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Māori HealthOrganising committee for Hui Whakapiripiri Researchers Lynne Pere, Kirsten Smiler, Tai Walker Whānau is Whānau. The application and understanding of the notion of whānau in the social policy environment Researcher Tai Walker Contracting for whānau ora This post-doctoral research explores the issues and challenges that funders, planners and providers have in contracting for “whānau ora” at the district level. It builds on two significant pieces of work undertaken by this research group: Amohia Boulton’s doctorate which examined performance measurement for Māori mental health providers, and the Health Reforms 2001 project which evaluated District Health Board (DHB) establishment. Through a detailed case study in a single DHB, an understanding of the contracting process between DHB and providers of services to Māori and mainstream will be gained. The research will seek to improve the local contracting process by synthesising provider, purchaser, policy and indigenous perspectives. Researchers Amohia Boulton, Chris Cunningham (Te Pūmanawa Hauora, Massey University), and Jackie Cumming Cultural identity and wellbeing This project is to disseminate the findings of Lynne Pere’s doctoral research, which examined the relationship between cultural identity and wellbeing. Testing the assumption that mental health depends as much on culture and identity as psycho-biology, the research examined the worldviews of 17 Tāngata Whai Ora (Māori who have had experience of mental illness). Their views on mental illness, within the context of the mental health recovery approach, constituted the core of the study. Researcher Lynne Pere A model for understanding “cultural” performance standards in Māori mental health, and Contracting for whānau ora Amohia Boulton’s PhD research focussed on developing a model for understanding the intersection between Māori and mainstream standards of health care performance. Amohia is based at Te Pūmanawa Hauora in Palmerston North while receiving co-supervision and training from the Health Services Research Centre. Amohia graduated with her PhD in late 2005, and now has funding from the Health Research Council of New Zealand for post-doctoral research on Contracting for whānau ora. Researchers: Amohia Boulton, Chris Cunningham ( Te Pūmanawa Hauora, Massey University) , and Jackie Cumming Māori Deaf: Perceptions of cultural and linguistic identity of Māori members of the New Zealand Deaf community This research is Kirsten Smiler’s MA thesis and investigates the nature of Māori Deaf people’s life experiences in terms of relationships, and language use within Māori and Deaf worlds. It describes some of the complexities and cross-cultural misunderstandings Māori Deaf people face and introduces a model to understand how participants articulate their identity as multifaceted and responsive. Kirsten completed the research, graduated in Social Sciences with an MA Applied Linguistics (Merit) in 2005, and is writing up the research findings for publication. Researcher: Kirsten Smiler Ngā Pā Harakeke o Ngati Porou. Exploring the perceptions, understandings and practice of the concepts of whānau and whānau ora This research is Tai Walker’s PhD thesis on Whakahokia mai te whānau ki te whānau: an exploration of the evolution of the concept of whānau. The research involves key informant interviews and focus groups with the government and non-government sector, and with members of Ngati Porou, in relation to concepts of whānau and whānau ora. Researcher: Tai Walker The relationship between cultural identity and wellbeing This doctorate research by Lynne Pere, due for completion in early 2006, examines the relationship between cultural identity and wellbeing, in order to answer the research question: “Does a secure cultural identity lead to improved wellbeing for Tāngata Whai Ora (Māori with experience of mental illness)? ” Indigenous people the world over have considered this relationship, questioning whether a confidence in ethnic values, customs, and practices leads to greater wellbeing. As a result of this research, Lynne has been able to demonstrate that although a secure cultural identity will not necessarily protect against mental illness, cultural identity is nonetheless an important factor in the mental health recovery process, and the recovery process itself can enhance cultural identity. Lynne joined the HSRC in late 2005. Researcher: Lynne Pere Access Research and Evaluation ProjectsNHC report: Literature review on rural health Researcher John Fraser Surgical needs analysis An analysis of the future needs of the New Zealand population for surgery and for surgeons was commissioned by the Royal Australasian College of Surgeons. Data on current levels of surgery was projected out to 2026 using Statistics New Zealand population projections. A survey of surgeons was carried out to assess current and future workload. Projections and workload were combined to estimate the need for surgeons in the future. Variation in surgical rates were used to estimate the current level of unmet need for surgery. A report has been submitted to the College and work is underway on a paper for publication. It is hoped that the estimates will assist in planning surgical services and in the design of surgical training programmes. Researchers Antony Raymont, Jackie Cumming District variations in rates of hospital admission This project is a continuation of previous work on this topic. The intention is to identify areas with low (or high) rates, unjustified by population characteristics. These data will be fed back to policy makers for use in their priority setting to increase the fairness of the public system. Variation across districts is an international issue and has been ascribed to supply factors, population differences and practitioner style. Research in New Zealand is in a good position to shed light on these factors since the relationship between populations and hospital services is defined and total volume of public surgery is determined by contract but the mix of surgery, and the volume of private surgery, is determined by clinical decisions. Analyses are underway with results due in 2006. Researchers: Antony Raymont, Jackie Cumming Funding: Health Services Research Centre, 2005-2006. Surgical needs analysis This new project consists of an analysis of the future needs of the New Zealand population for surgery and surgeons. Data on current levels of surgery will be projected out to 2031 using Statistics New Zealand population projections. A survey of surgeons will assess current and future workload. Projections and workload will be combined to estimate the need for surgeons in the future. This information will assist in the planning of surgical training programmes as well as in hospital planning. Analyses are underway and a survey of surgeons will be completed in 2006. Researchers: Antony Raymont, Jackie Cumming
Health System Research and Evaluation ProjectsWhat’s happening with abusive and inappropriate sexual behaviour among Year 7 and 8 students? This project is being undertaken with WellStop Incorporated (a group that provides programmes for men and adolescents who have been sexually abusive) and is looking at the issues for teachers around inappropriate sexual behaviour of 11-13 year olds at school. The research is investigating the issues for teachers concerning sexually inappropriate behaviour amongst young people in this age group and what information and support teachers might find helpful. Focus groups, interviews and a brief survey of teachers of Year 7 and 8 students in Wellington and Lower Hutt have been undertaken and the analysis of the data is underway. Population health: putting theory into practice This two-day development workshop was designed by HSRC as an opportunity for managers, clinicians, board members and policy makers in the NZ health sector to come together to explore what is meant by the term ‘population health’ and to share local good practice examples of such an approach. The workshop was held in Wellington in November 2007 and attracted over 50 participants from across the country. Case studies of population health work were complemented by inputs from academics carrying out research in this area, and a summary of the workshop has been prepared for publication. Commissioning for health gain: NHS executive study programme This five-day study programme for NHS senior managers and clinicians was designed and facilitated by HSRC in partnership with the Centre for Public Policy and Management at the University of Manchester Business School. The programme entails a preparatory block in the UK, a five-day study tour of planning and funding organisations in NZ, and a plenary block in the UK. Fourteen participants came to NZ in November 2007 and spent time visiting district health boards, primary health organisations, the Ministry of Health and providers, with a specific focus on the ways in which NZ is seeking to plan and fund health services in a way that enables a reduction in health inequalities and an overall improvement in health status. Just who do we think children are? This project involved an analysis of the submissions received by Parliament’s Justice and Electoral Select Committee on the Bill to repeal S.59 of the Crimes Act. The research was to ascertain whether submitters’ views of children and childhood influence their support or opposition to the use of physical punishment. The research is completed and will be published in 2007. Researchers Sophie Debski, Marie Russell, Sue Buckley The health impacts of violence and abuse: A literature review HSRC undertook a literature review on the health impact of childhood violence and abuse to inform the Ministry of Health’s strategic direction in respect of future health promotion services. Topics covered included: school bullying; dating violence; childhood physical abuse; intimate partner violence; childhood sexual abuse; rape; and children witnessing partner violence. This research was a collaboration with the Crime and Justice Research Centre for the Ministry of Health. Researchers Sue Buckley, Marie Russell, Hilary Stace What’s happening with abusive and inappropriate sexual behaviour among Year 7 and 8 students? This project is being undertaken with WellStop Incorporated and will look at the issues for teachers around inappropriate sexual behaviour of 11-13 year olds at school. WellStop is a group that works with people who have sexually abused and research what’s happening with young people and whether and what interventions at that stage might be effective. Focus groups, interviews and a brief survey of teachers of Year 7 and 8 students in Wellington and Lower Hutt will be undertaken in 2007. Researchers Sue Buckley, Marie Russell Achieving change in primary health care services The project is researching Primary Health Care Organisations’ (PHOs) experience in generating change in general practice as they work to implement the primary Health Care Strategy. It involves examining PHOs’ “visions of the future” of general practice and their experience in implementing these visions. The final report was released in 2006. Researcher Craig Johnston NHC Report: Informal caregivers literature review This review examines a sample of a large volume of work on the implications of being an informal caregiver. Key aspects of caregiving, including health inequalities and financial implications, are addressed in the review as well as possible interventions to help caregivers. Researchers Anne Goodhead, Janet McDonald Assessing governance, purchasing and accountability in the New Zealand health care sector This project documents and analyses the new relationships under District Health Boards, assessing their strengths and weaknesses compared with other ways of organising health care systems. All fieldwork on the project has been completed and research reports will be finalised in early 2007. Researchers Jackie Cumming, Tai Walker, Anne Goodhead, Marie Russell, Sue Buckley, Roshan Perera, Marianna Churchward, Janet McDonald, Lynne Pere, Toni Ashton, Tim Tenbensel, Michael Powell (University of Auckland), Lanuola Asiasiga, Fuafiva Fa’alau (Independent Researchers), Pauline Barnett, Clare Clayden (Christchurch School of Medicine, University of Otago), Chris Cunningham, Amohia Boulton (Massey University), and Nicholas Mays (London School of Hygiene and Tropical Medicine). Identifying key indicators of wellbeing for young New Zealanders This research aims to understand what wellbeing means to young New Zealanders in three ethnic groupings: Māori, Pasifika and Pākehā, and to identify key wellbeing indicators, based on the views of the informants. The study included literature reviews, focus groups and personal interviews with young people. Researchers Marie Russell, Kirsten Smiler, Marianna Churchward, Paul Jose (School of Psychology), Maia Bennett, Tai Walker, Jackie Cumming, Aliitasi Tavila, Mili Burnette, Jan Pryor (Roy McKenzie Centre for the Study of Families) and Liz Richardson (Faculty of Science) Improving performance in New Zealand health care: Hospital outcomes This new project will adapt and apply new outcome measures and modern statistical approaches to evaluating hospital performance in New Zealand. As well as providing information on variability and trends in in-patient outcomes and hospital-level predictors of these outcomes, the project will provide the statistical basis for a sophisticated system for analysis and monitoring of hospital outcomes. A particular focus of this project is the identification of aspects of hospital organisation and working environment which may be related to patient outcomes. The research commenced in 2005, with an initial data analysis to begin in 2006. Researchers: Jackie Cumming, Antony Raymont, John Fraser, Patrick Graham, Phil Hider ( Christchurch School of Medicine, University of Otago), Gregor Coster and Mary Finlayson ( University of Auckland). Funding: Health Research Council of New Zealand, 2005-2008. Improving health through primary care reform: An economic analysis This research will use economic techniques and data from two national health surveys to examine the impact that fees charged by local primary health care providers have on utilisation of primary and secondary health care, and on health outcomes. The implementation of the Primary Health Care Strategy has resulted in a large reduction in the fees charged by primary health care providers and, by examining data from both before and after its introduction, we can identify whether lowering fees affects health-related behaviours, and if so who is most affected. This preliminary research to test the feasibility of this approach will also more broadly describe the experiences of different population groups over time in relation to fees paid, health care utilisation, and self-reported reasons for not accessing care, to provide context for our main results. Researchers: Jackie Cumming, Antony Raymont, Steven Stillman (Motu Economic & Public Policy Research and Gregor Coster ( University of Auckland). Identifying key indicators of wellbeing for young New Zealanders (A new project) This research aims to understand what wellbeing means to young New Zealanders in three ethnic groupings: Māori, Pasifika and Pākehā, and to identify key wellbeing indicators, based on the views of the informants. During 2005 the study commenced with literature reviews and focus groups with young people. These will be analysed in early 2006 before the project moves into a second phase of data collection. Researchers: Marie Russell, Kirsten Smiler, Marianna Churchward, Paul Jose ( School Of Psychology), Maia Bennett, Tai Walker, Jackie Cumming, Jan Pryor (Roy McKenzie Centre for the Study of Families) and Liz Richardson (Faculty of Science). Funding: Health Research Council of New Zealand, Ministry of Youth Development, 2005-2007. Evaluation of the implementation and intermediate health outcomes of the Primary Health Care Strategy The aim of this research is to reach an in-depth understanding of the experience and activities of Primary Health Organisations in responding to the Primary Health Care Strategy. It will also measure change in programmes, processes and outcomes during the adoption and implementation of the Strategy; and assess the impact of the Strategy on reducing health inequalities. In 2005 the team published a report on the interim findings and began developing publications from the research. A number of presentations on the research took place in New Zealand and overseas. A further data collection round will begin in 2006. Research managers: Jackie Cumming, Antony Raymont, Barry Gribben, Carol Boustead (CBG Health Research). Researchers: Jackie Cumming, Antony Raymont, Roshan Perera, Marianna Churchward, Janet McDonald, Anne Goodhead, Barry Gribben, Carol Boustead, (CBG Health Research) Pauline Barnett (Christchurch School of Medicine, University of Otago), Nicole Coupe, Fuafiva Fa’alau (CBG Health Research), and Terri Green (Department of Management, University of Canterbury). Consultant researchers: Professor Tony Dowell (Wellington School of Medicine and Health Sciences, University of Otago), Professor Margaret Horsburgh (University of Auckland), Dr Bridie Kent (Independent Researcher), Professor Nicholas Mays (London School of Hygiene and Tropical Medicine), and Judith Smith (University of Birmingham). In addition, Durga Rauniyar and Mahi Paurini are seconded to the research team from the Ministry of Health, with Bronwyn Croxson seconded to the team from The Treasury. Funding: Health Research Council of New Zealand, Ministry of Health, ACC, 2003-2006. Experiences of primary health care A number of projects are underway in conjunction with the Ministry of Health, researching the experiences of New Zealanders with respect to primary health care, using data from the New Zealand Health Survey 1996/97 and 2002/03. These projects commenced in 2005 with a focus on Māori health services utilisation, Pacific health services utilisation, chronic care service utilisation and utilisation by different socio-demographic groups. Reports are due for publication in 2006. Researchers: Jackie Cumming, Megan Pledger, Arama Rata, Matt Viliamu, Renee Sowman, Emma Scheib, (summer students), Niki Stefanogiannis, Durga Rauniyar, (Ministry of Health). Funding: Ministry of Health, Health Services Research Centre, 2005-2006. Information for patients A suite of projects funded by the Ministry of Health, Victoria University Research Fund and the Cancer Society of New Zealand are exploring the experiences of information for patients. Completed or nearly completed projects are: “Information matters: how do consumers find out about pharmaceuticals?” Carried out with the Family Centre Social Policy Research Unit this was qualitative research about consumers’ sources of information about medicines, what information they want and where and how they want to receive it. The report was published by the Ministry of Health in 2005. Researchers: Marie Russell, Hilary Stace, Marianna Churchward, Peter King (Family Centre Social Policy Research Unit), Pauline Norris, (School of Pharmacy, University of Otago), Brian Field ( Victoria University of Wellington), Flora Tuhaka, Kiwi Tamasese, Kasia Waldegrave, Tangihaere Walker (Family Centre). Researchers: Tai Walker, Kirsten Smiler, Rawiri Tuhiwai-Ruru,Marie Russell andLouise Signal ( Wellington School of Medicine and Health Sciences, University of Otago). “Information for Patients stocktake” is a pilot stocktake of patient information leaflets covering cancer, cardiovascular and mental health issues, collected in Wellington and Palmerston North. Researcher: Hilary Stace Assessing governance, purchasing and accountability in the New Zealand health care sector This project documents and analyses the new relationships under District Health Boards, assessing their strengths and weaknesses compared with other ways of organising health care systems. All fieldwork on the project has been completed and research reports will be finalised in early 2006. Researchers: Jackie Cumming, Tai Walker, Anne Goodhead, Marie Russell, Sue Buckley, Roshan Perera, Marianna Churchward, Janet McDonald, Toni Ashton, Tim Tenbensel, Michael Powell (University of Auckland), Lanuola Asiasiga, Fuafiva Fa’alau (Independent Researchers), Pauline Barnett, Clare Clayden (Christchurch School of Medicine, University of Otago), Chris Cunningham, Amohia Boulton (Massey University), and Nicholas Mays ( London School of Hygiene and Tropical Medicine ). Funding: Health Research Council, Ministry of Health, The Treasury, State Services Commission, 2001-2006. Regional approaches to mental health This project includes an evaluation of the existing regional approaches to mental health service organisation and governance, as well as generating recommendations to further the desired objectives of the mental health sector. The researchers conducted interviews with a wide range of representatives from the both public and non-government sector throughout the country, as well as representatives from central agencies. This information was combined with a literature review to complete the research . The report was completed and published by the Ministry of Health and Mental Health Commission in 2005. Researchers: Anne Goodhead, Jackie Cumming and Amohia Boulton Funding: Ministry of Health,Mental Health Commission 2005. Performance indicators in primary care This research is Roshan Perera’s PhD thesis on the development of performance indicators for primary health care. The thesis explores both theoretical and practical issues regarding the development and implementation of performance indicators in primary health care, and details the development of an evidence-based tool for the assessment of performance indicators. The utilisation of performance indicators is discussed in the context of the national implementation of a set of performance indicators in New Zealand. Roshan completed a number of reports for District Health Boards New Zealand, and is currently finalising her PhD thesis. Researcher: Roshan Perera Achieving change in primary health care services (A new project) The project is researching Primary Health Care Organisations’ (PHOs) experience in generating change in general practice as they work to implement the primary Health Care Strategy. It involves examining PHOs’ “visions of the future” of general practice and their experience in implementing these visions. Fieldwork took place in 2005 and a final report is in preparation for release in 2006. Researcher: Craig Johnston Pacific HealthYour health is in your hands: Factors that influence Samoan women’s food choices within a church context Researcher Aliitasi Tavila Knowledge and use of antibiotics amongst Samoan people in New Zealand and Samoa Researchers Dr Pauline Norris (School of Pharmacy, University of Otago), Marianna Churchward, Cecilia Va’ai, Fuafiva Fa’alau Knowledge and use of antibiotics amongst Samoan people in New Zealand and Samoa The aim of this project is to explore Samoan people's understanding and use of antibiotics in order to develop strategies to reduce inappropriate use of antibiotics. Interviews with Samoan people took place in 2005 and the project will be completed in 2006. Researchers: Dr Pauline Norris ( School of Pharmacy, University of Otago), Marianna Churchward Funding: Health Research Council of New Zealand, 2005-2006. Your life is in your hands: the impact of food choices on health – from a Samoan womens’ perspective In late 2005 the HSRC won funding from the Ministry of Health to work with the Ministry to develop the Pacific research workforce. Aliitasi Tavila is working on a project exploring the perspectives of Samoan women about food choices and the impact of these choices on health. The project forms part of her study towards an MA (Applied) Social Science Research. Researcher: Aliitasi Tavila Funding: Ministry of Health, 2005-2006. Priority Setting Research and Evaluation ProjectsConvergence study Pathways to care and outcomes for elective surgery: a prospective cohort study This study is following for 18 months a cohort of approximately 2,800 patients considered for surgical referral by GPs. The study will identify patients receiving and not receiving surgery, exploring the reasons in each case, and auditing patients’ health care utilisation and health outcomes. Fieldwork for the research commenced in 2004 and is almost complete. Analysis is now underway on referral patterns. Data collection will be completed in 2006 and following a full analysis, dissemination of the findings will begin. Principal Researcher: Dr Debbie McLeod, Department of General Practice, Wellington School of Medicine & Health Sciences, University of Otago Researchers: Antony Raymont, Jackie Cumming, Megan Pledger Funding: Health Research Council of New Zealand, 2003-2006. Coronary artery bypass graft surgery – Evaluation of the validity of the prioritisation score and the impact of waiting This study is testing the predictive power of Clinical Priority Assessment Criteria (CPAC) scores (and components of scores), several serum bio-markers, total treadmill test times, and socioeconomic variables, and is assessing the costs of waiting for care. Data collection is well underway and will continue in 2006. Principal Researchers: Dr Mary Seddon, Professor Rod Jackson, ( School of Population Health, University of Auckland) Researchers: Jackie Cumming, Dale Bramley, Joanna Broad, Sue Crengle (University of Auckland), Elana Curtis, Patrick Graham (Christchurch School of Medicine, University of Otago), Terri Green (School of Management, Canterbury University), Ralph Stewart, Harvey White (University of Auckland). Funding: Health Research Council of New Zealand, 2003-2006. Other ProjectsEvaluation of ten national demonstration integrated care projects Nine projects funded by the Government from 1998 were evaluated. The projects were diverse, in terms of size, scope and aims, but all were based in mainstream services. Ten evaluation reports (an individual report on each project, and an Over Report) were published in March 2001 - see publication page. The team developed an "ideal model of integration" which has at its centre a cyclical process of procedure development, implementation and outcome measurement. Two essential components must be considered at every stage of this cycle: cooperation and collaboration; and Treaty issues. Findings include 1) projects were most promising for Maori where the project team took time to develop partner relationships with Maori providers and iwi, cemented this in a formal way, and then worked in with Maori at all levels; 2) changing the culture of organisations and the environment within which organisations interact is an important part of developing integration: 3) four of the projects showed a strong commitment to the principles of the Treaty of Waitangi, supporting a bicultural service responsive to Maori health; 4) a cost-effectiveness analysis of the projects could not be done because sufficient quantitative data were not available. Researchers: Marie Russell, Pamela Burns, Amanda Gilbert, Adrian Slack, Jackie Cumming, Debbie Peterson, Pauline Norris, Papaarangi Reid (Eru Pomare Maori Health Research Centre, Wellington School of Medicine and Health Sciences) An extension to the evaluation of the Hawkes Bay shared care pilot An earlier study evaluated arrangements whereby the care of people with ongoing needs for mental health services is shared between general practitioners and hospital-based community mental health services. the evaluation found that it took almost two years for s 19 May, 2009 e were several achievements such as the development of a consumer focussed care plan. There was not statistically significant improvement in health status, nor were there any changes in secondary service utilisation. Most consumers, GPs and the mental health considered shared care provides an improved service. This extension project continued the evaluation of the Hawkes Bay shared care pilot project service. It provided for a two-year follow-up of those who joined the pilot in the first year. This provided an opportunity to evaluate the pilot in its established stage. Researchers: Katherine Nelson, Jackie Cumming, Debbie Peterson, Evan Roberts, Peter Ellis (Wellington School of Medicine and Health Sciences). ACE-Inhibitor review In 1998 PHARMAC changed the way it subsidised ACE-inhibitors (drugs used for hypertension). This meant two ACE-inhibitors were available free of charge (except for normal prescription charges), while patients had to pay substantial charges for other ACE-inhibitors. Extra payments were made to doctors to allow patients to have free (or substantial discounted) visits to change their medication. This project investigates patients' and doctors' perceptions of the changes, and their economic impact. Data analysis was completed in 2000 and the final report presented to PHARMAC. Researchers: Tim Maling (Wellington School of Medicine and Health Sciences), Victoria Andersen, Bruce Aroll (University of Auckland), Pauline Norris, Jackie Cumming, Evan Roberts. Pharmacists' counselling about restricted medicine In the last decade, in New Zealand and elsewhere, medicines which were available only on doctor's prescription are becoming available from pharmacists. This project aimed to determine whether pharmacists ask questions and provide advice when they sell medicine. The project also looked at whether the characteristics of the pharmacy or the purchaser affected the nature or amount of counselling pharmacists provided. It used 'mystery shopper' visits to 180 pharmacies in 1999, and a questionnaire to all pharmacies in New Zealand in 2000. The questionnaire asked for background information on pharmacy characteristics. An excellent response rate was achieved. The study found wide variation between pharmacies in how much counselling they provided to shoppers. Some sold restricted medicines without asking basic questions to find out whether the medicine was appropriate. Two papers from the study have been accepted for publication in refereed journals, and other are in preparation. Numerous seminars and conference presentations have been given, and the results of the study are being in pharmacists' education. Researchers: Pauline Norris and Marianna Churchward Consumer understanding of pharmacy terms This project looked at consumers' understanding of nine terms commonly used by pharmacists, such as hypertension, antibiotic, inflammation. Three summer students from different ethnic groups interviewed approximately 80 people of their own ethnic background. The study found low levels of understanding of all the terms, particularly amongst the Tokelauan people. The results have been widely published and are also being used to inform pharmacists' undergraduate education. Researchers: Pauline Norris (Supervisor), Kiri Bird, Jack Kirifi and Tamika Simpson (Students). Consumer involvement in mental health research This Health Research Council funded training fellowship explores mental health orientated social science research as it is relates to mental health consumer. It also focuses on ethical issues, consumers’ experiences as research participants and researchers, and researchers' experiences of research with consumers. The research commenced in mid-1999 and is due for completion in 2003. Researcher: Debbie Peterson Variations in health care utilisation and geographical access Concerns about variations in access to health care services have been voiced for many years in New Zealand, and timely, equitable access to health care is a key health policy goal. Understanding these concerns, and meeting the Government's access aims, requires knowledge of how accessible services are, and how to improve this accessibility. While much has been written about variations in access to care and how to improve access to care, this study is a first stage in specifically understanding trends and variations of access to secondary health care in New Zealand. This project is the beginning of a larger programme of research on trends and variations in access to health care. The study, which combines economic and geographica approaches, looks at geographical access, summarising variations and changes in secondary care service utilisation rates over the 1991-1996 period. The project includes the development of conceptual model of access relevant to New Zealand, and through the multidisciplinary approach the original use of important, but under-utilised, national datasets. Researchers: Jackie Cumming, Adrian Slack, Dave Mare, Jason Timmins (Motu Economic & Public Policy Research), Lars Brabyn (Waikato University), Canterbury University, Chris Skelly, Barry Borman (Ministry of Health). Review of New Zealand experience of contracting in health services This project involves reviewing the experiences of contracting in health care in New Zealand during the 1990s, to provide advice to WHO on the ways in which contracting works in practice in health care. The project involves literature review, contract review and key and formal interviews. Researchers: Jackie Cumming, Toni Ashton, Malcolm McKinlay (University of Auckland), Ezrai Fae, Janet Holmes.
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