Covid mgmt in Primary Care_241121

BOP Covid Management in Primary Care 24 November 2021

Whakataka te Hau

Karakia Timatanga (opening) Whakataka te hau ki te uru Whakataka te hau ki te tonga Kia mākinakina ki uta Kia mātaratara ki tai E hī ake ana te atakura He tio, he huka, he hau hū Tīhei mauri ora!

Cease the winds from the west Cease the winds from the south Let the breeze blow over the land Let the breeze blow over the ocean Let the red-tipped dawn come with a sharpened air A touch of frost, a promise of a glorious day

Welcome, and a little Zoom housekeeping Thank you to everyone who has joined and to our colleagues from EBPHA, NMO, BOP DHB and WBOP PHO present.

Given the large group tonight if you have a question it’s our preference that you go to https://www.sli.do/ and enter code 091218. You can ask your question there. Alternatively you can use the Chat function. Please ensure your audio is Muted during the session.

Agenda Case numbers in the Bay of Plenty Covid-19 Modelling Bay of Plenty Covid 19 Primary Care Model Clinical Guide for primary care clinical management of COVID-19 in the community Q & A session

Current Cases in the Bay of Plenty 30 active cases in the Bay of Plenty following the 1 PM MOH announcement.

12 of these cases in the last 24 hours.

Two clusters.

As at 2 pm today there are 23 locations of interest in Tauranga, 22 in Mount Maunganui, 9 Te Puke, 3 in Papamoa

Modelling at 90 % vaccination rate

Modelling at 80 % vaccination rate

Covid 19 Primary Care Model

The BOP COVID-19 Community Case Management in Adults Model

EBOP Patient Journey

The guide for primary care clinical management of COVID-19 in the community Content for this guidance document has largely been drawn from the COVID-19 Case Management in Adults pathway provided on the Midland Health Pathways portal.

This pathway can be accessed here: https://midland.communityhealt hpathways.org/728651.htm Username: midlanduser Password: midlandpassword

The Covid Primary Response Team (CPRT) will co-ordinate clinical care •

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The CPRT will contact the practice where the patient is enrolled, or identify a service who can deliver care to a patient that is not enrolled locally, to initiate the virtual clinical assessment process Ideally, patients will be cared for by their usual primary care practitioner. Where this is not possible an alternative provider will be identified for their covid related care.

• Where there are multiple patients isolating at the same address a single provider will be identified, where possible, to ensure continuity of care to the household.

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

• Weekend review of known patients should ideally be managed by the practice. Where this is not possible care will need to be handed over to an alternate provider (details on this process TBC).

Covid Care Practice Contact Person Each practice needs to identify a contact person for the CPRT to liaise with regarding co-ordination of clinical care.

Please email the name and contact details for this nominated person to Covid Primary Response Team cprt@healthbop.org.nz

Three Part Initial Assessment. Part One.

Three Part Initial Assessment. Part Two.

Three Part Initial Assessment. Part Three.

Risk Stratification tool to assess level of care

DRAFT – NOT PUBLIC POLICY – October 2021

19

Confirmation of care and delivery of pulse oximeters Following virtual assessment the practice will send an email to the CPRT confirming: 1.the Provider delivering care (can be shared care) 2. the Level of Care (1 or 2), and 3. whether a pulse oximeter is required.

The CPRT will co-ordinate delivery of the pulse oximeter to the patient if required.

Ongoing Assessment • Establish what day this is in the course of the patient's COVID-19 illness and continue the clinical review cycle until at least day 10.

• For vaccinated cases, the isolation time is 10 days, provided the previous 72 hours were symptom free.

• Unvaccinated cases, the isolation time is 14 days provided the previous 72 hours were symptom free.

Clinical Review Cycle •

•

At COVID-19 Care 1, patients self-monitor symptoms daily and receive alternate day (or as clinically indicated) remote clinical assessment from an appropriate practitioner. This can be a nurse, NP or GP (if this is provided by a nurse, then NP or GP support must be available if required).

At COVID-19 Care 2: •

•

higher risk patients are reviewed by a suitable clinician daily (including weekends), with additional checks as clinically indicated. Patients should have access to a pulse oximeter if they have personal risk factors for COVID-19 Care 2. lower-risk patients self-monitor symptoms daily and may receive lower frequency of clinical assessment, but the household is contacted frequently.

Daily Symptom Checklist

Escalate care if the patient develops: •

rapid deterioration

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worsening fatigue, fainting, falls

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coughing up blood

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fever greater than 40°C

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severe shortness of breath at rest

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Clues to respiratory compromise

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chest pain on breathing in or tightness/pressure in the chest

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new onset of confusion or becoming drowsy

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change in oxygen saturation (SaO2)

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dehydration

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cold, clammy, mottled, or pale skin

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other factors indicating need for management in hospital

Call on call SMO via switchboard For escalation to Hospital Care and urgent or non-urgent advice

WBOP 07 579 8044

Release from Isolation – consideration of household contacts • If there are others in the house also self-isolating then there is an additional 10 days self isolation at the end of the recovery time of the positive case to ensure no new positive cases develop amongst the household. The recovered patient has to remain in isolation throughout this time as well.

• There may be instances where people are isolating in the same ‘household’ but doing so in complete isolation from the case. In this scenario, the additional 10 days isolation does not apply.

• Household contacts only have to isolate from their last exposure day and they require 10 days isolation and a swabbing regime which is immediate, day 5 and day 8.

Welfare Management Co-ordinated by a community hub

• Currently in development • Patient and whānau centered • Existing services will be supported to continue to provide care to their community where possible • An integrated team across health and welfare services including iwi, hapu, PHOs, Māori health providers, NGOs, MSD, local council and more • Providing health advocacy and navigation, social welfare, accommodation, transportation of goods and/or patients • Will be adaptive, flexible and responsive

Funding Model

Q and A Time .

Given the large group tonight if you have a question it’s our preference that you go to https://www.sli.do/ and enter code 091218. You can ask your question there. That way we can record all questions and ensure they are answered, either tonight or post event if time does not permit.

You can also add your questions to the Chat function or Raise your hand and if we have time towards the end of the Q&A we will unmute you so you can ask your question.

Kia tau Karakia whakamutunga (closing) Kia tau kia tātou katoa Te āio, te aroha me te marutau Tīhei Mauri Ora

May peace, love and safety Be upon us all Let there be life