Project SPLICE - Taranaki District Health Board

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Project SPLICE FINAL - February 2010 Many Mäori nurses were referring patients’ back to secondary services, returning patients to general practice and assisting patients to access social services, like home help which proved difficult in rural areas as carers travel costs are not reimbursed; Kaiawhina roles Although nurses and Kaiawhina working collaboratively in many organisations, concerns were raised about the overlap of some Kaiawhina activity with nurse activity; Kaumatua programmes Mäori providers believe Kaumatua programmes are not accessed (under-utilised) by mainstream providers such a general practice and hospital services and would welcome referrals; and Māori providers want access into Kaumatua programmes at a younger age for Māori; a wider range of activities contracted for, and programme evaluation undertaken. Traditional Mäori and other alternative therapies Miri miri (traditional Mäori massage), kawakawa (Rongoa Mäori), champissage (Indian head massage), and reiki (healing energy) were some of the therapies offered to as many as 50 people weekly. However referrals are received mainly from Mäori providers within the Tui Ora Ltd. Structure; a referral by a mainstream health provider has never been received 16 | P a g e
Project SPLICE FINAL - February 2010 3.0 A description of the model of care 3.1 Introduction All New Zealanders are affected by long-term conditions, whether as carers for family and whänau, taxpayers, health professionals or managing their own chronic condition. Mismanagement of chronic conditions is the leading cause of hospitalisations, accounts for 80 percent of all preventable deaths and is estimated to consume a major proportion of our health care funds [15]. Chronic conditions are also a barrier to independence, participation in the workforce and in society – social and economic costs we are yet to calculate as a nation. Chronic conditions account for a higher proportion of illness and deaths among Mäori, people on low incomes and Pacific peoples than among the general population. The need to reduce health inequalities remains urgent. For example, from 2007 to 2011, the prevalence of diabetes is predicted to increase by 148 percent among Pacific peoples and 132 percent among Mäori. Work to prevent and manage chronic conditions should ensure outcomes for groups at greatest disadvantage improve earliest and most significantly. If this approach is not taken, health inequalities are likely to grow. The most widely known framework for providing care to people with long term conditions is the Chronic Care Model, first enunciated by Wagner in 1998 [30]. The model attempted to draw together all the activities being used up to that time to care for patients with chronic illnesses and for which there was some evidence of effectiveness. The model describes an informed and activated patient in partnership with a prepared and pro-active health care team. It consists of six components; community resources; the healthcare system; patient self-management; decision support; delivery system (re)design; and clinical information systems. A recent meta-analysis of 112 studies concluded that interventions that contain at least one Chronic Care Model element improve clinical outcomes, processes of care and quality of life for patients with chronic illnesses [31]. Nevertheless, the six components are each relatively broad, and what might be classified as, for example, decision support in one programme might be very different from decision support in another programme. Examples are shown in the following table. Such elements are intrinsic to the development of the Model of Care within Taranaki DHB. Table 1: Strategies included within each category of the Chronic Care Model (From Tsai 2005 [31]) Delivery System Design Decision Support • Care management roles • Institutionalization of guidelines/prompts • Team practice • Provider education • Care delivery/coordination • Expert consultation support • Proactive follow-up • Clinical Information Systems • Planned visit • Patient registry system • Visit system change • Use of information for care management • Self-management Support • Feedback of performance data • Patient education • Community Resources • Patient activation/psychosocial support • For patients 17 | P a g e
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Project SPLICE - Taranaki District Health Board

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