Refreshed Rheumatic Fever Prevention Plan 2016 - 2018

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Lakes District Health Board

Refreshed Rheumatic Fever Prevention Plan

2016 - 2018

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Contact Person: Pip King Portfolio Manager Lakes DHB [email protected] 07 379 7823 027 555 2741

mailto:[email protected]

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Table of Contents

List of Abbreviations ...................................................................................................... 4

RHEUMATIC FEVER WORK PLAN SIGN-OFF ........................................................... 6

Purpose of the plan ....................................................................................................... 7

Structure of the Plan ........................................................................................ 7

Section 1: Overview of the review and refresh of the Lakes District Health Board (DHB) rheumatic fever prevention plan ...................................................... 8

1.1 Background ............................................................................................. 8

1.2 Which activities does the DHB believe were successful? Why? ............. 9

1.3 Which activities does the DHB believe were cost effective? Why? ....... 12

1.4 Which activities would the DHB have done differently? Why? .............. 13

Section 2: Governance.............................................................................................. 15

The current structure of Rheumatic Fever activities in Lakes DHB is shown below. ... 16

Section 3: Stakeholder Engagement ......................................................................... 17

3.1 Summary of Stakeholder Engagement .................................................. 17

Section 4: Achieving the Better Public Health Service Rheumatic Fever target (1 January 2016 to June 2017) .................................................................... 21

4.1 Where is the DHB in relation to meeting the 2017 target? What is the expected trend with or without new actions? ......................................... 21

4.2 What actions will be continued or introduced to ensure the 2017 target is met? ................................................................................................... 22

4.3: An outline of the DHB planned investment in interventions until 30 June 2017 ................................................ Error! Bookmark not defined.

4.4 Lakes DHB sustainability beyond June 2017 ........................................ 27

Appendix 1 ............................................................................................................. 28

TITLE: Terms of Reference for Rheumatic Fever Governance .................. 28

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List of Abbreviations

ARF Acute Rheumatic Fever

ASH Ambulatory Sensitive Hospitalisation

BOP Bay of Plenty

BOPDHB Bay of Plenty District Health Board

CoBoP Collaboration Bay of Plenty

CONS Children’s Outreach Nurse

DNS District Nursing Service

EBET Eastern Bay Energy Trust

GAS Group A streptococcus

GP General Practice / Practitioner

HNZC Housing New Zealand Corporation

HSL HealthShare Limited

ICD codes International Classification of Disease codes

Lakes DHB Lakes District Health Board

MoH Ministry of Health

MOH Medical Officer of Health

PHN Public Health Nurse

PHO Primary Health Organisation

PoPAG Population Health Professional Advisory Group

RAPHS Rotorua Area Primary Health Services

RHD Rheumatic Heart Disease

SES Smart Energy Solutions

Toi Te Ora Toi Te Ora – Public Health Service

THCT Tuwharetoa Health Charitable Trust

WHHS Western Heights Health Service Rotorua

WINZ Work and Income New Zealand

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Foreword

Rheumatic fever is a preventable cause of serious illness and death in the Lakes District Health Board (DHB) population, almost exclusively affecting our Maori children. Lakes DHB has a focus on improving the health of our children and the prevention of avoidable conditions. While we have made progress in many areas of child health we know more work is required to eradicate rheumatic fever from our population. The focus on rheumatic fever prevention by the Ministry of Health since 2012 has provided Lakes DHB with the vision and support to prioritise the planning and implementation of a rheumatic fever prevention programme. In addition we acknowledge the priority given to this work through the Prime Minister’s Better Public Health Service target to reduce the incidence of rheumatic fever by two thirds to 1.4 cases per 100,000 people by June 2017. We are well aware that while health might lead the rheumatic fever programme of work it is up to us to engage with a range of stakeholders across government agencies and community organisations, establishing robust cross sector working relationships to ensure a shared vision and coordinated approach to implementing interventions which can prevent rheumatic fever. Lakes DHB has several cross sector programmes involving children, families and young people which will enable us to continue using existing frameworks and relationships to ensure a coordinated implementation of rheumatic fever prevention interventions. These programmes involve social services, housing, education and parenting, aligning with our focus to work across sectors, sharing a common vision for children and young people to help them to thrive, achieve and belong. We are encouraged to have the opportunity to revitalise our DHB rheumatic fever plan to adjust our thinking and strategies as a result of our learnings so far. This plan was overseen by a range of stakeholders who represent a range of our population. My sincere thanks to all those involved and Lakes DHB looks forward to increased collaboration across stakeholders as we increase action against rheumatic fever. Ron Dunham Chief Executive Lakes District Health Board

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RHEUMATIC FEVER WORK PLAN SIGN-OFF

This document has been reviewed and accepted as the formal Lakes DHB Rheumatic Fever Plan for implementation in terms of content and sign off by:

Name: Mary Smith

Project Sponsor

General Manager, Planning and Funding

Lakes DHB

___________________ / /2015

Signature

Name: Johan Morreau

Rheumatic Fever Champion

Consultant Paediatrician

Lakes DHB

___________________ / /2015

Signature

Name: Neil Poskitt

Rheumatic Fever Champion

General Practitioner and Clinical

Leader of Child Health for RAPHS

___________________ / /2015

Signature

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Purpose of the plan The purpose of this document is to provide a refreshed rheumatic fever prevention plan following a review of our current plan, stakeholder engagement and a review of the learning’s and outcomes achieved so far. The current Lakes DHB plan was signed off to cover 2013-2018, but at this half-way mark we have been given the opportunity to revitalise the programme and utilise the learning’s so far and ensure the momentum is further built on. While our refreshed plan is unique to the Lakes DHB population and has been developed with our partners in the Lakes population we also remain in close contact with our regional DHB’s that also have higher than acceptable Rheumatic Fever rates. This has allowed Lakes DHB to share learnings and future strategies. Structure of the Plan Section 1: Presents an overview of the review and refresh of the Lakes District

Health Board (DHB) rheumatic fever prevention plan Section 2: Governance Section 3: Stakeholder Engagement Section 4: Achieving the 2017 Better Public Health Service rheumatic fever target

(to June 2017) Section 5: Ongoing investment in rheumatic fever prevention (July 2017 onwards)

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Section 1: Overview of the review and refresh of the Lakes District Health Board (DHB) rheumatic fever prevention plan

1.1 Background Lakes DHB and Bay of Plenty DHB (BoP DHB) recognised ARF as a priority issue in 2008. In 2009 a joint steering group was established to lead a range of DHB funded initiatives to address rheumatic fever which are now at various stages of implementation. Ministry of Health funded projects were introduced in 2012. The initial approach taken was based on the Heart Foundation Rheumatic Fever guidelines and tidying up our secondary prevention systems. With the introduction of the Ministry of Health funded programmes a range of evolving initiatives, both nationally driven and locally driven have been implemented in Lakes DHB. The ongoing development of the programmes has been a result of evaluation and learning. This review and refresh allows a re-focus and to further strengthen successful parts of the programmes and address some of the gaps highlighted through the stakeholder engagement and governance. Actions have been implemented in the following areas:

1. raising public awareness that ‘sore throats matter’ 2. continuing professional development for health professionals 3. rapid response services 4. healthy homes service 5. improving notification of ARF cases 6. improving case management and prevention of recurrence, including a

Rheumatic Fever register across Lakes DHB. 7. enhanced surveillance and audit of cases

A range of positive results have been demonstrated. These include raised awareness of rheumatic fever in higher risk communities and the general public; increased awareness of the sore throat guidelines among primary health care; school based health services and youth health services, the refining of the Lakes DHB rheumatic fever register, improved notification, and more recently rapid response and healthy homes programmes that are operating to agreed protocols and have the support of local communities. At the time of refreshing our rheumatic fever plan (September 2015) Lakes DHB has so far achieved our target of 4.7 in the 2014-15 year.

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1.2 Which activities does the DHB believe were successful? Why?

Activity Why was this successful and what

are the learnings? Future direction

1.2.1 Input and engagement with Iwi Governance

Lakes DHB process is to consult with our two Iwi Governance Boards Te Roopu Hauora O Te Arawa and Te Nohanga Kotahitanga O Tuwharetoa who represent Lakes’ iwi. Their knowledge of RF has been increased and provided the ability for them to reach out to their communities with the key messages.

They were able to provide information re how to actively reach out and engage with high risk Maori communities, especially through education and appropriate clinical services.

Provide an ongoing mechanism for Iwi Governance input into RF governance

Child and whanau friendly primary health care, no appointments, free, after hours, staff with integrity and expert knowledge

Receptionists who are child and whanau friendly

Appropriate physical spaces for children and whanau with sore throats

Efficient referral pathways for housing, curtains, bedding, heating that will not cause “shame”

Almost set a recycling system up that is the norm for household items

1.2.2 Rheumatic Fever Champions

We had two RF champions, a primary care and a secondary care clinician. These clinicians:

have credibility as the experts

provide a single point of contact for all RF related issues

raise awareness

provide and distribute the key messages to other clinicians

work together on providing professional development

implement the sore throat guidelines and any changes across the DHB

are able to answer any queries re diagnosis in a timely manner

provide audit and monitoring

Continue with the same RF champions

Add adult physician, cardiologist as a “champion”.

Allocate dedicated time for them to be available for governance, workforce development, clinical queries, improving follow up of RF patients with secondary cardiac disease.

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1.2.3 RF Nurse coordinator

Operational view of RF activities over the Lakes DHB population

Identify and fill gaps, provide “glue” to the system

Implement workforce development

Coordinate the resources

Expert knowledge

Continue with this role.

Increased workforce development across all clinician groups

Strengthen services caring for adults with Rheumatic Fever – prevention of recurrence, follow up of patients with cardiac disease.

Facilitate the systems for providing community, school and primary care for Lakes DHB children.

1.2.4 Primordial prevention

Healthy Homes programme. Has provided a focus on housing, has identified the barriers in referral pathways.

Facilitated a cross sector approach in the community of high need.

Enabled a community driven programme e.g. curtain bank, men’s shed, Citizens Advice Bureau, Rotorua Energy Trust (philanthropy).

Ministry meetings and workshops have been helpful.

Consolidate the Healthy Homes programme. Continue service development from a community led aspect.

Work with health and the other sectors on efficient and easy referral pathways e.g. paediatrics, WINZ.

1.2.5 Primary Prevention-sore throat management services in Western Heights

Identifying the high needs areas.

Adding more resource into this service for a combination skin and sore throat clinics.

Combination of school and community clinics. Morning in the schools and afternoons in the community.

Available until 6 pm. Word of mouth plus sign outside FREE clinics and no appointment needed.

Significant unmet need and demand. Approx 20% GAS + over the past 6 months.

Will need to add in community support workers and help with home visiting, antibiotic adherence.

Add in some further high needs primary schools.

Ongoing advertising through facebook and a 0800 number.

1.2.6 Primary Prevention-sore throat

Lakes DHB secondary schools are fortunate to have established health services in all but two secondary

Require ongoing updates and workforce development.

Many of the nurses are

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management services in Secondary school clinics

schools. This includes Kura Kaupapa, alternative education and school for young mums.

Nurses working under standing orders.

Ability to follow up.

employed by education, not health, we need to provide ongoing support, supervision monitoring and quality improvement.

1.2.7 Primary Prevention-sore throat management services by Public Health Nurses

Mobile service able to do home visiting and lots of follow up, household contacts, antibiotic adherence.

PHNs can transport children to primary care and facilitate access for children and families.

PHNs provide a whole child and family assessment have good referral pathways and are increasingly able to provide care to children with infected skin.

Implement standing orders with relevant supervision in place

Establish simple systems for accessing relevant pharmaceuticals needed

1.2.8 Primary Prevention-sore throat management services in after hours clinics ED and private

Audit of Rotorua ED highlighted the number of children attending after hours with sore throats. Audit highlighted inadequate treatments, and follow up.

This highlighted the fact that private after hours services are likely to be similar and that thresholds for using intramuscular Penicillin could reasonably be lowered.

Need ongoing workforce education for after hours services on rapid response care for a potential GAS sore throat.

Strengthen follow up requirements on discharge summaries.

1.2.9 Primary Prevention-sore throat management services in Primary Health Care

Primary Health care is seeing how successful the rapid response clinics and secondary school clinics which have introduced free sore throat and treatment packages of care for all children and young people up to age 18 years in RAPHS (PHO) are. These are funded through Primary Options for Acute Care (POAC) funding. The Turangi surgery (high need, high Maori) are providing this service from their own funding.

Wider advertising and demonstration to the MHN PHO how this is something primary care can provide successfully through nurse led services.

1.2.10 Primary Prevention-

Two Lakes DHB Youth One Stop Shops provide services across the DHB youth population. Very

Ongoing support and workforce development and a business as usual approach.

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sore throat management services in Youth One Stop Shops

experienced nurses and doctors. Funded on FTE no problems incorporating rapid response, sore throat awareness, education - happy to provide education to secondary school nurses and doctors.

1.2.11 Oral health

Lakes DHB children have some of the worst dental disease when compared nationally.

Raised sore throat awareness through the oral health services.

Providing free dental care in pregnancy and education of children’s dental hygiene.

Need to prioritise children at risk of RF. Provide screening and treatment more regularly.

Preschool tooth brushing campaigns in the kohanga reo and preschools in the high priority populations for RF prevention.

1.2.12 RF Awareness Campaign

National campaign has been very helpful.

Continue promoting the national campaign resources and distribution.

1.3 Which activities does the DHB believe were cost effective? Why?

Cost effective activities

Why? Future Direction

1.2.1 Community awareness raising

National messages, consistent and we didn’t have to develop anything ourselves.

Further use of the national messages and resources. Re assess once the national campaign ends.

1.2.2 Rapid response clinics

Utilising an existing primary care provider (General Practice) to deliver the RR response and HH services. Creates ease of access in terms of medical follow-up, both initial and ongoing. Same provider delivering sore throat and healthy homes services – economies of scale, supports effective service coordination and integration.

This has enabled a vehicle or framework for other health “spin offs”. These include caring for skin infections as well, demonstrating how

Continue to develop additional community clinics.

Consider adding in other child health initiatives e.g. we provide skin and sore throat care, those being cared for inevitably need more – Rx holistic community rapid response child health clinics, drop in, staffed appropriately etc.

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Cost effective activities

Why? Future Direction

free community clinics can work.

RRRF drop in clinics – amazingly effective method of capturing the target population. Service stat’s support impressive utilisation at a relatively small cost (1 RN and receptionist) for a few hours per week.

This challenges primary care to implement models of care (well integrated with general practice) that include easily accessible nurse led approaches (supported by general practice) to deliver care.

1.2.3 National Guidelines, national standing orders

Because all the groundwork was completed and these were very clear it has been relatively easy to get other services to pick them up and implement without added resource e.g. school clinics, PHNs.

Continue workforce development using the guidelines and online training.

1.2.4 Free under 13’s

Able to piggy back on this and able to use this funding for PHC to provide rapid response from 1 July 2015.

Business as usual

1.2.5 Focusing our core work on the Western Heights population for rapid response and healthy homes initiatives

Ability to implement a new service in a defined area which enabled a focus on this population rather than spreading the service thinly. Provided a framework for Western Heights to improve primary care response to children

Continue the focus

If resource becomes available , implement more widely

1.4 Which activities would the DHB have done differently? Why? There is very little in retrospect we would do differently. Much of the work we have been able to apply “learning as we go” , building on existing systems ,while

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maintaining flexibility, rather than needing to stick to a rigid plan. This has been helpful as services provided by doctors and nurses in the community continue to evolve.

Which activities would the DHB have done differently

Why?

Project Management and Stakeholder engagement

We recognise if we had put some dedicated resource in initially we would have had a quicker and more efficient roll out of programmes. It has also caused some disconnect and this has contributed to separate agreements for Healthy Homes and Rapid Response.

Primary Health Care provision of Rapid Response - it would have been helpful to get primary care providing these services more quickly

Free under 13’s has helped enormously.

More focus on workforce development and professional education

We have delivered a lot of this but the education and support needs are ongoing especially for locums

Subjects such as

correct treatment, rapid response rather than waiting confirmation

follow up

repeat questions on carriage, follow up swabs, stopping treatment when the swab is negative, household contacts

reluctance to use IM bicillin as an acceptable treatment option.

Require a consistent input

Involve the secondary/tertiary services more in the initial development of the Healthy Homes service proposal

This might have helped with getting more buy-in with the bicillin clients and referrals from secondary care.

Apply resource slightly differently to the rapid response and healthy homes services

There has been a significant administration component to processing throat swabs. Currently being completed by RNs – not good use of their relatively expensive time.

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Section 2: Governance

Currently there is a Lakes DHB and Bay of Plenty DHB joint Rheumatic Fever Steering group. This group was formed in 2009 in response to the high rheumatic fever incidence in both DHBs. The steering group has had oversight of a range of initiatives across both DHB’s. In refreshing the Lakes DHB prevention plan initial stakeholder feedback is that Lakes DHB forms a small rheumatic fever governance group specific to our population needs and the refreshed plan. It is still the intent to continue the joined up steering group for networking and sharing. Below is the list of current Lakes DHB governance members and their roles following stakeholder engagement. The members were appointed by the General Manager, Planning and Funding. The terms of reference allow for future members to be appointed. Stakeholder engagement identified the need for a small functional governance group with widespread reach, decision making mandate and able to think out side the square. The terms of reference include a commitment to the review of members annually.

Name Role

Pip King-Chair Portfolio Manager-Rheumatic Fever

Johan Morreau Rheumatic Fever Champion, Community and General Paediatrician

Neil Poskitt Rheumatic Fever Champion –Primary Health Care Child Health lead and General Practitioner

Peace Tamuno Adult Physician, cardiologist.

Mary McLean The Manager Western Heights Community, Rapid Response and Healthy Homes services

Elise Pope Rheumatic Fever Nurse

Kate Stewart Project Manager

Teresa Pou Regional Manager Housing New Zealand

Western Heights Community Association

Phyllis Tangitu General Manager Maori Health and Iwi Governance liaison

Sharon Rye Clinical Manager Tuwharetoa Charitable Trust and link to Whanau Ora

Alan Ching Regional Manager, Ministry of Social Development

Tayleva Petley Regional Manager, Child, Youth & Family

Anaru Marshall Wise Well-home insulation service

Hariata Johnson Maori Women’s Welfare League

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The current structure of Rheumatic Fever activities in Lakes DHB is shown below.

Rheumatic Fever Programme October 2015

Rheumatic Fever Governance

Rapid Response

WHHS

Tuwharetoa

SBHS

YOSS

P.H.C

ED/LPC

Healthy Homes

Rheumatic Fever Nurse

Workforce

development

Community

awareness

raising

Bicillins

DNS

P.C

CONS

High School

Nurses

RF Register

Chief Executive Lakes District Health Board

General Manager and Planning and Funding

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Section 3: Stakeholder Engagement 3.1 Summary of Stakeholder Engagement The following table has been used to summarise and record engagement with the key stakeholders. The stakeholders input was used to inform the review and refresh of this plan.

Engage with key

stakeholders Key points

Actions following engagement

and future actions

Lakes DHB Maori Health Team

Able to provide widespread iwi engagement and support

Provide information on correct processes to be used for future

To provide Maori Community Awareness raising Pou Whakamarama

Initial meetings with both iwi governance boards and presentations

Maori health to deliver a widespread community awareness raising programme to Maori to reach Maori over the Lakes population

Te Nohanga Kotahitanga o Tuwharetoa

Te Roopu Hauora o Te Arawa

Iwi Governance Clarify roles and responsibilities

Can provide awareness raising

Will take back to their hapu

Need the doctors to be more friendly and welcoming

Midland Health Network

Establish training requirements

Identify any issues

Offer support ongoing

Require ongoing workforce development as a result of overseas locums, new grad nurses

Development needs can be unique to each practice but include rapid response guidelines

Rotorua Area Primary Health Service

All primary care practices offering FREE rapid response to sore throats for 4-18 year olds


Identify any issues

Offer support

Ongoing workforce development required for doctors and practice nurses and even receptionists. Receptionists must know and be responsive about the FREE service

Keep providing the sore throat resources excellent

Want packs for sore throats made

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Engage with key



and future actions

up with the lab forms, pamphlets for the child and family, swab and the oral meds. So the nurses can easily have with them everything that they will need for care of sore throats

Need to establish more clearly what the fee is for 13-18 year olds for a fee for service claim

Tuwharetoa Health Charitable Trust

Tuwharetoa Whanau Ora


Identify any issues

Offer support and further planning to address the issues

Providing rapid response services under RF funding.

Streamline their reporting.

Workforce development.

Housing is a major issue in Turangi and every year the houses get one year older and further neglected. Out of town private landlords will not insulate.

Overcrowding significant issue in Turangi.

Prison population attracts families and transiency.

Gang population and this is an area of health need.

Youth One Stop Shops

Rotovegas

Anamata Café

School Based Health Services


Identify any issues

Offer support

Providing rapid response and follow up including adherence.

More willing to treat GAS with IMI Bicillin.

Very experienced doctors and nurses-know their community have community support.

Provide an integrated primary care, sexual and reproductive health, mental health drug and addictions so this is business as usual.

Will provide awareness raising.

Ngati Pikiao-Pacific Island community

Identify needs Require ongoing workforce development ,have locums but dedicated community support workers.

Provide posters and resources

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Engage with key



and future actions

ongoing.

High needs practice.

Toi Te Ora – Public Health Service

What are they providing?

Able to provide support with marketing and communications.

Provide Medical Officer of Health.

Western Heights Community Association

Includes health, Citizens Advice Bureau, Curtain Bank, Housing NZ, Home insulation services, pharmacy and mens shed.

Monthly meetings.

Providing support with structural overcrowding. Providing beds, linen, curtains, firewood recycled heaters, fire alarms.

Will apply for ongoing funding for resources.

Korowai Aroha

Tipu Ora

Ngati Pikiao

Whanau ora collective

Includes Pepe, Moko and Tamaiti teams –nurses and community support workers. Work with all pregnant women and their whanau until children are five years of age. Sort social needs as well as health

Monthly meetings.

Wide reach across primary health care, Kohanga Reo, Kura Kaupapa, and Whanau Ora.

Rotorua Children’s Team Operational management Group

Has high needs vulnerable children, large families, CYF referrals

Workforce development with the Lead professionals looking after these children and families required

Maori Women’s Welfare League

Willing to help in any way that we require. They are highly visible at many community events.

Rheumatic Fever Governance to scope.

Kia Puawai Maternal and Child Health Integrated service 0-5 year olds

Implementing minimum standards for babies and families in Western Heights and outcomes we want for children. Ensuring all children are enrolled, receiving universal services etc

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Engage with key



and future actions

After Hours Health Services

Are seeing a growing number of children and young people in Rotorua

Due to parents and young people unable to take time off work

Difficulty arranging appointments with primary care

Need workforce development

Resources

Expertise

Follow up can be an issue

Housing New Zealand

Clarification RF Healthy Homes referral pathways

Continued engagement to further refine pathways between services

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Section 4: Achieving the Better Public Health Service Rheumatic Fever target (1 January 2016 to June 2017)

4.1 Where is the DHB in relation to meeting the 2017 target? What is the

expected trend with or without new actions? Lakes DHB is committed to reducing the incidence of Rheumatic Fever to levels set by the better public services targets. The specific targets and actuals for Lakes DHB are summarised in table 1 below. Table 1: Acute Rheumatic Fever initial hospitalisation target and actuals, rates per year for

Lakes DHB (per 100,000 total population), 2009/10 to 2016/17

District Health Board

2009/10 –2011/12

Baseline rate

(3-year average

rate)

2012/13 Target:

Remain at baseline

level

2013/14 Target:

10% reduction

from baseline

level

2014/15 Target:

40% reduction

from baseline

level

2015 /16 Target:

55% reduction

from baseline

level

2016/17 Target:

2/3 reduction

from baseline

level

Lakes Target rates

7.8 7.8 7.0 4.7 3.5 2.6

Target numbers

8 8 7 5 4 3

Actuals rates

8.8 6.8 3.9 5.0

Actual numbers

9 7 4 5

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4.2 What actions will be continued or introduced to ensure the 2017 target is met?

Raising awareness of rheumatic fever and how to prevent it

Preventing the transmission of Group A streptococcal throat infections in households

Treating Group A streptococcal sore throat infections quickly and effectively in whatever context they arise

Current Interventions Increased interventions to be

introduced 1 January 2016 Rationale Measured by

Timeframe

Actions to raise awareness of rheumatic fever and how to prevent it among priority populations

RF communications plan

National campaign

Radio, TV and petrol station messages

Local resources widely distributed

Rheumatic Fever Nurse providing community awareness raising

Continue all current interventions

Add Maori community awareness raising-Pou Whakamarama. Introduce an appropriate person to work extensively in priority populations to ensure awareness raising reaches all parts of the community. Person with extensive Maori networks and partnered with community paediatrician.

Develop an ongoing mechanism to provide iwi governance with regular updates and communications

To develop a focus on priority populations

All recent ARF patients in Lakes DHB have been Maori/PI

A reluctance in some of our Maori and high needs population to seek health care early.

ARF rates and reaching the target

Number of community awareness raising sessions

Iwi Governance contacts

Quarter 3 2015-16

Pou Whakamarama in place

Set up quarterly reporting to iwi governance

Actions to preventing the transmission of Group A streptococcal throat infections in households

Healthy Home Programme Western Heights

Promote the Better Public Health Service targets including RF through the CoBOP (Collaboration Bay of Plenty) and Rotorua

Continue current initiatives

Healthy Homes Programme Western Heights

Increase healthy communal living messages through Community Awareness Raising

Provide the Public Health

Poor housing stock in Lakes DHB and overcrowding

Poor housing in Turangi with little or no upkeep

Noted bedding and

Healthy Homes reports-numbers of insulated homes and referrals

Turangi Healthy Housing programme

Quarter 4 2015-16

“Key Tips” programme in place pre Winter

Community awareness raising commenced

Standing orders in place across across PHNs and

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Timeframe

governance for the Childrens Team, Social Service sector trial and Te Arawa Whanau Ora

Develop a systems approach to identifying children and families at high risk of RF when the children and families are seen by health services.

System to enable agencies to flag children and families living in overcrowded and poor housing, including poor heating and clothing combined with presentations for respiratory illness, repeat GAS infections, ASH, vulnerable pregnant women, vulnerable children 0-5 years, children referred to the Children’s Team.

Promote healthy communal living habits in homes and schools.

Well Child/Tamariki Ora providers,

Nursing teams with more Healthy Homes resources when home visiting

Roll out a programme for train the trainer workshops for “Key tips for a warmer, drier home toolkit”

Explore options for Healthy housing programmes in Turangi supported by Tuwharetoa and Whanau Ora

Support Western Heights programme to source sustainable philanthropic funding streams and systems for household equipment, beds, bedding, heaters, dehumidifiers, dry firewood, mould kits

Increased focus on opportunistic treatment of skin conditions in children

Adopt of a “whatever it takes” approach to preventing RF

beds are in demand

DHB, whanau ora, and MSD all have workforce home visitors in priority communities for the “key tips for drier warmer households”

Limited supply of needed HH service resources currently

Casual correlation between skin infection and positive GAS identified

Responsive and flexible approach to RF promotion, identification and treatment of children and their family/whanau

Workshop for train the trainer sessions and number of attendees

Response to philanthropic applications

ARF rates

ARF rates

practice Nurses

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Timeframe

PHNs, Hauora providers, Trust, GPs, Accident and Emergency Departments in hospitals and community.

Actions to ensure treatment of Group A streptococcal throat infections quickly and effectively

Implementing the rheumatic fever and sore throat guidelines and clinical pathway as a priority in primary care.

Education and clinical updates for health professionals. Frontline clinicians, locums in primary health care and secondary care

Provision of treatment immediately

“Sore Throats Matter”

Community Campaign

Throat swabbing

Throat swabbing and standing orders of amoxicillin in all

Introduce a dedicated and increased RF workforce development programme to be delivered by the RF Nurse and RF Champions.

Include antibiotic adherence education and evidence.

Use the online training, face to face education sessions and site visits

Increase the advertising and community awareness raising of where to go when you have a sore throat.

Consider a local 0800 number, facebook.

Strengthen Lakes specific information – national 0800 number

Increase FREE rapid response service capacity at

Following stakeholder engagement identified knowledge gaps.

Lack of confidence in Rapid Response eg clinicians wanting to wait for results, resistance to using IMI Bicillin in high risk cases.

Lack of responsiveness by primary health care

Vulnerable population unengaged with health

Increasing afterhours seeking health behaviour in Lakes

ARF numbers in lakes DHB

Rapid Response Rheumatic Fever funded programmes reporting

Quarter 3 2015-16 Education programme and plan developed for providers

Delivery of the plan commences

Quarter 4 2015-16

Communications plan in place

Local advertising to raise awareness of rapid response services pre Winter

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Timeframe

secondary school clinics.

Public Health Nursing in primary schools to implement pathway into primary care for treatment of sore throats.

Education of health professionals on importance of improving access to assessment and treatment

Increase capacity of the community youth health services to provide free and easy access to young people with sore throats for assessment and treatment

Standing orders prescriber to be responsible for follow up, evaluation of treatment and compliance.

Increase support should it be needed through the public health nurses, child health nurses, family start.

the following services:

Western Heights Rapid Response service

Tuwharetoa Health

Rotovegas YOSS

Anamata Café YOSS

Secondary School based health services

Public Health Nurses

Primary Health Care-Rotorua

Primary Care Taupo

Primary care Turangi

Primary care Mangakino

After Hours care Rotorua and Taupo ED

Lakes Prime Care

Work with PHOs to progress primary health care responsiveness to children and families with sore throats.

Develop leadership structure and RF champions within primary care

Increased RF prevention focus needed within primary sector No current options for afterhours Rapid

ARF rates Number of clients accessing after hours services

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Timeframe

Afterhours RF rapid response clinics in primary care

Response RF clinic’s across the region with the exception of Western Heights

Actions to address social determinants impacting on transmission of Group A streptococcal infections

Lakes AOD service Specialist AOD resource embedded within rapid response sort throat nursing services:

Screening

Brief interventions

Education

Harm reduction

Referral pathways to primary/secondary AOD services

High proportion of at risk families/whanau present with AOD issues

ARF rates

Number of individuals engaged with AOD interventions

Quarter 3 and 4 2015-16

Roll our of integration into other services.

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4.4 Lakes DHB sustainability beyond June 2017

Included in 4.3 above is the Lakes DHB outline of the activities we are planning to invest in from 1 July 2017. Sustainable investment will come from the Ministry ongoing funding from 1 July 2017 plus Lakes DHB population based funding. Implementing the Map of Medicine clinical pathways for sore throats and treatments will be business as usual through primary care and youth health services. Public Health Nursing and Youth One Stop Shops and secondary school based health services are planned to continue with rapid response under standing orders.

The increased support and intensive child and youth health services being developed in Lakes population to feed into Family Start activity and the Rotorua and Taupo Children’s teams will be used to flag children at risk and needing housing, clothing, unmet physical health needs (including sore throats, oral health care, skin infections).

The Rheumatic Fever Governance will continue with rheumatic fever champions either as a stand alone governance or will merge into the Lakes DHB Te Whanake (Maternal, Child and Youth Health governance). There is also the ongoing cross sector Rotorua joint governance around children and families (White Paper, Whanau Ora, Social Service Sector trial as well as iwi, community based initiatives) which will increase access to insulated housing, safer families, improved education outcomes contributing to a reduction in inequalities.

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Appendix 1

Document No: This is a controlled document. The electronic version of this document is the most up to date and in the case of conflict the electronic version prevails over any printed version. This document is for internal use only and may not be accessed or relied upon by 3

rd parties for any purpose whatsoever.

TITLE: Terms of Reference for Rheumatic Fever Governance 1. Purpose/Description Rheumatic fever is a preventable cause of serious illness and death in the Lakes District Health Board (DHB) population, almost exclusively affecting our Maori children. Lakes DHB has a focus on improving the health of our children and the prevention of avoidable conditions. Whilst we have made progress in many areas of child health we know more work and further focus is required to eradicate Rheumatic Fever from our population. Lakes DHB is required to update and implement a refreshed Rheumatic Fever plan from 1 January 2016. As part of the refreshed plan Lakes DHB is required to put in place an appropriate Rheumatic Fever prevention governance group. This is to ensure collective decision making about the priorities and a coordinated implementation of the refreshed plan. The governance group will be charged with overseeing the development and the implementation of the refreshed plan. 2. Function/Scope of Meeting The Rheumatic Fever governance is to provide expert advice on the development and implementation of the Lakes DHB Rheumatic Fever prevention plan. This includes ensuring a balanced portfolio of interventions to reduce rheumatic fever incidence and applying flexibility to change decisions and services based on new evidence. An Advisory Group was initially consulted on development of the proposed Project Implementation Plan to the Ministry of Health prior to the contract for implementation being agreed. The Advisory Group is to be re-established to provide expert advice to the project manager, including the direction of the project, issues related to implementation, laboratory, health providers, data, partner notification and contact tracing. 3. Membership

Chair: Pip King Portfolio Manager Maternal, Child and Youth Health

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Minute Taker: Tiannie Hillman-Lepper Members:

Johan Morreau Rheumatic Fever Champion Neil Poskitt Rheumatic Fever Champion Mary McLean Manager Rapid Response services Elise Pope Rheumatic Fever Nurse Sharon Rye Clinical Manager Tuwharetoa Charitable Trust Phyllis Tangitu General Manager Maori Health Kate Stewart Project Manager Teresa Pou Housing New Zealand Anaru Marshall Wise Better Homes Peace Tamuno Adult Cardiologist Alan Ching Regional Manager MSD Tayelva Petley Regional Manager CYF Hariata Johnson MWWL

4. Meeting Schedule First meeting to be held Friday 16 October 2015. Subsequent meetings are to be agreed by the group attendees. The Governance Terms of Reference are to be reviewed annually to ensure they are current and have appropriate membership and that sustainable change is being delivered. 5. Minutes/Documentation Minutes recording key discussion points, actions and responsibility to be recorded, distributed for feedback before finalising one week after each meeting. Distribution by email. Documentation maintained in project records on project file and electronically on Rheumatic Fever share file at Lakes DHB. 6. Reporting The Portfolio Manager reports on behalf of Lakes DHB to the Ministry of Health on a quarterly basis. Authorised by: Pip King Portfolio Manager Endorsed by: Mary Smith General Manager

Refreshed Rheumatic Fever Prevention Plan 2016 - 2018

Documents

Transcript of Refreshed Rheumatic Fever Prevention Plan 2016 - 2018