Collaborative, multidisciplinary approach improves tamariki eczema management

Several Hawke’s Bay families have seen an improvement in the physical and emotional wellbeing of their young tamariki with eczema, thanks to a quality improvement project.

Hastings-based Te Taiwhenua o Heretaunga, provides a range of kaupapa Māori hauora services to improve the health status of Māori in Heretaunga.

Acute skin infections and eczema in 0–4-year-old Māori children, influenced by a lack of self-management support and access to preventative interventions, was resulting in preventable presentations to the organisation’s general practice clinic and Hawke’s Bay Hospital’s emergency department.

A project to address the problem was one of nine from primary care provider teams from around the country selected for the Health Quality & Safety Commission’s 2019 Whakakotahi quality improvement programme.

Primary care teams were supported by the Commission to implement quality improvement projects in an area of patient care they wanted to improve that was important to their patients and community, and to them as providers.

All the projects supported the Commission’s three primary care strategic priority areas of equity, integration and consumer engagement. Equity was given greater importance in the Whakakotahi 2019 selection criteria.

A member of each project team was also offered a position on the primary care quality improvement facilitator course delivered by Ko Awatea and the Commission's primary care and capability building programmes.

Project facilitator, Rachel Pere, says continuous whānau engagement was key to the project, beginning with a consumer focus group where whānau were invited to share what they thought were the barriers to better eczema management.

‘These included not being able to get appointments at the GP clinic, gaps in understanding how to uses the various medications and not being able to recognise when their eczema had gone past the point the whānau could manage it.

‘Eczema isn’t really curable. It is manageable, but you have to stay on top of it and managing it can feel like a fulltime job. This can take an emotional toll on the whole whānau, and feedback was that there a lack of emotional support available for whānau dealing with eczema.’

Each whānau had an hour-long appointment with one of the clinic’s two nurse prescribers to learn more about whānau life in general, so a more holistic approach to eczema management could be taken.

‘Stress can trigger eczema, so things like other illnesses, financial stress or the dynamics of the whānau not being good at a particular time can all have an impact,’ says Ms Pere.

Whānau used the Flinders Program Partners in Health Scale scoring tool to set their own targets and measure where they were at.

The nurses followed up with each whānau, and if the whānau ever needed help, they were put straight through to one of the nurses.

‘Whānau told us they really appreciated being able to build a relationship with one person at the clinic,’ says Ms Pere. ‘It saved them having to repeat their story numerous times and they felt listened to, comfortable and able to be open in consultations.

‘A pop-up in the patient management system meant anyone at the clinic interacting with the whānau could identify the child was part of the project, so if they presented with another issue, the opportunity was taken to check everything was OK with their eczema and that all their medicines and creams were up-to-date.’

Ten of the 12 whānau reached their eczema management targets. Ms Pere says that’s a fantastic result, especially as acute presentations have continued to drop in the six months since the project ended.
She says support from the Commission and doing the quality improvement facilitator course was very helpful to the project.

‘Initially, it took me a while to get used to the course language and tools, but as I began to apply the tools, I came to really enjoy it.

‘I realised the tools and the quality improvement cycle can be applied to everything you do, especially if something’s not working.’

Te Taiwhenua o Heretaunga general manager, Julia Ebbett, was the project’s sponsor and is currently doing the senior quality improvement advisor course.

‘Quality is one of the work streams of Te Taiwhenua o Heretaunga’s major transformation project currently underway. We’re looking at how we adopt a culture of quality improvement and how that fits with our kaupapa Māori approach. The tools will give us the “how to” and a discipline for that.'