Proceedings of the Waikato Clinical Campus Research Seminar, Thursday 31 October 2024

Examining climate change impacts on health service access in Aotearoa New Zealand: an experimental proof-of-concept

Mitchell Pincham,¹ Sam Quinsey,² Marcus Blake,² Jesse Whitehead¹*

¹Te Ngira: Institute for Population Research, University of Waikato, New Zealand

²Centre of Australian Research into Accessibility, Deakin Rural Health, Deakin University, Australia

*Corresponding author: jesse.whitehead@waikato.ac.nz

AIMS

To develop a proof-of-concept methodology to rapidly estimate accessibility to health services in Aotearoa in the context of extreme weather events.

METHODS

An exploratory quantitative analysis used publicly available geospatial data to estimate distance to nearest GP and hospital for every address (2.3 million) in Aotearoa under “normal” conditions. The road network dataset was then modified to reflect closures following Cyclone Gabrielle and access to health services estimated under new conditions. Estimates of access to services post–Cyclone Gabrielle and under normal conditions were compared.

RESULTS

The exploratory results revealed the extent of service access disruption due to Cyclone Gabrielle related road closures. Approximately 80,000 addresses were isolated from a GP, with approximately 100,000 addresses isolated from hospital services. Increased travel distances of more than 1km affected approximately 38,000 and 101,000 addresses, requiring increased travel to a GP and hospital respectively.

CONCLUSIONS

This research demonstrates a viable approach to creating dwelling-level accessibility datasets and evaluating the impacts of extreme weather on health service access. Future work will focus on refining the methodology and assessing its feasibility for health service providers to enhance care coordination in times of crisis.

Cancer WHIRI; a holistic, culturally safe healthcare model that enhances delivery of cancer care, and social and family wellbeing

Deanne King,¹ Nina Scott,¹ Myra Ruka,¹ Amy Jones,¹ Jacquie Kidd,² Lotta Bryant,³ Frances Robbins,¹ Nadine Riwai¹

¹Te Whatu Ora Waikato, Hamilton, New Zealand

²Auckland University of Technology, Auckland, New Zealand

³University of Waikato, Hamilton, New Zealand

BACKGROUND

Māori are twice as likely to die after a diagnosis of cancer compared to non-Māori in Aotearoa New Zealand. Māori receive delayed poorer quality treatment, and those with comorbidities are undertreated. Coordination of care is crucial for Māori patients and whānau (family), but poorly developed along this early part of the cancer pathway. Our vision is that a potential diagnosis of cancer results in positive racism-free health engagement, timely access to high-quality care and wellbeing gain for individuals and their whānau.

AIMS

This study sought to co-design, implement and evaluate a holistic cancer service that is patient- and whānau/family-centred using WHIRI, an established Māori model of care. This comprehensive, racism-free, wellbeing-enhancing and responsive approach was redesigned for the early part of the secondary care cancer pathway.

DESIGN AND METHOD

The WHIRI model includes navigation and an electronic holistic assessment tool with follow up protocols. WHIRI includes nurse-led case management, including a general practice doctor and daily clinical case reviews with proactive team management for making systems changes. Over 1 year, the team developed a WHIRI model of cancer care using Kaupapa Māori methodology incorporating the Meihana Model and access to traditional Māori medicine, rongoā. Key to this was working in partnership with patients, whānau, cancer clinicians, Māori navigators and key stakeholders in the cancer space. We used “He Pikinga Waiora” (Māori implementation framework) to guide the research process. The cancer WHIRI programme was piloted with 34 Māori patients referred for suspicion of cancer to Waikato Hospital.

RESULTS

Cancer WHIRI included the following components: patient- and whānau-centred care; relationships; maximised hauora/wellbeing and equity gain; systems; and tino rangatiratanga/Māori autonomy. Following these components within the pilot allowed healthcare professionals to create culturally safe environments to enhance the delivery of care, while incorporating modern and traditional medical practices such as rongoā Māori. The team will present results of the pilot and discuss the model, which has potential to expand nationally with reach from primary care through to palliative care.

Comparative study of severe traumatic brain injury outcomes using crash and impact prognostic calculators to predict FIM scores on discharge from rehabilitation services

Harini Ravi,¹ Sheena Moosa,² Thirayan Muthu,¹ Sami Raunio,¹ Peter Gan,¹ Alastair Smith,² Tony Young,³ Grant Christey^2,4

¹Department of Neurosurgery, Te Whatu Ora Waikato, Hamilton, New Zealand

²Te Manawa Taki Trauma System, Te Whatu Ora Waikato, Hamilton, New Zealand

³ABI Rehabilitation New Zealand

⁴Waikato Clinical School, The University of Auckland, Aotearoa New Zealand

INTRODUCTION

Traumatic brain injury (TBI) is a common and devastating condition affecting predominantly the younger population, with variable prognosis depending on severity. Predicting and communicating prognosis is often a difficult discussion with whānau in the ICU setting.

AIM

To assess functional outcomes of severe TBI (sTBI) in the Te Manawa Taki (TMT) cohort, and to compare the prognosis parameters with both CRASH and IMPACT cohorts.

METHODS

This is an observational retrospective cohort study spanning from June 2012 until December 2022. We recruited 79 sTBI patients using the TMT Trauma Registry, who were subsequently transferred to and discharged from the Acquired Brain Injury (ABI) Rehabilitation Service. ED admission CRASH and IMPACT prognostic model parameters and ABI discharge Functional Independence Measure (FIM) scores were analysed.

RESULTS

71% of the TMT cohort were male and 40% were of Māori ethnicity. The FIM scores on discharge from ABI showed 10% severe, 33% moderate and 57% mild disability respectively. CRASH and IMPACT 6-month unfavourable outcome estimates are 39% and 49% lower than previous studies. Our cohort had higher rates of major extra-cranial injury, one reactive pupil and non-evacuated haematoma compared to CRASH and greater GCS motor score of 1, hypoxia and hypotension compared to IMPACT. The results are statistically significant.

CONCLUSION

We successfully externally validated discrimination and calibration of CRASH and IMPACT using the TMT cohort. Our study showed feasibility to apply prognostic calculators to the TMT cohort; however, the rate of unfavourable outcomes was overestimated partly because of our small sample size.

WHIRI: a culturally safe approach to supporting Māori with chronic conditions

Lynley Uerata,¹ Ross Lawrenson,² Nina Scott,¹ Amy Jones,¹ Jade Tamatea,^1,3 Polly Atatoa-Carr,^1,2 Nikki Barrett,² Lynne Chepulis,² Ryan Paul^1,2

¹Te Whatu Ora Waikato, Hamilton, New Zealand

²University of Waikato, Hamilton, New Zealand

³Te Kupenga Hauora Māori, The University of Auckland, Aotearoa New Zealand

BACKGROUND

Socio-economic determinants shape the wellbeing of populations and are causative drivers of ethnic inequities in health outcomes. Māori experience differential access/exposure to socio-economic determinants, manifesting in higher rates of both chronic and acute disease compared to non-Māori. Māori also experience marked health determinant inequity, such as those measured in education, un/employment, housing, economic and justice sectors. In turn, Māori experience stark and enduring inequities in health, including higher rates of cancer, diabetes, asthma, kidney disease and other chronic conditions. Therefore, health determinants need to be considered in the design and delivery of healthcare models. This project aimed to develop and pilot a holistic hauora (wellbeing) needs assessment and clinical support for Māori living with chronic conditions, which acknowledges the importance of health determinants and provides culturally safe support to address needs.

METHOD

Weaving together elements of the Kaupapa Māori and mixed methods approaches and the He Pikinga Waiora framework, the research team co-designed with patients and practitioners a WHIRI model of care for chronic conditions. WHIRI includes an integrated team structured around navigators, a wellbeing assessment that acknowledges the health determinants with follow-up pathways, and links to a multidisciplinary, nurse-led clinical team. Overseen by an Indigenous clinical governance team, the model was piloted with 30 Māori patients, referred via Waikato Hospital, living with chronic conditions.

RESULTS

Different kinds of expertise identified ways to make healthcare more culturally safe and accessible for healthcare providers to deliver to patients and whānau. Drawing on Māori engagement practices (such as whakawhanaungatanga [making connections], karakia [prayer] and koha [offering]) and the Meihana model, navigators worked with patients and whānau to deliver WHIRI. We will present findings that show that Indigenous governance and co-design of the WHIRI approach enabled the safe identification and support for a range of unmet social determinants and clinical needs, resulting in important hauora/health gains for Māori and their whānau.