Clinical Mgmt Update

[Shared by email 10/02/22]

Dear Practice Managers, Please read the following updates on the clinical management of Covid-19 patients in the community:

CCCMS Roll out As shared in recent comms, the Covid Clinical Care Module (CCCM) system (previously named ‘BCMS’) will be going live today (Thursday 10th February), however locally we wanted to reiterate that we will take some time to fully transition to using this system within our region – to allow PHOs and Practices alike to gain confidence and training in its use, and to fully understand the changes that moving to this system will have on our current processes.

In the meantime, we encourage practices to identify relevant practice staff and enable them to complete training on this system in preparation. If you need information about the training available, contact your practice liaison.

•

A key change as of 10th February is that practices will receive notification of positive patient directly to their PMS inbox, following public health (TTO) process completion. You will still receive an emailed referral to accompany this as we transition to using CCCM. Please note – even if your practice is not currently accepting the care of your enrolled patients who test positive for Covid19 you will still receive this notification. CPRT will manually re-assign these patients elsewhere for clinical care.

•

In the instance where a practice receives inbox notification of a result prior to public health involvement (e.g. result direct from Pathlab) practices can choose to either make direct initial contact with this patient to complete Initial Assessments and carry out additional steps (as laid out below) OR they can wait until the Referral is received by email from CPRT (as per current process).

Current Process for Covid-19 Positive Case Referrals This is a reminder of the current practice in Western BOP for a patient that has tested positive for COVID-19. *Please note – this process will likely update if/when we enter Phase 2 of the Omicron outbreak and as we transition fully into using CCCM. Please refer to the BOP Clinical Guide for more information to support this: Covid19_BOP_Community_Care_Clinician_Guide_V2_221221.pdf (wboppho.org.nz)

Scenario 1 • • •

Positive case confirmed by TTO. TTO completes public health unit assessment process.

Referral emailed to CPRT. Practice will also receive direct notification to their inbox via CCCM. CPRT contacts GP practice directly with TTO Clinical and Mannaki Referral form.

• • •

GP confirms they will take on clinical care for patient to CPRT team via email (by 3pm same day, or 9am following day if received after 3pm) GP completes Patient clinical assessment.

Practice confirms Level of Care & Pulse Ox Requirements by email to CPRT.

Scenario 2 • • • •

Positive case confirmed by Pathlab – GP receives positive case direct to GP inbox.

This notification is prior to TTO process, prior to referral being sent to CPRT. GP chooses to wait for referral/notification to come through (as per Scenario 1) OR: GP makes contact with COVID-19 positive patient - completes initial Patient clinical assessment.

In this scenario, practice must inform CPRT that they have received the positive result, and are making initial contact – and complete the following steps: •

• •

•

Advise the patient: Their positive test result; That they are required to isolate at home; That all their household members should get an immediate COVID-19 test and stay home.

Household members can leave isolation to get tested; That they are likely to receive multiple calls in the first few days from different agencies.

As long as there is no immediate need for COVID-19 care, advise the patient that Public Health will contact them regarding contact tracing, what will happen next and what they need to do.

Following initial virtual assessment, the practice must send an email to the CPRT confirming the Provider delivering care, the Level of Care (1 or 2), and whether a pulse oximeter is required.

Note, a practice can report Shared Care if they are running a daily Doctor on Duty model.

If clinically indicated please continue to check on the patient. Please be aware that following the Public Health unit assessment there may be a change in plan and the patient may not require GP support.

Welfare Requirements All Welfare Support requests can be sent directly to: Welfare.Referral@bopdhb.govt.nz.

Over time this will move to a CCCM process.

Community Management - Practice Role • • • • • •

Following referral from the CPRT, the practice starts the process of clinical monitoring with arrangements to cover 7 days a week.

Low-risk patients: a telehealth consultation is expected at least every 2 days.

High- risk patients: the primary care team is required to contact the patient every day or more for clinical management.

Initial assessment undertaken by an NP or GP, ongoing assessment can be delegated to the nursing team with NP/GP oversight.

Inform the CPRT team via email confirming the Provider delivering care (this could be a shared care model), the Level of Care (1 or 2), and whether a pulse oximeter is required.

Patients identified over the weekend will be managed by an alternate provider until formal handover can be made.

• •

If your patient is also under the care of other services, e.g., Hospice, District nursing please can you let these teams know, where possible.

Payments for Community Management of Covid-19 patients are claimed directly via Halcyon.

Please note – options for ‘Household contact’ & ‘Non-Contact Call’ Claims have not yet gone live, but should be coming any day. Please keep a note of these in the meantime.

Afterhours Clinical Support In Western BOP we have a mixed model for providing afterhours clinical support which includes the use of a pool of local on-call clinicians, and the services of Tunstall. The preference is that practices manage the care of their own enrolled patients wherever possible (this includes covid positive cases and household contacts), but alternative arrangements are available in the instances where this is not at all possible.

Changing Models of Care through Phases of Community Spread As we move through the phased system of covid community spread, the model of care used will change from being primarily practice-led to patient-led.

The transition to CCCM begins the move to a more automated processing system, which should mean less admin at both practice and PHO/Community Hub end.

As the clinical model transitions, we expect this will mean practices move to focusing predominately on clinically high risk patients, with eventual clinical management being based on a self-management basis – i.e. people reaching in for care as needed.

As the model of care transitions, so will our regional processes. We will keep you updated along the way as soon as we are made aware of any changes to the current model of care.