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Article ; Online: The ownership elephant is becoming a mammoth: a policy focus on ownership is needed to transform Aotearoa New Zealand's health system.

Reidy, Johanna / Matheson, Don / Keenan, Rawiri / Crampton, Peter

2023 Volume 136, Issue 1576, Page(s) 74–81

Abstract: Explicit government policy about ownership of health services is an important yet missing element in Aotearoa New Zealand's health system. Policy has not systematically addressed ownership as a health system policy tool since the late 1930s. It is timely ...

Abstract	Explicit government policy about ownership of health services is an important yet missing element in Aotearoa New Zealand's health system. Policy has not systematically addressed ownership as a health system policy tool since the late 1930s. It is timely to revisit ownership amid health system reform and increasing reliance on private provision (for-profit companies), notably for primary and community care, and also as an integral part of digitalisation. Simultaneously, policy should recognise the importance and potential of both the third sector (NGOs, Pasifika, community-owned services), Māori ownership and direct government provision of services to address health equity. Iwi-led developments over recent decades, along with the establishment of the Te Aka Whai Ora (Māori Health Authority), and Iwi Māori Partnership Boards provide opportunities for emerging Indigenous models of health service ownership, more consistent with Te Tiriti o Waitangi and mātauranga Māori. Four ownership types relevant to health service provision and equity are briefly explored: private for-profit, NGOs and community, government and Māori. These ownership domains operate differently in practice and over time, influencing service design, utilisation and health outcomes. Overall, the New Zealand state should take a deliberate strategic view of ownership as a policy instrument, in particular because of its relevance to health equity.
MeSH term(s)	Humans ; Health Policy ; Health Services, Indigenous ; Maori People ; New Zealand ; Ownership
Language	English
Publishing date	2023-05-26
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	390590-1
ISSN	1175-8716 ; 0028-8446 ; 0110-7704
ISSN (online)	1175-8716
ISSN	0028-8446 ; 0110-7704
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Guest Editorial: Time again for an organised approach to general practice research in New Zealand?

Keenan, Rawiri / Lawrenson, Ross

Journal of primary health care

2021 Volume 13, Issue 1, Page(s) 3–4

MeSH term(s)	Anti-Bacterial Agents ; Conjunctivitis ; Cross-Sectional Studies ; General Practice ; Humans ; New Zealand
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2021-03-30
Publishing country	Australia
Document type	Editorial ; Comment
ZDB-ID	2572943-3
ISSN	1172-6156 ; 1172-6156
ISSN (online)	1172-6156
ISSN	1172-6156
DOI	10.1071/HCv13n1_ED2
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Article ; Online: Are patients with type 2 diabetes in the Waikato District provided with adequate education and support in primary care to self-manage their condition? A qualitative study.

Crosswell, Rebekah / Norman, Kimberley / Cassim, Shemana / Papa, Valentina / Keenan, Rawiri / Paul, Ryan / Chepulis, Lynne

Journal of primary health care

2024 Volume 16, Issue 1, Page(s) 61–69

Abstract: Introduction In Aotearoa New Zealand (NZ), type 2 diabetes (T2D) is predominantly managed in primary care. Despite established guidelines, patients are often suboptimally managed, with inequitable health outcomes. To date, few NZ studies have evaluated ... ...

Abstract	Introduction In Aotearoa New Zealand (NZ), type 2 diabetes (T2D) is predominantly managed in primary care. Despite established guidelines, patients are often suboptimally managed, with inequitable health outcomes. To date, few NZ studies have evaluated the primary care management of T2D at the time of diagnosis. Aim This study aims to explore patients' the provision of education and delivery of care to patients at the time of diagnosis, which is a crucial time in the disease trajectory. Methods Participants were recruited from a Māori health provider in the Waikato District, and diagnosed with T2D after January 2020. Patients were texted a link to opt into a survey (larger study) and then registered interest by providing contact details for an interview (current study). Semi-structured interviews were conducted and were audio recorded, transcribed, and thematically analysed. Results In total, 11 participants aged 19-65 years completed the interviews (female n = 9 and male n = 20); the comprised Māori (n = 5), NZ European (n = 5) and Asian (n = 1) participants. Three overarching themes were identified, including: (1) ineffective provision of resources and education methods; (2) poor communication from healthcare practitioners; and (3) health system barriers. Discussion Evidently, there are difficulties in primary care diabetes mellitus diagnosis and management. Improvements could include locally relevant resources tailored to patients' experiences and cultural identities. Utilising whānau support and a non-clinical workforce, such as health navigators/kaiāwhina, will drastically address current workforce issues and assist patient self-management. This will allow improved diagnosis experiences and better health outcomes for patients and whānau.
MeSH term(s)	Female ; Humans ; Male ; Diabetes Mellitus, Type 2/therapy ; Diabetes Mellitus, Type 2/diagnosis ; Maori People ; New Zealand ; Primary Health Care ; Qualitative Research ; Self-Management ; White People ; Asian People ; Young Adult ; Adult ; Middle Aged ; Aged
Language	English
Publishing date	2024-03-28
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2572943-3
ISSN	1172-6156 ; 1172-6156
ISSN (online)	1172-6156
ISSN	1172-6156
DOI	10.1071/HC23141
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Article ; Online: Understanding weight management experiences from patient perspectives: qualitative exploration in general practice.

Norman, Kimberley / Burrows, Lisette / Chepulis, Lynne / Keenan, Rawiri / Lawrenson, Ross

BMC primary care

2023 Volume 24, Issue 1, Page(s) 45

Abstract: Background: Obesity is a complex health issue affecting the quality of life of individuals and contributing to an unsustainable strain on healthcare professionals and national health systems. National policy guidelines indicate that general practice is ... ...

Abstract	Background: Obesity is a complex health issue affecting the quality of life of individuals and contributing to an unsustainable strain on healthcare professionals and national health systems. National policy guidelines indicate that general practice is best suited to deliver obesity healthcare, however, obesity rates continue to rise worldwide indicating interventions are ineffective in this space. The aim of this study was to explore the weight management experiences from patient perspectives. Methods: This qualitative study used semi-structured interviews with 16 rural Waikato general practice patients. Interviews were analysed using reflexive thematic analysis. Results: Four themes were identified: Inconsistent Information, Significance of Holistic Factors, Obesity Centre Need, and Education. Participants expressed frustration at contradictory health messages, commercial company and 'expert' definition distrust, and that 'holistic' aspects to health significant to the weight management journey were unable to be addressed in general practice. Conclusion: Whilst primary care is positioned as suitable for delivering obesity healthcare, this study found that participants do not perceive general practice to be equipped to deliver this care. Instead, participants argued for a specialist obesity centre capable of meeting all their obesity healthcare needs. Further, wider issues including on-line commodification of health and neo-liberal capitalism - factors that exploit people with a stigmatised health issue - can cause further harm to the participant. A radical modernisation of education, information, and resources from regulated, qualified and 'trusted' healthcare professionals who can provide safe, non-stigmatising supportive services is recommended to meet the unique and changing food climate, reduce obesity rates and improve health outcomes.
MeSH term(s)	Humans ; Delivery of Health Care ; Family Practice ; General Practice ; Obesity/epidemiology ; Obesity/therapy ; Quality of Life ; Primary Health Care
Language	English
Publishing date	2023-02-13
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2731-4553
ISSN (online)	2731-4553
DOI	10.1186/s12875-023-01998-7
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Article ; Online: Non-small cell lung cancer chemotherapy treatment outcomes and ethnicity: a twenty-year single-centre patterns of care study.

Nguyen, Ha / Keenan, Rawiri / Kennedy, Ian / Lao, Chunhuan / Lawrenson, Ross

The New Zealand medical journal

2023 Volume 136, Issue 1585, Page(s) 24–34

Abstract: Aim: To investigate the treatment of patients with advanced-stage non-small cell lung cancer (NSCLC) over a 20-year period in a single Aotearoa New Zealand centre with reference to the use of systemic anti-cancer chemotherapy (SACT) and to explore ... ...

Abstract	Aim: To investigate the treatment of patients with advanced-stage non-small cell lung cancer (NSCLC) over a 20-year period in a single Aotearoa New Zealand centre with reference to the use of systemic anti-cancer chemotherapy (SACT) and to explore ethnic disparities in treatment and outcomes. Method: Using a SACT database maintained by the Oncology Department at Waikato Hospital, Hamilton, Aotearoa New Zealand from 2000 to 2021 we derived summary statistics for patient factors and SACT regimens by ethnicity (Māori and non-Māori). We investigated Kaplan-Meier all-cause survival by ethnicity and SACT. Logistic regression was used to estimate the odds ratios of surviving 12 months and receiving first and second SACT. Results: One thousand and fifty-seven patients with advanced NSCLC were included, with 30% identified as Māori and 53% treated with SACT. The median survival for non-Māori and Māori receiving SACT was 11.9 and 8.5 months respectively (unadjusted odds ratio of surviving 12 months: 1.968; 95% CI: 1.352-2.865; p<0.001). Non-Māori receiving SACT were 86.2% more likely to survive 12 months than Māori. There were no ethnic disparities in the proportion of patients receiving first-line SACT; however, non-Māori were 1.5 times more likely to receive a second SACT than Māori. Conclusion: Significant ethnic difference between Māori and non-Māori exists for both survival and receipt of second-line SACT.
MeSH term(s)	Humans ; Carcinoma, Non-Small-Cell Lung/drug therapy ; Ethnicity ; Lung Neoplasms/drug therapy ; Maori People ; New Zealand ; Treatment Outcome
Language	English
Publishing date	2023-11-10
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	390590-1
ISSN	1175-8716 ; 0028-8446 ; 0110-7704
ISSN (online)	1175-8716
ISSN	0028-8446 ; 0110-7704
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Guest Editorial: Bringing primary health and community care in from the cold in the New Zealand health reforms? Tracing reform recommendations to budgets and structures.

Matheson, Don / Reidy, Johanna / Keenan, Rawiri

Journal of primary health care

2022 Volume 14, Issue 3, Page(s) 194–196

MeSH term(s)	Budgets ; Health Care Reform ; Humans ; New Zealand ; State Medicine
Language	English
Publishing date	2022-09-27
Publishing country	Australia
Document type	Journal Article
ZDB-ID	2572943-3
ISSN	1172-6156 ; 1172-6156
ISSN (online)	1172-6156
ISSN	1172-6156
DOI	10.1071/HC22077
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Article ; Online: Variation in open access vildagliptin use in Waikato patients with type 2 diabetes.

Chepulis, Lynne / Mayo, Christopher / Paul, Ryan / Keenan, Rawiri / Lawrenson, Ross

The New Zealand medical journal

2022 Volume 135, Issue 1548, Page(s) 77–88

Abstract: Aim: To determine what the variation was in the initial use of vildagliptin in patients with type 2 diabetes following approval of open access funding in October 2018, including by ethnicity, gender, age, funding model and patient HbA1c levels.: ... ...

Abstract	Aim: To determine what the variation was in the initial use of vildagliptin in patients with type 2 diabetes following approval of open access funding in October 2018, including by ethnicity, gender, age, funding model and patient HbA1c levels. Methods: Data were collected from 31 general practices for all adult patients with type 2 diabetes. National Health Index-matched medication data were obtained from the national Pharmaceutical Collection. Patients were included for analysis if they had received at least one diabetes medication in the 12 months prior to funding approval for vildagliptin. The proportion of patients who initiated vildagliptin therapy following open access funding approval was then evaluated, as was the time taken until the first dispensing (days since funding approval). Results: A total of 724 of 3,971 (18.2%) of patients initiated vildagliptin therapy; mean time to first dispensing was 192.1±112.4 days. In logistic regression, Asian patients were more likely and Māori less likely to receive vildagliptin than Europeans. Younger patients and those with an HbA1c of >64mmol/mol were also more likely to initiate therapy. Vildagliptin use by general practice ranged from 0.0-82.4%. Conclusions: Despite open access funding, there was inequity in the initial use of vildagliptin. Substantial variation by general practice indicates that practitioner education may be needed to ensure appropriate and early adoption of new diabetes medications.
MeSH term(s)	Access to Information ; Adamantane/therapeutic use ; Adult ; Diabetes Mellitus, Type 2/drug therapy ; Dipeptidyl-Peptidase IV Inhibitors/therapeutic use ; Glycated Hemoglobin A/analysis ; Humans ; Hypoglycemic Agents/therapeutic use ; Metformin/adverse effects ; New Zealand ; Nitriles/therapeutic use ; Pyrrolidines/therapeutic use ; Treatment Outcome ; Vildagliptin/therapeutic use
Chemical Substances	Dipeptidyl-Peptidase IV Inhibitors ; Glycated Hemoglobin A ; Hypoglycemic Agents ; Nitriles ; Pyrrolidines ; Metformin (9100L32L2N) ; Vildagliptin (I6B4B2U96P) ; Adamantane (PJY633525U)
Language	English
Publishing date	2022-01-21
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	390590-1
ISSN	1175-8716 ; 0028-8446 ; 0110-7704
ISSN (online)	1175-8716
ISSN	0028-8446 ; 0110-7704
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Article ; Online: Urgent referral to specialist services for patients with cancer symptoms: a cause for concern or oversimplifying a complex issue?

Keenan, Rawiri / Lawrenson, Ross / Stokes, Tim

BMJ quality & safety

2021 Volume 31, Issue 8, Page(s) 558–560

MeSH term(s)	Humans ; Neoplasms/therapy ; Referral and Consultation ; Specialization
Language	English
Publishing date	2021-12-03
Publishing country	England
Document type	Editorial ; Comment
ZDB-ID	2592909-4
ISSN	2044-5423 ; 2044-5415
ISSN (online)	2044-5423
ISSN	2044-5415
DOI	10.1136/bmjqs-2021-014222
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Article ; Online: Newly diagnosed type 2 diabetes - does New Zealand General Practice adequately prepare patients to self-manage their Condition?

Chepulis, Lynne / Mellsop-Kupe, Jessie / Moorhouse, Suzanne / Keenan, Rawiri / Norman, Kimberley / Paul, Ryan

BMC primary care

2023 Volume 24, Issue 1, Page(s) 162

Abstract: Background: Type 2 diabetes mellitus (T2D) is predominantly managed in primary care, and patients need to be provided with appropriate knowledge and education to understand how to best self-manage their condition. For optimal T2D self-management, ... ...

Abstract	Background: Type 2 diabetes mellitus (T2D) is predominantly managed in primary care, and patients need to be provided with appropriate knowledge and education to understand how to best self-manage their condition. For optimal T2D self-management, primary care teams should share this information from the time of diagnosis. Little is currently known about how and when these resources are being provided to patients with T2D in New Zealand. Methods: An online survey was carried out between Oct 2022 and Feb 2023. Patients diagnosed with T2D after Jan 2020 were invited to participate, with recruitment occurring via primary care and social media. Questions included information about demographics, diagnosis, provision of education resources and/or referral services as well as about current diabetes management. All responses were analysed with chi square tests. Free-text comments were summarised only. Results: A total of 203 participants from across New Zealand completed the survey, but 18 were excluded due to being diagnosed more than 3 years ago, or self-reporting with type 1 diabetes rather than T2D. Nearly three quarters (70.7%) of participants reported that they were given appropriate resources to understand and manage their T2D, though half of these would have like more information. Overall, family and friends, self-led research and healthcare-provided education were equally useful, though this differed by ethnic groups. Similarly, approx. 70% of patients thought that medications had been well explained. Free text comments suggested a need for more targeted information around food choice and insulin use as well as a need for empathy and appropriate language from healthcare providers. Conclusions: Primary care appears to be providing most newly diagnosed patients with appropriate resources to understand and manage their T2D, but there is room for improvement with up to a third of participants not understanding how to manage foods, medication and lifestyle choices to optimise health outcomes. Further work is required to address this gap and should include the use of culturally-appropriate materials to meet the multi-ethnic population needs.
MeSH term(s)	Humans ; Diabetes Mellitus, Type 2/diagnosis ; Diabetes Mellitus, Type 2/epidemiology ; Diabetes Mellitus, Type 2/therapy ; New Zealand/epidemiology ; Self-Management ; Family Practice ; General Practice
Language	English
Publishing date	2023-08-21
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2731-4553
ISSN (online)	2731-4553
DOI	10.1186/s12875-023-02118-1
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Article ; Online: Outcomes and access to angiography following non-ST-segment elevation acute coronary syndromes in patients who present to rural or urban hospitals: ANZACS-QI 72.

Miller, Rory / Nixon, Garry / Turner, Robin M / Stokes, Tim / Keenan, Rawiri / Jiang, Yannan / Grey, Corina / Kerr, Andrew

The New Zealand medical journal

2023 Volume 136, Issue 1573, Page(s) 27–54

Abstract: Aim: This study's aim was to identify differences in invasive angiography performed and health outcomes for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) presenting to either i) a rural hospital, or an urban hospital ii) with ... ...

Abstract	Aim: This study's aim was to identify differences in invasive angiography performed and health outcomes for patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) presenting to either i) a rural hospital, or an urban hospital ii) with or iii) without routine access to percutaneous intervention (PCI) in New Zealand. Methods: Patients with NSTEACS between 1 January 2014 and 31 December 2017 were included. Logistic regression was used to model each of the outcome measures: angiography performed within 1 year; 30-day, 1-year and 2-year all-cause mortality; and readmission within 1 year of presentation with either heart failure, a major adverse cardiac event or major bleeding. Results: There were 42,923 patients included. Compared to urban hospitals with access to PCI, the odds of a patient receiving an angiogram were reduced for rural and urban hospitals without routine access to PCI (odds ratio [OR] 0.82 and 0.75) respectively. There was a small increase in the odds of dying at 2 years (OR 1.16), but not 30 days or 1 year for patients presenting to a rural hospital. Conclusion: Patients who present to hospitals without PCI are less likely to receive angiography. Reassuringly there is no difference in mortality, except at 2 years, for patients that present to rural hospitals.
MeSH term(s)	Humans ; Acute Coronary Syndrome/diagnostic imaging ; Acute Coronary Syndrome/epidemiology ; Acute Coronary Syndrome/therapy ; Percutaneous Coronary Intervention/adverse effects ; Treatment Outcome ; New Zealand/epidemiology ; Coronary Angiography ; Hospitals, Urban
Language	English
Publishing date	2023-04-14
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	390590-1
ISSN	1175-8716 ; 0028-8446 ; 0110-7704
ISSN (online)	1175-8716
ISSN	0028-8446 ; 0110-7704
Database	MEDical Literature Analysis and Retrieval System OnLINE

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