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Start date: 2020Subject: search.filters.subject.Primary health care

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    A mixed-methods evaluation of an intervention for enhancing alcohol screening in adults aged 50+ attending primary health care
    (CSIRO Publishing on behalf of The Royal New Zealand College of General Practitioners, 2025-01-02) Towers A; Newcombe D; White G; McMenamin J; Sheridan J; Rahman J; Moore A; Stokes T
    Introduction Adults aged 50 years and over are drinking more than ever but primary health care (PHC) professionals find it challenging to screen them for alcohol-related harm, despite being at greater risk for harm than younger drinkers. Aim This intervention aimed to enhance alcohol screening for this cohort by (a) introducing an algorithm in the patient management system to automate detection of alcohol risk in patients and (b) providing training to support health professionals' practice of, knowledge about, and comfort with alcohol screening in this cohort. Methods Eleven PHC practices in Aotearoa New Zealand took part in this intervention, including 41 PHC health professionals. Development and integration of the automated alcohol screening process within PHC patient management systems was undertaken in parallel with health professional training approaches. Results Screening rates increased substantially at intervention initiation but fell immediately with the onset of the New Zealand COVID-19 national lockdown. Two-thirds of health professionals identified the system screening prompts, over 40% felt this changed their screening practice, and 33% increased their awareness of - and felt more comfortable screening for - alcohol-related risk in those aged 50+. Discussion We illustrated an initial increase in alcohol screening rates in those aged 50+ as a result of this intervention, but this increase could not be sustained in part due to COVID-19 disruption. However, health professionals indicated that this intervention helped many change their practice and enhanced their awareness of such risk and comfort in screening for alcohol-related risk in those aged 50+.
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    The key factors driving successful improvement in primary care : a mixed methods investigation of the determinants of quality improvement success in Aotearoa New Zealand : a thesis with publication presented in partial fulfilment of the requirements for the degree of Doctor of Philosophy, Massey University, Palmerston North, Aotearoa New Zealand
    (Massey University, 2023-11-30) Cullen, Jane
    Primary care is where the population receives most of their health care and where successful quality improvement (QI) can have the biggest impact on health, wellbeing, equity, and health system performance. A better understanding of the factors that influence QI in primary care is urgently needed to support a high-performing primary healthcare system. Most prior studies into the determinants of effective QI have focused on secondary care organisations and large-scale collaborative efforts. Primary care services such as general practice present a different set of challenges. Various key contextual factors have been identified in the literature, but few studies explain how they relate to each other and QI success. This study sought to answer the following questions: 1. What are the contextual factors influencing primary care improvement interventions? 2. How do the contextual factors, improvement content (topic and planned changes) and the implementation process influence each other and the improvement outcomes in primary care? 3. How applicable for primary care assessment is the Model for Understanding Success in Quality (MUSIQ), a tool for assessing modifiable contextual factors developed in secondary care? This research was an explanatory sequential mixed methods study based in the Aotearoa, New Zealand (NZ) primary care setting of general practice and Primary Health Organisations (PHOs). Amulti-case mixed methods approach was followed in the first stage. Mainly qualitative data were collected from primary care interviews guided by the Consolidated Framework for Implementation Research (CFIR). This was compared with quantitative data from the MUSIQ survey. The second stage consisted of a national survey where emerging theory was tested by partial least squares structural equation modelling (PLS-SEM). The findings revealed that most teams did not use formal QI methods, instead relying on their people-centred relationship skills and networks to drive QI via distributed leadership. Teams were intrinsically motivated by community and patient need and drew on strengths developed within the complexity and uncertainty of the primary care settings to drive QI. The collaborative skills which are increasingly required in the modern primary care setting support the shared social processes of sensemaking for enacting change. The key success factors driving QI in primary care are identified and how they relate to each other explained. A primary care adaptation of MUSIQ has been proposed that may aid improvement practitioners and researchers to assess primary care contexts. The key strengths should be developed and supported across primary care services and capability, capacity and resources supported centrally to increase the ability of primary care to improve services more easily and effectively.
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    Nursing care for people living with diabetes and associated conditions in Fiji : an iTaukei community context : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy, Massey University, Palmerston North, New Zealand
    (Massey University, 2021) Ravono, Akisi Nailaba
    This research examined the experiences of iTaukei (indigenous people of Fiji) patients and nurses in the context of the diabetes epidemic in Fiji. Vanua theory, which has some influence on iTaukei health beliefs and practices through its physical, social and cultural elements informed the design and conduct of the research. Despite the voluminous global literature on diabetes and non-communicable diseases (NCD), there was little written about the topic for Fiji and the Pacific. Fiji was among the first few countries to adopt public health initiatives that were developed to curb the incidence of NCD. However, such initiatives have faced a perpetual challenge in terms of implementation, monitoring and evaluation. The research used the Fijian Vanua Research Framework and veitalanoa, a data collection method, to gather information from twelve patients and eleven nurses from four medical areas in Fiji. The veitalanoa groups were complemented by four veitalanoa individual sessions and field observations. Findings revealed that patients struggled to cope with diabetes and associated complications while nurses were challenged to deliver best practice in inadequate nursing practice environments. Specifically, patients had difficulties both living with diabetes and accessing planned care and were culturally unlikely to question or challenge medical decisions, simply expecting safe and trustful care. Nurses were not able to nurse in the way they know is needed; they provided rudimentary and sometimes inappropriate care, and experienced extreme frustration while attempting to provide holistic care in a highly medicalised model of care. The nurses were aware of vanua etiquette and their connections with iTaukei patients, however, they could not apply such protocol. Despite study findings revealing significant challenges for patients and nurses, the participants suggested a way forward for the improvement of nursing care and primary health care in Fiji. Such changes may represent considerable challenge to the accepted hierarchies of power and decision making and will need to be strongly supported by a focus on patient centered care.