Deprivation requires a response: ‘Build back better’ for the health of Pacific peoples

The study included 312,670 Pacific patients enrolled in 924 practices, with 29,715 in 15 Pacific-owned practices at September 2018.

Models of practice. Pacific-owned practices were one of seven models of general practice; most (11 of 15) were owned by a trust or NGO. Other models were: traditional, corporate, PHO/DHB, trust/NGO, Pacific practices and Health Care Homes.

Traditional practices were the dominant model and enrolled 49 per cent of all Pacific patients and 73 per cent of the total enrolled population. Corporate practices enrolled a further 33 per cent of all Pacific patients.

In the average Pacific practice, 62 per cent of patients were Pacific, about five times the percentage of Pacific peoples in traditional practices (12 per cent), 10 times the percentage in Health Care Homes (6 per cent), and four times the percentage in corporate practices (14 per cent).

The study aim was to determine whether differences in patient health outcomes for Pacific peoples were associated with different models of practice.

Pacific practices overlapped with other practice models, constituting 11 (of 99) trust/NGO practices, one (of 127) HCH practices, none (of 103) corporate practices, and four (of 695) traditional practices.

Pacific practice size was smaller, with more younger and fewer older patients; there was a much larger percentage of Pacific patients than for total practices. Pacific practices were much more likely to hold a Very Low Cost Access contract, with lower patient copayments (87 per cent compared with 30 per cent for total practices).

Rural practices. No Pacific practices were rural. Fewer Pacific patients lived rurally compared with the total population.

Patient healthcare needs. Patients in Pacific practices were more likely to experience material deprivation, more likely to be dispensed an antibiotic, less likely to be dispensed a selective serotonin reuptake inhibitor, more likely to have diabetes and multimorbidity, and less likely to have continuity of practice.

Preventive care. The highest percentage of cervical screening (78 per cent) and cardiovascular risk assessment (73 per cent) was undertaken by nurses in Pacific practices. The highest rates of preventive care (cervical screening, cardiovascular risk assessment, PHQ9 mental health assessment, HbA1c testing) were in Pacific, trust/NGO and Māori practices.

Clinical input. In Pacific practices, considerably more nurse (61 per cent) and doctor (6 per cent) time (FTE) was spent with patients than in total practices. The median registered nurse FTE per 1000 patients was higher in Pacific (0.87) than in total practices (0.54). The median GP FTE per 1000 patients was similar in Pacific (0.67) and total practices (0.63).

Consultations after hours. A higher percentage of after-hours consultations were undertaken by a nurse or nurse practitioner than a GP in Pacific practices and PHO/DHB practices.

Consultations with patients not enrolled in a practice. Almost twice as many casual or walk-in patients were seen by a nurse than a GP in a Pacific practice (40 per cent) compared to a traditional (23 per cent), corporate (23 per cent) or Health Care Home (18 per cent) practice.

Outcomes for Pacific patients in Pacific practices were similar to other practice models with respect to polypharmacy, up-to-date immunisations at six months, ambulatory sensitive hospitalisations, or emergency department attendance (despite an enrolled patient profile suggesting increased need for primary care). Pacific practices had a slightly lower rate of HbA1c testing in people with diabetes.

Patient healthcare needs. Pacific patients were more likely to be dispensed antibiotics; to have diabetes and a higher multimorbidity score; and less likely to be dispensed tramadol or the most common type of antidepressant.

First Specialist Assessments (FSA). The Pacific rate of FSA was lower than for the total population (6.7 per cent with one FSA compared with 8.1 per cent). Given the overall high health needs of Pacific peoples, the higher rate of FSA not attended within the last year is concerning. FSA referrals are generated from both primary and secondary care so more information is required to establish what might be inappropriately low referral rates.

Nurse, NP, and GP time (FTE). Pacific, Māori and trust/NGO practices had the highest nursing workforce (medians 0.87, 0.98 and 1.09 FTE, respectively) compared with 0.69 for total practices. The median total workforce, nursing together with GPs, was Pacific (1.54 FTE), Māori (1.66 FTE) and trust/ NGO 1.78 FTE).

Dr Nelson Aguirre-Duarte, Comprehensive Care, Aotearoa New Zealand nelson@comprehensivecare.co.nz

Professor Bruce Arroll, University of Auckland, Aotearoa New Zealand bruce.arroll@auckland.ac.nz

Dr Carol Atmore, WellSouth Primary Health Network, Aotearoa New Zealand carol.atmore@wellasouth.org.nz

Professor Jenny Carryer, Massey University, Aotearoa New Zealand j.b.carryer@massey.ac.nz

Professor Peter Crampton, University of Otago, Aotearoa New Zealand peter.crampton@otago.ac.nz

Professor Anthony Dowell, University of Otago, Aotearoa New Zealand tony.dowell@otago.ac.nz

Dr Tana Fishman, independent researcher, Aotearoa New Zealand tana.fishman@gmail.com

Professor Robin Gauld, University of Otago, Aotearoa New Zealand robin.gauld@otago.ac.nz

Associate professor Matire Harwood, University of Auckland, Aotearoa New Zealand m.harwood@auckland.ac.nz

Professor Karen Hoare, Massey University, Aotearoa New Zealand k.j.hoare@massey.ac.nz

Dr Gary Jackson, Te Whatu Ora – Health New Zealand Counties Manukau, Aotearoa New Zealand gary.jackson@middlemore.co.nz

Dr Rawiri McKree Jansen, Te Aka Whai Ora – Māori Health Authority, Aotearoa New Zealand rawiri.mckreejansen@health.govt.nz

Professor Ngaire Kerse, University of Auckland, Aotearoa New Zealand n.kerse@auckland.ac.nz

Ms Debra Lampshire, University of Auckland, Aotearoa New Zealand d.lampshire@auckland.ac.nz

Associate professor Lynn McBain, University of Otago, Aotearoa New Zealand lynn.mcbain@otago.ac.nz

Mr Jayden MacRae, Datacraft Analytics, Aotearoa New Zealand jayden@datacraft.nz

Professor Jane Mills, La Trobe University, Australia jane.mills@latrobe.edu.au

Professor John Øvretveit, Karolinska Institutet, Sweden jovretbis@aol.com

Dr Roshan Perera, Health Hawke’s Bay – Te Oranga o Te Matau-aMāui, Aotearoa New Zealand roshan.perera@healthhb.co.nz

Professor Martin Roland, University of Cambridge, United Kingdom mr108@cam.ac.uk

Professor Tim Stokes, University of Otago, Aotearoa New Zealand tim.stokes@otago.ac.nz

Associate professor Maria Stubbe, University of Otago, Aotearoa New Zealand maria.stubbe@otago.ac.nz