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Background Lung cancer is typically diagnosed at a late stage. Early presentation and detection of lung cancer symptoms is critical to improving survival but can be clinically complicated and as yet a robust screening method for diagnosis is not available in routine practice. Accordingly, the barriers to help-seeking behaviour and diagnosis need to be considered. This review aimed to document the barriers to early presentation and diagnosis of lung cancer, based on patient and carer perspectives. Methods A systematic review of databases was performed for original, English language articles discussing qualitative research on patient perceived barriers to early presentation and diagnosis of lung cancer. Three major databases were searched: Scopus, PubMed and EBSCOhost. References cited in the selected studies were searched for further relevant articles. Results Fourteen studies met inclusion criteria for review. Barriers were grouped into three categories: healthcare provider and system factors, patient factors and disease factors. Conclusions Studies showed that the most frequently reported barriers to early presentation and diagnosis of lung cancer reported by patients and carers related to poor relationships between GPs and patients, a lack of access to services and care for patients, and a lack of awareness of lung cancer symptoms and treatment. Addressing these barriers offers opportunities by which rates of early diagnosis of lung cancer may be improved.

Techniques using machine learning for short term blood glucose level prediction in patients with Type 1 Diabetes are investigated. This problem is significant for the development of effective artificial pancreas technology so accurate alerts (e.g. hypoglycemia alarms) and other forecasts can be generated. It is shown that two factors must be considered when selecting the best machine learning technique for blood glucose level regression: (i) the regression model performance metrics being used to select the model, and (ii) the preprocessing techniques required to account for the imbalanced time spent by patients in different portions of the glycemic range. Using standard benchmark data, it is demonstrated that different regression model/preprocessing technique combinations exhibit different accuracies depending on the glycemic subrange under consideration. Therefore technique selection depends on the type of alert required. Specific findings are that a linear Support Vector Regression-based model, trained with normal as well as polynomial features, is best for blood glucose level forecasting in the normal and hyperglycemic ranges while a Multilayer Perceptron trained on oversampled data is ideal for predictions in the hypoglycemic range.

Diabetes mellitus (DM) is a significant driver of excess morbidity and premature mortality, though few contemporary or locally-derived data quantify this impact on New Zealanders, particularly Māori and Pacific Peoples. This prospective, national population study examines the life expectancy (LE) for New Zealanders with and without DM, and characterises mortality rates. Data from 01/01/2015 to 31/12/2019 housed in the Integrated Data Infrastructure, including the Virtual Diabetes Registry and Health New Zealand Mortality Collection, were linked. Estimated remaining LE years were calculated using abridged period life tables using the Chiang method for those with type 1 diabetes (T1D), type 2 diabetes (T2D), and without DM. Sub-group analysis by ethnicity was completed. Five-year cause-specific mortality rates per 100,000 people were compared by DM group. T1D and T2D prevalence was 0.4% and 5.5% in the overall sample (n = 4,505,478). Considerable ethnic differences in LE were evident, for example a 13-, 17.1-, and 24.5-year loss in remaining LE years was seen in men aged 0-19 years with T1D in the overall, Māori, and Pacific Peoples groups respectively compared to those without DM. An age-dependent reduction in remaining life expectancy years was also evident; for example an 8.6 (8.5-8.7) year reduction seen in females with DM aged 0-4, and 4.0 (4.0-4.1) year reduction for women with DM aged 65-69. Those with DM had higher cause-specific death rates. DM is associated with age-dependent reductions in LE across the entire lifespan, with disproportionately higher LE loss seen in Māori and Pacific Peoples.

Background Obesity is an international health issue which currently affects over 34% of New Zealand adults and leads to further physical and psychosocial health complications. People living in rural communities experience health inequities and have a high-risk of becoming obese. The aim of this study was to explore and identify barriers to effective weight management in rural Waikato general practice. Methods Using semi-structured interviews, 16 rural Waikato participants shared their experiences with barriers to weight management. Interviews were transcribed and analysed using thematic analysis. Results Four themes were identified: resource constraints, rural locality barriers, rural sociocultural norms barriers, and participants’ understanding the solutions needed to overcome their specific barriers to effective weight management. For these participants, finding a feasible weight management strategy was a challenging first step in their weight management journey. A programme that would ‘work’ meant one that was economically viable for low-income persons, accessible, even if living rurally with less resources, and did not cause harm or jeopardise their social connections within family or community. Conclusion Overall, participants noted a lack of weight management strategy ‘choice’ because of income, isolation or accessibility of their rural location and/or the sociocultural norms of the community they lived in restricted options available to them. Future weight management initiatives may be better devised from within communities themselves and will need to be cognisant of the barriers specific to rural communities. Rural perspectives have much to offer in any such reconsideration of weight management initiatives.

Background Obesity is a complex health issue affecting the quality of life of individuals and contributing to an unsustainable strain on healthcare professionals and national health systems. National policy guidelines indicate that general practice is best suited to deliver obesity healthcare, however, obesity rates continue to rise worldwide indicating interventions are ineffective in this space. The aim of this study was to explore the weight management experiences from patient perspectives. Methods This qualitative study used semi-structured interviews with 16 rural Waikato general practice patients. Interviews were analysed using reflexive thematic analysis. Results Four themes were identified: Inconsistent Information, Significance of Holistic Factors, Obesity Centre Need, and Education. Participants expressed frustration at contradictory health messages, commercial company and ‘expert’ definition distrust, and that ‘holistic’ aspects to health significant to the weight management journey were unable to be addressed in general practice. Conclusion Whilst primary care is positioned as suitable for delivering obesity healthcare, this study found that participants do not perceive general practice to be equipped to deliver this care. Instead, participants argued for a specialist obesity centre capable of meeting all their obesity healthcare needs. Further, wider issues including on-line commodification of health and neo-liberal capitalism - factors that exploit people with a stigmatised health issue - can cause further harm to the participant. A radical modernisation of education, information, and resources from regulated, qualified and ‘trusted’ healthcare professionals who can provide safe, non-stigmatising supportive services is recommended to meet the unique and changing food climate, reduce obesity rates and improve health outcomes.

Background The psychological status of New Zealanders living with type 1 diabetes (T1D) is unknown. This study's purpose is to determine the prevalence of general wellbeing, diabetes‐specific distress, and disordered eating, and explore their relationships with glycemic control. Methods Participants were patients aged 15–24 years with T1D (N = 200) who attended their routine multidisciplinary clinic at the Waikato Regional Diabetes Service. They completed questionnaires including the World Health Organization Well‐Being Index, the Problem Areas in Diabetes scales, and the Diabetes Eating Problem Survey‐Revised. Clinical and demographic information were also collected. Results Median age of participants was 19.3 years and 14% identified as Māori (indigenous people of Aotearoa New Zealand). Median HbA1c was 73 mmol/mol. One fifth of participants experienced low emotional wellbeing, including 7.5% who experienced likely depression. Diabetes distress was found in 24.1%, and 30.7% experienced disordered eating behaviors. Differences were identified between Māori and non‐Māori in measures of diabetes distress and disordered eating, with Māori more likely to score in clinically significant ranges (50% vs. 19.9%; 53.6% vs. 26.7%, p < 0.05). Disordered eating was correlated with HbA1c, body mass index, and social deprivation; diabetes distress was associated with HbA1c and inversely with age (all p < 0.05). Conclusions This study is the first of its kind to determine that New Zealanders living with T1D experience significant psychological distress. Research with larger Māori representation is needed to more closely review identified inequities. Replication in other local clinics will help contribute to the ongoing development of normative data for Aotearoa New Zealand.

IntroductionType 2 diabetes disproportionately affects Indigenous Māori in New Zealand. The reasons for this are multifactorial but include a history of colonialism, barriers to health care access and a lack of culturally appropriate interactions/relationships with health care providers. There is currently a need to develop models of health care delivery that are tailored to the needs of this population.AimThis pilot study evaluates the use of technology, education and culturally-informed wrap-around care (including medication optimisation) to improve type 2 diabetes biomarkers and self-management in a high-needs, majority Indigenous population.MethodsTwenty-three participants with HbA1c >80 mmol/L received 2–4 weeks of continuous glucose monitor (CGM) wear at baseline and at 3 months alongside culturally-informed type 2 diabetes education and clinical care. Clinical biomarkers and psychometric measures were recorded at 0, 3, 6 and 12 months and 0 and 3 months respectively. Medication changes were recorded throughout the study.ResultsMean (± s.d.) HbA1c significantly decreased from 93.4 ± 15.7 mmol/mol at baseline to 76.5 ± 14.8 mmol/mol at 3 months, with reductions maintained at 6 and 12 months by approximately three-quarters of participants (all P < 0.001 vs baseline). Diabetes self-management and LDL-cholesterol measures also improved significantly at 3 and 12 months, respectively.DiscussionCGM informed, culturally-appropriate care has the potential to lead to sustained improvements in glycaemia in high-risk, Indigenous populations managed in primary care.

Background Type 2 diabetes (T2D) is sub-optimally managed for many in Aotearoa New Zealand, and disproportionately affects Māori and Pacific peoples. In February 2021, SGLT2i/GLP1RA agents were funded for use for the first time with prioritisation for Māori, Pacific and those with cardiovascular and/or renal disease or risk (CVRD). This study evaluates the impact of health system factors on initiation of SGLT2i/GLP1RA therapy. Methods Primary care data was collected for patients with T2D aged 18–75 years from four primary care organisations (302 general practices) in the Auckland / Waikato region of New Zealand (Feb 2021 – July 2022). Initiation of SGLT2i/GLP1RA therapy was reviewed by patient (age, gender, ethnicity, CVRD status) and health system variables (funding, provider type, staffing, patient numbers, rurality, after-hours access). Logistic regression was used to estimate the odds ratio of a patient being dispensed SGLT2i/GLP1RA. Results Of 57,743 patients with T2D, 22,331 were eligible for funded SGLT2i/GLP1RA access and 10,272 of those (46.0%) were prescribed. Initiation of therapy was highest in Māori (50.8%) and Pacific (48.8%) patients (vs. 36·2–40·7% of other ethnic groups; P  < 0.001), but was comparable in those with and without CVRD (47·1% vs. 48·9%; P  = 0.2). Prescribing was highest in practices with higher doctor/patient numbers, low-cost fees, Māori health providers and clinics without after-hours access. Conclusion Prioritised access for SGLT2i/GLP1RA appears to be associated with a reduced health equity gap for Māori and Pacific patients with T2D in NZ, but work is required to improve prescribing for patients with CVRD.

Background Pharmacist prescribers have comprehensive pharmacotherapy knowledge that can be useful for management of complex health conditions such as type 2 diabetes, yet the number of pharmacist prescribers working in New Zealand primary care is low. Aim To explore the experiences of pharmacist prescribers in supporting type 2 diabetes management in New Zealand primary care. Methods Qualitative research design using semi-structured interviews with six pharmacist prescribers working in NZ primary care. Thematic analysis guided this study and themes were finalised with the wider research team. Results Three major themes were identified: team approach, health inequity and the role of a pharmacist prescriber. This study found that pharmacist prescribers may improve health equity by providing advanced pharmacotherapy knowledge within a wider primary care team to support complex patient needs and understanding the wider social determinants of health that impact effective diabetes management. Participants reportedly had more time to spend with patients (than GPs or nurses) and could also contribute to improving health outcomes by directly educating and empowering patients. Conclusion The views of pharmacist prescribers have seldom been explored and this study suggests that their role may be under-utilised in primary care. In particular, pharmacist prescribers can provide specialist prescribing (and often mobile) care, and may contribute to improving health outcomes and reducing inequity when used as part of a multi-disciplinary team.

Background Type 2 diabetes mellitus (T2D) is predominantly managed in primary care, and patients need to be provided with appropriate knowledge and education to understand how to best self-manage their condition. For optimal T2D self-management, primary care teams should share this information from the time of diagnosis. Little is currently known about how and when these resources are being provided to patients with T2D in New Zealand. Methods An online survey was carried out between Oct 2022 and Feb 2023. Patients diagnosed with T2D after Jan 2020 were invited to participate, with recruitment occurring via primary care and social media. Questions included information about demographics, diagnosis, provision of education resources and/or referral services as well as about current diabetes management. All responses were analysed with chi square tests. Free-text comments were summarised only. Results A total of 203 participants from across New Zealand completed the survey, but 18 were excluded due to being diagnosed more than 3 years ago, or self-reporting with type 1 diabetes rather than T2D. Nearly three quarters (70.7%) of participants reported that they were given appropriate resources to understand and manage their T2D, though half of these would have like more information. Overall, family and friends, self-led research and healthcare-provided education were equally useful, though this differed by ethnic groups. Similarly, approx. 70% of patients thought that medications had been well explained. Free text comments suggested a need for more targeted information around food choice and insulin use as well as a need for empathy and appropriate language from healthcare providers. Conclusions Primary care appears to be providing most newly diagnosed patients with appropriate resources to understand and manage their T2D, but there is room for improvement with up to a third of participants not understanding how to manage foods, medication and lifestyle choices to optimise health outcomes. Further work is required to address this gap and should include the use of culturally-appropriate materials to meet the multi-ethnic population needs.