Inequities in colonoscopy access: a retrospective audit of accepted referrals in Te Whatu Ora Counties Manukau.

AIM: Maori are more likely to have colorectal cancer (CRC) diagnosed in the emergency setting.[[1]] CRC patients diagnosed in the emergency setting have a higher stage, increased surgical complications and worse survival than those diagnosed elsewhere.[[2]] Access to colonoscopy is crucial to diagnosing CRC prior to an emergency presentation. This study aims to assess inequities in access to symptomatic and surveillance colonoscopies. METHODS: A retrospective audit of all accepted referrals for symptomatic and surveillance colonoscopies made in Te Whatu Ora Counties Manukau in 2018 (n=7,184) with analysis by multivariate logistic regression. RESULTS: Of the 751 Maori patients, 33.4% were removed off the waiting list and therefore did not have their colonoscopy performed, compared to 24.1% of the 4,047 NZ European patients. Maori patients were significantly more likely to be removed off the waiting list than NZ European patients with an adjusted odds ratio of 1.68 (95% confidence interval [CI] 1.40-2.02). Pasifika patients were significantly more likely to be removed off the waiting list than NZ European patients with an adjusted odds ratio of 2.30 (95% CI 1.92-2.75). CONCLUSIONS: Maori have significantly less access to colonoscopies than NZ Europeans. We suggest improvements to referral systems locally and nationally to facilitate equitable access.

How do New Zealand-trained general surgeons secure a SMO job? Are we effectively retaining our trainees?

BACKGROUND: In the context of increasing shortages in the New Zealand medical specialist workforce, this research seeks to answer the question 'Are we effectively retaining our New Zealand-trained general surgeons?' METHODS: Semi-structured interviews were undertaken with 16 general surgeons. Participants work in New Zealand and internationally. Interviews were transcribed, coded and themed. Thematic analysis was used to interpret the findings. RESULTS: This research finds that we are failing to effectively retain New Zealand-trained general surgeons through haphazard workforce planning and a lack of transparent recruitment processes. General surgeons who choose to take their first SMO role overseas are pushed to do so due to a lack of certainty about job opportunities in New Zealand, bullying, and relative ease of negotiation for job composition and conditions at international hospitals. General surgeons who take their first SMO role in New Zealand feel that securing a job is down to luck, existing relationships with influential people in surgical departments and timing. CONCLUSION: The failure to retain New Zealand-trained general surgeons in the New Zealand specialist workforce is amenable to improvements in workforce planning, improved coordination between clinical and administrative leadership in DHBs, and better career development support for trainees prior to receiving their FRACS and embarking on post-fellowship subspecialist training. Further research into the experiences of trainees and SMOs in general surgery and other surgical subspecialties is required to build a complete picture of the path from trainee to SMO, and areas where interventions could improve retention of New Zealand-trained general surgeons.

Describing the experience of Indigenous peoples with prenatal alcohol exposure and FASD: a global review of the literature to inform a Kaupapa Maori study into the experiences of Maori with FASD.

AIM: This paper reports the findings of a literature review in answer to the research question: "What are the strengths and weaknesses of the existing research into the experience of prenatal alcohol exposure and Foetal Alcohol Spectrum Disorder in Indigenous communities?" METHOD: MEDLINE (Ovid), psychINFO, CINAHL Plus and Web of Science, EMBASE, Informit databases were searched using key words to identify relevant literature. Given the anticipated scarcity of research relevant to our study, no geographic or chronologic limitations were placed on the searches. Studies which were solely descriptive were excluded, but reviews were included. The data analysis was informed by a Kaupapa Maori positioning and the 'CONSIDER' statement on reporting of health research involving Indigenous people. RESULTS: Thirty-four papers met the inclusion criteria. Four main categories of papers were found: protocols/methods development, evaluation of interventions to reduce alcohol-exposed pregnancy, research seeking to understand alcohol use in pregnancy and interventions to improve the experience of people with FASD and their families. Indigenous peoples of Australia, Canada and North America were the participants of the papers found in this review, with only one research study found from Aotearoa New Zealand. CONCLUSION: The existing literature on FASD in Indigenous communities internationally is heavily skewed towards the development and evaluation of interventions to reduce alcohol-exposed pregnancies. There is also a focus on studies which aim to understand and describe the variables which lead to alcohol use among Indigenous communities, and the relationship with alcohol use in the perinatal period. In the last ten years, a number of protocols/methods development for FASD-related interventions in Indigenous communities have been published. There is one published study from Aotearoa in the scientific literature into the experience of Maori with FASD.

Barriers and facilitators for Maori in accessing hospital services in Aotearoa New Zealand.

AIM: This paper reports the findings of a literature review to answer the research question, "What are the barriers and facilitators of access to hospital services for Maori?" METHOD: MEDLINE (Ovid) and PsycINFO were searched using keywords to identify relevant literature published between 2000 and 2020. The data analysis was informed by a Kaupapa Maori positioning and the CONSIDER statement on reporting of health research involving Indigenous peoples. RESULTS: Twenty-three papers met the inclusion criteria. We identified five themes that captured the barriers for Maori accessing hospital services (practical barriers, poor communication, hostile healthcare environment, primary care barriers and racism) and five facilitatory themes were identified (practical facilitators, whakawhanaungatanga, whanau, manaakitanga and cultural safety). CONCLUSION: This article confirms existing knowledge about practical barriers and facilitators to healthcare access for Maori and contributes to an emerging body of evidence about the impact of racism and culturally unsafe services in preventing Maori from accessing healthcare services. The facilitators identified provide a potential roadmap for the redesign of services so they are accessible and effective for Maori. Improving services in this way would support district health boards, the Ministry of Health and professional organisations to comply with their commitments to providing culturally safe services and health professionals.