P ACIFIC PEOPLES ’ USE OF PRIMARY CARE Timothy Kenealy, Debbie Ryan, Margaret Southwick RNZCGP Conference September 2011 Pacific Perspectives, University of Auckland, Whitireia Polytechnic

2 D OMAINS A health services view Health service trends over 10 years Beliefs and responses A Pacific view Pacific peoples’ perceptions and understandings of health, illness and primary health care systems Pacific Perspectives, University of Auckland, Whitireia Polytechnic

F EATURES OF P ACIFIC POPULATION Young Rapid growth Social networking Transnational mobility All Pacific are not the same Income, employment, education, housing Least gain Pacific Perspectives, University of Auckland, Whitireia Polytechnic

H OW ARE WE DOING ? 1 Life - 8 years less than European least gain mortality amenable to health services Higher ASH 2.5x European 2008/9 close contact infectious diseases, child respiratory & skin infections Higher severe asthma symptoms Lower diagnosed asthma and use of preventer medications Higher mental illness poor uptake of mental health services Higher rates of diabetes, mortality and complications Higher rates of stroke and stroke mortality greater dependence after stroke Higher cancer mortality once diagnosed Higher risk factors weight, smoking Pacific Perspectives, University of Auckland, Whitireia Polytechnic

H OW ARE WE DOING ? 2 Similar rates of primary care use since higher subsidies But presume needs higher Higher use of A&M clinics & ED Lower levels of satisfaction with their experiences of primary health care Higher self reported unmet needs due to cost Higher screening for diabetes and CVD bp 56% v 50% Diabetes 30% v 17 (MoH & MPIA, 2004) Immunisation up to 93% at 2 years Pacific Perspectives, University of Auckland, Whitireia Polytechnic

BarriersResponses Cost transport Capitation & increased subsidies POAC Outreach Language & culture family commitments understanding the nature/necessity of an appointment lack of time with doctor bringing and minding of other children Cultural competence Pacific providers Community health workers Translators Systems appointment times inflexible employment long waiting times Appointment systems Chronic Care Management Care Plus

W HAT ( PROBABLY ) WORKS ? 1 culturally appropriate health education language-specific resources involving family members Pacific health providers integrated services, “one-stop shop” church-based delivery mobile / outreach services transport workplace-based healthcare Pacific Perspectives, University of Auckland, Whitireia Polytechnic

W HAT ( PROBABLY ) WORKS ? 2 school-based nursing opportunistic services, eg imms in hospital flexible appointments nurse-led programme provider – community collaboration recording and tracking systems monitoring of outcomes Pacific Perspectives, University of Auckland, Whitireia Polytechnic

W HAT ( PROBABLY ) WORKS ? 3 systematic care (Kenealy et al, 2010) extended consultations (Kenealy et al, 2010) involving family, primary-secondary integration, involving extended team, home visits, case management (Rea et al, 2009, 2010a, 2010b, Sheridan et al, 2009) Practitioner community participation (Buetow et al 2010) Pacific Perspectives, University of Auckland, Whitireia Polytechnic

D OMAIN 2 P ACIFIC PERSPECTIVES Diverse Pacific ethnic groups Differences in language, religion, community organisation Emerging differences in measures of health and service use between Pacific groups Identities are fluid, multiple and contested

A PACIFIC VIEW This presents challenges not only for this research, but also for health care providers who want simple remedies for complex Pacific health issues.

Q UALITATIVE RESEARCH APPROACH Narrative methodology Language and translation “sufiga o le tuaoi” – negotiating boundaries Project outcomes – consciousness raising, discourse, capability development Pacific Perspectives, University of Auckland, Whitireia Polytechnic

W HAT CAN YOU DO ? As person & practitioner within consultation As leader within your own health care team As expert within health system As citizen