Tim Kenealy

• University of Auckland

Background: Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into seven models of primary care: Traditional, Corporate, Health Care Home, Māori, Pacific, Trusts / Non-govern...

Aim:To explore the views of general practitioners (GPs) and nurses on type 2 diabetes (T2D) management, including the use of recently funded T2D medications in New Zealand (NZ) and their perceived barriers to providing optimal care. Background:T2D is a significant health concern in NZ, particularly among Māori and Pacific adults. Characterised by p...

The prevalence of childhood obesity is increasing globally(1). While BMI is commonly used to define obesity, it is unable to differentiate between fat and muscle mass, leading to calls to measure body composition specifically(2). While several tools are available to assess body composition in infancy, it is unclear if they are directly comparable....

Background For more than a century, Māori have experienced poorer health than non-Māori. In 2019 an independent Tribunal found the Government had breached Te Tiriti o Waitangi by “failing to design and administer the current primary health care system to actively address persistent Māori health inequities”. Many Māori (44%) have unmet needs for pri...

Background For more than a century, Māori have experienced poorer health than non-Māori. In 2019 an independent Tribunal found the Government had breached Te Tiriti o Waitangi by “failing to design and administer the current primary health care system to actively address persistent Māori health inequities”. Many Māori (44%) have unmet need for prim...

Background Maternal vitamin status preconception and during pregnancy have important consequences for pregnancy outcome and offspring development. Changes in status from preconception to early and late pregnancy and postpartum have been inferred from crosssectional data, with lower pregnancy concentrations often ascribed to plasma volume expansion,...

Background: Primary care in Aotearoa New Zealand is largely delivered by general practices, heavily subsidised by government. Te Tiriti o Waitangi (1840) guarantees equal health outcomes for Māori and non-Māori, but differences are stark and longstanding. Seven models of primary care have evolved. We hypothesised that patient health outcomes would...

Background Primary care in Aotearoa New Zealand is largely delivered by general practices which are heavily subsidised by government. At least seven models of primary care have evolved: Traditional, Corporate, Health Care Home, Māori practices, Pacific practices, and practices owned by Primary Health Organisations/District Health Boards and Trust/N...

Background Māori are over-represented in Aotearoa New Zealand morbidity and mortality statistics. Other populations with high health needs include Pacific peoples and those living with material deprivation. General practice has evolved into different models of primary care. We describe nurse work in relation to these models of care; populations wit...

Background There is a lack of evidence regarding post-consultation symptom trajectories for patients with respiratory tract infections (RTIs) and whether patient characteristics can be used to predict illness duration. Aim To describe symptom trajectories in patients with RTIs, and assess baseline characteristics and adverse events associated with...

Background Bioelectrical impedance analysis (BIA) is widely used to measure body composition but has not been adequately evaluated in infancy. Prior studies have largely been of poor quality, and few included healthy term-born offspring, so it is unclear if BIA can accurately predict body composition at this age. Aim This study evaluated impedance...

This study aimed to cross-calibrate body composition measures from the GE Lunar Prodigy and GE Lunar iDXA in a cohort of young children. 28 children (mean age 3.4 years) were measured on the iDXA followed by the Prodigy. Prodigy scans were subsequently reanalysed using enCORE v17 enhanced analysis (“Prodigy enhanced”). Body composition parameters w...

Background Evidence that nutritional supplementation before and during pregnancy improves peripartum outcomes is sparse. In the Nutritional Intervention Preconception and During Pregnancy to Maintain Healthy Glucose Metabolism and Offspring Health (NiPPeR) trial we previously reported that a combined myo-inositol, probiotics and micronutrient suppl...

Objectives: To cross-calibrate body composition measures from the GE Lunar Prodigy and GE Lunar iDXA in a cohort of young children. Methods: 28 children (mean age 3.4 years) were measured on the iDXA followed by the Prodigy. Prodigy scans were subsequently reanalysed using enCORE v17 enhanced analysis (“Prodigy enhanced”). Body composition paramete...

Impact of COVID response to healthcare workers ad health systems.

The infant gut microbiome contains a portion of bacteria that originate from the maternal gut. In the infant gut these bacteria encounter a new metabolic environment that differs from the adult gut, consequently requiring adjustments in their activities. We used pilot community RNA sequencing data (metatranscriptomes) from ten mother-infant dyads p...

This narrative review focuses on why some people with diabetes are more successful than others at keeping their blood glucose levels within healthy limits. It investigates the social and community factors that influence how people with type 1 or type 2 diabetes manage their condition. Six general trajectories of glycaemic control, based on HbA 1c l...

Background: Diabetes care is often sub-optimal. Quality improvement (QI) initiatives are intended to improve care processes and thereby improve patient outcomes. There is a need to assess the degree of implementation of QI strategies, as a prerequisite to managing implementation. Aims: Our study aims to describe the level of implementation of si...

Aim: Gout is a health equity issue for Māori and Pacific peoples because disparities in quality of care exist. This study aims to describe domains of access that may contribute to the optimisation of gout care and, therefore, address health inequity. Methods: The practice management system at one general practice in Auckland was used to identify...

Bioelectrical impedance techniques are easy to use and portable tools for assessing body composition. While measurements vary according to standing vs supine position in adults, and fasting and bladder voiding have been proposed as additional important influences, these have not been assessed in young children. Therefore, the influence of position,...

Objective To assess the overall effect of delayed antibiotic prescribing on average symptom severity for patients with respiratory tract infections in the community, and to identify any factors modifying this effect. Design Systematic review and individual patient data meta-analysis. Data sources Cochrane Central Register of Controlled Trials, Ov...

Assessing the degree / completeness / extent of implementation of quality improvement (QI) strategies may help to predict their effectiveness in terms of patient outcomes. Purpose: Our study aims to describe the level of support for the implementation of six QI strategies (self-management support, team changes, case management, patient education, e...

Bioelectrical impedance techniques are easy to use and portable tools for assessing body composition. While measurements vary according to standing vs supine position in adults, and fasting and bladder voiding have been proposed as additional important influences, these have not been assessed in young children. Therefore, the influence of position,...

INTRODUCTIONGout remains a health equity issue; Māori and Pacific peoples are disproportionately afflicted, with increased burden and loss of quality of life, yet are less likely to receive appropriate management, which mainly occurs in primary care. AIMThis study aims to understand the perspectives of the mainly Māori and Pacific clinicians and st...

Objective: Better preconception metabolic and nutritional health are hypothesized to promote gestational normoglycemia and reduce preterm birth, but evidence supporting improved outcomes with nutritional supplementation starting preconception is limited. Research design and methods: This double-blind randomized controlled trial recruited from th...

Bioelectrical impedance analysis (BIA) is an easy to use, portable tool, but the accuracy of the technique in infants and young children (<24 months) remains unclear. A systematic literature review was conducted to identify studies that have developed and validated BIA equations in this age group. MEDLINE, Scopus, EMBASE, and CENTRAL were searched...

Aims/hypothesis Few studies examine the association between age at diagnosis and subsequent complications from type 2 diabetes. This paper aims to summarise the risk of mortality, macrovascular complications and microvascular complications associated with age at diagnosis of type 2 diabetes. Methods Data were sourced from MEDLINE and All EBM (Evid...

Introduction As a result of the current pandemic (COVID-19), many clinical teams are exposed to stressful situations that may lead to physical and mental issues for clinical staff themselves (we exclude the effects of personal infection with the virus). Recent studies suggest some predictors could depend on context, notably country and the type of...

Introduction As a result of the current pandemic (COVID-19), many clinical teams are exposed to stressful situations that may lead to physical and mental issues for clinical staff themselves (we exclude the effects of personal infection with the virus). Recent studies suggest some predictors could depend on context, notably country and the type of...

Gout is a health condition that can be managed to prevent morbidity and premature mortality. Mäori have a higher prevalence of gout yet are less likely to receive appropriate care than non-Mäori. There is scant literature presenting the patient/whänau voice relating to the health system response to gout. The study reported in this article aimed to...

Aim: To determine whether there were ethnic differences in HbA1c concentrations in adults with normal and abnormal glucose tolerance. Methods: Cross-sectional data were from 3,559 participants not previously diagnosed with diabetes aged 35-74 years. Participants underwent a 75 gm oral glucose tolerance test. Glucose and fructosamine levels were det...

We highlight the concerns that those with diabetes are a vulnerable group and that those infected with COVID-19 appear to have worse health outcomes. Further, while the cause of each are different, both pandemics are significant public health challenges requiring commitment form governments, and partnership with public health practitioners, the hea...

Aim: To measure intensification of therapy (the inverse of clinical inertia) by general practitioners in the management of hyperglycaemia, hypertension and dyslipidaemia in patients with diabetes. Methods: We analysed clinical practices results for Hb1c, blood pressure, lipids and pharmacy records for prescriptions according to the guidelines. We i...

Background: Numerous studies have shown gender-based similarity affects interactions in organizational contexts. However, studies in the health care arena have shown contradictory findings. Objective: To explore gender homophily in an inter-professional network comprising doctors and nurses across the primary and secondary care interface in diabete...

Programs to manage long term conditions in developed countries seek greater integration and communication between health professionals to improve health outcomes. But more empirical evidence is needed to measure integration and influence for health those who are involved in these programs. This paper analyses the way in which health professionals i...

There has been increasing interest in understanding body composition in early life and factors that may influence its evolution. While several technologies exist to measure body composition in infancy, the equipment is typically large, and thus not readily portable, is expensive, and requires a qualified operator. Bioelectrical impedance analysis s...

Objectives: The study sought to determine whether older people, on discharge from hospital and on referral to a supported discharge team (SDT), will have: (1) reduced length of stay in hospital; (2) reduced risk of hospital readmission; and (3) reduced healthcare costs. Design/intervention: Randomized controlled trial with follow-up at 4 and 12...

Aims To explore actions and motivations for self-management practices of Pacific adults following diagnosis of end stage renal disease (ESRD). Methods Focused ethnography using in-depth interviews with 16 Pacific people on haemodialysis for diabetic ESRD, in Auckland, New Zealand. Study participants were of Samoan, Cook Islander, Tongan, Niuean, o...

Introduction: Community based primary health care (CBPHC) organizations are critical providers of integrated care for complex patients. Exemplar cases exist, but efforts to scale up and spread successful models continue to face major challenges. While scale and spread has become a popular topic, there are still significant gaps in our understanding...

Background Compared with New Zealand Europeans, Pacific peoples in New Zealand develop type 2 diabetes at a higher rate and a younger age, and have 3.8 times higher incidence of end‐stage renal disease (ESRD). Objective To investigate contextual factors that shape understandings of disease for Pacific peoples with diabetes and ESRD. Methods Focus...

Background: Decline in eGFR is a biologically plausible surrogate end point for the progression of CKD in clinical trials. However, it must first be tested to ensure strong associations with clinical outcomes in diverse populations, including patients with higher eGFR. Methods: To investigate the association between 1-, 2-, and 3-year changes in...

Background: Change in albuminuria as a surrogate endpoint for progression of chronic kidney disease is strongly supported by biological plausibility, but empirical evidence to support its validity in epidemiological studies is lacking. We aimed to assess the consistency of the association between change in albuminuria and risk of end-stage kidney...

Introduction Delayed prescribing can be a useful strategy to reduce antibiotic prescribing, but it is not clear for whom delayed prescribing might be effective. This protocol outlines an individual patient data (IPD) meta-analysis of randomised controlled trials (RCTs) and observational cohort studies to explore the overall effect of delayed prescr...

Objective To evaluate the associations between adiposity measures (body mass index, waist circumference, and waist-to-height ratio) with decline in glomerular filtration rate (GFR) and with all cause mortality. Design Individual participant data meta-analysis. Setting Cohorts from 40 countries with data collected between 1970 and 2017. Participa...

Web appendix: Supplementary materials

Background The concept of “mechanism” is central to realist approaches to research, yet research teams struggle to operationalize and apply the concept in empirical research. Our large, interdisciplinary research team has also experienced challenges in making the concept useful in our study of the implementation of models of integrated community-ba...

Aim: To describe quality management processes and appropriate interpretation with respect to HbA1c point-of-care (POC) testing in a national diabetes and cardiovascular risk screening programme. Methods: We compared HbA1c results from capillary blood, measured by the cobas b 101 (Roche Diagnostics) POC testing system, with results from venous blood...

Rationale & objective: Chronic kidney disease (CKD) is complicated by abnormalities that reflect disruption in filtration, tubular, and endocrine functions of the kidney. Our aim was to explore the relationship of specific laboratory result abnormalities and hypertension with the estimated glomerular filtration rate (eGFR) and albuminuria CKD stag...

Background The impact of long‐term conditions is the “healthcare equivalent to climate change.” People with long‐term conditions often feel they are a problem, a burden to themselves, their family and friends. Providers struggle to support patients to self‐manage. The Practical Reviews in Self‐Management Support (PRISMS) taxonomy lists what provide...

Objective New‐onset diabetic ketoacidosis (DKA) is entirely preventable with early recognition of the symptoms of type 1 diabetes mellitus (T1D). In this study, we aimed to assess whether a simple and easily delivered educational campaign could reduce the risk of DKA. Methods A poster highlighting key features of new‐onset T1D was delivered once a...

Background: Information communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring...

Objective: To identify contextual factors that affect self-management of diabetes with comorbidities, and to evaluate in what way these factors affect self-management effectiveness. Methods: A systematic review of literature considered English language articles published within Medline, PsycINFO, Pubmed, CINAHL Plus, and Scopus databases that fo...

Health and social care systems across western developed nations are being challenged to meet the needs of an increasing number of people aging with multiple complex health and social needs. Community based primary health care (CBPHC) has been associated with more equitable access to services, better population level outcomes and lower system level...

Introduction Studying implementation of integrated models of community-based primary health care requires a “whole systems” multidisciplinary approach to capture micro, meso and macro factors. However, there is, as yet, no clear operationalization of a “whole systems” approach to guide multidisciplinary research programs. Theoretical frameworks and...

Purpose: We undertook a study to observe in detail the primary care interactions and communications of patients with newly diagnosed diabetes over time. In addition, we sought to identify key points in the process where miscommunication might occur. Methods: All health interactions of 32 patients with newly diagnosed type 2 diabetes were recorde...

Background: Supported Discharge Teams aim to help with the transition from hospital to home, whilst reducing hospital length-of-stay. Despite their obvious attraction, the evidence remains mixed, ranging from strong support for diseasespecific interventions to less favourable results for generic services. Objective: To determine whether older peopl...

Background: Supported Discharge Teams aim to help with the transition from hospital to home, whilst reducing hospital length-of-stay. Despite their obvious attraction, the evidence remains mixed, ranging from strong support for disease-specific interventions to less favourable results for generic services. Objective: To determine whether older p...

Background: Vitamin D insufficiency (defined as <75 nmol l⁻¹) is widespread among pregnant women around the world and has been proposed to influence offspring outcomes in childhood and into adult life, including adiposity and allergy. Disorders, including asthma and eczema, are on the rise among children. Our aim was to investigate the relationship...

Background Some evidence suggests that chronic kidney disease is a risk factor for lower-extremity peripheral artery disease. We aimed to quantify the independent and joint associations of two measures of chronic kidney disease (estimated glomerular filtration rate [eGFR] and albuminuria) with the incidence of peripheral artery disease. Methods In...

The aim of this paper is to set the foundation for subsequent empirical studies of the “Implementing models of primary care for older adults with complex needs” project, by introducing and presenting a brief descriptive comparison of the nine case studies in Quebec, Ontario and New Zealand. Each case is described based on key dimensions of Rainbow...

Background Family carers, as a “shadow workforce”, are foundational to the day-to-day integration of health service delivery for older family members living with complex health needs. This paper utilises Haggerty’s model of continuity of care to explore the contribution of family carers’ to the provision of care and support for an older family memb...

Healthcare system reforms are pushing beyond primary care to more holistic, integrated models of community based primary health care (CBPHC) to better meet the needs of the population. Across the world CBPHC is at varying stages of development and few standard models exist. In order to scale up and spread successful models of care it is important t...

Community-based primary health care describes a model of service provision that is oriented to the population health needs and wants of service users and communities, and has particular relevance to supporting the growing proportion of the population with multiple chronic conditions. Internationally, aspirations for community-based primary health c...

Introduction Many studies have investigated the process of healthcare implementation to understand better how to bridge gaps between recommended practice, the needs and demands of healthcare consumers, and what they actually receive. However, in the implementation of integrated community-based and integrated health care, it is still not well known...

Introduction Patient self-management support is central to care for long term conditions and for integrated care. Patients and their carers are the final arbiter of whether support for self-management has been effective. A new taxonomy lists 14 categories of provider activities that support patient self-management (Practical Reviews in Self-Managem...

Introduction A recent WHO multi-country study on maternal and newborn health concluded that there was no evidence of an association between high coverage with essential interventions and reduced mortality in health care facilities, or improvement in other outcomes.1 According to Horton the missing ingredient in this relation is quality of care.2 Qu...

Objectives To assess the effect of a point of care (POC) device for testing lipids and HbA1c in addition to testing by community laboratory facilities (usual practice) on the completion of cardiovascular disease (CVD) risk assessments in general practice. Methods We conducted a pragmatic, cluster randomised controlled trial in 20 New Zealand gener...

EPOCH trial protocol. (PDF)

Consort checklist. (DOC)

Background: Improved maternal nutrition and glycaemic control before and during pregnancy are thought to benefit the health of the mother, with consequent benefits for infant body composition and later obesity risk. Maternal insulin resistance and glycaemia around conception and in early pregnancy may be key determinants of maternal physiology and...

Aims: We compared the utility of glycated hemoglobin (HbA1c) and oral glucose tolerance (oGTT) in non-diabetic patients for identifying incident diabetes; all-cause mortality; cardiovascular disease (CVD) mortality; CVD, coronary heart disease (CHD), and ischemic stroke events; and diabetes microvascular complications. Methods: Data from a New Z...

This paper is a response to our recognition that approaches to equity and consumer involvement in research differed in emphasis between our researchers and jurisdictions. Whilst we shared common aspirations we varied in our priorities between equity groups and methods to represent consumer interests. New Zealand has a historical focus on equity for...

Aim: In a region with high rates of immunisation refusal, we examine whether refusing an immunisation at 6 weeks (the first scheduled immunisation) predicts the pattern for subsequent scheduled immunisations, and the characteristics of those who declined these immunisations. Method: We used data from the National Immunisation Register to identif...

p>Huge investments into research capacity building in low to middle-income countries¹ have resulted in a significant increase in the critical mass of research scientists.² However, the increase in researchers and research output has been more easily achieved in larger countries with a multitude of research institutions. Effort...

Aim: To determine whether the prevalence of diagnosed diabetes in the greater Auckland Region varies by General Electoral District (GED). Methods: Using encrypted National Health Identifiers and record linkage of routine health datasets, we identified a regional cohort of people with diagnosed diabetes in 2011 from inpatient records and medicati...

Background Action research (AR) and randomized controlled trials (RCTs) are usually considered to be theoretically and practically incompatible. However, we argue that their respective strengths and weaknesses can be complementary. We illustrate our argument from a recent study assessing the effect of telemonitoring on health-related quality of lif...

This study uses conversation analysis to explore 'candidate obstacles', a practice observed in sequences of patient resistance to lifestyle advice within health professional consultations. This article presents illustrative analyses of selected data excerpts drawn from audio-visual recordings of 116 tracked consultations between health professional...

Introduction: We compared the utility of glycated hemoglobin (HbA1c) and oral glucose tolerance (oGTT) in non-diabetic patients for identifying incident diabetes, all-cause mortality, cardiovascular disease (CVD) mortality, all-CVD events, coronary heart disease (CHD) events, ischaemic stroke events and diabetes microvascular complications. Hypothe...