Issue 328 - 21 August 2025

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

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Article Access

For articles that aren't open access, contact your Health NZ district 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.

Health Equity (New Zealand)

Does the Implementation of a Model of Care Improve the Value for Money of Mental Health Services in Prisons?
There is little research into appropriate measures of value for money in prison mental health services. The aim of this study, published in Criminal Behaviour and Mental Health, was to develop and evaluate an accountability framework for an enhanced Prison Model of Care for people with serious mental illness in five New Zealand prisons.

Adaptations to implementation frameworks for minority ethnic groups to improve health equity: systematic scoping review
There are critical gaps within implementation science concerning health equity, particularly for minoritised ethnic groups. Implementation framework adaptations are important to facilitate health equity, which is especially relevant for psychiatry due to ethnic inequities in mental health; however, the range of potential adaptations has yet to be synthesised. This systematic scoping review, published in BJPsych Open, aimed to identify and map the characteristics of adaptations to implementation frameworks for minority ethnic groups to improve health equity.

Community-based interventions to improve the health of migrant children in high-income countries: a systematic review
Migrant children, including those exposed to migration in utero, face structural barriers to health and social inclusion in high-income countries (HICs). Despite their heightened vulnerability, evidence on effective interventions to improve their health remains limited. The objective of this review, published in Social Science & Medicine, was to synthesise experimental and quasi-experimental evidence on community-based interventions aiming to improve health outcomes for migrant children in HICs.

Examining ethnic and geographic disparities in end-of-life care pathways and community specialist palliative care engagement: insights from the Waikato Region
This audit, published in The New Zealand Medical Journal, aims to evaluate differences in access and care between Māori and Pākehā patients, as well as between urban, rural and aged residential care (ARC) populations.

Quality Improvement (International)

Use of health equity tools in patient safety incident analyses: a scoping review
The aim of this study, published in BMJ Open, is to investigate the use and effectiveness of equity tools in current practices of patient safety incident analyses via a scoping review of the literature.

From complaint material to quality improvement: Exploring the use of patient complaints or compensation claims in quality improvement initiatives—a scoping review
There is increasing interest in how patient complaint material can be used to highlight areas requiring quality improvement (QI) in healthcare. However, knowledge of using complaint material to initiate or monitor QI is limited. This review, published in BMJ Quality & Safety, explored the use of complaint material in QI by identifying problems related to substandard care that were addressed by QI initiatives, exploring how complaint material was used before or after a QI initiative, and mapping changes in complaint material after QI initiatives.

Hospital Productivity (International)

Barriers and facilitators to the use of virtual wards: a systematic review of the qualitative evidence
Virtual wards offer an alternative to traditional inpatient care, delivering acute care, monitoring, and treatment at home to prevent hospital admissions or facilitate early discharge. The aim of this qualitative systematic review, published in the International Journal for Quality in Health Care, was to understand the barriers to and facilitators for the successful implementation and sustainability of virtual wards from the perspective of any involved stakeholder, using behavioural change models.

Cancer Services (New Zealand)

Inequities in 'failure to rescue' for Indigenous Māori after gastrointestinal cancer surgery in New Zealand
Indigenous populations worldwide experience unjust inequities in surgical outcomes. In Aotearoa New Zealand, Indigenous Māori experience poorer health outcomes, including higher rates of postoperative mortality. The aim of this study, published in The British Journal of Surgery, was to quantify ethnic disparities in 'failure to rescue' (FTR), complications, and mortality following gastrointestinal cancer surgery and to analyse trends over time.

How Frequently Is Colorectal Cancer Recurrence Detected in Clinic?
Outpatient clinic follow-up has been standard practice for decades following resection of colorectal cancer, however recent evidence regarding its efficacy in oncological detection is limited. With increasing health limitations and rising numbers of colorectal cancer patients, the role of clinic follow-up may need re-evaluation. The aim of this study, published in Diseases of the Colon and Rectum, is to determine the frequency of clinical examination compared to other modalities in identification of colorectal cancer recurrence in Northland.

A scoping review of the levels, implementation strategies, enablers, and barriers to cervical, breast, and colorectal cancer screening among migrant populations in selected English-speaking high-income countries
Cancer remains one of the leading causes of mortality and morbidity worldwide with colorectal, cervical, and breast cancers accounting for significant proportion of preventable deaths. Early screening, diagnosis, and treatment could prevent many of these deaths. However, migrants face persistent disparities in the screening, early diagnosis, and treatment of these cancers. This study, published in PloS One, synthesises evidence on cancer screening uptake, implementation strategies, as well as their enablers and barriers among migrants in English-speaking high-income countries (Australia, the USA, the UK, Canada, and New Zealand).

Cardiovascular Disease and Diabetes (New Zealand)

Inequities in the Care and Outcomes of Indigenous People Living With Kidney Failure
Kidney failure, defined as end-stage kidney disease requiring kidney replacement therapy, is a public health concern that disproportionately affects indigenous peoples around the world. Despite advancements in medical technologies and preventive public health interventions in kidney care, indigenous peoples continue to face significant barriers that limit their access to care. These barriers include limited availability of kidney care services in remote areas, cultural and language obstacles, systemic racism, low health literacy, geographic isolation, and mistrust in health care systems. Such challenges contribute to notable disparities in kidney disease outcomes and kidney replacement therapy access. Previous research in countries such as Canada, Australia, New Zealand, and the United States demonstrates a disproportionate burden of risk factors, chronic kidney disease, and the consequences of kidney failure and other complications among indigenous peoples. This review, published in Advances in Kidney Disease and Health, explores the global landscape of kidney failure among indigenous populations, examining epidemiological data, barriers to care, and outcomes of kidney replacement therapy.

Primary Health Care (New Zealand)

A mixed-methods evaluation of a culturally tailored maternal and child mHealth programme: txtpēpi
Pregnancy and the postnatal period are opportune times to support parental health and encourage future child health and wellbeing. txtpēpi is an individually tailored text message programme for parents and families providing information and support during pregnancy and the postnatal period. txtpēpi was developed for a region of Aotearoa New Zealand, with a high proportion of Māori (the Indigenous population) and people living rurally or in areas of high deprivation. This paper, published in the Journal of Health Psychology, presents a mixed-methods evaluation of txtpēpi using the RE-AIM Framework, involving interviews with 40 end-users and nine stakeholders, and analysis of system-recorded end-user data.

Primary Mental Health (New Zealand)

Improving primary care for people with mental health or substance use
This Equally Well resource has been produced by Te Pou and the Tupuānuku and Te Pu Korokoro researchers at the University of Otago. It is designed for primary care clinicians to enhance their understanding of diagnostic overshadowing. This happens when there is an attribution of presenting symptoms to an existing mental health or substance use diagnosis rather than a potential co-occurring physical health issue. Overshadowing can prevent people from getting the health care they need and contributes to poorer health outcomes in people with mental health or substance use conditions.

Primary Mental Health (International)

Bridging the gap: monthly telephone calls to enhance collaboration between primary care physicians and psychiatrists
The integration of mental health services within primary care settings is a growing priority in Canada, driven by the need to improve access and ensure comprehensive patient-centred care. This year-long pilot quality improvement (QI) project, published in BMJ Open Quality, was conducted to examine the feasibility and impact of introducing monthly telephone consultations between primary care physicians (PCPs) and psychiatrists working at a secondary care regional hospital in Ontario, Canada.

Smoking Cessation (New Zealand)

"Stealth Vaping Is Everywhere": The Narratives of Young Māori Adults in New Zealand
Vape use is increasing, particularly among young people who have never been cigarette smokers. Stealth vaping, that is, discrete use in places where it is prohibited, is also reported to be increasing. Regular vape use is high among those who identify as Māori, with the Tobacco Industry reported to be targeting Indigenous communities, thus continuing long-running harmful, colonial practices. This qualitative study, published in Nicotine & Tobacco Research, explored stealth vaping with 19 young adults, of whom 18 identified as Māori in the Indigenous context in New Zealand.

Smoking Cessation (International)

Facilitators and barriers to smoking cessation support among professionals in social and community service settings: a systematic review and thematic synthesis
Social and community service settings are a promising environment to support individuals with lower socioeconomic positions in quitting smoking. However, there remains a notable lack of support from their professionals in these settings. This study, published in Health Education Research, provides an overview of facilitators and barriers to smoking cessation support among these professionals.

Oral Health (International)

Artificial Intelligence in Australian Dental and General Healthcare: A Scoping Review
This review, published in the Australian Dental Journal, contextualises the role of generative Artificial Intelligence (AI) in healthcare within an Australian healthcare regulatory and ethical framework.

Key Ministry of Health Publications

Section 99 Inspection into Canterbury – Waitaha Adult Inpatient and Associated Mental Health Services
This report is the result of an inspection of Canterbury – Waitaha adult inpatient and associated mental health services. The Director of Mental Health has powers under section 99 of the Mental Health (Compulsory Assessment and Treatment) Act 1992 to inspect any hospital, or any ward, unit, or other part of a hospital, in which psychiatric treatment is given. This inspection arose from concerns the Director of Mental Health held as to whether there were systemic issues in these services. The inspection examined not only the operational and clinical governance and functioning of the adult inpatient and associated mental health services but also how that operational and clinical governance is overseen by wider organisational processes. The Section 99 report made nine findings and made 18 recommendations falling into three broad categories: governance; care models; and resourcing. The overarching theme across the recommendations is the need for better cooperation between service leadership and service delivery to prioritise the service, enable staff to do their best, improve the models of care, and plan for the future. Health New Zealand have already commenced an improvement programme on the basis of recommendations in the draft report.

Ministry of Health Consultations & Events

Clozapine: Proposed changes to blood monitoring and prescribing requirements - consultation questions for consumers and families
This Medsafe consultation seeks your feedback on proposed changes to the blood monitoring for clozapine. This consultation is for people taking clozapine. A family member or caregiver can also answer on someone’s behalf. This consultation closes on the 8th October 2025.

Clozapine: Proposed changes to blood monitoring and prescribing requirements - consultation questions for healthcare professionals
This Medsafe consultation seeks your feedback on proposed changes to the blood monitoring and prescribing requirements for clozapine. This consultation is seeking feedback from New Zealand-based healthcare professionals. This consultation closes on the 8th October 2025. 

Health Sector Initiative

Training tomorrow’s cardiac specialists, today
Rotorua Hospital’s Clinical Physiology team is investing in the future of heart healthcare by training the next generation of cardiac specialists, which is already making a significant difference for patients. Health New Zealand Lakes is currently supporting four trainees, two in cardiac sonography, one clinical physiologist, and one physiology technician, through a mix of on-the-job learning and academic study.

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.