The National Primary Medical Care Survey was undertaken to describe primary health care in New Zealand, including the characteristics of providers and their practices, the patients they see, the problems presented and the management offered. The study covered private general practices (ie, family doctors), community-governed organisations, and Accident and Medical (A&M) clinics and Hospital Emergency Departments.
Māori providers were not explicitly sampled, but were derived through the sampling scheme; the Māori providers included in the study are likely to be a significant proportion of Māori providers nationally, based on evidence gathered via a follow-up survey of primary health care providers. Although, it must be noted that the sample of providers cannot be considered nationally representative, as a definitive and validated Māori primary medical care provider population is not known. It was intended to compare data across practice types as well as over time.
Subsidiary aims included gathering information on the activities of nurses in primary health care, trialling an electronic data collection tool and developing coding software.
This report describes the characteristics of practitioners, patients and patient visits for a sample of 14 primary health care practices classified as Māori primary medical care providers. Other reports in the series describe private family doctors, community-governed non-profits, after-hours activities and other types of practice, and will analyse differences in practice content that have occurred over time or that exist between practice settings.
A nationally representative, multi-stage sample of private general practitioners (GPs), stratified by place and practice type, was drawn. Each GP was asked to provide data on themselves and on their practice, and to report on a 25% sample of patients in each of two week-long periods. Over the same period, all community-governed primary health care practices in New Zealand were invited to participate, as were a 50% random sample of all A&M clinics, and four representative Hospital Emergency Departments.
Medical practitioners in private general practices, community-governed non-profit practices and A&M clinics completed questionnaires, as did the nurses associated with them. Patient and visit data were recorded on a purpose-designed form.
To qualify for inclusion in the study, Māori primary medical care providers, as well as employing GPs, had to meet all of the following four Ministry of Health criteria:
- is an independent Māori health provider
- targets services towards Māori
- has a Māori management structure
- has a Māori governance structure.
The results presented here relate to 28 practitioners (21 doctors and seven practice nurses) employed at 14 Māori provider practices.
The findings include the following:
- All Māori provider practices had separate or external management and the majority had community representation in governance/management. This finding was similar to that for the CGNP practices, but markedly different from private GPs.
- A high percentage of Māori provider practices had undertaken formal community needs assessments, and used locality service planning and inter-sectoral case management, in contrast to private GPs.
- When compared with private GP providers, a higher percentage of Māori providers had written policies on complaints and quality management and operated computerised patient records.
- The percentage of Māori patients was substantially higher in Māori providers (58.9%) than in the other two practice types (11.8% and 19.4%, private GPs and Community Governed Non-profit respectively). It is also worth noting that non- Māori patients also used Māori provider services.
- Compared with private GPs, higher proportions of Māori provider practices provided maternity care, group health promotion, and complementary/alternative care. However, fewer Māori provider practices offered independent practice nurse consultations.
- Doctors working in Māori provider practices tended to be young, relatively new to both general practice and to the Māori provider practice, and female, and a higher percentage had qualified outside New Zealand in contrast to other provider types.
- Males under five years (20.8%) accounted for a greater proportion of consultations than did females under five years (10.2%). Males 75 years and over (3.8%) accounted for somewhat fewer of the consultations than did their female counterparts (6.7%). Women between the ages of 15 and 44 years (38.9%) accounted for more consultations than men between these ages (26.9%). This is likely to reflect consultations for reproductive issues in women of these ages, but may also indicate the relative under-use by or depleted numbers of middle-aged men.
- Māori provider practices had similar numbers of medical and nursing staff compared with Community-governed Non-profit practices and “private” practices, but employed more community health workers.
- Māori providers served a young patient population, of whom a high proportion were Māori and a disproportionate number were drawn from the most deprived geographical areas.
- Over 77% of the patients seen in this survey lived in households from high deprivation (deciles 8, 9 and 10) areas.
- Two-thirds of patients in the survey possessed a Community Services Card.
- Practice nurses saw a higher proportion of patients from high deprivation areas compared with doctors (58.4%). This suggests that Māori providers provide significant access to practice nurses for patients from high deprivation areas.
- Over 90% of patients regarded the practice as their usual source of care, slightly less than half were high users (had been to the GP at least six times in the previous year), and just over a tenth of visits lasted longer than 20 minutes.
- The number of reasons-for-visit was similar for males (1.35 per visit) and females (1.39 per visit). The four most common reasons noted were action, respiratory reasons, investigations and non-specific symptoms.
- About one-third of problems managed were newly identified. Practice nurses tended to see more long-term, follow-up and preventive care patient visits than doctors.
- A higher proportion of visits by the 25-44 years age group attending Māori providers involved three or four different problems compared with private GPs. This may reflect earlier onset of multiple pathologies in patients attending Māori providers.
- The total (all ages) number of treatment items per 100 problems was similar between Māori and private GP providers for “all treatment items” and “other treatment items”. However, the number of prescription items per 100 problems was slightly higher for Māori providers.
- Overall 27.1% of consultations included a test or investigation of some sort, 16% included a laboratory test, and imaging (such as X-rays and ultrasounds) was requested in 4% of consultations. Males had lower rates of investigation than females across all age groups.
- Just over 60% involved the writing of a prescription. Three-month follow-up was recommended in 62.3% of visits, and referrals were made in 17.9% of visits, and 1.7% of visits resulted in an emergency referral.
This is the first paper to report quantitative results on Māori providers of primary medical care. The results indicate that these practices are serving their intended populations and are demonstrating important characteristics of responsiveness to their needs. Care must be taken when interpreting the results of these analyses for two reasons. Firstly, the sampling framework used to enrol participants did not allow for a specific Māori sample and some Māori providers may have been missed. The sample cannot, therefore, be stated to be nationally representative of Māori providers; however it is expected that a reasonable cross-section are included. Secondly, tests of statistical significance have not been undertaken; any apparent differences have not been subjected to statistical scrutiny.
The findings provided here lend support to the policy of Māori provider development. In addition, they suggest Māori providers are increasing access to care for those who live in high deprivation areas. With respect to alignment with government policy, addressing barriers to accessing care and fostering an environment that is conducive to achieving Māori health gain Māori providers are out-performing other providers; the contributing areas are, for example, organisational/governance/management, ethnicity profile of staff, utilisation of community health workers, and the patient register profile. The proportion of Māori doctors working within Māori providers was higher than in other providers. However, this was far less than the proportion of Māori people in the general population, therefore supporting policies to assist Māori health workforce development.
The views expressed in this occasional paper are the personal views of the authors and should not be taken to represent the views or policy of the Ministry of Health or the Government. Although all reasonable steps have been taken to ensure the accuracy of the information, no responsibility is accepted for the reliance by any person on any information contained in this occasional paper, nor for any error in or omission from the occasional paper.