Covid mgmt in Primary Care Part 3 100222 v2

BOP Covid Management in Primary Care Part 3 10 February 2022

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

A little Zoom housekeeping For questions please go to https://www.sli.do/ and enter code 720590.

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OR you can use the Chat function.

Please ensure your audio is Muted during the session.

These slides and session recording will be shared via the PHO Covid Alert. To register for the alert email nsadmin@wboppho.org.nz

Agenda Speaker

Session

Dr Kate Grimwade, Infectious Diseases and General Physician, CMO, BOP DHB

Covid 19 Omicron Implications

Q&A Session Dr Claire Isham, Clinical Director, WBoP PHO Overview of The Ministry of Health Omicron strategy Phil Back, General Manager Network Services, WBoP PHO Sarah Johnson, Covid Primary Response Team Lead, WBoP PHO

Practice planning Introducing the WBOP Covid Primary Response Team (CPRT) Q&A Session

Catherine Warren, COVID Performance, Quality and Design Lead, BOP DHB

Roll out of the new Covid Clinical Care Module (CCCM, formerly BCMS) Covid Community Management Claiming through Halcyon Final Q&A Session

COVID 19 Omicron Implications Dr Kate Grimwade Infectious Diseases and General Physician CMO

Vaccination

Outbreak

Community care

Hospital readiness

Contact Tracing

Mandatory order

Testing / Swabbing

BOP Outbreak As at 9th February:

• One inpatient - Tauranga • Some delta around – all EBOP delta • Lower testing numbers over the weekend

CONFIDENTIAL

BOP Daily cases

BOP total cases

Omicron Gamechanger • NZ moved into red at 11.59pm 23rd Jan • Omicron cases – Nelson-Marlborough, Auckland, Palmerston North • Links to wedding, flights, multiple locations, other gatherings • Spread across most N Island – plateaued

Omicron – what is it?

• First identified in mid-November 2021 • Named as a variant of concern • Multiple mutations with over 30 in the spike protein • Rapidly spread worldwide

Omicron – why is it different?

Increased transmissability – estimated 3x that of delta Across Europe and US doubling time of 2-4 days Superspreader events Rapidly become the dominant strain across most of the world • Implications – huge numbers of infected people • Major challenges from staff shortages due to sickness • • • •

Omicron - Severity • Different pathogenesis – upper respiratory tract • Shorter incubation period – mean 3 days • Symptoms include URTI features – less anosmia, more sore throat • May be minimally symptomatic or asymptomatic – esp in vaccinated • Lower severity – hospitalisation rates around 50% that for delta • Duration of illness / LOS in hospital shorter

Omicron – vaccine protection • Breakthrough infections seen in both vaccinated and previously infected people • Some protection seen with dual vaccinated individuals – Pfizer • Close to levels with delta following 3rd dose • Protective effect against severe disease, hospitalisation and death – even with 2 doses • Impact on infectivity unclear

Omicron treatment options • Dexamethasone, tocilizumab and remdesivir retain usefulness • Monoclonal antibodies probably not as effective • Ronapreve – about to be provided by Pharmac – unlikely to be of use against omicron • Antivirals – Paxlovid, molnupiravir – still work – awaiting MedSafe approval

Omicron – what can we learn from elsewhere?

• Less severe but increased transmission means large numbers needing care • Services threatened – COVID and nonCOVID – due to staff sickness – 15-30% • Not feasible to maintain same approach – test and trace, PCR testing etc • Underline importance of controlling flow into hospital – COVID and nonCOVID – can manage if keep as much in the community as possible

Omicron – what can we do now?

Do the basic stuff well – mask, scan, distance Stay home if sick Vaccinate and boost Think about how we work as a team – varying roles as necessary, challenge models of care – doing things differently may be the only way to make things work • Get your personal/whānau plans sorted and ready to go • • • •

Adjusted Modelling • University of Waikato • Using actual data • Adjusted on a weekly basis

Updated modelling – daily cases and hospitalisation

Long Term projection – daily cases and hospitalisation

Long term projection - locality

Daily cases by ethnicity

Hospitalisation by ethnicity

Daily new cases – age bands

Hospitalisation by age bands

Q and A Time .

Ask your question via https://www.sli.do/ and enter code 720590 It’s an easier way to track the questions coming through

You can also add your questions to the Chat function

The Omicron Strategy

Phase One ‘St amp it out ’ ‘Stamp it out’ phase Testing

Operational Response Current testing parameters continue. PCR testing for symptomatic and close contacts.

Cases identified via positive PCR. Cases isolate for 14 days.

Situation: A few cases in the community, but most cases connected

Case investigation Contacts actively managed through NCTS and PHUs. Contacts isolate for 10 days. and contact tracing PHUs focus on complex cases and medium-high risk settings Begin shift to self service and automation

Health care

Clinical care by primary care teams and support by Care Coordination Hubs Most cases supported to isolate at home

Masks

Current mask settings plus a shift to use of medical masks for critical workers Mask use required at all times in all public indoor spaces and on public transport

Phase Two ‘Flat t en t he cur ve’ ‘Flatten the curve’ phase

Operational Response PCR testing for symptomatic people and close contacts

Testing

Some use of RATs for asymptomatic surveillance testing, test to return to work PCR to confirm diagnosis if positive RAT Cases identified via positive PCR. Cases isolate for 10 days.

Situation: Case numbers increasing significantly Growing pressure on health system (but manageable)

Case investigation Contacts actively managed through NCTS and PHUs. Contacts isolate for 7 days. and contact Increased use of digital pathways eg notification via text, self investigation web based tool tracing PHUs focus on high priority cases and medium-high risk settings Transition to cases using self service and automation

Health care

Clinical care by primary care teams focussing on people who need ongoing clinical care Cases supported to isolate at home Shift to use of medical masks for critical workers

Masks

Mask use required at all times in all public indoor spaces and on public transport

Phase Three ‘M anage it ’ ‘Manage it’ (high volume) phase

Operational Response Focus on testing priority populations, HCW and critical workforces

Testing

Shift to RATs for diagnostic testing in most symptomatic people and continue test to return to work Asymptomatic surveillance testing of HCW Cases identified via positive PCR, RATs or symptoms, 10 days isolation

Situation: Widespread community cases

Case investigation Contacts automatically notified from online self-investigation by cases and option for cases to selfand contact notify contacts, 7 days isolation tracing Need to change tack to manage pressure on health services and maintain critical/ essential services

PHUs focus on outbreak management and very high risk settings with support from NCIS

Health care

Majority of positive cases self-manage Clinical care and welfare support focusses on those with high needs General public recommended to use a medical mask, HCW mostly medical masks and some wider use of N95s

Mask

Mask use required at all times in all public indoor spaces and on public transport

COVID-19 Care in the Community Assessing and responding to clinical needs Key National Contact Tracing Solution COVID Clinical Care Module (was BCMS) Primary care involvement

Regionally coordinated telehealth contacts higher scored patients for clinical assessment

CPIR score (1-6) Risk of hospitalisation based on: • Age • Ethnicity • Vaccination status 6 5

Initial assessment using CPIR score

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Updated assessment updated with information from either telehealth or self-service form

Self management • Patient continues to self manage • Patient can escalate if needed

GP notified by Healthlink, community care hub, or patient

New case creation • Case created in NCTS and CCCM • Patient and GP notified

Patient journey

+ve

Text notification • Initial instructions

Active management De/Escalating as needed: • Automated • General practice • Public health • Hospital

Online self assessment • Clinical assessment • Contact tracing • Welfare needs Note telehealth will contact those without mobiles

Patients can escalate care by • Telehealth • Primary healthcare provider • 111

Equit y f irst – who is most at risk?

Equitable outcomes, particularly for our disadvantaged populations, are essential to every pillar of our Omicron response.

Higher transmission

Poor outcomes • •

People over 60 years of age Pregnant people

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People with other conditions such as cardiovascular, respiratory, diabetes, inflammatory conditions, immunodeficient states, autoimmune diseases, and mental health issues

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People with poor access to healthcare and prevention services

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Casual/contract workers

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People in aged residential care facilities and hospitals

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Unvaccinated people

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Māori and Pacific communities

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Disabled people

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People with drug/alcohol addiction

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People who experience high levels of material deprivation

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Young adults age 18-35

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People at large/high density indoor events

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People in temporary housing, overcrowded housing, poor ventilation

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People in prisons

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Healthcare staff

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People who work in frontline services like transport operators and food and beverage workers

Practice preparation for Omicron Plan for 15-20% staff reduction Consider the following questions: 1.

What are the most critical services that must be delivered (what services can be reduced or stopped)?

2.

What resources will you need to provide those critical services?

3.

How will you make decisions together and who are the deciders?

4.

How will decisions be communicated? To staff/Patients/PHO

MOH guidance to use when service provision is at risk of substantial compromise

Available to download via the PHO Portal Covid Page: http://portal.wboppho.org.nz/covid-19/

MOH guidance to use when service provision is not at risk of being compromised

Available to download via the PHO Portal Covid Page: http://portal.wboppho.org.nz/covid-19/

Staying connected: • Adopting a buddy arrangement with a neighbouring Practice or Practices – supporting each other to manage collective demand • Network huddles – Initially 3 per week x 30 minutes max.

Focused on key operational areas including; staffing, supplies, etc. and issues that need escalating to the EOC.

Introducing the WBOP Covid Primary Response Team (CPRT)

Covid Primary Response Team • Currently a team of 3 managing a 7 day referral and phone advice service to all practices across WBOP and supporting EBOP, as needed.

• Team is Sarah Johnson Team Lead and Jen Moore and Renee Still providing admin support • Changes ahead with the referrals and notifications process once CCCMs is implemented for all practices, but for now we will continue with the current process as per the clinical care guidelines and CPRT process • We are aware that practices often get the positive covid notification before we send the referral through. If your patient returns a positive swab and you have not had a referral from us, please feel free to continue on with the initial assessment as per the clinical care guidelines. We will send the referral as soon as it’s received from TTO. • We will endeavor, along with our Network Services Team colleagues to support you all through these transitional changes so please reach out to us

CPRT 07 5773234 cprt@healthbop.org.nz

Q and A Time .

Ask your question via https://www.sli.do/ and enter code 720590 It’s an easier way to track the questions coming through

You can also add your questions to the Chat function

• TESTING STATIONS • HOME VISITS • FIT TESTING • OXIMETER DELIVERY • HEALTH NAVIGATION • SUPPORTING COMMUNITY RESPONSE

LAUNCHING CCM PROFILES FROM PM S New functionality will integrate CCM so that it can be opened within a Health Providers PMS. 1.

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Open the person’s profile in the PMS Click on the HealthLink forms icon.

Click on the Border Covid Clinical Management link.

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If the person has an active CCM record, this link will open that person’s record. Health Providers will then be able to navigate their CCM information from within this page.

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When “complete session” is pressed, it will write a PDF of what has been done in CCM up until this point. This PDF will go to the Health Providers Patient Record Outbox.

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Healthlink

BCMS

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VIEWING THE SUM M ARY Select Note Timeline. This will enable you to view all Patient notes recorded.

2. By selecting the note icon, you can then add a note.

3. For notes you can filter down to type of note by clicking one of the following buttons: • All • Initial Assessment • Reg H check • Whiteboard • Clinical • Ad Vitals • Flag Management • Generic • Task 4. To return to Vital Summary chart you need to select Vital Timeline.

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BCMS

BCMS

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BCMS

Notification of new patient will come to Inbox Practices will be able to “reject” patient care if you’ve reached capacity Out of town patients will be allocated to the practice they’re enrolled with In phase 2 – “lower clinical risk people can contact health provider” In phase 3 – “ clinical care will be focused on anyone with high needs” Welfare flagged in the regular assessment will trigger a referral to MSD

Training sessions are available weekly by MoH Training documents and release notes are available You will be able to see “read only” notes for any welfare notes entered in NCTS after the case is in CCCM

Risk stratification tool is being updated nationally Information will be given at testing as we moving into self-referral for people to access services

If you need healthcare or advice: 1) For urgent or emergency care phone 111 2) If you have a healthcare provider such as a GP or Hauora you can phone them 3) If you are not able to reach your healthcare provider phone Tunstall 24hrs on 07 9284 181, who are providing local health advice for the BOP. You can also phone healthline 24hrs on 0800 611 116 for health advice 4) If you’re not sure who to call, contact the health navigator team between 8am-8pm, 7 days a week and they can point you in the right direction, West BOP: 0800 798 729 and East BOP: 0800 633 277

Covid Community Management Claiming through Halcyon

Claims now live in Halcyon for practices

• PMS Service Codes for set-up have been sent to practice managers to add.

• Any support needed for set-up contact your practice liaison.

• Please note - options for ‘Household contact’ & ‘Non-Contact Call’ Claims (locally funded) have not yet gone live, but should be coming any day. Please keep a note of these in the meantime, or use the former excel template if preferred.

Screenshot of Halcyon Claim Form (MedTech)

Escalation Claims • For any ‘Escalation’ Claims, please select ‘Assessment Type’ First and then tick following box for escalation claim, depending on the level of Clinical Care and Escalation:

Screenshot – Care Level 1

Screenshot – Care Level 2

Final Q and A Time .

Ask your question via https://www.sli.do/ and enter code 720590 It’s an easier way to track the questions coming through

You can also add your questions to the Chat function

BOPDHB Zoom Grand Round Covid Pandemic Plans – Session 9 Tuesday February 15, 12.30 PM This session provide ongoing updates as planning unfolds and continues to summarise what has happened locally and nationally since the last session, as well as work through the challenges and plans ahead as the Omicron situation evolves.

Join via https://bopdhb.zoom.us/j/87233645842?pwd=QTY0c2xzSXU0dEltKzB4V25KL0k5UT09 Meeting ID: 872 3364 5842 Passcode: 779986

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