Better Sooner More Convenient Primary Care - New Zealand Doctor
Better Sooner More Convenient Primary Care - New Zealand Doctor Better Sooner More Convenient Primary Care - New Zealand Doctor
There is no current capacity to increase numbers of ultrasounds usage and therefore this is dependent wither on a decrease in current requests or the establishment of a service in Buller. There are concerns regarding the capability of some of those ordering and interpreting investigations. With an increase in primary care consultations managed by nurses there is a need for increasing educational support as described in the plan above. 8 Effect on inequalities There is already very good direct access to radiology services which benefits low socio-economic families. Direct access to some CT investigations will remove the need for FSAs which will benefit those who have difficulty accessing extra appointments. The need for travel assistance for those living in Buller and travelling to Greymouth for diagnostic investigations is an important barrier for some and will be addressed as part of this plan. 9 Evidence for this initiative A number of other regions in NZ have piloted direct access to CT and to musculoskeletal ultrasound as shown in the following table 49 : Location Details General ultrasound Northland Whanganui Range of US – developed referral guidelines (GL) Used Australian radiology GL – too many referred Abdomen, pelvic, renal US Auckland Canterbury Referral GL developed Also pelvic for 5 conditions Soft tissue US Canterbury Triage GL and education Shoulder US Canterbury New pathway and education CT abdomen, liver, Canterbury Triage GL and education pancreas CT for headache BoP Nelson GL and education GL developed CT colonoscopy Whanganui Nelson Developed referral GL For those where colonoscopy not so important CT and MRI Wairarapa For TIA, breathlessness and atrial fib CT renal colic Nelson Freed up ED time, decreased FSAs 49 Summarised from MoH report: A summary of improving patient pathways – diagnostic pilots. 2009 Business case appendices V12 AC 25Feb2010 Page 76
LECG 50 evaluated whether “the improvement processes implemented in these pilots were cost effective and provided value for money”. They concluded that “redesign of pathways for patients referred by GPs for diagnostic tests do offer opportunities for cost effective improvements”. They also identified that “opportunities for improvement are location specific and need to be identified with care” and provided helpful guidance for the development and implementation of direct access pathways. LECG anlaysed in depth a number of pilots that have direct relevance to this project: Northland DHB musculoskeletal ultrasound, Nelson Marlborough CT urograms, Whanganui general ultrasound. The information from these analyses will be very useful in guiding the implementation of direct access on the West Coast. 10 Risk analysis Risk Probability Impact Contingency plan Too many CTs ordered – (significant amount of radiation per CT) Low High Develop referral guidelines and audit regularly. Only general practitioners order CTs. Unable to free up capacity for Low High Work closely with all those involved using a variety of approaches. musculoskeletal US Increase in numbers of x- rays ordered resulting from changed primary care delivery models Medium Medium Educational sessions and audits as described above. 11 Engagement Working group who developed this plan: Raewyn McKnight, Jason Lister, Wayne Champion, Jocelyn Tracey, Helen Reriti, Anthony Cooke. Other clinicians involved: Vicki Robertson, Martin Smith, Dr Martin London, Dr Andy Backhouse, Tony Young (Canterbury Radiology Group) . 50 Moore D, Black M, van Essen E. Evaluation of 13 diagnostic pilots. Report from LECG for MoH, Nov 2009. Business case appendices V12 AC 25Feb2010 Page 77
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There is no current capacity to increase numbers of ultrasounds usage and therefore this is<br />
dependent wither on a decrease in current requests or the establishment of a service in Buller.<br />
There are concerns regarding the capability of some of those ordering and interpreting<br />
investigations. With an increase in primary care consultations managed by nurses there is a<br />
need for increasing educational support as described in the plan above.<br />
8 Effect on inequalities<br />
There is already very good direct access to radiology services which benefits low<br />
socio-economic families. Direct access to some CT investigations will remove the need for FSAs<br />
which will benefit those who have difficulty accessing extra appointments.<br />
The need for travel assistance for those living in Buller and travelling to Greymouth for<br />
diagnostic investigations is an important barrier for some and will be addressed as part of this<br />
plan.<br />
9 Evidence for this initiative<br />
A number of other regions in NZ have piloted direct access to CT and to musculoskeletal<br />
ultrasound as shown in the following table 49 :<br />
Location<br />
Details<br />
General ultrasound Northland<br />
Whanganui<br />
Range of US – developed referral guidelines (GL)<br />
Used Australian radiology GL – too many referred<br />
Abdomen, pelvic, renal<br />
US<br />
Auckland<br />
Canterbury<br />
Referral GL developed<br />
Also pelvic for 5 conditions<br />
Soft tissue US Canterbury Triage GL and education<br />
Shoulder US Canterbury <strong>New</strong> pathway and education<br />
CT abdomen, liver, Canterbury Triage GL and education<br />
pancreas<br />
CT for headache BoP<br />
Nelson<br />
GL and education<br />
GL developed<br />
CT colonoscopy<br />
Whanganui<br />
Nelson<br />
Developed referral GL<br />
For those where colonoscopy not so important<br />
CT and MRI Wairarapa For TIA, breathlessness and atrial fib<br />
CT renal colic Nelson Freed up ED time, decreased FSAs<br />
49<br />
Summarised from MoH report: A summary of improving patient pathways – diagnostic pilots. 2009<br />
Business case appendices V12 AC 25Feb2010 Page 76
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