Proactive primary care model for frail older people in New Zealand delays aged‐residential care: A quasi‐experiment

Abstract IntroductionAn increasing number of individuals are living with multiple chronic conditions, often combined with psychosocial complexities. For these patients with complex conditions, an integrated primary care model that provides care coordination and a team-based approach can help manage their multiple needs. Information and communication technologies (ICTs) are recognized as a critical enabler of integrated primary care. A better understanding of the use of ICTs in an integrated care setting and how ICTs are being leveraged would be beneficial to identify knowledge gaps and could lead to successful implementation for ICT-based interventions.ObjectiveThis study will systematically scope the literature on the topic of ICT-enabled integrated healthcare delivery models for patients with complex care needs to identify which technologies have been used in integrated primary care settings. MethodThis study protocol outlines a scoping review of the peer-reviewed literature, using Arksey and O’Malley’s (enhanced by Levac et al.) scoping review methodology. Peer-reviewed- literature will be identified using a multi-database search strategy. The results of the search will be screened, abstracted, and charted in duplicate by 6 research team members. DiscussionThe key findings of the study will be thematically mapped to describe the implemented ICTs aimed for complex patients within the integrated primary care model and interactions of the elements (ICT, health model, and targeted patients). This review will be the first step to formally identify how ICT is used to support integrated primary health care models. The results will be disseminated through peer-reviewed publications, conference presentations, and special interest groups.

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Trauma responsive care model: An Aotearoa New Zealand research informed practice model for residential group homes

Aotearoa New Zealand Social Work ◽

10.11157/anzswj-vol33iss1id825 ◽

2021 ◽

Vol 33 (1) ◽

Author(s):

Andrea Greer

Keyword(s):

New Zealand ◽

Residential Care ◽

Positive Impact ◽

Research Question ◽

Group Homes ◽

Care Practice ◽

Multiple Perspectives ◽

Care Model ◽

Staff Members ◽

Aotearoa New Zealand

INTRODUCTION: This article presents a research-informed model of trauma responsive care for use in residential care practice social work settings with children and young people in Aotearoa New Zealand. The model was developed from a qualitative project which sought to address the research question “Does the quality of relationships with staff members have a positive impact on outcomes for children who reside in group home settings?”METHODS: Using semi-structured, in-depth interviews, eight children were interviewed regarding their experience of relationships while living within supervised group homes (SGHs). In order to gain multiple perspectives on this topic, six biological parents and two legal guardians of children were interviewed and focus group discussions were held with staff members from three SGHs. Thematic analysis was used to identify key themes identified from the findings.FINDINGS: Five dominant themes were identified from the children’s and parent’s interviews. The central theme was the importance of relationships; that relationship is the key when working with children who have experienced trauma. Children who have experienced trauma need to feel safe in the context of relationships and benefit from bottom-up interventions in order to heal from their traumatic experiences.CONCLUSION: A research-informed model of trauma responsive care was constructed from study findings informed by two principal bodies of knowledge: (1) attachment theory; and (2) neuroscience. The resultant trauma responsive care model provides a framework of strategies for anyone working with children in residential care settings who have experienced trauma and/ or attachment difficulties.

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A Home-Based, Primary-Care Model for Epilepsy Care in Low and Middle Income Countries: Basis and Design

10.1055/s-0039-1694899 ◽

2018 ◽

Author(s):

Suman Sharma ◽

Anuraag Chowdhury ◽

Sarit Sharma ◽

Rajinder Bansal ◽

Gagandeep Singh

Keyword(s):

Primary Care ◽

Care Model ◽

Middle Income ◽

Middle Income Countries ◽

Home Based Primary Care ◽

Primary Care Model ◽

Home Based ◽

Low And Middle Income

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InterWell: an integrated school-based primary care model

London Journal of Primary Care ◽

10.1080/17571472.2013.11493391 ◽

2013 ◽

Vol 5 (2) ◽

pp. 106-110 ◽

Cited By ~ 5

Author(s):

Peter J Whitehouse

Keyword(s):

Primary Care ◽

Care Model ◽

School Based ◽

Primary Care Model

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Patient-Centered Medical Home: An Emerging Primary Care Model and the Military Health System

Military Medicine ◽

10.7205/milmed-d-11-00109 ◽

2011 ◽

Vol 176 (11) ◽

pp. 1253-1259 ◽

Cited By ~ 9

Author(s):

Robert C. Marshall ◽

Martin Doperak ◽

Michelle Milner ◽

Charles Motsinger ◽

Terry Newton ◽

...

Keyword(s):

Primary Care ◽

Health System ◽

Medical Home ◽

Patient Centered Medical Home ◽

Military Health System ◽

Care Model ◽

Patient Centered ◽

Military Health ◽

Primary Care Model ◽

The Military

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Experiences of nursing in older care facilities in New Zealand

Australian Health Review ◽

10.1071/ah09679 ◽

2010 ◽

Vol 34 (1) ◽

pp. 11 ◽

Cited By ~ 15

Author(s):

Jenny Carryer ◽

Chiquita O. Hansen ◽

Judy A. Blakey

Keyword(s):

New Zealand ◽

Older People ◽

Registered Nurses ◽

Residential Care ◽

Nurse Practitioners ◽

Clinical Care ◽

Nursing Services ◽

The Impact ◽

Care For Older People

To examine issues related to the working life of registered nurses in residential care for older people in New Zealand, 48 registered nurses completed surveys (n = 28) or participated in discussions (n = 26) regarding their work roles, continuing education and interactions with specialist nurse services when providing care for older people living with chronic illnesses. This nursing workforce is characterised by ageing, relative isolation, reduced confidence and few opportunities for induction of new graduates. Registered nurses reported their struggle to deliver the appropriate quality of care to residents as acuity increases, general practitioner availability decreases and the opportunities for increasing their knowledge and competence remain limited. The provision of nursing services in residential care for older people is an area of growing concern to many Western countries. Nurse practitioners offer opportunities to improve the quality of residential care. What is known about the topic?The lack of registered nurses generally and the more critical shortage in residential care is well known. What does this paper add?This paper explains the impact on the current and future viability and the quality of registered nurse services in an area of service where acuity continues to rise and the demand for nursing services is increasing. What are the implications for practitioners?Nurses in older care settings often express a sense of isolation and note limited career development despite their passion for serving the frail older person. The establishment of nurse practitioner (gerontology) roles offers the potential for improved quality of clinical care for residents and clinical champions for development of nursing services.

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GP- and practice-related variation in ambulatory sensitive hospitalisations of older primary care patients

BMC Family Practice ◽

10.1186/s12875-020-01285-9 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Leah Palapar ◽

Laura Wilkinson-Meyers ◽

Thomas Lumley ◽

Ngaire Kerse

Keyword(s):

Primary Care ◽

New Zealand ◽

Older People ◽

Home Visiting ◽

Controlled Trial ◽

Community Dwelling ◽

Trial Registration ◽

Primary Care Redesign ◽

Practice Level ◽

Practice Characteristics

Abstract Background Reducing ambulatory sensitive hospitalisations (ASHs) is a strategy to control spending on hospital care and to improve quality of primary health care. This research investigated whether ASH rates in older people varied by GP and practice characteristics. Methods We identified ASHs from the national dataset of hospital events for 3755 community-dwelling participants aged 75+ enrolled in a cluster randomised controlled trial involving 60 randomly selected general practices in three regions in New Zealand. Poisson mixed models of 36-month ASH rates were fitted for the entire sample, for complex participants, and non-complex participants. We examined variation in ASH rates according to GP- and practice-level characteristics after adjusting for patient-level predictors of ASH. Results Lower rates of ASHs were observed in female GPs (IRR 0.83, CI 0.71 to 0.98). In non-complex participants, but not complex participants, practices in more deprived areas had lower ASH rates (4% lower per deprivation decile higher, IRR 0.96, CI 0.92 to 1.00), whereas main urban centre practices had higher rates (IRR 1.84, CI 1.15 to 2.96). Variance explained by these significant factors was small (0.4% of total variance for GP sex, 0.2% for deprivation, and 0.5% for area type). None of the modifiable practice-level characteristics such as home visiting and systematically contacting patients were significantly associated with ASH rates. Conclusions Only a few GP and non-modifiable practice characteristics were associated with variation in ASH rates in 60 New Zealand practices interested in a trial about care of older people. Where there were significant associations, the contribution to overall variance was minimal. It also remains unclear whether lower ASH rates in older people represents underservicing or less overuse of hospital services, particularly for the relatively well patient attending practices in less central, more disadvantaged communities. Thus, reducing ASHs through primary care redesign for older people should be approached carefully. Trial registration Australian and New Zealand Clinical Trials Register ACTRN12609000648224.

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