Journal of Primary Health Care

What is already known: The use of psychotropic medications in Australia has increased over the last two decades, with general practitioners being the primary prescribers. The COVID-19 pandemic exacerbated mental health issues in adults and the older population, leading to increased concerns about mental health and wellbeing. What this study adds: This study estimates prescribing rates of psychotropic medication by patient demographics and found higher rates of prescribing among females, older people, and those with low to moderate SES. There was a consistent increase in prescribing rates between 2018 and 2022, particularly during the COVID-19 pandemic.

What is already known: The integration of pharmacist roles into primary health care, including general practice, is growing in Aotearoa New Zealand, with geographical variation. Recent health policy and professional guidance support further development of these roles. What this study adds: There are more pharmacist prescribers in primary health care than there were in 2018, with strong interest in future prescribing roles, yet barriers to further expansion remain. Employers need to ensure that primary healthcare-based pharmacists are well supported in their role by other practice staff and that appropriate infrastructure is in place to facilitate this.

What is known about the topic: Even small prescription charges can prevent people from accessing medicines they need, leading to increased use of other health services. The FreeMeds randomised controlled trial found that eliminating $5 prescription charges led to a reduction in hospital use. What this research adds: This paper provides some of the human stories of participants in the FreeMeds study. Many reported having to make changes to how they took their medicines or making choices between obtaining their medicines or other essentials. Some reported hospitalisations due to inability to afford medicines. Few participants had discussed their inability to afford medicines with their general practitioners.

What is already known: International research shows that people with migraine face significant barriers to accessing effective management. Known barriers include expense of health care and treatments, lack of or misdiagnosis and inadequate access to and communication of effective treatment strategies. What this study adds: This is the first study in Aotearoa New Zealand to document barriers to effective migraine management. Findings are taken from the perspective of people with migraine. Issues were identified in a range of areas including health professional knowledge and training, poor interface between primary and secondary care, inadequately communicated care plans and patients feeling stigmatised by health professionals. We offer recommendations to improve access to effective migraine management.

What is already known: Polypharmacy is increasing as the population ages and causes harm. Deprescribing takes time and requires thoughtful consideration and patient interaction. What this study adds: Focused deprescribing is a significant reflective learning and quality improvement opportunity for medical students and general practitioner supervisors. This student-led activity adds benefit to the student, their supervisor, and the patient of a comprehensive medications review leading to improved knowledge, appropriate deprescribing, and reduced drug interactions.

What is already know: Continuity of care facilitates high-quality care and good patient health outcomes. Prescribing legislation changes in New Zealand (NZ) have resulted in medical and non-medical prescribers prescribing medicines for patients with chronic disease. Previous research has established a correlation between multiple prescribers’ involvement in a single patient’s care, discontinuity and medicines-related risks. What this study adds: Clinical complexities associated with the medicines management of patients with multimorbidity and the current service delivery model are challenging NZ general practice prescribers’ ability to manage continuity of care. There is a need for heightened awareness of the significance of medicines-related continuity of care, so prescribers within and across all health settings are supported to prescribe collaboratively and safely.

What is already known: Primary care faces significant challenges with multi-morbidity in ageing populations causing increased health care demand and complexity. Optimal use of the whole primary care workforce is key in addressing these challenges. What this study adds: This analysis provides a comparison between New Zealand and Australia regarding medicines that can be accessed via a community pharmacy through their classification as pharmacist-only medicines. It considers potential elements for a successful model of care including commissioning and tools for communication and collaboration with the wider health care team.

What is known about this topic: Judicious, appropriate antimicrobial stewardship (AMS) is crucial to reduce the development and spread of antimicrobial resistance. Registered nurses are ideally placed to enhance AMS activities due to their broad skillset and accessibility. Registered nurses, as a major component of the health workforce, are often significantly underutilised in health systems to promote AMS. What gaps this paper adds: This exploratory qualitative study found that registered nurses were clearly engaged in activities contributing to antimicrobial resistance reduction. To increase and enhance registered nurses’ AMS leadership roles throughout the health system they need greater support, increased collegial collaboration, and targeted education in this role. Registered nurses with increased health system support are positioned well to implement AMS programs in New Zealand. @FmhsNursing.

What is already known: Established cardiovascular disease (CVD) risk factors disproportionately affect South Asians more than other ethnic groups. What this study adds: New Zealand South Asians with modifiable CVD risk factors prefer lifestyle changes before being prescribed medication for type 2 diabetes, hypertension, or dyslipidaemia. Adherence to medication prescribed for these conditions is influenced by cultural practices, perceived need for and concerns about medication, and healthcare provider communication. Health professionals could play a key role in understanding and providing culturally appropriate advice on lifestyle changes for South Asians at risk for CVD.

What is already known: Medication management for adults with palliative care needs in the last year of life is complex and challenging. However, there is a limited synthesis of the literature describing the breadth of palliative care services provided by community pharmacies. What this study adds: This review provides evidence that community pharmacies worldwide offer a range of services to support people with palliative care needs and face similar challenges concerning how the public perceives their role in delivering palliative care. A thorough understanding of the role of community pharmacies could enhance care quality, extending benefits to individuals not currently receiving palliative care support in the community.

What is already known: Older people commonly take medicines to improve their health, however medicines can also be harmful. Little is known about medicines use in retirement village residents in Aotearoa New Zealand. What this study adds:Our findings, along with new information about medicine use in ‘oldest’ age, suggest that retirement village residents may benefit from talking to their health professional about their medicines to see if they are still the right medicines for them.

What is already known: HPV is the major cause of cervical cancer and can be detected from a self-collected vaginal or clinician-collected cervical sample with comparable sensitivity and specificity. HPV self-testing has been shown to be an effective tool to improve participation in cervical screening among never and under-screened people. What this study adds: HPV primary screening incorporating self-testing was widely accepted among screening-eligible primary care participants, but key messages about this new approach were not well understood. Education, information provision and clear communication at all stages of the screening pathway will be critical to support patient understanding of and confidence in HPV primary screening.

What is already known: Māori experience sexual and reproductive health (SRH) inequities. Healthcare providers (HCPs) and health services have critical roles in facilitating the health literacy of our population, which impacts on SRH. What this study adds: Wāhine Māori (Māori women) want to be well-informed when accessing SRH care and find this empowering, however, their experiences of this are variable and accurate SRH knowledge can be inaccessible. Improved dissemination of SRH knowledge, in the community and by HCPs, is needed.

What is already known: Despite being largely preventable, dental caries remains as the leading cause of children’s hospitalisations in New Zealand, particularly affecting Māori and Pasifika populations. What this study adds: This scoping review offers a systematic analysis highlighting its effectiveness in arresting caries with minimal invasiveness, cost-effectiveness, and the potential to promote oral health equity. Silver diamine can play a critical role in New Zealand’s public dental services in achieving better and more equitable outcomes.

What is already known: Knee pain is a common reason to consult a general practitioner (GP), but accurate diagnosis poses a challenge for GPs. To support GPs with this diagnostic dilemma in patients with knee pain, a prediction model could be a useful diagnostic decision support tool, however, this has not yet been developed. What this study adds: In patients with knee pain, for whom GPs experience diagnostic challenges, osteoarthritis is by far the most prevalent diagnosis, followed by patellofemoral pain and meniscal lesions. An age threshold of roughly 50 years is a strong predictor for knee osteoarthritis, patellofemoral pain, and meniscal lesions.

What is known about the topic: Palliative care significantly enhances the quality of life for advanced-stage cancer patients by addressing their comprehensive needs. The Chinese ethnic population faces substantial barriers in Australia to accessing palliative care services due to cultural and linguistic differences. There is generally a low awareness and many misconceptions about palliative care within ethnic communities, including Chinese Australians. What this study adds: The study highlights the specific challenges faced by Chinese Australian cancer patients and their caregivers in accessing palliative care services. It identifies language as the primary barrier, despite a strong interest in palliative care services among the Chinese ethnic community. The study highlights the need for local health authorities, medical associations, and community groups to develop and disseminate culturally and linguistically appropriate information to improve palliative care service uptake among the culturally and linguistically diverse community.

What is already known: The existing literature acknowledges the challenge of managing type 2 diabetes (T2D) on a systemic level, especially within Indigenous communities like the Māori population in New Zealand. Effective management of T2D is crucial to prevent complications and improve quality of life. What this study adds: This study contributes to the body of evidence on multidisciplinary, culturally sensitive primary care models for managing T2D. It highlights the benefits of utilising an extended primary care team (including a nurse, dietician, kaiāwhina, social worker, admin support and occupational therapist) to improve clinical outcomes and address health disparities.

What is already known: Rural Māori experience inequities in access to cardiovascular care compared to non-Māori and urban Māori. Despite this, little is known about the barriers and facilitators that drive access to quality cardiovascular care along the disease continuum for rural Māori. What this study adds: This study contributes new knowledge by prioritising the voices and experiences of rural Māori accessing heart health care, which have been largely absent from the literature to date.

What is already known: There is emerging evidence that task-shifting to alternate workforces may overcome some of the demands on ORL outpatient services. However, although follow-up care after grommet insertion is important, and may be appropriate to shift to other healthcare providers, there are limited data on both the family/whānau and GP perspectives and preferences within the New Zealand context. What this study adds: This study provides insight into the perspectives and experiences of families/whānau of children who have previously undergone grommet insertion, as well as the perspectives of GPs working within a large urban setting in Auckland, New Zealand, regarding the roles and responsibilities for providing follow-up care after the insertion of grommets.

What is already known: Long-term conditions programmes in New Zealand have traditionally been modelled on the Chronic Care Model from the United States (Wagner) and the Australian (Flinders) Partners in Health programme. In a changing health landscape, there is an increasingly diverse population with multimorbidity who need individualised and culturally competent care. The effectiveness of traditional programmes have been questioned, particularly for the most vulnerable people in our communities. What this study adds: The Client-Led Integrated Care model did not uniformly address the needs of all patients, nor did it target those with the most ability to benefit. Implementing programmes for multimorbidity in primary care should take account of the need to prioritise equity and the social determinants of health.

What is already known: Access to human papillomavirus (HPV) self-testing improves participation in cervical screening among people who are un- or under-screened. Primary care clinicians involved in the early implementation of HPV primary screening in Aotearoa New Zealand support the change in primary screening modality. What this study adds: The ability to self-test, clear clinician communication and support were important contributors to a good screening experience, while inadequately communicated information impacted negatively on multiple aspects of screening. Participants identified a range of practical suggestions for primary care providers to support access and acceptability among future screening participants.

What is already known: This study explores the communication challenges between general dental practitioners and general medical practitioners, especially when managing patients with complex medical conditions and multiple medications. It highlights key barriers such as time limitations, lack of knowledge, and the absence of integrated health records. What this study adds: The research offers practical solutions, including interprofessional education, shared health record systems, regular meetings, and clearer referral guidelines to improve collaboration between these healthcare providers.

What is known about the topic: Falls among community-dwelling older adults are a significant public health concern. Previous research has highlighted the importance of strength and balance exercises and falls prevention education in reducing fall incidence among older adults. What this study adds: This study shows the potential for student-run interventions in contributing to falls prevention efforts and improving the wellbeing of aging populations.

What we already know: Type 2 diabetes disproportionately affects New Zealand Māori; however, current primary health care service delivery does not meet the needs of many. Continuous glucose monitors (CGMs) can support management of type 2 diabetes, although studies suggest that glycaemic improvements resulting from CGM use alone are often not sustained longer term. What this study adds: A model of health care delivery that uses CGMs within a culturally-informed program of education and optimised health care delivery improves glycemia in the short term, with improvements maintained by most for at least 12 months. This model demonstrates the value of using culturally-informed health care delivery to support improvements in health equity.

What is already known: The introduction of polymerase chain reaction (PCR) has been seen as a rapid and sensitive method for respiratory virus surveillance, and the COVID-19 pandemic highlighted the critical need for rapid diagnosis of SARS-CoV-2 and the importance of using PCR testing for an accurate assessment. What this study adds: This study demonstrated the feasibility and clinical utility of using point-of-care test (POCT) swabbing for immediate rapid antigen test (RAT) and subsequent PCR testing for respiratory viruses in general practices in the middle of managing a viral pandemic.

What is already known: Dealing with uncertainty in medicine is troublesome. General practitioners are vulnerable to uncertainty due to their exposure to undifferentiated illness. Patient encounters, especially with those suffering from ambiguous conditions, can foster introspection within clinicians. What this study adds: This qualitative study suggests that conceptualising uncertainty as a holistic challenge, and implementing a bio-psycho-social problem orientation may help clinicians manage uncertainty in a manner that leaves the patient feeling positively supported and the clinician feeling positively inquisitive.

What is already known: There is increasing concern about the health and wellbeing of tertiary students internationally and comparatively little is known about the context in New Zealand, especially the support being provided for minority students. What this study adds: This research provides information on support services for Pacific students at a university in New Zealand including students’ response to support provided during the COVID-19 pandemic.

What is known about the topic: Routinely collected administrative and health data have potential to be used for research that provides real-world health insights that can inform policy and improve clinical practice and population health. Engaging stakeholders to establish priorities can help ensure research is fit for purpose, provides important health benefits, and has the greatest potential to improve health equity. What this study adds: Primary care clinicians and academics identified the top research areas to improve health equity in primary care as the health workforce, health services, mental health, and models of primary health care. The top research questions include evaluating the impacts of annual health checks for people with intellectual disability, the role of allied health as front-line primary health care providers, and the role of an embedded social worker in a general practice clinic setting.

What is known about this topic: There is a current paucity of research in emergency simulation training in primary care. Although there is literature on the use that emergency simulation education has in secondary care services such as emergency medicine (EM) or for intensive care unit (ICU) staff, it is not well established or validated in primary care. What this study adds: To the best of the author's knowledge, this is the first literature review of studies that evaluate the use of emergency care simulations for primary care clinicians. The findings from this review can help inform and guide the appropriate education and training of primary care clinicians.

What is already known: General practitioners find examining the retina with direct ophthalmoscopy challenging and have low confidence in interpreting findings. What this study adds: General practitioners using smart-phone non-mydriatic fundus photography achieved more adequate views and positive findings of the optic nerve and fundus compared to direct ophthalmoscopy and had close agreement for management referral with the reviewing ophthalmologist.

What is already known: Respiratory conditions are a major public health concern in Aotearoa New Zealand, and are responsible for a large proportion of the morbidity and mortality experienced by Māori and Pacific children. What this study adds: This paper provides an important overview of respiratory research that involve Māori and Pacific children living in Aotearoa New Zealand. It emphasises that more studies focusing on the needs of Māori and Pacific whānau and communities, and the use of culturally responsive approaches, are essential, ensuring that aspirations are whānau centred and tailored to their needs.

What is already known: Primary healthcare teams are well positioned to promote and protect patients’ oral health, and it is likely that more people at risk of oral disease or needing oral health care will present at primary healthcare practices. Primary healthcare teams need to have sufficient knowledge and confidence to address patients’ oral health complaints. What this study adds: Doctors and nurses appear open to incorporating oral health in their day-to-day practice. Integrating oral health in primary health care in Aotearoa New Zealand will require changes at the individual, professional and systems levels.