Kiwi pioneering spirit running high at Taupō Medical Centre

17 Aug 2017
Kiwi pioneering spirit running high at Taupō Medical Centre

Taupō Medical Centre is a place where innovation has truly become the norm and the expectation in their unrelenting quest to make things better for their patient population.

They've fully renovated their building, creating a healthcare precinct which is alive and buzzing with the Pinnacle Midlands Health Network extended care team, Pathlab and TRG radiology all co-located with their practice.

On top of the improvements to their physical surroundings, Taupō Med have also implemented a raft of new ways to work by becoming a Health Care Home. This includes things such as using patient portals to improve communication and access, holding team huddles, and using a phone triage system to better manage time for patients and GPs.

But it doesn't stop there. They got behind the "doctorless" clinic in South Taranaki by providing comprehensive virtual health consultations while the Patea and Districts Medical Trust continues to recruit a GP, and they're poised to implement a brand new patient management system, indici. This will push the boundary on the concept of a shared medical record, while putting the patient at the centre of their health record management.

Taupō Med have also been exploring how to use shared medical appointments (SMAs) and group consultations in the New Zealand context. While relatively new to our shores, the concepts have been used in the United States for about 20 years.

"The idea with a SMA is to get a group of patients together, still engaging in a 1:1 fashion, but there are other people in the room," says trained SMA facilitator Dr Glen Davies of Taupō Medical Centre.

"There's a wealth of evidence that tells us this setting can be more beneficial than the traditional consult, the patient interaction - that peer-to-peer sharing - cannot be underestimated."

In May they set up a Chronic Obstructive Pulmonary Disease (COPD) SMA.

"A shared medical appointment isn't just an education session. As a clinician you are still engaging with a patient 1:1, you just have to get your head around the fact there are others in the room, and at times those other people have valuable additions to make," says Dr Giles Turner, GP lead for the group.

"A younger member of our COPD group was still a smoker and she clearly had reservations about some of the smoking cessation suggestions I had for her.

"During our conversation an older women in the group shared her personal quit journey and it was brilliant. The young woman really responded her, partly due to her mana as a kaumātua, but also because she was able to talk from the heart. The interaction between the two was beautiful, they had an amazing connection, and I saw true change at a core level -a result we wouldn't have seen without the SMA setting," shares Dr Turner.

There are of course privacy considerations made. Confidentiality paperwork is formally signed by all attendees and staff, and there is time set aside after the SMA for feedback and conversation. Group facilitators need to be specially trained to help create a safe shared space for all participants.

Taupō Med hope SMAs will become the way they interact with most chronic care patients, and plan to be running 10 per week by this time next year.

Taupō Med are also exploring the possibilities that group consultations bring, starting with one particular whānau group. This has been led by Pinnacle Midlands Health Network lifestyle coach/exercise consultant Wendy Crisp.

"We had a patient who suffered a myocardial infarction (MI). Her whānau wanted to support her in regaining her health. Other members of the group have diabetes or obesity, and as a whānau they all felt ready to address their lifestyle choices.

"We set up a whānau wellness group where 14 family members have come together on a wellness journey," says Wendy.

The whānau wellness group has had eight sessions to date, with improved health outcomes such as reduced blood glucose levels and weight loss already seen, alongside improved health literacy and fitness levels.

"We've covered reading food labels, ran blood tests and reviewed and explained the results, carried out physical fitness testing, had an inspirational session from someone who had lost 100kg through lifestyle changes, and experienced a cooking session where the family made and enjoyed hummus," explains Dr Davies, another of the groups facilitators.

Dr Davies enjoys working with this group enormously, and sees a lot of value flowing from the initiative.

"Working alongside this whānau group has been a deeply moving, spiritual experience. It's been such a privilege to witness the humour, courage, love and deep respect for one another this family shares."

But the most exciting thing for Dr Davies has been watching the personal growth, with members of the group now becoming true health champions.
"They are training to run groups themselves and share their knowledge with others. They are building a YouTube channel to share their unique wisdom and humour - that's the ripple effect," explains Dr Davies.

The family also have started a private Facebook group called Ko tahi Tangata Toa to provide ongoing support as they progress to self-management.
Taupō Med are also working with the Taupō District Council to tackle the "obesogenic environment" with a project called Reverse Diabetes Taupō. This will explore how the Taupō community can work together to make the right choice the easy choice.

"Primary care has to do better than we have been doing. As a practice we are putting our hand up for anything that Pinnacle and Ventures throw at us. Perhaps some of these ideas will become the basis and catalyst for the much needed change we need to see in our sector," hopes Dr Davies.