Student: Dougal Thorburn
Supervisor: Prof Peter Davis
Sponsor: Public Health Research Theme
The National Medical Care Survey has collected data relating to primary health care services for 257 practitioners, 193 practices and 5661 patients. This research has described practitioner data (univariate analysis) such as practitioner age, qualifications, number of hours worked per week, employment arrangements, and practice data including variables related to practice access, service provision, equipment, mix of personnel, financial information.
The Maori component has been identified and analysed at three levels.
Firstly, Maori providers have been identified and their practice characteristics have been compared with Mainstream practice characteristics.
Secondly, the characteristics of the patients that attend Maori providers have been analysed and compared with those of the patients that attend mainstream providers.
Thirdly, the characteristics of Maori patients attending either Maori or mainstream providers have been analysed and compared with the characteristics of non-Maori patients attending either Maori of mainstream providers.
The comparison of Maori and mainstream provider characteristics revealed that Maori providers tend to be characterised by greater community involvement: at management level, are more likely to have a separate committee and more likely to have 'community' representation on it, at service provision level, more likely to provide group health promotion and community worker services, and at staff level are more likely to employ a community worker. To reduce barriers in accessing primary care, Maori providers charge less and are more likely to reduce or waive fees.
These outcomes should be approached with caution due to the effect of clustering and the possibility of different age distributions, altho patients attending Maori providers are of similar age, on average, to those at mainstream providers.
Maori provider patients are more likely to have a Community Services Card and are more likely to have longer visits than mainstream patients [implying greater need]. Although the most severe problem they present with is more urgent than that of mainstream patients, the disability extent of the worst problem is better. The rapport achieved between patients and Maori provider practitioners is worse than that of mainstream patients and providers. This could reflect the fact that patients of Maori providers are more likely to be new to their practitioner than mainstream provider patients.
The comparison of Maori patients with non-Maori patients must also be approached with caution because of clustering and the different age distributions [Maori patients are significantly younger than non-Maori]. Maori patients are more likely to hold a Community Services Card and to have a lower level of practitioner assessed social support but do not have longer visits in comparison to non-Maori patients. They are less likely to have certain investigations ordered, such as lipids and glucose, which may be of concern given the high rate of diabetes amongst Maori. Their worst presenting problem is, on average, assessed as being more urgent, more severe but with less, and more temporary, disability than non-Maori patients' worst presenting problem. Maori patients are more likely to be referred for acute assessment or to the Emergency Dept. The rapport achieved between Maori patients and their practitioner is, on average, worse than that between non-Maori and their practitioner. Again, this could reflect the fact the Maori patients are more likely to be new to their practitioner than are non-Maori.