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In March 2009 NDHB introduced an electronic referral (eReferral) platform for transmission of referrals to the hospital for use by Primary Care providers. In May 2012 we introduced electronic triage (eTriage) which supported web based referral triage with instant messaging back to the referrer into their electronic workflow. This delivered the expected benefits of improved communication to the referrer and a more secure, tracked and standard process. However it delivered significant additional unanticipated benefits that included: Provision of significantly more non contact outcomes for referrals Significantly reduced turn around times for referrals, often within 24 hours Provision of a rudimentary form of shared care across Northland by enabling ready access to specialist advice. We have found that eTriage is the component of a referral management system that delivers the most value. We recommend that this be a major focus for District Health Boards when developing referral pathways

At 1251 h on Feb 22, 2011, an earthquake struck Christchurch, New Zealand, causing widespread destruction. The only regional acute hospital was compromised but was able to continue to provide care, supported by other hospitals and primary care facilities in the city. 6659 people were injured and 182 died in the initial 24 h. The massive peak ground accelerations, the time of the day, and the collapse of major buildings contributed to injuries, but the proximity of the hospital to the central business district, which was the most affected, and the provision of good medical care based on careful preparation helped reduce mortality and the burden of injury. Lessons learned from the health response to this earthquake include the need for emergency departments to prepare for: patients arriving by unusual means without prehospital care, manual registration and tracking of patients, patient reluctance to come into hospital buildings, complete loss of electrical power, management of the many willing helpers, alternative communication methods, control of the media, and teamwork with clear leadership. Additionally, atypical providers of acute injury care need to be integrated into response plans.

Background and context An increasing number of drugs and blood products need to be delivered by intravenous infusion. In the Canterbury region of New Zealand, these have historically been delivered at a hospital site; however, some infusions could be delivered in a community setting without compromising patient safety.Assessment of problem The Canterbury health system has a key strategic objective of delivering care close to patients’ homes. In 2018, Canterbury district health board (DHB) put out a tender for a community infusion service that would deliver blood products and other intravenous drugs with appropriate medical oversight.Strategies for improvement Following an interview and selection process, a fee-for-service contract was developed with a group of general practices with partial common ownership. It was nurse-led with medical oversight available. In July 2018, a Community Infusion Service (CIS) was started in two urban sites in Canterbury. It later expanded to two more sites, one urban and one rural.Results From July 2018 to May 2021, over 3000 infusions and blood transfusions were delivered by the CIS across seven infusion types (blood; immunoglobulin; infliximab; natalizumab; pamidronate; toculizumab; zoledronic acid). Both general practice and hospital services referred patients to the CIS. No major incidents were reported. Patients reported satisfaction with the service.Lessons Infusions and blood products can be delivered safely nearer to patients’ homes in primary care in a New Zealand setting. Medical input was rarely required; however, the transition was resource-intensive; it required both overall process and criteria negotiations, as well as individual patient discussions. In its initial stages, the CIS did not have adequate clinical governance and operational support, which affected the speed and scale of its development.

Background and context The transgender community experiences high levels of mental distress. In the Canterbury region of New Zealand, transgender care was fragmented and there were gaps in service provision.Assessment of problem In 2019, a working group co-designed a model to coordinate and improve health care for the Canterbury transgender community. Their aim was to co-design and implement a comprehensive system for transgender health care that filled any existing gaps.Results A need was identified for support in the community for transgender patients with mild to moderate mental health needs who did not meet the threshold for referral to secondary care.Strategies for improvement Psychological packages of care were put in place in the community for transgender patients with mental health needs. In the first 9 months of the initiative, 85 patients received a package of care.Lessons This community-based model was well received by the community. Data analysis did not demonstrate a statistically significant reduction in depression and anxiety, but it did show a significant reduction in stress. Some further improvement opportunities existed, including shifting to a peer worker model and changing the evaluation tool.

ABSTRACT INTRODUCTION The HealthPathways programme is an online health information system used mainly in primary health care to promote a consistent and integrated approach to patient care. AIM The aim of this study is to perform a scoping review of the methodologies used in published impact and outcomes evaluations of HealthPathways programmes. METHODS The review included qualitative, quantitative or mixed-methods evaluations of the impact or outcome of HealthPathways. MEDLINE, Embase, CINAHL and Web of Science databases were searched. Seven programme aims were identified in the impact and outcome evaluation: (1) increased awareness and use of HealthPathways; (2) general practitioners are supported to adopt best practice, patient-centred care; (3) increased appropriate use of resources and services; (4) improved quality of referrals; (5) enhanced consistent care and management of health conditions; (6) improved patient journeys through the local health system; and (7) reduction in health-care cost and increased value for money. RESULTS Twenty-one studies were included in the final review; 15 were research papers and six were reports. ‘Increased awareness and use of HealthPathways’ was the most frequent programme aim evaluated (n = 12). Quantitative and qualitative research methodologies, as well as prospective and retrospective data collections, have been adopted to evaluate the impact and outcome of HealthPathways. DISCUSSION Assessing the impacts and outcomes of HealthPathways may be challenging due to limitations in primary data and the interconnectedness of change across the measured aims. Each aim may therefore require specific methodologies sensitive enough to capture the impact that HealthPathways are making over time.

Introduction: HealthPathways is a clinical information portal developed in New Zealand that enables general practitioners to manage and refer their patients in a local context. We analyzed specialist outpatient appointment costs in Mackay, Queensland before and after HealthPathways implementation. Methods: We retrospectively examined specialist outpatient costs for patients referred by Mackay general practitioners for conditions with varying levels of HealthPathways implementation. Ranked from most clinical pathways available to none, chronic diabetes, cardiology, respiratory, and urology visits from January to March 2015, pre-pathways, and January to March 2017, post-pathways, were assessed. Monte Carlo simulation was used to estimate cost changes. Per-visit costs were multiplied by visit numbers to estimate policy impact. Results: The mean cost per visit increased from $220 to $305 for diabetes and $270 to $323 for respiratory, and decreased from $296 to $257 for cardiology and $444 to $293 for urology. The policy impact for each disease group over 3, months after accounting for visit numbers was a likely saving of $30,360 for diabetes and $10,270 for cardiology, and a likely cost increase of $24,449 for respiratory and $20,536 for urology. Conclusions: We observed that conditions with more comprehensive clinical pathways cost Mackay HHS substantially less following implementation. Costs for low and no pathway implementation referrals increased slightly over the same period.

In 2008, Canterbury was delivering traditional hospital-centric care, with a weak primary-secondary interface. This did not meet the needs of the population, was financially unsustainable, and was adversely affecting patient care.

A nationwide program to promote preparation of advance care plans (AC Plans) was introduced in Canterbury, New Zealand, in 2013. The program was developed by local facilitators who provided support and organised education seminars and an accredited training program for health-care professionals. Information and templates for an AC Plan were available to these professionals and the community on local health-care websites and secure online systems designed to allow plans to be viewed across all health-care sectors. The number of AC Plans prepared has increased steadily, although people in minority ethnic populations or in the most deprived socioeconomic quintile are less likely to have a plan. While nurses have become the predominant group guiding people through the process of preparing an AC Plan, the involvement of staff in residential care homes has remained low. Local audit showed that 82% of people with an AC Plan died in a community setting, frequently their preferred place of death.

Aims • To determine if the HealthPathways site conforms with current best practice guidelines and health literacy principles. • To assess if the pathways are aligned with the World Health Organisation (WHO)’s principles of integrated care. • To determine if the referral and patient information on HealthPathways site is inclusive, i.e., where possible tailored to vulnerable populations (ATSI, LGBTIQ, CALD and PWD) and different age groups. • To determine if the HealthPathways site is user-friendly

INTRODUCTION Unmet needs are a key indicator of the success of a health system. Clinicians and funders in Christchurch, Canterbury, New Zealand were concerned that unmet health need was hidden. AIM The aim of this survey was to estimate the proportion of patients attending general practice who were unable to access clinically indicated referred services. METHODS The survey used a novel method to estimate unserviced health needs. General practitioners (GPs, n = 54) asked their patients (n = 2135) during a consultation about any health needs requiring a referred service. If both agreed that a service was potentially beneficial and not available, this was documented on an e-referral system for review. The outcomes of actual referrals were also reviewed. RESULTS The patient group was broadly representative of the Canterbury population, but over-sampled female and middle-aged people and under-sampled Māori. Data adjusted to regional demographics showed that 3.6% of patients had a GP-confirmed unserviced health need. Elective orthopaedic surgery, general surgery and mental health were areas of greatest need. Unserviced health needs were significantly (P ≤ 0.05) associated with greater deprivation, middle-age, and receiving high health-use subsidies. DISCUSSION To our knowledge, this is the first survey of GP and patient agreement on unserviced referred health needs. Measuring unserviced health needs in this way is directly relevant to service planning because the gaps identified reflect clinically indicated services that patients want and need. The survey method is an improvement on declined referral rates as a measure of need. Key factors in the method were using a patient-initiated GP consultation and an e-referral system to collect data.

This evaluation has explored the value of the Murray HealthPathways program against its objectives and, in particular, to explore the value of the HealthPathways program in: informing, guiding and supporting health professional practice; improving the experience and outcomes of patients and carers; and enabling health system improvement. The evaluation has also sought to inform the potential future directions for Murray HealthPathways. The evaluation process has taken place over a six-week period and has analysed data from existing sources, as well as captured new data from individual and group interviews, an online survey distributed to clinicians across the Murray PHN region and through the development of case studies illustrating key dimensions of the program and its impact. The limited scope and timeframe for the evaluation has meant that some key dimensions that would be ideal to measure were not able to be fully explored. This particularly relates to the value of the program relative to the investment of resources. The evidence that has been gathered and the conclusions that are strongly supported by those sources, however, show a program that is highly valued and valuable, and that delivers on all its objectives, either fully or partly. Great potential is seen in Murray HealthPathways as a resource now that supports, informs and guides health professionals in their practice and contributes to quality, appropriate and efficient care. In this report, the evaluation methods are described and the findings from each core method presented.

This project was implemented to identify and develop clinical HealthPathways to assist in the health management of children, adolescents and adults on the autism spectrum. HealthPathways is a web-based health information site, developed by Streamliners NZ. It helps clinicians, mainly general practitioners (GPs) to guide patients through the health system with clear referral pathways for their local area. The Autism HealthPathways were originally scoped and designed specifically for the Mackay Hospital and Health Service region with the long-term intention to share content across the national and international HealthPathways community. To achieve this outcome the project team needed to: understand the barriers and enablers to the provision of health care to children, adolescents and adults on the spectrum develop and implement evidence-based clinical care pathways for children/adolescents and adults on the spectrum evaluate health professional satisfaction with the pathway. As a result of this research the team developed autism-related content in nine HealthPathways to support the assessment and clinical care of children and adults across the lifespan. Pathways cover autism assessment and support, intellectual disability, developmental concerns, and mental health conditions, with a particular focus on post-diagnosis supports. Autism HealthPathways are now available for adoption and adaptation in 43 health regions, caring for more than 28 million people across Australia, New Zealand and the United Kingdom. To find out more about adapting or adopting Autism HealthPathways for your region, contact your local HealthPathways team directly via the HealthPathways Community website.

Clinical guidelines are recommendations targeted at medical professionals which aim to optimise patient care. When successfully implemented, clinical guidelines have been shown to improve processes of care and clinical outcomes. However, clinical guidelines are often not successfully implemented and there exists a significant variation in rates of compliance between different doctors. Factors which affect compliance fall in to four categories: patient, doctor, environment and guideline. In 2015 the Canterbury District Health Board changed to a new platform of online clinical guidance called Hospital HealthPathways. This platform differed significantly from its predecessor The Blue Book in both the development process and design of the clinical guidance. This study compared the use of and compliance with guideline recommendations between these two different platforms of clinical guidance. By doing so, this study was able to examine how guideline use and compliance is affected by the development process and design of a clinical guideline. Sub-group analysis examined how compliance varied between different clinicians, different patients, and different environments and also the interaction between these factors and guideline design. A sub-analysis examined barriers to guideline compliance reported by clinicians to understand the perceived obstacles clinicians had to following guideline recommendations. Finally, this study developed the concept of “appropriate non-compliance” by quantifying and describing cases where it was appropriate for clinicians not to follow local clinical guideline recommendations whilst managing patients.

HealthPathways (HPW) is an online health information portal which provides general practitioners (GPs), guidance on the assessment, management and referral of a range of conditions linked to local resources. However, there is a lack of understanding of the acceptance of pathways within primary health. The paper aims to discuss this issue. Design/methodology/approach This qualitative study identified baseline factors that promote the successful implementation of HPW in a major local health district (LHD) in Australia. The development, implementation and acceptance of Diabetes HPW were evaluated. A total of 16 semi-structured interviews were conducted with 12 stakeholders and 4 GPs. Interviews were digitally recorded, transcribed and analyzed qualitatively using a thematic analysis approach. Findings Four major themes were identified that promote the integration of care in the region through utilizing HPW: engagement, sustainability, transparency and accountability. Several factors identified as “enablers” or “barriers” are described at micro and macro levels of the healthcare system. Originality/value By combining the perspectives of both stakeholders and end-users, this qualitative evaluation of the localized HPW has identified relational and structural factors that promote the successful implementation of HPW to facilitate the integration of care in this LHD. Furthermore, this study provides other implementers with a comprehensive evaluation of the HPW development.