Improving health outcomes for populations and for people

EDITORIALSFROM THE EDITORImproving health outcomes for populationsand for peopleFelicity Goodyear-Smith MBChB, MD,FRNZCGP, EditorJ PRIM HEALTH CARE2012;4(4):266–267.CORRESPONDENCE TO:Felicity Goodyear-SmithProfessor and GoodfellowPostgraduate Chair,Department of GeneralPractice and PrimaryHealth Care, TheUniversity of Auckland,PB 92019 Auckland,New Zealandf.goodyear-smith@auckland.ac.nzSocioeconomic position (SEP) can be animportant determinant for health. It can beassessed by different measures that look atfactors such as occupation, education, income, livingstandards or area of residence—none of whichcapture the full picture. Our lead article comparesthe performance of five measures in predictinghealth outcomes, concluding that NZiDep(an individual-level index of social deprivation),and ELSI, an index of living standards, are thebest predictors, and NZDep (obtained from geocodedaddresses) is a reasonable alternative whenimpractical to use individual measures. 1 In hisguest editorial, Professor Tony Blakely exploresthe two main reasons for considering SEP: toadjust for it as a confounder, and to determine theassociation of a socioeconomic factor with a givenhealth outcome. 2 For the former, he concludesthe best approach is to adjust for NZDep and asmany other factors as possible, and for the latter,NZiDep is a robust measure.Certainly SEP can be a major contributing factorin health outcomes. A nutritional survey inHawke’s Bay conducted among people aged 65and older found that poor nutrition was associatedwith being Maori and living alone. 3 Thismonth’s Back to Back debates whether or notthe government should cap the health budgetand spend more on housing and food. ProfessorHowden-Chapman argues that, given a constrainedfiscal environment, investing in housingrather than hospitals will lead to better healthoutcomes, 4 whereas Dr White counters thatthe best investment we can make is to increasespending on health. 5This issue includes two studies on GreenPrescriptions—a proven means of increasingphysical activity and improving health outcomes.One study looked at barriers perceivedby general practitioners (GPs) to their olderpatients carrying out a Green Prescription, andidentifies practical strategies for GPs to helpthese patients increase their exercise levels. 6Another study involved Pacific women whosuccessfully followed a Green Prescription programme,finding that the social aspect was themain reason the women enjoyed and completedthe programme. 7A collaborative approach to managing chronicdisorders and multi-morbidities is likely toimprove health outcomes. Healthcare ImprovementCollaboratives have been established aimedat enhancing practices’ management of long-termconditions, leading to better clinical outcomes,facilitated planned care and quality improvement.An evaluation of this initiative found modestclinical improvements, but identified difficultiespractices encountered in implementing thesechanges and being able to monitor their progress. 8GPs caring for patients with chronic diseasesand comorbidities have so many diverse thingsto consider. A population survey about awarenessof drug safety and possible adverse effectsof prescription and over-the-counter medicationsadults were taking revealed a very low level ofdrug safety knowledge, with the recommendationthat primary care practitioners must play arole in promoting drug safety awareness. 9 GPsare unlikely to suggest to diabetic patients thatthey should consider the ambient temperaturewhen they use a self-monitoring meter to measuretheir blood glucose. At 20°C, the recordingwill be close to their true blood glucose, but atwarmer temperatures their meter reading willunderestimate and at cooler temperatures it willoverestimate their blood glucose level. 10 Whilethe differences are not huge, ideally we shouldeducate patients that their meters are most reliableat a temperature of 20°C. A study whichinterviewed people with chronic illness found266 VOLUME 4 • NUMBER 4 • DECEMBER 2012 J OURNAL OF PRIMARY HEALTH CARE

EDITORIALSFROM THE EDITORthat most were reluctant to take medication forpain relief and often lived in chronic pain. 11 Theauthors recommend that their GPs ask about andacknowledge patients’ pain, and reassure themthat taking pain medication will assist them intheir daily living.GPs have so much to learn and to do, but withincreasing numbers of medical students it ischallenging to give them adequate time incommunity-based general practice placements. Arandomised controlled trial found that studentsattending ‘simulated’ GP clinics using actors hadimproved communication skills, confidence inhistory-taking and ability to detect depressioncompared to those placed at general practices, butthe latter group had more confidence in managingcommon conditions and giving injections thantheir peers. 12 These modes of teaching appear tobe complementary and a combination may be theway to go.Our Vaikoloa column advocates teaching medicalstudents about factors that impact on Pacific people’shealth by exposure to their local communitythrough a weekend stay with a Pacific family. 13Finally our Ethics column reminds us that a medicaleducation requires more than the skills andknowledge to practise medicine. It also requiresan education in values to prepare them for theprofessional role they will play in society. 14Yet again this issue reveals the complex world ofprimary health care.References1. Salmond C, Crampton P. Measuring socioeconomic position inNew Zealand. J Prim Health Care. 2012;4(4):271–280.2. Blakely T. What socioeconomic factors shall I measure and includein my analyses? J Prim Health Care. 2012;4(4):268–270.3. McElnay C, Marshall B, O’Sullivan J, Jones L, Ashworth T,Hicks K, et al. Nutritional risk amongst community living Maoriand non-Maori older people in Hawke’s Bay. J Prim HealthCare. 2012;4(4):299–305.4. Howden-Chapman P. We should cap the health budget andspend more money on housing and food—the ‘yes’ case. JPrim Health Care. 2012;4(4):337–339.5. White H. We should cap the health budget and spend moremoney on housing and food—the ‘no’ case. J Prim HealthCare. 2012;4(4):340–341.6. Patel A, Kolt G, Keogh J, Scholfield G. The Green Prescriptionand older adults: what do general practitioners see as barriers?J Prim Health Care. 2012;4(4):320–327.7. Tava’e N, Nosa V. The Green Prescription programme and theexperiences of Pacific women in Auckland. J Prim Health Care.2012;4(4):313–319.8. Palmer C, Bycroft J, Healey K, Field A, Ghafel M. Can formalCollaborative methodologies improve quality in primary healthcare in New Zealand? Insights from the EQUIPPED AucklandCollaborative. J Prim Health Care. 2012;4(4):328–336.9. Brounéus F, Macleod G, MacLennan K, Parkin L, Paul C.Drug safety awareness in New Zealand: public knowledgeand preferred sources for information. J Prim Health Care.2012;4(4):288–293.10. Kinchiku S, Kotani K, Kajiya S, Yodo K, Maruguchi Y, UenomachH. Influence of ambient temperature on the correlationbetween self-monitoring of blood glucose and plasmaglucose values in diabetes management. J Prim Health Care.2012;4(4):294–298.11. Budge C, Carryer J, Boddy J. Learning from people withchronic pain: messages for primary care practitioners. J PrimHealth Care. 2012;4(4):306–312.12. Elley C, Clinick T, Wong C, Arroll B, Kennelly J, Doerr H, et al.Effectiveness of simulated clinical teaching in general practice:randomised controlled trial. 2012;4(4):281–287.13. Sopoaga F. Can Pacific communities in New Zealand contributeto improving the health care they receive? J Prim HealthCare. 2012;4(4):343.14. Harland T, Pickering N, Anderson L. Valuing teaching andteaching values. J Prim Health Care. 2012;4(4):346–347.Erratum: The anatomical placement of body organs by Australian and New Zealandpatients and health professionals in general practiceIn the September 2012 edition of the Journal of Primary Health Care, an original short report research article ‘The anatomical placement ofbody organs by Australian and New Zealand patients and health professionals in general practice’ was authored by Professor Marjan Kljakovic.The research and authorship was also carried out by Ms Jo Risk, currently Project Manager, Southern General Practice Network, NSW,Australia, and was funded under the PHCRED researcher development program in 2010. We acknowledge this co-authorship and funding,and appropriate amendments have been made to the electronic version of the Journal, and submitted to the National Library of Medicine foramendment to the PubMed listing. This paper should be cited as:Kljakovic M, Risk J. The anatomical placement of body organs by Australian and New Zealand patients and health professionals in generalpractice. J Prim Health Care 2012;4(3):239–41.VOLUME 4 • NUMBER 4 • DECEMBER 2012 J OURNAL OF PRIMARY HEALTH CARE 267