Health reality show: regular celebrities, high stakes, new game: a model for managing complex primary health care.
OBJECTIVE
To evaluate a collaborative model that integrates secondary care support into general practice, targeting the main health problems of patients with long-term conditions.


METHODS
The model was tested in two general practices in an area of high deprivation. Eligible patients were high users of the Middlemore Hospital Adult Medical Service. Model elements included nurse home visiting, record review, inter-professional case conference, and assertive follow-up and intervention. Data were collected from clinical records and interviews with patients and clinicians. Interviews were analysed using a general inductive approach.


RESULTS
Record review and home visiting uncovered clinical and social information buried in the 'systems records' or unknown. Inter-professional case conferences resulted in prioritising interventions before assigning to practitioners for follow-up. Home visiting led to advocacy for social services, not possible in earlier general practice or emergency department (ED) consultations. Specialist hospital physician support in accessing hospital services strengthened the relationship with general practice. Case finding was an unexpected outcome of home visiting with individuals from the same household as the index patient assisted to access services.


CONCLUSIONS
All model elements -- nurse home visiting, record review, inter-professional case conference, and assertive follow-up and intervention -- were essential to resolving problems seriously impacting health status.
Sheridan
Nicolette
N
School of Nursing, University of Auckland, Auckland, New Zealand. n.sheridan@auckland.ac.nz
Kenealy
Tim
T
Parsons
Matthew
M
Rea
Harry
H
D000328:Adult; D000368:Aged; D019058:Community Networks / Q000458:organization & administration*; D005260:Female; D006301:Health Services Needs and Demand / Q000458:organization & administration*; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D007373:Interinstitutional Relations; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D020380:Needs Assessment / Q000458:organization & administration*; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D010353:Patient Education as Topic / Q000458:organization & administration; D010865:Pilot Projects; D011314:Preventive Health Services / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D011369:Professional-Patient Relations; D016896:Treatment Outcome