Is there equity of patient health outcomes across models of general practice in Aotearoa New Zealand? A national cross-sectional study

作者：Nicolette Sheridan, Tom Love, Timothy Kenealy, The Primary Care Models Study Group, 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：International Journal for Equity in Health · 年份：2023 · DOI：10.1186/s12939-023-01893-8 · 被引用次数：22 · 研究领域：Primary Care and Health Outcomes、Athletic Training and Education、Health Policy Implementation Science

BACKGROUND: Primary care in Aotearoa New Zealand is largely delivered by general practices, heavily subsidised by government. Te Tiriti o Waitangi (1840) guarantees equal health outcomes for Māori and non-Māori, but differences are stark and longstanding. Seven models of primary care have evolved. We hypothesised that patient health outcomes would differ between models of care; and that Māori, Pacific peoples and those living in material deprivation would have poorer outcomes from primary care. METHODS: We conducted a cross-sectional study of patient-level data from national datasets and practices, at 30 September 2018, using multilevel mixed effects regression analyses (patients clustered within practices). Primary outcomes, considered to be measures of unmet need for primary care, were polypharmacy (≥ 65 years), HbA1c testing in adults with diabetes, childhood immunisations (6 months), ambulatory sensitive hospitalisations (0-14, 45-64 years) and emergency department attendances. Explanatory variables adjusted for patient and practice characteristics. Equity, by model of care, ethnicity and deprivation, was assumed if they showed no significant association with patient outcomes. Patient characteristics included: age, ethnicity, deprivation, multi-morbidity, first specialist assessments and practice continuity. Practice characteristics included: size, funding and doctor continuity. Clinical input (consultations and time with nurses and doctors) was considered a measure of pr...