Letteratura scientifica selezionata sul tema "Maori service provision"

Aims and methodTo identify the patient characteristics and rates of retention in a residential rehabilitation drug and alcohol service (Springhill) based on an eclectic model of care. Patients were assessed using the Alcohol and Drug Outcome Measure (ADOM), a brief tool designed for the New Zealand setting. We looked at correlations between demographic, social and drug use parameters. Logistic regression assessed the relative impact of each variable on completion.ResultsThe 183 patients who completed the data collection did not differ from 47 non-completers by demographic data; 62.2% of patients completed the programme, with equal number of men and women. One in five participants was Maori, the indigenous minority. Alcohol (51.9%) was the commonest drug of misuse, with methamphetamine (16.4%) and cannabis (14.2%) also significant. Completers were more likely to be Maori, have conflict with family and housing problems, although the last became non-significant in logistic regression.Clinical implicationsRetention rates are higher in Springhill than in comparable programmes. Ethnicity and family conflict predict completion, although the reasons for this are unclear. ADOM is an effective tool that can be used in a clinical setting to enable analysis of service provision.

Objective: The paper describes the methodologies and results obtained on a large cohort of prison inmates in New Zealand who were screened for psychiatric disorder. Method: All women and remanded male inmates in New Zealand prisons, and a randomly selected cohort of 18% of sentenced male inmates were interviewed. Interviewers used the Composite International Diagnostic Interview –Automated to establish DSM-IV diagnoses, and the Personality Disorders Questionnaire to identify personality disorder. All prisons in New Zealand were visited. Results: The results indicate markedly elevated prevalence rates for major mental disorder in the prison population when compared with community samples. This is especially the case for substance misuse, psychotic disorders, major depression, bipolar disorder, obsessive–compulsive disorder and posttraumatic stress disorder. Of particular concern is not only the increased prevalence rates for schizophrenia and related disorders but also the high level of comorbidity with substance misuse disorders demonstrated by this group. While 80.8% of inmates diagnosed with bipolar disorder were receiving psychiatric treatment in the prison, only 46.4% of depressed inmates and 37% of those suffering from psychosis were receiving treatment. Maori inmates were grossly overrepresented in the remand, female and male sentenced inmate population compared with the general population. Conclusions: A significant increase in provision of mental health services is required to cope with the high number of mentally ill inmates. The level of need demonstrated by this study requires a level of service provision that is quite beyond the capacity of current forensic psychiatry services, Department of Corrections Psychological Services or the prison nursing and medical officers. The elevated rates of common mental disorders argues for the use of improved psychiatric screening instruments, improved assessment and treatment capacities in the prison and an increased number of forensic psychiatric inpatient facilities to care for those psychotic inmates who are too unwell to be treated in the prison.

Objectives(1) To establish the likelihood of dying within 12 months for a cohort of hospital inpatients in New Zealand (NZ) on a fixed census date; (2) to identify associations between likelihood of death and key sociodemographic, diagnostic and service-related factors and (3) to compare results with, and extend findings of, a Scottish study undertaken for the same time period and census date. National databases of hospitalisations and death registrations were used, linked by unique health identifier.Participants6074 patients stayed overnight in NZ hospitals on the census date (10 April 2013), 40.8% of whom were aged ≥65 years; 54.4% were women; 69.1% of patients were NZ European; 15.3% were Maori; 7.6% were Pacific; 6.1% were Asian and 1.9% were ‘other’.SettingAll NZ hospitals.Results14.5% patients (n=878) had died within 12 months: 1.6% by 7 days; 4.5% by 30 days; 8.0% by 3 months and 10.9% by 6 months. In logistic regression models, the strongest predictors of death within 12 months were: age ≥80 years (OR=5.52(95% CI 4.31 to 7.07)); a history of cancer (OR=4.20(3.53 to 4.98)); being Māori (OR=1.62(1.25 to 2.10)) and being admitted to a medical specialty, compared with a surgical specialty (OR=3.16(2.66 to 3.76)).ConclusionWhile hospitals are an important site of end of life care in NZ, their role is less significant than in Scotland, where 30% of an inpatient cohort recruited using similar methods and undertaken on the same census date had died within 12 months. One reason for this finding may be the extended role of residential long-term care facilities in end of life care provision in NZ.

Introduction : A key strategy for improving the management of patients with diabetes is the provision of a free annual review ‘Get Checked’. Although it is known that certain patients do not attend these free reviews, little is known about the barriers. METHODS: A group of patients with diabetes who had not attended an annual review in the previous two years were identified and sent questionnaires asking about the barriers to attending. Non-respondents where followed up with a telephone call. Barriers were thematically analysed. FINDINGS: 26/68 patients identified patients responded (38%). Key issues identified included difficulty with transport, conflict with work and lack of motivation. There were differences in responses between Maori and non-Maori. CONCLUSION: Recommendations include more emphasis in recognising Maori tikanga (culture), more flexible provision of services to allow working patients to attend and increased emphasis on reminders for patients. KEYW ORDS: Diabetes mellitus; Maori; family practice; barriers

INTRODUCTION: There are unacceptable ethnic differences in cancer survival in Aotearoa/New Zealand. For people with cancer, quality of life and survival are shaped by access to care, but research on Maori access to, and through, cancer care is limited. Internationally, research has shown that primary care plays an important role in providing patient-centred, holistic care and information throughout the cancer care journey. Additionally, Maori health providers provide practical support and facilitate access to all levels of health care. Here we describe the cancer journeys of Maori patients and whanau and identify factors that may facilitate or inhibit access to and through cancer care services. METHODS: Twelve Maori patients affected by cancer and their whanau (family) in the lower North Island took part in face-to-face semi-structured interviews exploring their experiences of cancer screening, diagnosis, treatment, survival and palliative care. FINDINGS: Three key areas were identified that impacted upon the cancer care journey: the experience of support; continuity of care; and the impact of financial and geographic determinants. CONCLUSION: Primary care plays a key role in support and continuity of care across the cancer journey. Alongside interpersonal rapport, a long-term relationship with a primary health provider facilitated a more positive experience of the cancer care journey, suggesting that patients with a ‘medical home’ are happier with their care and report less problems with coordination between services. Positive, longstanding relationships with general practitioners and Maori health providers assisted patients and whanau with the provision and understanding of information, alongside practical support. KEYWORDS: Cancer; family; health services, indigenous; Maori health; primary health care cancer

BACKGROUND AND CONTEXT: Reducing health disparities for children living in deprived areas has been difficult to achieve. This paper describes the implementation of a nurse-led, child-specific clinic within a general practice setting to improve health outcomes for high needs Maori/Pacific Island and NZDep96 quintile groups 4 and 5 children and their whanau/families. ASSESSMENT OF PROBLEM: The medical centre that implemented the clinic had a high number of enrolled children with chronic and recurrent morbidities. Children frequently did not attend clinic appointments, and there was high use of after-hours services. RESULTS: An outcome audit after 18 months demonstrated a significant (>30%) reduction in eczema severity, daily irritability, and daily occurrence of pain. Post-intervention fewer children were hospitalised and there was a 50% reduction in antibiotic use. STRATEGIES FOR IMPROVEMENT: The aim of the nurse-led clinic was to improve health gains, facilitate morbidity control of chronic conditions, and to offer prevention strategies to promote wellness for the target population. The reduction of morbidity severity by 10% was measured with specific morbidity scoring systems for eczema, constipation and nocturnal enuresis. Other outcome indicators measured vomiting/reflux, wheezing/coughing, constipation/soiling, irritability, sleep disturbances, hospital admissions, and antibiotic use. LESSONS: Nurse-led clinics facilitated by nurses with advanced skills can reduce health disparities for the target population. The amount of time the nurse is able to spend with the child and whanau/family, and the provision of opportunistic assessments as required, has effected positive change in those children most in need. KEYWORDS: Child health; low decile families; Maori/Pacific families: chronic conditions; nurse-led clinic

Objective This paper investigates the characteristics of pharmacies that are associated with the degree of counselling provided to customers purchasing medicines. Methods Twelve ‘mystery shoppers’ (research assistants posing as normal customers) purchased restricted medicines at 180 pharmacies around New Zealand. One drug (diclofenac) and one class of drugs (vaginal antifungals) were purchased. The amount of counselling provided was recorded, and linked to profile data on the pharmacies, obtained through a questionnaire, from Census data, and from direct observations of pharmacies. Results Location within a city, a large town, or strip shopping did not affect the level of counselling pharmacies provided. Pharmacies adjacent to medical centres gave significantly less counselling to diclofenac purchasers than other pharmacies. No consistent relationship was found between pharmacy size and the level of counselling provided. There were large differences between areas of the country. A strong negative relationship was found between the amount of counselling given about thrush, and the proportion of Pacific Island people in the population around the pharmacy. Although only some results reached statistical significance, there seems to have been a similar trend for pharmacies to provide less counselling in areas with more Maori people and with higher levels of social deprivation. Conclusions Regional variation in the provision of pharmacy services, and in particular the tendency for pharmacies to provide less counselling in areas that are likely to have higher health care needs, must be addressed if pharmacies are to fulfil their potential as health care providers.

INTRODUCTION: Domestic violence in its myriad shapes and forms is a crime affecting every level of society. Gaining a true understanding of intimate partner violence (IPV) victimology allows for the meaningful provision of intervention services. AIM: To explore the prevalence of IPV disclosure during routine screening in a large general practice in provincial New Zealand. METHODS: Data were collected from 13 October 2008 to 30 June 2014 from 6827 individuals screened for IPV on 10 062 occasions and were analysed relative to age, ethnicity, gender, screening outcome, screener and health centre enrolled status. RESULTS: Analysis indicated an overall ever-positive disclosure rate of IPV of 11.1%, lower than New Zealand studies that place ever-positive prevalence as high as 78%. Maori women disclosed an ever-positive rate of 21.6%, Pacific women 13.2%, compared to 8.9% for NZ European/Other women. Casual patients positively disclosed in 13.7% of instances as opposed to enrolled patients in 10.5%. Disclosure of past abuse was made 1.3 times more often than that of a current abusive situation. Those aged between 16 and 65 years disclosed an ever-positive rate =10%. While nurses screened 5.5 times more patients than doctors, the doctors facilitated a higher percentage of positive disclosures than the nurses. DISCUSSION: Disclosure rates from a general practice setting do not mirror those of population studies or administrative datasets due to differences in samples and data collection methods. Routine annual screening is effective, with both doctors and nurses providing support for approximately equal numbers of patients in immediate danger. KEYWORDS: Disclosure; domestic violence; ethnic groups; general practice; women

The text analyzes the transformation of the accreditation/evaluation) of higher education from a policy of the Evaluative State, in the ´80s, to a global policy with different modalities. Based on the concepts developed by Susan Robertson and Roger Dale in relation to the multi-scalar governance of higher education, it is shown the existence of accreditation policies at different scales, as well as the participation of different institutions and actors (international, private and non profit). The impact of the General Agreement on Trade and Services (GATS) in higher education, and specifically in evaluation/accreditation, generated policies such as global accreditation and regional accreditations. Also new institutions as accreditation agencies, and new strategies as guidelines for accreditation appeared, which are presented and analyzed in the text. It derives from a research, based on bibliography, documentary analysis and interviews with experts in internationalization and evaluation of higher education.ResumoO texto analisa a transformação da acreditação/avaliação da educação superior de uma política do Estado Avaliador na década de 1980 para uma política global desdobrada em diversas modalidades. A partir de conceitos desenvolvidos por Susan Robertson e Roger Dale acerca da governança multiescalar da educação, será mostrada a existência de políticas de avaliação em diversas escalas, assim como a participação de diversas instituições e atores (internacionais, privados e do terceiro setor). Mostra-se que o impacto do Acordo Geral de Comercio e Serviços (GATS) na educação superior e, especificamente na avaliação/acreditação, gerou políticas tais como o acreditador global e as acreditações regionais; e instituições como as agências de acreditação nacionais e/ou regionais e as redes dessas agências, que elaboram diretrizes apresentadas e analisadas no texto. Este é produto de pesquisa baseada em bibliografia, análise documental e entrevistas com especialistas em internacionalização e avaliação da educação superior.ResumenEl texto analiza la transformación de la acreditación/evaluación de la educación superior de una política del Estado Evaluador, en la década de 1980, a una política global desdoblada en diversas modalidades. A partir de conceptos desarrollados por Susan Robertson y Roger Dale acerca de la gobernanza multiescalar de la educación superior, será mostrada la existencia de políticas de evaluación en diferentes escalas, así como la participación de diversas instituciones y actores (internacionales, privados y del tercer sector). Se afirma que el impacto del Acuerdo General de Comercio y Servicios (GATS) en la educación superior y, específicamente en la evaluación/acreditación, generó políticas tales como el acreditador global y las acreditaciones regionales e instituciones como las agencias de acreditación, las redes de agencias que elaboran directrices para acreditación que son presentadas y analizadas en el texto. 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The goal of this study was to review Maori oral health services utilising a kaupapa Maori framework. The aims of the study were to identify the issues in the development, implementation and operation of Maori dental health services within each of the three types of Maori health providers (mainstream, iwi-based, partnership). The three Maori oral health services are: (i) Te Whare Kaitiaki, University of Otago Dental School, Dunedin. (ii) Te atiawa Dental Service, New Plymouth. (iii) Tipu Ora Dental Service, in partnership with the School Dental Service, Lakeland Health, Rotorua. Method: A literature review of kaupapa Maori research was undertaken to provide the Maori framework under which this study was conducted. The kaupapa Maori methodology utilised the following criteria: (i) Rangatiratanga: The assertion of Maori leadership; (ii) Whakakotahitanga: A holistic approach incorporating Te Whare Tapa Wha; (iii) Whakapapa: The origins and development of oranga niho; (iv) Whakawhanuitanga: Recognising and catering for the diverse needs of Maori; (iv) Whanaungatanga: Culturally appropriate forms of relationship management; (v) Maramatanga: Raising Maori awareness, health promotion and education; and (vi) Whakapakiri: Recognising the need to the build capacity of Maori health providers. Ethical approval was granted by the Otago, Bay of Plenty and Taranaki Ethics Committees to undertake interviews and focus groups with Maori oral health providers in Dunedin, Rotorua and New Plymouth. Information was also sought from advisors and policy analysts within the Ministry of Health. A valuable source of information was hui korero (speeches and/or discussion at Maori conferences). An extensive literature was undertaken including an historical search of material from private archives and the now defunct Maori Health Commission. Results: An appropriate kaupapa Maori methodology was developed which provided a Maori framework to collate, describe, organise and present the information on Maori oral health. In te ao tawhito (the pre-European world of the Maori) there was very little if any dental decay. In te ao hou (the contemporary world of the Maori) Maori do not enjoy the same oral health status as non-Maori across all age groups. The reasons for this health disparity are multifactorial but include the social determinants of health, life style factors and the under-utilisation of health services. In order to address the disparities in Maori oral health, Maori providers have been very eager to establish kaupapa Maori oral health services. The barriers to the development, implementation, and operation of a kaupapa Maori oral health service are many and varied and include access to funding, and racism. Maori health providers have overcome the barriers through two strategies: firstly, the establishment of relationships within both the health sector and the Maori community; and secondly, through their passion and commitment to oranga niho mo te iwi Maori (oral health for all Maori). The outcome of this review will contribute to Maori health gain through the recognition of appropriate models and strategies which can be utilised for the future advancement of Maori oral health services, and hence to an improvement in Maori oral health status. Conclusion: This review of Maori oral health services has found that there are oral health disparities between Maori and non-Maori New Zealanders. In an effort to overcome these disparities Maori have sought to provide kaupapa Maori oral health services. Whilst there is a diversity in the provision of Maori oral health services, kaupapa Maori services have been developed that are appropriate, effective, accessible and affordable. They must have the opportunity to flourish.

Maori health development advanced with the Hui Taumata (1984) and with the emergence of by Maori for Maori health service delivery. Rapua te ora, by Maori for Maori health service delivery. Rapua te ora, by Maori for Maori health service delivery is an expression of tino rangatiratanga. The case study of budget holding presents a Maori analysis of contemporary health services delivery to meet the needs of Maori. Maori engage in research as dynamic participants who define their roles. Maori provide new analyses of health whilst adding to the diversity of views within health research, health services administration, and health services management. Nested case study method is used to prepare this thesis. Methods nested within the case study are a literature review; empowerment evaluation, information systems strategy, provider profile method, and structural analysis. Kaupapa Maori theory, which underpins the Maori centered research approach, is used to ensure the research objectives are relevant and meet needs of Maori. Budget holding is a mechanism for provider development, systematically linking national public health oblectives to local and regional needs. At different levels of development Maori providers, new to public health, require careful anf thoughtful administration, where necessary, thoughtful management. The benefits for administrating the provision of public health services for Maori are clear vertical accountability to the purchaser, clear local accountabilities, and provider development consistent with local Maori health needs. Conclusions drawn from this case study are that Maori provider development is a response to health reforms characterised by multiple transformations of health service funding. Provider development and meeting disparate accountabilities are important issues for sustainability and the development of Maori providers for public health, and are applicable to the wider community, both national and international.

New Zealand's mental health performance and monitoring framework is a complex and evolving one. Its initial development occurred at a time when it was taken for granted that mainstream understandings of health and mainstream systems of service delivery would not only be appropriate for all New Zealanders, but would also service the needs of all New Zealanders. Latterly however there has been an acknowledgment that a wholly different understanding of health and health care has existed in this country; the worldview understood and shared by tangata whenua. This thesis uses a theoretical framework devised specifically for this research to investigate the experience of Maori mental health providers as they contract to provide mental health services for the Crown; to ascertain whether Maori mental health providers deliver outside of their contracts; and to examine the role multiple accountabilities play in contracting. The theoretical framework, the "Maori research paradigm net" is inclusive of both the kaupapa Maori and Maori centred approaches, moving beyond the traditional dichotomy that frames Maori health research and allowing the researcher the freedom to select and use the best and most appropriate research tools from both traditional social science research practices, and from Maori culture and tikanga, to answer the research question posed. The thesis concludes that Maori mental health providers deliver mental health services at the interface between two philosophical viewpoints or worldviews: that of the Maori community in which they are located and to whom they provide services; and that of the funder, from whom they obtain resources to enable them to deliver services. As a consequence of working at the interface, Maori providers regularly and routinely work outside the scope of their contracts to deliver mental health services which are aligned with those values and norms enshrined in Maori culture. To adequately acknowledge and validate the beneficial extra-contractual provision which occurs as a result of delivering mental health services at the interface, and prevent less desirable provision, a more responsive contracting environment and a performance measurement framework, which integrates both worldviews and which takes account of the multiple accountabilities that Maori providers manage, is required.