Journal of Primary Health Care

What is already known: Degenerative cervical myelopathy (DCM) is the leading cause of adult spinal cord dysfunction, with average diagnostic delays of 2.5 years often resulting in irreversible neurological impairment. Primary care clinicians are well positioned to identify DCM early, yet international research suggests that condition awareness is lacking. What this study adds: This study is the first to assess DCM awareness and diagnostic confidence among primary care clinicians in Aotearoa New Zealand, revealing critical knowledge gaps. The findings highlight the need for targeted education and standardised referral criteria to facilitate timely detection and surgical consultation.

What is already known: Although telerehabilitation offers the potential to improve access to rehabilitation for people with mild traumatic brain injury (mTBI) and reduce health disparities, the services must be tailored to meet the specific needs of this population. What this study adds: This study provides information about the aspects of rehabilitation that are most valued by patients and how telerehabilitation services can be designed to best meet the specific needs of this population in Aotearoa New Zealand. Considering the travel time, cost and familiarity with their therapist, the results suggest that long telerehabilitation sessions would be the most valued option.

What is already known: Low back pain (LBP) guidelines often restrict recommendations for imaging to cases presenting with specific ‘red flags’. Imaging of non-specific LBP (NSLBP) is associated with high economic cost and no prognostic benefit, but imaging continues to be over-utilised in the diagnostic evaluation of LBP in general practice. What this study adds: Although Australian GP registrars appear to be taking a considered approach to imaging for NSLBP, the prevalence of imaging likely exceeds optimal levels, at significant cost and potentially poorer patient outcomes.

What is known about the topic: Routinely collected administrative and health data have potential to be used for research that provides real-world health insights that can inform policy and improve clinical practice and population health. Engaging stakeholders to establish priorities can help ensure research is fit for purpose, provides important health benefits, and has the greatest potential to improve health equity. What this study adds: Primary care clinicians and academics identified the top research areas to improve health equity in primary care as the health workforce, health services, mental health, and models of primary health care. The top research questions include evaluating the impacts of annual health checks for people with intellectual disability, the role of allied health as front-line primary health care providers, and the role of an embedded social worker in a general practice clinic setting.

What is already known: Consultation with key stakeholders is important to inform health research. Including health users from populations with significant health needs is necessary to ensure health research addresses health inequities. What this study adds: This study provides themes from a health user perspective to support future research in the primary health service area to improve and optimise health and wellbeing and reduce health inequities.

What is already known: We had co-designed a framework for management of concussion in Aotearoa New Zealand secondary schools with school stakeholders and students with concussion and their parents. What this study adds: Participants from national, regional, and local sports, education, and healthcare organisations suggested that the framework would be of high value to address inconsistent implementation of post-concussion student support, and provided recommendations for wider implementation.

What is known about this topic: There is a current paucity of research in emergency simulation training in primary care. Although there is literature on the use that emergency simulation education has in secondary care services such as emergency medicine (EM) or for intensive care unit (ICU) staff, it is not well established or validated in primary care. What this study adds: To the best of the author's knowledge, this is the first literature review of studies that evaluate the use of emergency care simulations for primary care clinicians. The findings from this review can help inform and guide the appropriate education and training of primary care clinicians.

The Southern Primary Care Research Network (PCRN) is a regional research database that facilitates access to primary care data for research that improves health and health equity. This article describes the Southern PCRNs governance and infrastructure development and research undertaken so far. Three data linkage projects, a scoping review, research prioritisation exercises, and the development of an ethical framework for data use are described. Ongoing network funding will help realise the potential of routinely collected health data to inform equitable service delivery, policy, and innovation in population health.

What is known about the topic: Falls among community-dwelling older adults are a significant public health concern. Previous research has highlighted the importance of strength and balance exercises and falls prevention education in reducing fall incidence among older adults. What this study adds: This study shows the potential for student-run interventions in contributing to falls prevention efforts and improving the wellbeing of aging populations.

What is already known: Knee pain is a common reason to consult a general practitioner (GP), but accurate diagnosis poses a challenge for GPs. To support GPs with this diagnostic dilemma in patients with knee pain, a prediction model could be a useful diagnostic decision support tool, however, this has not yet been developed. What this study adds: In patients with knee pain, for whom GPs experience diagnostic challenges, osteoarthritis is by far the most prevalent diagnosis, followed by patellofemoral pain and meniscal lesions. An age threshold of roughly 50 years is a strong predictor for knee osteoarthritis, patellofemoral pain, and meniscal lesions.

What is known about the topic: Individuals who hazardously consume alcohol may also present with nutritional problems such as weight loss, underweight, malnutrition, micronutrient deficiency and/or low food security. Previous research has shown limited input from the dietitian during admission to hospital for alcohol withdrawal. What this study adds: Healthcare professionals working within Primary Health Networks have variable confidence providing nutrition-related care to patients discharged from hospital post alcohol withdrawal, indicating a gap in nutrition-related service provision. These insights support the need for best practice guidelines for nutritional management in this population to enhance the role of dietitians within the multidisciplinary team.

What is already known: The Abortion Legislation Act 2020 removed legal barriers to abortion in Aotearoa New Zealand (NZ). However abortion services have not yet evolved to provide care within the full extent of the law. What this study adds: Multiple barriers to provision of optimal first trimester abortion care exists in NZ. Solutions include workforce development and addressing abortion stigma.

What we already know: Paracetamol is the most widely used prescription and over-the-counter drug in the world but has a higher potential for clinically significant toxicity than other common non-opioid analgesics. International research suggests that the public tends to have inadequate knowledge of paracetamol and its safety; however, this information is missing in Aotearoa New Zealand (NZ), where paracetamol is readily available. What this study adds: There appears to be a substantial knowledge gap regarding the safe use of paracetamol in NZ, including the ability to recognise paracetamol-containing formulations. The NZ public reports a high level of unintentional misuse, including taking more than the recommended dose, not waiting long enough between doses, and exceeding the recommended dosage in 24 hours. There appears to be moderate public support for introducing policies around the supply and sale of paracetamol in NZ.

What is already known: Physical activity has a well-established role in diabetes primary care management. What this study adds: This research describes physical activity practices and glycaemic control in Fiji’s diabetic population, and identifies systemic gaps in guideline implementation and adherence while proposing future research and policy directions to improve diabetes care in Fiji.

What is already known about the topic: Prefilled syringes of bolus-dose, single medications for anticipatory subcutaneous administration are prepared for patients receiving palliative care by certain community pharmacies in Aotearoa New Zealand. Current guidelines for the prefilled syringes recommend an expiry of 3 days if they are stored in refrigerated conditions. There are significant financial and environmental costs if these syringes are discarded unused. What this study adds: The medications compounded for bolus-dose administration by eight pharmacies in a 180-day period were in line with international guidelines for the anticipatory needs of patients receiving palliative care. ‘Published guidance’ was the most common source of the assigned expiry, but there was uncertainty about the sterility and stability of the compounded syringes. There is a need for improved funding for the service and enhanced communication with prescribers and palliative care staff about what is involved from the pharmacy’s perspective.

What is already known: The use of AI scribes in primary care consultations raises significant and complex clinical, ethical, medicolegal, and data governance issues. Perceived benefits (eg reducing administrative burden, enhancing efficiency, and improved patient care) have driven rapid front-line uptake of these tools in New Zealand (NZ) while national regulations and guidelines are still being developed. What this study adds: The key advantages of AI scribes noted by NZ primary care practitioners surveyed in 2024 were: reducing multi-tasking, time savings, reduction in cognitive load, and improved rapport with patients. Key concerns were: compliance with NZ legal and ethical frameworks, security of patient data, errors or omissions in clinical notes, and the risk of patient data leaving NZ.

What is already known: Rural interprofessional education programmes are challenging to establish yet provide rich learning for students about interprofessional collaborative practice. They are thought to be effective in encouraging students to work in rural practice as graduates. What this study adds: Rural interprofessional education programmes take time to establish, tailor to the local community, and bed down. Conditions for success include being embraced by the local community and having local programme staff who are responsive and work well with local clinical staff, community stakeholders, and students.

What is already known: Comprehensiveness in primary care is crucial for managing most medical needs in a population while integrating the patient’s context. What this study adds: This study provides a menu of validated options for communities and health systems to appropriately implement, measure, and capture comprehensiveness in primary care.

What is already known: Māori populations experience significant diabetes outcome disparities because of the systemic inequities resulting from colonisation, racism and limited access to culturally appropriate care. This necessitates culturally responsive diabetes care tailored to the needs of Māori populations. What this study adds: This study offers a comprehensive clinician-centred view of culturally responsive care for patients with type 2 diabetes. It focuses on the clinician’s role in seamlessly integrating whānau participation and collaborative practice within Māori communities. The research highlights thoughtful approaches that clinicians utilise to bridge cultural gaps to improve health outcomes. It also introduces and conceptualises the ‘Ascending the Poutama’ framework as a novel, culturally grounded model for understanding and optimal diabetes care.

What is already known: Primary care has been recognised as a key setting to address maternal health disparities by identifying and managing clinical and social risks during early pregnancy. What this study adds: This quality improvement reports implementation of the Best Start early pregnancy assessment model in primary care, highlighting the importance of integrating clinical systems and wrap-around services.

What is already known: Many women experience genitourinary symptoms of menopause and use low-dose vaginal oestrogen to manage symptoms. This treatment is only available with a prescription in New Zealand, but in other countries it can be supplied over-the-counter following consultation with a pharmacist. What this study adds: Pharmacists in New Zealand would like to be able to provide their patients with low-dose vaginal oestrogen to manage genitourinary symptoms of menopause. Pharmacists believe that being able to offer low-dose vaginal oestrogen is within their scope of practice and would improve medicine access for women in the community.

What is already known: Many people with migraine, even chronic and disabling migraine, do not seek or receive effective treatment from primary care. What this study adds: Primary care clinicians have the resources and knowledge to effectively manage most people with migraine, but cost, availability of appointments and waiting times create barriers to help-seeking and management. Reliable and equitable access to specialist advice is also needed to support clinicians and patients with more complex or difficult to treat migraine.

What is already known: The relationship between the determinants of health and health outcomes is well-researched both nationally and internationally, but the determinants of health are not adequately acknowledged in health system design and delivery in Aotearoa New Zealand. Solutions that mitigate the negative impact of poor access to the determinants of health are often not concurrently explored. What this study adds: This paper provides details on the significance of the determinants of health for Māori living with chronic disease, and how determinants shape the everyday experience and management of chronic disease. Evidence is provided about how determinants can be addressed at patient, whānau (family) and systems levels.

What is already known: Māori and Pacific peoples in Aotearoa New Zealand have lower participation rates in the National Bowel Screening Programme, even though the programme is proven to save lives by finding bowel cancer early. Research shows that trusted conversations with general practitioners and other primary care providers can help increase screening. Special tools used in general practice computer systems can prompt these conversations and make it easy for doctors and nurses to request screening kits for patients. What this study adds: This study shows that planned campaigns run through general practices can lead to more people asking for bowel screening kits, especially among Māori and Pacific patients. Over two years, there was a 134% increase in kit requests. However, it also found that many people who request a kit do not return it. This highlights the need for extra support and follow-up to help people complete the screening process.

What is already known: Cefalexin is a broad-spectrum, first-generation cephalosporin that is typically reserved as a second-line or alternative agent for common soft tissue, respiratory, and urinary tract infections, with dosing 2–4 times daily for a duration generally ranging from 3 to 10 days, depending on the indication. Over the past decade, cefalexin dispensing has increased substantially in community and general practice settings in Aotearoa New Zealand (NZ). Although the overuse and misuse of any antibiotic can contribute to antimicrobial resistance, inappropriate use of broad-spectrum agents is particularly associated with the emergence of drug-resistant pathogens. However, data evaluating the indications for, and clinical appropriateness of, cefalexin prescribing remain limited. What this study adds: This study presents the first focused evaluation of cefalexin prescribing appropriateness and guideline compliance in general practice in NZ. It highlights specific areas for targeted antimicrobial stewardship interventions and lays the foundation for future research and broader stewardship initiatives.

What is already known. Primary care professionals have a critical role in the early detection of cancer, including enabling timely investigations by secondary diagnostic services. Lung cancer survival is substantially worse for Māori than non-Māori in Aotearoa New Zealand (NZ), with Māori being more likely to have their lung cancer diagnosed following an emergency presentation and facing barriers in accessing secondary diagnostic services. What this study adds. Key informants from the lung cancer sector agree that intervening to address the disparities in lung cancer survival in NZ is possible. This study argues for system-level resourcing and change, especially at the primary healthcare level, which will need high-quality leadership and political buy-in to drive change.

What is already known: The Primary Health Care Strategy and subsequent government health policy have aimed to improve access to and expand the role of nurses in primary health care. Utilising nurse expertise had been identified as a potential solution to ease GP workloads. It remains unclear the degree to which this has occurred. What this study adds: This research contributes an up-to-date analysis of trends in primary healthcare consultation rates by practitioner type at a national level, across a 16-year study period that includes those years when the COVID-19 pandemic was at its height.

What is already known: This scoping review explores and synthesises strategies for enhancing research capacity among family physicians in primary care (PC), identifying approaches that can facilitate their involvement in research. The review highlights five key strategic approaches – Training and mentoring programmes, Networking, Development of strategic models (blueprints), Strategic communication interventions, and Knowledge transfer and exchange – which can strengthen research engagement and improve the integration of research into clinical practice. What this study adds: Implementing multifaceted capacity-building strategies can foster a stronger research culture in PC, ultimately leading to improved evidence-based care. Future research should focus on assessing these strategies’ adaptability and long-term impact across different healthcare settings.

What is already known: There is some existing historical information about Pacific health providers receiving Pacific Provider Development Funding and the issues they face, but no recent or comprehensive analysis. What this study adds: This study provides an in-depth analysis of the work of Pacific health providers in 2023–2024, including a first-ever categorisation of these providers, the services they provide, and the locations they provide services from. It also provides information on finances and growth over time.

Psychological distress in Aotearoa New Zealand has risen sharply from 2011 to 2023, especially among young women, Māori, Pacific peoples, and those living in poverty. Primary care services are under strain, facing growing mental health needs while grappling with workforce shortages and funding challenges. The study highlights an urgent need for investment in culturally responsive, integrated, and accessible mental health support across New Zealand communities.

What is known about the topic: Improved health outcomes for patients are achieved when consideration of spiritual and social domains are included with the physical and mental in a medical care model. Understanding health as the capacity to adapt and self-manage requires a high level of patient self-efficacy. What this study adds: This report proposes a strategy for implementation in general practice and primary care settings that addresses the four domains of wellbeing and promotes self-efficacy and patient activation. Measures of health outcomes, both quantitative and qualitative, demonstrate the effectiveness of this strategy.

What is known about the topic: Variations in context are thought to drive the variable outcomes from quality improvement in health care. Despite the importance of primary care to the health system, research into primary contextual factors and tools to understand and measure factors in primary care are rare. What this study adds: This research evaluates the use of MUSIQ in primary care and provides direction for improving its applicability in this area. Duplicated levels have been removed and specific primary care factors added to improve applicability, particularly for small to medium-sized general practice settings. The primary care adaptation of MUSIQ can be used to assess the primary care context surrounding quality improvement efforts and guide action to improve the likelihood of success.

What is already known: Weight stigma and lack of size inclusion are widespread in healthcare systems and society. People with high body mass index were prioritised for COVID-19 vaccinations and a long needle was recommended for this population group. What this study adds: Despite prioritisation, findings from people with high body mass included in this study show that this population group was not routinely factored into the design or implementation of vaccination centres that could accommodate their needs. This included lack of suitable seating, barriers to physical access within vaccination centres, and inconsistency in the use of long needles for vaccinations. The findings of this study should inform strategies to enhance inclusivity and equity for future population health programmes.

What is already known: Type 2 diabetes management in primary care in New Zealand could be improved. International research has shown that upskilling healthcare professionals involved in diabetes management can positively influence health outcomes and patient engagement. What this study adds: The study provides insights into the usefulness of mentoring programmes for nurses in New Zealand and supports future initiatives for the continuous professional development of health professionals in primary care settings within the scope of type 2 diabetes management.

What is already known: Inequities related to long-term conditions for Pacific people in Aotearoa New Zealand have been reported over several decades. Evidence suggests that when models of care reflect diverse understandings of health, it has benefits for people living with long-term conditions and their families that can help reduce longstanding health disparities. What this study adds: Health research about Pacific people that offers insight to holistic understandings of health and wellbeing, highlights the potential of family-centred long-term condition models of care designed to look beyond the treatment of single conditions.

What is already known: Child abuse is highly prevalent in NZ. Primary health care (PHC) nurses work across a variety of settings, and are therefore more likely than other health professionals to encounter children whom they suspect are at risk. Recognising suspected abuse and the decision making on reporting is challenging, particularly amidst the ethical, moral, and legal complexities. What this study adds: The relationships PHC nurses in NZ develop with children and their families when they are suspicious of child abuse or neglect, mean they are well placed to lead best practice development on how best to support those with whom they work.

What is known about the topic: Palliative care significantly enhances the quality of life for advanced-stage cancer patients by addressing their comprehensive needs. The Chinese ethnic population faces substantial barriers in Australia to accessing palliative care services due to cultural and linguistic differences. There is generally a low awareness and many misconceptions about palliative care within ethnic communities, including Chinese Australians. What this study adds: The study highlights the specific challenges faced by Chinese Australian cancer patients and their caregivers in accessing palliative care services. It identifies language as the primary barrier, despite a strong interest in palliative care services among the Chinese ethnic community. The study highlights the need for local health authorities, medical associations, and community groups to develop and disseminate culturally and linguistically appropriate information to improve palliative care service uptake among the culturally and linguistically diverse community.