Primary healthcare utilisation among adults with mood and anxiety disorders: an analysis of the New Zealand Health Survey

ABSTRACT INTRODUCTION In New Zealand, as in other OECD countries, there is a high and growing prevalence of mental health problems, particularly anxiety and depression. These conditions are associated with a range of physical illnesses, and as a result this population have high and often complex needs for healthcare services, particularly through primary care. AIM To use data from the New Zealand Health Survey (NZHS) to examine the associations between internalising disorders (including anxiety, depression and bipolar disorder) and measures related to the utilisation of primary healthcare services. METHODS The study was based on responses from 13,719 adults who took part in the 2015–16 NZHS. Logistic regression analyses adjusted for sociodemographic variables were undertaken to examine the effect of having an internalising disorder on each measure related to primary healthcare utilisation. The strength of associations was indicated by odds ratios (ORs). RESULTS Adults with an internalising disorder were more likely to utilise primary health services (OR = 1.43–2.56, P < 0.001) compared to adults without an internalising disorder. However, they were more likely to have unmet needs due to cost or transport (OR = 2.45–3.38, P < 0.001), unfilled prescriptions due to cost (OR = 3.03, P < 0.001) and less likely to report positive experiences with general practitioners (OR = 0.67–0.79, P < 0.01). DISCUSSION Adults with internalising disorders require a higher level of support from primary healthcare, yet experience more barriers to accessing these services, and report less positive experiences with general practitioners. The NZHS may be a useful source of routinely collected data for understanding, monitoring and improving primary health service utilisation among people with internalising disorders.

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Impact of COVID-19 pandemic on utilisation of healthcare services: a systematic review

BMJ Open ◽

10.1136/bmjopen-2020-045343 ◽

2021 ◽

Vol 11 (3) ◽

pp. e045343

Author(s):

Ray Moynihan ◽

Sharon Sanders ◽

Zoe A Michaleff ◽

Anna Mae Scott ◽

Justin Clark ◽

...

Keyword(s):

Systematic Review ◽

Primary Outcome ◽

Unmet Need ◽

Healthcare Utilisation ◽

Healthcare Services ◽

Risk Of Bias ◽

Secondary Outcome ◽

Severe Illness ◽

Service Utilisation ◽

Registration Number

ObjectivesTo determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic.DesignSystematic review.EligibilityEligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics and therapeutics. Studies were excluded if from single centres or studied only patients with COVID-19.Data sourcesPubMed, Embase, Cochrane COVID-19 Study Register and preprints were searched, without language restrictions, until 10 August, using detailed searches with key concepts including COVID-19, health services and impact.Data analysisRisk of bias was assessed by adapting the Risk of Bias in Non-randomised Studies of Interventions tool, and a Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures and narrative synthesis.Outcome measuresPrimary outcome was change in service utilisation between prepandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (eg, triage scores).Results3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services prepandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (IQR −51% to −20%), comprising median reductions for visits of 42% (−53% to −32%), admissions 28% (−40% to −17%), diagnostics 31% (−53% to −24%) and for therapeutics 30% (−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27 (45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no difference.ConclusionsHealthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health systems reduce unnecessary care in the postpandemic recovery.PROSPERO registration numberCRD42020203729.

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Family-centred interventions by primary healthcare services for Indigenous early childhood wellbeing in Australia, Canada, New Zealand and the United States: a systematic scoping review

BMC Pregnancy and Childbirth ◽

10.1186/s12884-017-1247-2 ◽

2017 ◽

Vol 17 (1) ◽

Cited By ~ 14

Author(s):

Janya McCalman ◽

Marion Heyeres ◽

Sandra Campbell ◽

Roxanne Bainbridge ◽

Catherine Chamberlain ◽

...

Keyword(s):

United States ◽

Early Childhood ◽

New Zealand ◽

Scoping Review ◽

Primary Healthcare ◽

Healthcare Services ◽

The United States

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Pandemic impacts on healthcare utilisation: a systematic review

10.1101/2020.10.26.20219352 ◽

2020 ◽

Author(s):

Ray Moynihan ◽

Sharon Sanders ◽

Zoe A Michaleff ◽

Anna Scott ◽

Justin Clark ◽

...

Keyword(s):

Systematic Review ◽

Health Systems ◽

Primary Outcome ◽

Healthcare Utilisation ◽

Healthcare Services ◽

Data Sources ◽

Secondary Outcome ◽

Severe Illness ◽

Service Utilisation ◽

List Type

AbstractObjectivesTo determine the extent and nature of changes in utilisation of healthcare services during COVID-19 pandemic.DesignSystematic reviewEligibilityEligible studies compared utilisation of services during COVID-19 pandemic to at least one comparable period in prior years. Services included visits, admissions, diagnostics, and therapeutics. Studies were excluded if from single-centres or studied only COVID-19 patients.Data sourcesPubMed, Embase, Cochrane COVID-19 Study Register, and pre-prints were searched, without language restrictions, until August 10, using detailed searches with key concepts including COVID-19, health services and impact.Data analysisRisk of bias was assessed by adapting ROBINS-I and Cochrane Effective Practice and Organization of Care tool. Results were analysed using descriptive statistics, graphical figures, and narrative synthesis.Outcome measuresPrimary outcome was change in service utilisation between pre-pandemic and pandemic periods. Secondary outcome was the change in proportions of users of healthcare services with milder or more severe illness (e.g. triage scores).Results3097 unique references were identified, and 81 studies across 20 countries included, reporting on >11 million services pre-pandemic and 6.9 million during pandemic. For the primary outcome, there were 143 estimates of changes, with a median 37% reduction in services overall (interquartile range −51% to −20%), comprising median reductions for visits of 42%(−53% to −32%), admissions, 28%(−40% to −17%), diagnostics, 31%(−53% to −24%), and for therapeutics, 30%(−57% to −19%). Among 35 studies reporting secondary outcomes, there were 60 estimates, with 27(45%) reporting larger reductions in utilisation among people with a milder spectrum of illness, and 33 (55%) reporting no change.ConclusionsHealthcare utilisation decreased by about a third during the pandemic, with considerable variation, and with greater reductions among people with less severe illness. While addressing unmet need remains a priority, studies of health impacts of reductions may help health-systems prioritise higher-value care in the post-pandemic recovery.Funding, Study registrationNo funding was required. PROSPERO: CRD42020203729Strengths and limitations of this study–The review is the first broad synthesis of global studies of pandemic related changes in utilisation across all categories of healthcare services.–The review provides novel findings informing design of future studies of pandemic-related changes in utilisation and its impacts.–Limitations include the possibility of publication bias and the potential of our eligibility criteria to exclude important data sources such as studies in single-centres and unpublished datasets from health systems.–Heterogenous designs and settings precluding meta-analysis.

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Provision and accessibility of primary healthcare services for people who are homeless: a qualitative study of patient perspectives in the UK

British Journal of General Practice ◽

10.3399/bjgp19x704633 ◽

2019 ◽

Vol 69 (685) ◽

pp. e526-e536 ◽

Cited By ~ 15

Author(s):

Ellie Gunner ◽

Sat Kartar Chandan ◽

Sarah Marwick ◽

Karen Saunders ◽

Sarah Burwood ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Qualitative Study ◽

Primary Healthcare ◽

Primary Care Providers ◽

Healthcare Services ◽

Negative Experiences ◽

Healthcare Centre ◽

Primary Health ◽

Primary Healthcare Centre

BackgroundAnecdotal reports of people who are homeless being denied access and facing negative experiences of primary health care have often emerged. However, there is a dearth of research exploring this population’s views and experiences of such services.AimTo explore the perspectives of individuals who are homeless on the provision and accessibility of primary healthcare services.Design and settingA qualitative study with individuals who are homeless recruited from three homeless shelters and a specialist primary healthcare centre for the homeless in the West Midlands, England.MethodSemi-structured interviews were audiorecorded, transcribed verbatim, and analysed using a thematic framework approach. The Theoretical Domains Framework (TDF) was used to map the identified barriers in framework analysis.ResultsA total of 22 people who were homeless were recruited. Although some participants described facing no barriers, accounts of being denied registration at general practices and being discharged from hospital onto the streets with no access or referral to primary care providers were described. Services offering support to those with substance misuse issues and mental health problems were deemed to be excluding those with the greatest need. A participant described committing crimes with the intention of going to prison to access health care. High satisfaction was expressed by participants about their experiences at the specialist primary healthcare centre for people who are homeless (SPHCPH).ConclusionParticipants perceived inequality in access, and mostly faced negative experiences, in their use of mainstream services. Changes are imperative to facilitate access to primary health care, improve patient experiences of mainstream services, and to share best practices identified by participants at the SPHCPH.

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Old-aged patients’ experiences with patient-centered primary health care in Serbia

European Journal of Public Health ◽

10.1093/eurpub/ckaa166.516 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

K Vojvodic ◽

G W Wolf

Keyword(s):

Health Care ◽

Primary Health Care ◽

Healthcare Services ◽

Patient Centeredness ◽

Patient Centered ◽

Aged Patients ◽

Cross Sectional ◽

Healthcare Needs ◽

Primary Health ◽

Positive Experiences

Abstract Objective The population in Serbia is getting older, with the population aged 65+ increasing from 17.2% to 19.6% (2007-2017). As people age, their health needs become more complex and health services must be adopted to their needs. Patient-centeredness is regarded as the basis for modern healthcare services. Patients' satisfaction surveys are widely used to identify experiences of patients, including old ones. The aim of this study was to assess old-patient centeredness of primary healthcare (PHC) in Serbia according to patients' experiences with healthcare workers. Methods Between 2009 and 2015 cross-sectional studies were conducted in 169 Serbian PHC centers (160.948 patients), thereby using a questionnaire referring to socio-demographic characteristics, preventive care counseling, experiences with general practitioners (GPs) (knowledge of patients' health status, listening, giving clear explanations concerning illness and medicines), nurses (friendliness and provision of information), co-payment for healthcare and the overall satisfaction with PHC. Non-parametric tests (Chi-square and Kruskal-Wallis) were used for statistical analyses. Results A large portion of the respondents asserted to be satisfied or very satisfied with the obtained PHC services, the majority had positive experiences with GPs and nurses. About one third (32.7%) of patients were 60 years or older. Significant differences concerning the number of positive experiences in contact with GPs and nurses were found between age groups. In both domains patients 60 years or older, had more positive experiences and were overall more satisfied with PHC services than younger (p < 0.001). Conclusions The results show that old aged patients have positive experiences with GPs and nurses in Serbian PHC. Primary health care meets their needs and can be regarded as patient-centered. The main limitation of the study was the lack of a questionnaire specific for old aged, which could better explore their needs and experiences. Key messages Patient-centeredness is regarded as the basis for modern healthcare services and doctors and nurses have leading role in providing patient-centered healthcare. Old aged patients have specific healthcare needs and health systems have big challenge in obtaining adequate health care with good health outcomes.

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The future shape of primary healthcare in New Zealand

Australian Health Review ◽

10.1071/ah000176a ◽

2000 ◽

Vol 23 (4) ◽

pp. 176

Author(s):

Philip Davies ◽

Mark Booth

Keyword(s):

Health Care ◽

Primary Health Care ◽

New Zealand ◽

Primary Healthcare ◽

Primary Health ◽

Discussion Document ◽

The Future

The Minister of Health in New Zealand earlier this year released a discussion document titled "The Future Shape ofPrimary Health Care" which outlines some far-reaching proposals for the provision of primary health care serviceswithin New Zealand. This article sets the discussion document in the context of primary health care within NewZealand by examining current arrangements for primary health care, previous arrangements and the proposalsoutlined in the discussion document.

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Geographical Accessibility of Community Health Assist Scheme General Practitioners for the Elderly Population in Singapore: A Case Study on the Elderly Living in Housing Development Board Flats

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph15091988 ◽

2018 ◽

Vol 15 (9) ◽

pp. 1988 ◽

Cited By ~ 3

Author(s):

Ong Deborah ◽

Marcus Chiu ◽

Kai Cao

Keyword(s):

Community Health ◽

General Practitioners ◽

Primary Healthcare ◽

Older Persons ◽

The Elderly ◽

Healthcare Services ◽

Housing Development ◽

Policy Makers ◽

Gis Technique ◽

Geographical Accessibility

Accessible primary healthcare is important to national healthcare in general and for older persons in particular, in societies where the population is ageing rapidly, as in Singapore. However, although much policy and research efforts have been put into this area, we hardly find any spatial perspective to assess the accessibility of these primary healthcare services. This paper analyzes the geographical accessibility of one major healthcare service in Singapore, namely, General Practitioners (GPs) services under the Community Health Assist Scheme (CHAS) for older persons. A Python script was developed to filter the website data of the Housing Development Board (HDB) of Singapore. The data derived was comprehensively analyzed by an Enhanced 2-Step Floating Catchment Area (E2SFCA) method based on a Gaussian distance-decay function and the GIS technique. This enabled the identification of areas with relatively weak geographical accessibility of CHAS-GPs. The findings are discussed along with suggestions for health practitioners, service planners and policy makers. Despite its initial nature, this study has demonstrated the value of innovative approaches in data collection and processing for the elderly-related studies, and contributed to the field of healthcare services optimization and possibly to other human services.

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