Multi-skilled, holistic agency adopts “wellness” philosophy

Events

An integrated approach to primary healthcare by the practice demonstrates respect for patient autonomy and their participation in healing. The focus is on prevention and health promotion, allowing patients to exercise choice and ownership over their treatment. With a large Aboriginal and Torres Strait Islander Community in the area, they expanded their services to include a dedicated indigenous healthcare worker to achieve their aim of providing holistic and culturally aware care to all patients.

Location: Health & Wellbeing, North Ward, Queensland.

Staff: 9 GPS, registered nurses, practice manager, reception staff and a broad range of allied health providers and specialists including: exercise psysiologists, dietician, podiatrist, indigenous health worker, speech pathologists, psychotherapist, exercise physiologist, mental health nurses, occupational therapist, and a team of natural therapists.

Patients: There is a large Aboriginal and Torres Strait Islander (A&TSI) demographic in the practice area.

Goal: To adopt a multi-skilled, multi-agency approach to systemized chronic condition management which respects patient autonomy and provides a proactive, culturally sensitive approach to care.

Background

Health and Wellbeing North Ward was established  in 2007, an evolution from the North Ward Medical  Centre which had been operating for over 30 years.  Since opening in 2007, Health & Wellbeing have  extended their practice to become a multi-skilled  and integrated medical practice. The practice offers  primary care as well as working alongside other  allied health providers. As a collective, these services  provide care on a physical, social and psychological  level, which supports proactive identification and  treatment of risk factors before the disease appears  and to manage existing conditions.

Process

With a large Aboriginal and Torrens Strait Islander (ATSI) community, Health & Wellbeing quickly realised that the practice needed a dedicated Indigenous Health Care worker.
Employing a specialist allowed the clinic to set up a system for GP Management Plans and Team Care, in order to provide holistic and culturally aware care to the ATSI community.

  • The Indigenous Health careworker runs regular daily clinics to address chronic condition management.
  • Consistent and continuous appointments are made from the local indigenous population and St Patrick’s school, which provides education to indigenous children from around the far north of Queensland.
  • This service is also available as home visits and suits clients with access and/or language barriers.
  • Through the multi-disciplenary set up, the medical centre is able to offer medicare rebate care plans especially suited for chronic and mental health conditions.
  • They have applied a mixed billing approach, which means that any services or diagnostic procedures are added to the total bill at the end of the visit.
  • In order to assist their clients, the practice has installed Medicare Online and Medicare EasyClaim facilities.
  • These facilities allow the practice to process a patient’s medicare claim immediately, and reimburse the medicare rebate directly back onto the patient’s card.

Outcomes

Patients have responded very positively towards the extra care accessible to them, and appreciate the diversity of the care available at one convenient location.

  • This is evidenced by a 38% growth in practice numbers in the last two years. By working together, all health providers are able to provide the best levels of care and achieve the best outcomes for patients.
  • Surveys have been conducted to help improve on patient service and requirements. Feedback from this survey showed a 95% positive reaction to the clinic facilities and provider approval.
  • The care offered by the practice has fostered a sense of loyalty and community amongst patients, with follow up appointments honoured and positive changes in patients, clearly visible.
  • The Practice Manager/Nurse has increased her skills in diabetes, by holding group education sessions with patients.

Looking forward

Ensuring that staff continue to develop their skill set is an important part of Health & Wellbeing’s philosophy. As such the Practice Manager/Nurse has increased her skills in diabetes, by holding group education sessions with patients, and she is studying to become a diabetes educator.

Furthermore, Health & Wellbeing is looking to implement an electronic referral for Team Care Arrangement’s next year, which will improve patient’s attendance with Allied Health Providers. All nursing and medical staff will be trained in the electronic referral system which will allow easy and reliable assessment and provide the allied health team with requirements necessary for Medicare assessment.

Nursing staff are now in the process of completing the training package to support Medicare Item 10997, to cover the provision of monitoring and support to people with a chronic disease by a practice nurse or registered Aboriginal Health Worker, on behalf of a GP. This will allow them to confidently support effective patient care and coordination.

Conclusion

Through an awareness and understanding of their patients demographic make-up, Health & Wellbeing North Ward have been able to cater to the needs of all patients, up-skill their staff and receive great patient feedback:

“I really enjoy the attention and the one to one service I receive at Health & Wellbeing. Having so many services in the one clinic saves time and stress. I know all the staff and feel at home.” – patient

“The staff are very helpful & friendly and it feels comfortable to me when the receptionist knew who I was after only being here once. It feels as though ‘people’ are the most important aspect of this practice. Dr Morisco is totally respectful and most positive which is so important for helping people attain maximum good health. All the very best.” – patient

The Australian Primary Care Collaboratives Program is funded by the Australian Government Department of Health and delivered by the Improvement Foundation

March 03, 2014

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