AIMS: We sought to investigate the current state of education to support person- and whānau-centred care (PWCC) in our setting and to inform a new approach to teaching and learning. Additionally, we investigated the pote...AIMS: We sought to investigate the current state of education to support person- and whānau-centred care (PWCC) in our setting and to inform a new approach to teaching and learning. Additionally, we investigated the potential use case of an artificial intelligence (AI) tool to enable clinical communication skill development. METHODS: A mixed-method co-design approach was used, combining data from a consumer group, an anonymous staff survey (n=312) and a clinician focus group. The project captured lived experiences of communication in clinical care, enablers and barriers to effective training, and perspectives on future educational innovations including AI. RESULTS: Consumers emphasised the importance of individualised, culturally safe communication and clear, jargon-free language. Findings confirmed that while clinicians generally gain confidence with experience, existing training in communication and PWCC is inconsistent and often inaccessible. Clinicians identified a need for more frequent feedback and practical opportunities for skill development. This feedback should be from a person and whānau perspective. Notably, 90% of clinicians expressed openness to using an AI-based tool for improving communication skills. CONCLUSION: Traditional workplace education models are insufficient to meet the growing need for effective PWCC, including culturally safe communication in healthcare. An AI-enabled, feedback-driven tool may present a viable complementary solution to current offerings, provided it is co-designed with consumers and clinicians, is culturally grounded and is integrated into existing systems. Further investigation into the development and validation of a tool is warranted.
AIM: To describe the extent and nature of vaping behaviour in a high-risk group of adolescents compared to a regionally representative comparison group of same-age peers at 17.5 years (range 16-19). Vaping rates were exa...AIM: To describe the extent and nature of vaping behaviour in a high-risk group of adolescents compared to a regionally representative comparison group of same-age peers at 17.5 years (range 16-19). Vaping rates were examined by sex, age, socio-economic status (SES) and ethnicity. METHODS: Participants were 53 high-risk adolescents with prenatal substance exposure and family psychosocial adversity and 83 adolescents randomly recruited at birth. At mean age 17.5 years, participants were interviewed about current and lifetime vaping. RESULTS: Overall, two-thirds of adolescents reported having ever vaped, and 43% reported vaping regularly (>monthly). Adolescents in the high-risk group were more likely to report both ever (87% vs 55%; p<.001) and regular vaping (64% vs 30%; p<.001). Regular vaping was associated with lower family SES, although this effect was not significant after accounting for high-risk group status. Māori youth were significantly over-represented among regular vapers compared to non-vapers, but this association was largely explained by family SES. CONCLUSION: Vaping rates among Canterbury youth are high, with findings suggesting elevated rates for already higher-risk health-vulnerable adolescents. Offering accessible support for existing users and stronger regulations to limit vape product accessibility will be critical to minimise population harm and reduce longer-term health impacts.
AIMS: This study aimed to determine the association between demographic and clinical characteristics of mental health-related callouts to the ambulance services in Aotearoa New Zealand, focussing on differences among Māo...AIMS: This study aimed to determine the association between demographic and clinical characteristics of mental health-related callouts to the ambulance services in Aotearoa New Zealand, focussing on differences among Māori, Pacific peoples and non-Māori non-Pacific peoples (NMNPP). METHODS: A retrospective cross-sectional study analysed routinely collected data from electronic patient report forms between 1 July 2022 and 30 June 2023. Mental health-related callouts were identified using clinician-coded impressions from the Aotearoa New Zealand Paramedic Care Collection. RESULTS: Of 26,847 callouts, a higher proportion involved individuals under the age of 24 among Māori (31.9%) and Pacific people (29.3%) compared to NMNPP (19.1%) (p<0.001). Callout proportion was higher in the most deprived areas, particularly among Māori (47.7%) and Pacific peoples (49.9%) versus NMNPP (24.5%) (p<0.001). Of total individual callouts, 15.8% presented more than once, with a higher proportion among Māori. CONCLUSIONS: This study demonstrates an association between ethnicity, deprivation and mental health-related ambulance callouts, with Māori and Pacific populations in deprived areas experiencing proportionately higher callouts. Findings highlight the need for culturally responsive interventions and equitable access to care. Ambulance data can inform policy and monitor mental health trends.
AIM: We aimed to validate the interRAI Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale in predicting unplanned hospital admissions following emergency department (ED) visits among comm...AIM: We aimed to validate the interRAI Detection of Indicators and Vulnerabilities for Emergency Room Trips (DIVERT) scale in predicting unplanned hospital admissions following emergency department (ED) visits among community-dwelling older adults in an urban Aotearoa New Zealand population. METHODS: We conducted a retrospective cohort study of adults aged ≥55 years who underwent interRAI home care (HC) version 9.1 assessment between May 2021 and April 2022. The DIVERT score, derived from HC assessment data, categorised patients into risk levels. Hospital records were reviewed for unplanned hospital admissions via ED within 90 days of assessment. Statistical analyses, including survival and regression models, were used to evaluate predictive validity and explore risk factors. RESULTS: Between May 2021 and April 2022, 2,006 patients were assessed, with a mean age of 79.8 years (range 55-103). Admission rates within 90 days increased with higher DIVERT scores, from 18.2% (score 1) to 41.9% (score 6). Among high-risk groups (scores 5-6), a higher comorbidity burden was significantly associated with admission (p<0.001), while age, ethnicity and deprivation showed no statistically significant association. Primary causes of admission included infections, heart failure and falls. Mortality rates were notably higher in admitted patients at both 30 and 90 days. CONCLUSIONS: This study confirms the predictive validity of the interRAI DIVERT scale for unplanned hospital admissions among community-dwelling older adults in urban Aotearoa New Zealand. The strong association between higher scores and increased admission rates supports its use in risk-stratification within this population.
AIM: Computed tomography coronary angiography (CTCA) is a sensitive tool for the diagnosis of atherosclerotic coronary artery disease (CAD). The study aim was to determine whether the finding of coronary atheroma on CTCA...AIM: Computed tomography coronary angiography (CTCA) is a sensitive tool for the diagnosis of atherosclerotic coronary artery disease (CAD). The study aim was to determine whether the finding of coronary atheroma on CTCA was associated with the subsequent use of statin therapy. METHODS: Patients with chest pain who underwent CTCA in 2020-2021 were identified from the Aotearoa New Zealand All Cardiology Services Quality Improvement (ANZACS-QI) cardiac computed tomography (CT) registry at Middlemore Hospital, Auckland, New Zealand. Patients were categorised into three groups: no atheroma, atheroma with non-obstructive CAD and atheroma with obstructive CAD. RESULTS: There were 548 patients with acute chest pain and 746 with stable chest pain. Of those with acute chest pain, no atheroma, non-obstructive and obstructive CAD was documented in 37.2%, 38% and 24.8%, respectively. In patients with obstructive CAD, statin dispensing was 52.9% pre-admission, 92.6% early post-CTCA and 87.5% at 1 year. In those with non-obstructive CAD, statin dispensing was 45.7% pre-admission, 67.8% early post-CTCA and 59.6% at 1 year. In those without atheroma, statins were dispensed in 23.5% at pre-admission and in 28.9% at 1 year. In the stable chest pain cohort, patterns of statin dispensing post-CTCA were similar to those in the acute chest pain cohort. On multivariate regression the presence of atheroma both with/without obstructive CAD was associated with higher levels of statin dispensing. CONCLUSION: The finding of atheroma with obstructive CAD on CTCA is associated with appropriate increases in statin use. There are opportunities to optimise care by greater statin utilisation in non-obstructive CAD and down-titration in those without atheroma.
AIMS: This paper aims to explore the relationship between e-biking and health in the context of a novel, marae-led e-biking programme for Māori and Pacific adults in a suburban community. METHODS: Focus groups were condu...AIMS: This paper aims to explore the relationship between e-biking and health in the context of a novel, marae-led e-biking programme for Māori and Pacific adults in a suburban community. METHODS: Focus groups were conducted with participants in an e-biking programme (n=20) prior to receiving e-bikes, and individual interviews were conducted with participants at approximately 6 months (n=23) and 12 months (n=22). RESULTS: Wanting to improve health was a motivation for trying e-biking. E-biking supported better physical and mental health, including self-reported improvement in a range of long-term conditions. E-biking was often possible and enjoyable for people who experienced barriers to physical activity, although poor health could also act as a barrier to e-biking. Factors that supported ongoing e-biking included having someone to ride with, the enjoyable nature of e-biking, and integrating e-biking for active travel. CONCLUSIONS: This study suggests that e-biking is possible and beneficial for a wide range of people who do not currently cycle. Recommendations from individual health practitioners are likely to be important alongside community and population level interventions to support the uptake of cycling. Practice points to support individual health practitioners to discuss e-biking are provided.
Persistent inequities in cancer outcomes for Māori and Pacific peoples remain one of the most significant challenges facing the Aotearoa New Zealand health system. These disparities are evident across incidence, stage at...Persistent inequities in cancer outcomes for Māori and Pacific peoples remain one of the most significant challenges facing the Aotearoa New Zealand health system. These disparities are evident across incidence, stage at diagnosis, access to treatment and survival. While often attributed to behavioural risk factors, the predominant drivers are structural, including barriers to access, health system design, workforce limitations and broader socio-economic determinants. Despite long-standing recognition, progress has been inconsistent and insufficient. Addressing these inequities requires a shift from description to accountability, with equity embedded as a core performance metric. Culturally aligned services, improved access to care, strengthened primary care and the use of registry-based data to drive quality improvement are essential components of a system capable of delivering equitable outcomes. Comprehensive cancer centres could offer a further opportunity to reduce variation and improve access to high-quality multidisciplinary care. In parallel, screening policy must better reflect epidemiological realities, including the earlier onset of colorectal cancer among Māori. Equity in cancer care is fundamental to the definition of a high-performing health system. Without measurable progress, equity remains deferred-and therefore denied.
Recently the Health Research Council of New Zealand (HRC) announced the prioritisation of projects that enhanced the development of clinician-researchers. In this viewpoint article, we argue that a clinician-researcher c...Recently the Health Research Council of New Zealand (HRC) announced the prioritisation of projects that enhanced the development of clinician-researchers. In this viewpoint article, we argue that a clinician-researcher career involving publicly funded, investigator-led clinical research with meaningful end points to inform clinical care is currently not sustainable in New Zealand.
Patient trust is key to the delivery of healthcare and realisation of artificial intelligence's (AI) benefits in health. Trust in health institutions and the health professionals working within them directly impacts pati...Patient trust is key to the delivery of healthcare and realisation of artificial intelligence's (AI) benefits in health. Trust in health institutions and the health professionals working within them directly impacts patient engagement with health services and their health outcomes. Patients want to be able to trust the health system and health services to respect, protect and use their data responsibly to minimise any potential harms. Further, when integrating AI within health services, patients want to be able to trust that this is done with good governance, including the correct approvals and processes, to ensure equitable and safe care. Due to the complexity and fast-changing landscape of AI and the varied levels of AI literacy, trust is arguably even more important. Patients need to be able to trust services to use their health information responsibly and integrate AI in care appropriately regardless of whether they fully understand the technology. Through transparency and good AI governance, trust can be built and maintained, but if broken or lost, it will be difficult to repair and will have wider implications. This paper provides recommendations for actions to be taken to build and maintain trust in health institutions within the context of the evolving AI landscape.
AIM: We aimed to conduct a comparative analysis of the open disclosure frameworks in Australia and New Zealand to identify the strengths, weaknesses and trade-offs of their respective approaches and to propose a hybrid m...AIM: We aimed to conduct a comparative analysis of the open disclosure frameworks in Australia and New Zealand to identify the strengths, weaknesses and trade-offs of their respective approaches and to propose a hybrid model that integrates the best practices from both systems. METHOD: This qualitative comparative policy analysis systematically reviewed key policy documents from Australia and New Zealand. Data extraction focussed on the principles, processes, governance, legal aspects and implementation strategies of each framework. A multi-theoretical approach was adopted, applying four core theoretical frameworks-institutional theory, regulatory governance, ethics of care and implementation science-to analyse the extracted data. The analysis involved thematic coding, a cross-country comparison through each theoretical lens and a synthesis of the findings to identify the trade-offs between the two models and to inform the development of a refined hybrid model. RESULT: The analysis revealed that Australia's framework, which is embedded in national safety standards, emphasises system-wide governance and accreditation, offering flexibility but at the risk of implementation variability. In contrast, New Zealand's model, which is legally mandated under consumer rights legislation, prioritises individual accountability and patient rights, ensuring strong enforcement but potentially fostering a compliance-driven culture. The key differences between the two frameworks emerged in their legal specificity, enforcement mechanisms and the practicalities of their implementation. The analysis highlighted the critical role of ethical considerations, workforce capacity and organisational readiness for the effective implementation of open disclosure. CONCLUSION: Both the Australian and New Zealand open disclosure frameworks offer valuable insights into the challenge of balancing systemic governance and consumer rights. A hybrid approach that integrates Australia's focus on systemic learning with New Zealand's robust legal mandate for patient rights and explicit ethical considerations could provide a more effective and equitable framework for open disclosure, and could enhance healthcare quality and transparency. Future research should focus on the empirical evaluation of the practical implementation and outcomes of such hybrid models.
AIM: Pasifika Futures Ltd, as a Whānau Ora commissioning agency, was part of phase two of the government-funded Whānau Ora initiative that was active between 2014 and 2025 in supporting Pacific families across Aotearoa N...AIM: Pasifika Futures Ltd, as a Whānau Ora commissioning agency, was part of phase two of the government-funded Whānau Ora initiative that was active between 2014 and 2025 in supporting Pacific families across Aotearoa New Zealand in improving health, education, housing and employment outcomes. This study investigated wellbeing outcomes of Pacific families engaged in Whānau Ora services over 8 years of this period to identify socio-demographic groups with the highest needs. METHOD: This was an observational, national cross-sectional study of 11,999 Pacific families engaged with Whānau Ora services between July 2015 and June 2023. The Measurement Assessment Scoring Tool (MAST), a measure of multi-domain outcomes, was used to assess family wellbeing. Regression models yielded comparative mean differences and odds ratios. RESULTS: Multivariable-adjusted regressions showed that needs, assessed using MAST scores, were significantly higher in families with Sāmoan or Tuvaluan ethnicity, non-English speaking, larger family households or younger family age. Compared with Auckland, needs were higher (all p<0.0001) for those living in Northland and lowest for families living in the South Island (by 4.0), families living in Wellington (by 6.1) and families living in the Midland area (by 6.8). CONCLUSION: Socio-demographic factors are associated with lower holistic wellbeing in Pacific families. These results can inform targeted interventions directed at reducing wellbeing disparities.
BACKGROUND: Burnout is a chronic syndrome that compromises physician wellbeing and patient care. This study aimed to quantify burnout among New Zealand ophthalmologists and identify key demographic and practice-related f...BACKGROUND: Burnout is a chronic syndrome that compromises physician wellbeing and patient care. This study aimed to quantify burnout among New Zealand ophthalmologists and identify key demographic and practice-related factors associated with increased risk, as well as to assess lifetime burnout experiences, time off taken and barriers to seeking help. METHODS: A cross-sectional study of 171 New Zealand ophthalmologists used a modified Mini Z 2.0 Burnout Survey to assess workplace satisfaction, stress and burnout, while additional questions gathered demographic and practice characteristics, as well as retrospective data on burnout frequency, time off taken, help sought and perceived barriers. RESULTS: Out of 161 delivered surveys, 84 responses were received (52% response rate). Overall burnout was 20%, with a significantly higher rate in the public sector (p<0.05). Burnt-out respondents reported notably lower job satisfaction, team effectiveness and workload control. No significant associations were found with other demographic or practice factors. Sixty-three percent had experienced burnout at least once, and 40% reported multiple episodes, yet only 15.5% took time off. Among those who sought help (51%), family members were the most common source of support, while 43% did not seek help, primarily due to time constraints. CONCLUSION: This study shows that burnout affects one in five New Zealand ophthalmologists. Findings underscore the importance of reducing stigma and cultivating supportive environments that encourage help-seeking without fear of repercussions. Reducing administrative tasks and expanding mental health resources, especially in the public sector, may mitigate burnout and strengthen workforce recruitment and retention.
AIMS: Income is a key determinant of health and health equity. This paper outlines the current welfare supports for people with longterm conditions and reviews the issues associated with accessing those supports, particu...AIMS: Income is a key determinant of health and health equity. This paper outlines the current welfare supports for people with longterm conditions and reviews the issues associated with accessing those supports, particularly during health system engagement. METHODS: Weaving a Kaupapa Māori methodology, the He Pikinga Waiora framework and a qualitative approach, our team spoke to 130 healthcare providers across the Waikato Region in face-to-face and virtual engagements about system-level issues associated with accessing welfare support. Notes taken during these engagements were analysed using inductive thematic analysis, systems thinking and a Kaupapa Māori lens. RESULTS: Because of the way health and welfare systems operate and limited access to advocacy, computerised resources and information about welfare and other supports, key informants observed that patients experienced many difficulties accessing the right type and level of welfare support, with likely consequent impact on health outcomes. These realities were exacerbated because providers were not enabled to help patients navigate the welfare system. CONCLUSION: The health and welfare systems are not designed to enable access to welfare support. Providers could have a more meaningful role ensuring equitable access to welfare and other supports but are underfunded, understaffed and unsupported. A more integrated approach and cross-sectoral action are needed.
AIMS: Emerging research suggests exposure to vape stores and their proximity to schools play a role in vaping initiation among adolescents. In New Zealand, regulatory changes enacted that restrict sales of flavoured vape...AIMS: Emerging research suggests exposure to vape stores and their proximity to schools play a role in vaping initiation among adolescents. In New Zealand, regulatory changes enacted that restrict sales of flavoured vape products to specialist vape retailers (SVRs) have led to growth in "store-within-a-store" (SWAS) SVRs in or beside convenience stores to circumvent restrictions. This paper assesses the number and type of SVR retailers, including SWAS, and their proximity to educational institutes (primary, secondary and tertiary) and marae across Auckland suburbs with different socio-economic deprivation levels. METHODS: Google Maps data and tools were used to assess SVR "type" and distance from schools, marae and other SVRs in selected Auckland suburbs. One hundred and sixty SVRs were examined across 14 suburbs. RESULTS: The median number of SVRs per suburb was 9.5. Forty-four percent of SVRs were SWAS. SWAS density increased with socio-economic deprivation, with high-deprivation suburbs containing a median of 8.5 SWAS compared with 2.0 in low-deprivation suburbs. Half of the SVRs (56%) were located within 300m of at least one educational institute. CONCLUSION: SWAS density in Auckland increased with neighbourhood socio-economic deprivation. SWAS retailers likely contribute to greater exposure to vape retail and products among adolescents in these areas.
AIM: This study aims to investigate the relationship between experiences of discrimination (ethnic/race-based, gender and sexuality-based discrimination) in a healthcare setting, and healthcare services avoidance in Paci...AIM: This study aims to investigate the relationship between experiences of discrimination (ethnic/race-based, gender and sexuality-based discrimination) in a healthcare setting, and healthcare services avoidance in Pacific Rainbow+ in Aotearoa New Zealand. METHODS: This study draws from a sample of Pacific Rainbow+ (Pacific cisgender sexuality minorities [n=239] and Pacific transgender and non-binary [n=126]) individuals taken from the Manalagi Survey. Multivariate logistic regression analyses were performed to test for a relationship between predictors based on respondent self-reported experiences, within a healthcare setting in Aotearoa New Zealand, of discrimination (race/ethnic discrimination or racism, sexuality and/or gender diversity-homophobia/transphobia and heterosexism) and outcome variables (avoiding healthcare and mental health services). RESULTS: Discrimination based on ethnicity/race was more highly reported by both cisgender sexuality minorities and the transgender and non-binary groups in our sample, with this typology of discrimination also associated with increased odds of healthcare services avoidance. Discrimination based on race/ethnicity was further associated with increased likelihood of mental health service usage. On average, cisgender sexuality-diverse respondents reported 1.15 instances of listed forms of discrimination, and this nearly doubled for transgender and non-binary respondents. Notably, when the overall number of discriminatory exposures increased by a single point, respondents had an approximate 60% odds ratio (OR) of healthcare avoidance. CONCLUSION: This study affirms findings of much research that describe discrimination (multiple forms) as a common experience for Rainbow+ individuals while seeking out healthcare services. Further, it reveals that these experiences have a predictive impact on the likelihood of Pacific Rainbow+ avoiding healthcare services. While this study's cross-sectional nature limits the ability to infer causality, these findings do underscore the importance of undertaking more intersectional research into the drivers and inhibitors of healthcare-seeking behaviours and healthcare service usage of Pacific Rainbow+ in Aotearoa New Zealand.