Northland DHB

Adrianne Murray, Nurse Practitioner (prescribing),
Primary Health Care, Whanau Ora, Northland DHB

Population:  Target populations are ‘at risk’ Maori whanau within Primary Care

 

Identified Need: Gaps in service provision for Maori clients in primary care who have complex or chronic care/ children, youth whanau with high needs/risk factors such as; poorly managed disease (cardiovascular, respiratory, diabetes), co-morbidity, polypharmacy, socio-economic at risk, rural access issues, unmet vaccinations, delayed development, pre term infants, high users of GP or hospital visits

 

SERVICE DELIVERED

• Clinical responsibility and case management for people with: Complex or chronic care, children, youth and whanau with high needs
• Professional consultancy/leadership/liaison role

 

IMPLEMENTATION & FUNDING COMPONENT OF NP POSITION

• Planned key stake holder meetings to discuss: NP development/funding/Implementation commenced 2004 (prior to first NP roll out in Northland).
• Present: Registered Nurse in final year of NP preparation, Northland DHB portfolio managers: PHC/Maori,  delegates of major Northland Iwi provider groups, Ministry of Health PHC portfolio manager

ESTABLISHMENT COMPONENT

• Northland DHB funded: monitoring undertaken between DHB and Maori Provider Organization
• Steps:  Scoping, recruitment, clinical establishment, capital and administration

OUTCOMES

Establishment of the role following pilot based on outcomes which included:

• Establishment of Nurse led clinics in rural outreach communities previously without primary care services
• >80% Maori clients enrolled with service
• Quantitative and qualitative data supports effective service outcomes (number of consultations, number of presentations via age group/ethnicity, co morbidity of conditions seen etc.)
• Reduced rates of readmissions for chronic care clients and high needs children accessing GP due to NP service 

EVALUATION

• Kaupapa Maori Advanced Nurse Service contract is currently entering a formalized research study authorized by Northland DHB to evaluate the effectiveness of the service

FEEDBACK ON NP CONTRIBUTION

• Client feedback positive for NP service as effective, providing continuity of care, high quality service, able to meet most primary care needs
• GP colleagues have found service very supportive to locums starting in rural practice
• Large number of consultations within service is seen as meeting previously unmet need
• Service contributes to national framework supporting NP development and sustainability