane Database of Systematic Reviews, were to assess the effects of environmental interventions (excluding taxation) on the consumption of sugar‐sweetened beverages and sugar‐sweetened milk, diet‐related anthropometric measures and health outcomes, and on any reported unintended consequences or adverse outcomes.

Childhood Obesity (New Zealand)

Management of childhood obesity: an audit of clinical practice in secondary care
Childhood obesity continues to be a major health issue for children world-wide, with well-recognised major health effects. Published in the Journal of Paediatrics and Child Health, this study evaluated the prevalence of obesity in children presenting to secondary care in Southern New Zealand, as well as their clinical management.

Oral Health (International)

University-based initiatives towards better access to oral health care for rural and remote populations: a scoping review
Published in PLoS One, this scoping review maps a wide array of literature to identify academic programs that have been developed to enhance oral health care for rural and remote populations and to provide an overview of their outcomes.

Key Ministry of Health Publications

Household food insecurity among children: New Zealand Health Survey
Food insecurity is defined as a limited or uncertain availability of nutritionally adequate and safe foods or limited ability to acquire personally acceptable foods that meet cultural needs in a socially acceptable way. This publication, based on the New Zealand Health Survey, explores the prevalence of household food insecurity in New Zealand children aged 0-14 years. It also provides insights into the wider circumstances of children living in food insecure households, including their health status, development and unmet need for health care.

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.