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Is there equity of patient health outcomes across models of general practice in Aotearoa New Zealand?

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Authors:
Summary:

A national cross-sectional study has shown that being Māori or Pasifika, or living in material deprivation, is associated with poorer health outcomes, regardless of the type of primary care offered. Outcomes assessed were polypharmacy in individuals aged ≥65 years, glycosylated haemoglobin testing in adults with diabetes, childhood immunisations received by 6 months of age, ambulatory sensitive hospitalisations in those aged 0-14 years and 45-64 years, and emergency department attendances. A total of 924 primary care practices with 4,491,964 enrolled patients were included in the study. While 73% of the population were enrolled in traditional primary care practices, the proportion of Māori, Pasifika and individuals living in material deprivation was low in these practices. Māori, Pasifika and trust/non-governmental organisation practices had disproportionate enrolments of patients with high health needs. Although patients with higher health needs received more clinical input, this was insufficient to achieve equity across all outcomes. No one model of primary care out-performed others for all health outcomes.

Comment:
A critical investigation on primary care models in Aotearoa, there is an incredible amount of information here. A couple of key messages for me: there are few Māori and Pasifika patients enrolled in individual ‘traditional’ clinics (I hear this from health students); and different models of care were associated with different outcomes, yet most clinics stuck with one type of model. For those of us working in primary care, a lot to think about.
Reference: Int J Equity Health. 2023;22(1):79.
Independent commentary by Dr. Matire Hardwood

Dr Matire Harwood (Ngapuhi) has worked in Hauora Māori, primary health and rehabilitation settings as clinician and researcher since graduating from Auckland Medical School in 1994. She also holds positions on a number of boards, committees and advisory groups including the Health Research Council. Matire lives in Auckland with her whānau including partner Haunui and two young children Te Rangiura and Waimarie.

Research Review publications are intended for New Zealand health professionals.

Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

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