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Up for the Challenge for Making a Difference?. Based in Mangere – South Auckland Started 1995 as a Midwifery Service Today we have nearly 90 people delivering.

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Presentation on theme: "Up for the Challenge for Making a Difference?. Based in Mangere – South Auckland Started 1995 as a Midwifery Service Today we have nearly 90 people delivering."— Presentation transcript:

1 Up for the Challenge for Making a Difference?

2 Based in Mangere – South Auckland Started 1995 as a Midwifery Service Today we have nearly 90 people delivering health and social services from Mangere to Papakura GPs Nurses Midwives Breastfeeding advocates, HCAs, whanau support workers, parent educators, navigators Collaborative service partners include – CMDHB mental health and addiction services from Waitemata DHB, Aotearoa Credit Union Manage over 250 students per year – doctors, nurses, midwives etc TURUKI HEALTH CARE- WHO ARE WE?

3 Turuki Health Care Primary Care GP and clinic services Midwifery Mama Pepi Tamariki Maternal, Infant and child Mental Health Addiction and Family Violence services Rheumatic Fever Oral Health in development Teen Parenting and Family Start programmes Pharmacy Financial Literacy SERVICES

4 Clinics GPDelivered at THC and at Southern Cross Campus Nurse led clinics including LTCTHC, mobile and schools Smoking CessationClinic and across services Cardio vascularClinic DiabetesClinic and community activities Mental Health and addictionsTHC and Co location of services RespiratoryTHC and mobile GP AND NURSE LED CLINICS

5 Maori Male 76 years old – Presents for Repeat Ventolin Rx Health Care Assistant sees patient in triage and talks to pt. regarding his breathing difficulties, offers appt COPD Nurse specialist that day, he agrees. Assessment Summary: Diagnosed asthma age 12, no inhalers until age 48. Spirometry: Severe obstruction - acceptable and reproducible. Post FEV1 0.57=25% FVC 2 = 62% ratio 29%. No sig reversibility. Auscultation - expiratory wheeze anterior lungs - normal breathe sounds posterior PHQ9: not depressed Smoking: 10/day for 57 yrs Symptoms: wheeze only when has the" flu " = all winter. Coughing daily, cough at night 3-4 times/ tight chest. sputum - white/yellow daily ??unsure of amount. sob sometimes when bending, uphills and stairs. no nasal drip. Current Meds: salbutamol 4-7 times/daily. flixotide 1pbd wo spacer. Recommended spiriva (refused atrovent 3-4times/daily) od, seretide 2pbd via spacer and salbutamol 2pprn via spacer - stop flixotide - pt anxious about change but grandson present and very supportive. Education: Taught what inhalers do and what COPD is - stressed importance of coming again to assess affect. Taught tech and spacer care. Stressed importance of stopping smoking. Not interested - says too late hes going to die anyway Given COPD book to read and give to whanau - discussed what COPD is briefly. Next appointment made CASE STUDY – WORKING WITH WHANAU

6 CASE STUDY – WORKING WITH WHANAU (CONT) Patient DNAs next 2 appointments Practice sends out Health Care Assistant to patients home to re-engage Patient feels let down by the system, doesnt feel his condition was ever explained to him by previous GPs. States that had he known the importance of stopping smoking and perhaps if it was clearly explained to him he would have tried earlier. States feeling depressed and all he can think about are end of life issues HCA talks to patient about support that we can provide, talks to whanau about questions they have and importance of Pt. being supported by the whanau Patient agrees, whanau state they are on board Patient attends clinic fortnightly for education and support Home visiting education and support for whanau also put in place, Daughter and Grandchildren very supportive 6 months after initial assessment – patient has quit smoking Compliance getting better each month with inhaler use and regular taking of medication 1 year on: Still not smoking Still attending appointments on regular basis Whanau are educated on COPD, whanau take control of pts appointments, hospital visits etc and keep on top of his medication.

7 Best evidence based practice Follow up after DNAs – dont give up Engagement of whanau Empowerment Relationships WHAT MADE A DIFFERENCE…

8 Turuki Health Care - ProCare Papakura Marae – National Hauora Coalition Te Kaha o te Rangatahi Collectively - we cover the area from Mangere to Franklin We have one joint contract – Family Start. We are the only Collective to hold the contract We have become mistresses and masters in managing unholy alliances -Anon KOTAHITANGA WHANAU ORA COLLECTIVE

9 National Hauora Coalition manage CM DHB Maori Health Contracts They are also the contract holders for Rheumatic Fever in schools and now for Healthy Homes ProCare are also one of the leads for Locality planning in Manukau/Papakura Whanau Ora Commissioning – TPK will be administering the 3 new Commissions MoH and MSD are now working on their own whanau ora and outcomes developments Multiple outcome frameworks for reporting against Be friends with everyone, be financially viable, have diverse funding streams ( and have your Trust develop an Auckland Real Estate portfolio!) WHATS HAPPENING IN THE HOOD FOR WHANAU ORA PROVIDERS? - MANAGING A COMPLEX WEB OF RELATIONSHIPS

10 Mastery in relationships and engagement is key We work in an ever changing landscape With complex relationships to manage in order to deliver effective services to whanau. However we also need the capability to know what we are counting and why NAVIGATING THE WAKA

11 ProviderServiceOutputsIndicators OneHealth PromotionFTEs employed? TwoMental health Service Full Governance? ThreeClinical ServicesNumber of non clinical services delivered ? FourBreastfeedingExclusively Fully Partially Breastfed 19 categories 8 pages. Does not contribute to national data In measuring outcomes all effort needs to measured and connected to the desired and agreed outcomes – how much; how well; anyone better off? NHC RATIONALE FOR OUTCOMES BASED CONTRACTS

12 JOINED UP OUTCOMES FRAMEWORK Whanau Ora Outcomes from the NHC For Mama Pepi Tamariki Indicators for Effective Asthma Management All pepi and tamariki have the best start in life Pepi and tamariki have no absences from pre school and school due to asthma Reduction in hospitalisation rates in tamariki especially pre school tamariki and pepi All rangatahi realise their potentialRangatahi have no restriction of normal activities as a result of having asthma All whanau have control of their quality of life Whanau are well informed and are partners in the management process of asthma All whanau living well with a long term condition All children experience lesser morbidity experienced by others in the population ( Best Practice Evidence based Guideline Management of Asthma in Children aged 1-15 years 2005. Paediatric Society of New Zealand)

13 Better Outcomes can be achieved by: Primary care professionals who are well informed in the use of evidence based guidelines Cultural Competence to enhance the delivery of care Computerised decision support tools Clinical audits with feedback to the clinicians People and systems working together Crengle.S, Robinson.E, Cameron.G, Arroll.B (2011). Pharmacological management of childrens asthma in general practice: findings from a community-based cross-sectional survey in Auckland, New Zealand. New Zealand Medical Journal 25 November 2011, Vol 124 No 1346; ISSN 1175 8716,Pages 44-56. SUMMARY

14 There are many moving parts to improving health outcomes for whanau who have asthma including addressing the inequalities in morbidity We need to create better synergy between policy, funding, clinicians, support workers, workforce development and health promotion and WHANAU Support development of common outcome framework and joined up indicators and relevant data collection for serious health issues such as asthma Conferences such as this one are important for strengthening relationships and striving to do more RELATIONSHIPS, RELATIONSHIPS, RELATIONSHIPS SUMMARY ADDRESSING ASTHMA IN A WHANAU ORA CONTEXT – WHAKANUI ORANGA

15 Te Puea Winiata CEO Turuki Health Care Vicky Maiava Nurse Leader Turuki Health Care CONTACT DETAILS

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