scholarly journals What is the answer to the challenge of multimorbidity in New Zealand?

2020 ◽  
Vol 12 (2) ◽  
pp. 118 ◽  
Author(s):  
Anna Askerud ◽  
Chrystal Jaye ◽  
Eileen McKinlay ◽  
Fiona Doolan-Noble
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Health System ◽  
Integrated Care ◽  
Self Management ◽  
Ageing Population ◽  
Management Support ◽  
Primary Care System ◽  
Health Records ◽  
Care System

ABSTRACT The increasing prevalence of multimorbidity, a growing ageing population and lack of success in addressing the negative effect of socioeconomic and cultural determinants of health are major challenges for New Zealand’s primary care sector. Self-management support strategies, personalised care planning, integrated care and shared health records have all been proposed as mechanisms to address these challenges. The organisation of the health system, however, remains largely unchanged, with limited accommodation and few funding concessions made for the requirements of these different approaches and tools. As a result, the primary care system is no longer a good match for the population it serves. With one in four New Zealanders reporting multimorbidity, and people aged >65 years predicted to double in number by 2050, this article argues that over the next decade, New Zealand requires a health system focused on incorporating self-management support, personalised and integrated care and shared health records. This will require further educating of not only health professionals, but also patients in the purpose behind these approaches. In addition, it will mean transitioning to a primary care system more suited to the needs of people with long-term conditions. The key gain from a radical redesign will be a more equitable health system focused on a broader range of health needs.

scholarly journals Using Mobile Health to Support the Chronic Care Model: Developing an Institutional Initiative

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Shantanu Nundy ◽  
Jonathan J. Dick ◽  
Anna P. Goddu ◽  
Patrick Hogan ◽  
Chen-Yuan E. Lu ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Health Plan ◽  
Chronic Care Model ◽  
Chronic Care ◽  
Primary Care Team ◽  
Self Management ◽  
Management Support ◽  
Care Model ◽  
Team Based Care

Background. Self-management support and team-based care are essential elements of the Chronic Care Model but are often limited by staff availability and reimbursement. Mobile phones are a promising platform for improving chronic care but there are few examples of successful health system implementation.Program Development. An iterative process of program design was built upon a pilot study and engaged multiple institutional stakeholders. Patients identified having a “human face” to the pilot program as essential. Stakeholders recognized the need to integrate the program with primary and specialty care but voiced concerns about competing demands on clinician time.Program Description. Nurse administrators at a university-affiliated health plan use automated text messaging to provide personalized self-management support for member patients with diabetes and facilitate care coordination with the primary care team. For example, when a patient texts a request to meet with a dietitian, a nurse-administrator coordinates with the primary care team to provide a referral.Conclusion. Our innovative program enables the existing health system to support ade novocare management program by leveraging mobile technology. The program supports self-management and team-based care in a way that we believe engages patients yet meets the limited availability of providers and needs of health plan administrators.

scholarly journals The Flinders Programme of Chronic Condition Self-Management in New Zealand: survey findings

2010 ◽  
Vol 2 (4) ◽  
pp. 288 ◽  
Author(s):  
Margaret Horsburgh ◽  
Janine Bycroft ◽  
Felicity Goodyear-Smith ◽  
Dianne Roy ◽  
Faith Mahony ◽  
...  
Keyword(s):  
Primary Care ◽  
New Zealand ◽  
Chronic Condition ◽  
Complex Interventions ◽  
Time Frame ◽  
Self Management ◽  
Management Support ◽  
Long Term Conditions ◽  
Primary Care Nurses

INTRODUCTION: The Flinders ProgramTM of Chronic Condition Self-Management in New Zealand (NZ) has been given focus as a useful and appropriate approach for self-management support and improvement of long-term condition management. AIM: To determine the use of the Flinders ProgramTM in NZ and identify barriers and enablers to its use. METHOD: A web-based survey was undertaken in June 2009 with 355 eligible participants of the 500 who had completed ‘Flinders’ training in NZ since 2005. RESULTS: 152 (43%) respondents completed the survey over a one-month time frame. Of those who responded, the majority were primary care nurses (80%; 118). Fifty-five percent (82) of survey respondents reported using some or all of the Flinders tools. Of these, 11% (16) reported using all of the tools or processes with 77% (104) of respondents having completed six or fewer client assessments utilising the Flinders tools. This indicates that respondents were relatively inexperienced with use of the Flinders ProgramTM. Barriers to implementation were identified as the time needed for structured appointments (up to one hour), funding, resistance from colleagues, lack of space and insufficient ongoing support. DISCUSSION: Despite the extent of training in the use of the Flinders ProgramTM, there is limited use in clinical practice of the tools and processes associated with the model. Without structured support for quality improvement initiatives and self-management programmes, the ability to implement learned skills and complex interventions is limited. KEYWORDS: Self-management; long-term conditions; chronic conditions; chronic illness; primary care; nurses

scholarly journals Impact of integrated healthcare: Taiwan’s Family Doctor Plan

2019 ◽  
Vol 34 (Supplement_2) ◽  
pp. ii56-ii66 ◽  
Author(s):  
Li-Lin Liang
Keyword(s):  
Primary Care ◽  
Health Services ◽  
Integrated Care ◽  
Contextual Factors ◽  
Family Doctor ◽  
Emergency Department Visits ◽  
System Level ◽  
Primary Care System ◽  
Design Elements ◽  
Care System

Abstract Integration of health services has been pursued worldwide. Diversity in integration approaches and in the contexts in which integrated programmes operate, however, hinders comparative analysis of care integration in both high-income countries (HICs) and low- and middle-income countries (LMICs). This study evaluates an HIC programme implemented in a delivery system resembling those of LMICs, especially its weak primary care system. The programme, Taiwan’s Family Doctor Plan (FDP), targets high-cost and chronic patients, incorporating key elements of integrated care, viz., case management, multidisciplinary teams and care pathways. This study estimates the effects of shifting from usual to integrated care and locates contextual factors that may distort programme implementation. To estimate programme effects, difference-in-differences analysis is applied to a balanced panel comprising >160 000 patients over 2009–13. Because physician participation is voluntary, a propensity score matching method is used to match providers. The research findings reveal that introduction of the FDP has not reoriented the model of care from fragmented towards integrated health services. It reduces continuity of care and has no effect on co-ordination of care. Regarding quality of care, the FDP is shown to have no effect on avoidable admissions and increases drug injections and emergency department visits. Several contextual factors may serve as barriers that impede elements of FDP from generating desirable outcomes. These include absence of registration and gatekeeping systems; limited capacities of clinics; and preponderance of fee-for-service remuneration. These findings suggest that HIC design elements may not be directly transferrable to settings with weak primary care systems, as is typical of LMIC healthcare. Changes at the system level, such as establishing regular sources of care, may be necessary before elements of integrated care are introduced to a weaker primary care system.

scholarly journals Estimating the Costs of Implementing Comprehensive Primary Care: A Narrative Review

2019 ◽  
Vol 6 ◽  
pp. 233339281984248
Author(s):  
Grant R. Martsolf ◽  
Ryan Kandrack ◽  
Mark W. Friedberg ◽  
Brian Briscombe ◽  
Peter S. Hussey ◽  
...  
Keyword(s):  
Primary Care ◽  
Narrative Review ◽  
Fee For Service ◽  
Primary Care System ◽  
High Functioning ◽  
Illness Burden ◽  
Care Practices ◽  
Primary Care Practices ◽  
Limited Generalizability ◽  
Care System

The performance of the any health-care system relies on a high-functioning primary care system. Increasing primary care practices’ adoption of “comprehensive primary care” capabilities might yield meaningful improvements in the quality and efficiency of primary care. However, many comprehensive primary care capabilities, such as care management and coordination, are not compensated via traditional fee-for-service payment. To calculate new payments for these capabilities, policymakers would need estimates of the costs that practices incur when adopting, maintaining, and using the capabilities. We performed a narrative review of the existing literature on the costs of adopting and implementing comprehensive primary care capabilities. These studies have found that practices incur significant costs when adopting and implementing comprehensive primary care capabilities. However, the studies had significant limitations that prevent extensive use of their estimates for payment policy. Particularly, the strongest studies focused on a small numbers of practices in specific geographic areas and the concepts and methods used to assess costs varied greatly across the studies. Furthermore, none of the studies in our review attempted to estimate differences in costs across practices with patients at varying levels of complexity and illness burden which is important for risk-adjusting payments to practices. Therefore, due to the heterogeneous designs and limited generalizability of published studies highlight the need for additional research, especially if payers wish to link their financial support for comprehensive primary care capabilities to the costs of these capabilities for primary care practices.

Twelve Evidence-Based Principles for Implementing Self-Management Support in Primary Care

2010 ◽  
Vol 36 (12) ◽  
pp. 561-570 ◽  
Author(s):  
Malcolm Battersby ◽  
Michael Von Korff ◽  
Judith Schaefer ◽  
Connie Davis ◽  
Evette Ludman ◽  
...  
Keyword(s):  
Primary Care ◽  
Self Management ◽  
Evidence Based ◽  
Management Support
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