Uncertain times for health research in Aotearoa New Zealand

High quality primary health care underpinned by evidence-informed health care delivery and practice is the foundation of a high functioning health care system.¹ In order for us to generate the Aotearoa New Zealand (NZ) specific evidence we need to inform high quality health care delivery and clinical practice we need a strong health research sector. Sadly, we are now in uncertain times regarding the future direction of NZ health research given the deep funding cuts that have recently been applied to several major research funding bodies, notably the Health Research Council (HRC).² As editors we are proud to have been able to publish in the journal multiple impactful research papers funded from the full range of HRC grants: Programme Grants, Project Grants and Activation Grants and would wish this to continue in the future. Another related area of major concern is the recent decision to downgrade NZ’s access to the Cochrane Library: the gold standard database for the high-quality, independent evidence we need to inform healthcare decision-making.³ We are therefore very pleased to be able to continue to host our Cochrane Corner. This issue addresses ‘Changes to Cochrane Library access’.⁴

This issue has a series of linked papers^5–7 that address the establishment of a Primary Care Research Network (PCRN) in Southern NZ led by Leitch and colleagues at the University of Otago. The research was funded locally^5,6 and nationally through a HRC activation grant.⁷ The Southern PCRN was developed to enable access to primary care data through the establishment of a regional research database, and to create the supportive governance and infrastructure necessary for enabling a broader programme of research. The first paper sets out the background and lessons learnt from the initiative. It concludes that strategic investment in primary care research infrastructure is essential for NZ to fully realise the potential of routinely collected health data in order to inform equitable health service delivery, clinical practice and health policy.⁵ The other two linked papers address the primary care research priorities for people in Southern NZ⁷ and clinicians and researchers.⁶

The diagnosis of specific musculoskeletal problems by general practitioners (GPs) and other primary care health professionals is addressed in three papers. Debie and colleagues⁸ from the Netherlands sought to determine the most common established diagnoses in patients with knee pain referred by their GP to a primary care orthopaedic clinic, and explored the association of these diagnoses with age. They found that an age threshold of roughly 50 years is a strong predictor for knee osteoarthritis, patellofemoral pain, and meniscal lesions. Morgan and colleagues⁹ from Australia looked at the use of imaging by GP registrars for another common primary care problem: new onset non-specific low back pain (LBP). They found that the prevalence of imaging likely exceeds optimal levels, at significant cost and potentially poorer patient outcomes. Chauhan and colleagues used a cross-sectional survey design to identify gaps in the diagnosis of degenerative cervical myelopathy (DCM) in NZ primary health care. DCM is the leading cause of adult spinal cord dysfunction globally with a 5% prevalence in people over 40 years of age. The survey found gaps in DCM awareness, diagnostic confidence, and knowledge among primary care clinicians.

Mild traumatic brain injury (mTBI), of which concussion is a specific type, is commonly diagnosed and treated with face-to-face rehabilitation in a range of health care and educational settings in NZ and is the subject of two papers. The first looks at telerehabilitation, which offers the potential to improve access to rehabilitation for people with mTBI and reduce health disparities for those living in geographically rural and remote areas. Lam and colleagues¹⁰ surveyed mTBI survivors or close acquaintances of mTBI patients to determine patients’ preferences for telerehabilitation. They found that there was a preference for rehabilitation rather than no rehabilitation, with an overall preference for long telerehabilitation sessions. They conclude by noting that research is warranted to assess the efficacy and feasibility of implementing telerehabilitation programmes in clinical settings for mTBI patients. The second paper by Badenhorst and colleagues,¹¹ in contrast, explores the perceptions of key national, regional, and local stakeholders regarding the value of a FRAmework for maNaging Concussion in Schools (FRANCS) and develops recommendations for wider-scale implementation. Participants considered that national adoption of FRANCS would help address the significant challenges faced by schools in supporting students with concussion.

Our two final primary research studies address very different clinical settings. The first, by Yap and colleagues,¹² is a pilot study to evaluate a student-led community falls prevention programme for older people at risk of falls in the Waikato. Participants reported positive perceptions of the programme’s effectiveness in enhancing knowledge and preventing falls. The second, by McLean and colleagues,¹³ explores the nutrition care provided across an Australian state (New South Wales) for patients discharged from hospital post alcohol withdrawal. They found a variable level of reported confidence among healthcare professionals providing nutrition care. They conclude that this may represent a gap in service provision for this group of patients.

The issue ends with a rapid systematic review by Gauznabi¹⁴ on the use and impacts of emergency care simulation training in primary care. All the included studies in the review were consistent in terms of the significant benefits emergency care simulation has for primary care staff in improving confidence, clinical practice and emergency management systems for dealing with acutely unwell patients. The benefits applied to both clinical and non-clinical staff.

NZ risks losing skilled primary care researchers in the face of the recent health research funding cuts. However, we are a nation of number-eight fencing wire innovators, and we hope our researchers can find ways to continue their innovative work in excellent public science despite these fiscal challenges.