Journal of Primary Health Care

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: 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.

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 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: 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 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: 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: 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: 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 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 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 known about the topic: For over two decades, New Zealand has aimed to make primary health care more accessible, equitable and efficient, shifting more services into communities. While early efforts lowered patient fees and improved access, ongoing challenges—such as staff shortages and persistent inequities—suggest the system remains underfunded. What this study adds: This study provides the first in-depth look at how New Zealand’s government has funded primary health care in relation to health funding over the past 15 years. Despite increases in dollar terms, funding has not kept pace with population growth, inflation, or overall health spending, raising questions about whether primary care is truly a priority. Our findings call for a stronger financial commitment, recommending routine funding monitoring, a minimum funding benchmark, and a greater share of PHC funding to ensure a fair and resilient system.

What is already known: Degenerative cervical myelopathy (DCM) is the leading cause of adult spinal cord dysfunction, with average diagnostic delays of 2.5 years often resulting in irreversible neurological impairment. Primary care clinicians are well positioned to identify DCM early, yet international research suggests that condition awareness is lacking. What this study adds: This study is the first to assess DCM awareness and diagnostic confidence among primary care clinicians in Aotearoa New Zealand, revealing critical knowledge gaps. The findings highlight the need for targeted education and standardised referral criteria to facilitate timely detection and surgical consultation.

What is already known: Closed Books are a barrier to accessing primary health care enrolment. In June 2022, there were 347 (33%) general practices that had Closed Books with the lower North Island being particularly affected. What this study adds: This study looks at how Closed Books are distributed across Aotearoa New Zealand in 2024 and how this has changed at the general practice level since 2022.

What is known about the topic: Individuals who hazardously consume alcohol may also present with nutritional problems such as weight loss, underweight, malnutrition, micronutrient deficiency and/or low food security. Previous research has shown limited input from the dietitian during admission to hospital for alcohol withdrawal. What this study adds: Healthcare professionals working within Primary Health Networks have variable confidence providing nutrition-related care to patients discharged from hospital post alcohol withdrawal, indicating a gap in nutrition-related service provision. These insights support the need for best practice guidelines for nutritional management in this population to enhance the role of dietitians within the multidisciplinary team.

What is already known: Evidence suggests that e-cigarettes can increase smoking quit rates. However vaping rates are exceeding smoking in adolescents with active marketing of e-cigarettes to young people leading to some who have never smoked cigarettes taking up vaping. What this study adds: Vaping is more frequent than smoking in young adolescents (aged 14 years and under), with increased rates among girls and Māori, with few indicating that vaping was taken up to help quit smoking. Many young adolescents respond positively when asked if they want help with their vaping. Tight controls of vaping products are needed to prevent e-cigarette marketing from attracting non-smoking adolescents, while ensuring access for those who wish to use vaping to help quit smoking.

What is already known: Hazardous alcohol use is increasing substantially in older adults, yet they are less likely than younger adults to be screened for alcohol use and related harms in primary health care. What this study adds: This research demonstrates the acceptability and value in an approach to identifying alcohol-related harm in those aged 50+ that combines the knowledge of primary health care professionals about alcohol-related harm in this cohort and the use of existing electronic health records to automate detection of risk factors.

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: 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 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 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 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.