Journal of primary health care最新文献_第8页

An area-based analysis of general practice fees in Aotearoa New Zealand. 新西兰奥特亚罗瓦地区全科诊疗费用的地区分析。

IF 0.9

Journal of primary health care Pub Date : 2024-06-01 DOI: 10.1071/HC23157

Megan Pledger, Maite Irurzun-Lopez, Jacqueline Cumming

{"title":"An area-based analysis of general practice fees in Aotearoa New Zealand.","authors":"Megan Pledger, Maite Irurzun-Lopez, Jacqueline Cumming","doi":"10.1071/HC23157","DOIUrl":"10.1071/HC23157","url":null,"abstract":"Introduction The pursuit of health care equity is a fundamental objective for Aotearoa New Zealand, and patient co-payments in primary care challenge this goal. Aim This study aimed to investigate the relationship between primary health care co-payments and the sociodemographic variables in areas where general practices provide health care. Methods Using census data, facilities information from the Ministry of Health, and socioeconomic deprivation indices, linear regression models were used to explore the relationship between weighted average fees charged by general practices and various sociodemographic variables in statistical area 2 regions. Results The study finds that areas with higher proportions of males and economically deprived individuals are associated with lower weighted average fees. Conversely, areas with higher proportions of retirement-aged and European individuals are linked with higher weighted average fees. The inclusion of the Very-Low-Cost-Access variable, indicating a subsidy scheme at the general practice level, made all the sociodemographic variables practically insignificant, suggesting Very-Low-Cost-Access practices are in the right geographical location to target high needs groups. Discussion The findings affirm the complexity of health care inequities in Aotearoa New Zealand, influenced not only by financial factors but also by demographic variables as they play out geographically. While subsidy schemes like the Very-Low-Cost-Access scheme appear to reach groups with greater need, a high level of unmet need due to cost suggests that the fees are still too high. Policymakers need to consider disparities in the on-going health care reforms and make further changes to subsidy schemes to reduce unmet need.","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":"16 2","pages":"121-127"},"PeriodicalIF":0.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468861","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Exploring the role of physician associates in Aotearoa New Zealand primary health care. 探索医生助理在新西兰奥特亚罗瓦初级医疗保健中的作用。

IF 0.9

Journal of primary health care Pub Date : 2024-06-01 DOI: 10.1071/HC23134

Albert Andrew

{"title":"Exploring the role of physician associates in Aotearoa New Zealand primary health care.","authors":"Albert Andrew","doi":"10.1071/HC23134","DOIUrl":"10.1071/HC23134","url":null,"abstract":"Introduction New Zealand's health care system faces significant shortages in health care workers. To address workforce challenges and meet the population's health needs, health care systems around the world have introduced new clinical roles, such as physician associates/assistants (PAs) into existing health care teams. Aim This article aims to examine the benefits, challenges, and broader implications of regulating PAs in the context of New Zealand's primary care sector, with a specific emphasis on how it may impact general practice. Methods A range of literature surrounding the role, impact, and perception of PAs were selected and included in this article. Results The PA profession can significantly strengthen New Zealand's primary care workforce, improving patient access and continuity of care. However, the global deployment of PAs has faced scrutiny due to concerns about its potential risks to patient safety and the overall viability of such a role. Discussion If regulated, the PA profession can reshape New Zealand's primary care, offering a partial solution to current medical staff shortages. Trained under a generalised medical model similar to doctors, PAs possess the necessary skills to perform both routine and non-routine medical tasks. This dual capability can significantly improve primary care service provision, reduce existing workloads, and allow for a more efficient deployment of doctor expertise. However, medico-legal issues and the supervisory burden can impede widespread integration into general practice. Despite challenges, the success of the PA role relies on mutual trust, respect, and support from other clinical team members within primary health care.","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":"16 2","pages":"210-213"},"PeriodicalIF":0.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Private practice model of physiotherapy: professional challenges identified through an exploratory qualitative study. 私人物理治疗实践模式：通过探索性定性研究发现的专业挑战。

IF 0.9

Journal of primary health care Pub Date : 2024-06-01 DOI: 10.1071/HC23150

Ben Darlow, Gill Stotter, Eileen McKinlay

{"title":"Private practice model of physiotherapy: professional challenges identified through an exploratory qualitative study.","authors":"Ben Darlow, Gill Stotter, Eileen McKinlay","doi":"10.1071/HC23150","DOIUrl":"10.1071/HC23150","url":null,"abstract":"Introduction Community-based primary care physiotherapy has developed through private practice, fee-for-service model in Aotearoa New Zealand where independent businesses operate in competition. Aim We aimed to explore how the private practice model of physiotherapy impacts patient care, physiotherapists, and professional behaviour. Methods Six physiotherapists managing musculoskeletal conditions in a primary care private practice in Aotearoa New Zealand were recruited using maximum variation purposive sampling. In-depth individual face-to-face semi-structured interviews were audio-recorded, transcribed verbatim, and analysed using Interpretive Description. Inductive data analysis synthesised and contextualised data, creating a thematic framework that developed across interviews. Results All physiotherapy participants discussed concerns about culture and professionalism in private practice physiotherapy despite not being asked about these. Three themes were identified. 'Competitive business model and lack of collaboration' - participants thought that competition between practices resulted in a lack of trust, collegiality, and collaboration, and pressure on clinicians to maintain income. '(Un)professional behaviour' - participants thought that physiotherapists were defensive and averse to scrutiny, resulting in reluctance to admit when they needed help, or to undertake peer review or seek second opinions. 'Lack of support and mentoring' - the professional culture in private practice was perceived to reduce support and mentoring, with negative impacts that affected physiotherapists at all stages of career. Conclusion This exploratory qualitative study suggests that competition dominates communication and collaboration in private practice physiotherapy and may have wider implications for professionalism and the quality of patient care. Competitive business models and an aversion to scrutiny may reduce collegial interaction and professional behaviour.","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":"16 2","pages":"143-150"},"PeriodicalIF":0.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468868","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Time for a change? Unity not competition for the sake of our communities. 是时候做出改变了吗？为了我们的社区，团结而非竞争。

IF 0.9

Journal of primary health care Pub Date : 2024-06-01 DOI: 10.1071/HC24063

Rawiri Keenan Te Ati Awa Taranaki, Jenny Carryer

引用次数: 0

Implementing new forms of collaboration and participation in primary health care: leveraging past learnings to inform future initiatives. 在初级医疗保健中实施新的合作和参与形式：利用过去的经验为未来的举措提供信息。

IF 0.9

Journal of primary health care Pub Date : 2024-06-01 DOI: 10.1071/HC24026

Lesley Middleton, Claire O'Loughlin, Tim Tenbensel, Pushkar Silwal, Marianna Churchward, Lynne Russell, Jacqueline Cumming

{"title":"Implementing new forms of collaboration and participation in primary health care: leveraging past learnings to inform future initiatives.","authors":"Lesley Middleton, Claire O'Loughlin, Tim Tenbensel, Pushkar Silwal, Marianna Churchward, Lynne Russell, Jacqueline Cumming","doi":"10.1071/HC24026","DOIUrl":"10.1071/HC24026","url":null,"abstract":"Introduction Within primary health care policy, there is an increasing focus on enhancing involvement with secondary health care, social care services and communities. Yet, translating these expectations into tangible changes frequently encounters significant obstacles. As part of an investigation into the progress made in achieving primary health care reform in Aotearoa New Zealand, realist research was undertaken with those charged with responsibility for national and local policies. The specific analysis in this paper probes primary health care leaders' assessments of progress towards more collaboration with other health and non-health agencies, and communities. Aim This study aimed to investigate how ideas for more integration and joinedup care have found their way into the practice of primary health care in Aotearoa New Zealand. Methods Applying a realist logic of inquiry, data from semi-structured interviews with primary health care leaders were analysed to identify key contextual characteristics and mechanisms. Explanations were developed of what influenced leaders to invest energy in joined-up and integrated care activities. Results Our findings highlight three explanatory mechanisms and their associated contexts: a willingness to share power, build trusting relationships and manage task complexity. These underpin leaders' accounts of the success (or otherwise) of collaborative arrangements. Discussion Such insights have import in the context of the current health reforms for stakeholders charged with developing local approaches to the planning and delivery of health services.","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":"16 2","pages":"198-205"},"PeriodicalIF":0.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Unmet need for primary health care and subsequent inpatient hospitalisation in Aotearoa New Zealand. A cohort study. 新西兰奥特亚罗瓦地区未得到满足的初级保健需求与随后的住院治疗。一项队列研究。

IF 0.9

Journal of primary health care Pub Date : 2024-06-01 DOI: 10.1071/HC24018

Megan Pledger, Jacqueline Cumming

{"title":"Unmet need for primary health care and subsequent inpatient hospitalisation in Aotearoa New Zealand. A cohort study.","authors":"Megan Pledger, Jacqueline Cumming","doi":"10.1071/HC24018","DOIUrl":"10.1071/HC24018","url":null,"abstract":"Introduction The inability to afford a consultation with a general practitioner may lead to delays in accessing care pathways. Aim This study aimed to explore the characteristics of people by their unmet need for a general practitioner consultation because of cost, and the characteristics of subsequent inpatient hospitalisations. Methods From the New Zealand Health Surveys (2013/14-2018/19), two groups were formed based on their unmet need for a general practitioner consultation due to cost. These groups were compared by socio-demographic factors and subsequent inpatient hospitalisation characteristics during follow-up. Time to an inpatient hospitalisation was the outcome in a proportional hazards regression model with need status as the key variable. The model was expanded to include confounding variables: sex, age group, ethnicity, the New Zealand Deprivation Index and self-rated health. Results The need group, characterised by having a higher proportion of females, younger adults, Māori, increased socioeconomic deprivation and poorer self-rated health experienced a greater chance of hospitalisation, a similar number of visits during follow-up, shorter stays and a quicker time to hospitalisation compared to the no-need group. Proportional hazards survival models gave a 28% higher hazard rate for the time to an inpatient hospitalisation for the need group compared to the no-need group. The inclusion of all the confounders in the model gave a similar hazard ratio. Discussion Although consultation fees vary across general practices, it is evident that this may not eliminate the cost barriers to accessing care for some groups. Needing multiple consultations may contribute to persistent unmet needs.","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":"16 2","pages":"128-134"},"PeriodicalIF":0.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468908","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

The primary care workforce crisis: defining the problems and finding solutions. 初级保健人员危机：界定问题并寻找解决方案。

IF 0.9

Journal of primary health care Pub Date : 2024-06-01 DOI: 10.1071/HC24078

Felicity Goodyear-Smith, Tim Stokes

引用次数: 0

He Aroka Urutā. Rural health provider perspectives of the COVID-19 vaccination rollout in rural Aotearoa New Zealand with a focus on Māori and Pasifika communities: a qualitative study. He Aroka Urutā.新西兰奥特亚罗瓦农村地区医疗服务提供者对COVID-19疫苗接种推广的看法，重点关注毛利人和帕西菲卡人社区：一项定性研究。

IF 0.9

Journal of primary health care Pub Date : 2024-06-01 DOI: 10.1071/HC23171

Katharina Blattner, Lynne Clay, Rawiri Keenan, Jane Taafaki, Sue Crengle, Garry Nixon, Kiri Fortune, Tim Stokes

{"title":"He Aroka Urutā. Rural health provider perspectives of the COVID-19 vaccination rollout in rural Aotearoa New Zealand with a focus on Māori and Pasifika communities: a qualitative study.","authors":"Katharina Blattner, Lynne Clay, Rawiri Keenan, Jane Taafaki, Sue Crengle, Garry Nixon, Kiri Fortune, Tim Stokes","doi":"10.1071/HC23171","DOIUrl":"10.1071/HC23171","url":null,"abstract":"Introduction From a coronavirus disease (COVID-19) pandemic perspective, Aotearoa New Zealand (NZ) rural residents formed an at-risk population, and disparities between rural and urban COVID-19 vaccination coverage have been found. Aim To gain insight into factors contributing to the urban-rural COVID-19 vaccination disparity by exploring NZ rural health providers' experiences of the vaccine rollout and pandemic response in rural Māori and Pasifika communities. Methods Rural health providers at four sites participated in individual or focus group semi-structured interviews exploring their views of the COVID-19 vaccine rollout. Thematic analysis was undertaken using a framework-guided rapid analysis method. Results Twenty interviews with 42 participants were conducted. Five themes were identified: Pre COVID-19 rural situation, fragile yet resilient; Centrally imposed structures, policies and solutions - urban-centric and Pakehā focused; Multiple logistical challenges - poor/no consideration of rural context in planning stages resulting in wasted resource and time; Taking ownership - rural providers found geographically tailored, culturally anchored and locally driven solutions; Future directions - sustained investment in rural health services, including funding long-term integrated (rather than 'by activity') health services, would ensure success in future vaccine rollouts and other health initiatives for rural communities. Discussion In providing rural health provider perspectives from rural areas serving Māori and Pasifika communities during the NZ COVID-19 vaccine rollout, the importance of the rural context is highlighted. Findings provide a platform on which to build further research regarding models of rural health care to ensure services are designed for rural NZ contexts and capable of meeting the needs of diverse rural communities.","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":"16 2","pages":"170-179"},"PeriodicalIF":0.9,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141468865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Substitution of regulated health professionals, such as doctors and nurses, with unregulated health care workers, such as physician assistants, gives rise to concerns around patient safety and accountability issues: No. 用医生助理等不受监管的医护人员取代医生和护士等受监管的医护专业人员，会引起对患者安全和问责问题的担忧：没有。

IF 0.9

Journal of primary health care Pub Date : 2024-06-01 DOI: 10.1071/HC24077

Allan R Moffitt

引用次数: 0

Attention deficit and hyperactivity disorder and use of psychostimulants in Aotearoa, New Zealand: exploring the treatment gap. 新西兰奥特亚罗瓦的注意力缺陷和多动症与精神兴奋剂的使用：探索治疗差距。

IF 0.9

Journal of primary health care Pub Date : 2024-03-01 DOI: 10.1071/HC23126

Steven Lillis

{"title":"Attention deficit and hyperactivity disorder and use of psychostimulants in Aotearoa, New Zealand: exploring the treatment gap.","authors":"Steven Lillis","doi":"10.1071/HC23126","DOIUrl":"10.1071/HC23126","url":null,"abstract":"Introduction Attention deficit and hyperactivity disorder (ADHD) is a common neurodevelopmental disorder affecting about 7% of those aged up to 12 years, 5% of teenagers and 3% of adults. It is associated with poor academic performance, substance abuse, criminality, poor social functioning and other negative outcomes. Psychotherapeutic treatment is moderately successful, whereas pharmacotherapy with stimulant medication is more efficacious and is recommended in many international guidelines. Anecdotal evidence suggests underuse of these medications in Aotearoa, New Zealand. Aim To estimate how many patients with ADHD are prescribed psychostimulants in Aotearoa, New Zealand. Methods National prescribing data for dexamphetamine and methylphenidate in 2022 were obtained and matched against estimated prevalence of ADHD by age. Results There is a significant treatment gap for which inability to access first-line medication is likely to be the predominant explanation. Discussion The data suggest failure of our health system to provide reasonable health care for a significant number of people with ADHD, and results in inequity in outcomes. New approaches are needed that will increase access to first-line medication, yet maintain appropriateness of diagnosis and limit risk of medication diversion.","PeriodicalId":16855,"journal":{"name":"Journal of primary health care","volume":"16 1","pages":"27-32"},"PeriodicalIF":0.9,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140318537","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0