Gerontology Nurse Specialist in Primary Care
In September 2010, HWNZ, together with Waitemata PHO, the University of Auckland, and Waitemata DHB, established the Gerontology Nurse Specialist (GNS) in Primary Care demonstration, a nurse-led initiative with a preventative and early intervention focus.
With the rapidly increasing older adult population, there is an increasing need for a nurse role with gerontology expertise to meet the needs of this group.
The demonstration took place from September 2010-July 2011 and focused on care coordination for at-risk older adults, aiming to ensure efficient management of services, sharing of patient information and improved liaison between community and secondary care services.
The GNS operated within an integrated health model, based in Waitemata PHO. This model enabled the nurse to serve three primary healthcare practices, with the support of the PHO. The GNS coordinated care with various providers working with older adults in the community, as well as with the speciality services at Waitemata DHB.
The objectives of the demonstration were to:
- Provide a pathway for the development of a specialist gerontology registered nurse in a PHO/primary care environment
- Up-skill general practice teams in the management of high need older adults in the community
- Provide systematic proactive screening in primary healthcare for high risk older people
- Provide a comprehensive gerontology assessment in primary healthcare
- Increase care planning using IT-based decision support
- Improve the co-ordination of care for the older adult in the community by ensuring appropriate access to interdisciplinary teams across primary, community and secondary services.
A comprehensive external evaluation was undertaken which found that:
- The GNS role received high levels of patient, practice and stakeholder support, and was an effective way of delivering comprehensive care as well as building gerontology specialist capacity in primary care.
- The BRIGHT screen was a cost-effective tool for systematic screening of the Older Adult population.
- The integrated health model was effective in developing geriatric specialist skills into primary care.
- The model provides a mechanism for the up-skilling of the primary care workforce in older adult care.
Positive benefits experienced by health professionals and patients included:
- The GNS saved GPs’ and practice nurses’ time.
- The GNS was an important liaison point for health professionals, older people, and their families.
- The GNS was able to spend more time with older people to thoroughly assess health problems and manage them appropriately.
- Patients found the GNS to be very knowledgeable, thorough, capable, flexible, and accessible.
The evaluation report recommended that the demonstration move to a second phase; a health care utilisation and cost effectiveness trial. It also recommended that the demonstration be expanded to include rapid response co-ordination for people newly discharged from hospital and early intervention for dementia care.
Read the full evaluation report ‘Evaluation of a Gerontology Nurse Specialist in Primary Health Care’ (PDF, 2.85MB)
The second phase of the Gerontology Nurse Specialist demonstration is now underway and HWNZ will continue to partner with Waitemata PHO and the University of Auckland to consider the cost effectiveness of this model of care and how it enables integration between primary and secondary care.
The demonstration will look at the transition of care for older people newly discharged from hospital, and will include a telephone call and a home visit by the nurse specialist. It will also expand the scope to develop an education and IT toolkit for GPs’ for earlier recognition and diagnosis of dementia.
The evaluation for this phase will include healthcare utilisation costs (hospital bed days, emergency admissions, pharmacy utilisation and professional health care provider utilisation).
There are strong indications the model could be very cost-effective and the next round of evaluation results will inform plans for wider roll out.
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