Limited knowledge about the nursing workforce in New Zealand general practice inhibits the optimal use of nurses in this increasingly complex setting. Using workforce survey data published biennially by the Nursing Council of New Zealand, this study describes the characteristics of nurses in general practice and contrasts them with the greater nursing workforce, including consideration of changes in the profiles between 2015 and 2019. The findings suggest the general practice nursing workforce is older, less diverse, more predominately New Zealand trained and very much more likely to work part-time than other nurses. There is evidence that nurses in general practice are increasingly primary health care focused, as they take on expanded roles and responsibilities. However, ambiguity about terminology and the inability to track individuals in the data are limitations of this study. Therefore, it was not possible to identify and describe cohorts of nurses in general practice by important characteristics, such as prescribing authority, regionality and rurality. A greater national focus on defining and tracking this pivotal workforce is called for to overcome role confusion and better facilitate the use of nursing scopes of practice.
Background Prior research findings are mixed regarding whether prosocial behavior is positively or negatively related to socioeconomic status and its correlates, such as economic pressure. This may be due to the lack of considerations for the type of prosocial behavior. Aims In this study, we aimed to examine how six types of prosocial behavior (i.e., public, anonymous, compliant, emotional, dire, and altruistic) are related to economic pressure among early adolescents. We hypothesized that family economic pressure would be associated with each type of prosocial behavior in differing ways. Materials & Methods Participants were 11–14 years old (N = 143, Mage = 12.2 years, SDage = 0.87, 63 boys, 1 trans‐identified boy, 55 girls), early adolescents and their parents. Among them, 54.6% were non‐Hispanic/Latinx (NH/L) White, 23.8% were NH/L Black, 11.2% were NH/L Asian, 2.1% were NH/L Multiracial, and 8.4% were Hispanic/Latinx. Parents reported family economic pressure and adolescents' six types of prosocial behavior. Results Path analysis revealed that economic pressure was negatively associated with emotional and dire prosocial behavior over and above age, gender, and race/ethnicity. Family economic pressure was unrelated to public, anonymous, compliant, and altruistic prosocial behavior. Discussion These findings show some support for the Family Stress Model, such that economic stress might hinder youth's prosocial development. At the same time, youth may have similar levels of certain types of prosocial behavior regardless of their family's economic pressure. Conclusion This research provided insight into the complex relation between economic pressure and youth's prosocial behavior which varies depending on the type of behavior.
Background Primary care in Aotearoa New Zealand is largely delivered by general practices which are heavily subsidised by government. At least seven models of primary care have evolved: Traditional, Corporate, Health Care Home, Māori practices, Pacific practices, and practices owned by Primary Health Organisations/District Health Boards and Trust/Non-Governmental Organisations. Te Tiriti o Waitangi (1840) guarantees equal outcomes for Māori and non-Māori, but stark differences are longstanding and ongoing. Pacific peoples and those living with material deprivation also have unequal health outcomes. Methods Cross-sectional study (30 September 2018), data from national datasets and practices at patient level. We sought associations between practice characteristics and patient health outcomes, adjusted for patient characteristics. Practice characteristics included: model of care, size, funding model, rurality; number of consultations and time spent with nurses and doctors; practice and doctor continuity. Six primary outcomes measures were chosen: polypharmacy (≥ 65 years), HbA1c testing in adults with diabetes, immunisations (6 months), ambulatory sensitive hospitalisations (0–14, 45–64 years) and emergency department attendances. Results The study included 924 general practices with 4,491,964 enrolled patients. Traditional practices enrolled 73% of the population, but, on average, the proportion of Māori, Pacific and people living with material deprivation was low in any one Traditional practice. Patients with high needs disproportionately clustered into Māori, Pacific and Trust/NGO practices. There were multiple associations between models of care and patient health outcomes in fully-adjusted regressions. Patient health outcomes were most strongly associated with: age, Māori or Pacific ethnicity, deprivation (IMD), multi-morbidity (M3), clinical input, number of first specialist assessments, changing practice, and prescribing (SSRIs, tramadol, antibiotics). Being Māori or Pacific remained associated with poorer outcomes after full adjustment including measures of deprivation. Patients with high health need received more clinical input but this was insufficient to achieve equity of outcomes. Practice-level variance was highest for emergency department attendances. Conclusions Resource models of care with disproportionately high and complex patient health need (Māori, Pacific and Trust/NGO practices). Associations between patient and practice characteristics, and patient health outcomes, should be central to investment decisions.
Background Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into different models of primary care. We describe nurse work in relation to these models of care; populations with high health need; and patient health outcomes. Methods Cross-sectional study (30 September 2018), data from national datasets and practices at patient level. Six primary outcome measures were selected because they could be improved by primary care: polypharmacy (≥65 years), HbA1c testing in adults with diabetes, immunisations (6 months), ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Analysis adjusted for patient and practice characteristics. Results Nurse FTE, and combined nurse, nurse practitioner and general practitioner FTE, were substantially higher in Trust/NGO, Māori, and Pacific practices than Traditional, Corporate, or Health Care Home practices. A progressive increase of clinically complex patients was associated with more clinical input and higher scores on all outcome measures. The highest rates of nurse consultations afterhours and with unenrolled patients, improving access, were in PHO/DHB, Pacific, Trust/NGO and Māori practices. Compared to general practitioners, nurses undertook more cardiovascular risk assessment in all models of care except PHO/DHB, and more cervical screening in Pacific, Trust/NGO and Māori practices. The highest rates of preventative care by nurses (cervical screening, cardiovascular risk assessment, PHQ9 assessment, HbA1c testing) were in Māori, Trust/NGO and Pacific practices. There was an 8-fold difference, across models of care, in percentage of PHQ9 undertaken by nurses and a 5-fold difference in cervical screening and HbA1c testing. Work not attributed to nurses in the practice records meant nurse work was underestimated to an unknown degree. Conclusions Transferring work to nurses in Traditional, Health Care Home, and Corporate practices, would release GP FTE to be utilised for other work. Worse patient health outcomes were associated with higher patient need and higher clinical input. It is plausible that there is insufficient clinical input to meet the degree of patient need. More practitioner FTE is required, especially in practices with high volumes of complex patients.
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