For most New Zealanders, primary health care is the first port of call when we are sick or injured, and these services should work equally well for all people. However, says Professor Nicolette Sheridan (Ngāpuhi) of Massey’s School of Nursing, this is not always the case.

‘For many people, the primary health care system doesn’t meet their needs. I’ve been involved with hundreds of patients and families, many in the poorest parts of New Zealand, who describe primary health care services that don’t engage them, and are delivered in ways that they don’t value. On the other side, many health professionals also have difficulty with a system that doesn’t support them to give the kind of care that they want.’

Professor Sheridan’s research focuses on improving health and care for those New Zealanders who are underserved by conventional models of care, and who face inequities due to age, gender, ethnicity, geography and poverty. ‘These inequities play out in terms of differences in life expectancy, burden of illness, access to care and unequal health outcomes,’ she explains. ‘Total population life expectancy is lower for Māori and Pacific peoples, and the gap is attributed to conditions amenable to prevention. Early intervention and ongoing patient engagement with primary health care is crucial. It’s important to think about the ways that we engage with people to address their needs, and how we design services for the future, especially for those who are not getting the same good care that others are getting.’

Traditional general practice has been the dominant model of primary health care in New Zealand. However, she says, ‘it’s really important to look at how this model can evolve to be more responsive to the needs and expectations of people in the future. Health systems in all countries are placing an emphasis on primary health care to reduce exclusion and inequalities in health. A good primary health care system will provide health care for all people by ethnicity, by age, for older people, for children, for people living in rural and urban settings, and will be better integrated with housing and other social agencies.’

Currently, Professor Sheridan is co-leading an international project, funded in New Zealand by the Health Research Council and in Canada by the Canadian Institutes of Health Research, that is examining innovative models of primary health care for older adults with chronic conditions. ‘We have nine case studies — three each in New Zealand, Ontario and Quebec — all serving diverse populations. We’re looking at what goes on, from the patient and family carer perspective, at the clinician-provider level, at the organisational level, and then at the higher policy level. We’re collecting data from multiple sources to identify the factors that lead to successful implementation of primary health care.’

A common thread is the importance of trust in patient-provider relationships. ‘We found in one case study that when patients and their whānau engaged with the providers they trusted, who understood their social and cultural values and their situation, they got the right support to selfmanage their conditions.’

Coordination of services is another important aspect, particularly for those with multiple conditions. ‘It’s very difficult to coordinate care over time. Communication is not always the best between different agencies and there’s a huge role for nurses and other health workers in advocating on behalf of people, navigating services and making sure that providers understand what patients and their families consider is most important. It means having a relationship and knowing that person and whānau. At an organisational level it can mean continuity of information and IT systems that link hospitals, primary health care providers, and patients.’

The next stage for the New Zealand research team is to transfer what they have learnt to a separate organisation, which is Hospice New Zealand. ‘We’re working in partnership with hospices undertaking innovations in aged residential care, with general practice, and with family carers,’ says Professor Sheridan. ‘They have received government funding to undertake innovations, and we’re supporting them with their evaluations by using findings from the earlier project to evaluate implementation.

‘Our research is about primary health care performance and creating the kind of system that’s smarter, more responsive, and works better for patients and families, as well as providers. We’re committed to identifying a primary health care model that’s equitable and can substantially improve outcomes for Māori and all New Zealanders.’