Patient health outcomes associated with models of general practice in Aotearoa New Zealand: a national cross-sectional study

作者：Nicolette Sheridan, Tom Love, Timothy Kenealy, Nelson Aguirre-Duarte, Bruce Arroll, Carol Atmore, Jenny Carryer, Peter Crampton, Anthony Dowell, Tana Fishman, Robin Gauld, Matire Harwood, Karen Hoare, Gary Jackson, Rawiri McKree Jansen, Ngaire Kerse, Debra Lampshire, Lynn McBain, Jayden MacRae, Jane Mills, John Øvretveit, Teuila Percival, Roshan Perera, Martín Roland, Debbie Ryan, Jacqueline Schmidt‐Busby, Tim Stokes, Maria Stubbe, Sarah Hewitt, Daniel Watt, Chris Peck · 发表于：Research Square · 年份：2022 · DOI：10.21203/rs.3.rs-2310451/v1 · 研究领域：Primary Care and Health Outcomes、Global Health Workforce Issues、Emergency and Acute Care Studies

Abstract 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 a...