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

WHAT CAN YOU DO?

As person & practitioner within consultation

As leader within your own health care team

As expert within health system

As citizen