Te Piki Oranga using telehealth to overcome barriers to access for whānau

Publication date: 9 September 2021

Kaupapa Māori primary health provider Te Piki Oranga, based at the top of the South Island, will be introducing telehealth throughout its health services to help remove the barriers some whānau in the region face when trying to access health services.

The initiative, called Matihiko (Digital Source of Wellbeing), has received funding from the Ministry of Health’s Digital Enablement Programme, which provides support for innovation in digital health care. The programme has a particular focus on co-investing in projects that improve access or participation for people who do not access health services and need to. It’s all about improving equity.

The Ministry is working closely with project teams, sharing learning between participating organisations as a community of practice and looking for opportunities to help others learn from these initiatives as they adopt and promote these or similar services elsewhere. The projects are examples of the types of innovation that will be supported by the better access to information enabled by the Hira programme.

Hira will be an ‘ecosystem’ of data and digital services that will enable consumers to access and control their health information through their choice of website or application using a digital device such as a smartphone, tablet or computer. New Zealanders will be more empowered to manage their health, wellbeing and independence. Organisations can work together to share information so that people don’t have to repeat personal details multiple times. Clinicians can harness digital technologies to improve services. The sector and digital innovators can design and contribute innovative data and digital services, making Hira more powerful.

Te Piki Oranga was established up in 2014, in collaboration with Nelson Marlborough Health and existing Māori health providers. It delivers a range of health services on behalf of regional and national health partners, including personal health, mental health and addictions, Well Child/Tamariki Ora and health social work.

Anne Hobby, Tumuaki (general manager) at Te Piki Oranga, says the size and remoteness of the region can make it difficult for whānau to access primary care and other vital health services.

‘The area we service goes from below Seddon, to Picton, over to Motukea, to Golden Bay, and almost as far as Murchison. While we have urban areas in Nelson and Blenheim, there is a lot of non-urban area. In urban areas the rents are often higher, so whānau sometimes have to live further out. They don’t necessarily have the transport or the budget to be able to easily access services and doctors back in the towns.

‘By having telehealth access from clients’ homes to our services and to GP services, it will give those with low income and high needs more access to services. It will take away some of those barriers of cost, travel, needing to find childcare and so on.’

Kaipakihi kaiwhakahaere (business support manager) Ra Hippolite says while nurses can often see whānau in their own home, it is more difficult for doctors to visit.

‘However, we can book appointments with clinicians and specialists by using telehealth. One of our ideas is to get a robust tablet and show whānau how it works. They would be shown how to book a consultation with the doctor, have that appointment, and then the tablet can be left with whānau so they can keep using it.

‘That gives people peace of mind – it’s like a phone call with the doctor but using video conferencing. The doctor can see a wound, they can see baby, they can do so much more than you could with just the telephone.

‘If the appointment needs to be face-to-face, whānau will be able to book it online and make the timing work for them. They can look at the doctor’s availability and pick a time that suits them to go to town – and plan to do other things while they’re there.’

Ra says the key is making the process of using telehealth as simple as possible.

‘Tablets will have the data card built into them and will be secure. If the data card is removed, the tablet will shut down. We want clients to think of the tablet as a tool that is going to benefit their whānau.’

He says once a person is back on the path of wellness – self-managing their condition and not needing to see clinicians as frequently – the tablet can give given to another whānau.

Ricky Car is pūkenga kaiwhakahaere (site manager) for Te Piki Oranga in Blenheim. He says the telehealth approach also provides an opportunity to support people with lower health literacy.

‘If someone has complex health issues that are difficult to understand, we would do our best to have a registered nurse with them in their home during the online appointment with the doctor. The nurse can explain to the client what the doctor is asking and also explain to the doctor what the client is presenting with.

‘There will be other times where simply showing the client how to use the technology will suffice, and they can have the telehealth appointment on their own. It will all provide a more streamlined and efficient way of operating, with the best use of everyone’s time.’

Te Piki Oranga has introduced a new kaupapa Māori GP service called Manu Ora. The service provides appointment times that work for whānau. Nurses and doctors will have more time to talk with patients and address the issues they present with. Telehealth is a key component of the service, as those who are not able to attend in person can access the service online.

Anne says before the COVID-19 lockdown she was sceptical about whether telehealth would work for people who had difficulty accessing health services.

‘But I have had to eat my words. During lockdown, people liked telehealth for a number of reasons. They didn’t have to leave their home – a place they felt confident and comfortable in. If you’re using telehealth, you can have half a dozen people sitting in the room with you if you want, you’re in control. And it’s still face-to-face even though it’s at a distance.

‘During COVID we had counsellors using telehealth, Justice, doctors, specialists were using it, and it was working for whānau.’

Ra says one of the most challenging things will be finding the people who would gain most from being part of Matihiko.

‘We want to provide support to those having the most difficultly accessing health services, who are facing the biggest barriers. They have the most to gain. We will be working closely with iwi to find those people.’

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