Whakakotahi - 'to be as one' - Whakakotahi: Partnering for primary care quality improvement
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14/05/2021
Whakakotahi:
Partnering for primary care quality improvement
Jane Cullen & Kiritahanga Savage
Whakakotahi – ‘to be as one’
Partnering with primary
care teams to work on
small‐scale improvement
projects chosen by the
providers
1
14/05/2021
Source: Achieving medicine access equity in Aotearoa New Zealand: Towards a theory of change, PHARMAC, April 2019
Whakakotahi – ‘to be as one’
Focused on:
• equity
• integration
• consumer engagement
2
14/05/2021
Whakakotahi – primary care improvement
2017 2018 2019
Three projects Six projects Nine projects
Diabetes Diabetes (2) Diabetes (3)
Gout New patient enrolment – access Eczema (2)
Post‐stent management to services Asthma
Access to services for Māori Gout
Asthma Access to health screening for
Skin and soft tissue infections – methadone treatment patients
Tuvaluan youth Access to medicines (rural)
https://www.hqsc.govt.nz/our‐programmes/primary‐care/resources‐
for‐providers‐starting‐quality‐improvement‐projects/
Barriers
• Access to data and data infrastructure
• Knowledge, time and resources for quality
improvement
• Variation in experience and knowledge of co‐design
3
14/05/2021
2021 Co‐design in primary care
• Unichem All Seasons Pharmacy
• Western Bay of Plenty PHO: Picture for pc cd
– The Doctors Bayfair and Papamoa
– Ngāti Kahu Hauora
– Chadwick Healthcare
• Hauora Heretaunga:
– Te Taiwhenua o Heretaunga
– Hasting Health Centre
• Porirua Union Community Health
Services
Next steps
• Quality improvement educational pipeline
• Building a national measures library
4
14/05/2021
Lack of Timely & Safe Access to Medicines at the Te
Whānau ā Apanui Community Health Centre.
Kiritahanga Savage
Ko wai?.... No hea?...
Registered Patient No’s: ~1537
This can double over the summer
holiday period
Staff:
1.5 FTE GP (2)
2.6 FTE Nurses (3)
2.0 FTE Admin staff (2)
0.6 AHA (1)
Mai i Te Taumata o Apanui ki
Potaka: Base clinic Te Kaha,
Outreach clinics: Maraenui
Marae, Omaio, Waihau Bay
150km length of coastline. Helipads at Te Kaha and Waihau Bay. St
Johns First Response Ambulance services Te Kaha/Waihau Bay
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14/05/2021
Who are the people?
Tatauranga taupori: Demographics
• Approx. 1500 Registered Patients - may
double over the summer holidays
• High deprivation
• Predominantly `Māori population
• 13 hapu/marae
• 5 of the 6 resident staff at Te Whānau ā
Apanui have whakapapa to Te Whānau ā
Apanui.
• Whānau loyal and grateful for the delivery
of medicines using depot systems or rural
delivery
Te Whānau a Apanui Community Health Centre
Project Facilitator: Ōpōtiki Pharmacist ‐
• 1.5 FTE GP (2)
– Kiritihanga Savage Mariana Hudson
• 2.6 FTE Nurses (3)
Doctor: • 2.0 FTE Admin staff (2)
– Dr Emily Gill
• 0.6 AHA (1)
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14/05/2021
What are the challenges? – distance
• Ōpōtiki minimum of 1 hr – nearest pharmacy
• Whakatāne 2 hrs ‐ ED, inpatient
• Tauranga 3 hrs ‐ angioplasty suite, MRI
• Hamilton 4.5 hrs – closest tertiary hospital
Issues: Availability of vehicles, cost of petrol
Inequity….
A matter of health and wellbeing and equal access for all…..
Maori vs Non‐Maori‐
Are prescribing levels of some medications lower for some population groups?
Is there assumption that some population groups will not take their meds
Levels of health literacy hinder optimal holistic wellbeing
Rural vs Urban
Ready access to medications:
Transport/fuel/funds – to get to depot/clinic/to pay for delivery to mailbox
East BOP vs West BOP
Number of Pharmacies accessible to patients‐ 1 hour plus travel time.
Community Pharmacist contracted allocation insufficient
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14/05/2021
Problem Statement
Waihau Bay patients do not receive Non‐ MPSO
medications within 3 ‐5 days after the script has been
generated.
Challenges include:
‐Prescription generation to patient receipt workflow.
‐Pain points of staff, patients and Pharmacy about script
process (firefighting).
Tools Used
• Affinity Chart
• Driver Diagram
• Fish Bone
• Process Mapping Date:
Waihau Bay
Requested By
‘Apt’= script done with patient
Item #
# of
Payment
?does this need to be done by
Delivery
‘C’ = patient collects
Reconcile
This is done by
during a consul appointment. medications clinic or pharmacy staff ‘M’= Mailbox delivery pharmacy?
•
‘Pt’ + patient reqeusted without Per ‘D’= Depot (default)
Data
consult (e.g Red Book):? Pt patient/day
brings hospital script to clinc.
‘Pha’= repeat blister pack lists:
other?
Name Apt. Pt. Pha A/c Ch Inv C M D
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
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Aim Statement
To ensure that >90% of our patients at Waihau Bay
Outreach clinic who are prescribed non‐MPSO
medicine have equitable access to and receive their
medication within 48 hours of it being prescribed by
Mar 2020.
How to measure?
CONTACT/QUERIES RE MEDICATION COLLECTION POINTS
MEDICATIONS/PRESCRIPTIONS –RECEIVED
CHEMIST 36 100%100%
8%
FROM: 94%
90%
PT WHANAU 86%
30
5% 78% 80%
24
70%
24 67%
60%
18 50%
40%
12
30%
4 20%
6 3 3 2 10%
0 0%
PT DEPOT OTHER MAILBOX CHEMIST CLINIC
87%
Prescription generated/sent/received?
Medications received?
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14/05/2021
Data input
Our driver diagram
Reliable couriers
Transport
systems Family support
Health literacy
90% of Te Kaha Medical Centre,
Waihau Bay patients prescribed Sociotechnical Stakeholder understanding
non‐MPSO medicines receive them communication
within 48 hours of being prescribed Staff management
system
by March 2020 Seamless information transfer
Medication Agreed process – Clin, pharm,
management patient
pathways Medication stock availability
1014/05/2021
Our successful change ideas
• Daily list of faxed prescriptions
• Record daily printed scripts faxed to pharmacy
• Policy in place and discussed with all stakeholders for
consistency with script process
• Develop new agreement process with involvement of
pharmacy
Our results ‐ % scripts received within 48 hours
1114/05/2021
Medication queries handled by stakeholders
RN: Its like night and day! Happier
patients, happier clinicians, happier Number of queries related to lack of
receipt of medications
Pharmacy staff!! 40
Pharmacy staff: Smoother processes 35
30
enable all stakeholders to get what they 25
20
need, when they need it. 15
Admin: The change makes an ordinary 10
5
day extraordinary! 0
April May June July Aug Sept Oct‐19
Admin: Number of incident occurrences
dropped markedly‐ from at least 3‐4 per
day to maybe 1‐2 per week
Te korero a te hapori – Voice of the consumer
1214/05/2021
Team feedback on use of tools
• Made me realise the complexity of the process, had not
appreciated so many others input having an effect on outcome – GP
• Helpful in unpacking the complexities of a seemingly simple process
– RN/GP
• Affinity diagram helped focus our aim – GP
• Process Mapping, we could start making plans to “Do something” –
RN/GP/Admin
Lessons Learned
Whole team/Full stakeholder input
“If you can’t measure it,
Makes for more positive end result
it is harder to improve on it”
for all!
“Not everything that can be Nā tö rourou, nā taku rourou….. ka ea!
measured is helpful… and • Adapt… Adopt… define…refine….
not everything that can be…
will be…”
1314/05/2021
Ehara taku toa, i te toa takitahi engari, he toa takitini
My success should not be bestowed onto me alone,
as it was not individual success
but success of a collective
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