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Poisons information centres (PICs) offer advice on chemical safety, perform risk assessments over the phone in cases where a person has been exposed to a substance and provide clinical advice about management of the exposure. The term ‘exposure’, in the context of poison centres, refers to any route of contact (eg, ingestion, inhalation, dermal, etc) between a person and a substance (which can be a pharmaceutical, chemical, commercial product, etc). The New Zealand National Poisons Centre (NZNPC) offers a 24/7 specialist service for exposure enquiries from all New Zealanders, including both the general public and healthcare professionals. The service is available through a toll-free number (0800 POISON (0800 764 766)) staffed by specially trained poison information officers (PIOs), with clinical toxicologists providing clinical supervision and support. Depending on the scenario and risk assessment, the NZNPC may recommend that a patient present to a medical facility for further management, or that the exposure can be safely managed at home with instructions on what to look out for, saving the patient and family an unnecessary trip to the doctor or hospital. The NZNPC does not routinely follow up cases and verify whether advice was followed; however, a previous study found a high rate of adherence.1

Pasifika communities in New Zealand have a youthful demographic, which is relevant here because a substantial proportion of NZNPC calls relate to young children.2 While Pasifika families are diverse in their collective health-literacy resources and experiences in accessing health services,3,4 for many families there are challenges in accessing health services,5 which may be heightened in an urgent situation such as suspected poisoning. While there is little specific literature available on Pasifika peoples and poisoning in New Zealand, the risks of poisoning events likely vary by age group in the Pasifika population, as in the general population.2 Compared to other ethnicities, the rates of death and hospital presentations due to unintentional poisoning were highest for Pasifika New Zealanders in the age group 65 and older.6 On the other hand, Pasifika women and men had lower rates of presenting to New Zealand hospitals due to intentional self-poisoning (self-harm) compared to Māori and people of other, non-Asian ethnicities, but at similar rates to people of Asian ethnicities.7  

Telehealth is a means of service delivery that has the potential to minimise the impact of some barriers to access, such as transportation. Significant questions remain, however, about how telehealth can deliver services equitably to Pasifika populations, with a recent evaluation reporting that use of the Healthline and Quitline services (two other national toll-free telehealth services) was lower among Pasifika communities than for other New Zealanders.8 This study expands this knowledge base by exploring Pasifika engagement with the NZNPC. The aim of this study was to describe Pasifika access to the NZNPC service and unpack the characteristics of this engagement through routinely collected health data from the service.

Methods

This retrospective analysis investigated de-identified call data from NZNPC relating to human patients exposed to any substance from 1 January 2018 to 31 December 2019. Ethnicity information is collected in the call records of the NZNPC, either by directly collecting the information from the caller, or by extracting ethnicity information from the National Health Index (NHI)9 number database when the patient’s NHI is identified at the time of the call. Exposure patients were stratified into three ethnicity groups for analysis: Pasifika (any Pacific ethnicity listed in patient ‘ethnicity’ data field [Cook Island Māori, Fijian, Niuean, Samoan, Tokelauan, Tongan, Other Pacific Peoples, Pacific Peoples not further defined]);10 non-Pasifika (at least one other known ethnicity and no Pacific ethnicity listed); unknown ethnicity (missing information, or caller refused to provide it). For the main analysis, call clusters where multiple calls are made about the same patient in the same exposure event (‘linked calls’) were excluded to not over count these patients.

Ministry of Health (MOH) prioritised ethnicity level 1 (Māori, Pacific Peoples, Asian, MELAA [Middle Eastern, Latin American, African], Other, European, Not stated/Refused to say)10 was used to give a general description of the total patient population by ethnicity, but the three main groups described above were used for the main analysis to identify as many Pasifika patients from the data as possible. Patient demographics, reason for the exposure event, crude rates of exposure, caller relationship to the patient, caller location, site of exposure, most frequent substance categories and management advice were analysed in RStudio (1.1.456; RStudio Inc.) and Excel (2016; Microsoft Corp.).

The study used previously collected de-identified health data and was approved by the Human Ethics Committee of the University of Otago (ref# HD20/002). The study was conducted in accordance with the Declaration of Helsinki.11

Results

During the two-year study period, the NZNPC provided advice during 42,631 calls to a total of 44,234 human patients who had been exposed to a substance. After linked calls were excluded (3,781 calls with 4,049 patients), there were 40,185 patients in 38,760 calls. Their MOH level 1 prioritised ethnicities are described in Table 1, along with a breakdown by the three ethnicity groups used in the study.

Table 1: Ethnicity of exposure patients managed by the New Zealand National Poisons Centre, 2018–2019.

*Linked calls excluded. MOH=Ministry of Health; MELAA=Middle Eastern/Latin American/African.

When the three pre-planned ethnicity groups were created from the data, there were 1,367 Pasifika patients, 24,892 non-Pasifika, and 13,926 people of unknown ethnicity. The characteristics of these three groups of patients are summarised in Table 2. The median age of Pasifika patients was 2.0 years (interquartile range (IQR) 1–4 years; 0.2% unknown age), while the median was 2.0 (IQR 1–20 years; 0.3% unknown age) for non-Pasifika and 14.0 (IQR 2–32; 34.0% unknown age) for people of unknown ethnicity. The properties and circumstances of the calls are described in Table 3.

Table 2: Patient characteristics from exposure calls to the New Zealand National Poisons Centre, 2018–2019.

*Linked calls excluded. **Total New Zealand population (4,793,358) minus Pacific population (Census 2018)12 equals non-Pacific population. N/A = not applicable.

Table 3: Characteristics of exposure calls to the New Zealand National Poisons Centre, 2018–2019.

*Linked calls excluded. **This category contains calls originating from the ambulance service setting.

Substances involved in the exposures

The exposure event involved a median of 1.0 substance per patient for Pasifika, non-Pasifika and patients of unknown ethnicity (IQR 1–1 for all three groups). The most common substance types were liquid products (46.6% for Pasifika, 45.9% for non-Pasifika, 37.5% for people of unknown ethnicity) and capsules and tablets (36.1% for Pasifika, 30.9% for non-Pasifika, 40.2% for people of unknown ethnicity). The route of exposure was ingestion for 78.3% of Pasifika, 73.1% of non-Pasifika and 65.7% of patients of unknown ethnicity.

A total of 720 Pasifika patients (52.7%) had a therapeutic agent involved in their exposure event, while 391 (28.6%) had a household chemical involved and 269 (19.7%) a miscellaneous chemical. On the other hand, 27,061 non-Pasifika patients (44.4%) had a therapeutic agent involved, 18,393 (30.2%) had a household chemical involved and 16,831 (27.6%) had a miscellaneous chemical involved in the exposure. All three groups had most frequently been exposed to a simple analgesic (eg, paracetamol [Table 4]). The NZNPC mostly advised management at home (either no treatment or self-treatment [Table 5]).  

Table 4: Ten most-frequently encountered substance classes in the three ethnicity groups; % of all substances within patient group.

NSAID = non-steroidal anti-inflammatory drug. *Linked calls excluded. **Eg, paracetamol.

Table 5: Management advice given by the New Zealand National Poisons Centre, stratified by ethnicity group.

*Linked calls excluded. **Not enough information available at the time of the call to make a definite recommendation yet.

Discussion

There is very little published literature on Pasifika peoples and poisoning, and especially about calls to a poisons information centre (PIC) regarding Pasifika patients. This study begins to address this gap in knowledge. Over the two years covered in this study, most Pasifika patients were under the age of six, and the people calling about them were most often members of the public calling about an exposure occurring in a residential environment. This is important information for Pasifika parents and communities, in terms of highlighting the need to limit children’s access to chemicals and substances within home environments. The most common substance classifications in these exposures included simple analgesics (eg, paracetamol), cosmetics and miscellaneous household chemicals (eg, baking supplies, batteries, cigarettes, etc). All of these products are commonly found in New Zealand households. The wellbeing of children and youth are central to the aspirations of Pasifika peoples, with parents wanting to give their children the best start in life.13 Ideally, exposures/poisonings are prevented. However, as an urgent source of support, services like NZNPC are a valuable resource, as they can be immediately accessed via phone for expert advice. In this study, the majority of exposures were able to be managed at home, saving families potentially expensive trips to a medical centre or hospital.

Only 3.4% of all NZNPC patients, and 5.2% of patients with known ethnicity, were Pasifika. These observed rates are relatively low, as the Pasifika population comprises 8.1% of the total New Zealand population.12 Further, as the Pasifika population aged 0–4 comprises 14.3% of the total New Zealand population of that age,12 and over two-thirds of the patients with known ethnicity who were managed by the NZNPC were aged under six, more calls relating to Pasifika patients could be expected. Further research is needed to directly explore possible barriers to service access.

Possibilities for exploration include that Pacific peoples have a lower prevalence of poisoning compared to other ethnicities, or that they experience very mild exposures that they do not feel require formal care. This seems unlikely, as rates of poisoning generally increase with increasing levels of deprivation,6,7 and Pasifika people are over-represented in these areas.14 Additionally, it might be expected that larger and/or multigenerational Pasifika households could create additional challenges for storing medications and other chemicals in spaces that are inaccessible to children. Such multigenerational household compositions could function as a protective factor as well, as other, non-parental relatives may be able to provide additional supervision of children in the household.

Alternately, it may be that there is a degree of unmet need in accessing poisons information. This could be because Pasifika families are not aware of the service, or because they may look to other resources to manage exposures. It is impossible to define an ‘optimal’ rate of using a PIC service. The rate of healthcare professional calls relating to Pasifika patients was similar for non-Pasifika in this study, which indicates that at least some people from both groups did seek medical care for exposures. The reasons suggested for their lower uptake of two other free national telehealth services, Healthline and Quitline, included reluctance to make contact, as they had no previous relationship with the services, concern that they were not being understood and that the advice was being tailored to their ethnicity rather than their acute needs.8,15 People may also fear being judged or accused of being careless and ‘allowing’ a child to get injured in this way, and experiences of racism within the health system may exacerbate these concerns.16,17 While NZNPC staff focus on providing non-judgmental advice to all callers, potential callers who have not previously used the service may not be aware of this. This is an area where further research would be useful.

Another interesting line of inquiry is to explore concepts of ‘poisoning’ within the diverse Pasifika cultures in New Zealand and traditional models of managing the risks of poisoning across the Pacific region. Health promotion approaches that align with these models could then be developed and evaluated to see whether they resonate and engage families more than current approaches.

Implications

As most exposures reported to the NZNPC could be managed at home, the service has the potential to save people time and resources, as they do not need to obtain the same assessment and advice elsewhere. On the other hand, in cases requiring medical care, the NZNPC can assist by advising people to seek such care in a timely fashion. There are valuable opportunities here to promote the safe storage of chemicals and substances in Pasifika homes and to build awareness and relationships between the NZNPC, the Pasifika health sector and Pasifika communities. The facilitators and barriers to Pasifika families contacting the NZNPC for advice regarding substance exposures need to be explored further, while taking into account the rich variety of different Pasifika cultures represented in the New Zealand population.

Limitations

Some Pasifika people were likely misclassified due to being in the unknown ethnicity category. Even when an NHI number is available, ethnicity details may not correctly identify a person’s Pasifika ethnicity,18 and indications of Pasifika ethnicity may be lost over time as information is updated, effectively ‘changing’ a person’s ethnicity in the NHI database.5 Although the caller being a healthcare professional and the exposure being intentional do not necessarily mean that the exposure was more toxicologically significant, it should be noted that the unknown-ethnicity category had higher rates of these characteristics than the Pasifika and non-Pasifika categories. Such exposures may be more likely to result in a recommendation to be medically assessed. Any Pasifika patients ‘lost’ in this unknown ethnicity group may therefore lead to an underestimation of rates of medical referrals in Pasifika patients. Further, the relatively high proportion of patients of unknown age (34.0%) in the unknown-ethnicity subgroup of patients limits the reliability of the median age reported for that group. But, as this study did not seek to perform statistical comparisons between the groups, no corrections such as imputations19 were performed.

Conclusion

The New Zealand National Poisons Centre receives what appears to be a relatively small number of calls about exposures to Pasifika patients—disproportionately small compared to the population prevalence of Pasifika people in New Zealand. It is unclear whether this finding represents a low prevalence of exposures in the Pasifika communities, a low utilisation of the NZNPC by the Pasifika communities or some other combination of factors.

Summary

Abstract

Aim

Poisoning is a common type of injury in New Zealand. The New Zealand National Poisons Centre (NZNPC) offers a free 24/7 specialist assessment service for enquiries about substance exposures for all New Zealanders. This study aimed to characterise calls to the NZNPC relating to Pasifika patients to explore the potential for unmet need or health disparity in this area.

Method

A retrospective analysis of 2018–2019 human exposure call data was performed. Patients were stratified into three groups: those with at least one Pacific ethnicity listed (Pasifika); those with known ethnicities but no Pacific ethnicity listed (non-Pasifika); those of unknown ethnicity (unknown). Demographic variables and substance groups were described.

Results

Of the 40,185 human exposure patients, 1,367 (3.4%) were Pasifika, 24,892 (61.9%) were non-Pasifika and 13,926 (34.7%) were of unknown ethnicity. The median age of Pasifika patients was 2.0 years, with 78.0% aged 0–5, and the exposure most commonly involved a liquid product (46.6%) and a simple analgesic (8.3%).

Conclusion

The NZNPC receives a relatively small number of calls about exposures to Pasifika patients, especially given the youthful population demographic. It is unclear whether there is unmet need for this service, and this study suggests the need for further research.

Author Information

Eeva-Katri Kumpula: Postdoctoral Research Fellow, National Poisons Centre, University of Otago, Dunedin. Rosalina Richards: Associate Professor, Health Science Divisional Office, Centre for Pacific Health, Va’a o Tautai, University of Otago, Dunedin. Pauline Norris: Professor, Health Science Divisional Office, Centre for Pacific Health, Va’a o Tautai, University of Otago, Dunedin. Vanda Symon: Postdoctoral Fellow, Health Science Divisional Office, Centre for Pacific Health, Va’a o Tautai, University of Otago, Dunedin. Adam C Pomerleau: Director, Clinical Toxicologist, Emergency Physician (FACEM), National Poisons Centre, University of Otago, Dunedin.

Acknowledgements

Correspondence

Dr Eeva-Katri Kumpula, National Poisons Centre, PO Box 56, Dunedin 9054, 03-479 5168 (no fax available)

Correspondence Email

eeva-katri.kumpula@otago.ac.nz

Competing Interests

Nil.

1. Watts M, Fountain JS, Reith D, Schep L. Compliance with poisons center referral advice and implications for toxicovigilance. Clin Toxicol. 2004;42(5):603-10.

2. Kumpula E-K, Shieffelbien LM, Pomerleau AC. Enquiries to the New Zealand National Poisons Centre in 2018. Emerg Med Australas. 2020; doi: 10.1111/1742-6723.13563.

3. Sa’uLilo L, Tautolo E-S, Smith M. Health literacy, culture and Pacific peoples in Aotearoa, New Zealand: A review. Pacific Health. 2020;3.

4. Pio FH, Nosa V. Health literacy of Samoan mothers and their experiences with health professionals. J Prim Health Care. 2020;12(1):57-63.

5. Southwick M, Kenealy T, Ryan D. Primary Care for Pacific People: A Pacific and Health Systems approach. Report to the Health Research Council and the Ministry of Health Wellington: Pacific Perspectives; 2012. Cited 03/03/2020. Available from: https://www.health.govt.nz/system/files/documents/publications/primary-care-pacific-people-pacific-health-systems-approach.pdf.

6. Peiris‐John R, Kool B, Ameratunga S. Fatalities and hospitalisations due to acute poisoning among New Zealand adults. Intern Med J. 2014;44(3):273-81.

7. Kumpula E-K, Nada-Raja S, Norris P, Quigley P. A descriptive study of intentional self-poisoning from New Zealand national registry data: exploring the challenges. Aust N Z J Public Health. 2017;41(4):535-40.

8. Sapere Research Group. FINAL Post-Implementation Review Report of the National Telehealth Service Wellington: Ministry of Health – Manatū Hauora; 2017. Cited 03/03/2020. Available from: https://www.health.govt.nz/system/files/documents/pages/post-implementation-review-national-telehealth-service.pdf.

9. Ministry of Health – Manatū Hauora. National Health Index Data Dictionary version 5.3. Wellington: Ministry of Health – Manatū Hauora; 2009.

10. Ministry of Health – Manatū Hauora. Ethnicity Data Protocols for the Health and Disability Sector. Wellington: Ministry of Health – Manatū Hauora; 2004.

11. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191-4.

12. Statistics New Zealand. Age and sex by ethnic group (grouped total responses), for census night population counts, 2018 Census 2020. Cited 23/01/2020. Available from: http://nzdotstat.stats.govt.nz/wbos/Index.aspx?DataSetCode=TABLECODE8317

13. Ministry for Pacific Peoples. Pacific Aotearoa: Lalanga Fou. Wellington: Ministry of Pacific Peoples; 2018.

14. Craig E, Taufa S, Jackson C, Han DY. The Health of Pacific Children and Young People in New Zealand Dunedin: Ministry of Health; 2008.

15. Sapere Research Group. Phase 2 Report on the National Telehealth Service Evaluation Wellington: Ministry of Health – Manatū Hauora; 2019. Cited 03/03/2020. Available from: https://www.health.govt.nz/system/files/documents/pages/phase_2_report_on_the_national_telehealth_service_evaluation_28_02_19_redacted.pdf.

16. Harris RB, Stanley J, Cormack DM. Racism and health in New Zealand: Prevalence over time and associations between recent experience of racism and health and wellbeing measures using national survey data. PLoS One. 2018;13(5):e0196476.

17. Kapeli SA, Manuela S, Sibley CG. Perceived discrimination is associated with poorer health and well‐being outcomes among Pacific peoples in New Zealand. J Community Appl Soc Psychol. 2020;30(2):132-50.

18. Lepa T, Norris P, Horsburgh S, Taungapeau F. Accuracy of National Health Index numbers for Pacific people in New Zealand. Aust N Z J Public Health. 2013;37(2):189-90.

19. Kwak SK, Kim JH. Statistical data preparation: management of missing values and outliers. Korean J Anesthesiol. 2017;70(4):407-11.

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Poisons information centres (PICs) offer advice on chemical safety, perform risk assessments over the phone in cases where a person has been exposed to a substance and provide clinical advice about management of the exposure. The term ‘exposure’, in the context of poison centres, refers to any route of contact (eg, ingestion, inhalation, dermal, etc) between a person and a substance (which can be a pharmaceutical, chemical, commercial product, etc). The New Zealand National Poisons Centre (NZNPC) offers a 24/7 specialist service for exposure enquiries from all New Zealanders, including both the general public and healthcare professionals. The service is available through a toll-free number (0800 POISON (0800 764 766)) staffed by specially trained poison information officers (PIOs), with clinical toxicologists providing clinical supervision and support. Depending on the scenario and risk assessment, the NZNPC may recommend that a patient present to a medical facility for further management, or that the exposure can be safely managed at home with instructions on what to look out for, saving the patient and family an unnecessary trip to the doctor or hospital. The NZNPC does not routinely follow up cases and verify whether advice was followed; however, a previous study found a high rate of adherence.1

Pasifika communities in New Zealand have a youthful demographic, which is relevant here because a substantial proportion of NZNPC calls relate to young children.2 While Pasifika families are diverse in their collective health-literacy resources and experiences in accessing health services,3,4 for many families there are challenges in accessing health services,5 which may be heightened in an urgent situation such as suspected poisoning. While there is little specific literature available on Pasifika peoples and poisoning in New Zealand, the risks of poisoning events likely vary by age group in the Pasifika population, as in the general population.2 Compared to other ethnicities, the rates of death and hospital presentations due to unintentional poisoning were highest for Pasifika New Zealanders in the age group 65 and older.6 On the other hand, Pasifika women and men had lower rates of presenting to New Zealand hospitals due to intentional self-poisoning (self-harm) compared to Māori and people of other, non-Asian ethnicities, but at similar rates to people of Asian ethnicities.7  

Telehealth is a means of service delivery that has the potential to minimise the impact of some barriers to access, such as transportation. Significant questions remain, however, about how telehealth can deliver services equitably to Pasifika populations, with a recent evaluation reporting that use of the Healthline and Quitline services (two other national toll-free telehealth services) was lower among Pasifika communities than for other New Zealanders.8 This study expands this knowledge base by exploring Pasifika engagement with the NZNPC. The aim of this study was to describe Pasifika access to the NZNPC service and unpack the characteristics of this engagement through routinely collected health data from the service.

Methods

This retrospective analysis investigated de-identified call data from NZNPC relating to human patients exposed to any substance from 1 January 2018 to 31 December 2019. Ethnicity information is collected in the call records of the NZNPC, either by directly collecting the information from the caller, or by extracting ethnicity information from the National Health Index (NHI)9 number database when the patient’s NHI is identified at the time of the call. Exposure patients were stratified into three ethnicity groups for analysis: Pasifika (any Pacific ethnicity listed in patient ‘ethnicity’ data field [Cook Island Māori, Fijian, Niuean, Samoan, Tokelauan, Tongan, Other Pacific Peoples, Pacific Peoples not further defined]);10 non-Pasifika (at least one other known ethnicity and no Pacific ethnicity listed); unknown ethnicity (missing information, or caller refused to provide it). For the main analysis, call clusters where multiple calls are made about the same patient in the same exposure event (‘linked calls’) were excluded to not over count these patients.

Ministry of Health (MOH) prioritised ethnicity level 1 (Māori, Pacific Peoples, Asian, MELAA [Middle Eastern, Latin American, African], Other, European, Not stated/Refused to say)10 was used to give a general description of the total patient population by ethnicity, but the three main groups described above were used for the main analysis to identify as many Pasifika patients from the data as possible. Patient demographics, reason for the exposure event, crude rates of exposure, caller relationship to the patient, caller location, site of exposure, most frequent substance categories and management advice were analysed in RStudio (1.1.456; RStudio Inc.) and Excel (2016; Microsoft Corp.).

The study used previously collected de-identified health data and was approved by the Human Ethics Committee of the University of Otago (ref# HD20/002). The study was conducted in accordance with the Declaration of Helsinki.11

Results

During the two-year study period, the NZNPC provided advice during 42,631 calls to a total of 44,234 human patients who had been exposed to a substance. After linked calls were excluded (3,781 calls with 4,049 patients), there were 40,185 patients in 38,760 calls. Their MOH level 1 prioritised ethnicities are described in Table 1, along with a breakdown by the three ethnicity groups used in the study.

Table 1: Ethnicity of exposure patients managed by the New Zealand National Poisons Centre, 2018–2019.

*Linked calls excluded. MOH=Ministry of Health; MELAA=Middle Eastern/Latin American/African.

When the three pre-planned ethnicity groups were created from the data, there were 1,367 Pasifika patients, 24,892 non-Pasifika, and 13,926 people of unknown ethnicity. The characteristics of these three groups of patients are summarised in Table 2. The median age of Pasifika patients was 2.0 years (interquartile range (IQR) 1–4 years; 0.2% unknown age), while the median was 2.0 (IQR 1–20 years; 0.3% unknown age) for non-Pasifika and 14.0 (IQR 2–32; 34.0% unknown age) for people of unknown ethnicity. The properties and circumstances of the calls are described in Table 3.

Table 2: Patient characteristics from exposure calls to the New Zealand National Poisons Centre, 2018–2019.

*Linked calls excluded. **Total New Zealand population (4,793,358) minus Pacific population (Census 2018)12 equals non-Pacific population. N/A = not applicable.

Table 3: Characteristics of exposure calls to the New Zealand National Poisons Centre, 2018–2019.

*Linked calls excluded. **This category contains calls originating from the ambulance service setting.

Substances involved in the exposures

The exposure event involved a median of 1.0 substance per patient for Pasifika, non-Pasifika and patients of unknown ethnicity (IQR 1–1 for all three groups). The most common substance types were liquid products (46.6% for Pasifika, 45.9% for non-Pasifika, 37.5% for people of unknown ethnicity) and capsules and tablets (36.1% for Pasifika, 30.9% for non-Pasifika, 40.2% for people of unknown ethnicity). The route of exposure was ingestion for 78.3% of Pasifika, 73.1% of non-Pasifika and 65.7% of patients of unknown ethnicity.

A total of 720 Pasifika patients (52.7%) had a therapeutic agent involved in their exposure event, while 391 (28.6%) had a household chemical involved and 269 (19.7%) a miscellaneous chemical. On the other hand, 27,061 non-Pasifika patients (44.4%) had a therapeutic agent involved, 18,393 (30.2%) had a household chemical involved and 16,831 (27.6%) had a miscellaneous chemical involved in the exposure. All three groups had most frequently been exposed to a simple analgesic (eg, paracetamol [Table 4]). The NZNPC mostly advised management at home (either no treatment or self-treatment [Table 5]).  

Table 4: Ten most-frequently encountered substance classes in the three ethnicity groups; % of all substances within patient group.

NSAID = non-steroidal anti-inflammatory drug. *Linked calls excluded. **Eg, paracetamol.

Table 5: Management advice given by the New Zealand National Poisons Centre, stratified by ethnicity group.

*Linked calls excluded. **Not enough information available at the time of the call to make a definite recommendation yet.

Discussion

There is very little published literature on Pasifika peoples and poisoning, and especially about calls to a poisons information centre (PIC) regarding Pasifika patients. This study begins to address this gap in knowledge. Over the two years covered in this study, most Pasifika patients were under the age of six, and the people calling about them were most often members of the public calling about an exposure occurring in a residential environment. This is important information for Pasifika parents and communities, in terms of highlighting the need to limit children’s access to chemicals and substances within home environments. The most common substance classifications in these exposures included simple analgesics (eg, paracetamol), cosmetics and miscellaneous household chemicals (eg, baking supplies, batteries, cigarettes, etc). All of these products are commonly found in New Zealand households. The wellbeing of children and youth are central to the aspirations of Pasifika peoples, with parents wanting to give their children the best start in life.13 Ideally, exposures/poisonings are prevented. However, as an urgent source of support, services like NZNPC are a valuable resource, as they can be immediately accessed via phone for expert advice. In this study, the majority of exposures were able to be managed at home, saving families potentially expensive trips to a medical centre or hospital.

Only 3.4% of all NZNPC patients, and 5.2% of patients with known ethnicity, were Pasifika. These observed rates are relatively low, as the Pasifika population comprises 8.1% of the total New Zealand population.12 Further, as the Pasifika population aged 0–4 comprises 14.3% of the total New Zealand population of that age,12 and over two-thirds of the patients with known ethnicity who were managed by the NZNPC were aged under six, more calls relating to Pasifika patients could be expected. Further research is needed to directly explore possible barriers to service access.

Possibilities for exploration include that Pacific peoples have a lower prevalence of poisoning compared to other ethnicities, or that they experience very mild exposures that they do not feel require formal care. This seems unlikely, as rates of poisoning generally increase with increasing levels of deprivation,6,7 and Pasifika people are over-represented in these areas.14 Additionally, it might be expected that larger and/or multigenerational Pasifika households could create additional challenges for storing medications and other chemicals in spaces that are inaccessible to children. Such multigenerational household compositions could function as a protective factor as well, as other, non-parental relatives may be able to provide additional supervision of children in the household.

Alternately, it may be that there is a degree of unmet need in accessing poisons information. This could be because Pasifika families are not aware of the service, or because they may look to other resources to manage exposures. It is impossible to define an ‘optimal’ rate of using a PIC service. The rate of healthcare professional calls relating to Pasifika patients was similar for non-Pasifika in this study, which indicates that at least some people from both groups did seek medical care for exposures. The reasons suggested for their lower uptake of two other free national telehealth services, Healthline and Quitline, included reluctance to make contact, as they had no previous relationship with the services, concern that they were not being understood and that the advice was being tailored to their ethnicity rather than their acute needs.8,15 People may also fear being judged or accused of being careless and ‘allowing’ a child to get injured in this way, and experiences of racism within the health system may exacerbate these concerns.16,17 While NZNPC staff focus on providing non-judgmental advice to all callers, potential callers who have not previously used the service may not be aware of this. This is an area where further research would be useful.

Another interesting line of inquiry is to explore concepts of ‘poisoning’ within the diverse Pasifika cultures in New Zealand and traditional models of managing the risks of poisoning across the Pacific region. Health promotion approaches that align with these models could then be developed and evaluated to see whether they resonate and engage families more than current approaches.

Implications

As most exposures reported to the NZNPC could be managed at home, the service has the potential to save people time and resources, as they do not need to obtain the same assessment and advice elsewhere. On the other hand, in cases requiring medical care, the NZNPC can assist by advising people to seek such care in a timely fashion. There are valuable opportunities here to promote the safe storage of chemicals and substances in Pasifika homes and to build awareness and relationships between the NZNPC, the Pasifika health sector and Pasifika communities. The facilitators and barriers to Pasifika families contacting the NZNPC for advice regarding substance exposures need to be explored further, while taking into account the rich variety of different Pasifika cultures represented in the New Zealand population.

Limitations

Some Pasifika people were likely misclassified due to being in the unknown ethnicity category. Even when an NHI number is available, ethnicity details may not correctly identify a person’s Pasifika ethnicity,18 and indications of Pasifika ethnicity may be lost over time as information is updated, effectively ‘changing’ a person’s ethnicity in the NHI database.5 Although the caller being a healthcare professional and the exposure being intentional do not necessarily mean that the exposure was more toxicologically significant, it should be noted that the unknown-ethnicity category had higher rates of these characteristics than the Pasifika and non-Pasifika categories. Such exposures may be more likely to result in a recommendation to be medically assessed. Any Pasifika patients ‘lost’ in this unknown ethnicity group may therefore lead to an underestimation of rates of medical referrals in Pasifika patients. Further, the relatively high proportion of patients of unknown age (34.0%) in the unknown-ethnicity subgroup of patients limits the reliability of the median age reported for that group. But, as this study did not seek to perform statistical comparisons between the groups, no corrections such as imputations19 were performed.

Conclusion

The New Zealand National Poisons Centre receives what appears to be a relatively small number of calls about exposures to Pasifika patients—disproportionately small compared to the population prevalence of Pasifika people in New Zealand. It is unclear whether this finding represents a low prevalence of exposures in the Pasifika communities, a low utilisation of the NZNPC by the Pasifika communities or some other combination of factors.

Summary

Abstract

Aim

Poisoning is a common type of injury in New Zealand. The New Zealand National Poisons Centre (NZNPC) offers a free 24/7 specialist assessment service for enquiries about substance exposures for all New Zealanders. This study aimed to characterise calls to the NZNPC relating to Pasifika patients to explore the potential for unmet need or health disparity in this area.

Method

A retrospective analysis of 2018–2019 human exposure call data was performed. Patients were stratified into three groups: those with at least one Pacific ethnicity listed (Pasifika); those with known ethnicities but no Pacific ethnicity listed (non-Pasifika); those of unknown ethnicity (unknown). Demographic variables and substance groups were described.

Results

Of the 40,185 human exposure patients, 1,367 (3.4%) were Pasifika, 24,892 (61.9%) were non-Pasifika and 13,926 (34.7%) were of unknown ethnicity. The median age of Pasifika patients was 2.0 years, with 78.0% aged 0–5, and the exposure most commonly involved a liquid product (46.6%) and a simple analgesic (8.3%).

Conclusion

The NZNPC receives a relatively small number of calls about exposures to Pasifika patients, especially given the youthful population demographic. It is unclear whether there is unmet need for this service, and this study suggests the need for further research.

Author Information

Eeva-Katri Kumpula: Postdoctoral Research Fellow, National Poisons Centre, University of Otago, Dunedin. Rosalina Richards: Associate Professor, Health Science Divisional Office, Centre for Pacific Health, Va’a o Tautai, University of Otago, Dunedin. Pauline Norris: Professor, Health Science Divisional Office, Centre for Pacific Health, Va’a o Tautai, University of Otago, Dunedin. Vanda Symon: Postdoctoral Fellow, Health Science Divisional Office, Centre for Pacific Health, Va’a o Tautai, University of Otago, Dunedin. Adam C Pomerleau: Director, Clinical Toxicologist, Emergency Physician (FACEM), National Poisons Centre, University of Otago, Dunedin.

Acknowledgements

Correspondence

Dr Eeva-Katri Kumpula, National Poisons Centre, PO Box 56, Dunedin 9054, 03-479 5168 (no fax available)

Correspondence Email

eeva-katri.kumpula@otago.ac.nz

Competing Interests

Nil.

1. Watts M, Fountain JS, Reith D, Schep L. Compliance with poisons center referral advice and implications for toxicovigilance. Clin Toxicol. 2004;42(5):603-10.

2. Kumpula E-K, Shieffelbien LM, Pomerleau AC. Enquiries to the New Zealand National Poisons Centre in 2018. Emerg Med Australas. 2020; doi: 10.1111/1742-6723.13563.

3. Sa’uLilo L, Tautolo E-S, Smith M. Health literacy, culture and Pacific peoples in Aotearoa, New Zealand: A review. Pacific Health. 2020;3.

4. Pio FH, Nosa V. Health literacy of Samoan mothers and their experiences with health professionals. J Prim Health Care. 2020;12(1):57-63.

5. Southwick M, Kenealy T, Ryan D. Primary Care for Pacific People: A Pacific and Health Systems approach. Report to the Health Research Council and the Ministry of Health Wellington: Pacific Perspectives; 2012. Cited 03/03/2020. Available from: https://www.health.govt.nz/system/files/documents/publications/primary-care-pacific-people-pacific-health-systems-approach.pdf.

6. Peiris‐John R, Kool B, Ameratunga S. Fatalities and hospitalisations due to acute poisoning among New Zealand adults. Intern Med J. 2014;44(3):273-81.

7. Kumpula E-K, Nada-Raja S, Norris P, Quigley P. A descriptive study of intentional self-poisoning from New Zealand national registry data: exploring the challenges. Aust N Z J Public Health. 2017;41(4):535-40.

8. Sapere Research Group. FINAL Post-Implementation Review Report of the National Telehealth Service Wellington: Ministry of Health – Manatū Hauora; 2017. Cited 03/03/2020. Available from: https://www.health.govt.nz/system/files/documents/pages/post-implementation-review-national-telehealth-service.pdf.

9. Ministry of Health – Manatū Hauora. National Health Index Data Dictionary version 5.3. Wellington: Ministry of Health – Manatū Hauora; 2009.

10. Ministry of Health – Manatū Hauora. Ethnicity Data Protocols for the Health and Disability Sector. Wellington: Ministry of Health – Manatū Hauora; 2004.

11. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191-4.

12. Statistics New Zealand. Age and sex by ethnic group (grouped total responses), for census night population counts, 2018 Census 2020. Cited 23/01/2020. Available from: http://nzdotstat.stats.govt.nz/wbos/Index.aspx?DataSetCode=TABLECODE8317

13. Ministry for Pacific Peoples. Pacific Aotearoa: Lalanga Fou. Wellington: Ministry of Pacific Peoples; 2018.

14. Craig E, Taufa S, Jackson C, Han DY. The Health of Pacific Children and Young People in New Zealand Dunedin: Ministry of Health; 2008.

15. Sapere Research Group. Phase 2 Report on the National Telehealth Service Evaluation Wellington: Ministry of Health – Manatū Hauora; 2019. Cited 03/03/2020. Available from: https://www.health.govt.nz/system/files/documents/pages/phase_2_report_on_the_national_telehealth_service_evaluation_28_02_19_redacted.pdf.

16. Harris RB, Stanley J, Cormack DM. Racism and health in New Zealand: Prevalence over time and associations between recent experience of racism and health and wellbeing measures using national survey data. PLoS One. 2018;13(5):e0196476.

17. Kapeli SA, Manuela S, Sibley CG. Perceived discrimination is associated with poorer health and well‐being outcomes among Pacific peoples in New Zealand. J Community Appl Soc Psychol. 2020;30(2):132-50.

18. Lepa T, Norris P, Horsburgh S, Taungapeau F. Accuracy of National Health Index numbers for Pacific people in New Zealand. Aust N Z J Public Health. 2013;37(2):189-90.

19. Kwak SK, Kim JH. Statistical data preparation: management of missing values and outliers. Korean J Anesthesiol. 2017;70(4):407-11.

Contact diana@nzma.org.nz
for the PDF of this article

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Poisons information centres (PICs) offer advice on chemical safety, perform risk assessments over the phone in cases where a person has been exposed to a substance and provide clinical advice about management of the exposure. The term ‘exposure’, in the context of poison centres, refers to any route of contact (eg, ingestion, inhalation, dermal, etc) between a person and a substance (which can be a pharmaceutical, chemical, commercial product, etc). The New Zealand National Poisons Centre (NZNPC) offers a 24/7 specialist service for exposure enquiries from all New Zealanders, including both the general public and healthcare professionals. The service is available through a toll-free number (0800 POISON (0800 764 766)) staffed by specially trained poison information officers (PIOs), with clinical toxicologists providing clinical supervision and support. Depending on the scenario and risk assessment, the NZNPC may recommend that a patient present to a medical facility for further management, or that the exposure can be safely managed at home with instructions on what to look out for, saving the patient and family an unnecessary trip to the doctor or hospital. The NZNPC does not routinely follow up cases and verify whether advice was followed; however, a previous study found a high rate of adherence.1

Pasifika communities in New Zealand have a youthful demographic, which is relevant here because a substantial proportion of NZNPC calls relate to young children.2 While Pasifika families are diverse in their collective health-literacy resources and experiences in accessing health services,3,4 for many families there are challenges in accessing health services,5 which may be heightened in an urgent situation such as suspected poisoning. While there is little specific literature available on Pasifika peoples and poisoning in New Zealand, the risks of poisoning events likely vary by age group in the Pasifika population, as in the general population.2 Compared to other ethnicities, the rates of death and hospital presentations due to unintentional poisoning were highest for Pasifika New Zealanders in the age group 65 and older.6 On the other hand, Pasifika women and men had lower rates of presenting to New Zealand hospitals due to intentional self-poisoning (self-harm) compared to Māori and people of other, non-Asian ethnicities, but at similar rates to people of Asian ethnicities.7  

Telehealth is a means of service delivery that has the potential to minimise the impact of some barriers to access, such as transportation. Significant questions remain, however, about how telehealth can deliver services equitably to Pasifika populations, with a recent evaluation reporting that use of the Healthline and Quitline services (two other national toll-free telehealth services) was lower among Pasifika communities than for other New Zealanders.8 This study expands this knowledge base by exploring Pasifika engagement with the NZNPC. The aim of this study was to describe Pasifika access to the NZNPC service and unpack the characteristics of this engagement through routinely collected health data from the service.

Methods

This retrospective analysis investigated de-identified call data from NZNPC relating to human patients exposed to any substance from 1 January 2018 to 31 December 2019. Ethnicity information is collected in the call records of the NZNPC, either by directly collecting the information from the caller, or by extracting ethnicity information from the National Health Index (NHI)9 number database when the patient’s NHI is identified at the time of the call. Exposure patients were stratified into three ethnicity groups for analysis: Pasifika (any Pacific ethnicity listed in patient ‘ethnicity’ data field [Cook Island Māori, Fijian, Niuean, Samoan, Tokelauan, Tongan, Other Pacific Peoples, Pacific Peoples not further defined]);10 non-Pasifika (at least one other known ethnicity and no Pacific ethnicity listed); unknown ethnicity (missing information, or caller refused to provide it). For the main analysis, call clusters where multiple calls are made about the same patient in the same exposure event (‘linked calls’) were excluded to not over count these patients.

Ministry of Health (MOH) prioritised ethnicity level 1 (Māori, Pacific Peoples, Asian, MELAA [Middle Eastern, Latin American, African], Other, European, Not stated/Refused to say)10 was used to give a general description of the total patient population by ethnicity, but the three main groups described above were used for the main analysis to identify as many Pasifika patients from the data as possible. Patient demographics, reason for the exposure event, crude rates of exposure, caller relationship to the patient, caller location, site of exposure, most frequent substance categories and management advice were analysed in RStudio (1.1.456; RStudio Inc.) and Excel (2016; Microsoft Corp.).

The study used previously collected de-identified health data and was approved by the Human Ethics Committee of the University of Otago (ref# HD20/002). The study was conducted in accordance with the Declaration of Helsinki.11

Results

During the two-year study period, the NZNPC provided advice during 42,631 calls to a total of 44,234 human patients who had been exposed to a substance. After linked calls were excluded (3,781 calls with 4,049 patients), there were 40,185 patients in 38,760 calls. Their MOH level 1 prioritised ethnicities are described in Table 1, along with a breakdown by the three ethnicity groups used in the study.

Table 1: Ethnicity of exposure patients managed by the New Zealand National Poisons Centre, 2018–2019.

*Linked calls excluded. MOH=Ministry of Health; MELAA=Middle Eastern/Latin American/African.

When the three pre-planned ethnicity groups were created from the data, there were 1,367 Pasifika patients, 24,892 non-Pasifika, and 13,926 people of unknown ethnicity. The characteristics of these three groups of patients are summarised in Table 2. The median age of Pasifika patients was 2.0 years (interquartile range (IQR) 1–4 years; 0.2% unknown age), while the median was 2.0 (IQR 1–20 years; 0.3% unknown age) for non-Pasifika and 14.0 (IQR 2–32; 34.0% unknown age) for people of unknown ethnicity. The properties and circumstances of the calls are described in Table 3.

Table 2: Patient characteristics from exposure calls to the New Zealand National Poisons Centre, 2018–2019.

*Linked calls excluded. **Total New Zealand population (4,793,358) minus Pacific population (Census 2018)12 equals non-Pacific population. N/A = not applicable.

Table 3: Characteristics of exposure calls to the New Zealand National Poisons Centre, 2018–2019.

*Linked calls excluded. **This category contains calls originating from the ambulance service setting.

Substances involved in the exposures

The exposure event involved a median of 1.0 substance per patient for Pasifika, non-Pasifika and patients of unknown ethnicity (IQR 1–1 for all three groups). The most common substance types were liquid products (46.6% for Pasifika, 45.9% for non-Pasifika, 37.5% for people of unknown ethnicity) and capsules and tablets (36.1% for Pasifika, 30.9% for non-Pasifika, 40.2% for people of unknown ethnicity). The route of exposure was ingestion for 78.3% of Pasifika, 73.1% of non-Pasifika and 65.7% of patients of unknown ethnicity.

A total of 720 Pasifika patients (52.7%) had a therapeutic agent involved in their exposure event, while 391 (28.6%) had a household chemical involved and 269 (19.7%) a miscellaneous chemical. On the other hand, 27,061 non-Pasifika patients (44.4%) had a therapeutic agent involved, 18,393 (30.2%) had a household chemical involved and 16,831 (27.6%) had a miscellaneous chemical involved in the exposure. All three groups had most frequently been exposed to a simple analgesic (eg, paracetamol [Table 4]). The NZNPC mostly advised management at home (either no treatment or self-treatment [Table 5]).  

Table 4: Ten most-frequently encountered substance classes in the three ethnicity groups; % of all substances within patient group.

NSAID = non-steroidal anti-inflammatory drug. *Linked calls excluded. **Eg, paracetamol.

Table 5: Management advice given by the New Zealand National Poisons Centre, stratified by ethnicity group.

*Linked calls excluded. **Not enough information available at the time of the call to make a definite recommendation yet.

Discussion

There is very little published literature on Pasifika peoples and poisoning, and especially about calls to a poisons information centre (PIC) regarding Pasifika patients. This study begins to address this gap in knowledge. Over the two years covered in this study, most Pasifika patients were under the age of six, and the people calling about them were most often members of the public calling about an exposure occurring in a residential environment. This is important information for Pasifika parents and communities, in terms of highlighting the need to limit children’s access to chemicals and substances within home environments. The most common substance classifications in these exposures included simple analgesics (eg, paracetamol), cosmetics and miscellaneous household chemicals (eg, baking supplies, batteries, cigarettes, etc). All of these products are commonly found in New Zealand households. The wellbeing of children and youth are central to the aspirations of Pasifika peoples, with parents wanting to give their children the best start in life.13 Ideally, exposures/poisonings are prevented. However, as an urgent source of support, services like NZNPC are a valuable resource, as they can be immediately accessed via phone for expert advice. In this study, the majority of exposures were able to be managed at home, saving families potentially expensive trips to a medical centre or hospital.

Only 3.4% of all NZNPC patients, and 5.2% of patients with known ethnicity, were Pasifika. These observed rates are relatively low, as the Pasifika population comprises 8.1% of the total New Zealand population.12 Further, as the Pasifika population aged 0–4 comprises 14.3% of the total New Zealand population of that age,12 and over two-thirds of the patients with known ethnicity who were managed by the NZNPC were aged under six, more calls relating to Pasifika patients could be expected. Further research is needed to directly explore possible barriers to service access.

Possibilities for exploration include that Pacific peoples have a lower prevalence of poisoning compared to other ethnicities, or that they experience very mild exposures that they do not feel require formal care. This seems unlikely, as rates of poisoning generally increase with increasing levels of deprivation,6,7 and Pasifika people are over-represented in these areas.14 Additionally, it might be expected that larger and/or multigenerational Pasifika households could create additional challenges for storing medications and other chemicals in spaces that are inaccessible to children. Such multigenerational household compositions could function as a protective factor as well, as other, non-parental relatives may be able to provide additional supervision of children in the household.

Alternately, it may be that there is a degree of unmet need in accessing poisons information. This could be because Pasifika families are not aware of the service, or because they may look to other resources to manage exposures. It is impossible to define an ‘optimal’ rate of using a PIC service. The rate of healthcare professional calls relating to Pasifika patients was similar for non-Pasifika in this study, which indicates that at least some people from both groups did seek medical care for exposures. The reasons suggested for their lower uptake of two other free national telehealth services, Healthline and Quitline, included reluctance to make contact, as they had no previous relationship with the services, concern that they were not being understood and that the advice was being tailored to their ethnicity rather than their acute needs.8,15 People may also fear being judged or accused of being careless and ‘allowing’ a child to get injured in this way, and experiences of racism within the health system may exacerbate these concerns.16,17 While NZNPC staff focus on providing non-judgmental advice to all callers, potential callers who have not previously used the service may not be aware of this. This is an area where further research would be useful.

Another interesting line of inquiry is to explore concepts of ‘poisoning’ within the diverse Pasifika cultures in New Zealand and traditional models of managing the risks of poisoning across the Pacific region. Health promotion approaches that align with these models could then be developed and evaluated to see whether they resonate and engage families more than current approaches.

Implications

As most exposures reported to the NZNPC could be managed at home, the service has the potential to save people time and resources, as they do not need to obtain the same assessment and advice elsewhere. On the other hand, in cases requiring medical care, the NZNPC can assist by advising people to seek such care in a timely fashion. There are valuable opportunities here to promote the safe storage of chemicals and substances in Pasifika homes and to build awareness and relationships between the NZNPC, the Pasifika health sector and Pasifika communities. The facilitators and barriers to Pasifika families contacting the NZNPC for advice regarding substance exposures need to be explored further, while taking into account the rich variety of different Pasifika cultures represented in the New Zealand population.

Limitations

Some Pasifika people were likely misclassified due to being in the unknown ethnicity category. Even when an NHI number is available, ethnicity details may not correctly identify a person’s Pasifika ethnicity,18 and indications of Pasifika ethnicity may be lost over time as information is updated, effectively ‘changing’ a person’s ethnicity in the NHI database.5 Although the caller being a healthcare professional and the exposure being intentional do not necessarily mean that the exposure was more toxicologically significant, it should be noted that the unknown-ethnicity category had higher rates of these characteristics than the Pasifika and non-Pasifika categories. Such exposures may be more likely to result in a recommendation to be medically assessed. Any Pasifika patients ‘lost’ in this unknown ethnicity group may therefore lead to an underestimation of rates of medical referrals in Pasifika patients. Further, the relatively high proportion of patients of unknown age (34.0%) in the unknown-ethnicity subgroup of patients limits the reliability of the median age reported for that group. But, as this study did not seek to perform statistical comparisons between the groups, no corrections such as imputations19 were performed.

Conclusion

The New Zealand National Poisons Centre receives what appears to be a relatively small number of calls about exposures to Pasifika patients—disproportionately small compared to the population prevalence of Pasifika people in New Zealand. It is unclear whether this finding represents a low prevalence of exposures in the Pasifika communities, a low utilisation of the NZNPC by the Pasifika communities or some other combination of factors.

Summary

Abstract

Aim

Poisoning is a common type of injury in New Zealand. The New Zealand National Poisons Centre (NZNPC) offers a free 24/7 specialist assessment service for enquiries about substance exposures for all New Zealanders. This study aimed to characterise calls to the NZNPC relating to Pasifika patients to explore the potential for unmet need or health disparity in this area.

Method

A retrospective analysis of 2018–2019 human exposure call data was performed. Patients were stratified into three groups: those with at least one Pacific ethnicity listed (Pasifika); those with known ethnicities but no Pacific ethnicity listed (non-Pasifika); those of unknown ethnicity (unknown). Demographic variables and substance groups were described.

Results

Of the 40,185 human exposure patients, 1,367 (3.4%) were Pasifika, 24,892 (61.9%) were non-Pasifika and 13,926 (34.7%) were of unknown ethnicity. The median age of Pasifika patients was 2.0 years, with 78.0% aged 0–5, and the exposure most commonly involved a liquid product (46.6%) and a simple analgesic (8.3%).

Conclusion

The NZNPC receives a relatively small number of calls about exposures to Pasifika patients, especially given the youthful population demographic. It is unclear whether there is unmet need for this service, and this study suggests the need for further research.

Author Information

Eeva-Katri Kumpula: Postdoctoral Research Fellow, National Poisons Centre, University of Otago, Dunedin. Rosalina Richards: Associate Professor, Health Science Divisional Office, Centre for Pacific Health, Va’a o Tautai, University of Otago, Dunedin. Pauline Norris: Professor, Health Science Divisional Office, Centre for Pacific Health, Va’a o Tautai, University of Otago, Dunedin. Vanda Symon: Postdoctoral Fellow, Health Science Divisional Office, Centre for Pacific Health, Va’a o Tautai, University of Otago, Dunedin. Adam C Pomerleau: Director, Clinical Toxicologist, Emergency Physician (FACEM), National Poisons Centre, University of Otago, Dunedin.

Acknowledgements

Correspondence

Dr Eeva-Katri Kumpula, National Poisons Centre, PO Box 56, Dunedin 9054, 03-479 5168 (no fax available)

Correspondence Email

eeva-katri.kumpula@otago.ac.nz

Competing Interests

Nil.

1. Watts M, Fountain JS, Reith D, Schep L. Compliance with poisons center referral advice and implications for toxicovigilance. Clin Toxicol. 2004;42(5):603-10.

2. Kumpula E-K, Shieffelbien LM, Pomerleau AC. Enquiries to the New Zealand National Poisons Centre in 2018. Emerg Med Australas. 2020; doi: 10.1111/1742-6723.13563.

3. Sa’uLilo L, Tautolo E-S, Smith M. Health literacy, culture and Pacific peoples in Aotearoa, New Zealand: A review. Pacific Health. 2020;3.

4. Pio FH, Nosa V. Health literacy of Samoan mothers and their experiences with health professionals. J Prim Health Care. 2020;12(1):57-63.

5. Southwick M, Kenealy T, Ryan D. Primary Care for Pacific People: A Pacific and Health Systems approach. Report to the Health Research Council and the Ministry of Health Wellington: Pacific Perspectives; 2012. Cited 03/03/2020. Available from: https://www.health.govt.nz/system/files/documents/publications/primary-care-pacific-people-pacific-health-systems-approach.pdf.

6. Peiris‐John R, Kool B, Ameratunga S. Fatalities and hospitalisations due to acute poisoning among New Zealand adults. Intern Med J. 2014;44(3):273-81.

7. Kumpula E-K, Nada-Raja S, Norris P, Quigley P. A descriptive study of intentional self-poisoning from New Zealand national registry data: exploring the challenges. Aust N Z J Public Health. 2017;41(4):535-40.

8. Sapere Research Group. FINAL Post-Implementation Review Report of the National Telehealth Service Wellington: Ministry of Health – Manatū Hauora; 2017. Cited 03/03/2020. Available from: https://www.health.govt.nz/system/files/documents/pages/post-implementation-review-national-telehealth-service.pdf.

9. Ministry of Health – Manatū Hauora. National Health Index Data Dictionary version 5.3. Wellington: Ministry of Health – Manatū Hauora; 2009.

10. Ministry of Health – Manatū Hauora. Ethnicity Data Protocols for the Health and Disability Sector. Wellington: Ministry of Health – Manatū Hauora; 2004.

11. World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. JAMA. 2013;310:2191-4.

12. Statistics New Zealand. Age and sex by ethnic group (grouped total responses), for census night population counts, 2018 Census 2020. Cited 23/01/2020. Available from: http://nzdotstat.stats.govt.nz/wbos/Index.aspx?DataSetCode=TABLECODE8317

13. Ministry for Pacific Peoples. Pacific Aotearoa: Lalanga Fou. Wellington: Ministry of Pacific Peoples; 2018.

14. Craig E, Taufa S, Jackson C, Han DY. The Health of Pacific Children and Young People in New Zealand Dunedin: Ministry of Health; 2008.

15. Sapere Research Group. Phase 2 Report on the National Telehealth Service Evaluation Wellington: Ministry of Health – Manatū Hauora; 2019. Cited 03/03/2020. Available from: https://www.health.govt.nz/system/files/documents/pages/phase_2_report_on_the_national_telehealth_service_evaluation_28_02_19_redacted.pdf.

16. Harris RB, Stanley J, Cormack DM. Racism and health in New Zealand: Prevalence over time and associations between recent experience of racism and health and wellbeing measures using national survey data. PLoS One. 2018;13(5):e0196476.

17. Kapeli SA, Manuela S, Sibley CG. Perceived discrimination is associated with poorer health and well‐being outcomes among Pacific peoples in New Zealand. J Community Appl Soc Psychol. 2020;30(2):132-50.

18. Lepa T, Norris P, Horsburgh S, Taungapeau F. Accuracy of National Health Index numbers for Pacific people in New Zealand. Aust N Z J Public Health. 2013;37(2):189-90.

19. Kwak SK, Kim JH. Statistical data preparation: management of missing values and outliers. Korean J Anesthesiol. 2017;70(4):407-11.

Contact diana@nzma.org.nz
for the PDF of this article

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