Journal of Primary Health Care

What is already known: Within the ‘apprenticeship-like’ model of general practice training operating in many countries, the trainee’s in-consultation recourse to real-time supervisor assistance or advice is considered to be essential for both patient safety and trainee learning. Some trainees, however, may feel uncomfortable presenting their concerns or questions to the supervisor in the patient’s presence and/or believe that patient impressions of their competence will be adversely affected by calling on supervisory assistance. What this study adds: Contrary to predictions of utility-based models of behaviour, we found no association of trainees’ documented in-consultation help-seeking with either (i) their beliefs about the impact of help-seeking on patient impressions of their competence, or (ii) their levels of comfort/discomfort presenting within the patients’ hearing.

What is already known: In-practice learning is central to GP registrars developing competencies within the apprenticeship-style model of GP training. Feedback followed by reflection is important for GP registrars’ in-practice learning. Patient encounter tools can provide clear in-practice feedback to registrars, yet little published evidence is available to support the use of such tools within general practice training. What this study adds: This study demonstrates that patient encounter tools, such as ReCEnT, can be useful for registrars’ self-reflection on their clinical practice and can lead to changes in practice and learning approaches. The relative lack of engagement between numerous registrars and their supervisors or MEs on ReCEnT feedback reports indicates a missed opportunity for supported reflection and suggests more work is needed on effective engagement for ReCEnT to be used as an assessment for learning in general practice training.

What is already known: There is a recognised shortage of dermatologists in New Zealand, thus innovative strategies are required to improve access to specialist care. Collaborative services between specialists and general practitioners already exist, but have not been widely utilised in the field of dermatology. What this study adds: This collaborative dermatologist and general practitioner clinic model is the only one of its kind in New Zealand. It acts as an effective triage service, as the majority of presenting patients do not require further referral to secondary care.

What is already known: Limited evidence suggests there are barriers to accessing psychostimulants for those with ADHD. This leaves many without the option to access and use the most effective medications. What this study adds: This research indicates that the use of psychostimulants is low. Although some fraction of the treatment gap might be explainable by other reasons, barriers to access remains significant.

What is known about the topic: There has been a general expectation internationally that GPs are to play a central role in the collection of family health history as part of precision medicine. However, for more than 20 years it has remained widely reported as being both poorly and infrequently undertaken. What this study adds: Family health history information was used to varying degrees – risk ascertainment, patient engagement with a diagnosis, social context and building relationships. Perceived low quality (unreliability) of family health history information and accessibility issues are potential indicators of current limits of family health history, especially as a part of precision medicine. An opportunity exists to establish specific roles to enable socio-culturally appropriate collection, storage and use of family health history information.

What is already known: In Australia’s apprenticeship-style model of GP training, in-practice learning and experience for GP registrars is central to the development of their confidence and clinical competencies. The Registrar Clinical Encounters in Training (ReCEnT) project is a patient encounter tracking and learning tool (PETAL) that has been shown to provide opportunities for GP registrars along with their supervisors and medical educators (MEs) to reflect on registrars’ clinical practice and identify their learning needs, leading to change in practice. There is limited qualitative literature on how registrars, supervisors and MEs describe the utility of workplace-based assessment tools such as PETALs, particularly within proposed programmatic assessment frameworks. What this study adds: This study builds on previous survey findings, providing greater depth of understanding from the perspective of GP registrars, supervisors and MEs regarding how ReCEnT can be useful as an educational and reflective PETAL tool for GP registrars during their training. Meaningful engagement between GP registrars and their supervisors and MEs enables ReCEnT to be more effective as a tool for learning in general practice training. More work needs to be done on how PETALs, such as ReCEnT, best fit within a programmatic assessment framework for general practice training.

What is already known: Diabetes-related foot problems affect around one-third of people with diabetes in New Zealand. Early identification of the at-risk patient is crucial in the prevention of diabetic foot ulcers. Annual diabetes reviews (ADRs) delivered by general practice teams that include a comprehensive foot evaluation and risk categorisation are recommended by local and international guidelines.

What this study adds: People with type 2 diabetes identified important barriers to attending ADRs several of which are amenable to change. Participants provided suggestions on how to improve the delivery of the ADR in primary care, including the utilisation of Māori tailored models of care such as the Te Whare Tapa Whā model and Māori support workers.

What is already known?: Diagnosis of type 2 diabetes is a challenging time, where healthcare professionals must consider health literacy, previous medical history, whānau, finances, and psychosocial factors. Current research states the treatment in primary care is suboptimal, compounded by clinical inertia, and that appointment times of 15 min are typically not long enough for sufficient diagnosis and treatment. What this study adds: The current system of educating and supporting patients in primary care is viewed by patients as unsuitable in terms of appointment times, education, and communication. Graphic, conversational, or imagery-based education methods are preferred to pamphlets, and written sources of information that are tailored to the individual are needed, and must reflect cultural context. More support is required in terms of healthcare practitioners’ relationships and culturally safe and compassionate patient care.

What is already known: Cancer screening programs (cervical, breast, and bowel) participation is generally low, especially in regional and rural areas in Queensland, Australia. What this study adds: This scoping review provides a suggested approach to understanding the known determinants of cancer screening participation to help influence the uptake among target populations.

What is known about the topic: This rapid review offers an evidence‐based synthesis of the existing literature concerning the evolving role of nurse prescribers. What this study adds: It provides valuable insights for the primary care interprofessional team, underscoring the potential of nurse prescribing as a solution to enhance diabetes care.

What is already known: Keratinocytic cancers are increasing worldwide. Teledermatology is a valuable tool for communication between general practitioners, dermatologists, and plastic surgeons. What this study adds: It describes the teledermatology diagnosis of 358 suspected keratinocytic cancers after e-referral, and pathways to excision by general practitioners, dermatologists, and plastic surgeons.

What is already known: Primary healthcare teams are well positioned to promote and protect patients’ oral health, and it is likely that more people at risk of oral disease or needing oral health care will present at primary healthcare practices. Primary healthcare teams need to have sufficient knowledge and confidence to address patients’ oral health complaints. What this study adds: Doctors and nurses appear open to incorporating oral health in their day-to-day practice. Integrating oral health in primary health care in Aotearoa New Zealand will require changes at the individual, professional and systems levels.

What is known about the topic: Mental health challenges pose a significant public health risk. There is a need to build workforce capacity to address the mental health needs of children and youth in order to promote positive outcomes in later life. What this study adds: All sectors must take responsibility for promoting mental health in children and youth. This participatory action research study presents communities of practice as providing a sustainable mechanism by which international evidence can be received, transformed and translated into practice.

What is already known: The COVID-19 pandemic and its sequelae served to reduce access to health care providers, exacerbated unmet preventive and diagnostic health needs and made online health information even more important for consumers to make decisions about self- and family-care. What this study adds: This survey asked an ethnically diverse group of patients attending cardiology outpatients what format of information was most valued and strategies they use to trust the information they find. Simple fact sheets were the most preferred online format followed by videos and discussion groups with the best ‘life-hack’ being to get their health professional’s advice on the most trusted website for their condition.

What is already known: Some patients with mild traumatic brain injury (mTBI) can experience persistent symptoms for many years if not treated early. Early access to specialist services such as concussion services can significantly improve patient recovery. What this study adds: This study provides initial evidence that a supported health care pathway following mTBI is feasible to implement in primary care and can facilitate early access to concussion services for those who need it.

Disparities between rural and urban COVID-19 vaccination coverage both in NZ and globally have been demonstrated. New Zealand rural health provider perspectives of the COVID-19 vaccination rollout provide insight into factors contributing to the urban–rural COVID-19 vaccination disparity. Findings emphasise the relevance of context in delivering health initiatives rurally, which should be geographically tailored, culturally anchored and locally driven.

What is already known: There is a shift towards general practitioners (GPs) prescribing gender-affirming hormone therapy (GAHT) in primary care settings using an informed consent model of care. There is a lack of long-term data on health and wellbeing outcomes for people taking GAHT in Aotearoa New Zealand. What this study adds: The insights from this study offer a blueprint for current and future survey design, to ensure data collection is responsive to the needs of transgender and non-binary (TNB) communities and health care providers. These findings will inform future research to equip health care professionals involved in prescribing GAHT with local, evidence-based data to support their delivery of quality health care to TNB people.

What is already known: The use of psychotropic medications in Australia has increased over the last two decades, with general practitioners being the primary prescribers. The COVID-19 pandemic exacerbated mental health issues in adults and the older population, leading to increased concerns about mental health and wellbeing. What this study adds: This study estimates prescribing rates of psychotropic medication by patient demographics and found higher rates of prescribing among females, older people, and those with low to moderate SES. There was a consistent increase in prescribing rates between 2018 and 2022, particularly during the COVID-19 pandemic.

What is already known: Aotearoa New Zealand prioritises the pursuit of health care equity as a central objective. The existence of patient co-payments in primary care poses obstacles to achieving this goal. To address these challenges, the government has implemented various schemes aimed at alleviating them. What this study adds: The sociodemographic characteristics of people in the areas where general practices are located are related to the amount charged for an appointment with a general practitioner. The strongest relationships are seen across ethnicity and socioeconomic deprivation levels with lower fees being associated with higher proportions of Māori and Pacific peoples in that area and among people who are more socioeconomically deprived. The Very-Low-Cost-Access scheme appears to reduce these associations indicating that general practices operating under the scheme appear to reach groups with greater need.

What is already known: Community-based primary care physiotherapy is provided in Aotearoa New Zealand through a private practice, fee-for-service model. The impact of this model on patient care, physiotherapists, and professional behaviour is unknown. What this study adds: This exploratory study suggests that competition can dominate communication and collaboration in private practice physiotherapy. Competitive business models and an aversion to scrutiny may reduce collegial interaction and professional behaviour.

What is already known: Community-based attachments (CBAs) are mandatory in NZ for junior doctors in their first 2 years of study. Some research indicates that CBAs are a positive experience for the practice and the junior doctors. What this study adds: An estimated average cost for hosting PGY2s in general practice was $NZ4907 (range $890–$9183) per placement before consideration of space costs, over and above current funding provided by Health New Zealand |Te Whatu Ora (TWO) Health Workforce Directorate. The small business model of general practice is in tension with providing a positive experience for the PGY2s in a new learning environment, and better communication and cooperation between practices and TWO employing hospitals are needed.

What is already known: Limited international research with Pacific Island communities has examined ear disease and hearing health knowledge and beliefs to inform health service delivery. What this study adds: This study is the first mixed-methods investigation using a Pacific methodological approach to examine Pacific peoples’ ear and hearing health worldviews, including knowledge, beliefs, and experiences of the hearing healthcare system in Aotearoa New Zealand. It will assist healthcare professionals in providing more responsive ear and hearing care services for Pacific peoples.

What is already known: While there is extensive global documentation on the sociodemographic attributes of yoga instructors and users, along with their motivations for engaging in yoga, the specifics of yoga instructors and users in New Zealand remain relatively unexplored. What this study adds: This study aims to fill this gap by investigating the distinctive traits and backgrounds of yoga instructors and users in New Zealand. Additionally, the study examines the rationale behind yoga use, the factors that shape participant involvement, participantr methods of seeking information, and how participants communicate with healthcare providers. The insights garnered from this research aim to provide valuable information to the healthcare sector in New Zealand.

What is already known: Screening sexually active young people for asymptomatic chlamydia and gonorrhoea is important to detect infection, prevent transmission and reduce reproductive health risks. Free online postal self-sampling for sexually transmitted infection (STI) testing is an acceptable alternative to clinic-based testing in some countries, but accessibility and acceptability of online testing in Aotearoa New Zealand is unknown. What this study adds: Opinions about online STI testing among Māori and Pacific young people were mixed, but more concerns than potential advantages were identified. Equity in access to online STI testing by Māori and Pacific young people could be improved by reducing cost, improving awareness about STI testing, and addressing barriers identified in the online testing pathway.

What’s already known: Sexual orientation and gender identity (SOGI) minority populations face known and preventable health inequities. However, SOGI data are not collected in routine data collection such as administrative health data, and there are limited studies exploring whether these populations are comfortable with having their data stored in these datasets. What does this study add: The research offers estimates of comfort with having sexual identity data recorded in official datasets among the GBM population of NZ, contributing to a larger body of research that primarily focusses on disclosure in health care settings.

What is already known: In various countries, health care providers aim to diversify the health workforce by introducing new clinical roles such as physician associates/assistants (PAs) to tackle ongoing workforce shortages. Numerous studies highlight PAs as cost-effective contributors who enhance access to safe and effective care. Despite these benefits, the integration of PAs into health care systems has encountered considerable scrutiny from both the public and medical professionals. What this study adds: The Ministry of Health has recently proposed the regulation of the PA profession, allowing foreign-trained PAs to take on clinical responsibilities in both primary and secondary care settings. This article examines the feasibility and implications of introducing PAs into New Zealand’s primary care sector, particularly within the context of general practice.