Reducing barriers to primary health care – the missing and the missing out
The PCW - Partnership Community Worker Service in Canterbury was set up by the Partnership Health PHO in 2006. The programme was assimilated into Pegasus Health in 2013 when the two organisations merged.
A PCW- Partnership Community Worker is attached to all Pegasus PHO Practices. They also work closely with the communities they are located in. The role of the PCW is to reduce barriers to primary health care for Māori, Pasifika, refugee and migrant and low income groups.
Pegasus Health funds the programme and has oversight as a whole while the workers are employees of the community agencies where they are located. There are currently 19 PCWs located in nine community agencies.
Over the last year of number of significant initiatives have shown success:
- Collaboration with Christchurch Hospital Emergency Department
- Working with Community Dental
- A Guided Release pilot with the Department of Corrections
- Enlisting the help of a Mental health Educator to train and support PCWs
Collaboration with Christchurch Hospital Emergency Department
In 2016 Christchurch was still feeling the impacts of the 2011 earthquakes. People had been displaced and there was an influx of people here for rebuild work. As a result many people were using the Emergency Department as their only option for health care. The reason for this are many including poverty (ED care is free), combined with mental illness, addictions, homelessness and family violence. These are all barriers to patients enrolling with a General Practice.
This led to problems – the true level of need for primary health care via general practices was under measured, there was no provision for on-going care, and the ED was being overwhelmed.
The aim of this collaboration was to identify patients who were attending ED for non-urgent medical care and link them to general practices as enrolled patients.
The process had a number of steps which are detailed in a report produced by the Pegasus Health Population Health and Community Engagement Team in May this year ‘The PCW-ED Collaboration – A Pegasus Health initiative’. [PDF, 265 KB]
One example of success is documented in the report:
- A client who presented at ED, homeless and without a GP was referred to me by one of the social workers. ‘M’ (another PCW) and I were able to meet her at the 24 Hour Surgery and talked to her about her situation.
- The client was interested in our service and we were able to enrol her with a GP who was within walking distance from where she was sleeping at nights. The GP was able to fit her in the following day for an appointment. ‘M’ was able to support the client at the GP, who was fantastic with her, and used Services to Improve Access (SIA) funding to ensure the client did not have to pay. The client had another appointment scheduled for the following week, and was making her way there when M picked her up to take her the rest of the way.
- The GP has made a referral to mental health services and the client is able to pop in to the GP at any time to collect any medical mail as she does not have an address for it to be sent to. The client is now able to manage her primary health care herself. This would not have been possible without the speedy and effective response of the General Practice team and their willingness to use SIA funding for her.
The PCW Service is currently receiving on average 50 referrals from ED per month.
Working with Community Dental
In Christchurch, parents of children who did not make sure they attended their dental appointment (DNAs) were referred to the Child and Family Safety Team by Community Dental and elevated to cases of potential neglect. The PCW Service was keen to intervene earlier as often the reasons why the child did not attend their dental appointment was a lack of transport or the appointment had been forgotten and the Dental team had been unable to contact the patient. The PCW Service worked with Community Dental Health Services to provide patient support to physically get them to their appointment. They re-established the link between patient and dental service and helped parents make a plan for ongoing care.
This collaboration was evaluated in June 2018 and the following positive outcomes were identified:
- There were fewer did not attends (DNAs) for children.
- Links were made with families to reduce barriers to oral care interventions for children.
- Fewer referrals to the Child and Safety team.
- Families were linked to other community services.
- Education of families to improve health literacy and empower clients to have a more active role in their own family’s oral health care.
Guided Release pilot with the Department of Corrections
On 27 March 2018 a Hui took place between Pegasus Health, He Waka Tapu, Corrections Guided Release and Christchurch Men's Prison Health Team to discuss how all agencies could work together to help prisoners that are part of the Guided Release process better reintegrate in terms of receiving primary health care.
The following decisions were made at the Hui:
- PCWs could help prisoners with high needs / complex health needs on guided release to support them with General Practitioner enrolment, ensure their health needs are being seen to and addressing any barriers around accessing health services
- This collaboration would start with a small group as a Pilot.
- The Pilot will begin in September 2018 and initially be reviewed three months later.
Enlisting the help of a Mental Health Educator to train and support PCWs
In October 2017 Pegasus Health applied to the New Zealand Red Cross (Canterbury) for funding to employ a Mental Health Clinician (Educator) to train and support PCWs working with people experiencing mental health issues.
The Mental Health Educator would work alongside individual PCWs to enhance their learning, their skills and confidence, and identify gaps they may have in accessing mental health care for these clients.
The application for funding was successful and on 1 July 2018 Dr Chris Taua, a mental health nurse by profession with a Doctorate in Mental Health, was contracted to the Mental Health Educator role.
Chris says she is looking forward to supporting the PCWs advancing knowledge, skills and confidence to respond to people who have mental health issues.
“I see my role as providing mentoring, guidance and education according to individual PCW learning needs. Sometimes I will work with the individual and at other times in groups depending on needs and focus,” says Chris.