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Collaborative approach leads to fewer hospital stays for Tairāwhiti kids


Health providers in the Tairāwhiti-Gisborne district have worked together to reduce the rate of avoidable hospital admissions among the district's most vulnerable babies and young children.

Figures released by the Ministry of Health in January revealed that ambulatory sensitive hospitalisation (ASH) rates for children from birth to four in Tairāwhiti have decreased, with both Māori and total rates for this age group at or below the national average for the first time. This reflects a steady downward trend among these populations since 2012. 

Ambulatory sensitive hospitalisations refer to mostly acute admissions regarded as avoidable if treated earlier in a primary care setting. These include conditions such as gastroenteritis, asthma, pneumonia, bronchitis and upper respiratory tract infections, cellulitis and skin infections, and acute dental conditions.

Tairāwhiti has a large portion of its population in the lowest socio-economic group in the country - 48 per cent are in the most deprived deciles - and they are more likely to be at risk for these conditions and unnecessary hospital admissions.

"It shows that when you put in the energy and dedication, you get tangible changes in the health of a community," said Jim Green, CE of Hauora Tairāwhiti (Tairāwhiti District Health Board).

Mr Green said primary care providers in Tairàwhiti have played an important role in reducing ASH rates, in particular with their prompt response to skin conditions such as cellulitis, which had been an ongoing issue for vulnerable children in the Gisborne district. "This is a prime example of the responsiveness of primary care," said Mr Green. "They identified the problem, took time to analyse the problem, looked at solutions, implemented them and observed the benefits."

He also acknowledged the work of hospital staff and professionals across the whole healthcare sector, who have worked together to make changes. The Government's Healthy Homes Initiative has also played a role. "We have the highest number of retrofitted houses in the country, and we are beginning to see the impact of drier, warmer, healthier homes," said Mr Green.

John Macaskill-Smith, CEO of Pinnacle Midlands Health Network, a not-for-profit network of doctors and more than 80 practices across the Midland region, said that it was fantastic to see Tairāwhiti's young children benefitting from the collaboration of many.

"We sat down and wanted to make a difference to young people - the primary health providers and the District Health Board," said Mr Macaskill-Smith. "A clinical response isn't enough to make a difference. A whole system approach is required. To have an impact we have to look at the big picture, including social and environmental factors."

He is proud of the role Pinnacle practices have played in meeting the needs of the district's children and their families. "To practices we want to say, 'well done'! Some of these issues we are describing are not short term fixes. They require consistent attention," said Mr Macaskill-Smith.

He said that Pinnacle practices have systems in place to more consistently identify children and families at risk, and respond to that. Standardised tool sets are used across the service, and practice teams use a Patient Prompt system to identify patients who have a gap in their health care, such as children who are not up-to-date with immunisations. "Things can slip people's mind and then a minor issue becomes an acute issue," said Mr Macaskill-Smith.

Medical Director for Pinnacle Midlands Health Network, Dr Jo Scott-Jones, says the ASH rate decline is good news for the district - especially for children and their families. Dr Scott-Jones has spent almost three decades working as a GP, most of that at his practice in Opotiki.

"From a primary care perspective it's good for our community that children are not ending up in hospital unnecessarily, and that reduction in hospitalisation makes a big difference for parents and families," said Dr Scott-Jones.   "Being admitted to hospital can take days out of life - days off work for parents and caregivers, which can have an impact on the family's finances, and days off school for the child and possibly their siblings - so there is a greater impact to hospitalisation of a child than you might think."

Mr Green said the district health board is committed to making a difference for children in the first five years of life, especially the most vulnerable 20 per cent of kids. "Our goal is to have the happiest, healthiest kids in the world at the age of five, and the reduced ASH rates are evidence that we are doing it."


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