WBOPPHO Green Prescription Adult Service for Eastern Bay of Plenty 1 Jan-30 June 2023

The following report summarises progress of the Green Prescription Adult Service for three practices in the Eastern Bay of Plenty; The Doctors Total Health, The Doctors Phoenix, The Doctors Kopeopeo.

For clients that we cannot contact via phone, messages are left on either landlines or mobiles, and then a letter is sent requesting the client contact us before they are categorised as un-contactable and discharged. This period we have seen our pending number increase compared with last reporting period. This period we have seen our pending number increase compared with last reporting period, however all referrals have been contacted and appointments have been made.

We have a total of 155 active on the programme at the moment for WBOPPHO enrolled clients (total is 373 for our EBOP service including 218 EBPHA enrolled population).

Please note the number over six months is because we allow six months on the programme from their first contact rather than referral date (however this report on our database calculates from referral date).

SUMMARY OF MEDICAL CONDITIONS

Please note the total number of all medical conditions may differ from referral numbers due to some clients having multiple conditions. Most of the 169 clients referred this period have at least two medical conditions, which is why they are listed in the format below.

HEALTH OUTCOMES

As outlined previously, clients usually stay on the programme for six months duration. We strongly encourage all clients who are to be discharged to come in for repeat measures for comparative data, however not all agree to come in or attend their discharge consultation.

Our wellbeing measure has changed this reporting period to a simple self reported scale of 1-4. This is taken at initial consultation and at discharge and client led. We have found that the previously used Short Warwick-Edinburgh Mental Wellbeing Scale was not well engaged with particularly by our māori clients.

74% of clients who had outcome measures in this period have maintained or decreased their weight, 72% of clients have maintained or decreased their BMI, and 95% of clients have decreased or maintained their waist circumference. 97% of clients have increased or 4

maintained their physical activity level. 53% have improved their wellbeing score and 37% have maintained their wellbeing score.

No benefits gained

SIGNIFICANT TRENDS/HIGHLIGHTS/CHALLENGES FOR PERIOD

Referral numbers have increased by 20% this reporting period compared with the previous six month period. Engagement to the programme continues to remain high with 96% engagement rate, and 53% of māori engaged with the programme matched with 54% of māori referred to programme.

We have had a full staff team operating in our EBOP Green Prescription (GRX) programme from April, after a period of staffing changes. Across these three staff we cover Ōpōtiki, Whakatāne, Ōhope, Edgecumbe, Tāneatua, Ruatoki, Waimana and Kawerau areas.

The weekly walking groups in Whakatāne, Edgecumbe and Ōpōtiki have seen a significant downturn in numbers from April to June with unpredictable weather patterns bringing on heavy rain forecasts during our summer and then cold snaps during the winter months. Covid-19 infection rates have seen a surge in numbers in our communities and the cost-ofliving crisis sees more of our clients opting to walk in their neighbourhood, to save petrol. Home based exercise resources are provided to clients who express a preference to exercise at home.

Fortnightly Pool Clinics – Whakatāne

Pool Clinics continue to be successful at the Whakatāne Fitness & Aquatic Centre and on a fortnightly basis these pool clinic sessions have provided an excellent opportunity for advisors to engage with a higher number of clients in one setting. Having all advisors on site at the facility is an integral part to supporting both new and current clients returning to a physical activity in a safe environment. There continues to be a high level of engagement and feedback has been positive from our clients and the staff at the pools. The numbers attending aqua classes on average are 40-50 and pool clinic attendees on average are 3035 being weighed, girth measured, and blood pressures taken.

Monthly Hikoi Kakariki Clinics - Whakatāne

Due to the downturn in clients attending our hikoi group in Whakatāne, we have encouraged clients to be weighed and measured at the fortnightly pool clinics. Being in an indoor setting, weather conditions are not a barrier, so clients can keep on track with their measurements.

SERVICE DELIVERY

CLINICS HELD AND NUMBERS ATTENDING

Advisors continued to provide a flexible and adaptive service responding to changes post the Covid19 environment. During this period, advisors have been back full-time in the office and/or rural clinics and have been seeing most clients face-to-face. However, some clients have asked for phone consultations mostly in part to being at work and wanting to be phoned during their lunch breaks or if they have issues with not having transport. During this past six months, face-to-face client contact has significantly increased with phone consultations requested on occasion.

Whakatāne Clinic

Held at our Sport BOP office, a total of 109 Whakatāne clinic days were completed from midJanuary through to the end of June, consisting of both initial and follow up appointments. On average 12-15 new clients were seen with 70-80 follow up appointments fulfilled within a normal week.

Ōpōtiki Clinic

Held fortnightly at Te Tāhuhu o Te Rangi - Ōpōtiki District Library. One advisor completed 13 clinics throughout this period. On average, two new clients were seen with 810 follow up appointments completed within that day (including the follow ups completed within group activities).

Kawerau Clinic

One advisor completed 13 clinics in total throughout this period. On average two new clients were seen with 8-10 follow up appointments completed within a day. Clients are now being seen face-to-face with a few requesting phone call initial consultations and follow ups.

Edgecumbe Clinic - NEW

One advisor completed 4 clinics, on average one new client was seen with 3-5 follow up appointments completed within the three hours' time allocated within the library space.

Whakatāne Aquatic Centre Pool Clinics

Ten Green Prescription fortnightly Pool Clinics based at the Whakatāne Aquatic and Fitness Centre were held from 9th February to 15th June, with three advisors based at the facility from 8.30am until 10.15am before and after the Thursday 9am GRx Aqua class. A total of 300 follow ups were completed with clients during these clinics, with an average of 40-50 clients from across the region still attending the aqua class, with a further 2-4 other clients popping in, to follow up with their advisor and some completing their measures on site. Noticeably in this period we now have on average 70% Māori attending both aqua classes and pool clinics.

GROUP ACTIVITY OPTIONS OFFERED AND NUMBERS ATTENDING:

Hikoi Kākāriki Weekly Walking Group is a permanent feature of the Green Prescription calendar in the Eastern Bay of Plenty towns of Whakatāne, Edgecumbe and Ōpōtiki, led by Green Prescription advisors and/or a Green Prescription community champion every week to ensure the sustainability of all walking groups in the future. Initially, offered as an entry level to physical activity during the warmer months for clients that were not interested in pool activities or aqua classes. On average in all three EBOP towns, Whakatāne, Edgecumbe and Ōpōtiki, up to five Green Prescription clients attended every week. Of that, 40% were females, 60% were male and 30% were Māori (a further drop of 10% from last 6-months) as 6

more Māori clients opt for aqua, pool and gym activities. More males are opting to walk in our groups with a small decline in females opting to walk on their own or with a friend at other times of the day more often.

GRX Aqua classes, Whakatāne (run by the Whakatāne Aquatic Centre) with two weekly GRx Aqua classes still on offer this period, we have seen consistency in participation numbers, on average 40-50 people in class. Unfortunately, the Whakatāne Aquatic & Fitness Centre decided not to re-establish the 9am Friday aqua class as a discounted Green Prescription class of $3.00 previously on offer pre-Covid19. Two extra evening aqua classes at full price have also been added for Monday and Wednesdays at 5.30pm which is another option for our working Green Prescription clients.

Aqua classes, Kawerau (run by Kawerau District Council) the two weekly aqua classes have seen some disruptions during the last six months with the Kawerau District Council closing the pools for a few weeks at a time due to staff being unavailable due to Covid infections and some hot water pipe issues at other times. The full renovation of the entrance way including the office space and the car park areas have been completed and are a great asset to the community. On average ten Green Prescription clients are regular users of the pools.

Toa Kakariki Group Session – Supermarket tour

No sessions were held the last 6 months. Upcoming supermarket tours are planned for July and October this year with a focus of having three smaller groups with each advisor of 2-4 each session.

PROMOTION AND DEVELOPMENT OF SERVICES

All WBOPPHO GP practices were updated regularly via emails and provided with three seasonal newsletters from Green Prescription advisors containing information of service adaptions and current changes to the programme. All medical practices were contacted by phone with two medical practices requesting practice visits. The other medical centres have shown an interest to be contacted later in the year.

The COPD Disabilities Resource Presentation was facilitated by one advisor in March with 15 people in attendance. Green Prescription physical activity and nutritional resources were discussed and shared during the one-hour presentation.

The HTL met with health coaches to explain the Green Prescription programme and to discuss collaboration between Health Coaches and Green Prescription Advisors. The HTL shared the new Green Prescription Referral form for Health Coaches with their team and explained the process for referring to the programme.

The HTL met with the Clinical Leader from Whānau Āwhina Plunket Central Region to explain the Green Prescription Programme and the potential for Plunket Nurses to be able to refer. The HTL then attended a Central Region staff hui where the programme was explained and the new referral form for Plunket Nurses shared with the group.

The HTL and KOYF Team leader met with the manager of the new Tuhoe Rangitahi Hub in Taneatua to view the facility and to discuss the possibility of holding clinics and physical activity options at the hub. The hub is a multi-use facility which includes medical suites, performing arts education spaces and indoor gym. The staff are currently running group fitness classes for kaumatua in the morning and rangatahi in the afternoon. The manager would like to see the facility utilised more by the community so is enthusiastic about collaborating with other community groups and programmes.

EBOP Green Prescription Facebook Group (currently 320 members)

This closed group continues to be a positive and important way to support and engage with clients virtually. The focus of this period was to keep clients engaged by posting up in advance, reminders of weekly physical activity options, upcoming new physical activity events including pool clinic dates for 2023 and the latest Green Prescription EBOP newsletter. The main themes being shared are physical activity, wellbeing, and nutrition with photos from group activities being highlighted. On average, two posts are shared every week with 80-120 engagements and reactions with each post.

CASE STUDIES

A 51-year-old Māori male came onto the programme newly diagnosed with prediabetes. He admitted to not being as active as he would like and didn’t really know where to start to make nutritional changes. We did a comparison of sugars in his drink intake, and he was so surprised. He decided that he was going to cut out the juice and try and drink more water. He was also going to monitor his portion sizes at mealtimes and between meals. Since being on the programme, the client has done exactly what he agreed he would do with nutrition without adding in much more activity. He is so pleased with his progress so far; he has lost 9kgs and 7cm around his waist. He is hoping in the next month to increase his activity by walking and adding in some home based activities.

A 51 year old Māori female came onto the programme with low mood, high anxiety and had not left her home for months. She was too scared to sleep as she thought she would not wake up. She had gained over 60kgs and could not walk to her letter box without having to stop and catch her breath. She was training to be a nurse but was thinking of giving that all up due to her lack of fitness and self confidence. Since being on the programme, the client has worked with the dietitian and health coach. With Green Prescription, she started at the pools doing aqua aerobics classes. The client made huge changes to her nutrition monitoring her portion sizes, cutting down on takeaways and meal replacement shakes. Her activity has increased dramatically. She is now going to the pools 3- 4 times a week. She has also stuck to her studies and is nearly at the end of her training. The client is so pleased with her results and progress on the programme. She has lost 45.7kgs, improved her wellbeing and energy levels and is continually resetting new goals to move forward.

A 80 year old European female came on the programme with joint pain, urinary issues and mobility issues. She was only able to walk her dog 10 mins two days a week due to her joint pain and energy levels. She was not really that interested in joining the pools as it was getting too cold, and her joints would not cope. Her biggest goal was weight loss so that she didn’t have so much load on her joints and she felt her energy levels would also benefit. She also knows that she would travel better as she is going to the UK to celebrate her birthday with her family there. Since coming on the programme the client has reduced her portion sizes, she is eating her meals off a smaller plate and her husband is also following suit. She has cut down on her evening treats and now has a cup of tea and one biscuit. The client is now walking a bit further with her dog and is now adding in another walk so is now up to three walks a week. She has lost 2kgs in two months and is very happy with her progress.