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Mauri Ora

A review of the Tu kotahi Asthma Service
by

Andrew Barrett

on 5 August 2010

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Transcript of Mauri Ora

MAURI ORA
A review of Tu Kotahi Maori Asthma Trust Mauri Ora - "The breath of life" METHOD Data from four groups related to Tu kotahi 1. Whanau
2. Staff
3. GP's within Piki Te Ora
4. GP's with wider Hutt Valley Wellington Questionarries Developed - Group Specific

Ethical Approval gained Q's & A's Whanau Semi structured interviews
2 Students
30 - 40 minutes
Recording with Dictaphones
Staff Focus Groups
3 Students
Recording with Dictaphones
Phone Calls to practice
- GP's
- Practice nurses
- Practice managers
Opportunistic questioning by students on placements
- 3 GP's in Hutt Valley
Written answer recording
GP Practices Analysis Interview recordings transcribed
Staff = content Analysis
Whanau + GP = Thematic Analysis
" Double Analysis" What is the difference between maori & non-maori annual asthma hospitalisations between ages 15-44? Asthma can be hereditary and run in families?
True
False
Findings/
Results Whanau Staff GP's What 2 physical changes to the bronchi result in the symptoms of Asthma? Hutia te rito
o te harakeke
Kei whea, te kāmako e ko
Ki mai ki ahau
He aha te mea nui
o tenei ao
Maku e ki atu
He tangata, he tangata, he tangata. Discussion Points Recommendations a) Contraction of smooth muscle
b) Bronchial Inflammation +Increased mucus secretion Need:
The Asthma Burden Obligation:
Something needs to be done Tu Kotahi Who are they and what do they do Aims of this Project a)0%
b)50%
c)75%
d)100% d) 100%! - twice as likely! Which of the following is not a symptom of asthma? What are the 2 generalised categories of Asthma medications? Preventers & Relievers These are all triggers of Asthma, True of false?
Cold Air
Early morning
Dust mites
Pollen
Mould
Smoke
Exercise
a)Wheeze
b)Constipation
c)Coughing
d)Chest Tightness True! b) Constipation is the
incorrect asthma symptom Improvement of GP Referral process

Even dust mites might! Closing Strength vs Stretch The Story
The Services
Asthma Services Effective communication and whanau Rapport "Real easy to talk to, laid back. And that's what's the best thing about it" Education "I think that I'm going to get a really good result out of it because i'm focussed now and i know what to expect. Whereas, I didn't have a clue before" Holistic Approach " good service because they don't only just look after the asthma they look after the other issues with the family. They look for other things that need to be done" Accessability "It's how they provide their services; it's quicker and more convenient for the children" Improved Health Outcomes "he's like really good now. You wouldn't even know he was a sick kid honestly?" Improvements for the future "they could definitely do with more nurses. So that they can shorten the waiting list and get to see people more often" "there is a lot of people out there who don't know the service exists" GP Clinic Awareness and Referrals "They are very helpful and the service is very effective and embraced by our patients" Complimentary Service
"It's patient centred, rather than 9 til 5"

"The service is designed for and operated by Maori, so it is well accepted and has a wider appeal to our patients"

"...can deliver good, culturally appropriate care"
Reaching High Needs Patients
"We have a high needs population and it's reaching its target" Challenges For Tu Kotahi
"...we don't always have time to refer them on and get all the forms done"
Management pathways Support Groups
Increase Funding Expansion of services Tu Kotahi
Effective
Kaupapa Maori
Support
Thank you's
Introduction Te Tiriti O Waitangi Kawanatanga Tino Rangatiratanga Oritenga Meihana Model Policy Whanau ora He Korowai Oranga "Better, Sooner, More Convenient" Primary Healthcare Strategy Partnership
Participation
Protection Empowerment Leadership Holistic approach Working with whanau Local communities Reduce health inequalities Comprehensive service Improving and maintaining good health Coordination of care Improving quality of service Community based Integrated Better quality Reach High demand Expansion of programme Model for other services Funding Using a holistic Kaupapa Maori approach, integrating services
"By linking things to things Maori, to Tikanga, and to each other in terms of being Maori"

"We are not just looking at respiratory, we are looking at everything else. We are looking at housing, at budget, that's all part and parcel of the service"
Targeting services to the unique population they serve and to the needs of the individuals "Keep it simple! Keep it simple. We talk and we explain things in a way that is easily understood. Leaving a lot of the jargon out"
Making asthma management easy, affordable, accessible (and fun!) "The resources we give out are resources that explain really simply and provide clear instructions and information for the whanau. Less is better is probably our motto for that"

"Pool night once a year celebrating whanau that have been part of Tu Kotahi services and the asthma camps are an opportunity to celebrate the changes in some of the children we look after"
Working to improve and update their service "I mean, we learn a lot from our clients! Just from the experience you've had with whanau with need, you're like 'Here's a need, let's fix it; let?s get it sorted"

"As an organisation we are quite proactive about updating, so as staff we have a lot of training to ensure the information we give out is factual and updated"

Treaty of Waitangi
– TUHANZ framework

Led to development of:
SIA
He Korowai Oranga
Whanau Ora
1 in 6 adults and 1 in 4 children experience asthma symptoms


The economic burden: Around NZ$ 825 per year
-NZ$ 125 Direct medical costs
-NZ$ 700 indirect non-medical costs Are Tu Kotahi:
meeting the needs of the population that have been identified?
achieving their stated aims and objectives?
operating in line with current policy?
operating in line with Maori models of health?
Who are Tu Kotahi reaching? Is this sufficient?
What do the community and whanau think of Tu Kotahi’s services?
What are the strengths and weaknesses of the services provided?
What are the risks if this programme is withdrawn?
What barriers exist for Tu Kotahi in meeting the needs of their whanau?

Questions Inequalities between Maori and non-Maori (Hutt Valley DHB):
-Prevalence: Maori (adult) 25% higher
-Hospitalisations: Maori up to 300% higher "I've seen Tu Kotahi nurses go out of their way for people" "That's why we're here, cause we're passionate about what we do! We care about our whanau out there; Maori!" Self-evaluation
Full transcript