Getting to know you
Most people only go to see their GP or practice nurse when something goes wrong - an upset stomach, a sore foot, a chest infection.
The problem with that traditional approach is that health professionals often have limited information to form a true picture of the patient and to plan their care accordingly.
At Amesbury Health Centre, in Palmerston North, they realised that there isn't enough time in a 15-minute consultation to really get to know patients - so they did something about it.
They began inviting older patients, aged 75 years and up, to the centre for a free hour long sit-down with a practice nurse.
Jane Ayling, a nurse who worked on the project, says it was astonishing how much they learned about those patients - many of whom had been coming to the health centre for a decade or longer.
"We thought we knew them really well from that long-term interaction, but we found out an incredible amount about them - their physical activity, what happens in their homes, their diet, their transport needs and more," she says
"Based on that information the practice nurse (in consultation with the patient and sometimes with a GP) works out an individualised care plan for each patient."
'Charlie' (not his real name) - is in his 70s and has been a regular at Amesbury for some years. Like many others, his interactions have been brief, focusing on his needs when he felt unwell.
"This assessment was very informative for me as a patient. I never realised I could do so much more to improve my health," Charlie says.
In line with the care plan, he's now taken up some light physical activity, and foresworn the slice of cake he used to have each day for afternoon tea.
The initial trial has now turned into a process of nurse-led care plans which is being rolled out across 42 GP practices in the MidCentral area. Amesbury is now doing the assessment on all new patients aged over 75 who have known long-term illnesses.
Read more case studies in Better, Sooner, More Convenient Health Care in the Community (PDF, 912KB)
