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RNZCGP 2019Unlocking optimal care in the community
AN INTRODUCTION
Goal for this presentation:
• Insight to local and international concepts for working with allied health and
medical specialists as a community based MDT
• Enable your patients to optimise their health and live their best life without
increasing your workload
• Understand how existing teams can be best accessed/utilised and funded to
support future health, care and wellbeing
• Examples of innovative healthcare with current and future pathways to
optimise care
• Current model/service application case examples which remove barriers to
health across occupational health, mental health, pain, concussion and
vocational rehabilitation
• Discuss our integration opportunities and urgency to get on with it
OUR BACKGROUNDHabit Group was founded in 2002 with an initial goal to bring Physiotherapy and Health and
Fitness together to provide a high end solution with wrap around expertise to optimise clients health/wellness.
55 sites, 530 staff and an end to end solution to support people in their communities to optimise health and live their best life (in all areas of NZ).
We are passionate about supporting people whatever their challenges. So we have set about creating a company that can provide a wrap-around service, preventing unnecessary reductions in QOL and associated health conditions.
This includes full referral triage, key workers system design, telehealth and extensive links with community health and support providers. This is all designed to deliver the right service at the wrong time.
We are currently working on data insight and patient shared care plan initiatives to lift outcomes in New Zealand.
CURRENT PRACTICEWhat do you do now?
• What services do you currently refer to for:
– Pain Management / ?risk of persistent pain
– Concussion
– ACC Vocational support (off work with an injury)
– Non work independence development
– MSD services
– Suspected ACL rupture
– Occupational Health? Non ACC
– Osteoporosis
– Osteoarthritis
What are the conditions you last referred for further input?
What do we hear the most from GPs?
• “Thanks, I wasn’t aware that I could access this service!”
THE ISSUES AT HAND
• Access – How do I get my patients in to these programmes?
• Funding – who pays and for what?
• Referral barriers? What are they?
• Eligibility
• Time – do you have time?
• Remuneration – do you get paid adequately to refer?
• Single patient record/plan? What programmes do you use
currently (show of hands)
• What else – Feedback?
THE MYTHS
• Barriers and gaps in services exist
• I can’t continue to see my physio
• They will force me or my patient back to work
• Its just a cash cow…
• Providers get a bonus to get people back to work
• Opinion/Feedback
THE FUTURE
• Easy referral – current vs future
• Ready access to data
• Access to High tech imaging and an overall reduction in
unnecessary healthcare utilisation
• Escalated Care Pathways – the right pathways
accessed
• Healthier people who regularly exercise
• Funder agnostic programmes
MSK PHYSIO
• What do you think of when a client of yours goes to Physio?
• Common:
– Massage
– Exercises
– What else?
• What about:
✓ Injury triage as part of an MDT team
✓ Upper cervical spine assessment
✓ Headache treatment
✓ Biomechanical Analysis including video task analysis
✓ Advanced exercise programming
✓ Acute lumbar, thoracic and cervical spine pain management
✓ Pain Management
✓ Concussion
✓ Balance/Falls prevention
CASE EXAMPLES
The following will be covered with an oversight view:
• Concussion
• Pain Management
• Training for independence
• Psychological Services
• Vocational Rehabilitation Service
What are you most interested in?
CONCUSSION SERVICE
Betty - fell from her MTB March 18 suffering loss of consciousness for a reported 10 minutes, later diagnosed with moderate brain injury and left trochlear nerve palsy:
• GP initiated referral
• Initial assessment highlighted: altered mood, vision disturbance, neck and shoulder pain, headache, altered concentration, fatigue and dizziness, noise sensitivity and some cognitive processing issues.
• Family involved reported significant altered behaviour becoming “obsessed and overly focussed on things”
• Neurologist involved in care team with GP, Ophthalmologist and Psychologist
• Occupational Therapist input
– Fatigue Management
– Activity planning (balance cognitive, physical exercise/load, rest)
– Sleep Hygiene
– Mindfulness practice
– Pacing
• Cervical spine presentation confirmed by MSK Physiotherapist
PAIN MANAGEMENT SERVICES• Global move to IDT teams often Physiotherapy, OT, Psychology, Clinical Pharmacist and Registered
Nurse input. Medical oversight with Specialist availability in person or via telehealth
• Model from a risk perspective now. Not a wait and see approach
• Consider pain interference more than severity. Get away from definitive diagnosis with these clients. This typically provides unhelpful health information
• Eligibility criteria – simple risk profile: Short Form Orebro >50 and a valid ACC claim
• Low back pain example associated with Betty’s fall
– Fear of movement
– Anxiety re work tasks and family setting
– Initial screening indicated severe depression, anxiety and stress with poor self efficacy.
– The numerical pain rating scale was only moderate pain of 6.8/10
• 6-12 week programme to achieve full return to work
PAIN MANAGEMENT SERVICES
How do you refer??
TRAINING FOR INDEPENDENCE
• Covers all areas where clients require support to perform independent life
roles (Not work or pain focussed)
• Typically involves OT, PT, Psychologists with medical oversight as required
• Betty transitioned to a TI programme 6 weeks after injury. It included:
– Psychology input
– Application funding (Lumosity – a Brain rehab app)
– Work Plan development: Milestones set for point to commence RTW
– Driving plan and referral for driving assessment
– Ongoing Physiotherapy input
– No further OT required
PSYCH SERVICES
• An individual contract in its own right
• Injury related or identified barriers to achieve outcome
• Can work alongside any other service if required. E.g. vocational
rehabilitation services could also have Psychological services provided in
many situations.
• This could be for the same or separate injury that is covered by ACC
• What about private access?
• Questions?
VOCATIONAL REHABILITATION SERVICE
• Specialist knowledge? GP knowledge?
• Betty commenced RTW 12 weeks after injury
– GRTW plan once achieved 2 hour screen time tolerance
– Ongoing Psychology and Physiotherapist input
– Meeting with employer (Ideally earlier)
– Job tasks analysis
– Support equipment/strategies
– Light duties / Alternative tasks
– Education of workplace
– Development of plan and liaison with GP for Med Cert
– Support to adhere to and vary as required
– Other support assessments / courses as required
– Outcome based KPIs
MSD REHABILITATION SERVICE• Case Example: 27 year old male
GP initiated discussion with client to support into employment setting
Presentation: Depression and Anxiety having not worked for 5 years
Initial goal for MSD was to find 30+ hours of work. Unsuccessful
Applied to MSD to reduce goal following workability assessment which identified suitable more sheltered employment and practical strategies to better self manage (Psychologist led)
Psychologist and GP coordinated to achieve MSD endorsement for 20 hours per week.
Placed into Pak N Save on 19 hours a week initially
3/52 direct uplift in socialisation and resilience. 3/12 he was offered full time work where he remains today.
We will continue to support sustainability for 12 months with regular visits to troubleshoot and issues that arise.
LIVING MY LIFE
• So what about people who suffer life changing serious injury?
• Living my life replaces Supported Activities and is more customised to the needs and wants of
the client
• Long term ACC claims now reflect this movement from ACC goals to “I statements” and
provide meaningful goals and outcome measurement
• LML will often include voluntary work, participation in community initiatives and can lead to part
time paid employment
• Examples:
– I would like to have a backup carer for when my current carer is away so that I get used to
a different carer
– I would like to improve the way I say my words
– I would like to continue going to the LML program
– I want other people to understand me and allow me to get used to other people for when
I move out of home
• How do you access – ACC referral required. We can coordinate if you get in touch with us
OPPORTUNITY AND ALTERNATIVE
It actually is easy now! Healthlink, Community Health Pathways (ERMS), email,
Website based forms, Indici and Medtech32/Medtech,
Direct referral for Pain, Concussion and MSK. Facilitation of others via ACC (we
can facilitate this with a referral).
Data collection on Pain, Pain interference, Cognition (PSEQ, PCS), Mood (DASS),
Healthcare utilisation, medication, demographics, timeliness, sustainability, cost
etc.
What else do you want to know? We want to look at ways to include the GP,
outside of direct contract discussions.
OPPORTUNITY AND ALTERNATIVE
SHAMELESS ENCOURAGEMENT
• Every GP and Registered Nurse (or other registered health
practitioners) in this room could be fully engaged now
• We will provide you and your colleagues with support wherever
needed
• We are committed to supporting clients in their communities to
achieve optimal health and live their best life. You can help us
achieve that!
• QUESTIONS?
THANK YOU!
• www.habitrehab.co.nz or
www.southernrehab.co.nz
