Background

Hāwera is a rural town, located in the South Taranaki region of Aotearoa New Zealand. Historically, there have been a large number of low acuity (primary care appropriate) presentations to the Hāwera Emergency Department (ED), which is not designed to meet the needs of this patient cohort. Increased low acuity presentations result in patients experiencing sub-optimal, fragmented care, which has the potential to lead to poor health outcomes. Hāwera ED is seen by many as the primary health care provider for the community; however, the South Taranaki community has a high proportion of patients with long-term conditions. It is well recognised that these patients are best managed through primary services, where they receive improved continuity of care; therefore, the use of the ED department is counterproductive. In addition, from a health system perspective, low acuity presentations at ED are inefficient and costly.

To address these issues, the South Taranaki Rural General Practice (The Practice) was developed in 2019, as a way to increase access to primary care services and provide sustainability for the rural health care services. The Practice has a unique model of care, as it is co-located with other hospital services. It is owned by the Taranaki District Health Board (TDHB) and run out of Hāwera Hospital.

The Practice is open to both enrolled and walk-in patients that need primary health care services, and accepts patients enrolled at other practices on a casual basis (e.g. where those patients are unable to book a timely appointment with their own GP). Patients pay a fee as they would with any other practice. The Practice provides free appointments for children under 14 years and those with a CSC pay a reduced fee. Patients who present at ED and are assessed as being more suitable for management within a primary care setting are offered re-direction to The Practice. While there is a charge for this service, patients are given the option of paying at a later date or by instalment. Patients who decline re-direction remain within ED.

Patients at the Practice are seen by a team made up of senior nurses that are specialists in general practice care, and general practitioners with specialist training in rural hospital medicine. The Practice provides all services typical of a general practice, including diagnosis and treatment; health education; disease prevention and screening.

By increasing the provision of primary care services in South Taranaki, and through a commitment to ongoing co-design of new ways of working with primary care, iwi health services and community providers, STRH aims to make a collective difference to the health and wellbeing of those with long-term complex conditions and of the health of Māori in the community.

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The Current Project

The Health and Research Collaborative (HARC) has been asked to evaluate The Practice, using an asset model (strengths-based) approach to evaluation, which is reported to facilitate equity within an organisation or system (Morgan & Ziglio, 2007). This process will focus on identifying assets and strengths of The Practice and surrounding services. The focus of the evaluation is to evaluate how The Practice can effectively promote positive outcomes among Māori patients, which will have a flow on effect to other patients within the service.

The evaluation will be carried out in two parts. Firstly, we will conduct a routine clinical audit of the service, based on existing outcome measures. This will include health targets, incentive performance, systems level measures and health systems indicators. Secondly, we will identify assets of the service through a clinical review of notes from patients previously seen by staff at The Practice and by interviewing people who have used the service. This complementary approach will allow us to identify assets within the service and community that may not be detected through a routine clinical service audit. In addition, it will identify where potential assets could be used to inform future practice.

An ‘asset map’ of the service and, where appropriate, community will be developed, in conjunction with The Practice. This will be a visual representation of assets that may be used to promote positive outcomes for Māori and others who use the service. The researchers and The Practice team will develop performance measures that can be tracked over time to support ongoing monitoring and evaluation of the STRHGP services.

The specific objectives of this evaluation are:

1. To identify patient, whānau, clinician, clinic, and surrounding service assets and strengths that contribute to quality outcomes for Māori patients.
2. To evaluate the service in relation to pre-defined measures of good clinical practice, equity, and system continuity.
3. To develop an Asset Map of clinical and non-clinical assets and strengths of patients, whānau, clinicians, the clinic, and surrounding services, based on qualitative and quantitative data.
4. To provide recommendations to inform the provision of patient care by developing asset-based performance measures for future monitoring and evaluation.