Primary and Capitation funding to PHO ensure
Primary health care contribute greatly to communityhealth.
This essay will discuss vision and key direction of primary health carestrategy with NewZealand Cancer Care plan contribution to development of primaryhealth care system .This essay focuses on smoking as a modifiable risk factorfor lung cancer. Primary health care nursing intervention to manage effect oflung cancer on patient, family and community will also be discussed.
Primary Health Care strategy (2001) comprises clearvision and directions for improvement of primary health care which aimed to beachieve within 10 years of period. Thevision of primary health care Strategy focused on Population Health Approach.(Ministry Of Health MOH, 2017a). Firstly vision aims at active contributionof local community in primary health services by development of Primary HealthOrganization (PHO), working toward voluntary enrolment of people and involvingpeople in making own health decision. To make health services easily accessiblein coordination with ongoing care, Primary Health Care deliver range ofpromotion and preventive health services, with the help of range of healthprofessionals (multidisciplinary teams). (Pack, Minister,Churchward &Tanuvasa,2013)Another part vision mainly to work toward making allprimary health care services accessible to all community group equally.
Measuresincluded such as Fair allocation of funding to provide high quality services tounderprivileged groups (Maori and Pacific) and Capitation funding to PHO ensureequality in health status of all community group.( May&Blick,2008) .Encouraging Involvement of Maori and pacific provider in primary health careservices to reduce disparity in health status (MOH, 2001a)To accomplish these vision, six directions been laidout in Primary health care strategy.
First key direction focuses on activeparticipation of local communities and enrolled population. Primary health organizations(PHO) need topromote community participation by responding to their needs, encouraging PHOenrolment, providing thorough information about available health resources. (MOH,2001b).Patient engagement in health services also encouraged through interventions suchas patient’s access to own health record information resources thoughpatient portal, seeking patient’s perception toward care delivery services. (Health quality and safety commissionNewzealand, 2017). Second direction is to reduce inequality in healthstatus of different groups.
This is being achieved by PHO by identifying underprivilegedgroup (Maori and pacific), encourage their enrolment in PHO and implementingcommunity specific interventions to address their needs. (MOH, 2007a).Measures implemented:consultation fee reduced for Pacific patients by 12% and for M?ori by 10%. Pacificled PHO and access PHOs has been developed (Cumming & Gribben ,2007).Third direction emphasise on provision of accessibleand comprehensive health services. PHO contribute to this by providing screeningand preventive service, supporting patient with chronic illness, fairallocation of funding and education regarding optimal use of all services.Report published by Health Services Research Centre, on evaluation of primaryhealth care strategy in 2005 shows that Government funding for primary healthcare has been increased to make services cost effective also more peoplegetting subsidies.Fourth direction focuses on providing coordinatedcare to enrolled population.
PHO and District Health Board (DHB) willcollaborate with local bodies, education, welfare, housing and public transportprimary public health, and mental health and disability services. (MOH 2017b)with this direction Ministry of social development developed Joint strategicPlanning approach to ensure cross-sectoral coordination in 2003(MOH 2009).Fifth direction involvePrimary workforce development & strategic plan to attract and retain workforcein rural health MOh.2008) The Public Health Workforce Development Plan(2007-2016) adopted this direction by focussing on providing emergency trainingand health promotion skill development to primary care staff. (MOH, 2007b)Sixth direction is improving quality of service byperiodical audit to review the PHO workers knowledge and work. Effective collectionand storage of information of public with maintain confidentiality to easy andcost-effective access of patient information to health professional undersecure guideline and government agencies to decide reforms to be doneformulating future strategy. (MOH,2007c) In 2012, 21,235 diagnosed and 8500 died with cancerin New Zealand (MOH, 2015). New Zealand Cancer Plan 2015-2018 is developed byMinistry of health to curb the high prevalence of cancer in newzealand.
Mainfocus of the plan is to provide high quality, effective, accessible andequitable cancer services for early diagnosis and better recovery (MOH, 2014a).The objectives are to reduce incidence of cancer byintroducing health promotion measures like healthy nutrition and lifestyle modification,to encourage early detection and prevention by easy access to informationresources, to develop primary health care services& screening servicescloser to community. Also to Increase chances of recovery immediate referral tospecialist services equipped with high end equipment and trainedprofessionals.) and to ensure fair allocation of fund to cancer services (MOH,2014b)In order to evaluate contribution of at primaryhealth care level can be seen by the new target introduced in plan is patient withhigh suspicion cancer need referred urgently to enhance recovery. To meet thistarget PHO has adopted guideline of clinical pathway approach (early detectionprevention, diagnosis and treatment and follow up care) to streamline theprocess of r referral to higher centre. (Central PHO, 2018). The contribution of primaryhealth care services can be seen as 90% of patient referredwith symptoms of cancer recived treatment within 62 days ,in year 2016-2017.(MOH,2017a)Health promotion measure under this plan is Implementationof the Better help for smokers to quit health target 2016/2017.
under thisdifferent measures introduced to help people quit smoking like free NRT andcounselling.in community. Efficacy of this initiative can be seen as In fourth quarter of 2017,Sixteen PHOs havemet the 90 percent target.
86.6% of PHO enrolled patients quit smoking (MOH,2017b).Strengthening Cancer Nurse Coordinator Initiative allowcommunity an access to nurse cancer specialist at primary level care. CNC issource of information regarding cancer and available resources, treatmentmodalities for community. (Kerr,C.2016).).The main role is to equip community with knowledge to help them to takeinformed decision about cancer treatment.
As per MOH 2016 evaluation reportCNCI has improved Patient’s access to diagnostic and treatment services,improved patient experience of coordinated clinical pathway.In prostate cancer services, prostate cancermanagement and referral clinical guidelines were released in July and September2015 to help Primary health care professionals to monitor the side effect ofunnecessary treatments for men with low-risk prostate cancer. It will also helpcommunity to acknowledge about possible damages and benefits of testingtreatment options. so patient, family and community can make informed decisions.(Prostate cancer Foundation OfNewzealand,2017)Regional Cancer Networks have restructured theirstrategic plans in align with new objective of this plan. For example Midlandstrategic plan (2015-2020) included new initiatives like modified screeningservices, early referral, more coordination between PHO, DHB and Specialistoncology services.
(Midland Cancer Network,2016) TASK 2The main modifiable risk factor for lung cancer isconsidered as smoking. Among lung cancer patients 80% are smoker in New Zealand.90%of lung cancers are attributable to tobacco smoking. Around5000 people die each year in New Zealand because of smoking or second-handsmoke exposure (MOH, 2017c)Tobacco smoke contains many carcinogenic factor. Thestrong correlation between smoking and susceptibility to lung cancer due thesmoke associated respiratory carcinogen.
(Adam & Chandrakumar 2015) A smokerincreases their risk of cancer because the chemicals in cigarette havemutagenic property damage DNA and immune system. DNA controls normal cellgrowth. Smoking causes some mutation in DNA. Weakened immune system fails toprotect lungs against this resulting in destruction of lung epithelium andcilia which are protective structure of lung, eventually Lung loses itsfunctionality and structure due to effect of carcinogen of smoking.
( Xue ,Yang & Seng 2014)To reduce the prevalence tobacco smoking in NewZealand, Tobacco Control Program came into action in 2005.Tobacco controlprogram aim to prevent initiation of smoking, early intervention among smoker,helping to quit and stick to it. Interventions included in tobacco control plancommunity based smoking cessation services like Nicotine Replacement Therapy andbehavioural counselling therapies through DHB and PHO, QUITLINE and other massmedia campaign to target adolescent, e-cigarette to avoid second hand smokingand Smoke-free Environments Regulations 2007 enforcement. (MOH, 2016b) To evaluate contemporary nursing management in thisinitiative is delivering community based health promotion services.
PHO using OccupationalHealth Nurses to reach out to the people in community. PHO provide them training,resource, referral and follow up guideline to approach people for smoking cessation.They mainly intervene with the workers who may not visit their GP.
OccupationalHealth nurses does Screening for tobacco use, encourage and support smokers toquit. Occupational also make sure that smoke free environment regulationfollowed at workplace (MOH, 2015).The Target of Better help for smokers to quit hasbeen incorporated in this program.
Primary health care nurses providecounselling Using ABC (Ask,brief advice, cessation) approach for smokingcessation and Provide Nicotine replacement treatment. The success of this programcan be seen as Better Help for Smokers to Quit 2016/2017 target nearly 90%percent of PHO enrolled patients who smoke have been offered help to quitsmoking. Sixteen PHOs have met or exceededthe 90 percent target and five PHOs have improved their performance by morethan five percent.(MOH,2017d).Primary health care nurse also work mainly withpregnant women who smoke providing medication and counselling regarding adverseeffect of smoking on pregnancy(McRobbie, 2013)Effect of smoking cessation interventions, smokingrate for adults has declined from 20 percent in 2006 to 16.6 percent in 2014likewise in adolescent students.
The gapbetween the M?ori (7.17 percent) and non-M?ori (2.81percent) rates of smokingis reducing.
Adult per capita consumption of tobacco has dropped byapproximately 23 percent between 2010 and 2014. (MOH,2016c).While, Even after all this measure some pitfalls hasbeen identified in thi program. Massey university Published program evaluation report in 2014 oneffectiveness community services, it has been noticed that some community grouplike Maori, Pacific and pregnant woman still had quit rate at its lowest around4% 7% and 30%.in 2014 . To address this program need to be reviewed withemphasis on community based services like face to face counselling andbehavioural support by primary health care professionals.
Funding to communitybased services to get free smoking cessation support has been increased. These measurescontribute to address identified issues in program. (MOH, 2014)Smoke free nurses New Zealand is initiative of NewZealand practicing registered nurses to reduce smoking not only in communitybut among nurses. Strategies implemented under this initiative are, Collaborationof nurses working in DHB,PHO and tertiary institution, maintaining equity byformulating Maori and pacific oriented strategy. It also involve differentnursing intervention like supporting and conducting Smoking cessation researchand campaign,providing Support tobacco control activities and MOH targetSmokefree 2025, reduce smoking among nurses.(smokefreeNurses,2010)Under this initiative Primary health care nursesinvolvement to target smoking cessation in community setting is fostered.Nursing intervention include nurse prescribing of stop smoking medications, andnurse-led stop smoking clinics with individual and group-based treatment. Thesmoke free nurses developed website to provide one stop-shop source for informationfor Primary health care to deliver effective smoking cessation interventions.
(Smokefreenurses,2010)To support the Effectiveness of Program there hasbeen increase in knowledge of GP clinic staff regarding smoking cessationintervention. Many students admitted that online website has useful informationtailored to student smoking cessation need. An online campaign what smokerreally want which focus on teaching nursesto find out real need of smoker & intervention to meet those need receivedaward for professional development .
It is reported the advice and support fromnursing staff increased people’s success in quitting smoking. (Smoke-freeNurses, 2010)However, this initiative still lacking in coverageof primary health workforce in rural setting. Intervention needed to addresssmoking incidence in Maori & pacific smoking. ( T.Rangahau,2015) In Response to this,smokefreenurses has set vision ‘Primary Health Care Nurses leading Smokefree Aotearoainto 2025’ which aim to train Maximum Primary health care nurses to implementdifferent health promotion measures like smoking cessation campaign incommunity. Also to promote primary health care nurses to work with communitylike Maori, pacific, mental health and pregnant patient to reduce smokingprevalence.
(MaryCathew,2015)TASk3Primary health care nurses are responsible to meetphysical and psychological demand of individual, family and community groupimpacted by lung cancer.(Mcmurry and Clendon,2010). Important interventionregistered nurse working in primary health care for lung cancer patient toward providingsymptomatic treatment.
Interventions involve Assessment, Management andmonitoring of symptoms in lung cancer Patient’s Symptoms prevalent in lungcancer patient Breathlessness and cough in lung cancer patient teachingbreathing exercises, positioning, pacing ,huff coughing techniques at home,.Primary Health Care Nurses should identify medical emergency and need forimmediate referral to specialist services (Wisemen, 2012). Another symptomsPain need to assess try to manage by teaching complementary method likerelaxation & distraction technique, need to refer to primary health care practitioner to prescribeanalgesic like opioid for chronic pain.
(Leader,2015)Primary care nurses should keep Palliative careapproach while managing lung cancer patient. Nurse need to recognise an illpatient after chemotherapy and implement a plan. The plan need to be outlinedin coordination with specialist cancer nurse to manage symptoms of adverseeffect of chemotherapy. For example nausea, bowel distress, fatigue to drug canbe manage by advising patient to take prescribe drug like ondansetron ,encouraging fluid intake and diet modification(Tariman & Szubski,2015).
Nurses need to consider holistic approach whiledealing with the patient with lung cancer, In order to support cancer patients,nurses need to identify different psychological, social, emotional needs ofpatients to improved chances of positive outcome. Being diagnosed as cancerpatient itself is disastrous for patient nurses need to invest time in buildinga trusting relationship with their patients. Using Good communication skillsand empathetic approach can identify the special needs of patients Buildstrong support system around patient involving family and community member (.
O’conner ,2017) Also identifyspiritual needs, Promote cultural practices like prayer to strengthen copingmechanism.( Hatamipour,&Rassouli 2015 ) Intervention needed to manage family member of lungcancer patient as they also suffer with stress and uncertainty related to newlydiagnosed lung cancer. Around 80% of lung cancer patient’s family experiencesome level of psychological distress throughout process.
(Mosher & Champion, 2016).Primary health care nurses have the opportunity to reduce anxiety due touncertainty about disease by giving information about treatment course,, sideeffects of treatment and their management, emergency management,exercise-related information, resources available to make family member fullyequipped to care for lung cancer patient. Support and assistance dealing with symptoms.It has been noted that providing appropriate information and psychosocialsupport to family member associated with less unmet need in patients and increasedshared informed decisions regarding treatment.
(A. Skufca-Smrdel, 2017)Nursing intervention for family needed to managefinancial burden in family due to anticipated high cost of lung cancertreatment. Nurse should advocate for best and cost-effective possible options deliveryto patient as nurse is most trusted health team member. Nurses need to raiseaware ness regarding different policies and program available in health setting to reducefinancial burden of cancer treatment on family.
(WHO 2008a ) For example in newZealand Tarceva funding is available to people with locally advanced ormetastatic non-squamous, non-small cell Lung Cancer (Hicks & Wong, 2013).Lung cancer rates were significantly higher in MaoriContributing 50 % excess deaths per year. Lung CancermDeath rate is higher inpacific men.
(Teng Atkinson,), Nurses working with these communities needto raise awareness regarding, importance of screening for early detection,cancer treatment and Palliative care options available for community As stated inreport Many Maori patient are ignorant that hospice care is free of cost in New Zealand. (MOH, 2005) .Nurses need to modify this informationresources in community specific language to reduce communication barrier. Nursescan collaborate with Maori and Pacific community member to provide effectiveinterventions in community setting. Survey Result of contribution of Maori HealthProvider s contribute to cancer prevention, screening and care by delivering awide range of programmes, including health promotion, advocacy, information andsupport alongside clinical care. ( Slater,Matheson, Davies,Goodyer, Holdaway, Loschmann 2016) This essay has discussed vision and key direction ofprimary health care strategy along with effect of New Zealand cancer plan2015-2018 on development of primary health care.
Smoking has been considered asmost prevalent risk factor for lung cancer.to reduce incidence of smokingtobacco control initiative and smoke free nurses initiative has discussed.Primary health care nurse interventions for lung cancer as a health promotion,advocating best treatment, community specific measure and cancer symptomsmanagement has been discussed.