TURUKI HEALTH CARE
Up for the Challenge for Making a Difference?
TURUKI HEALTH CAREWHO ARE WE?
• 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
SERVICES
GP and clinic
services
Midwifery
Mama Pepi
Tamariki
Pharmacy
Maternal, Infant
and child Mental
Health
Financial
Literacy
“Turuki Health
Care Primary Care
Addiction and
Family
Violence
services
Teen Parenting
and Family Start
programmes
Rheumatic
Fever
Oral Health in
development
GP AND NURSE LED CLINICS
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
CASE STUDY – WORKING WITH
WHANAU
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/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 anyway
Given COPD book to read and give to whanau - discussed what COPD is briefly.
Next appointment made
CASE STUDY – WORKING WITH
WHANAU (CONT)
Patient DNA’s next 2 appointments
Practice sends out Health Care Assistant to patients home to re-engage
Patient 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 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 pt’s appointments, hospital visits etc and keep on
top of his medication.
WHAT MADE A DIFFERENCE…
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Best evidence based practice
Follow up after DNAs – don’t give up
Engagement of whanau
Empowerment
Relationships
KOTAHITANGA WHANAU ORA
COLLECTIVE
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
WHAT’S HAPPENING IN THE “HOOD” FOR
WHANAU ORA PROVIDERS? MANAGING A COMPLEX WEB OF RELATIONSHIPS
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!)
NAVIGATING THE WAKA
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
NHC RATIONALE FOR OUTCOMES
BASED CONTRACTS
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
Exclusively
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 ?
“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 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)
SUMMARY
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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
ADDRESSING ASTHMA IN A WHANAU ORA
CONTEXT – WHAKANUI ORANGA
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
CONTACT DETAILS
Te Puea Winiata
CEO
Turuki Health Care
tpwiniata@thc.org.nz
Vicky Maiava
Nurse Leader
Turuki Health Care
vmaiava@thc.org.nz