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IntroductionDelayed diagnosis of gut disease is a continuing problem, variously attributed to a range of patient, doctor, and health system factors. Gut disease often begins with indeterminate gut behaviours that are hard to classify.AimThis study aimed to investigate delayed diagnosis from the point of view of the patient, or prospective patient. How gut and gut disease was understood, what might prompt them to seek care, and their experiences of seeking care.MethodsUsing a qualitative design, we interviewed 44 people in New Zealand. Thirty-three had a diagnosis of gut disease, and 11 did not, though some of the patients in this latter group had symptoms.ResultsSome participants had a smooth trajectory from first noticing gut symptoms to diagnosis. However, a subgroup of 22 participants experienced long periods of troublesome gut behaviours without a diagnosis. For this subgroup of 22 participants, we found people struggled to work out what was normal, thus influencing when they sought health care. Once they sought health care, experiences of that care could be frustrating, and achieving a diagnosis protracted. Some who remained undiagnosed felt abandoned, though had developed strategies to self-manage.DiscussionIndeterminate gut behaviours remain complex to deal with and it can difficult for both patients and doctors to assess when a symptom or group of symptoms need further investigation, watchful waiting or the use of other supportive strategies. Effectively communicating with healthcare staff can be a significant problem and there is currently a gap in support for patients in this regard.

IntroductionSexual and reproductive health (SRH) is important for well-being, yet Indigenous peoples, including Māori, have poorer SRH outcomes than non-Indigenous peoples. Healthcare providers (HCPs) play a critical role in enhancing patients’ health literacy, directly impacting health outcomes by providing clear, accessible information and guidance. Therefore, it is important to explore the experiences that wāhine Māori (Māori women) have when interacting with HCPs and how they learn about SRH. Such research could guide interventions to improve dissemination of SRH knowledge to Māori.AimThis study aimed to explore the experiences wāhine Māori have of sexual health care and accessing SRH knowledge.MethodsWāhine were interviewed in this Kaupapa Māori study. Interviews were transcribed and coded, and thematic analysis was performed.ResultsTwelve wāhine were interviewed. An overarching theme, He mana tō te mātauranga (knowledge is power), was identified. There were four subthemes: being informed about contraceptive options is empowering, informed consent is important, high-stress situations call for better communication and improved dissemination of SRH knowledge is needed. The wāhine valued being well-informed about their health and options, however, their experiences of receiving information varied.DiscussionWāhine Māori want to be told more about their health and options when encountering HCPs regarding SRH. Being informed is empowering, while feeling uninformed results in a breakdown in trust in the healthcare system and inability to exercise mana motuhake (autonomy). Facilitating improved dissemination of knowledge about SRH may help improve SRH outcomes for Māori by supporting health literacy, so that Māori can make informed decisions about their health.

IntroductionMāori have poorer sexual and reproductive health (SRH) outcomes compared to non-Māori New Zealanders. Patient experiences of SRH services affect how they access, utilise, and benefit from services. Learning about how wāhine Māori (Māori women) experience care related to SRH could inform improvements in how services provide care for wāhine.AimThis study aimed to explore the experiences wāhine have when accessing SRH services.MethodsThis qualitative study utilised semi-structured interviews to explore the lived experiences of wāhine when accessing sexual healthcare. Inductive thematic analysis was performed to generate themes from the data.ResultsTwelve wāhine were interviewed. An overarching theme, Te Hāpai i te mana wāhine, te takahi i te mana wāhine (empowering women, disempowering women), was identified. This theme had four subthemes: creating comfortable spaces; manaakitanga (kindness and respect) overcomes barriers to care; patients are people, not numbers; and the importance of mana-enhancing care. The data showed that wāhine benefit from services and care that make them feel comfortable and respected and that dehumanising care can impact further engagement with services.DiscussionWāhine have variable experiences when accessing sexual healthcare, and although some of those experiences showed how positive interactions with healthcare staff facilitated effective care, many experiences demonstrated how dehumanising clinical care can sometimes be. Such care risks perpetuating health inequities indirectly by eroding the trust wāhine have in healthcare services, and directly by limiting the effectiveness of healthcare encounters. Recommendations are made to improve care provided to wāhine in sexual health settings.

Background and context: This paper outlines the process of moving a continuing education programme for primary healthcare professionals from a fully in-person model to fully online so it could continue during coronavirus disease 2019 (COVID-19) lockdowns. The programme uses a peer-led Small Group model with the leader facilitating interactive discussion based on background content researched by a team from Pegasus Health.Assessment of problem: When the COVID-19 restrictions were implemented in March 2020, the usual in-person Small Group meetings could not continue. Rather than allowing the programme to lapse, a new format was needed.Strategies for improvement: In response, the Pegasus Health team transitioned the programme to an eSmall Group model using Zoom. Training packages were developed and disseminated online and the interactive, real-time nature of the programme retained. eSmall Groups began in May and were evaluated late in 2020.Results: The online format was strongly supported, though some attendees missed the collegiality of meeting in-person. From 2021, attendees could opt for either online, in-person, or a summer/winter split between in-person and online. The ability to return to fully online was retained, allowing a seamless transition during the periods of further restrictions that followed in 2021–22.Lessons learnt: The Small Group model has evolved to a multi-format programme that suits individual preferences, but can respond to pandemic or emergency situations if needed. It continues to have a high level of engagement among primary healthcare professionals.

INTRODUCTION: The delivery of health care by primary care general practices rapidly changed in response to the coronavirus disease 2019 (COVID-19) pandemic in early 2020.AIM: This study explores the experience of a large group of New Zealand general practice health-care professionals with changes to prescribing medication during the COVID-19 pandemic.METHODS: We qualitatively analysed a subtheme on prescribing medication from the General Practice Pandemic Experience New Zealand (GPPENZ) study, where general practice team members nationwide were invited to participate in five surveys over 16 weeks from 8 May 2020.RESULTS: Overall, 78 (48%) of 164 participants enrolled in the study completed all surveys. Five themes were identified: changes to prescribing medicines; benefits of electronic prescription; technical challenges; clinical and medication supply challenges; and opportunities for the future. There was a rapid adoption of electronic prescribing as an adjunct to use of telehealth, minimising in-person consultations and paper prescription handling. Many found electronic prescribing an efficient and streamlined processes, whereas others had technical barriers and transmission to pharmacies was unreliable with sometimes incompatible systems. There was initially increased demand for repeat medications, and at the same time, concern that vulnerable patients did not have usual access to medication. The benefits of innovation at a time of crisis were recognised and respondents were optimistic that e-prescribing technical challenges could be resolved.DISCUSSION: Improving e-prescribing technology between prescribers and dispensers, initiatives to maintain access to medication, particularly for vulnerable populations, and permanent regulatory changes will help patients continue to access their medications through future pandemic disruption.

Explores how GPs and pharmacists understand the professional role of the pharmacist and its current expansion following the Jul 2012 implementation of The Pharmacy Services Agreement (the new model signed between community pharmacists and District Health Boards), and their views of the emphasis on increased collaboration and integration between the two roles in the care of patients. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

INTRODUCTION: Pegasus Health Charitable Ltd, a Christchurch Primary Health Organisation, is contracted by the Canterbury District Health Board to provide continuing professional development for primary care practitioners in the region. Rurally located health practitioners have largely been unable to participate because of the travel time and distances involved.AIM: The initiative reported in this paper aimed to fill this gap by developing an accessible and high-quality multidisciplinary model of professional development for general practitioners, nurse practitioners, practice nurses and community pharmacists in rural areas of North Canterbury, New Zealand.METHODS: A survey was conducted to learn from the experiences of 14 health professionals in an existing multidisciplinary group, which had developed as a local initiative in one rural community.RESULTS: The survey had an 86% response rate. All respondents believed the multidisciplinary format worked well, had improved collaborative working and increased the consistency of patient care. Access to professional development had improved and the meetings provided a useful forum for the mostly part-time staff to interact as a group. The main caution noted was the potential to become inward looking without being exposed to fresh ideas from other practices.DISCUSSION: The multidisciplinary model was considered workable and valuable by the survey respondents. Based on our findings, the multidisciplinary model has been formalised by the Pegasus team responsible, and three new groups are now operating successfully in rural areas of North Canterbury.

Access to unhealthy commodities is a key factor determining consumption, and therefore influences the prevalence of non-communicable diseases. Recently, there has been an increase in the availability of food ‘on-demand’ via meal delivery apps (MDAs). However, the public health and equity impacts of this shift are not yet well understood. This study focused on three MDAs in New Zealand and aimed to answer (1) what is the health profile of the foods being offered on-demand, (2) how many food outlets are available and does this differ by physical access or neighbourhood demographics and (3) does the health profile of foods offered differ by physical access or neighbourhood demographics? A dataset was created by sampling a set of street addresses across a range of demographic variables, and recording the menu items and number of available outlets offered to each address. Machine learning was utilised to evaluate the healthiness of menu items, and we examined if healthiness and the number of available outlets varied by neighbourhood demographics. Over 75% of menu items offered by all MDAs were unhealthy and approximately 30% of all menu items across the three MDAs scored at the lowest level of healthiness. Statistically significant differences by demographics were identified in one of the three MDAs in this study, which suggested that the proportion of unhealthy foods offered was highest in areas with the greatest socioeconomic deprivation and those with a higher proportion of Māori population. Policy and regulatory approaches need to adapt to this novel mode of access to unhealthy foods, to mitigate public health consequences and the effects on population groups already more vulnerable to non-communicable diseases.

Abstract Services offering on-demand delivery of unhealthy commodities, such as fast food, alcohol and smoking/vaping products have proliferated in recent years. It is well known that the built environment can be health promoting or harmful to health, but there has been less consideration of the digital environment. Increased availability and accessibility of these commodities may be associated with increased consumption, with harmful public health implications. Policy regulating the supply of these commodities was developed before the introduction of on-demand services and has not kept pace with the digital environment. This paper reports on semi-structured interviews with health policy experts on the health harms of the uptake in on-demand delivery of food, alcohol and smoking/vaping products, along with their views on policies that might mitigate these harms. We interviewed 14 policy experts from central and local government agencies and ministries, health authorities, non-Government Organisations (NGOs) and university research positions in Aotearoa New Zealand using a purposive sampling strategy. Participants concerns over the health harms from on-demand services encompassed three broad themes—the expansion of access to and availability of unhealthy commodities, the inadequacy of existing restrictions and regulations in the digital environment and the expansion of personalized marketing and promotional platforms for unhealthy commodities. Health policy experts’ proposals to mitigate harms included: limiting access and availability, updating regulations and boosting enforcement and limiting promotion and marketing. Collectively, these findings and proposals can inform future research and public health policy decisions to address harms posed by on-demand delivery of unhealthy commodities.

Explores the experiences of New Zealand general practice teams in their perception of delayed patient care during the early stages of the COVID-19 pandemic. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.