Is there equity of patient health outcomes across models of general practice in Aotearoa New Zealand? A national cross-sectional study.

Sheridan N; Love T; Kenealy T; Primary Care Models Study Group

Is there equity of patient health outcomes across models of general practice in Aotearoa New Zealand? A national cross-sectional study.

dc.citation.issue	1
dc.citation.volume	22
dc.contributor.author	Sheridan N
dc.contributor.author	Love T
dc.contributor.author	Kenealy T
dc.contributor.author	Primary Care Models Study Group
dc.coverage.spatial	England
dc.date.accessioned	2024-07-11T23:32:40Z
dc.date.available	2024-07-11T23:32:40Z
dc.date.issued	2023-05-04
dc.description.abstract	BACKGROUND: Primary care in Aotearoa New Zealand is largely delivered by general practices, heavily subsidised by government. Te Tiriti o Waitangi (1840) guarantees equal health outcomes for Māori and non-Māori, but differences are stark and longstanding. Seven models of primary care have evolved. We hypothesised that patient health outcomes would differ between models of care; and that Māori, Pacific peoples and those living in material deprivation would have poorer outcomes from primary care. METHODS: We conducted a cross-sectional study of patient-level data from national datasets and practices, at 30 September 2018, using multilevel mixed effects regression analyses (patients clustered within practices). Primary outcomes, considered to be measures of unmet need for primary care, were polypharmacy (≥ 65 years), HbA1c testing in adults with diabetes, childhood immunisations (6 months), ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Explanatory variables adjusted for patient and practice characteristics. Equity, by model of care, ethnicity and deprivation, was assumed if they showed no significant association with patient outcomes. Patient characteristics included: age, ethnicity, deprivation, multi-morbidity, first specialist assessments and practice continuity. Practice characteristics included: size, funding and doctor continuity. Clinical input (consultations and time with nurses and doctors) was considered a measure of practice response. RESULTS: The study included 924 general practices with 4,491,964 enrolled patients. Traditional practices enrolled 73% of the population, but, on average, the proportion of Māori, Pacific and people living with material deprivation was low in any one Traditional practice. Patients with high health needs disproportionately enrolled in Māori, Pacific and Trust/NGO practices. There were multiple associations between models of care and patient health outcomes in fully adjusted regressions. No one model of care out-performed others across all outcomes. Patients with higher health need received more clinical input but this was insufficient to achieve equity in all outcomes. Being a Māori or Pacific patient, or living in material deprivation, across models of care, remained associated with poorer outcomes. CONCLUSIONS: Model-level associations with poor patient outcomes suggest inequity in measures that might be used to target investment in primary care.
dc.description.confidential	false
dc.format.pagination	79-
dc.identifier.author-url	https://www.ncbi.nlm.nih.gov/pubmed/37143152
dc.identifier.citation	Sheridan N, Love T, Kenealy T, Primary Care Models Study Group . (2023). Is there equity of patient health outcomes across models of general practice in Aotearoa New Zealand? A national cross-sectional study.. Int J Equity Health. 22. 1. (pp. 79-).
dc.identifier.doi	10.1186/s12939-023-01893-8
dc.identifier.eissn	1475-9276
dc.identifier.elements-type	journal-article
dc.identifier.issn	1475-9276
dc.identifier.number	79
dc.identifier.pii	10.1186/s12939-023-01893-8
dc.identifier.uri	https://mro.massey.ac.nz/handle/10179/70158
dc.language	eng
dc.publisher	BioMed Central Ltd
dc.publisher.uri	https://equityhealthj.biomedcentral.com/articles/10.1186/s12939-023-01893-8
dc.relation.isPartOf	Int J Equity Health
dc.subject	Ambulatory sensitive hospitalisations
dc.subject	Deprivation
dc.subject	Emergency department attendance
dc.subject	Immunisations
dc.subject	Models of care
dc.subject	Māori
dc.subject	Pacific
dc.subject	Patient health outcomes
dc.subject	Polypharmacy
dc.subject	Primary care
dc.subject	Adult
dc.subject	Humans
dc.subject	Child
dc.subject	Cross-Sectional Studies
dc.subject	New Zealand
dc.subject	Ethnicity
dc.subject	General Practice
dc.subject	Outcome Assessment, Health Care
dc.title	Is there equity of patient health outcomes across models of general practice in Aotearoa New Zealand? A national cross-sectional study.
dc.type	Journal article
pubs.elements-id	461676
pubs.organisational-group	College of Health