학술논문
Hauora Maori - Maori health: a right to equal outcomes in primary care
Document Type
Report
Author
Sheridan, Nicolette; Jansen, Rawiri McKree; Harwood, Matire; Love, Tom; Kenealy, Timothy; Aguirre-Duarte, Nelson; Arroll, Bruce; Atmore, Carol; Carryer, Jenny; Crampton, Peter; Dowell, Anthony; Fishman, Tana; Gauld, Robin; Hoare, Karen; Jackson, Gary; Kerse, Ngaire; Lampshire, Debra; McBain, Lynn; MacRae, Jayden; Mills, Jane; Øvretveit, John; Percival, Teuila; Perera, Roshan; Roland, Martin; Ryan, Debbie; Schmidt-Busby, Jacqueline; Stokes, Tim; Stubbe, Maria
Source
International Journal for Equity in Health. February 27, 2024, Vol. 23 Issue 1
Subject
Language
English
ISSN
1475-9276
Abstract
Author(s): Nicolette Sheridan[sup.1] , Rawiri McKree Jansen[sup.2] , Matire Harwood[sup.3] , Tom Love[sup.4] , Timothy Kenealy[sup.3] , Nelson Aguirre-Duarte[sup.] , Bruce Arroll[sup.] , Carol Atmore[sup.] , Jenny Carryer[sup.] , Peter [...]
Background For more than a century, Maori have experienced poorer health than non-Maori. In 2019 an independent Tribunal found the Government had breached Te Tiriti o Waitangi by "failing to design and administer the current primary health care system to actively address persistent Maori health inequities". Many Maori (44%) have unmet needs for primary care. Seven models of primary care were identified by the funders and the research team, including Maori-owned practices. We hypothesised patient health outcomes for Maori would differ between models of care. Methods Cross-sectional primary care data were analysed at 30 September 2018. National datasets were linked to general practices at patient level, to measure associations between practice characteristics and patient health outcomes. Primary outcomes: polypharmacy ([greater than or equal to] 55 years), HbA1c testing, child immunisations, ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Regressions include only Maori patients, across all models of care. Results A total of 660,752 Maori patients were enrolled in 924 practices with 124,854 in 65 Maori-owned practices. Maori practices had: no significant association with HbA1c testing, ambulatory sensitive hospitalisations or ED attendances, and a significant association with lower polypharmacy (3.7% points) and lower childhood immunisations (13.4% points). Maori practices had higher rates of cervical smear and cardiovascular risk assessment, lower rates of HbA1c tests, and more nurse (46%) and doctor (8%) time (FTE) with patients. The average Maori practice had 52% Maori patients compared to 12% across all practices. Maori practices enrolled a higher percentage of children and young people, five times more patients in high deprivation areas, and patients with more multimorbidity. More Maori patients lived rurally (21.5% vs 15%), with a greater distance to the nearest ED. Maori patients were more likely to be dispensed antibiotics or tramadol. Conclusions Maori practices are an expression of autonomy in the face of enduring health system failure. Apart from lower immunisation rates, health outcomes were not different from other models of care, despite patients having higher health risk profiles. Across all models, primary care need was unmet for many Maori, despite increased clinical input. Funding must support under-resourced Maori practices and ensure accountability for the health outcomes of Maori patients in all models of general practice. Keywords: Maori, Health equity, Models of care, Primary care, Nursing, Patient outcomes, Immunisations, Emergency department attendance, Avoidable hospitalisations, Ambulatory sensitive hospitalisations, Deprivation
Background For more than a century, Maori have experienced poorer health than non-Maori. In 2019 an independent Tribunal found the Government had breached Te Tiriti o Waitangi by "failing to design and administer the current primary health care system to actively address persistent Maori health inequities". Many Maori (44%) have unmet needs for primary care. Seven models of primary care were identified by the funders and the research team, including Maori-owned practices. We hypothesised patient health outcomes for Maori would differ between models of care. Methods Cross-sectional primary care data were analysed at 30 September 2018. National datasets were linked to general practices at patient level, to measure associations between practice characteristics and patient health outcomes. Primary outcomes: polypharmacy ([greater than or equal to] 55 years), HbA1c testing, child immunisations, ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Regressions include only Maori patients, across all models of care. Results A total of 660,752 Maori patients were enrolled in 924 practices with 124,854 in 65 Maori-owned practices. Maori practices had: no significant association with HbA1c testing, ambulatory sensitive hospitalisations or ED attendances, and a significant association with lower polypharmacy (3.7% points) and lower childhood immunisations (13.4% points). Maori practices had higher rates of cervical smear and cardiovascular risk assessment, lower rates of HbA1c tests, and more nurse (46%) and doctor (8%) time (FTE) with patients. The average Maori practice had 52% Maori patients compared to 12% across all practices. Maori practices enrolled a higher percentage of children and young people, five times more patients in high deprivation areas, and patients with more multimorbidity. More Maori patients lived rurally (21.5% vs 15%), with a greater distance to the nearest ED. Maori patients were more likely to be dispensed antibiotics or tramadol. Conclusions Maori practices are an expression of autonomy in the face of enduring health system failure. Apart from lower immunisation rates, health outcomes were not different from other models of care, despite patients having higher health risk profiles. Across all models, primary care need was unmet for many Maori, despite increased clinical input. Funding must support under-resourced Maori practices and ensure accountability for the health outcomes of Maori patients in all models of general practice. Keywords: Maori, Health equity, Models of care, Primary care, Nursing, Patient outcomes, Immunisations, Emergency department attendance, Avoidable hospitalisations, Ambulatory sensitive hospitalisations, Deprivation