Project 3: Meso/Micro Level – Service delivery – Implementation and impact of new models of care

The third aspect of our programme grant was to consider new models of care.  The COVID-19 pandemic has meant that aspects of the planned project have been put on hold.  This project has been redirected to focus on patient experiences of health care in a pandemic.

Project outline: Patient experiences of health care in a pandemic

Aotearoa New Zealand is currently amid a global pandemic, caused by the emergence of a new virus, the coronavirus COVID-19, in Wuhan, China. Overseas, the virus has infected and caused the deaths of thousands of people and health care systems have struggled to cope. In Aotearoa New Zealand, the first case of COVID-19 occurred on 28 February and a state of emergency was declared on 25 March, with the introduction of unprecedented restrictions on travel, work and social contact. On 23 March, Aotearoa New Zealand went into Alert Level 3, moving to Alert Level 4 on 25 March. These Alert Levels specify measures to be taken to contain COVID-19, and at Levels 3 and 4 (known as the ‘lockdown’), primary health care services had to rapidly shift from providing mostly face-to-face interactions to alternative methods, to reduce the potential spread of COVID-19. Alternative methods included telephone and virtual/video consultations, email or messaging apps, using online patient portals to communicate with patients and online methods for authorising prescriptions.

This research seeks to understand how these changes in primary health care delivery have affected patients. We expect that these non-face-to-face methods will be new experiences for many in the context of seeking health care. Although some health centres have implemented telephone triage and telephone consults in recent years, for example through the new Health Care Home model of care, before the pandemic these were not widespread or routine practice.

Our research questions include:

  • what type of contact have patients had with primary health care services during alert levels 3 and 4 (the ‘lockdown’) of the COVID-19 pandemic?  – what changes have patients experienced in primary health care during this time and what are the positive and negative aspects of these changes?  – what changes do patients want to see continue?
  • have patients delayed seeking health care during the lockdown, and if so, why?

For this research, we have undertaken an online survey and in-depth interviews with people who have contacted primary health care services during the lockdown.

For further information, contact:

Dr Lesley Middleton

The team

Lesley Middleton is a health services researcher and senior lecturer (health
policy) at the School of Health, Victoria University of Wellington. Having held senior roles in the health and science and technology portfolios, she has a longstanding interest in how explicit and implicit intentions for health sector improvement translate into desired changes.

Jackie Cumming is an advisor to the research team.  She is a past Director of the Health Services Research Centre.

Lynne Russell (Kāi Tahu, Ngāti Kahungunu, Rangitāne, Ngāti Porou, Kāti Māmoe, Te Wainui a Rua, Ngāti Raukawa) is a senior Māori health researcher in the Health Services Research Centre / Te Hikuwai Rangahau Hauora, within the Victoria University of Wellington Faculty of Health (Te Wāhanga Tātai Hauora, Te Herenga Waka). Her primary role within this team is to work with its members to ensure tikanga, Māori ethical processes and protocols are respected, so that the research produces findings that can support Aotearoa New Zealand to improve primary health care services and reduce health inequities for Māori. She will conduct interviews with key Māori stakeholders and lead the analysis and interpretation of this data.

Marianna Churchward is a senior Pacific health researcher with the Health Services Research Centre/Te Hikuwai Rangahau Hauora, within the Victoria University of Wellington Faculty of Health (Te Wāhanga Tātai Hauora, Te Herenga Waka). Her primary role is to work alongside the team specifically to contribute through research to improve health services for Pacific people.

Megan Pledger is a biostatistician at the Health Services Research Centre. In Project 3, she will advise on developing a survey and will analyse the results.

Eileen McKinlay is an Associate Professor at the Department of Primary Health Care & General Practice, University of Otago, Wellington and a registered nurse.

Jonathan Kennedy is a Senior Lecturer at the Department of Primary Health Care & General Practice, University of Otago, Wellington, and a general practitioner in Newtown, Wellington.

Tim Tenbensel

Tim Tenbensel is an Associate Professor and has specialised in health policy research since the late 1990s. He has been part of research teams investigating the implementation of New Zealand health sector reforms, including the early years of District Health Boards, the National Health Targets of 2009-18 and the System Level Measures framework. He has published extensively on comparative health policy, performance management, institutional continuity and change, and complexity theory and health policy.

Previous staff

Fiona Imlach was leading this project until November 2020. She is an epidemiologist and honorary fellow of the NZ College of Public Health Medicine. Fiona was a Senior Research Fellow at the Health Services Research Centre. 

Karen McBride-Henry is an Associate Professor in the School of Nursing, Midwifery & Health Practice, Victoria University of Wellington. She is also a registered nurse.

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