Better Sooner More Convenient Primary Care - New Zealand Doctor

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Appendix One: Health Equity Assessment Tool - Integrated Family Health Centres 1. What health issue is the programme addressing? Access to better sooner more convenient primary health services. Quality of service/care pathways through primary – community - secondary health services. 2. What inequalities exist in this health area? Despite year on year increases in PHO enrolments occurring at faster rate for Māori, enrolment in primary care remains lower than for non Māori. Māori enrolment in primary care is lowest in the Grey District. Māori enrolled in primary care access GP/nurse appointments at a lower rate than non Māori. Māori are under enrolled and have lower utilization rates in some primary care programs (eg. care plus, CVD annual reviews, immunisation) but not all (cancer navigation services, diabetes annual review, youth sexual health, primary mental health, green prescription). Māori have poorer health outcomes in the majority of health outcomes monitored. 3. Who is the most advantaged and how? Data would indicate that non Māori are the most advantaged, with higher enrolments and higher access rates than Māori, they receive the benefits associated with primary practice enrolment including: VLCA fees lower after hours fees recall for screening, annual reviews and immunisations access to programs including, smoking cessation, green prescriptions, brief intervention counselling and self management education programs. 4. How did the inequality occur? (What are the mechanisms, by which this inequality was created, is maintained or increased?) The inequality was created, and is maintained through a variety of mechanisms including: long term impact of colonization and the resulting education and economic disparities lower enrolments in primary care mainstream service effectiveness Business case appendices V12 AC 25Feb2010 Page 2
ongoing GP shortage creating an environment where: - it can take up to 20 days for a routine appointment, disadvantaging those with more difficulty using the system - a number of medical practices have had closed books, including at one stage all practices in Greymouth (now only one of three), meaning those who were unregistered could not register, compounding the inequalities as Māori are disproportionately represented in the unregistered population - consults can be rushed, which is not conducive for providing holistic whanau ora services. 5. What are the determinants of this inequality? Socio-economic, culture, living conditions, geographic location, social and community influences and behavioural determinants all impact on the development and maintenance of inequalities in primary care access, utilization and health outcomes. 6. How has the Treaty of Waitangi in the context of the <strong>New</strong> <strong>Zealand</strong> Public Health and Disability Act 2000 been addressed? Māori are entitled to the same health status as other West Coasters, and addressing the existence of inequalities in enrolments, access and outcomes for Māori, requires a specific and dedicated focus. The Integrated Family Health Centre (IFHC) Model is a more holistic model of service delivery, utilizing a greater range of health practitioners, including kaiawhina/navigators within multi-disciplinary teams that are in turn more integrated with community and secondary health services. Ensuring Māori benefit more than non Māori, from the implementation of Integrated Family Health Centres will contribute to reducing the existing inequalities in enrolments and access to services and health outcomes. Employing specific Māori nursing positions within each integrated family health centre, employing a kaiawhina to focus on improving enrolments, developing Māori workforce, and increasing mainstream service effectiveness by increasing cultural competencies among non-Māori staff are identified as the dedicated focus to achieve. 7. Where/how will you intervene to tackle this issue? (use the Ministry of Health Intervention Framework to guide your thinking). The proposal intervenes at the Health and Disability Services level of the Intervention Framework to improve health and reduce inequalities. Specifically: Business case appendices V12 AC 25Feb2010 Page 3
Page 1 and 2:
Business Case Better, Sooner, More
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1 Caveats/status This business case
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Current situation By three years Wa
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staffed on a capacity model - in wh
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support from DHBs, specialist clini
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10.4 Key milestones................
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Annual government health funding pe
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Ambulatory Sensitive Hospitalisatio
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The base populations of the three d
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Māori/Pacific Not Māori/Pacific D
Page 21 and 22: 4.7 West Coast region service deliv
Page 23 and 24: 5 Future model of care 5.1 The desi
Page 25 and 26: support them. Help with understandi
Page 27 and 28: LEVERS VISION Better, sooner, more
Page 29 and 30: providing the majority of care). Th
Page 31 and 32: The Community Health System Deliver
Page 33 and 34: To better integrate the support pro
Page 35 and 36: 5.5 Enablers A key aspect of this b
Page 37 and 38: Two rounds of meetings with front l
Page 39 and 40: While doctor-nurse substitution has
Page 41 and 42: Nick Goodwin, Kings Fund 14 , in hi
Page 43 and 44: Quality domains Each new initiative
Page 45 and 46: Preventative Acute LTC management R
Page 47 and 48: Preventative Acute LTC management R
Page 49 and 50: The core services are provided or p
Page 51 and 52: Total required FTEs for the Grey IF
Page 53 and 54: 7 Governance, Ownership & Managemen
Page 55 and 56: Option D: PHO/DHB jointly owned Pri
Page 57 and 58: The IFHS will need the ability to b
Page 59 and 60: Of note, a large proportion of the
Page 61 and 62: The DHB delegates decision making o
Page 63 and 64: Limited integration of community se
Page 65 and 66: 10.4 Key milestones The table below
Page 67 and 68: Expanded pharmacy roles Improving a
Page 69 and 70: Devolved community based services w
Page 71: Appendices Appendix One: Health Equ
Page 75 and 76: 10. What are the unintended consequ
Page 77 and 78: It is common for people with an acu
Page 79 and 80: Outcome measures Indicator Baseline
Page 81 and 82: determine ratio of nurses and GPs t
Page 83 and 84: C. Extended role for pharmacists:
Page 85 and 86: 11 Engagement Working group who dev
Page 87 and 88: Appendix B: Acutely unwell adult pa
Page 89 and 90: 4 Objectives to implement nur
Page 91 and 92: Review Buller after hours arrangeme
Page 93 and 94: Year three Community education camp
Page 95 and 96: 13 Costs Budget considerations:
Page 97 and 98: established. This group now oversee
Page 99 and 100: Output measures Tobacco control / s
Page 101 and 102: Improving immunisation coverage - h
Page 103 and 104: Year three Continued joint plan
Page 105 and 106: extending health promotion activiti
Page 107 and 108: Immunisation Coverage Funder Provid
Page 109 and 110: The Community Health System Deliver
Page 111 and 112: Clinical care Practice self managem
Page 113 and 114: and increases in the numbers of pat
Page 115 and 116: Ambulatory Sensitive Hospitalisatio
Page 117 and 118: % CVD on lipid lowering drugs, beta
Page 119 and 120: Health navigators/ kaiawhina: chan
Page 121 and 122: Committee‟s objectives 41 of prov
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- lack of consistency of care betwe
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qualifications and skills. Where ca
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6 Deliverables / activities Impleme
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“With an aging population and an
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Differences between revenue generat
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Appendix Seven: Integration - Healt
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It is expected that HealthPathways
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Year two implement the process to
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Low uptake by primary and secondary
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Appendix Eight: Improved access to
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to easily access by telephone). Oth
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Year One - July 2010 to June 2011 T
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LECG 50 evaluated whether “the im
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Appendix Nine: Referred services 1.
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them by technical errors or lack of
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Identify patients that would benefi
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• Provision of patient specific m
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12 Organisational accountabilities
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emain under the care and management
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Service user pathways in an optimal
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Model for shared care pathways deve
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Implementation plan: to June 30 Dev
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Year two Review progress, outcome m
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10 Risk analysis Risk Probability I
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Appendix Eleven: Frail older people
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ehab and treatment programmes that
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Year one: Maintain and continue the
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Māori have a higher incidence of m
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11 Organisational accountabilities
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There are often vacancies for allie
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6 Deliverables / activities Program
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Professional development: Provide
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Mainstream arguments are concerned
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Appendix Thirteen: IFHCs - Faciliti
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A key possibility is that land at t
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This option is effectively a Greenf
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7 Westland IFHC Facilities options
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Year two Substantive-IFHC in Greymo
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12 Costs Capital costs Greymouth IF
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utilize MedTech, but via their own
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4 Objectives: To implement c
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Security An individual‟s health i
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8 Effect on inequalities The increa
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Appendix Fifteen: Project advisory
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