Māori a third more likely to be admitted with treatment injuries

Māori are a third more likely to be admitted to hospital with treatment injuries and 43 percent more likely to be admitted because of healthcare complications than non-Māori according to new research.

The research reviewed hospital records from the Lakes and Bay of Plenty regions over five years (2014 to 2018) and covering around 300 treatment injury patients and almost 14,000 people admitted with complications, all over 50 years of age. See NZMJ 21 July 2023.

“There is always the potential for adverse outcomes to occur when you receive any healthcare,” says co-author and pharmacist Dr Joanna Hikaka (Ngāruahine). “Our research showed Māori older adults were more likely to experience adverse outcomes than non-Māori.

“We believe it is important for the New Zealand health system to routinely report adverse outcomes resulting from healthcare and respond when there are differences in outcomes between different groups in the population” Dr Hikaka says.

Treatment injuries, also known as medical misadventure, include the likes of unintentional cuts and punctures during surgery, while complications of healthcare, include infections and reactions to medicines.

Although older Māori were more likely than older non-Māori to be admitted to hospital because of all of these issues, Māori living in the same regions were less likely to have a treatment injury-related ACC claim.

Researchers are calling for a transparent, publicly available monitoring and reporting system so that the health system and providers can respond.

Dr Gina Svensen, lead author of this paper and a junior doctor at Christchurch hospital said, “Our findings highlight inadequacies in the provision of quality healthcare for Māori and prompt further investigation of this at a national level.

“The health system reform provides an opportunity to improve monitoring and reporting of adverse outcomes in healthcare in New Zealand.

“As health professionals, this knowledge can inform and facilitate changes in our practice to address inequities in healthcare for patients across New Zealand.”

More than half of healthcare complications for both Māori and non-Māori related to medications. An example of this might be when a medication used to treat high blood pressure is too strong and leads to very low blood pressure, falls, and injury.

Dr Hikaka said, “As we get older, the way medicines act and react in our body’s changes. Medication reviews that involve discussions between patients and their health professionals can reduce the risk of adverse outcomes and are an important part of ongoing care particularly as people age.”

The researchers at Waipapa Taumata Rau, the University of Auckland are currently working in partnership with Te Arawa Whānau Ora Collective to explore how paeārahi (Whānau Ora navigators) can support koeke (older Māori) to prevent unintentional injuries and to access injury-related care.

Hariata Vercoe, general manager at Korowai Aroha Health Centre in Rotorua, and one of the research investigators says “Paeārahi have been established in the Te Arawa Whānau Ora Collective for over 10 years now, and are great connectors, advisors, navigators and advocates working alongside whānau.

“We now have paeārahi who specialise in injury care which has been of great benefit to koeke.”

The results from the formal evaluation of this service are expected later in the year.

Māori have poorer access to heart-failure medicines than others in Aotearoa another recently published study finds. This is likely to contribute to worse heart failure outcomes for Māori.

Māori may experience more barriers than non-Māori when it comes to taking heart-failure medicines as prescribed, according to new research from the universities of Otago and Auckland.

The researchers looked at data for almost 14,000 heart failure patients between 2012 and 2019 and found a significant disparity between Māori and non-Māori with respect to taking the prescription medicines.

“For people with heart failure, prescription medicines play an important role in improving everyday life and keeping people out of hospital,” says Dr Hikaka, pharmacist and senior research fellow at Waipapa Taumata Rau, University of Auckland.

“But for these medications to be most effective, people need to take medications, to take the right medications for them, and to have access to information to make decisions about their medications.”

Around 170,000 people live with heart disease in Aotearoa New Zealand. Māori and Pacific people don’t live as long as non-Maori and Pacific, by about seven to eight years, predominantly because of heart disease.

“Medications can improve the life of those with heart failure. We need to ensure that health services and systems are working for Māori so that Māori experience these benefits too,” says Dr Hikaka (Ngāruahine), author of this research, published in Drugs & Aging¹.

Associate Professor Hamish Jamieson, geriatrician and specialist in older persons’ health at the University of Otago, who led this research, has experience using this kind of ‘big data’ in research.

The assessments are also known as interRAI and the information can be used for research as people consent to their anonymised data being used at the time of assessment.

“These assessments and data give us the opportunity, at a population level, to identify and respond to unjust variations in healthcare and improve the lives of people in Aotearoa,” says Dr Jamieson. 

As of 1 July 2023, the government has removed the $5 co-payment for prescriptions medicines.

Removing this financial barrier will support increased access to medicines for many. However, Dr Hikaka says medication adherence can be influenced by many other factors, not just cost, as shown by previous research undertaken by the Māori Pharmacists’ Association and National Hauora Coalition.²

“We have talked to Māori across Aotearoa about their experiences of medication adherence. The people we spoke to provided many solutions to improve medication adherence,” Dr Hikaka says.

“These solutions included proactive support by health professionals and acknowledging that medications are just one important component of holistic wellbeing.

“It is not good enough for us just to identify that there are inequities in medication use in Aotearoa, we need to be listening to whānau and acting to address these inequities.”

1.   New research study published in Drugs & Aging: Hikaka J, Abey-Nesbit R, McIntosh B, Schluter PJ, Nishtala PS, Scrase R, Jamieson HA. Utility of Big Data to Explore Medication Adherence in Māori and Non-Māori Community-Dwelling Older Adults with Heart Failure in Aotearoa New Zealand: A Cross-sectional Study. Drugs & Aging. 2023 Jun 29:1-9.

2.   Earlier research that is also referenced: Hikaka J, Parore N, Haua R, Anderson A, Hudson M, McIntosh B, Pewhairangi K, Brown R. Māori, pharmacists, and medicines adherence–A mixed methods study exploring indigenous experiences of taking medicines ‘as prescribed’ and mechanisms of support. Exploratory Research in Clinical and Social Pharmacy 2022 Sep 1;7:100175.