Up for the Challenge for Making a Difference?

TURUKI HEALTH CARE

• 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?

“Turuki Health Care Primary Care

GP and clinic services

MidwiferyMama 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

PharmacyFinancial Literacy

SERVICES

Clinics

GP Delivered at THC and at Southern Cross Campus

Nurse led clinics including LTC THC , mobile and schools

Smoking Cessation Clinic and across services

Cardio vascular Clinic

Diabetes Clinic and community activities

Mental Health and addictions THC and Co location of services

Respiratory THC and mobile

GP AND NURSE LED CLINICS

Maori Male 76 years old – Presents for Repeat Ventolin RxHealth 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 posteriorPHQ9: 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/week.no 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 anywayGiven COPD book to read and give to whanau - discussed what COPD is briefly. Next appointment made

CASE STUDY – WORKING WITH WHANAU

CASE STUDY – WORKING WITH WHANAU (CONT)

Patient DNA’s next 2 appointmentsPractice sends out Health Care Assistant to patients home to re-engagePatient feels let down by the system, doesn’t feel his condition was ever explained to him by previous GP’s. 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 issuesHCA talks to patient about support that we can provide, talks to whanau about questions they have and importance of Pt. being supported by the whanauPatient agrees, whanau state they are on boardPatient attends clinic fortnightly for education and supportHome visiting education and support for whanau also put in place, Daughter and Grandchildren very supportive6 months after initial assessment – patient has quit smokingCompliance getting better each month with inhaler use and regular taking of medication1 year on:Still not smokingStill attending appointments on regular basisWhanau are educated on COPD, whanau take control of pt’s appointments, hospital visits etc and keep on top of his medication.

• Best evidence based practice• Follow up after DNAs – don’t give up• Engagement of whanau• Empowerment • Relationships

WHAT MADE A DIFFERENCE…

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

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!)

WHAT’S HAPPENING IN THE “HOOD” FOR WHANAU ORA PROVIDERS? -

MANAGING A COMPLEX WEB OF RELATIONSHIPS

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

Provider Service Outputs Indicators

One Health Promotion

FTEs employed ?

Two Mental health Service

Full Governance

?

Three Clinical Services

Number of non clinical services delivered

?

Four Breastfeeding ExclusivelyFullyPartially 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

“JOINED UP OUTCOMES FRAMEWORK”

Whanau Ora Outcomes from the NHCFor 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 asthmaReduction in hospitalisation rates in tamariki especially pre school tamariki and pepi

All rangatahi realise their potential

Rangatahi 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)

• 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 children’s 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

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

SUMMARYADDRESSING ASTHMA IN A WHANAU ORA CONTEXT –

WHAKANUI ORANGA

Te Puea Winiata

CEO

Turuki Health Care

tpwiniata@thc.org.nz

Vicky Maiava

Nurse Leader

Turuki Health Care

vmaiava@thc.org.nz

CONTACT DETAILS