Māori Health Review Issue 53

The Health Quality and Safety Commission’s Atlas of Healthcare variation (www.hqsc.govt.nz/atlas) shows that on average 41% of people with gout across New Zealand are regularly prescribed allopurinol. However, there is marked nationwide variation, with regular use of allopurinol ranging from 33% among people residing in the Auckland District Health Board (DHB) area to 47% in Nelson-Marlborough. These researchers sought to determine whether the quality of gout care varies in Aotearoa New Zealand primary care, using data from the New Zealand Atlas of Healthcare Variation to examine regularity of allopurinol dispensing, laboratory testing for serum urate, and acute hospitalisation for gout. For New Zealanders aged 20–79 years with gout, 57% were dispensed allopurinol in 2010/11. Of these, 69% were receiving allopurinol regularly, and only 34% of people dispensed allopurinol had serum urate testing in a 6-month period. The annual hospitalisation rate was 1% of people with gout. Māori and Pacific people with gout were less likely to be on regular allopurinol treatment, despite having more than twice the chance of being hospitalised with acute gout.

The Counties Manukau DHB (CMDHB) in South Auckland serves the most economically deprived areas of New Zealand, with a high proportion of young mothers, and women of Māori and Pacific ethnicity. CMDHB has high rates of late booking for antenatal care and also the highest perinatal mortality rate in New Zealand, with a 3-year perinatal-related mortality rate of 13.70 per 1000 births compared with the national rate of 10.75 per 1000 births. This study aimed to identify barriers to early initiation of antenatal care (before 19 weeks of pregnancy) among women using CMDHB maternity services. The study recruited 826 pregnant women who were either in late pregnancy (>37 weeks gestation) or who had recently delivered (<6 weeks postnatal). They completed a questionnaire about their antenatal care at CMDHB. 137 women (17%) booked for antenatal care at >18 weeks (late bookers). Ethnic groupings were 43% Pacific Peoples, 20% Māori, 14% Asian, and 21% European or other ethnicities. According to multivariate analysis, women were significantly more likely to book late for antenatal care if they had limited resources (e.g. no transport) (OR 1.86), no tertiary education (OR 1.96), or were not living with a husband/ partner (OR 2.34). Notably, the odds of late booking for antenatal care was almost 6 times higher among Māori (OR 5.70) and Pacific (OR 5.90) women compared to those of European and other ethnicities.

This paper describes Māori, Pacific and New Zealand European experiences of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA). Patients identifying as Māori (n=5), Pacific (n=5), or NZ European (n=8) ethnicity referred for CPAP treatment for OSA attended separate, 1.5-hour group discussions facilitated by a health care worker of the same ethnic group. Patients in all three groups reported that they had little knowledge of OSA or CPAP prior to treatment initiation. All participants identified barriers to treatment (both at the CPAP initiation phase and long-term), reported feelings of being ‘overwhelmed’ with information during the initial CPAP education session, and discussed the importance of successful role models.

Outcomes are reported from an audit comprising a before-and-after assessment of 185 patients referred to the GPSI Diabetes service – a patient-centred intervention for diabetes management – between 2008 and 2010. The aim of this audit was to determine if this patient-centred intervention improves diabetes care, as measured by changes in glycosylated haemoglobin (HbA1c). The GPSI Diabetes service is a communitybased service, run by a general practitioner with a specific interest (GPSI) in diabetes, and a practice nurse. Adults with diabetes are referred to the service by their GP and care is provided using a set of loosely structured diabetes-specific patient-centred approaches. Following a series of visits, patients are discharged back to their GP. At intake, baseline HbA1c was higher among Māori than among New Zealand Europeans. This difference was reduced by the patient-centred intervention. Immediate and sustained (two-year) improvements in HbA1c were observed in both New Zealand Europeans and Māori with type 2 diabetes and type 1 diabetes. Completed patient and GP satisfaction questionnaires did not contain any negative feedback, but the response rate was low among patients.

The experience and impact of racism on Māori registered nurses within the New Zealand health system was explored in this analysis of narratives contributed by 15 Māori registered nurses. The transcribed interview material was coded using Jones’s levels of racism. The structural analysis identified that experiences of racism were a commonality. The nurses experienced racism on institutional, interpersonal, and internalised levels, leading to marginalisation and being overworked yet undervalued.

Outcomes are reported from an investigation into abnormal sleep duration and daytime sleepiness during pregnancy among Māori and non-Māori women versus the general population, and the influence of sociodemographic factors. Self-reported total sleep time (TST) over a 24-hour period, Epworth Sleepiness Scale scores and sociodemographic information were obtained from nullipara and multipara women aged 20–46 years at 35–37 weeks of pregnancy (358 Māori and 717 non-Māori), and from women in the general population (381 Māori and 577 non-Māori). In analyses accounting for ethnicity, age, socioeconomic status, and employment status, pregnant women were found to have on average 30 minutes less TST than women in the general population. The distribution of TST was also greater in pregnant women, who were 3 times more likely to sleep for ≤6 hours and 1.9 times more likely to sleep >9 h. Pregnant women >30 years of age experienced greater age-related declines in TST. Pregnant women were 1.8 times more likely to report excessive daytime sleepiness (EDS). Abnormal sleep duration was more likely among women identifying as Māori, those who were unemployed, and those doing night work. EDS was also more likely among Māori women and women who worked at night.

This book chapter addresses disparities in Indigenous health workforce development in New Zealand. It discusses the recent development of the Hauora Māori curriculum within the Faculty of Medical and Health Sciences at the University of Auckland, which aims to improve Māori student recruitment and help to retain Māori and Pacific students, to ensure tertiary success within the Academy.

This research was designed to help address the evidence gap regarding economic evaluations that could assist decision-makers to allocate additional resources in the primary prevention of cardiovascular disease (CVD) in Australia’s Indigenous population. The study authors explain that CVD is the leading cause of disease burden in Australia’s Indigenous population and the greatest contributor to the Indigenous ‘health gap’. Five interventions (1 community-based and 4 pharmacological) to prevent CVD in Indigenous Australians were selected for economic evaluation. Pharmacological interventions were evaluated as delivered either via Aboriginal Community Controlled Health Services or mainstream general practitioner services. All pharmacological interventions produced more Indigenous health benefit when delivered via Indigenous health services, but cost-effectiveness ratios were higher due to greater health service costs. Cost-effectiveness ratios were also higher in remote than in non-remote regions. The polypill proved to be the most cost-effective intervention, while the community-based intervention produced the most health gain. The study authors advise that policy makers seeking to address health inequities and bridge the health gap must consider both the extent of health gain and cost-effectiveness ratios. As they conclude, “failure to do so may result in redirection of resources away from where they are needed most to address health inequities”.