The three core outcomes for the medicines system as set out in the Strategy are:

• access
• optimal use
• quality, safety and efficacy.

Implementing Medicines New Zealand is about the changes required to deliver on Medicines New Zealand. This action plan supports the achievement of the Strategy’s outcomes by:

• making the most of every point of care
• enabling shared care through an integrated health care team
• optimal use of antimicrobials
• empowering individuals and families/whānau to manage their own medicines and health
• optimal medicines use in older people and those with long-term conditions
• competent and responsive prescribers
• removing barriers to access.

This will be done by harnessing the collective efforts of all health professionals, including those working in community organisations, primary health care, pharmacies, hospitals, rest homes and end-of-life care.

Implementing Medicines New Zealand 2015 to 2020 can be downloaded at:  http://www.health.govt.nz/publication/implementing-medicines-new-zealand-2015-2020

Ministry of Health (2015). Implementing Medicines New Zealand 2015 to 2020. Wellington: Miistry of Health

Fifty-eight studies were included, which addressed a wide array of health outcomes and risk behaviors. The review examined the effects of four types of strategies or interventions: community system-level change strategies; broad health and social care system-level strategies; interventions using lay community health outreach workers or group-based health education led by professional staff; and group-based health education.

The authors found that "... interventions led by community coalitions may connect health and human service providers with ethnic and racial minority communities in ways that benefit individual health outcomes and behaviors, as well as care delivery systems". However, they go on to say that "... because information on characteristics of the coalitions themselves is insufficient, evidence does not provide an explanation for the underlying mechanisms of beneficial effects".

This article is available to read in free full text at:  http://dx.doi.org/10.1002/14651858.CD009905.pub2

Anderson LM, Adeney KL, Shinn C, Safranek S, Buckner-Brown J, Krause LK. (2015). Community coalition-driven interventions to reduce health disparities among racial and ethnic minority populations. Cochrane Database of Systematic Reviews, 6, CD009905.

This evidence briefing on the commissioning of social prescribing has been produced by the Centre for Reviews and Dissemination. 

To read the article, go to:  http://www.lianza.org.nz/sites/default/files/Library%20Life%20434%20May%202015.pdf

The Healthy Families section on the Ministry of Health website describes the programme and its implementation.

Health Minister Jonathan Coleman has today launched Healthy Families East Cape at Te Poho o Rawiri Marae in Gisborne.

“Healthy Families NZ is about encouraging people to live healthier lives by making good food choices, being physically active, moderating alcohol consumption and being smoke-free,” says Dr Coleman.

“The programme challenges communities to think differently about how to address the underlying causes of poor health at a local level.”

The East Cape is the first community to launch the initiative. $2.7 million is being invested into Healthy Families East Cape over four years. Lead provider Te Whare Hauora o te Aitanga Hauiti has established the Horouta Whânaunga Collective - a partnership of eight local iwi.

“Today’s launch of Healthy Families East Cape highlights how local iwi have come together to improve people’s health. We want to see this type of approach adopted by communities across the country,” says Dr Coleman.

In Budget 2014 the Government invested $40 million over four years to establish ten Healthy Families NZ communities which will cover the highest risk population.

Dedicated local health prevention teams will work with local leaders to create healthy changes where people spend their time – in schools, workplaces, marae, sports clubs and other community settings.

Healthy Families NZ is based on the world-leading Healthy Together Victoria initiative which is achieving large scale reach across the Victorian population.

The programme will also be launched later this year in Invercargill, Far North, Lower Hutt, Rotorua, Whanganui, Manukau, Manurewa-Papakura, Spreydon-Heathcote, and Waitakere.

Community and Voluntary Sector Minister Jo Goodhew today announced a new funding round has opened for the Support for Volunteering Fund, and applications can now be lodged online.

“Each year the Fund seeks to support, promote and strengthen volunteering in the community with $502,000 available for volunteers and volunteer projects,” Mrs Goodhew says.

“Funds are provided to projects that support volunteering in New Zealand,” Mrs Goodhew says. “In previous years it has allowed some centres to increase recruitment and training of volunteers and managers.”

Funding in previous years has allowed Arohanui Hospice to increase volunteer numbers by 238 people, and in 2014 the Chinese New Settlers Services Trust held 40 workshops to help new Asian migrants gain employment and settle into the community.

“The Fund also supports Māori, Pacific and ethnic communities or other organisations with capacity and capability-building projects that promote and support volunteering,” Mrs Goodhew says.

Organisations applying for funds are required to have legal entity status, appropriate governance and management structures and processes in place.

For the first time applicants can now make their submission online. Applications to the fund must be submitted by 6 May 2015.

Visit www.communitymatters.govt.nz for more information.

Semi-structured individual and group interviews with 45 participants (representing clinical team members, administrative team members, service managers/team leaders, senior managers and software support team members). 

"The analysis found that communication was not always effective, and there was a lack of awareness, knowledge and understanding of the programme. Many staff did not find the Productive Community Services work relevant, and although certain improvements were sustained, suboptimal practices crept back. Although negative outcomes were reported, such as the programme taking time away from patients initially, many benefits were described including improved stock control and work environments, and better use of the Electronic Patient Record system".

The authors discuss the implications of these findings.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1016/j.ijnurstu.2015.02.005 or contact your DHB library, or organisational or local library for assistance.

Bradley, D. & Griffin, M. (2015). Staff perceptions of a Productive Community Services implementation. International Journal of Nursing Studies, 52(6), 1052–1063

A mixed methods qualitative evaluation was undertaken to understand self-management service provision to culturally diverse communities (i.e. how components such as lay workers, group-based design, and culturally-appropriate educational material are intended to encourage behavioural change). The authors interviewed lay educators delivering the Chronic Disease Educator programme along with attendees, whilst observing workshops. Data were thematically analysed using a content-based constant comparison approach through a number of interpretative analytical stages.

Lay educators felt part of the local community, relating to attendees from different races and ethnicities. However, lay educators faced challenges when addressing health beliefs and changing lifestyle practices. Culturally-tailored components aided communication, with educator’s cultural awareness leading to close relationships with attendees, while the group-based design facilitated discussions of the emotional impact of illness.

The authors conclude that lay educators bring with them a number of nuanced skills and knowledge when delivering self-management education. The development and training required for this role is inhibited by financial constraints at policy-level. The interpretation of being from the ‘community’ links with the identity and status of the lay role, overlapping notions of race, ethnicity, and language.

This is an open access article and is available to read in free full text at:  http://dx.doi.org/10.1186/s12913-015-0712-8

Sidhu, M.S., et al. (2015). A critique of the design, implementation, and delivery of a culturally-tailored self-management education intervention: a qualitative evaluation. BMC Health Services Research, 15:54

These data represent the activity of, and outcomes achieved, by a number of community based (face-to-face) stop smoking services.

Community and Voluntary Sector Minister Jo Goodhew announced today that $231,000 of funding will be shared by seven community groups under the Community Internship Programme.

“Community groups often require experienced and skilled professionals to help manage projects, develop business plans, and form marketing strategies,” Mrs Goodhew says.

“This funding means groups can employ people with the specialist skills they require to help them achieve clearly identified objectives.”

The seven community groups who will benefit from this latest funding round are Canterbury Men’s Centre, Life Unlimited Charitable Trust, Methodist Mission Southern, Te Kaahui O Rauru, The Asthma Foundation, The Wellington Boys’ and Girls’ Institute, and Volunteer Resource Centre Manawatu & Districts.

“Some of the outcomes that will be achieved this year include a software system up-scale for Methodist Mission Southern, an asset map of natural resources and business plan for Te Kaahui O Rauru, and a strategy document for the Asthma Foundation,” Mrs Goodhew says.

The Community Internship Programme was established in 2001, and has provided 110 internships across a variety of non-profit organisations. More information is onwww.communitymatters.govt.nz.

"No published papers were identified for inclusion in the review. Fifteen patient safety investigative frameworks were collected and analysed. Twelve of the retrieved frameworks were intended for the investigation of community-acquired pressure ulcers; seven of which took account of the setting where the ulcer originated as being the patient's home". The authors conclude that there is "...evidence to suggest that many of the root cause analysis frameworks used to investigate community-acquired pressure ulcers in England are unsuitable for this purpose". The authors discuss the implications of these findings.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/jocn.12644 or contact your DHB library, or organisational or local library for assistance.

McGraw, C. and Drennan, V. M. (2015), Evaluation of the suitability of root cause analysis frameworks for the investigation of community-acquired pressure ulcers: A systematic review and documentary analysis. Journal of Clinical Nursing, 24: 536–545. 

The review included 13 studies (4 randomised controlled trials, 1 non-randomised comparative study and 8 one-group descriptive studies). "All studies reported high participant satisfaction with the peer support intervention, and the majority noted positive outcomes regarding psychological adjustment. The quality of the description of the peer support programmes as well as the research methodology of the studies was rated as fair".

The autors conclude that "one-to-one peer support programmes have the unique advantage of being a low-cost intervention approach, but also showing potential for relieving the health-care system by reallocating some aspects of the cancer care to community settings. Future research should address the methodological weaknesses in study design and reporting".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1111/ecc.12273 or contact your DHB library, or organisational or local library for assistance.

Meyer, A., Coroiu, A. and Korner, A. (2015). One-to-one peer support in cancer care: a review of scholarship published between 2007 and 2014. European Journal of Cancer Care, 24(3), 299–312

Available to download and read in free full text at: http://www.health.govt.nz/publication/review-tobacco-control-services

SHORE & Whariki Research Centre (2014). Review of tobacco control services. Wellington: Ministry of Health

The authors describe the establishment of a multidisciplinary European Association of Palliative Care Taskforce and its work to scope the extent of and learn what facilitates and hinders the development of palliative care in the community across Europe.

This is one of two reviews on communication interventions for childhood vaccination. The companion review focuses on face-to-face interventions for informing or educating parents.

"The review found two studies. The first study took place in India. Here, families, teachers, children and village leaders were encouraged to attend information meetings where they were given information about childhood vaccination and could ask questions. Posters and leaflets were also distributed in the community. The second study was from Pakistan. Here, people who were considered to be trusted in the community were invited to meetings where they discussed the current rates of vaccine coverage in their community and the costs and benefits of childhood vaccination. They were also asked to develop local action plans, to share the information they had been given and continue the discussions with households in their communities".

The authors conclude that there is "... limited evidence that interventions aimed at communities to inform and educate about early childhood vaccination may improve attitudes towards vaccination and probably increase vaccination uptake under some circumstances. However, some of these interventions may be resource intensive when implemented on a large scale and further rigorous evaluations are needed. These interventions may achieve most benefit when targeted to areas or groups that have low childhood vaccination rates.’"

This article is available to dowwnload and read in free full text at: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD010232.pub2/full

Saeterdal I., Lewin S., Austvoll-Dahlgren A., Glenton C., Munabi-Babigumira S. (2014). Interventions aimed at communities to inform and/or educate about early childhood vaccination. Cochrane Database of Systematic Reviews, 11, CD010232.

They reviewed the literature to explore whether CHWs are also effective in improving the health and the delivery of health care services to ethnic minority older adults in Western countries.

Seven studies were included. The effectiveness of the implementation of CHW programmes in older adults belonging to ethnic minorities is not univocal. In two studies, the authors found no significant differences. In five studies, they found some positive effects. They did not find negative effects in any of the studies.

For better interpretation of the results, effect ratios (ERs) were calculated as the number of positive findings divided by the total number of measured findings. Substantial effects on the access to care and on health behaviour were found. The mean ER for health outcomes was considerably lower.

The authors conclude that there are indications that CHWs serve as a means of improving health care use and health behaviour and, to a lesser extent, health outcomes among ethnic minority older adults. Further research is required to draw more solid conclusions on the effectiveness of CHW interventions in this target group. 

This is an open access article and can be downloaded and read in full free text at:  http://dx.doi.org/10.1186/s12913-014-0497-1

Verhagen, I., et al. (2014). Community health worker interventions to improve access to health care services for older adults from ethnic minorities: A systematic review. BMC Health Services Research, 14:497.

The King’s Fund visited six services where consultants are delivering or facilitating care outside hospital. This report presents the findings from those visits as case studies. It identifies key characteristics and challenges to this way of working and seeks out evidence of the benefits to patients and the NHS more broadly".

The case studies are as follows:

• Portsmouth and South East Hampshire diabetes service
• Leeds interface geriatrician service 
• Imperial child health general practice hubs 
• Sunderland dermatology and minor surgery service
• Haywood rheumatology centre
• Whittington respiratory service

The report is available to read in full text at: http://www.kingsfund.org.uk/publications/specialists-out-hospital-settings

Read the related media release: http://www.kingsfund.org.uk/press/press-releases/consultants-need-spend-more-time-outside-hospital-report-finds

Robertson, R., et al. (2014). Specialists in out-of-hospital settings Findings from six case studies. London: King's Fund.

Twenty-seven studies from 14 different healthcare systems were included. "In the included studies, total annual costs for dementia of up to $70,911 per patient (mixed setting) were estimated (average estimate of total costs = $30,554). The shares of cost categories in the total costs for dementia indicate significant differences for different care settings. Overall main cost drivers of dementia are informal costs due to home based long term care and nursing home expenditures rather than direct medical costs (inpatient and outpatient services, medication)".

The authors discuss the implications of these findings.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1002/gps.4198 or contact your DHB library, or organisational or local library for assistance.

Schaller S., Mauskopf J., Kriza C., Wahlster P. and Kolominsky-Rabas P. L. (2015). The main cost drivers in dementia: A systematic review, International Journal of Geriatric Psychiatry, 30(2), 111–129.

The service supports integration of pharmacist services for the patient between community pharmacy, community-based services, general practice and secondary care. 

This project is a partnership project with Midlands Health Network and the Midland Community Pharmacy Group (MidCPG) for the development and implementation of the role of the Tokoroa Clinical Pharmacist. 

To read the report for the period 1 February to 31 July 2014, go to: https://www.midlandshn.health.nz/publications/tokoroa-clinical-pharmacists-service-report

"District Nurses’ role in breaking bad news of transition to dying was challenging, but the conversation was described as essential preparation for a good death. Four main challenges with the conversations were patients’ responses to the prognosis (unawareness, denial and anger), timing the conversation, complexities of the home environment and limited preparation in this aspect of their work"

The authors conclude that District Nurses "... need carefully tailored training in this aspect of their work, to enable them to provide optimal end of life care".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1177/0269216314551813 or contact your DHB library, or organisational or local library for assistance.

Griffiths, J., et al. (2015). Breaking bad news about transitions to dying: A qualitative exploration of the role of the District Nurse. Palliative Medicine, 29 (2), 138-146.

The studies consistently reported carers' requirements of practical support and information as a theme across studies, suggesting that effective ways of delivering information and support to caregivers need to be developed and implemented as a matter of priority. It also highlighted the needs of the professionals providing support to carers, to ensure the health and wellbeing needs of carers, to include signposting and referral to avoid reaching crisis point and resultant burnout".

To read the full abstract, and for information on how to access the full text, go to: http://www.magonlinelibrary.com/doi/abs/10.12968/bjcn.2014.19.7.346 or contact your DHB library, or organisational or local library for assistance.

Laing, M. & Sprung, S. (2014). Enabling the health and wellbeing of carers through district nursing support. British Journal of Community Nursing, 19(7).

Southern nurse-led health clinics are being piloted thanks to Ministry of Health funding (Te Ruinga - spreading proven innovations) combined with Southern DHB and Southern PHO support.

“Everybody is extremely excited that we have been given the opportunity to deliver Nurse-Led clinics. Progress and interest to date is encouraging as we move to providing increasingly integrated and coordinated health services within Māori communities,” said Southern DHB District Manager Māori Health, Pania Coote.

The Clinics will provide and facilitate a range of health and social services for Dunedin, Central Otago, East and North Otago, Bluff, South Invercargill, Gore and Mataura communities, and are being led by Māori Health Providers across the Southern district.

Nadine Goldsmith (Southland based) and Lorna Scoon (Otago based) have been appointed as the nursing leads for the clinics, and both are currently both working towards becoming Nurse Practitioners.

“The funding for these clinics also provides a fantastic opportunity for the nurses in the roles to have the financial, professional and clinical support available to assist them to become Nurse Practitioners. On completion of their training, having two Nurse Practitioners working within the different Māori communities will provide a great opportunity to improve patient outcomes,” said Southern Primary Health Organisation Nurse Director, Wendy Findlay.

What makes these clinics unique is that they are shaped by community needs, they link the whānau into community and GP services whilst responding to the vision of Whānau Ora.

“We are committed (primary, secondary and community) to work effectively together to establish Nurse-Led clinics across the Southern district, utilizing our combined resources to jointly make a difference in reducing health inequalities and enhancing quality of life, ” said Pania.

Māori Health Providers, Kāi Tahu ki Otago Limited and Awarua Social and Health Services are both working in collaboration with the following partners to deliver the community based service:

Tokomairiro Waiora Inc.
Tumai Ora Whānau Services
Uruuruwhenua Health
Te Hou Ora Otepoti Inc.
Waihōpai Rūnaka Inc.
Hokonui Rūnanga Health & Social Services Trust

Chris Rosenbrock, Manager, Kāi Tahu ki Otago Limited, commented that “these partners provide pathways for clinics to happen within their communities and the kaupapa for each clinic is determined by the community.”

The clinics are free and Patricia (Trish) Young, Kaihautu – CEO, Awarua Social & Health Services said that she was “excited about the availability of free Marae based health clinics for whānau in Bluff, Hokonui, Mataura, Waihōpai and South City. Working collaboratively with Rūnanga across Murihiku will ensure that we capture whānau to improve access to health services and develop better pathways for them into other primary health care providers.”

For details on the Pacific Comunity Innovations Fund, go to: http://www.health.govt.nz/our-work/populations/pacific-health/pacific-community-innovations-fund

This focus group involved six people, all with Type 2 diabetes and most of whom were at the end of their working lives. Half of the group were Māori and half European.

The common theme amongst this group was about education – from what kind of food to buy, to educating their families and the community about diabetes and ways to encourage healthier behaviours – to building strong relationships between patients and health care practitioners.

One participant who had recently been diagnosed felt that “diabetes is something we have done to ourselves. It’s undoing that wrong doing, to make the best thing happen from now on. A pamphlet for our families would be the best thing”.

A health worker in the focus group echoed these thoughts, saying, “All of the information is for individuals. There is very little for the families – especially for families of people with Type 2 diabetes.”

One group member said it was hard explaining to family members when she needed to eat if her sugars got low. They’d tell her she couldn’t eat now because “we’re not eating until later on.”

“I live with three other people so it’s about changing the way we do groceries together too”, added another participant.

Another common challenge the patients faced was working in jobs that create barriers to physical movement or healthy eating – one member of the group was a taxi driver who drank energy drinks to stay awake and another was a confectionary buyer for a retail chain. In the end, the confectionary buyer recruited other staff members to do the testing for him which helped him tremendously, whereas the taxi driver reported feeling better after giving up drinking energy drinks, but by then both had been diagnosed with Type 2 diabetes.

One member of the group had gestational diabetes which had later come back as Type 2 diabetes. In her words, “my body broke and never came back”.

Another woman in the group had recently lost 55kgs. She told us she loves her food and is a very good cook so she found it very hard at first. “Trying to tackle everything at once can be overwhelming” so her advice was to “just change one thing at a time and you can do it.”

Two of the participants in this group are health workers so they were able to give us an insight into themes they could see reoccurring. One pointed out how important it was to teach people to read food labels so they can really understand what they are eating, “most people know you shouldn’t have sugar, but they don’t know about the hidden sugars.”

“Education is key – helping the patients prepare and understand what is happening. One of my patients even taped me on their phone so they could listen back to my advice again. People will often go through a period of denial but they always come back and start to engage more and knowing the person is the key to getting the information through. I often get in trouble for long appointments but the relationship with my patients is key.”

This sentiment was definitely highlighted by patients within the group, with one gentleman adding, “You have to be able to trust the person who is giving you the instructions”.

Some of the group had defining moments with their illness when their health practitioner had shocked them by challenging their lifestyle. One participant told us he had been drinking heavily prior to being admitted to Wellington hospital and added, “The doctor said ‘Why are we looking after you with all these pills when you come along with a bottle of kerosene and pour it on the fire?’ I walked out that day four years ago and haven’t had a drink since.”

Another patient’s doctor told them, “I want you to take these pills I am giving you and as soon as you get home I want you to go into the bathroom and flush them all down the toilet!” “I was shocked,” the patient explained, “But he told me that’s what I might as well do unless I was going to change my habits.”

Turning points came in other forms with other members of the group. When one of the women was diagnosed with diabetes, she reacted by going against everything she was told she couldn’t do and went on a big eating binge. But her turning point came when she came of a coma on the couch at home to find her three year old son saying, “Come on mummy, please wake up.”

Other challenges the group faced were the perceived price of healthy versus non-healthy food and drink. “It’s hard when you see fizzy drink for 80 cents and milk is $3.80,” one participant commented.

They also described the challenge of not having their family understand, with another participant remarking, “This is a community issue. My family have said things like ‘Aunty’s just a fat pig that is why she got diabetes but to me it’s a community problem.”

Transport to health services was another challenge. There were limited free shuttle services available in this community but the times they ran did not match times when the diabetes clinic was open, and partipants felt these sorts of services could be co-ordinated better.

Key recommendations we are exploring as a result;

• Resources to promote better understanding and support from family members
• Relationship and trust with health providers
• Co-ordination of community services and hospital services
• Perception of cost of healthy food vs fast food
• Targeting support to certain professions where work lifestyle seems to increase risk

A randomised controlled trial of a family-based, second-hand smoke intervention has failed to reduce the occurrence of acute respiratory illness in indigenous infants in Australia and New Zealand, despite previous research suggesting that such an intervention could be effective.

University of Auckland clinical trialist, Dr Natalie Walker, led the New Zealand arm of the international study, which delivered an intensive three-month programme involving  behavioral “coaching” about the dangers of second-hand smoke to children, commitment to smoking restrictions in the home/car, positive role modeling, and strategies for overcoming obstacles to making smoke-free changes. Family members who smoked were also given smoking cessation support. 

Senior indigenous researchers Dr Marewa Glover (University of Auckland) in New Zealand and Professor Ngiare Brown in Australia guided founding the programme on Māori and Aboriginal holistic models of health, which was then delivered by indigenous community health workers.

The findings, which have just been published in the journal Nicotine & Tobacco Research 2014 (Oxford University Press), show that while parents’ who received the intervention reported that exposure of their infants to second-hand smoke was low (about 95 per cent reported having smoke-free homes and cars), the mean urinary cotinine/creatinine ratios (CCRs) in the infants at baseline and at four months were consistent with exposure to second-hand smoke.

The authors found that over 12 months the programme had no effect on the rate of health care presentations for acute respiratory illness, second-hand smoke exposure for the infants, or parental smoking.

Dr Walker says the results show that emphasis needs to be placed on supporting parents to stop smoking preconception, during pregnancy, and postnatal. Furthermore, breast feeding should continue to be encouraged, but smoking while breast feeding should be discouraged.

The report concludes that: “These findings suggest that simply having smoke-free homes and cars is not sufficient to protect children from exposure to second-hand smoke.”

This study is funded by the Health Research Council of New Zealand and the National Health and Medical Research Council of Australia, via the International Investment Opportunities Fund (IIOF) Trans-Tasman Clinical Trials Collaboration Initiative. Additional funding support was provided by Cure Kids New Zealand and the James Russell Lewis Trust.

View the article abstract here.

This discussion paper was commissioned by the Health Promotion Forum under its Occasional Paper series.

The paper is available to read in full text at:  http://www.hauora.co.nz/assets/files/Occasional%20Papers/Developing%20a%20competent%20global%20health%20promotion%20workforce%20-%20pedagogy%20and%20practice%20-%20July%2014.pdf

Hall, C. (2014). Developing a competent global health promotion workforce: Pedagogy and practice. Auckland: Health Promotion Forum.

Staff attitudes ranged from resistance to enthusiasm, with varied opinions about the motives for investing in telehealth and the potential impact on nursing roles. Having reliable and flexible technology and dedicated resources for telehealth work were identified as essential in helping to overcome early barriers to acceptance, along with appropriate staff training and a partnership approach to implementation. Early successes were also important, encouraging staff to use telehealth and facilitating clinical learning and increased adoption.

The authors conclude that the mainstreaming of telehealth hinges on clinical ‘buy-in’. Where barriers to successful implementation exist, clinicians can lose faith in using technology to perform tasks traditionally delivered in person. Addressing barriers is therefore crucial if clinicians are to adopt telehealth into routine practice.

This is an open access article and is available to read in free full text at: http://onlinelibrary.wiley.com/doi/10.1111/jan.12480/abstract

Taylor J., Coates E., Brewster L., Mountain G., Wessels B. & Hawley M.S. (2015) Examining the use of telehealth in community nursing: identifying the factors affecting frontline staff acceptance and telehealth adoption. Journal of Advanced Nursing, 71(2), 326–337.

The guidance was published in July 2014 and is available to download and read in free full text at: https://www.gov.uk/government/publications/supporting-adult-carers-through-community-nursing

Journal of Public Health Management and Practice publishes in a wide range of population health topics including research to practice; emergency preparedness; bioterrorism; infectious disease surveillance; environmental health; community health assessment, chronic disease prevention and health promotion, and academic-practice linkages. 

The Association’s objectives are to: 

• provide leadership and advocacy for the home and community health sector; 
• establish, promote and recognise high standards for the conduct of home and community health services’ 
• address members’ educational and information needs; 
• provide a united voice for the Association’s membership, to government and the public; 
• maintain links and provide opportunities for the development of the sector and 
• develop home and community health services that reflect the Association’s obligations under the Treaty of Waitangi

This review highlights the history of community health worker programmes around the world.

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1146/annurev-publhealth-032013-182354 or contact your DHB library, or organisational or local library for assistance.

Perry, H.B., et al. (2014). Community health workers in low-, middle-, and high-income countries: An overview of their history, recent evolution, and current effectiveness. Annual Review of Public Health, 35.

Four acute hospital wards and two community hospital wards were included in the study and the authors conclude from the results that "... vertically integrated healthcare system supported care transitions from acute hospital wards through removal of organisational boundaries. However, boundaries between staff in different settings remained a barrier to transitions, as did capacity issues in community healthcare and social care. Staff in acute and community settings need opportunities to gain better understanding of each other’s roles and build relationships and trust".

This article is available to read in full text at:  https://www.ijic.org/index.php/ijic/article/view/1175/2382

Baillie, L., et al. (2014). Care transitions for frail, older people from acute hospital wards within an integrated healthcare system in England: A qualitative case study. International Journal of Integrated Care, 14, Jan-Mar.

The palliative care teams served different geographies and varied in team composition and size but had the same core team members and role: a core group of palliative care physicians, nurses, and family physicians who provide integrated palliative care to patients in their homes. The teams’ role was to manage symptoms, provide education and care, coordinate services, and be available without interruption regardless of time or day.

Across all palliative care teams, 31.2% of the exposed group were in hospital and 28.9% had an emergency department visit in the last two weeks of life respectively, compared with 39.3% and 34.5% of the unexposed group. The pooled relative risks of being in hospital and having an emergency department visit in late life comparing exposed versus unexposed were 0.68 and 0.77 respectively. Fewer exposed than unexposed patients died in hospital (503 (16.2%) v 887 (28.6%), P<0.001), and the pooled relative risk of dying in hospital was 0.46 (0.40 to 0.52).

The authors conclude that community-based specialist palliative care teams were effective at reducing acute care use and hospital deaths at the end of life.

This is an open access article and can be read in free full text at:  http://www.bmj.com/content/348/bmj.g3496

Seow, H., et al. (2014). Impact of community based, specialist palliative care teams on hospitalisations and emergency department visits late in life and hospital deaths: a pooled analysis. BMJ, 348:g3496.

The new initiative will see the nurses work with 20 churches in west Auckland and ten on the North Shore, assisting them to develop a tailored health programme that will be integrated into the church’s activities.

Waitemata DHB chief executive, Dr Dale Bramley, says the programme is about developing a long term health conversation with each church community and individuals within that community that require ongoing support.

To read the full media release from Waitemata DHB, go to:  http://www.scoop.co.nz/stories/GE1405/S00172/nurses-and-communities-work-to-improve-pacific-health.htm

People with diabetes are receiving better, sooner and more convenient care thanks to a Nursing Practice Partnership (NPP) between primary health organisations and Capital & Coast DHB.

The NPP model pairs the expertise of hospital-based diabetes nurse specialists with practice nurses in the GP setting, enabling them to manage patients’ care closer to home.

Building on work developed by the Newtown Medical Centre, and the Newtown and Porirua Union Health services, Karori Medical Centre (KMC) has been trialling the model since May 2012. Of the 55 patients who took part in the pilot, nearly 80 percent have dropped their HBA1C glucose levels to a more manageable level, GP Dr Jeff Lowe says. 

Having a lower HBA1C level means patients are at less risk of micro vascular complications such as impaired vision, kidney problems, ulcers, and lower limb amputations. 

“It’s about using the nursing workforce in a different way. We’re not talking primary diabetes care or secondary diabetes care, just diabetes care. We believe that’s the future,” Dr Lowe says.

KMC practice nurse Jacqui Levine says the opportunity to work with CCDHB diabetes nurse specialist Lorna Bingham “has certainly increased my confidence in working with patients with diabetes. Lorna has given us a lot of skills and knowledge”. 

Managing patients in the community provides continuity of care for patients and staff alike, says practice nurse Heather Wilson. 

“It means knowing the patient, knowing where they’re at, and working with them to get their diabetes under control. It’s having the opportunity to ring them up if they haven’t had their blood test done, so we are keeping in touch.” 

Patient Chris Ward, who was able to start insulin medication in the community rather than the hospital during the pilot, says the partnership is “brilliant”. 

“Starting Insulin was something I was concerned about but I learnt how to do it all [at KMC]. Now I can deliver the injection myself and it’s just a quick phone call to Heather if I have a problem. I feel more in control now,” Mr Ward says. 

Mr Ward says knowing that he can contact Heather at any time means that he feels more confident managing his diabetes. 

More than 243,000 Kiwis have been diagnosed with some form of Diabetes, and 22,593 of those live within the greater Wellington region of Capital & Coast, Hutt Valley and Wairarapa districts. 

CCDHB is currently rolling out this model of care to a further 15 General Practices to provide better support for people with diabetes.

To read the full abstract, and for information on how to access the full text, go to: http://www.heartlungcirc.org/article/S1443-9506(13)01315-2/abstract or contact your DHB library, or organisational or local library for assistance.

Ong, K. S., et al. (2014). Cost-effectiveness of interventions to prevent cardiovascular disease in Australia's indigenous population. Heart, Lung and Circulation, 23 (5), 414-421.

Health services for people with kidney-related conditions get a significant boost with the opening of a new 18-station community dialysis centre (satellite and home therapies) on the North Shore.

Tātari Oranga O Te Raki, which means ‘filtering for wellness – North’, was officially opened by North Shore MP Maggie Barry today.

Waitemata DHB chief executive Dr Dale Bramley says the new centre in Mairangi Bay is part of a long term strategy to provide closer-to-home care for renal patients in the district.

"We marked the first phase of the renal programme in 2011 with the opening of the $9.2 million North Shore Dialysis Centre located next to North Shore Hospital,” says Dr Bramley.

“This was aimed at providing in-centre renal dialysis for people with kidney failure.”

“This second phase, of which Tātari Oranga O Te Raki is the key project, sees an emphasis on community solutions that will allow patients to manage, or partially manage, their own dialysis in a community setting.”

The new centre complements the DHB’s existing facilities, which include a Waitakere haemodialysis satellite unit and clinics at Waitakere Hospital, as well as the North Shore Dialysis Centre.

“The $3.6 million investment will support greater independence for current and future patients with chronic kidney disease. Once this second phase is complete, our DHB will have sufficient community dialysis capacity to accommodate projected demand up to 2020,” says Dr Bramley.

Tātari Oranga O Te Raki allows for up to 36 dialysis patients per day, with capacity for an additional 18 working patients to dialyse in the evenings. It will feature a dedicated home therapies area to train and support patients for peritoneal dialysis and home haemodialysis.

Along with the community facility, phase two also saw the addition of three plumbed dialysis spaces to North Shore Hospital inpatient service’s existing two spaces in 2013.

Waitemata DHB renal service clinical director Dr Janak de Zoysa, says the new facility offers high quality care and greater convenience for renal patients in our district.

 “This will allow a wider range of treatment options. It will support patients to dialyse at home and mean that those patients who are unable to dialyse at home will not have to travel as far or wait as long for treatment.”

The planned third and final phase of the programme will see the establishment of vascular surgery, interventional radiology and community nephrology services in the district.

Research released this month shows that Waikato District Health Board's Supported Transfer and Accelerated Rehabilitation Team (START) programme reduces the length of stay in hospital and the risk of readmission following discharge. The research also showed the increased time the patients then spent recuperating at home under START care, reduced costs for the DHB over six months.

In the research 198 older people entered the trial and were randomised to either usual care or START.  All older people were followed up over six months.  In the hospital admission immediately prior to entering the trial, the older people in the usual care group spent on average 21.6 days in hospital versus 17.1 days in START.  START therefore achieved its objective of decreasing hospital length of stay.  

In the six months following discharge from hospital, participants in the Usual Care group spent 20.6 days in hospital against 14.2 days in START; indicating that the START service had a highly effective role in reducing readmissions.  

Total costs were also reduced; per participant costs in the Usual Care group were a mean NZ$16,943 versus NZ$10,836 in the START group (which included NZ$1,618 of START costs) in the six months following the initial hospital discharge.

The Health Research Council of New Zealand (HRC) through the Research Partnerships for New Zealand Delivery (RPNZHD) initiative funded Waikato DHB and the University of Auckland to conduct research on START to see whether it was achieving its intended objectives. The research results now come to the recently launched The Institute of Healthy Ageing.

The Institute of Healthy Ageing chair Barbara Garbutt said when Waikato DHB introduced START on a trial basis in Hamilton in October 2011 “we wanted to be sure results were evidence based.”

The programme rolled out in Thames/Hauraki and South Waikato from 1 February 2012 and is now in place throughout Waikato DHB.

START works with patients and their families in the patient’s own home to set rehabilitation goals and help patients to reach those goals.

Professor Matthew Parsons, Waikato DHB’s chair in gerontology nursing, a joint appointment between Auckland University and Waikato DHB, led the research.

“Having such dramatic research outcomes which proved START does what it sets out to do, was both reassuring and important for New Zealand as we strive to improve services for New Zealand’s older people,” said Prof Parsons.

“What makes these results so important is that we know from other research that the less time older people spend in hospital the better the rehabilitation outcomes are for them if they are well supported by something like the START programme in their own homes and community,” he said.

Older people receive rehabilitation at home for up to six weeks by a team of highly skilled health care assistants overseen by registered nurses with input from occupational therapists, physiotherapists and geriatricians.  Clients receive an individualised package of support and rehabilitation, which involves up to four visits a day, seven days a week.
START aims to enable early seamless discharge from hospital and to prevent readmission.  A GP can also refer directly to the service to prevent an admission.

ACC is currently working with The Institute of Healthy Ageing, Waikato DHB and the University of Auckland to explore how START can improve the experiences of older people following accidents and a similar trial started earlier this year.

To see the original press release and for a link to a presentation given at the March 2014 Disability Support Advisory Committee meeting, go to: http://www.waikatodhb.health.nz/about-us/news-and-events/news/a-better-start-for-older-people-reduces-hospital-stays/

Five types of special events were identified: health fairs, parties, cultural events, special days, and plays. Many focused on breast cancer only, or in combination with other cancers. For cancer screening as an outcome of the events, mammography screening rates ranged from 4.8% to 88%, Pap testing was 3.9%, and clinical breast exams ranged from 9.1% to 100%. For colorectal screening, FOBT ranged from 29.4% to 76%, and sigmoidoscopy was 100% at one event. Outcome measures included intentions to get screened, scheduled appointments, uptake of clinical exams, and participation in cancer screening.

The authors conclude that some special events can lead to increases in cancer screening, especially if they provide onsite screening services. However, there is insufficient evidence to demonstrate that special events are effective in increasing cancer screening.

This is an open access article and is available to read in free full text at: http://www.biomedcentral.com/1471-2458/14/274/abstract

Escoffery, C., et al. (2014). A systematic review of special events to promote breast, cervical and colorectal cancer screening in the United States. BMC Public Health, 14, 274.

The focus is on keeping New Zealanders healthy and out of hospital. You’ll see examples in this booklet where treatments that were traditionally only available in hospital are now provided at local health centres, for instance, intravenous antibiotics for the skin infection cellulitis.

Health services are increasingly available in locations that are more convenient for the patient. This leads to potential health problems being identified earlier, before hospital services are needed. School based health services such as the Rheumatic Fever Prevention Programme are one example you’ll see here.

More health professionals are using telemedicine giving people, particularly those living in rural parts of the country such as Opotiki, better and sometimes faster access to the care they need.

You’ll see examples in this booklet where community-based health professionals are working together with hospital-based clinicians to provide New Zealanders who have long-term conditions with better support so they don’t need hospital treatment. And, better support is available at home for those who’ve recently been discharged, to reduce the likelihood of readmission. The Christchurch-based mobile pharmacist who is helping people manage their medications at home and a similar initiative in Tauranga are two examples shown here.

Care Closer to Home is dedicated to New Zealand’s health professionals – the hospital-based clinicians, the GPs, nurses, midwives, pharmacists, physiotherapists and caregivers who are working together creating better health services in your community.

To download the booklet in full text, go to:  http://www.health.govt.nz/publication/care-closer-home

Ministry of Health (2014). Care Closer to Home. Wellington: Ministry of Health.

Based on questionnaires completed by 581 of the 844 smokers living with mental illness who registered for the programme, the authors estimated the cessation rate as 15.3%. They note that "cessation rates were higher for those who attended more sessions, had decided at registration that they wanted to quit or had a lower level of nicotine dependence".

To read the full abstract, and for information on how to access the full text, go to: http://dx.doi.org/10.1136/tobaccocontrol-2013-051179 or contact your DHB library, or organisational or local library for assistance.

Ashton, M., et al. (2015). Evaluation of a community-based smoking cessation programme for people with severe mental illness. Tobacco Control, 24(3), 275-280

The authors identify three core themes:

• patients’ health beliefs affect their participation 
• patients’ experiences differ from their experiences with hospital-based care
• patients and providers value the role of nurses differently in community-based care.

The authors conclude that patients who participated in these interventions "... reported greater satisfaction when [specialised community-based care interventions] helped them better understand their diagnosis, facilitated increased socialization, provided them with a role in managing their own care, and assisted them in overcoming psychological and social barriers".

Available to read in free full text at:  http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3817855/

Winsor, S., et al. (2013). Experiences of patient-centredness with specialized community-based care: A systematic review and qualitative meta-synthesis. Ontario Health Technology Assessment Series, 13(17), 1-33.

As the focus is on ‘home-like’ residential services, this guide does not apply to hospital-level care.

The guidance is based on current good practice, legislation, best available evidence and published guidelines. It is consistent with the New Zealand medicines strategy, Actioning Medicines New Zealand (Associate Minister of Health and Minister of Health 2010).

The guide is designed to support good practice and policy development. It does not replace sound clinical judgement, organisation-specific policies and procedures, or current legislation. The appendices include resources that may be useful for operational staff and for people taking medication.

The Guide may be referenced in audits and evaluations of services for which it was developed.

To access the Guide, go to:  http://www.health.govt.nz/publication/medicines-management-guide-community-residential-and-facility-based-services-disability-mental

Ministry of Health (2013). Medicines management guide for community residential and facility-based services – disability, mental health and addiction. Wellington: Ministry of Health.

The booklet showcases eight integrated health services operating throughout New Zealand.  It provides real-life solutions they have developed for tackling challenges, examples of developments that have been effective, and advice from those who have already gone through the transition to integrated models of care.

The booklet is available from the RNZCGP website, at: http://www.rnzcgp.org.nz/assets/documents/RNZCGP-Integrate-and-Innovate.pdf

The pilot aimed to improve outcomes for patients; create access to better, more integrated care outside hospital; reduce unnecessary hospital admissions; and enable effective working of professionals across provider boundaries.

The period of the evaluation was September 2011 to July 2012, when the pilot was in its early stages of development. The study was funded by the Imperial College Healthcare Charity and comprised four distinct streams of work, each generating a distinct research volume, on which this research summary is based:

•     Strategic implementation and the policy context (Nuffield Trust)
•     Quality of care and health outcomes (Imperial College London)
•     Understanding patient and provider experience and communication (Imperial College London)
•     Impact on service use and cost (Nuffield Trust).

Access to the full text of the report is free online at: http://www.nuffieldtrust.org.uk/publications/evaluation-first-year-inner-north-west-london-integrated-care-pilot

They focus on provider perceptions of cultural competency among local service organisations and how this influenced trust and desire to work together for the benefit of families. Twenty-one of 27 selected organisations responded to the online social network survey, and 14 key informant interviews were conducted. 

The authors conclude that perceived cultural competency affected the degree of trust and collaboration between services when addressing the needs of recent immigrant families. 

To view the full abstract and for information on how to access the full text, go to:
http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=8822291&fulltextType=RA&fileId=S1463423612000254 or contact your DHB library, or organisational or local library for assistance.

Isaacs, S., et al. (2013). Competence trust among providers as fundamental to a culturally competent primary healthcare system for immigrant families. Primary Health Care Research & Development, 14(1), 80-89.

This briefing shows how the community health sector in the UK is driving the transformation of local care systems and how innovative community healthcare providers are enabling people to stay healthy and independent and avoid crises that lead to unplanned hospital admissions.

This briefing also details the challenges that need to be overcome to build upon this work and drive forward the necessary shift of care into the community.

The briefing is available to read in full text at: http://www.nhsconfed.org/Publications/briefings/Pages/Transforming-local-care.aspx

NHS Confederation (2013). Transforming local care: Community healthcare rises to the challenge. Briefing, 258.

The mission of PCD is to promote the open exchange of information and knowledge among researchers, practitioners, policy makers, and others who strive to improve the health of the public through chronic disease prevention.

The vision of PCD is to be the premier forum where practitioners and policy makers inform research and researchers help practitioners and policy makers more effectively improve the health of the population.

Articles focus on preventing and controlling chronic diseases and conditions, promoting health, and examining the biological, behavioral, physical, and social determinants of health and their impact on quality of life, morbidity, and mortality across the life span.

A range of case management interventions were identified, with nine of 11 trials showing no reduction of unplanned hospital admissions with case management compared with usual care.

To view the full abstract and for information on how to access the full text, go to:
http://fampra.oxfordjournals.org/content/30/3/266 or contact your DHB library, or organisational or local library for assistance.

Huntley, A. L., et al. (2013). Is case management effective in reducing the risk of unplanned hospital admissions for older people? A systematic review and meta-analysis. Family Practice, 30(3), 266-275.

Kevin Lichtwark experienced problems with his balance after undergoing coronary surgery and it left him feeling “incompetent and very down”. 

Two months later, thanks to persistent support from Waikato DHB’s START team, the 77-year-old Hamilton man’s physical and emotional stability have improved “out of sight”.

START stands for Supported Transfer and Accelerated Rehabilitation Team and is a multidisciplinary group with expertise in rehabilitation. The team works with patients and their families in the patient’s own home to set rehabilitation goals and help patients to reach those goals.

In Kevin’s case, members of the START team assisted him almost every day twice a day for five weeks until his balance and confidence were restored. Kevin was so impressed with the service he hand-wrote his gratitude to START staff. 

“Because of my age, I wasn’t the best at all. I was flipping all over the show. I felt very low because usually if I am going to do something, I’ll just do it,” he said. 

“However, START staff walked me through it. They helped me with strength and balance exercises. They showered me. They called at night. They made sure I took my medication. All until I could get my balance back.”

Journeying the road to recovery within the comfort of his own home meant that Kevin was able to mend more quickly. 

“Here at home I have my wife and I have familiarity. It prevented me from lying in hospital and thinking the worst. It was incredible – I’m sure I got better faster because of it,” he said. 

START staff coached Kevin through balance exercises at his kitchen bench, and later in the six weeks when his stability improved they supported him to stroll outside in the sun. 

“The exercises help to build stamina, which is important for patients both physically and emotionally,” START healthcare assistant Margaret Maxwell said. 

Thanks to the START team Kevin has gone from shaky to strong in a space of time he recognises as impossible had he spent it in hospital. 

“I know sometimes these teams are underappreciated, but I want to genuinely say that the START staff do a great job. My balance has improved out of sight and I am now feeling good about myself. You must keep this service going.”

The START service began operating in Hamilton in October 2011, started in Thames/Hauraki and South Waikato from 1 February, 2012 and now operates DHB wide. 

For more information about the START programme and to hear Kevin speak for himself about the START programme, visit www.waikatodhb.health.nz/START

In their review, they investigate whether such effects might be replicated in community settings, including primary care. They review translational studies to assess the the impact of diabetes prevention interventions delivered outside large randomised trials.

This article is available to read in full text at: http://onlinelibrary.wiley.com/doi/10.1111/dme.12018/full

Johnson, M., et al. (2013). Can diabetes prevention programmes be translated effectively into real-world settings and still deliver improved outcomes? A synthesis of evidence. Diabetic Medicine, 30(1), 3-15.

This vision builds on ‘Compassion in Practice’, the national vision for nurses midwives and care staff. It was developed by a strategic partnership of the Department of Health, NHS Commissioning Board Authority, The Queen’s Nursing Institute, and with the district nurse leaders and practitioners. The vision recognises the unique and specialist contribution of district nurses and their teams.

It sets out the strong foundations of district nursing services:

• 6Cs – enduring values underpinning the service and delivery
• trust – which starts with therapeutic relationships between patients and carers
• partnerships across GP and other services – collaborative working across agencies to support care
• supporting transition of care – working with partners to provide seamless support including discharge planning, transition to residential or hospice care
• supporting patient choice – working with patients and carers to encourage active participation in care and decision making
• managing risk – reducing social isolation through supportive care co-ordination, supporting the needs of carers and safeguarding vulnerable patients.

It also outlines the developments and innovations that ensure services can meet current and future needs.

To download the document, go to: http://www.dh.gov.uk/health/2013/01/vision-district-nursing/

The authors report that the higher success rates for “specialist” practitioners in the English stop-smoking services are partly attributable to more extensive training and supervision and greater adherence to evidence-based practice.

To view the full abstract and for information on how to access the full text, go to:
http://ntr.oxfordjournals.org/content/15/7/1239 or contact your DHB library, or organisational or local library for assistance.

McDermott, M.S., et al. (2013). Factors associated with differences in quit rates between “specialist” and “community” stop-smoking practitioners in the English stop-smoking services. Nicotine & Tobacco Research, 15(7), 1239-1247.

A relationship initiated by Waikato District Health Board staff and community health workers in the Huntly area has paved the way for better access to health services for Māori.
It’s also saving a lot of time and cutting costs.

Allied Health’s Ngaruawahia-based team have slashed their “no show” numbers and gained a better uptake from many Māori families by linking with Waikato’s Raukura Hauora O Tainui’s disability support team, chronic disease management nurse, and community health workers.

The DHB's Allied Health professional team is made up of physiotherapist Shelley McConnel, social worker Stephen Chong and occupational therapist Andrew Parkin.

Previous client misunderstandings about access to housing modifications and adaptive equipment have been gradually reduced since Andrew attended kaumatua meetings to explain his role and discuss the issues.

Community Health social work uses a strength-based perspective assisting people to help themselves with existing resources and sourcing new ones. “This includes working with agencies that already have strong working relationships with new and existing clients and Raukura Hauora O Tainui have been very responsive to working collaboratively,” Stephen says.

Physiotherapist Shelley McConnel used to have a big file of referrals for people she never saw as they weren't comfortable to accept interventions they didn’t understand from someone they didn’t know.

“Raukura Hauora O Tainui are part of the local community and are known to them. so now I phone the health care workers, they arrange for me to visit with them, introducing me, also keeping me up to date if needs change later on,” says Shelley.

The Raukura team help DHB staff meet with clients who are reluctant, shy or difficult to contact.

“They help us to contact and establish positive working relationships with whanau in the community,” Andrew says. “They are able to address specific barriers to whanau accessing services, help to explain our roles and the treatments we offer.”

Andrew says that means forming a relationship with the patient, and addressing the whole person.

Raukura Hauora O Tainui have identified benefits for them by linking with the DHB team – working together to solve problems and link their clients to other services as necessary – and getting to the heart of clients’ issues.”

Raukura health care worker Max Noda says a trust has built up. Processes and criteria are explained and it also helps with pre-screening of available DHB services.

Andrew says Raukura gets direct access to his team's multidisciplinary expertise. “Many local people are able to access our expert assessment and treatment in their own community. And being local, we are responsive to their clients’ needs, and able to be flexible in how we work.”

The two teams have been meeting formally for two years, usually twice a year. It’s a chance for DHB initiatives and any policy and criteria changes to be outlined, to strategise over individual patients, to share information, and to discuss problems like transport to the hospital.

“So now if we have a problem we can go straight to the Raukura team, we know who to call,” Andrew says.

“We are now more responsive to what’s happening in the community, and why clients have missed appointments.”

When an elderly man was struggling at home, the Raukura community health team got his housework sorted. His health came right as his living conditions improved and DHB services were accessed.

“That’s when sometimes we need to refer to an agency that goes the extra mile,” says Stephen.

The goal of the Pimatisiwin Journal is to promote the sharing of knowledge and research experience between researchers, health professionals, and Aboriginal leaders and community members. The journal provides a forum for this diverse population to publish on research process and findings in a cross-disciplinary, cross-cultural setting. The primary focus is on health and health research in Indigenous communities, broadly defined. Articles can be of interest to many fields, including sociological, psychological, medical, anthropological, experiential, methodological, both qualitative and quantitative in nature.

Overall, the authors suggest that review of the literature suggests there is considerable uncertainty around the effectiveness and resource implications of the various model configurations and delivery approaches. In this paper, they review the current evidence on the efficacy of such programs, using the Australian Transition Care Program as a case study.

This is an open access article and is available to read in full text at: http://www.biomedcentral.com/1471-2318/12/6/

Gray, L.C., et al. (2012). How effective are programs at managing transition from hospital to home? A case study of the Australian transition care program. BMC Geriatrics, 12:6.

“We are thrilled to present this award to Helen,” PHA spokesperson Lisa McNab said at the PHA’s annual conference at Pipitea Campus, Victoria University, Wellington today.

“Helen has used her experience as a mother of a child with rheumatic fever as her own trajectory into the Maori health sector. Her work and national profile are impressive. She now leads the prevention of rheumatic fever in Maori communities around the country.”

To read the full story in Scoop, go to: http://www.scoop.co.nz/stories/GE1209/S00019/rheumatic-fever-champion-wins-tu-rangatira-mo-te-ora-award.htm

Ten studies examining a range of complex interventions totalling 3407 patients with multimorbidity were identified. All were randomised controlled trials with a low risk of bias. 

All studies involved complex interventions with multiple components. In six of the 10 studies the predominant component was a change to the organisation of care delivery, usually through case management or enhanced multidisciplinary team work. In the remaining four studies, intervention components were predominantly patient oriented.

Overall the results were mixed, with a trend towards improved prescribing and drug adherence. The results indicated that it is difficult to improve outcomes in this population but that interventions focusing on particular risk factors in comorbid conditions or functional difficulties in multimorbidity may be more effective. 

The authors conclude that evidence on the care of patients with multimorbidity is limited, despite the prevalence of multimorbidity and its impact on patients and healthcare systems. Interventions to date have had mixed effects, although are likely to be more effective if targeted at risk factors or specific functional difficulties. 

This is an open access article and is available to read in free full text at: http://www.bmj.com/content/345/bmj.e5205

Smith, S.M., et al. (2012). Managing patients with multimorbidity: Systematic review of interventions in primary care and community settings. BMJ, 345:e5205

Health and Social Care in the Community publishes systematic and narrative reviews, policy analysis and empirical qualitative or quantitative papers including papers that focus on professional or patient education.

Individual semi-structured interviews and focus groups in four case-studies were held with a total of 54 participants. "A `quasi-family' model of leadership emerged, with significant emphasis on the importance of personal relationships and support. Nursing grade had a greater impact on perceptions of leadership than geographical context or professional and clinical focus".

To read the full abstract and for information on how to access the full text, go to: http://www.ingentaconnect.com/content/bsc/jan/2012/00000068/00000007/art00004  or contact your local or organisational library for assistance.

Cameron, S., et al. (2012). Exploring leadership in community nursing teams. Journal of Advanced Nursing, 68(7), 1469-1481.

Health issues related to changes in lifestyle are emerging with the long-term settlement of refugee communities. Reduced physical activity, diets high in fats and sugars and smoking place refugee groups, particularly those from South Asian, Middle Eastern and African groups, at risk of cardiovascular disease, obesity and diabetes. The inclusion of refugee groups and their ethnic communities in mainstream prevention, screening and intervention services and programmes is of importance in maintaining good health outcomes for settled communities.

To download the handbook, or for information on ordering copies, go to: http://www.health.govt.nz/publication/refugee-health-care-handbook-health-professionals

To read the article, go to: http://www.guardian.co.uk/healthcare-network/2012/jun/13/new-zealand-healthcare-services

Fifty-two studies were included. Many different intervention types and settings were associated with change in health literacy (73% of all studies) and change in SNAPW (75% of studies). More low intensity interventions reported significant positive outcomes for SNAPW (43% of studies) compared with high intensity interventions (33% of studies). More interventions in primary health care than the community were effective in supporting smoking cessation whereas the reverse was true for diet and physical activity interventions.

Conclusion: Group and individual interventions of varying intensity in primary health care and community settings are useful in supporting sustained change in health literacy for change in behavioral risk factors. Certain aspects of risk behaviour may be better handled in clinical settings while others more effectively in the community. The authors note that their findings have implications for the design of programmes.

Taggart, J., et al. (2012). A systematic review of interventions in primary care to improve health literacy for chronic disease behavioral risk factors. BMC Family practice, 13:49, doi:10.1186/1471-2296-13-49

This is an open access article, available to read in full text at: http://www.biomedcentral.com/1471-2296/13/49/abstract

Goris, J., et al. (2013). Effectiveness of multicultural health workers in chronic disease prevention and self-management in culturally and linguistically diverse populations: A systematic literature review. Australian Journal of Primary Health, 19(1) 14-37.

To read the full abstract and for information on how to access the full text, go to: http://www.publish.csiro.au/nid/261/paper/PY11130.htm or contact your local or organisational library for assistance.

The structured group education programme for six hours was delivered in the community by two trained healthcare professional educators.

This was a multicentre cluster randomised controlled trial in primary care, with randomisation at practice level. The study was set in 207 general practices in 13 primary care sites in the UK, and 731 of the 824 participants in the original trial were eligible for follow-up after three years.

Based on the results, the authors conclude that "... a single programme for people with newly diagnosed type 2 diabetes mellitus showed no difference in biomedical or lifestyle outcomes at three years although there were sustained improvements in some illness beliefs".

Khunti, K., et al. (2012). Effectiveness of a diabetes education and self management programme (DESMOND) for people with newly diagnosed type 2 diabetes mellitus: Three year follow-up of a cluster randomised controlled trial in primary care. BMJ, 344:e2333.

This is an open access article, available to read online at: http://www.bmj.com/content/344/bmj.e2333