Compounding inequity: a qualitative study of gout management in an urban marae clinic in Auckland
Leanne Te Karu 1 3 , Matire Harwood 1 , Linda Bryant 1 , Tim Kenealy 2 , Bruce Arroll 11 Department of General Practice and Primary Healthcare, University of Auckland, Private Bag 92019, Auckland Mail Centre, Auckland 1142, New Zealand
2 Integrated Care Department of Medicine, University of Auckland, New Zealand
3 Corresponding author. Email: Leanne.Te-Karu@auckland.ac.nz
Journal of Primary Health Care 13(1) 27-35 https://doi.org/10.1071/HC20112
Published: 15 March 2021
Journal Compilation © Royal New Zealand College of General Practitioners 2021 This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License
Abstract
INTRODUCTION: Gout remains a health equity issue; Māori and Pacific peoples are disproportionately afflicted, with increased burden and loss of quality of life, yet are less likely to receive appropriate management, which mainly occurs in primary care.
AIM: This study aims to understand the perspectives of the mainly Māori and Pacific clinicians and staff at an urban marae practice about barriers and challenges to delivering effective care to a Māori and Pacific community with high burden of gout.
METHODS: Semi-structured interviews were conducted with 10 staff members delivering health care to a mostly Indigenous community. Interviews sought to ascertain staff views of enablers and barriers to optimal gout management and analyse them thematically.
RESULTS: Three themes were identified: community disadvantage; demands unique to Indigenous providers; and challenges and opportunities for optimising gout management. High prevalence and heavy impact of gout on wellbeing in the community was intertwined with socioeconomic disadvantage, precariousness of employment and entrenched inaccurate (yet pliable) patient views on gout, to the detriment of focused, effective care. Structural and funding demands on providers inhibited staff focus on the clear community need. Providers saw the culturally safe and competent approach necessary for improvement as requiring community empowerment with appropriate clinical tools and adequate resourcing.
DISCUSSION: Despite provider intent to deliver culturally appropriate and safe care and equitable health outcomes for patients suffering from gout, general practice initiatives without aligned resourcing or incentives are inhibited when inequity is pervasive. Simply asking Māori providers to do more for the same amount of resource may not be effective.
KEYwords: General practice; uric acid; health equity; Indigenous; primary health care, Māori.
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