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1
Lakes District Health Board
Refreshed Rheumatic Fever Prevention Plan
2016 - 2018
2
Contact Person: Pip King Portfolio Manager Lakes DHB [email protected] 07 379 7823 027 555 2741
3
Table of Contents
List of Abbreviations ...................................................................................................... 4
RHEUMATIC FEVER WORK PLAN SIGN-OFF ........................................................... 6
Purpose of the plan ....................................................................................................... 7
Structure of the Plan ........................................................................................ 7
Section 1: Overview of the review and refresh of the Lakes District Health Board (DHB) rheumatic fever prevention plan ...................................................... 8
1.1 Background ............................................................................................. 8
1.2 Which activities does the DHB believe were successful? Why? ............. 9
1.3 Which activities does the DHB believe were cost effective? Why? ....... 12
1.4 Which activities would the DHB have done differently? Why? .............. 13
Section 2: Governance.............................................................................................. 15
The current structure of Rheumatic Fever activities in Lakes DHB is shown below. ... 16
Section 3: Stakeholder Engagement ......................................................................... 17
3.1 Summary of Stakeholder Engagement .................................................. 17
Section 4: Achieving the Better Public Health Service Rheumatic Fever target (1 January 2016 to June 2017) .................................................................... 21
4.1 Where is the DHB in relation to meeting the 2017 target? What is the expected trend with or without new actions? ......................................... 21
4.2 What actions will be continued or introduced to ensure the 2017 target is met? ................................................................................................... 22
4.3: An outline of the DHB planned investment in interventions until 30 June 2017 ................................................ Error! Bookmark not defined.
4.4 Lakes DHB sustainability beyond June 2017 ........................................ 27
Appendix 1 ............................................................................................................. 28
TITLE: Terms of Reference for Rheumatic Fever Governance .................. 28
4
List of Abbreviations
ARF Acute Rheumatic Fever
ASH Ambulatory Sensitive Hospitalisation
BOP Bay of Plenty
BOPDHB Bay of Plenty District Health Board
CoBoP Collaboration Bay of Plenty
CONS Children’s Outreach Nurse
DNS District Nursing Service
EBET Eastern Bay Energy Trust
GAS Group A streptococcus
GP General Practice / Practitioner
HNZC Housing New Zealand Corporation
HSL HealthShare Limited
ICD codes International Classification of Disease codes
Lakes DHB Lakes District Health Board
MoH Ministry of Health
MOH Medical Officer of Health
PHN Public Health Nurse
PHO Primary Health Organisation
PoPAG Population Health Professional Advisory Group
RAPHS Rotorua Area Primary Health Services
RHD Rheumatic Heart Disease
SES Smart Energy Solutions
Toi Te Ora Toi Te Ora – Public Health Service
THCT Tuwharetoa Health Charitable Trust
WHHS Western Heights Health Service Rotorua
WINZ Work and Income New Zealand
5
Foreword
Rheumatic fever is a preventable cause of serious illness and death in the Lakes District Health Board (DHB) population, almost exclusively affecting our Maori children. Lakes DHB has a focus on improving the health of our children and the prevention of avoidable conditions. While we have made progress in many areas of child health we know more work is required to eradicate rheumatic fever from our population. The focus on rheumatic fever prevention by the Ministry of Health since 2012 has provided Lakes DHB with the vision and support to prioritise the planning and implementation of a rheumatic fever prevention programme. In addition we acknowledge the priority given to this work through the Prime Minister’s Better Public Health Service target to reduce the incidence of rheumatic fever by two thirds to 1.4 cases per 100,000 people by June 2017. We are well aware that while health might lead the rheumatic fever programme of work it is up to us to engage with a range of stakeholders across government agencies and community organisations, establishing robust cross sector working relationships to ensure a shared vision and coordinated approach to implementing interventions which can prevent rheumatic fever. Lakes DHB has several cross sector programmes involving children, families and young people which will enable us to continue using existing frameworks and relationships to ensure a coordinated implementation of rheumatic fever prevention interventions. These programmes involve social services, housing, education and parenting, aligning with our focus to work across sectors, sharing a common vision for children and young people to help them to thrive, achieve and belong. We are encouraged to have the opportunity to revitalise our DHB rheumatic fever plan to adjust our thinking and strategies as a result of our learnings so far. This plan was overseen by a range of stakeholders who represent a range of our population. My sincere thanks to all those involved and Lakes DHB looks forward to increased collaboration across stakeholders as we increase action against rheumatic fever. Ron Dunham Chief Executive Lakes District Health Board
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RHEUMATIC FEVER WORK PLAN SIGN-OFF
This document has been reviewed and accepted as the formal Lakes DHB Rheumatic Fever Plan for implementation in terms of content and sign off by:
Name: Mary Smith
Project Sponsor
General Manager, Planning and Funding
Lakes DHB
___________________ / /2015
Signature
Name: Johan Morreau
Rheumatic Fever Champion
Consultant Paediatrician
Lakes DHB
___________________ / /2015
Signature
Name: Neil Poskitt
Rheumatic Fever Champion
General Practitioner and Clinical
Leader of Child Health for RAPHS
___________________ / /2015
Signature
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Purpose of the plan The purpose of this document is to provide a refreshed rheumatic fever prevention plan following a review of our current plan, stakeholder engagement and a review of the learning’s and outcomes achieved so far. The current Lakes DHB plan was signed off to cover 2013-2018, but at this half-way mark we have been given the opportunity to revitalise the programme and utilise the learning’s so far and ensure the momentum is further built on. While our refreshed plan is unique to the Lakes DHB population and has been developed with our partners in the Lakes population we also remain in close contact with our regional DHB’s that also have higher than acceptable Rheumatic Fever rates. This has allowed Lakes DHB to share learnings and future strategies. Structure of the Plan Section 1: Presents an overview of the review and refresh of the Lakes District
Health Board (DHB) rheumatic fever prevention plan Section 2: Governance Section 3: Stakeholder Engagement Section 4: Achieving the 2017 Better Public Health Service rheumatic fever target
(to June 2017) Section 5: Ongoing investment in rheumatic fever prevention (July 2017 onwards)
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Section 1: Overview of the review and refresh of the Lakes District Health Board (DHB) rheumatic fever prevention plan
1.1 Background Lakes DHB and Bay of Plenty DHB (BoP DHB) recognised ARF as a priority issue in 2008. In 2009 a joint steering group was established to lead a range of DHB funded initiatives to address rheumatic fever which are now at various stages of implementation. Ministry of Health funded projects were introduced in 2012. The initial approach taken was based on the Heart Foundation Rheumatic Fever guidelines and tidying up our secondary prevention systems. With the introduction of the Ministry of Health funded programmes a range of evolving initiatives, both nationally driven and locally driven have been implemented in Lakes DHB. The ongoing development of the programmes has been a result of evaluation and learning. This review and refresh allows a re-focus and to further strengthen successful parts of the programmes and address some of the gaps highlighted through the stakeholder engagement and governance. Actions have been implemented in the following areas:
1. raising public awareness that ‘sore throats matter’ 2. continuing professional development for health professionals 3. rapid response services 4. healthy homes service 5. improving notification of ARF cases 6. improving case management and prevention of recurrence, including a
Rheumatic Fever register across Lakes DHB. 7. enhanced surveillance and audit of cases
A range of positive results have been demonstrated. These include raised awareness of rheumatic fever in higher risk communities and the general public; increased awareness of the sore throat guidelines among primary health care; school based health services and youth health services, the refining of the Lakes DHB rheumatic fever register, improved notification, and more recently rapid response and healthy homes programmes that are operating to agreed protocols and have the support of local communities. At the time of refreshing our rheumatic fever plan (September 2015) Lakes DHB has so far achieved our target of 4.7 in the 2014-15 year.
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1.2 Which activities does the DHB believe were successful? Why?
Activity Why was this successful and what
are the learnings? Future direction
1.2.1 Input and engagement with Iwi Governance
Lakes DHB process is to consult with our two Iwi Governance Boards Te Roopu Hauora O Te Arawa and Te Nohanga Kotahitanga O Tuwharetoa who represent Lakes’ iwi. Their knowledge of RF has been increased and provided the ability for them to reach out to their communities with the key messages.
They were able to provide information re how to actively reach out and engage with high risk Maori communities, especially through education and appropriate clinical services.
Provide an ongoing mechanism for Iwi Governance input into RF governance
Child and whanau friendly primary health care, no appointments, free, after hours, staff with integrity and expert knowledge
Receptionists who are child and whanau friendly
Appropriate physical spaces for children and whanau with sore throats
Efficient referral pathways for housing, curtains, bedding, heating that will not cause “shame”
Almost set a recycling system up that is the norm for household items
1.2.2 Rheumatic Fever Champions
We had two RF champions, a primary care and a secondary care clinician. These clinicians:
have credibility as the experts
provide a single point of contact for all RF related issues
raise awareness
provide and distribute the key messages to other clinicians
work together on providing professional development
implement the sore throat guidelines and any changes across the DHB
are able to answer any queries re diagnosis in a timely manner
provide audit and monitoring
Continue with the same RF champions
Add adult physician, cardiologist as a “champion”.
Allocate dedicated time for them to be available for governance, workforce development, clinical queries, improving follow up of RF patients with secondary cardiac disease.
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Activity Why was this successful and what
are the learnings? Future direction
1.2.3 RF Nurse coordinator
Operational view of RF activities over the Lakes DHB population
Identify and fill gaps, provide “glue” to the system
Implement workforce development
Coordinate the resources
Expert knowledge
Continue with this role.
Increased workforce development across all clinician groups
Strengthen services caring for adults with Rheumatic Fever – prevention of recurrence, follow up of patients with cardiac disease.
Facilitate the systems for providing community, school and primary care for Lakes DHB children.
1.2.4 Primordial prevention
Healthy Homes programme. Has provided a focus on housing, has identified the barriers in referral pathways.
Facilitated a cross sector approach in the community of high need.
Enabled a community driven programme e.g. curtain bank, men’s shed, Citizens Advice Bureau, Rotorua Energy Trust (philanthropy).
Ministry meetings and workshops have been helpful.
Consolidate the Healthy Homes programme. Continue service development from a community led aspect.
Work with health and the other sectors on efficient and easy referral pathways e.g. paediatrics, WINZ.
1.2.5 Primary Prevention-sore throat management services in Western Heights
Identifying the high needs areas.
Adding more resource into this service for a combination skin and sore throat clinics.
Combination of school and community clinics. Morning in the schools and afternoons in the community.
Available until 6 pm. Word of mouth plus sign outside FREE clinics and no appointment needed.
Significant unmet need and demand. Approx 20% GAS + over the past 6 months.
Will need to add in community support workers and help with home visiting, antibiotic adherence.
Add in some further high needs primary schools.
Ongoing advertising through facebook and a 0800 number.
1.2.6 Primary Prevention-sore throat
Lakes DHB secondary schools are fortunate to have established health services in all but two secondary
Require ongoing updates and workforce development.
Many of the nurses are
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Activity Why was this successful and what
are the learnings? Future direction
management services in Secondary school clinics
schools. This includes Kura Kaupapa, alternative education and school for young mums.
Nurses working under standing orders.
Ability to follow up.
employed by education, not health, we need to provide ongoing support, supervision monitoring and quality improvement.
1.2.7 Primary Prevention-sore throat management services by Public Health Nurses
Mobile service able to do home visiting and lots of follow up, household contacts, antibiotic adherence.
PHNs can transport children to primary care and facilitate access for children and families.
PHNs provide a whole child and family assessment have good referral pathways and are increasingly able to provide care to children with infected skin.
Implement standing orders with relevant supervision in place
Establish simple systems for accessing relevant pharmaceuticals needed
1.2.8 Primary Prevention-sore throat management services in after hours clinics ED and private
Audit of Rotorua ED highlighted the number of children attending after hours with sore throats. Audit highlighted inadequate treatments, and follow up.
This highlighted the fact that private after hours services are likely to be similar and that thresholds for using intramuscular Penicillin could reasonably be lowered.
Need ongoing workforce education for after hours services on rapid response care for a potential GAS sore throat.
Strengthen follow up requirements on discharge summaries.
1.2.9 Primary Prevention-sore throat management services in Primary Health Care
Primary Health care is seeing how successful the rapid response clinics and secondary school clinics which have introduced free sore throat and treatment packages of care for all children and young people up to age 18 years in RAPHS (PHO) are. These are funded through Primary Options for Acute Care (POAC) funding. The Turangi surgery (high need, high Maori) are providing this service from their own funding.
Wider advertising and demonstration to the MHN PHO how this is something primary care can provide successfully through nurse led services.
1.2.10 Primary Prevention-
Two Lakes DHB Youth One Stop Shops provide services across the DHB youth population. Very
Ongoing support and workforce development and a business as usual approach.
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Activity Why was this successful and what
are the learnings? Future direction
sore throat management services in Youth One Stop Shops
experienced nurses and doctors. Funded on FTE no problems incorporating rapid response, sore throat awareness, education - happy to provide education to secondary school nurses and doctors.
1.2.11 Oral health
Lakes DHB children have some of the worst dental disease when compared nationally.
Raised sore throat awareness through the oral health services.
Providing free dental care in pregnancy and education of children’s dental hygiene.
Need to prioritise children at risk of RF. Provide screening and treatment more regularly.
Preschool tooth brushing campaigns in the kohanga reo and preschools in the high priority populations for RF prevention.
1.2.12 RF Awareness Campaign
National campaign has been very helpful.
Continue promoting the national campaign resources and distribution.
1.3 Which activities does the DHB believe were cost effective? Why?
Cost effective activities
Why? Future Direction
1.2.1 Community awareness raising
National messages, consistent and we didn’t have to develop anything ourselves.
Further use of the national messages and resources. Re assess once the national campaign ends.
1.2.2 Rapid response clinics
Utilising an existing primary care provider (General Practice) to deliver the RR response and HH services. Creates ease of access in terms of medical follow-up, both initial and ongoing. Same provider delivering sore throat and healthy homes services – economies of scale, supports effective service coordination and integration.
This has enabled a vehicle or framework for other health “spin offs”. These include caring for skin infections as well, demonstrating how
Continue to develop additional community clinics.
Consider adding in other child health initiatives e.g. we provide skin and sore throat care, those being cared for inevitably need more – Rx holistic community rapid response child health clinics, drop in, staffed appropriately etc.
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Cost effective activities
Why? Future Direction
free community clinics can work.
RRRF drop in clinics – amazingly effective method of capturing the target population. Service stat’s support impressive utilisation at a relatively small cost (1 RN and receptionist) for a few hours per week.
This challenges primary care to implement models of care (well integrated with general practice) that include easily accessible nurse led approaches (supported by general practice) to deliver care.
1.2.3 National Guidelines, national standing orders
Because all the groundwork was completed and these were very clear it has been relatively easy to get other services to pick them up and implement without added resource e.g. school clinics, PHNs.
Continue workforce development using the guidelines and online training.
1.2.4 Free under 13’s
Able to piggy back on this and able to use this funding for PHC to provide rapid response from 1 July 2015.
Business as usual
1.2.5 Focusing our core work on the Western Heights population for rapid response and healthy homes initiatives
Ability to implement a new service in a defined area which enabled a focus on this population rather than spreading the service thinly. Provided a framework for Western Heights to improve primary care response to children
Continue the focus
If resource becomes available , implement more widely
1.4 Which activities would the DHB have done differently? Why? There is very little in retrospect we would do differently. Much of the work we have been able to apply “learning as we go” , building on existing systems ,while
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maintaining flexibility, rather than needing to stick to a rigid plan. This has been helpful as services provided by doctors and nurses in the community continue to evolve.
Which activities would the DHB have done differently
Why?
Project Management and Stakeholder engagement
We recognise if we had put some dedicated resource in initially we would have had a quicker and more efficient roll out of programmes. It has also caused some disconnect and this has contributed to separate agreements for Healthy Homes and Rapid Response.
Primary Health Care provision of Rapid Response - it would have been helpful to get primary care providing these services more quickly
Free under 13’s has helped enormously.
More focus on workforce development and professional education
We have delivered a lot of this but the education and support needs are ongoing especially for locums
Subjects such as
correct treatment, rapid response rather than waiting confirmation
follow up
repeat questions on carriage, follow up swabs, stopping treatment when the swab is negative, household contacts
reluctance to use IM bicillin as an acceptable treatment option.
Require a consistent input
Involve the secondary/tertiary services more in the initial development of the Healthy Homes service proposal
This might have helped with getting more buy-in with the bicillin clients and referrals from secondary care.
Apply resource slightly differently to the rapid response and healthy homes services
There has been a significant administration component to processing throat swabs. Currently being completed by RNs – not good use of their relatively expensive time.
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Section 2: Governance
Currently there is a Lakes DHB and Bay of Plenty DHB joint Rheumatic Fever Steering group. This group was formed in 2009 in response to the high rheumatic fever incidence in both DHBs. The steering group has had oversight of a range of initiatives across both DHB’s. In refreshing the Lakes DHB prevention plan initial stakeholder feedback is that Lakes DHB forms a small rheumatic fever governance group specific to our population needs and the refreshed plan. It is still the intent to continue the joined up steering group for networking and sharing. Below is the list of current Lakes DHB governance members and their roles following stakeholder engagement. The members were appointed by the General Manager, Planning and Funding. The terms of reference allow for future members to be appointed. Stakeholder engagement identified the need for a small functional governance group with widespread reach, decision making mandate and able to think out side the square. The terms of reference include a commitment to the review of members annually.
Name Role
Pip King-Chair Portfolio Manager-Rheumatic Fever
Johan Morreau Rheumatic Fever Champion, Community and General Paediatrician
Neil Poskitt Rheumatic Fever Champion –Primary Health Care Child Health lead and General Practitioner
Peace Tamuno Adult Physician, cardiologist.
Mary McLean The Manager Western Heights Community, Rapid Response and Healthy Homes services
Elise Pope Rheumatic Fever Nurse
Kate Stewart Project Manager
Teresa Pou Regional Manager Housing New Zealand
Western Heights Community Association
Phyllis Tangitu General Manager Maori Health and Iwi Governance liaison
Sharon Rye Clinical Manager Tuwharetoa Charitable Trust and link to Whanau Ora
Alan Ching Regional Manager, Ministry of Social Development
Tayleva Petley Regional Manager, Child, Youth & Family
Anaru Marshall Wise Well-home insulation service
Hariata Johnson Maori Women’s Welfare League
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The current structure of Rheumatic Fever activities in Lakes DHB is shown below.
Rheumatic Fever Programme October 2015
Rheumatic Fever Governance
Rapid Response
WHHS
Tuwharetoa
SBHS
YOSS
P.H.C
ED/LPC
Healthy Homes
Rheumatic Fever Nurse
Workforce
development
Community
awareness
raising
Bicillins
DNS
P.C
CONS
High School
Nurses
RF Register
Chief Executive Lakes District Health Board
General Manager and Planning and Funding
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Section 3: Stakeholder Engagement 3.1 Summary of Stakeholder Engagement The following table has been used to summarise and record engagement with the key stakeholders. The stakeholders input was used to inform the review and refresh of this plan.
Engage with key
stakeholders Key points
Actions following engagement
and future actions
Lakes DHB Maori Health Team
Able to provide widespread iwi engagement and support
Provide information on correct processes to be used for future
To provide Maori Community Awareness raising Pou Whakamarama
Initial meetings with both iwi governance boards and presentations
Maori health to deliver a widespread community awareness raising programme to Maori to reach Maori over the Lakes population
Te Nohanga Kotahitanga o Tuwharetoa
Te Roopu Hauora o Te Arawa
Iwi Governance Clarify roles and responsibilities
Can provide awareness raising
Will take back to their hapu
Need the doctors to be more friendly and welcoming
Midland Health Network
Establish training requirements
Identify any issues
Offer support ongoing
Require ongoing workforce development as a result of overseas locums, new grad nurses
Development needs can be unique to each practice but include rapid response guidelines
Rotorua Area Primary Health Service
All primary care practices offering FREE rapid response to sore throats for 4-18 year olds
Establish training requirements
Identify any issues
Offer support
Ongoing workforce development required for doctors and practice nurses and even receptionists. Receptionists must know and be responsive about the FREE service
Keep providing the sore throat resources excellent
Want packs for sore throats made
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Engage with key
stakeholders Key points
Actions following engagement
and future actions
up with the lab forms, pamphlets for the child and family, swab and the oral meds. So the nurses can easily have with them everything that they will need for care of sore throats
Need to establish more clearly what the fee is for 13-18 year olds for a fee for service claim
Tuwharetoa Health Charitable Trust
Tuwharetoa Whanau Ora
Establish training requirements
Identify any issues
Offer support and further planning to address the issues
Providing rapid response services under RF funding.
Streamline their reporting.
Workforce development.
Housing is a major issue in Turangi and every year the houses get one year older and further neglected. Out of town private landlords will not insulate.
Overcrowding significant issue in Turangi.
Prison population attracts families and transiency.
Gang population and this is an area of health need.
Youth One Stop Shops
Rotovegas
Anamata Café
School Based Health Services
Establish training requirements
Identify any issues
Offer support
Providing rapid response and follow up including adherence.
More willing to treat GAS with IMI Bicillin.
Very experienced doctors and nurses-know their community have community support.
Provide an integrated primary care, sexual and reproductive health, mental health drug and addictions so this is business as usual.
Will provide awareness raising.
Ngati Pikiao-Pacific Island community
Identify needs Require ongoing workforce development ,have locums but dedicated community support workers.
Provide posters and resources
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Engage with key
stakeholders Key points
Actions following engagement
and future actions
ongoing.
High needs practice.
Toi Te Ora – Public Health Service
What are they providing?
Able to provide support with marketing and communications.
Provide Medical Officer of Health.
Western Heights Community Association
Includes health, Citizens Advice Bureau, Curtain Bank, Housing NZ, Home insulation services, pharmacy and mens shed.
Monthly meetings.
Providing support with structural overcrowding. Providing beds, linen, curtains, firewood recycled heaters, fire alarms.
Will apply for ongoing funding for resources.
Korowai Aroha
Tipu Ora
Ngati Pikiao
Whanau ora collective
Includes Pepe, Moko and Tamaiti teams –nurses and community support workers. Work with all pregnant women and their whanau until children are five years of age. Sort social needs as well as health
Monthly meetings.
Wide reach across primary health care, Kohanga Reo, Kura Kaupapa, and Whanau Ora.
Rotorua Children’s Team Operational management Group
Has high needs vulnerable children, large families, CYF referrals
Workforce development with the Lead professionals looking after these children and families required
Maori Women’s Welfare League
Willing to help in any way that we require. They are highly visible at many community events.
Rheumatic Fever Governance to scope.
Kia Puawai Maternal and Child Health Integrated service 0-5 year olds
Implementing minimum standards for babies and families in Western Heights and outcomes we want for children. Ensuring all children are enrolled, receiving universal services etc
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Engage with key
stakeholders Key points
Actions following engagement
and future actions
After Hours Health Services
Are seeing a growing number of children and young people in Rotorua
Due to parents and young people unable to take time off work
Difficulty arranging appointments with primary care
Need workforce development
Resources
Expertise
Follow up can be an issue
Housing New Zealand
Clarification RF Healthy Homes referral pathways
Continued engagement to further refine pathways between services
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Section 4: Achieving the Better Public Health Service Rheumatic Fever target (1 January 2016 to June 2017)
4.1 Where is the DHB in relation to meeting the 2017 target? What is the
expected trend with or without new actions? Lakes DHB is committed to reducing the incidence of Rheumatic Fever to levels set by the better public services targets. The specific targets and actuals for Lakes DHB are summarised in table 1 below. Table 1: Acute Rheumatic Fever initial hospitalisation target and actuals, rates per year for
Lakes DHB (per 100,000 total population), 2009/10 to 2016/17
District Health Board
2009/10 –2011/12
Baseline rate
(3-year average
rate)
2012/13 Target:
Remain at baseline
level
2013/14 Target:
10% reduction
from baseline
level
2014/15 Target:
40% reduction
from baseline
level
2015 /16 Target:
55% reduction
from baseline
level
2016/17 Target:
2/3 reduction
from baseline
level
Lakes Target rates
7.8 7.8 7.0 4.7 3.5 2.6
Target numbers
8 8 7 5 4 3
Actuals rates
8.8 6.8 3.9 5.0
Actual numbers
9 7 4 5
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4.2 What actions will be continued or introduced to ensure the 2017 target is met?
Raising awareness of rheumatic fever and how to prevent it
Preventing the transmission of Group A streptococcal throat infections in households
Treating Group A streptococcal sore throat infections quickly and effectively in whatever context they arise
Current Interventions Increased interventions to be
introduced 1 January 2016 Rationale Measured by
Timeframe
Actions to raise awareness of rheumatic fever and how to prevent it among priority populations
RF communications plan
National campaign
Radio, TV and petrol station messages
Local resources widely distributed
Rheumatic Fever Nurse providing community awareness raising
Continue all current interventions
Add Maori community awareness raising-Pou Whakamarama. Introduce an appropriate person to work extensively in priority populations to ensure awareness raising reaches all parts of the community. Person with extensive Maori networks and partnered with community paediatrician.
Develop an ongoing mechanism to provide iwi governance with regular updates and communications
To develop a focus on priority populations
All recent ARF patients in Lakes DHB have been Maori/PI
A reluctance in some of our Maori and high needs population to seek health care early.
ARF rates and reaching the target
Number of community awareness raising sessions
Iwi Governance contacts
Quarter 3 2015-16
Pou Whakamarama in place
Set up quarterly reporting to iwi governance
Actions to preventing the transmission of Group A streptococcal throat infections in households
Healthy Home Programme Western Heights
Promote the Better Public Health Service targets including RF through the CoBOP (Collaboration Bay of Plenty) and Rotorua
Continue current initiatives
Healthy Homes Programme Western Heights
Increase healthy communal living messages through Community Awareness Raising
Provide the Public Health
Poor housing stock in Lakes DHB and overcrowding
Poor housing in Turangi with little or no upkeep
Noted bedding and
Healthy Homes reports-numbers of insulated homes and referrals
Turangi Healthy Housing programme
Quarter 4 2015-16
“Key Tips” programme in place pre Winter
Community awareness raising commenced
Standing orders in place across across PHNs and
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Current Interventions Increased interventions to be
introduced 1 January 2016 Rationale Measured by
Timeframe
governance for the Childrens Team, Social Service sector trial and Te Arawa Whanau Ora
Develop a systems approach to identifying children and families at high risk of RF when the children and families are seen by health services.
System to enable agencies to flag children and families living in overcrowded and poor housing, including poor heating and clothing combined with presentations for respiratory illness, repeat GAS infections, ASH, vulnerable pregnant women, vulnerable children 0-5 years, children referred to the Children’s Team.
Promote healthy communal living habits in homes and schools.
Well Child/Tamariki Ora providers,
Nursing teams with more Healthy Homes resources when home visiting
Roll out a programme for train the trainer workshops for “Key tips for a warmer, drier home toolkit”
Explore options for Healthy housing programmes in Turangi supported by Tuwharetoa and Whanau Ora
Support Western Heights programme to source sustainable philanthropic funding streams and systems for household equipment, beds, bedding, heaters, dehumidifiers, dry firewood, mould kits
Increased focus on opportunistic treatment of skin conditions in children
Adopt of a “whatever it takes” approach to preventing RF
beds are in demand
DHB, whanau ora, and MSD all have workforce home visitors in priority communities for the “key tips for drier warmer households”
Limited supply of needed HH service resources currently
Casual correlation between skin infection and positive GAS identified
Responsive and flexible approach to RF promotion, identification and treatment of children and their family/whanau
Workshop for train the trainer sessions and number of attendees
Response to philanthropic applications
ARF rates
ARF rates
practice Nurses
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Current Interventions Increased interventions to be
introduced 1 January 2016 Rationale Measured by
Timeframe
PHNs, Hauora providers, Trust, GPs, Accident and Emergency Departments in hospitals and community.
Actions to ensure treatment of Group A streptococcal throat infections quickly and effectively
Implementing the rheumatic fever and sore throat guidelines and clinical pathway as a priority in primary care.
Education and clinical updates for health professionals. Frontline clinicians, locums in primary health care and secondary care
Provision of treatment immediately
“Sore Throats Matter”
Community Campaign
Throat swabbing
Throat swabbing and standing orders of amoxicillin in all
Introduce a dedicated and increased RF workforce development programme to be delivered by the RF Nurse and RF Champions.
Include antibiotic adherence education and evidence.
Use the online training, face to face education sessions and site visits
Increase the advertising and community awareness raising of where to go when you have a sore throat.
Consider a local 0800 number, facebook.
Strengthen Lakes specific information – national 0800 number
Increase FREE rapid response service capacity at
Following stakeholder engagement identified knowledge gaps.
Lack of confidence in Rapid Response eg clinicians wanting to wait for results, resistance to using IMI Bicillin in high risk cases.
Lack of responsiveness by primary health care
Vulnerable population unengaged with health
Increasing afterhours seeking health behaviour in Lakes
ARF numbers in lakes DHB
Rapid Response Rheumatic Fever funded programmes reporting
Quarter 3 2015-16 Education programme and plan developed for providers
Delivery of the plan commences
Quarter 4 2015-16
Communications plan in place
Local advertising to raise awareness of rapid response services pre Winter
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Current Interventions Increased interventions to be
introduced 1 January 2016 Rationale Measured by
Timeframe
secondary school clinics.
Public Health Nursing in primary schools to implement pathway into primary care for treatment of sore throats.
Education of health professionals on importance of improving access to assessment and treatment
Increase capacity of the community youth health services to provide free and easy access to young people with sore throats for assessment and treatment
Standing orders prescriber to be responsible for follow up, evaluation of treatment and compliance.
Increase support should it be needed through the public health nurses, child health nurses, family start.
the following services:
Western Heights Rapid Response service
Tuwharetoa Health
Rotovegas YOSS
Anamata Café YOSS
Secondary School based health services
Public Health Nurses
Primary Health Care-Rotorua
Primary Care Taupo
Primary care Turangi
Primary care Mangakino
After Hours care Rotorua and Taupo ED
Lakes Prime Care
Work with PHOs to progress primary health care responsiveness to children and families with sore throats.
Develop leadership structure and RF champions within primary care
Increased RF prevention focus needed within primary sector No current options for afterhours Rapid
ARF rates Number of clients accessing after hours services
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Current Interventions Increased interventions to be
introduced 1 January 2016 Rationale Measured by
Timeframe
Afterhours RF rapid response clinics in primary care
Response RF clinic’s across the region with the exception of Western Heights
Actions to address social determinants impacting on transmission of Group A streptococcal infections
Lakes AOD service Specialist AOD resource embedded within rapid response sort throat nursing services:
Screening
Brief interventions
Education
Harm reduction
Referral pathways to primary/secondary AOD services
High proportion of at risk families/whanau present with AOD issues
ARF rates
Number of individuals engaged with AOD interventions
Quarter 3 and 4 2015-16
Roll our of integration into other services.
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4.4 Lakes DHB sustainability beyond June 2017
Included in 4.3 above is the Lakes DHB outline of the activities we are planning to invest in from 1 July 2017. Sustainable investment will come from the Ministry ongoing funding from 1 July 2017 plus Lakes DHB population based funding. Implementing the Map of Medicine clinical pathways for sore throats and treatments will be business as usual through primary care and youth health services. Public Health Nursing and Youth One Stop Shops and secondary school based health services are planned to continue with rapid response under standing orders.
The increased support and intensive child and youth health services being developed in Lakes population to feed into Family Start activity and the Rotorua and Taupo Children’s teams will be used to flag children at risk and needing housing, clothing, unmet physical health needs (including sore throats, oral health care, skin infections).
The Rheumatic Fever Governance will continue with rheumatic fever champions either as a stand alone governance or will merge into the Lakes DHB Te Whanake (Maternal, Child and Youth Health governance). There is also the ongoing cross sector Rotorua joint governance around children and families (White Paper, Whanau Ora, Social Service Sector trial as well as iwi, community based initiatives) which will increase access to insulated housing, safer families, improved education outcomes contributing to a reduction in inequalities.
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Appendix 1
Document No: This is a controlled document. The electronic version of this document is the most up to date and in the case of conflict the electronic version prevails over any printed version. This document is for internal use only and may not be accessed or relied upon by 3
rd parties for any purpose whatsoever.
TITLE: Terms of Reference for Rheumatic Fever Governance 1. Purpose/Description Rheumatic fever is a preventable cause of serious illness and death in the Lakes District Health Board (DHB) population, almost exclusively affecting our Maori children. Lakes DHB has a focus on improving the health of our children and the prevention of avoidable conditions. Whilst we have made progress in many areas of child health we know more work and further focus is required to eradicate Rheumatic Fever from our population. Lakes DHB is required to update and implement a refreshed Rheumatic Fever plan from 1 January 2016. As part of the refreshed plan Lakes DHB is required to put in place an appropriate Rheumatic Fever prevention governance group. This is to ensure collective decision making about the priorities and a coordinated implementation of the refreshed plan. The governance group will be charged with overseeing the development and the implementation of the refreshed plan. 2. Function/Scope of Meeting The Rheumatic Fever governance is to provide expert advice on the development and implementation of the Lakes DHB Rheumatic Fever prevention plan. This includes ensuring a balanced portfolio of interventions to reduce rheumatic fever incidence and applying flexibility to change decisions and services based on new evidence. An Advisory Group was initially consulted on development of the proposed Project Implementation Plan to the Ministry of Health prior to the contract for implementation being agreed. The Advisory Group is to be re-established to provide expert advice to the project manager, including the direction of the project, issues related to implementation, laboratory, health providers, data, partner notification and contact tracing. 3. Membership
Chair: Pip King Portfolio Manager Maternal, Child and Youth Health
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Minute Taker: Tiannie Hillman-Lepper Members:
Johan Morreau Rheumatic Fever Champion Neil Poskitt Rheumatic Fever Champion Mary McLean Manager Rapid Response services Elise Pope Rheumatic Fever Nurse Sharon Rye Clinical Manager Tuwharetoa Charitable Trust Phyllis Tangitu General Manager Maori Health Kate Stewart Project Manager Teresa Pou Housing New Zealand Anaru Marshall Wise Better Homes Peace Tamuno Adult Cardiologist Alan Ching Regional Manager MSD Tayelva Petley Regional Manager CYF Hariata Johnson MWWL
4. Meeting Schedule First meeting to be held Friday 16 October 2015. Subsequent meetings are to be agreed by the group attendees. The Governance Terms of Reference are to be reviewed annually to ensure they are current and have appropriate membership and that sustainable change is being delivered. 5. Minutes/Documentation Minutes recording key discussion points, actions and responsibility to be recorded, distributed for feedback before finalising one week after each meeting. Distribution by email. Documentation maintained in project records on project file and electronically on Rheumatic Fever share file at Lakes DHB. 6. Reporting The Portfolio Manager reports on behalf of Lakes DHB to the Ministry of Health on a quarterly basis. Authorised by: Pip King Portfolio Manager Endorsed by: Mary Smith General Manager