New Zealand Cardiology Wards and Adventures Taylor Myers Locke.
Post on 28-Dec-2015
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Objectives
• New Zealand Healthcare System
• Cardiovascular care in New Zealand
• Identifying cardiovascular at-risk populations
• Improvements in the Cardiovascular Healthcare delivery
• Comparison to Kansan’s health
• Kansas Heart and Stroke Collaborative: understanding, identifying, and comparison
• New Zealand adventures
New Zealand Healthcare Model
www.moh.govt.nz
• Funded by public, private and nongovernmental sectors
• Tax resources provided 83 percent of healthcare
• Improvement needed• Rural
• Asian, Pacific Islander,
• Maori adult population
• Systematic care
District Health Boards
• Non-profit boards made of a combination of elected, appointed and Maori representatives
• responsibility of healthcare planning, funding and implementation is broken up geographically
• High degree of autonomy
• Not all created equal
http://www.whyora.co.nz/Understanding-health/Health-Systems/
State of New Zealand Cardiovascular Disease
• Heart disease accounts for 30 percent of national mortality
• Increasing admission rates for ACS and AMI
• Multidisciplinary approach to heart failure treatment
Elliott J and Richards M.
Maori Population
• Comprise 15% of New Zealand’s population
• CV disease (CVD) is highest
• Coronary Artery Disease Death occurs on average a decade earlier • < 65 in 45 % of Maori population vs 11% in non-Maori
• Increased CVD risk factors• Smoking, hypertension, diabetes mellitus
Whalley GA, et al.http://www.businessinsider.com.au/jimmy-nelsons-tribal-photos-before-they-pass-away-2014-2
ACS NZ Audits and Improvements
• Started in 2002, aimed to improve ACS outcomes
• Identified weaknesses with rural and Maori populations, 50% less investigations and revascularization procedures in certain DHBs
• The 2012 audit recognized gaps in access to echocardiography, cardiac angiography, and delays in care at non-intervention centers
NZACS SNAPSHOT Audit Group
Comparison to Kansans?
• Large rural population resulting in lack of access
• Coronary heart disease mortality rates have decreased at national and state level
• Highest mortality rates in rural Kansas
• CAD risk factor rates have increased• Diabetes mellitus, obesity, hypertension
Kansas Department of Health and Environment
Kansas Heart and Stroke Collaborative
• Transforming model of care for heart and stroke disease, in areas traditionally with limited access
• Preventative and post event care managed by care managers and health coaches within the community
• Developing shared clinical guidelines, and EMRs
Ranney, Dave.
Key Contrasts
• Combining preventative to quaternary care (like the DHBs in New Zealand)
• Shared Clinical Guidelines
• Community healthcare providers to help manage patient with diagnosis and discharge• Heart failure nurse managers in New Zealand
• No national EMR and poor information exchange
Kiwi Healthcare Culture
• Young Pacific Islander immigrants or Maori population hospitalized for CV disease
• Reasonable expectations for disease state and end-of-life
• Conscious of ordering unnecessary tests and procedures
• Long wait time for specialist care and work up
• Heavily dependent on general practitioner
http://www.kiwibird.org/
Clinical Experience
• Mr. S had right sided heart failure with subsequent end stage liver disease requiring Lasix drip, followed by pressor support
• Family highly involved in care
• Stayed on cardiology ward throughout stay, never in CCU or MICU
• My work up and management differed• Maybe less is more?
Conclusions
• New Zealand health infrastructure is evolving, but well managed and providing quality care throughout the nation
• New Zealander’s struggle with cardiovascular risk factors and disease, especially the Maori population
• Community support and standardization throughout New Zealand is a model that is loosely reflected in the Kansas Heart and Stroke Collaborative
• Clinicians should be open to change and challenged to provide the best care possible
References
• New Zealand Health System Review. Health Systems in Transition, World Health Organization, Vol.4 No. 2. 2014.
• Whalley GA, et al. Higher prevalence of left ventricular hypertrophy in two Māori cohorts: findings from the Hauora
Manawa/Community Heart Study. Australian and New Zealand journal of public health. 2015-01-05;n-a-n/a.
• Elliott J, Richards M. Heart attacks and unstable angina (acute coronary syndromes) have doubled in New Zealand since
1989: how do we best manage the epidemic? N Z Med J. 2005;118 (1223).
• New Zealand Acute Coronary Syndromes (NZACS) SNAPSHOT Audit Group. The management of acute coronary
syndrome patients across New Zealand in 2012: results of a third comprehensive nationwide audit and observations of
current interventional care. N Z Med J. 2013 Dec 13;126(1387):36-68.
• Ranney, Dave. "Moser to Lead Heart Disease, Stroke Collaborative at KU Hospital - See More At:
Http://www.khi.org/news/article/moser-lead-heart-disease-stroke-collaborative/#sthash.Zik3k6bG.v6EtJs8Y.dpuf." Kansas
Health Institute. 5 Dec. 2014. Web. 24 Mar. 2015.
• "Working Together for a Healthy Kansas: Kansas Action Plan for Heart Disease and Stroke Prevention, 2012-2017." Kansas
Department of Health and Environment. Heart and Stroke Alliance of Kansas, 1 Apr. 2013. Web. 24 Mar. 2015.
<http://www.kdheks.gov/cardio/download/CVH.pdf>.
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