department of primary health care and general practice
DESCRIPTION
Playing the advantage in policy: maximising the opportunities and benefits of primary care in the NZ health system. Department of Primary Health Care and General Practice University of Otago – Wellington – New Zealand Tony Dowell . Benefits and Opportunities. Celebrating what we do best - PowerPoint PPT PresentationTRANSCRIPT
![Page 1: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/1.jpg)
Playing the advantage in policy: maximising the opportunities and benefits of primary care in the NZ
health system
Department of Primary Health Care and General Practice University of Otago – Wellington – New ZealandTony Dowell
Department of Primary Health Care and General Practice Wellington School of Medicine and Health Sciences
![Page 2: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/2.jpg)
Benefits and Opportunities
• Celebrating what we do best– High quality integrated primary care and clinical general
practice to enrolled populations– Keeping care patient focused + built on relationships
• Effective working across the primary / secondary sector
• Two BIG policy opportunities• Long term condition management• Children
– Life course approach• elective waiting lists
![Page 3: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/3.jpg)
Policy Benefits of current primary care system
• General Practice fundamental platform for Primary Health Care in NZ
• Access to primary care • Continuity of Care• Enrolment• Local delivery and organisation of health care• Teamwork • Present role mix is working ‘reasonably well’• Good access to treatment / medication • Good access to IT
![Page 4: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/4.jpg)
The Heart of General Practice PolicyThe whole person - family
Time and history
Place
The world and its uncertainty
Partnership
![Page 5: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/5.jpg)
Primary Health Organisations
![Page 6: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/6.jpg)
Policy opportunities at a systems and organisational level
• Enhanced referral systems – EHR• Evolving primary care team roles
– Physician assistant– Primary care coordinator (e.g mental health)
• Finding the place for public health as part of primary care
• Getting policy joined up in:– Lifestyle – alcohol , obesity, recreational drugs– Child health (Well child / Midwifery – see later)
![Page 7: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/7.jpg)
Changing numbers and types of organisation
![Page 8: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/8.jpg)
Changing numbers and types of organisation
PHO No 1
PHO No 2
![Page 9: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/9.jpg)
Better Sooner More Convenient
![Page 10: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/10.jpg)
Policy Opportunity 1Long Term Condition
Management
Diabetes, Arthritis, Depression, COPD Stroke, IHD etc ….
![Page 11: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/11.jpg)
Diabetes care
• ‘for this i don’t know how much you know or don’t know about diabetes but it’s ‘
• Multiple consultations• Multiple providers• Check list management
of risk factors• ? How effective and
coordinated
![Page 12: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/12.jpg)
There’s not enough time ?
![Page 13: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/13.jpg)
Redesigning long term condition consultations
• Time is sufficient but used without coordination within the PHCT
• Professional isolation of primary health care team members
• Reduplication of information out of context from patients needs or experience
• Checklist approach to care sometimes prevents the main issues being addressed
![Page 14: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/14.jpg)
Policy opportunity 2Child health
![Page 15: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/15.jpg)
‘Jack’ - 9 Years
• Father in jail• 2 siblings, • Mother 29: medical condition, unable to sustain a job though trying – in and out of jobs• Overweight• Learning difficulties at school• Bullying in the playground
Medical history:- Multiple visits to GP and A +M
Asthma, eczema, chest infections, skin infections, injuries, 10 hospital admissions – bronchilitis (baby x2) asthma (x3), broken leg, head injury, cellulitis (x2), dental abscess
![Page 16: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/16.jpg)
The intervention potential
Age
80 +
60-80
40-60
20-40
0-20
Developing risk factors
Established risk factors
Established disease
![Page 17: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/17.jpg)
The early early years
![Page 18: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/18.jpg)
![Page 19: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/19.jpg)
Policy Solutions
Not one single solution but principles are simple:Utilisation of enrolment policy and systems
more effectivelyAccess to primary care 24/7Integration at many levels and across sectorsFunding and policy to support child
population-based approaches
![Page 20: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/20.jpg)
Maternal and child health
• Antenatal engagement • Early enrolment• Access to care• Know the population, utilise the PMS
• Identification of ‘vulnerable’• Referral and relationships with local services
• Integration with maternity and well child health
![Page 21: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/21.jpg)
TimeTeamwork
Systems and I.T.
![Page 22: Department of Primary Health Care and General Practice](https://reader035.vdocuments.mx/reader035/viewer/2022062520/568160e3550346895dd01504/html5/thumbnails/22.jpg)
Thank you