Maori Health Review

Making Education Easy Issue 53 – 2014

Maori Health Review

Barriers to early initiation of antenatal care in a multi-ethnic sample in South Auckland, New Zealand

Authors: Corbett S et al.

Summary: The Counties Manukau DHB (CMDHB) in South Auckland serves the most economically deprived areas of New Zealand, with a high proportion of young mothers, and women of Māori and Pacific ethnicity. CMDHB has high rates of late booking for antenatal care and also the highest perinatal mortality rate in New Zealand, with a 3-year perinatal-related mortality rate of 13.70 per 1000 births compared with the national rate of 10.75 per 1000 births. This study aimed to identify barriers to early initiation of antenatal care (before 19 weeks of pregnancy) among women using CMDHB maternity services. The study recruited 826 pregnant women who were either in late pregnancy (>37 weeks gestation) or who had recently delivered (<6 weeks postnatal). They completed a questionnaire about their antenatal care at CMDHB. 137 women (17%) booked for antenatal care at >18 weeks (late bookers). Ethnic groupings were 43% Pacific Peoples, 20% Māori, 14% Asian, and 21% European or other ethnicities. According to multivariate analysis, women were significantly more likely to book late for antenatal care if they had limited resources (e.g. no transport) (OR 1.86), no tertiary education (OR 1.96), or were not living with a husband/ partner (OR 2.34). Notably, the odds of late booking for antenatal care was almost 6 times higher among Māori (OR 5.70) and Pacific (OR 5.90) women compared to those of European and other ethnicities.

Comment: Given the fact that good antenatal care is associated with positive long-term outcomes, more must be done to address these issues for Māori and Pacifica mums and their babies.

Reference: N Z Med J. 2014;127(1404):53-61


Continuous positive airway pressure treatment for obstructive sleep apnoea: Maori, Pacific and New Zealand European experiences

Authors: Bakker JP et al.

Summary: This paper describes Māori, Pacific and New Zealand European experiences of continuous positive airway pressure (CPAP) treatment for obstructive sleep apnoea (OSA). Patients identifying as Māori (n=5), Pacific (n=5), or NZ European (n=8) ethnicity referred for CPAP treatment for OSA attended separate, 1.5-hour group discussions facilitated by a health care worker of the same ethnic group. Patients in all three groups reported that they had little knowledge of OSA or CPAP prior to treatment initiation. All participants identified barriers to treatment (both at the CPAP initiation phase and long-term), reported feelings of being ‘overwhelmed’ with information during the initial CPAP education session, and discussed the importance of successful role models.

Comment: A nice project about a relatively little-known subject. I’ve seen first-hand the difference CPAP can make to people’s lives including better management of diabetes, hypertension and mood disorders. Strategies to improve its uptake must therefore be identified and supported.

Reference: J Prim Health Care. 2014;6(3):221-8


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Disclaimer: This publication is not intended as a replacement for regular medical education but to assist in the process. The reviews are a summarised interpretation of the published study and reflect the opinion of the writer rather than those of the research group or scientific journal. It is suggested readers review the full trial data before forming a final conclusion on its merits.

Research Review publications are intended for New Zealand health professionals.

A patient-centred clinical approach to diabetes care assists long-term reduction in HbA1c

Authors: Titchener J

Summary: Outcomes are reported from an audit comprising a before-and-after assessment of 185 patients referred to the GPSI Diabetes service – a patient-centred intervention for diabetes management – between 2008 and 2010. The aim of this audit was to determine if this patient-centred intervention improves diabetes care, as measured by changes in glycosylated haemoglobin (HbA1c). The GPSI Diabetes service is a communitybased service, run by a general practitioner with a specific interest (GPSI) in diabetes, and a practice nurse. Adults with diabetes are referred to the service by their GP and care is provided using a set of loosely structured diabetes-specific patient-centred approaches. Following a series of visits, patients are discharged back to their GP. At intake, baseline HbA1c was higher among Māori than among New Zealand Europeans. This difference was reduced by the patient-centred intervention. Immediate and sustained (two-year) improvements in HbA1c were observed in both New Zealand Europeans and Māori with type 2 diabetes and type 1 diabetes. Completed patient and GP satisfaction questionnaires did not contain any negative feedback, but the response rate was low among patients.

Comment: Useful information here about how to apply the concept of ‘patient-centred care’ in clinical practice.

Reference: J Prim Health Care. 2014;6(3):195-202


Maori Health Review
Maori Health Review