Primary Health Care

• Overview
• National Primary Medical Care Survey (NatMedCa) Reports
• Evaluation of the Implementation & Intermediate Outcomes of the PHCS
• Primary Health Organisations: The First Year (June 2002 - July 2003) from the PHO Perspective
• Intersectoral Community Action for Health (ICAH) Evaluation: An Overview
• Evaluation of Care Plus
• Evaluation of Primary Mental Health Initiatives
• Evaluation of Reducing Inequalities Contingency Funded (RICF) Projects
• Evaluation of Primary Health Care Nursing Innovations
• Future Reports

• The implementation of the Primary Health Care Strategy
• The impact the Strategy has had on the delivery of primary health care services
• Resulting changes in the health of the population

• Evaluations are independently conducted
• There is a strong formative component
• Consumer and community responses are assessed
• There is a focus on intermediate outcomes

• First year of PHOs
• Care Plus programme
• Primary Mental Health Initiatives
• Initiatives to increase access funded through the Reducing Inequalities Contingency Fund
• Primary Health Care Nursing Innovations
• Intersectoral Community Action for Health (ICAH) initiatives

1. Family Doctors: Methodology and description of the activity of private GPs;
2. Primary Health Care in Community-governed Non-Profits: The work of doctors and nurses;
3. Maori Providers: Primary health care delivered by doctors and nurses;
4. A Comparison of Primary Health Care Provided by Rural and Non-Rural General Practices
5. The work of doctors in accident and medical clinics
6. A comparison of Māori and non- Māori patient visits to doctors;
7. Pacific patterns in primary health care: a comparison of Pacific and all patient visits to doctors;
8. A description of activity of selected hospital emergency departments in New Zealand;
9. Nurses and their work in primary health care.

The Evaluation of the Implementation and Intermediate Outcomes of the PHS: First Reposrt May 2005

• A strong positive response to the goals of the Strategy
• Fee reductions seemed to be leading to improved access for key population groups
• Some concern about the sustainability of the Strategy
• Some preference for targeted funding
• Good community representation on PHO boards
• Some innovative approaches to primary health care (e.g. increasing role for nurses and community health workers; new services such as clinics and outreach services).

Evaluation of Primary Health Care Strategy: Practice Data by Dr Jacqueline Cumming and Dr Barry Gribben. September 2007

• What changes have there been in the co-payments that patients pay when they use primary health care services since the introduction of the Strategy? How are changes in fees related to government policy objectives?
• Since the introduction of the Strategy, what changes have there been in the utilisation of primary health care services by New Zealanders?
• Are more patients being seen by nurses?
• What changes are there in the pattern of ACC claims made, before and after the Strategy? Are more new ACC claims being made?

• Co-payment fees paid by patients for GMS consultations
• Utilisation rates for a fixed cohort of patients registered 12 months before the change to PHO funding
• Proportion of visits recorded with a nurse as the practitioner
• ACC claims - the proportion of consultations for which an ACC claim was made
• ACC new claims - derived from ACC data

• Actual fees charged to patients are falling but the amount differs between age groups and different funding models.
• Access practices are generally achieving low fee goals but this has been through small reductions in actual fees charged
• In Interim practices the greatest reductions are in the 65+ age group.
• The data suggests that although the fee reductions were not always as high as desired that overall fee reductions were greater for Māori and Pacific (reflecting their greater enrolment in Access PHOs), patients from lower socio-economic groups (though not always) and those in Access practices. These are the population groups that were more likely to see cost as a barrier.
• Reductions in fees were greater for those who had not had a CSC card than those who had, as would be expected
• The proportion of ACC claims and the proportion of new ACC total claims do not show any change before and after the introduction of the Strategy. This suggests that practices are not shifting costs to ACC
• Consultation rates are raising in all age groups
• This pattern is also noticeable in the 18 - 64 age group in Interim Practices where the roll out had not taken place where the roll outs had not taken place at the time of the analysis.
• The research focused on actual fees charged rather than scheduled fees for which the Government required.
  
  A number of further reports are expected in 2007. Topics include reports on fees and utilisation over the last five years in 125 practices, governance of PHOs, primary health care nursing, general practices and the impact of the Primary Health Care Strategy on Maori and Pacific peoples.
  

• Give an overall description of PHOs, including structures, processes and services
• Describe the participants’ experiences of PHO implementation
• Describe participants perceptions of the strengths and weaknesses of PHOs at that early stage of implementation

• Improve management of chronic conditions
• Reduce inequalities
• Improve primary health care teamwork
• Reduce the cost of services for high-need primary health care users

• Improving access
• Liaison and integration of services
• Improving patient outcomes
• Education and training
• Decision support and IT
• Service provision to specified population, for example, Maori, Pacific and youth

• Community Health Workers - the delivery of health care services in the home and community
• Free / low cost access to services - various mechanisms are employed to reduce access costs
• Centre based activities - the delivery of health care services to particular age groups in non-traditional settings, generally in community facilities owned or used by the target group
• Outreach services - these service aim to reach out to people in the community to assist them with their health and social needs

• Experience of Maori in Maori-led PHOs compared with Maori in ‘Mainstream’ PHOs
• Experience of Pacific in Pacific-led PHOs compared with Pacific in ‘Mainstream’ PHOs
• Further analysis of data to demonstrate the role of fee changes in relation to utilisation of services
• Intermediate outcomes, quality of care (performance management measures)
• Repeat of analysis in 2008 to include all age groups over a longer period

• PHOs – Characteristics, Relationships, Roles
• Practices – Workforce, Teamwork
• Nursing – Roles, Training, Workforce, Teamwork
• Financing & fees
• Māori health & experience of Māori PHOs
• Pacific health & experience of Pacific PHOs
• Impact on ACC claims
• Population health, Access, Service Delivery and Community Engagement

• Which groups in the population benefit?
• Overall costs
• Value for money