This annual report - Taranaki District Health Board

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Giuffrida A, et al. 1999. Target payments in primary care: effects on professional practice and health careoutcomes. Cochrane Database of Systematic Reviews doi:10.1002/14651858.CD000531http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000531/abstractThis review examined the effect of target payments on the professional practice of primary care physicians (PCPs) andhealth care outcomes. Only two RCTs (involving 149 practices) were included in the review, both of which assessed theeffect of target payments on immunisation rates. One study (313 PCPs, 6,600 2 year olds and 6,400 5 year olds)assessed the effect of target payments on immunisation rates using an interrupted time series design. Before 1 April1990 GPs received a fee for each immunisation made. After 1 April 1990, a lump sum payment was made if GPsimmunised at least 70 per cent of the eligible population (a higher rate of payment was paid to the GPs that reached a 90per cent target), but nothing was paid if they immunised less than the lower target. Immunisation rates improved after theintroduction of target payment, however, a logistic regression model of the trend found that there was no evidence thatthe overall linear trend had changed as a result of the introduction of target payments.Other Systematic ReviewsGlenton C, et al. 2011. Can lay health workers increase the uptake of childhood immunisation? Systematic reviewand typology. Tropical Medicine & International Health, 16(9), 1044-53.This review assessed the effects of lay health workers (LHWs) on childhood immunisation uptake. Twelve studies,(including 10 RCTs) were included in the review, mostly comparing LHWs with no intervention or standard care. Seven ofthe studies were conducted among economically disadvantaged populations in high-income countries (LHWs madehome visits to parents to promote routine childhood immunisations and encourage clinic visits for vaccination), and theremaining five studies were conducted in low and middle income countries (in some of which LHWs gave vaccinations).Most of the studies showed that LHWs increased immunisation coverage. The diversity of settings meant the metaanalysiswas possible for only four of the studies, all in high income settings (3568 participants). These LHWprogrammes were associated with a statistically significant increased the number of children whose immunisations wereup to date (RR 1.19, 95% CI 1.09 to1.30). The authors conclude that while LHWs show promise in improving vaccinationcoverage, further high quality studies are need in low and middle income countries.National Collaborating Centre for Women’s and Children’s Health. 2009. Reducing differences in the uptake ofimmunisations (including targeted vaccines) in children and young people aged under 19 years: systematicreview of effectiveness and cost effectiveness evidence. London: National Collaborating Centre for Women’s andChildren’s Health. http://www.nice.org.uk/PH21This review provides the evidence base for the NICE guidance (available at http://www.nice.org.uk/PH21) on reducingdifferences in uptake of immunisations. The review is focussed on what interventions are effective and cost effective inreducing differences in immunisation uptake in children and young people aged under 19 years. The effectivenessreview included 142 studies and the cost-effectiveness review included 10 studies. Three key themes were identified:issues relevant to all childhood vaccines; issues relevant to MMR as an exemplar of a universal vaccine; issues relevantto neonatal Hep B as an exemplar of a targeted vaccine. Interventions assessed included: recipient reminder/recallsystems; home visits; client or family incentives/disincentives; interventions in school or day care settings; provider basedinterventions (including education, reminders and incentives); national immunisation programmes; and multi-componentinterventions. A review of studies examining barriers to immunisation and the views and experiences of children, youngpeople, parents/carers, and health professionals is included. Only one study included evaluated differential uptake ofimmunisations across population subgroups, although numerous studies assessed targeted interventions. The executivesummary provides 66 effectiveness evidence statements and three cost-effectiveness evidence statements. The qualityof included studies was variable and while there were some RCTs included, only 16 intervention studies had the highestquality rating. Evidence-based recommendations include: improve access to immunisation services, for example, by extending clinic times and making sure clinics are ‘childfriendly’ provide parents and young people with tailored information and support and an opportunity to discuss any concerns check children and young people’s immunisation status during health appointments and when they join nurseries,playgroups, schools and further education colleges, and offer them vaccinations ensure babies born to hepatitis B-positive mothers are given all recommended doses of the vaccine on time, ablood test to check for infection and, where appropriate, hepatitis B immunoglobulin.Falagas ME & Zarkadoulia E. 2008. Factors associated with suboptimal compliance to vaccinations in children indeveloped countries: a systematic review. Current Medical Research and Opinion, 24(6), 1719-41.This review evaluated factors associated with suboptimal compliance to vaccinations, focussed on children andadolescents in developed countries. Thirty-nine original studies were included in the review. Factors influencingcompliance with vaccinations were divided into parental-childhood characteristics and healthcare structure-healthprofessionals characteristics. Parent-childhood characteristics that were statistically significantly associated withsuboptimal compliance were: non-white race, low socioeconomic status, paying for vaccination, lack of health insurance,low parental education, older age of the child, younger maternal age, large family size, late birth order, lack of knowledgeabout disease and vaccination, negative beliefs/attitudes towards vaccination, fear of side-effects/risks/contraindications,not remembering vaccination schedules and appointments, sick child delays, and delayed well child visits. Factorsrelated to healthcare structures and health professionals that were statistically significant associated with suboptimalcompliance included: scepticism/doubts regarding provided medical information, inadequate support from healthcareproviders, lack of available health structures, and problems concerning transportation and accessibility to vaccinationclinics. The authors suggest that by understanding factors associated with suboptimal compliance, efforts to improvecompliance can be better targeted.Immunisation Coverage - 168
Briss PA, et al. 2000. Reviews of evidence regarding interventions to improve vaccination coverage in children,adolescents, and adults. The Task Force on Community Preventive Services. American Journal of PreventiveMedicine, 18(1 Suppl), 97-140.This publication reports on a series of systematic reviews that examined the effectiveness, applicability, economicimpact, and barriers to use of population-based interventions to improve universal vaccination coverage, and provides aset of evidence-based recommendations. Three categories of interventions were addressed: increasing communitydemand for vaccination, enhancing access to vaccination services, and provider-based interventions. Recommendationsinclude: use of client Reminder/recall interventions; multi-component interventions that include education; vaccinationrequirements for childcare, school, and college attendance; reducing out-of-pocket costs; expanding access in healthcare settings as part of multi-component interventions expanding access; vaccination programmes in women, infants,and children settings; home visits, although home visiting can be highly resource intensive relative to other options whenapplied only to improve vaccination coverage; assessment and feedback for vaccination providers There was insufficientevidence to support community-wide, education-only interventions, clinic-based, education-only interventions, client orfamily incentives, client-held medical records, vaccination programmes in schools or childcare centres, or providereducation only. The reviews were used to inform the Community Guide to interventions to increase the use of universallyrecommended vaccines (http://www.thecommunityguide.org/vaccines/universally/index.html) which continues to beupdated.Other Relevant EvidenceThis parliamentary Health Committee inquiry into improving rates of childhood immunisation examined: statistics ontimeliness and completion of vaccination in New Zealand, and international comparisons; the National ImmunisationRegister; relevant literature on optimising timeliness and completion rates; information on community concerns, informedconsent and conscientious objection; and an assessment of the benefits of immunisation. Key informants inform thereport. A large number of recommendations are made regarding what methods could be applied at minimal cost toimprove immunisation coverage in New Zealand. Recommendations include an expansion of targets to older age groups,improvements in the National Immunisation Register, exploration of provider and parent incentives, and improvedinformation resources targeted at parents. Dr Nikki Turner’s “six start” plan to improve rates of childhood immunisation,covering enhanced business as usual, contractual/legislative aspects, responsibilities and support for primary care andparents, communication and safety surveillance, is included in the appendices.Health Committee. 2011. Inquiry into how to improve completion rates of childhood immunisation, and Briefingsfrom the Chief Coroner on the coronial process, from Dr Michael Tatley on the adverse reaction process, andfrom Professor Sir Peter Gluckman on how to improve completion rates of childhood immunisation. 49thParliament: March. http://www.parliament.nz/en-NZ/PB/SC/Documents/Reports/8/c/a/49DBSCH_SCR5060_1-Inquiryinto-how-to-improve-completion-rates-of.htmOn 22 June 2011, the Government, led by the Ministry of Health, issued its response to the Health Select Committee’sReport, noting that the Ministry had met, or that work was underway to meet, the majority (24) of the Report’s 30recommendations (http://www.parliament.nz/en-NZ/PB/Presented/Papers/6/d/4/49DBHOH_PAP21651_1-Government-Response-to-Report-of-the-Health-Committee.htm). A briefing paper, released by the Ministry of Health in August 2012outlines the Ministry’s progress on implementation of the six remaining recommendations, including ongoing explorationof incentives for parents and providers and improved immunisation information for pregnant women(http://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-programmedecisions/progress-report-inquiry-how-improve-completion-rates-childhood-immunisation).Kaplan DW. 2010. Barriers and Potential Solutions to Increasing Immunization Rates in Adolescents. Journal ofAdolescent Health, 46(2, Supplement 2), S24-S33.This paper discusses the barriers and potential solutions to increasing vaccination rates in adolescents from a US pointof view. While many barriers such as cost are common to all children, adolescents have changing emotional andcognitive development which may shape their receptivity to vaccination, and adolescents have lower rates of contact withacute and preventive health care, resulting in fewer vaccination opportunities. The solutions identified after of review ofthe literature include: accessible electronic immunisation information systems that contain a complete vaccination historyand flag recommended vaccines; offering alternative sites for vaccination such as schools; compulsory or mandatedvaccines for middle and high school entry; and a review of consent procedures.Bonanni P, et al. 2009. Varicella vaccination in Europe - taking the practical approach. BMC Medicine, 7(1), 26.This report, by members of the Working Against Varicella in Europe (WAVE) group, funded by GlaxoSmithKlineBiologicals, considers the practicalities of introducing routine childhood varicella vaccination in Europe, and discussesthe benefits and challenges of different vaccination options. The authors argue that the epidemiology of varicella inEurope, and evidence of the effectiveness of routine varicella vaccination in Germany (preliminary reports only), supportthe adoption of routine vaccination in Europe, particularly now that the combined measles, mumps, rubella and varicellavaccine is available. Barriers to routine vaccination are assessed, including costs, perceptions that varicella is not aserious disease, and the need to achieve high coverage rates. The authors all have industry connections.Note: the publications listed were identified using the search methodology outlined in Appendix 1Immunisation Coverage - 169
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Cover Artwork: Long-tailed Blue But
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LIST OF FIGURESFigure 1. Gross Dome
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Figure 41. Number of Students Invol
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Figure 85. Proportion of Babies Bor
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Figure 127. Relationship Between th
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Table 21. Policy Documents Relevant
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Table 108. Proportion of Young Peop
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INTRODUCTION AND OVERVIEWIntroducti
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three then reviews mental health is
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Table 1. Overview of the Determinan
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Stream Indicator New Zealand Distri
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47MACROECONOMICINDICATORS
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Expenditure-based Measure of GDPThe
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Gini Coefficient: The Lorenz curve
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CHILD POVERTY AND LIVING STANDARDSI
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After Housing Costs (AHC)Relative P
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Figure 8. Proportion of Dependent C
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14 Items (Enforced Lacks) are inclu
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Local Policy Documents and Evidence
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Other Relevant New Zealand Evidence
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UNEMPLOYMENT RATESIntroductionIn th
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Figure 12. Unemployment Rates by Ag
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Unemployment Rates by Qualification
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Figure 18. Quarterly Unemployment R
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CHILDREN RELIANT ON BENEFIT RECIPIE
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Table 4. Number of Children Aged 0-
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Table 5. Number of Children Aged 0-
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YOUNG PEOPLE RELIANT ON BENEFITSInt
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Table 7. Number of Young People Age
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New Zealand Distribution by Ethnici
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Figure 25. Young People Aged 16-24
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Table 10. Number of Young People Ag
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HOUSEHOLD COMPOSITION91
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Data Source and MethodsDefinitionPr
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Figure 29. Proportion of Children A
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Robertson J, et al. 2006. Review of
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Canadian National Occupancy Standar
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Figure 33. Proportion of Children a
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Other Relevant EvidenceMarmot Revie
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Note 2: The number of new school en
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Figure 36. Proportion of New Entran
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Sylva K, et al. 2004 The Effective
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Page 126 and 127: Figure 43. Highest Educational Atta
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Page 132 and 133: SENIOR SECONDARY SCHOOL RETENTION A
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Page 146 and 147: TRUANCY AND UNJUSTIFIED ABSENCESInt
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Page 167: Soares-Weiser K, et al. 2012. Vacci
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Page 173 and 174: Figure 75. Proportion of New Zealan
Page 175 and 176: Proportion Receiving Core Contacts
Page 177 and 178: Figure 81. Proportion of Babies who
Page 179 and 180: The B4 School CheckThe B4 School Ch
Page 183 and 184: Other Relevant EvidenceThe Scottish
Page 185 and 186: 185SUBSTANCE USE
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Page 190 and 191: Maternal Smoking at First Registrat
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Page 204 and 205: Table 37. Number of Cigarettes Smok
Page 208 and 209: Figure 93. Proportion of Year 10 St
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Page 212 and 213: TOBACCO USE IN YOUNG PEOPLEIntroduc
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Page 216 and 217: 2009 New Zealand Tobacco Use Survey
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Source of Tobacco in the Last Month
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Carson KV, et al. 2011. Community i
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Other Relevant PublicationsMāori A
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Other Cochrane Systematic Reviews o
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ALCOHOL-RELATED HOSPITAL ADMISSIONS
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Figure 100. Alcohol-Related Hospita
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Table 45. Listed External Causes of
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Midland Region Distribution and Tre
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Shults RA, et al. 2009. Effectivene
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Mortality from conditions with a so
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Table 50. Mortality from Conditions
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Figure 105. Hospital Admissions for
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Table 55. Hospital Admissions for C
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Table 57. Hospital Admissions for C
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Midland Region Distribution by Caus
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INFANT MORTALITY AND SUDDEN UNEXPEC
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New Zealand Distribution and Trends
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Figure 111. Total Infant Mortality,
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Table 62. Neonatal and Post Neonata
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Table 65. Neonatal and Post Neonata
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Distribution by Ethnicity, NZ Depri
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Figure 116. Sudden Unexpected Death
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Vennemann M, et al. 2007. Do immuni
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276
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with a review of interventions aime
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deprivation in some parts of the wo
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who delay a second pregnancy by two
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Family ViolenceDefinitions and New
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need for multidisciplinary interven
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6 days to determine gestational age
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In New Zealand, information on fact
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post intervention. Engagement in ed
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antenatal care, including two nutri
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throughout pregnancy, birth and the
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Alcohol and Other DrugsNational and
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Zealand had a number of specialist
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in one Cochrane review [274] (see p
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interventions to treat antenatal de
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In ConclusionWhile it is hoped that
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308
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Data Source and MethodsDefinition1.
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Other Systematic ReviewsLouwers ECF
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INJURIES ARISING FROM ASSAULT IN YO
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New Zealand Distribution by Age and
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Flood M & Fergus L. 2008. An Assaul
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Note 2: The numbers in this section
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Table 78. Number of Notifications t
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Table 80. Outcome of Assessment for
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Table 82. Number of Notifications R
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Table 84. Outcome of Assessment for
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Data Source and MethodsDefinition1.
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Family Violence Investigations Wher
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Table 90. Local Policy Documents an
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Stover CS, et al. 2009. Interventio
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348
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350
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oader contextual influences on the
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In addition, Table 112 on Page 414
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Williams SB, et al. 2009. Screening
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Ministries of Education, Health, Ju
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Figure 129. Children and Young Peop
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Table 92. Children Aged 0-14 Years
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IN-DEPTH TOPIC: MENTAL HEALTH ISSUE
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this [350]. The review stated that
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psychotic disorders including first
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Social Workers in SchoolsIn 2011 th
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Children or young people with sever
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EpidemiologyThe 2009 review by Meri
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A diagnosis of conduct disorder acc
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programme using a questionnaire. Si
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developmentally appropriate diagnos
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playthings or the environment, appe
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state more than it cost) provided t
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ACCESS TO MENTAL HEALTH SERVICES: L
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Table 97. Children and Young People
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Midland Region DistributionChildren
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ACCESS TO MENTAL HEALTH SERVICES: L
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Table 101. Hospital Admissions for
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Numbers Accessing Services by Diagn
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Table 103. Young People Aged 15-24
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Table 108. Proportion of Young Peop
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Midland Region DistributionAmongst
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Fletcher A, et al. 2008. School Eff
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New Zealand Distribution and Trends
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Figure 138. Mortality from Suicide
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Figure 139. Mortality from Suicide
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Ougrin D & Latif S. 2011. Specific
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426
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428
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Guide to Community Preventive Servi
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information on all of the events oc
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3. In addition, some providers admi
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as in the majority of the analyses
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APPENDIX 5: THE NATIONAL MORTALITYC
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As a result of these changes, there
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2. Research also suggests that ethn
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APPENDIX 8: POLICE AREA BOUNDARIESF
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Figure 142. Police Area Boundaries
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3. The condition exhibits a socioec
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REFERENCES1. Children's Commissione
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33. Mackay R. 2005. The Impact of F
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71. Ministry of Health. 2011. Immun
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107. ASH New Zealand. 2011. Nationa
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141. Child and Youth Mortality Revi
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175. Pihama L. 2011. Overview of M
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208. King-Hele S, Webb RT, Mortense
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244. Nelson Marlborough District He
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274. Ramsay J, Carter Y, Davidson L
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306. Jewkes R. 2002. Intimate partn
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347. Heflinger CA, Hinshaw SP. 2010
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376. Ministry of Education. 2012. W
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410. Ministry of Health. 2001. New
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443. Zeanah PD, Bailey LO, Berry S.
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480. Weinberg MK, Olson KL, Beeghly
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