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PACIFIC PEOPLES’USE OF PRIMARY CARE
Timothy Kenealy, Debbie Ryan,
Margaret Southwick
RNZCGP Conference September 2011
Pacific Perspectives, University of Auckland, Whitireia Polytechnic
2 DOMAINS
A health services view Health service trends over 10 years Beliefs and responses
A Pacific view Pacific peoples’ perceptions and
understandings of health, illness and primary health care systems
Pacific Perspectives, University of Auckland, Whitireia Polytechnic
FEATURES OF PACIFIC POPULATION Young Rapid growth Social networking Transnational mobility All Pacific are not the same Income, employment, education,
housing Least gain
Pacific Perspectives, University of Auckland, Whitireia Polytechnic
HOW ARE WE DOING? 1 Life - 8 years less than European
least gain mortality amenable to health services Higher ASH
2.5x European 2008/9 close contact infectious diseases, child respiratory & skin
infections Higher severe asthma symptoms
Lower diagnosed asthma and use of preventer medications
Higher mental illness poor uptake of mental health services
Higher rates of diabetes, mortality and complications Higher rates of stroke and stroke mortality
greater dependence after stroke Higher cancer mortality once diagnosed Higher risk factors weight, smoking
Pacific Perspectives, University of Auckland, Whitireia Polytechnic
HOW ARE WE DOING? 2
Similar rates of primary care use since higher subsidies But presume needs higher Higher use of A&M clinics & ED Lower levels of satisfaction with their
experiences of primary health care Higher self reported unmet needs due to cost
Higher screening for diabetes and CVD bp 56% v 50% Diabetes 30% v 17 (MoH & MPIA, 2004)
Immunisation up to 93% at 2 years
Pacific Perspectives, University of Auckland, Whitireia Polytechnic
Barriers ResponsesCost• transport
Capitation & increased subsidiesPOACOutreach
Language & culture• family commitments• understanding the
nature/necessity of an appointment• lack of time with doctor• bringing and minding of other children
Cultural competencePacific providersCommunity health workersTranslators
Systemsappointment timesinflexible employmentlong waiting times
Appointment systemsChronic Care ManagementCare Plus
WHAT (PROBABLY) WORKS? 1
culturally appropriate health education language-specific resources involving family members Pacific health providers integrated services, “one-stop shop” church-based delivery mobile / outreach services transport workplace-based healthcare
Pacific Perspectives, University of Auckland, Whitireia Polytechnic
WHAT (PROBABLY) WORKS? 2
school-based nursing opportunistic services, eg imms in
hospital flexible appointments nurse-led programme provider – community collaboration recording and tracking systems monitoring of outcomes
Pacific Perspectives, University of Auckland, Whitireia Polytechnic
WHAT (PROBABLY) WORKS? 3
systematic care (Kenealy et al, 2010) extended consultations (Kenealy et al,
2010) involving family, primary-secondary
integration, involving extended team, home visits, case management (Rea et al, 2009, 2010a, 2010b, Sheridan et al, 2009)
Practitioner community participation (Buetow et al 2010)
Pacific Perspectives, University of Auckland, Whitireia Polytechnic
DOMAIN 2 PACIFIC PERSPECTIVES
Diverse Pacific ethnic groups Differences in language,
religion, community organisation Emerging differences in
measures of health and service use between Pacific groups
Identities are fluid, multiple and contested
A PACIFIC VIEW
This presents challenges not only for this research, but also for health care providers who want simple remedies for complex Pacific health issues.
QUALITATIVE RESEARCH APPROACH
Narrative methodology
Language and translation
“sufiga o le tuaoi” – negotiating boundaries
Project outcomes – consciousness raising, discourse, capability development
Pacific Perspectives, University of Auckland, Whitireia Polytechnic