CCDHB PULMONARY REHABILATION AND WHANAU CARE SERVICES: EEP Effective Evolving Partnership

1. CCDHB PULMONARY REHABILATIONAND WHANAU CARE SERVICES:EEPEffective Evolving Partnership Often in health there is pilots or projects to looks at new ways to deliver health. Just as effective and often not talked about is what happened in this case what I have termed EEP � effective evolving partnership. Whereby two existing services have worked together to combine resources to help maximise the effectiveness of both services Often in health there is pilots or projects to looks at new ways to deliver health. Just as effective and often not talked about is what happened in this case what I have termed EEP � effective evolving partnership. Whereby two existing services have worked together to combine resources to help maximise the effectiveness of both services

2. Pulmonary Rehabilitation Programme Is a multi disciplinary programme for patients with COPD or other chronic lung diseases Combination of exercise and education for a set period of time Evidence based � one of the few interventions that show sustained improvement in quality of life for COPD clients

3. CCDHB Pulmonary Rehabilitation Programme Commenced in the late 1990�s Held at three campuses; Wellington Hospital, Kenepuru Hospital and Kapiti Health Centre Concurrent classes: 6 classes a week , two classes a week at each campus Two minutes each set of exercise, two minutes rest. Exercise tailored to the patients need, e.g. some clients can not do arm exercises due to injury etc so exercises are modified to suit Two minutes each set of exercise, two minutes rest. Exercise tailored to the patients need, e.g. some clients can not do arm exercises due to injury etc so exercises are modified to suit

4. CCDHB Pulmonary Rehabilitation Programme 1 FTE Pulmonary Rehab nurse, with physio support in each class, clerical assistance, MDT support for the education sessions. Clinical overview and back up provided by 1 FTE Community Respiratory CNS Course runs for 8 weeks Pre assessment and post assessment by nurse and physio Assessment is breathlessness questionnaire, baseline observations, client history and 6 minutes walk test Assessment is breathlessness questionnaire, baseline observations, client history and 6 minutes walk test

5. CCDHB Pulmonary Rehabilitation Programme One hour of exercise and half an hour of education Patients �graduate� and are then referred to one of the community classes run by NGO�s and PHO�s Two follow up classes a year for two weeks for those patients that need more intensive follow up than is provided in the community classes Contracted to have 200 individual patients attend the course per year. July 2010 to June 2011 we had 294 patients attend the course. We also �bring back patients�. If a patient drops out for whatever reason , then we fill the gap with a recent graduate who needs more intensive support than can be given in the community group. Because of the group dynamics that develop in the class , it is easier to bring back a �graduate� than a new patient, plus eliminates the need for pre assessment of the patient joining the class half way through Pulmonary Rehab nurse maintains strong links to the community class We also �bring back patients�. If a patient drops out for whatever reason , then we fill the gap with a recent graduate who needs more intensive support than can be given in the community group. Because of the group dynamics that develop in the class , it is easier to bring back a �graduate� than a new patient, plus eliminates the need for pre assessment of the patient joining the class half way through Pulmonary Rehab nurse maintains strong links to the community class

6. Maori Participation Numbers of Maori being referred, attending and completing the course were low Maori with COPD are admitted to hospital with exacerbations at a higher rate than non Maori, especially Maori women Higher smoking rate, higher risk rate So overall a great, efficient high achieving service. Except we struggle to increase Maori access and participationSo overall a great, efficient high achieving service. Except we struggle to increase Maori access and participation

7. Prior models In 2008, marae based classes were commenced in the Porirua region with partnership with Maraeroa marae and Ora Toa PHO Successful and various versions of this model have continued to be successful within the Porirua community Attempts at using this model in the Wellington region were not so successful Maori Health Providers in Wellington are �younger� �smaller�, not the links available that we within the Porirua region. We did do a separate class for Maori in Wellington. Numbers were small, drop off rate was high. We provided transport with taxis, so we increased access. In spite of that we did not improve participation. In this case the feedback from Maori with this separate class is that they did not want to be seen as separate, which not get commented on in the Porirua region. They had different taxi drivers which they did not like as they had to explain every time where to go and come to. Did not repeat that class and continued discussions with Whanau Care Services as to a solution Maori Health Providers in Wellington are �younger� �smaller�, not the links available that we within the Porirua region. We did do a separate class for Maori in Wellington. Numbers were small, drop off rate was high. We provided transport with taxis, so we increased access. In spite of that we did not improve participation. In this case the feedback from Maori with this separate class is that they did not want to be seen as separate, which not get commented on in the Porirua region. They had different taxi drivers which they did not like as they had to explain every time where to go and come to. Did not repeat that class and continued discussions with Whanau Care Services as to a solution

8. EEP 2009 appointed to Whanau Care Services (WCS) was a speciality clinical nurse (SCN) (chronic conditions) who had previously been an experienced respiratory nurse. Her role is aimed at improving access, coordination, and liaison of health services for Maori. Her aim with Pulmonary Rehabilitation Services was to improve the way Maori accessed and participated in the Pulmonary Rehabilitation Service Pulmonary Rehabilitation Services wanted to improve participation by Maori clients in the Pulmonary Rehabilitation programme. SHARED GOALS At the same time, along came Tuppy in WCS. One of the keys to an effective working relationship is working with people that have the same vision and passion . In this case nurse was Tuppy Parker, ex resp nurse from Lower Hutt, so very committed to Pulmonary Rehabilitation At the same time, along came Tuppy in WCS. One of the keys to an effective working relationship is working with people that have the same vision and passion . In this case nurse was Tuppy Parker, ex resp nurse from Lower Hutt, so very committed to Pulmonary Rehabilitation

9. EEP Maori clients are transported by WCS staff in a DHB car, usually three clients per course Attendance at pre assessment by WCS SCN. WCS staff attending classes Kaiawhina attending class with frail Maori MDT approach to clients overall health wellbeing Transportation was identified by previous Maori clients as being a barrier to attending class. As discussions on this issue continued, the partnership between the two services grew very quickly. Being able to use the pre assessment time, staff and equipment gave the WCS SCN the opportunity for an objective assessment of physical functioning, that she did not have the opportunity to assess with the funding constraints of her role. Attending the class allowed the opportunity for assessment of clients cultural, social and physical needs. Constant assessment Kaiawhina attending the class along side frail Maori, improved physical safety and confidence of client. Opportunity for good communication between physio, nurse, WCS SCN as to any issues , needs that arose in class Transportation was identified by previous Maori clients as being a barrier to attending class. As discussions on this issue continued, the partnership between the two services grew very quickly. Being able to use the pre assessment time, staff and equipment gave the WCS SCN the opportunity for an objective assessment of physical functioning, that she did not have the opportunity to assess with the funding constraints of her role. Attending the class allowed the opportunity for assessment of clients cultural, social and physical needs. Constant assessment Kaiawhina attending the class along side frail Maori, improved physical safety and confidence of client. Opportunity for good communication between physio, nurse, WCS SCN as to any issues , needs that arose in class

10. Client Outcomes Transported together provided awhi/support for each other within the class. Reduced feelings of Whakama/shyness Increased motivation and shared goals with the group sharing the car ride WCS staff took the opportunity to reinforce the education from the programme on the journey home Earlier interventions There have been great client outcomes The presence of WCS staff in the class also increased the patients comfort levels, also felt like it provided them with a voice if an aspect of the class was not comfortable for them . Support staff have also been provided for frail Maori to provide them with increased physical safely. Maori getting debilitating chronic disease younger so you had 55 year old Maori male as sole Maori in class with predominantly 70 plus Pakeha female. Not a cohort that would usually mix Sometimes Maori who previously stated lack of transportation meant they could not attend , start to find their own way to the class. Increased motivation to attend and increased physical well being and confidence , meaning catching buses and walking up the hill from the bus stop to the classes is no longer a barrier Physio sees in hospital if admitted increasing sense of �Whanau� with Pulmonary Rehabilitation community In-depth discussions occurring in the car on the way home about the education, self management , sharing of their experiences of their condition. Discussions that were not taking place in the course itself initially. Some did not have Whanau support so have benefited hugely to the Pulmonary rehab family. Do not want to let other members down that share the car. An unwell client, getting sputum spec with help of physio that day, take sputum spec to GP and get antibiotics same day. Reinforces self management plan. Communication between two services if someone is unwell New networks of positive goals. Two Maori guys in their 50�s , mates who smoke and drink, enabled them to make friends and support each through those lifestyle changes. There have been great client outcomes The presence of WCS staff in the class also increased the patients comfort levels, also felt like it provided them with a voice if an aspect of the class was not comfortable for them . Support staff have also been provided for frail Maori to provide them with increased physical safely. Maori getting debilitating chronic disease younger so you had 55 year old Maori male as sole Maori in class with predominantly 70 plus Pakeha female. Not a cohort that would usually mix Sometimes Maori who previously stated lack of transportation meant they could not attend , start to find their own way to the class. Increased motivation to attend and increased physical well being and confidence , meaning catching buses and walking up the hill from the bus stop to the classes is no longer a barrier Physio sees in hospital if admitted increasing sense of �Whanau� with Pulmonary Rehabilitation community In-depth discussions occurring in the car on the way home about the education, self management , sharing of their experiences of their condition. Discussions that were not taking place in the course itself initially. Some did not have Whanau support so have benefited hugely to the Pulmonary rehab family. Do not want to let other members down that share the car. An unwell client, getting sputum spec with help of physio that day, take sputum spec to GP and get antibiotics same day. Reinforces self management plan. Communication between two services if someone is unwell New networks of positive goals. Two Maori guys in their 50�s , mates who smoke and drink, enabled them to make friends and support each through those lifestyle changes.

11. Client Outcomes Increased attendance by Maori and Maori are not only completing the course, but asking to come back for another class Increased self referrals from Maori due to �word of mouth� Increased referrals from WCS to Pulmonary Rehabilitation and vice versa Increased �capture� of patients due to two services linking up Increase effectiveness of both services Has improved quality of life Numbers are climbing slowly. So there were 1 � 2 per class, we are now getting 3 � 5 per class and they are stronger attendees. Has improved quality of life Numbers are climbing slowly. So there were 1 � 2 per class, we are now getting 3 � 5 per class and they are stronger attendees.

12. Client Outcomes Significant lifestyle changes for Maori clients, such as smoking cessation, decrease in alcohol intake, healthy eating Increase in self determination by Maori clients Increased sense of community within the Pulmonary Rehabilitation class Making their own way to class. Advising if unable to attending class. Change in appearance, management of life. Wrap around effect of both services Exercised in safe environment and feel nurturedMaking their own way to class. Advising if unable to attending class. Change in appearance, management of life. Wrap around effect of both services Exercised in safe environment and feel nurtured

13. Future development Transportation is a challenge on the WCS, so looking at other options. Currently trailing more input from Kaiawhina with oversight by SCN, as opposed to direct involvement by SCN Continue to develop links in the community with view of Marae based classes Assisting WCS to obtain further funding to extend their services into Kenepuru and Kapiti region. Continue to liaise and link with other services Effective Evolving Partnership Marae based classes have worked well in the Porirua region so keen to extend into Kapiti and Wellington. Was so successful in terms of providing support struggled to have resources to maintain current level of support. Sending our report about Whanau care to use Continual conversation � often casual conversation yields links and informationMarae based classes have worked well in the Porirua region so keen to extend into Kapiti and Wellington. Was so successful in terms of providing support struggled to have resources to maintain current level of support. Sending our report about Whanau care to use Continual conversation � often casual conversation yields links and information