Understanding the context of hospital transfers and away-from-home hospitalisations for Māori

Wednesday, November 23rd, 2022 | claly44p | No Comments

Cormack D, Masters-Awatere B, Lee A, Rata A, Boulton A. Understanding the context of hospital transfers and away-from-home hospitalisations for Māori. The New Zealand Medical Journal. 2022 Nov 11;135(1565):41-50.

In this paper, 10% of acute hospital admissions, transfers and arranged admissions for Māori are to hospitals outside of their home domicile which increases with higher levels of deprivation.  With around 25% of Māori living rurally the burden of travel is even greater.  Let’s hope Te Whatu Ora & Te Aka Whai Ora make this a priority in addressing health disparities.

OPEN ACCESS https://journal.nzma.org.nz/journal-articles/understanding-the-context-of-hospital-transfers-and-away-from-home-hospitalisations-for-maori-open-access

EDITORIAL https://journal.nzma.org.nz/journal-articles/the-long-road-to-good-care


 In Aotearoa New Zealand, people regularly travel away from their home to receive hospital care. While the role of whānau support for patients in hospital is critical for Māori, there is little information about away-from-home hospitalisations. This paper describes the frequency and patterning of away-from-home hospitalisations and inter-hospital transfers for Māori. Data from the National Minimum Dataset (NMDS), for the 6-year period of 1 January 2009–31 December 2014, were analysed. Basic frequencies, means and descriptive statistics were produced using SAS software. We found that more than 10% of all routine hospitalisations constituted an away-from-home hospitalisation for Māori; that is, a hospitalisation that was in a district health board (DHB) other than the DHB of usual residence for the patient. One quarter (25.19%) of transfer hospitalisations were to a DHB other than the patient’s DHB of domicile. Away-from-home hospital admissions increase for Māori as deprivation increases for both routine and transfer admissions, with over half of Māori hospital admissions among people who live in areas of high deprivation. This analysis aids in understanding away-from-home hospitalisations for Māori whānau, the characteristics associated with these types of hospitalisations and supports the development and implementation of policies which better meet whānau Māori needs. The cumulative impact of the need to travel to hospital for care, levels of poverty and a primarily reimbursement-based travel assistance system all perpetuate an unequal cost burden placed upon Māori whānau. 



Paper conveners wanted

Tuesday, January 25th, 2022 | Rory | No Comments

Pointing the finger @ you!

Work from home (mainly) as a paper convener with the University of Otago’s rural post-graduate team. These are 0.1-0.15FTE positions. These roles would best suit those who have completed the Diploma of rural and provincial hospital medicine (or equivalent) and are currently working (or have prior experience) in a senior medical position in rural New Zealand.  Come and join our passionate team and help share your knowledge and experience with great students wanting to upskill to provide the best outcomes in rural medical settings!


Please contact rural.postgrad@otago.ac.nz email for further information.

Vacancy – Regional Coordinator Rural Medical Immersion Programme (Wairarapa)

Monday, December 20th, 2021 | claly44p | No Comments

The above part time position is currently being advertised (0.3 to 0.5 FTE). It would suit a general practitioner or rural hospital doctor with an interest in teaching. Should the successful applicant be suitably qualified and seeking a more formal academic role including a research commitment, there is the potential to offer the position at Senior Lecturer level.

For more information & to apply online see:


Ngāti Porou Hauora: COVID-19 Reflections on initial response

Monday, November 15th, 2021 | claly44p | No Comments

Ngāti Porou Hauora (NPH) provides health services to 9000 people in Gisborne and across the East Coast.  In this publication key people in the organisation provide a fascinating insight into how NPH responded to the threat of COVID-19 as it reached Aotearoa in early 2020 and identifies learnings to take forward as Delta threatens.  The importance of keeping connections and communication channels open across the organisation, community and DHB along with resilient and resourceful staff pulling together are highlighted along with fears and vulnerabilities.

The report can be accessed through NPH website:


Equitable spatial accessibility of COVID-19 vaccine?

Thursday, September 16th, 2021 | Rory | No Comments

Spatial inequity in distribution of COVID-19 vaccination services in Aotearoa


Whitehead J, Atatoa P, Scott N, Lawrenson R. Spatial inequity in distribution of COVID-19 vaccination services in Aotearoa. Preprint on medRxiv. https://doi.org/10.1101/2021.08.26.21262647


This is a pre-print version. It has not been peer reviewed but is open access. The final publication (after peer review/editorial process) maybe (slightly) different and we will link to that when it is available.

From Jesse the lead author:

We examined the spatial accessibility of Covid-19 vaccination services across NZ at the start of the latest Covid-19 delta outbreak. We estimated access by looking at the number of vaccination services available to communities within a 30 minute drive, relative to the size of the local population. The locations of Covid-19 vaccinations services on the 18th August 2021 were distributed unevenly, and resulted in better spatial access for urban, wealthy, and European populations. Access was significantly worse for rural areas, Māori, older people, and areas of high socioeconomic deprivation. We also found significant variation in levels of access by DHB region. Furthermore, high access to Covid-19 vaccination services at the DHB level was associated with more equitable vaccination uptake for Māori. DHBs that provided the best access to vaccination services had the highest vaccination rate ratios for Māori.

Spatial accessibility to COVID-19 Vaccination Services

Are we surprised?


Aim This research examines the spatial equity, and associated health equity implications, of the geographic distribution of Covid-19 vaccination services in Aotearoa New Zealand.

Method We mapped the distribution of Aotearoa’s population and used the enhanced-two-step-floating-catchment-method (E2SFCA) to estimate spatial access to vaccination services, taking into account service supply, population demand, and distance between populations and services. We used the Gini coefficient and both global and local measures of spatial autocorrelation to assess the spatial equity of vaccination services across Aotearoa. Additional statistics included an analysis of spatial accessibility for priority populations, including Māori (Indigenous people of Aotearoa), Pacific, over 65-year-olds, and people living in areas of high socioeconomic deprivation. We also examined vaccination service access according to rurality, and by District Health Board region.

Results Spatially accessibility to vaccination services varies across Aotearoa, and appears to be better in major cities than rural regions. A Gini coefficient of 0.426 confirms that spatial accessibility scores are not shared equally across the vaccine-eligible population. Furthermore, priority populations including Māori, older people, and residents of areas with socioeconomic constraint have, on average, statistically significantly lower spatial access to vaccination services. This is also true for people living in rural areas. Spatial access to vaccination services, also varies significantly by District Health Board (DHB) region as does equality of access, and the proportion of DHB priority population groups living in areas with poor access to vaccination services. A strong and significant positive correlation was identified between average spatial accessibility and the Māori vaccination rate ratio of DHBs.

Conclusion Covid-19 vaccination services in Aotearoa are not equitably distributed. Priority populations, with the most pressing need to receive Covid-19 vaccinations, have the worst access to vaccination services.

The place of Rural Hospitals in New Zealand’s Health System: an exploratory study

Thursday, September 2nd, 2021 | Rory | No Comments

For those of you who are in leadership roles can you please fill in the below survey (it’s QUICK!). For those who are not – can you please forward within your workplaces!

You can cash in your chocolate fish in a time when we can talk again.



The place of Rural Hospitals in New Zealand’s Health System: an exploratory study

University of Otago Research Grant 2021; PI Kati Blattner, RF Lynne Clay,

CI’s Tim Stokes, Garry Nixon, Rory Miller, Sue Crengle, Lauralie Richard & Ray Anton  

Aims: To identify current and future priorities for NZ rural hospitals and gain a national picture of NZ rural hospital provision to provide a platform for further research through:stakeholder interviews, a national online survey & identification of key service characteristics.

Progress to date:

Interviews: Thank you to rural hospital leaders and key stakeholders who have participated

representing 18 RH (with 2 more IV scheduled), and 4 national stakeholder groups.

National Survey: For people in leadership roles (clinical & non-clinical), we have now launched our short survey. Please access today!


Service Characteristics: A worksheet of key service provision information populated from RH websites. We will be emailing these to RH leaders for assistance to verify and add missing details.

Building a sustainable rural physician workforce

Tuesday, August 24th, 2021 | Rory | No Comments

Ostini R, McGrail MR, Kondalsamy-Chennakesavan S, Hill P, O’Sullivan B, Selvey LA, et al. Building a sustainable rural physician workforce. Med J Aust [Internet]. 2021 Jul 5 [cited 2021 Aug 10];215(1):S1–33. Available from: https://www.mja.com.au/journal/2021/215/1/building-sustainable-rural-physician-workforce


Summary by Katelyn Costello

This is a collection of papers produced by the University of Queensland as a supplement in the July Medical Journal of Australia. Workforce maldistribution is a huge issue around the world. This piece attempts to address the rural workforce issue focusing on high quality and contextualised training (and sustaining) of physicians (RACP) to service rural populations in Australia. This 38 page document has been summarised into a few take-home points with some commentary/further questions relating to our context here in Aotearoa:

  • Connectedness and support networks:  
    • Rural training opportunities need to be attractive and prioritised  
    • Trainees and consultants report increased isolation and poorer support networks than urban counterparts 
      • We have the rural student clubs, the rural GP Network, Rural Health Conference and Rural Hospital Summit in NZ… just to name a few

        è What else could we do? Extra support/mentoring for new Fellows?


  • Rural generalism is awesome: 
    • Professional satisfaction and experiences are high in rural
    • However the definition of who and what is a rural generalist still isn’t clear for General Physicians and Paediatricians working in rural Australia
      • Is this a reason to further support that here in NZ rural physicians (including FACEM) should have dual training with Rural Hospital Medicine?
  • Don’t forget about regional areas:
    • Lower levels of work satisfaction were reported in regional areas. In the NZ context this is often an area that is staffed more by general physicians also rather than rural hospital specialist… Should the rural hospital model be expanded into regional areas?!? will the health reforms bring about any change?
  • We need to take a multifaceted approach
    • This diagram nicely summarises some of the key aspects. It focuses on general medicine/physicians but it could similarly be applied to rural general practice and rural hospital medicine

Do people living in rural and urban locations experience differences in harm when admitted to hospital?

Wednesday, June 2nd, 2021 | Rory | No Comments

Atmore C, Dovey S, Gauld R, et al. Do people living in rural and urban locations experience differences in harm when admitted to hospital? A cross-sectional New Zealand general practice records review study. BMJ Open 2021;11:e046207. doi:10.1136/ bmjopen-2020-046207


People living in rural communities had no difference in hospital harm compared to people living in urban communities, except when they were transferred, and then more than double the harm – maybe they were sicker or maybe the transfer process itself was part of it, this needs to be looked into further. From this GP record review, 3% of patients admitted to rural hospitals were transferred.


Objective Little is known about differences in hospital harm (injury, suffering, disability, disease or death arising from hospital care) when people from rural and urban locations require hospital care. This study aimed to assess whether hospital harm risk differed by patients’ rural or urban location using general practice data.

Design Secondary analysis of a 3-year retrospective cross-sectional general practice records review study, designed with equal numbers of rural and urban patients and patients from small, medium and large practices. Hospital admissions, interhospital transfer and hospital harm were identified.

Setting New Zealand (NZ) general practice clinical records including hospital discharge data. Participants Randomly selected patient records from randomly selected general practices across NZ. Patient enrolment at rural and urban general practices defined patient location.

Outcomes Admission and harm risk and rate ratios by rural-urban location were investigated using multivariable analyses adjusted for age, sex, ethnicity, deprivation, practice size. Preventable hospital harm, harm severity and harm associated with interhospital transfer were analysed.

Results Of 9076 patient records, 1561 patients (17%) experienced hospital admissions with no significant association between patient location and hospital admission (rural vs urban adjusted risk ratio (aRR) 0.98 (95% CI 0.83 to 1.17)). Of patients admitted to hospital, 172 (11%) experienced hospital harm. Rural location
was not associated with increased hospital harm risk
(aRR 1.01 (95% CI 0.97 to 1.05)) or rate of hospital harm per admission (adjusted incidence rate ratio 1.09 (95%
CI 0.83 to 1.43)). Nearly half (45%) of hospital harms became apparent only after discharge. No urban patients required interhospital transfer, but 3% of rural patients did. Interhospital transfer was associated with over twice the risk of hospital harm (age-adjusted aRR 2.33 (95% CI 1.37 to 3.98), p=0.003).

Conclusions Rural patient location was not associated with increased hospital harm. This provides reassurance for rural communities and health planners. The exception was patients needing interhospital transfer, where risk was more than doubled, warranting further research.

Supporting Allied Health Professionals in Rural New Zealand – presentation 1 June 12pm

Thursday, May 27th, 2021 | Rory | No Comments

Sarah is giving a presentation on her thesis:

1 June 2021 – 12pm

In-person: Room 1.02 School of Physiotherapy, University of Otago, Dunedin

Zoom: Meeting ID: 965 3790 5832 I Password: 407013


Sarah Walker (HRC Clinical Research Training Fellow)

Abstract: Sarah’s PhD aims to explore the roles of allied health professionals working in rural New Zealand. This will be done through a qualitative strand looking at the experiences of rural allied health professionals, the challenges they face and the attributes and skills needed to reach the full potential of their roles, and a quantitative strand characterising the clinical scope of practice of rural physiotherapists in comparison to their urban counterparts. This presentation will introduce Sarah as a rurally based researcher, outline the methods, and indicate preliminary findings from the qualitative strand..

Bio: Sarah began her PhD with the School of Physiotherapy in February 2020, based at the Section of Rural Health in Dunstan Hospital, Clyde. She is co-supervised by the Department of General Practice and Rural Health, and also works 0.3FTE as a Physiotherapist and Clinical Lead for Central Otago Health Services. Sarah’s research focuses on rural healthcare and the rural allied health workforce. Sarah is due to finish her PhD in May 2023