Fiona Doolan-Noble

Evolution of a health navigator model of care within a primary care setting: a case study

OBJECTIVE Patient navigation originated as an approach for reducing disparities in cancer care and consequent health outcomes. Over time navigator models have evolved and been used to address various health issues in differing contexts. This case study outlines the evolution, purpose and effects of a lay-led health navigator model in a deprived, sparsely populated, New Zealand rural setting, where primary care services are frequently understaffed and routinely overstretched. METHODS Routinely collected service utilisation data, survey results and health navigator interview data were utilised to illustrate the client group the service works with, why primary care refer to the service, as well as lessons learned from implementation to ongoing service provision. RESULTS Those referred to the navigator service generally represented the most vulnerable in the community. Survey respondents, overall, were highly satisfied with the service. Navigators identified barriers and facilitators to implementation, as well as ongoing obstacles and enablers to service provision. CONCLUSIONS This lay-led navigator service provided support to a group of unwell individuals, with few resources and multiple barriers to negotiate, and has effectively engaged with health and social care services, while overcoming various barriers and obstacles to its establishment and ongoing operation.

New Zealand patients’ perceptions of chronic care delivery

Purpose – Care coordination for patients with chronic conditions is one aim of an integrated health care delivery system. The purpose of this paper is to compare findings from two separate New Zealand studies and discusses the implications of the results. Design/methodology/approach – The paper describes and discusses the use of Patient Assessment of Chronic Illness Care Measure in two different geographic areas of New Zealand and at different times. Findings – The studies suggest that, despite the time that has elapsed since government investment in care coordination for long-term conditions, there has been little change in the nature of service delivery from the patient perspective. Originality/value – The paper highlights the shortcomings of simply providing additional funding for care coordination, without built in accountabilities, no planned evaluation and no concerted focus on what the model of care should look like.

Multimorbidity, clinical decision making and health care delivery in New Zealand Primary care: a qualitative study

BackgroundMultimorbidity is a major issue for primary care. We aimed to explore primary care professionals’ accounts of managing multimorbidity and its impact on clinical decision making and regional health care delivery.MethodsQualitative interviews with 12 General Practitioners and 4 Primary Care Nurses in New Zealand’s Otago region. Thematic analysis was conducted using the constant comparative method.ResultsPrimary care professionals encountered challenges in providing care to patients with multimorbidity with respect to both clinical decision making and health care delivery. Clinical decision making occurred in time-limited consultations where the challenges of complexity and inadequacy of single disease guidelines were managed through the use of “satisficing” (care deemed satisfactory and sufficient for a given patient) and sequential consultations utilising relational continuity of care. The New Zealand primary care co-payment funding model was seen as a barrier to the delivery of care as it discourages sequential consultations, a problem only partially addressed through the use of the additional capitation based funding stream of Care Plus. Fragmentation of care also occurred within general practice and across the primary/secondary care interface.ConclusionsThese findings highlight specific New Zealand barriers to the delivery of primary care to patients living with multimorbidity. There is a need to develop, implement and nationally evaluate a revised version of Care Plus that takes account of these barriers.

General practice: balancing business and care

193 CSIRO Publishing Journal Compilation

Are nurses more likely to report providing care plans for chronic disease patients than doctors? Findings from a New Zealand study

Objectives The main aim of this study was to compare the perceptions of general practitioners (GPs) and primary care nurses (PCNs) in the Southern Region of New Zealand regarding their provision of chronic illness care. Whether PCNs rated their frequency of providing aspects of chronic illness care higher than GPs was a key question. Methods The modified version of the Patient Assessment of Chronic Illness Care (PACIC) was used to compare the perceptions of GPs and PCNs. Results Surveys were received from 77% of practices in the Southern region. Responding PCNs were more likely than their GP counterparts to document they provided aspects of chronic illness care ‘most of the time’ or ‘always’ in 18 activities from the six M-PACIC domains. Their level of providing patients with formal care plans was surprisingly low. Conclusion This level of engagement of PCNs with chronic illness care was no surprise. The low number reporting they provided patients with a care plan, most of the time or always, was unexpected. Aspects of care planning, however, were reported as taking place more frequently. This discrepancy between the process of care planning and the outcome, a care plan, is not unique to this region of New Zealand and warrants further research.

Evaluating a model of delivering specialist palliative care services in rural New Zealand

INTRODUCTION Various methods of delivering specialist palliative care to rural areas have been discussed in the literature, but published evaluations of these models are sparse. This study surveyed the stakeholders of a rural specialist palliative care service (SPCS) to help identify potential gaps and inform planning regarding the future vision. METHODS A survey was sent to all relevant stakeholders across the West Coast of New Zealand, including staff in primary care, aged residential care and the hospital. It focused on understanding the local model of palliative care, the quality of the current service and perceived gaps. RESULTS Thirty-three per cent of the surveys were returned, from a cross-section of health-care providers. The medical respondents rated the quality of the service higher than nursing and allied health participants. All of the groups reported feeling the specialist palliative care team (SPCT) was under-resourced. Additional educational opportunities were considered essential. DISCUSSION Stakeholders found the service easy to access, but improvements in communication, educational opportunities and forward planning were identified as being needed. This information helps the West Coast SPCT plan its future direction and develop a higher-quality service that meets the needs of all stakeholders.

Breastfeeding peer support in rural New Zealand: the views of peer supporters

BACKGROUND New Zealand (NZ) has a high rate of breastfeeding initiation, declining sharply during the first six months. Although there is a range of support available to breastfeeding mothers, access can be problematic in rural areas. To extend the accessibility of breastfeeding support to rural women, a Primary Health Organisation established a breastfeeding peer supporters (BPS) programme (Mum4Mum - M4M). OBJECTIVES The objective of this study was to gain an understanding of the impact of the BPS training programme on participants, as well as understanding how they utilised the information, both personally and in their communities. METHODS All women who had completed the M4M training and for whom current contact details were available were contacted and invited to complete an online survey. The text data contained in returned surveys was collated and analysed using a general inductive thematic approach. RESULTS Forty-one out of 100 BPS graduates completed the survey. Five key themes emerged from the qualitative analysis: knowledge gained and shared; increased confidence; role of peer support; acceptance; personal satisfaction. CONCLUSION The M4M programme improved the personal knowledge and skills of participants and enhanced confidence in breastfeeding ability, which in turn empowered responding participants to successfully support other women to breastfeed in their communities. As a consequence, respondents reported experiencing a heightened sense of personal satisfaction. Furthermore, the initiative successfully established a network of BPS across a sparsely populated rural area of NZ.

Healthcare leaders’ views on successful quality improvement initiatives and context

Purpose The purpose of this paper is to investigate the contextual factors contributing to the sustainability of healthcare quality improvement (QI) initiatives. Design/methodology/approach Themes from semi-structured interviews with international healthcare leaders are compared with Kaplan and Provost et al.s (2012) model for understanding success in quality (MUSIQ). Critical success factors within these themes are shown in detail. Findings The interviews provide a rich source of information on critical success factors. The themes largely correspond with MUSIQ, reinforcing its robustness. An important factor emerging from the interviews was the importance of engagement with patients and families in QI, and this needs consideration in seeking to understand context in QI. Research limitations/implications Interview participants represent a limited set of western countries and health systems. Their experiences may not hold true in other settings. Practical implications The detail on critical success factors provides QI practitioners with guidance on designing and implementing sustainable initiatives. Originality/value Including consideration of contextual factors for engagement with patients and families in frameworks for context in QI appears to be an original idea that will add value to such frameworks. Researchers in patient engagement are starting to address contextual factors and connections should be made with this work.

Business of Care: Global perspectives

The eleven articles in this inaugural special issue of the Journal of Primary Health Care all focus on balancing the tensions between operating a sustainable business and providing health care, known as hybridisation tension. Hybridisation tensions arise when a primary care practice is exposed to the demands of antagonistic goals— namely providing patient centred high quality care that meets the needs of the population it serves, and maintaining a business that is at least sustainable and meets the expectations of funders and business owners. These tensions have been present in the sector going back to the inception of general practice services as we know them in New Zealand in 1938.1,2