Summary of findings
Our estimated odds ratio suggest that Māori and Pasifika patients have a lower odds of having action taken following an alert. The fact these results were not statistically significant is possibly due to the small numbers of patients in all ethnicity groups (excluding European). For future studies, a larger sample may provide more compelling evidence to suggest systematic or clinically meaningful differences in action taken by ethnicity.
Women had nearly double the number of alerts compared to men, which is consistent with the fact women see their GPs more frequently than men, even after excluding consultations relating to gynaecological and obstetric conditions.24 An unexpected finding was that females in this study were significantly less likely to have action taken compared to males following an alert. Women have a long history of experiencing inequitable health care compared to men, such as receiving less pain relief for similar levels of acute and chronic pain.25,26 This may be attributable to the status of women in society; addressing gender equality is considered an important factor in improving women’s health.27
Strengths and limitations
This paper provides a snapshot of high-needs general practice patients in New Zealand, as well as some of the risks they are exposed to while receiving routine healthcare. This study had a wide geographical spread of patients, and an ethnic distribution profile similar to the New Zealand population, although the study had a lower proportion of Asian patients and a higher proportion of Other ethnicities.28 A weakness of this study is that it is underpowered to detect differences by ethnicity, however it was able to detect trends in levels of healthcare by gender and ethnicity.
Comparison with existing literature
The underlying premise of this work was a rich literature demonstrating increased risk of harm and unfair treatment of people based on ethnicity. This is well documented for Māori and Pasifika patients.5,7 Migrants and people who don’t speak English face additional challenges in a healthcare setting due to cultural and language barriers.29,30 In addition, preliminary review of these data led us to anticipate differences in clinician action based on ethnicity.
Our findings suggest patient gender influences whether general practice clinicians take action after receiving an alert. It is possible that patient ethnicity also has some effect, although our results are not statistically significant. While other factors may be at play, implicit associations of gender and ethnicity can influence medical judgement and result in biased provision of care.31–34
Implications for health policy
As the proportion of older patients increases in New Zealand general practice, so too do their numbers of long-term conditions and long-term medications.15,35 The burden of multimorbidity is known to be particularly high for Māori and Pasifika patients.36 These factors add to the complexity of general practice consultations.37 Targeted alert systems can help busy general practitioners identify patients at greatest risk of experiencing medication-related harm, and take actions to mitigate those risks.16,38 Clinicians in this study took action following receipt of targeted event alerts more often than not. Promoting use of such a system has the potential to reduce medication-related harm in general practice.
Inequitable care is evident throughout the New Zealand health system.4,7 The causes for this are multifactorial; no doubt racism and sexism contribute to health inequities, adverse patient experiences and negative health outcomes.39,40 While addressing these issues at a system level is important,7 this paper focussed on the action of individual clinicians. Training clinicians to speak up against racism and sexism, as well as recognise their own implicit biases, may help reduce inequities based on those characteristics.31,41−43