title: Rising demand for health care: The sustainability of community general practice in the Waikato

authors: Amey, Janet Heather

subjects: General practice

abstract: Community general practice is the cornerstone of New Zealand’s health system, providing first contact health care, care coordination and acting as gatekeeper to expensive hospital services. An ageing population now brings increasing demand for the care provided in general practice, with chronic conditions a major contributing factor. This rising demand, alongside limited workforce capacity will seriously test general practice sustainability. 

These evolving and multifaceted challenges are within the context of long-standing health access and outcome inequalities, particularly for Māori (and more recently the Pacific population) compared with Pākehā. The pursuit of equity is inherent in all health sector strategies, but any meaningful improvement will necessitate wide-ranging reform of current planning, funding and service delivery pathways across traditional sector boundaries.

The sustainability of general practice is about the sustainability and efficiency of the entire health system. To better measure the contribution of general practice care to the system, and improve demand projections, an expanded service use measure was developed, combining services of a general practice nature from Emergency Department and Accident & Medical settings with services delivered in community general practice.

Drawing on approaches from demography, epidemiology and health services research, linked demographic and health administrative data were used to undertake a retrospective, observational study of service use for 235,666 people enrolled with the Pinnacle Midlands Health Network in 2013/14. Using the new expanded measure, service use levels at a locality level were established by age, gender, ethnic group, chronic condition status, practice funding model, high needs status, income and geography of residence.

Significant variation was found in annual average consults (1.0 to 13.4 consults in 2013/14). Statistical analysis identified age, chronic conditions and gender as the key demand drivers responsible for such variation, with regional level results masking significant spatial variation. Where the cost of care was lower, people used a higher level of services in the enrolled practice setting and a lower level outside of it, suggesting the importance of affordable care. Māori and Pacific used significantly fewer services than Pākehā although there was substantial sub-regional variation. Using the expanded measure, the vast majority of care was delivered in the enrolled setting, including for those with chronic conditions.

Demand projections, based on the expanded measure of general practice, out to 2038 show the uneven geography of future demand due to disordered cohort flows and sub-regional population contexts. Overall, demand for services is projected to rise by 34 per cent to almost two million consults across the Waikato District Health Board catchment, with this driven predominantly by services for those aged 65+ years (or 45+ years in Hamilton City, Waikato and Waipa Districts).

Models of care are being transformed as general practices and Primary Health Organisations look to the future. Reorganisation of work roles, improved use of health information and use of emerging health technologies will be required to re-configure general practice in preparation for an ageing future, and to eliminate recalcitrant health inequalities. Real and inclusive collaboration across traditional system boundaries is perhaps the greatest challenge to general practice sustainability.

text: Rising demand for health care: The sustainability of community general practice in the Waikato Community general practice is the cornerstone of New Zealand’s health system, providing first contact health care, care coordination and acting as gatekeeper to expensive hospital services. An ageing population now brings increasing demand for the care provided in general practice, with chronic conditions a major contributing factor. This rising demand, alongside limited workforce capacity will seriously test general practice sustainability. 

These evolving and multifaceted challenges are within the context of long-standing health access and outcome inequalities, particularly for Māori (and more recently the Pacific population) compared with Pākehā. The pursuit of equity is inherent in all health sector strategies, but any meaningful improvement will necessitate wide-ranging reform of current planning, funding and service delivery pathways across traditional sector boundaries.

The sustainability of general practice is about the sustainability and efficiency of the entire health system. To better measure the contribution of general practice care to the system, and improve demand projections, an expanded service use measure was developed, combining services of a general practice nature from Emergency Department and Accident & Medical settings with services delivered in community general practice.

Drawing on approaches from demography, epidemiology and health services research, linked demographic and health administrative data were used to undertake a retrospective, observational study of service use for 235,666 people enrolled with the Pinnacle Midlands Health Network in 2013/14. Using the new expanded measure, service use levels at a locality level were established by age, gender, ethnic group, chronic condition status, practice funding model, high needs status, income and geography of residence.

Significant variation was found in annual average consults (1.0 to 13.4 consults in 2013/14). Statistical analysis identified age, chronic conditions and gender as the key demand drivers responsible for such variation, with regional level results masking significant spatial variation. Where the cost of care was lower, people used a higher level of services in the enrolled practice setting and a lower level outside of it, suggesting the importance of affordable care. Māori and Pacific used significantly fewer services than Pākehā although there was substantial sub-regional variation. Using the expanded measure, the vast majority of care was delivered in the enrolled setting, including for those with chronic conditions.

Demand projections, based on the expanded measure of general practice, out to 2038 show the uneven geography of future demand due to disordered cohort flows and sub-regional population contexts. Overall, demand for services is projected to rise by 34 per cent to almost two million consults across the Waikato District Health Board catchment, with this driven predominantly by services for those aged 65+ years (or 45+ years in Hamilton City, Waikato and Waipa Districts).

Models of care are being transformed as general practices and Primary Health Organisations look to the future. Reorganisation of work roles, improved use of health information and use of emerging health technologies will be required to re-configure general practice in preparation for an ageing future, and to eliminate recalcitrant health inequalities. Real and inclusive collaboration across traditional system boundaries is perhaps the greatest challenge to general practice sustainability.

year: 2018

title: Hei Āwhina Mātua: A kaupapa Māori response to behaviour

authors: Berryman, Mere

abstract: Hei Āwhina Mātua (strengthening parents and other adults), a kaupapa Māori research and development project, sought to capitalise on the strengths available within both whānau and teachers so that both groups could take joint responsibility for students' learning and behaviour. This required professionals trained in delivering learning and behavioural programmes for individual students working in culturally responsive and collaborative ways with adults, whānau, teachers and community members, This chapter returns to this study to reconsider the key findings.

text: Hei Āwhina Mātua: A kaupapa Māori response to behaviour Hei Āwhina Mātua (strengthening parents and other adults), a kaupapa Māori research and development project, sought to capitalise on the strengths available within both whānau and teachers so that both groups could take joint responsibility for students' learning and behaviour. This required professionals trained in delivering learning and behavioural programmes for individual students working in culturally responsive and collaborative ways with adults, whānau, teachers and community members, This chapter returns to this study to reconsider the key findings.

year: 2015

title: “Computer what's your favourite colour?” children's information-seeking strategies in the classroom

authors: Vanderschantz, Nicholas

abstract: This research investigates children's information seeking in primary and intermediate school classrooms as seen by their teachers. We report the results of a series of semi-structured interviews with teachers of pre-teen children. The teachers discussed specific issues that children encounter during information search, including query construction and information triage difficulties. Further issues were identified during the interviews regarding motivation, frustration and poor strategies for overcoming barriers. We compare the results of our teacher interviews reported here with the results of an interview study with children. This paper concludes that even with significant advancements in technology, teachers and children still require further assistance in order to succeed in their inquiry practices.

text: “Computer what's your favourite colour?” children's information-seeking strategies in the classroom This research investigates children's information seeking in primary and intermediate school classrooms as seen by their teachers. We report the results of a series of semi-structured interviews with teachers of pre-teen children. The teachers discussed specific issues that children encounter during information search, including query construction and information triage difficulties. Further issues were identified during the interviews regarding motivation, frustration and poor strategies for overcoming barriers. We compare the results of our teacher interviews reported here with the results of an interview study with children. This paper concludes that even with significant advancements in technology, teachers and children still require further assistance in order to succeed in their inquiry practices.

year: 2019