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What is the GASP Tool?
Harbour Health has developed a web-based asthma assessment and decision support software tool, called GASP (Giving Asthma Support for Patients). It is suitable for adults and children. The GASP tool has the potential to standardise asthma patient education and management, ensuring evidence based best practice by adhering to the NZ Guidelines.

The purpose of the tool is to assist doctors and GASP-trained nurses in a comprehensive assessment and management of asthma (and also COPD).  

This web-based tool is believed to be the first of its kind and was developed over two years ago by Harbour Health’s respiratory manager Wendy McNaughton and Solution Architect, Murray Speight from Comprehensive Health Services. The Tool has been approved by Professor D. Robin Taylor and the Asthma and Respiratory Foundation.


The facts

 
The History
In Auckland, almost 200 nurses, known locally as “GASP nurses”, have completed an advanced asthma course. This training is an extension of the Asthma & Respiratory Foundation’s Fundamentals Programme and has NZQA accreditation at levels 7 & 8. Nurses completing the course are competent in all areas of asthma management, including setting up a nurse-led clinic and working collaboratively with the GP for improved patient education, health and well being.
This has resulted in many successful nurse-led asthma clinics in the North Shore and urban Rodney districts, which in turn have led to positive outcomes for patients’ health and greater job satisfaction for the nurses involved. However, use of paper-based assessment tools and calculators was cumbersome, time consuming and difficult to audit, hence our development of the electronic GASP tool.

The GASP Pilot
A 6-month pilot to test the GASP tool commenced in January 2008. It involved 18 GASP nurses across five GP practices, tracking 75 patients, aged 5-64 years.
The aims were to improve patient knowledge and concordance, encourage self management and reduce ambulatory sensitive admissions


The results:
Reduction in hospital admissions
Seven patients had required hospital admission prior to the first GASP consultation; there were no hospital admissions for the 75 patients during the six month GASP pilot.
Reduction in emergency visits
The number of emergency visits to hospitals, after hour services, or GP for asthma symptoms reduced from 29 to 5 for patients involved in the GASP pilot.
Reduction in use of oral steroids
Prior to the pilot 31 patients were using oral steroids; this reduced to 4 patients during the GASP pilot.
Improved peak flow measurement
All 7 acute asthma patients who had been admitted to hospital in the period before the GASP pilot had improved peak flow measures after the pilot  Overall, 50% of the 75 patients involved in the pilot improved their peak flow rate.

 
Advantages of the GASP Tool
GASP is a gold standard for asthma management and is based on the New Zealand, BTS/SIGN and GINA Guidelines. GPs can be confident that the advice the GASP nurse gives a patient is based on robust best practice evidence. Being an electronic tool, it can be updated as necessary.
GASP is web-based and is compatible with Med-Tech 32 and soon with My Practice. It populates data to and from the patient’s notes.
Ease of Use: The GASP Tool is on ONE page. It is very easy to use and the GASP nurses find it saves time and follows a format which they are comfortable with. All the calculations required for an asthma assessment are automatic, so it is less time-consuming and less open to errors. It allows the GASP nurse to interact better with and include the patient in the assessment process, which many enjoy.
Patient consent and privacy: The patient is offered an option to share personal and medical information with the PHO. This is anonymous and is identifiable by NHI number only.
Assessment: Using a variety of pop-up prompts and drop down boxes, the GASP Tool offers a comprehensive assessment of the patient’s history of asthma; triggers; exacerbations; inhaler technique; adherence to treatment; symptom scores; medication use. 

Patient education plays a pivotal part of the assessment process, and the GASP nurses play a key role in this area.
Objective Tests can be a stand-alone option. They include:
Reversibility tests, which are calculated to assist the clinician with diagnosing asthma or COPD accurately.
Spirometry and Nitric Oxide (FENO) testing, with assistance for interpretation of results.
Personalized Trigger Advice will show the patient how best to manage triggers and can be printed and given to the patient.
A personalized Action Plan can be printed for the patient. The calculations used are based on the patient’s best home peak flow measurement. However, they can also be generic or “symptom based” and offered to both adults or children.
The Decision Support is a complex tool which provides hundreds of different decision probabilities and offers the clinician evidence based advice and points to consider.

Audit
The Claims Management system controls quality by collecting patient’s data for the PHO, providing information on current population trends and costs. This is essential for a robust audit to be analysed and gives an insight into areas of care requiring more support and education.

Future Plans
Since the official launch of the GASP Tool in November 2008, Harbour Health has given the GASP programme to all its GP Practices.
Other primary health organisations are welcome to enquire about accessing the GASP Tool, at a subsidised cost.
Harbour Health will also provide training to nurses from other healthcare organisations.
A 2-year research project, in collaboration with Massey University and the Asthma Foundation, is now underway, aimed at tracking the impact of using the GASP tool.

For more information, please contact:
Wendy McNaughton, Respiratory Programme Manager, Harbour Health
DDI:    09 448 0467
Mobile:  0275 415 377
Email:  wmcnaughton@harbourhealth.org.nz

New Zealand has the 2nd highest incidence of asthma in the world, affecting over 600,000 kiwis – 1 in 6 adults and 1 in 4 children.
Asthma is one of the top three reasons for children and young adults (15 – 24 years) to be admitted to Waitemata District hospitals.
The rate of hospital admissions are two to three times higher for Maori and Pacific Island children aged 5 -14 than for non Maori and Pacific Island children .
In a 2004 survey of respiratory services provided to New Zealanders by 21 DHBs, the researchers commented that “…we are failing New Zealanders and should urgently address serious issues in our respiratory Care” and that asthma is “the leading cause for people visiting their GPs and being admitted to hospital.” They criticised the lack of care given to patients with asthma, saying that there is no accountability on a national level and that no quality measurements or targets exist for respiratory disorders .     

Welcome to Harbour Health

Harbour Health undertakes to work with all health providers and the community to develop programmes and services that ensure all patients who are enrolled with Harbour Health through their family doctor, are able to benefit from access to appropriate and affordable services.

 

B4 School Check Programme

 

Harbour Health is now offering a new FREE health and development check, for all four year olds, through its affiliated general practices.  

The B4 School Check which is funded by the Ministry of Health, includes assessment of childrens growth, development, general health, and immunisation.  The aim is to identify anything that could affect a child's ability to get the most benefit from school, such as a hearing problem or communication difficulty.  The check, which takes about 40 minutes to complete, also provides parents or caregivers the valuable opportunity to discuss their child’s health and development with a specially trained nurse. 

Please contact your Harbour Health Practice to make an appointment for your child
and for more information about the check itself please visit the Ministry of Health website www.moh.govt.nz/b4schoolcheck

 

SAFE

(Smoke Alarm and Fire Education)

Project

  

The SAFE Project is a joint initiative between New Zealand Fire Service and Harbour Health’s Otago Exercise Programme (OEP) to increase fire safety awareness and install Smoke Alarms in the homes of those on the Otago Exercise Programme. 

 

The SAFE Project has been in place since 2005 and OEP participants can refer into this service via their OEP Physiotherapist or by ticking the referral option in the OEP Feedback Survey. 

 

Referrals are received at Harbour Health (Lis Cowling or Naseema Dutt).  They are then emailed to the Fire Service Community Education Officer (formerly Nella Booth, now Gary Beer).  From there they are forwarded to the closest Fire Station and the Fire Fighters then visit each person, provide and install free Smoke Alarms in addition to using the time to promote fire safety through education.

 


Cervical Cancer Vaccine

Each year in New Zealand about 160 women are diagnosed with cervical cancer and it will be the cause of death for 60 of these women.. 

99% of instances of cervical cancer are caused by the humanpapillomavirus (HPV). HPV is a very common virus that is spread through sexual contact. Four out of five people become infected at some time during their lifetime. While most HPV infections clear by themselves, some types can cause changes on the cervix (neck of the uterus or womb) that may lead to cervical cancer many years later.

Girls and young women can now be protected from the most common HPV types that can cause cervical cancer by a vaccine called Gardasil. The vaccine works by causing the body’s immune system to produce its own protection (antibodies) against these HPV types and is most effective if given before girls are exposed to HPV virus (ie before they start having any sexual contact)

From September 1st 2008 FREE HPV vaccine will be offered to young women born in 1990 and 1991 and younger girls who have left school. by all general practices affiliated to Harbour Health. School vaccination programmes will commence in 2009 for all young women aged 12 – 18 years.
The vaccine programme requires three doses of the vaccine given over a six month period to provide the most effective protection.

It is important that girls and young women have regular cervical smears from the age of 20 years once they become sexually active as Gardasil does not protect against all causes of Cervical Cancer.

Other information may be found on www.immune.org.nz and www.cervicalcancervaccine.govt.nz.  or phone or visit your General Practice to speak to your General Practitioner or Practice Nurse.

 

 

CHILDHOOD VACCINATION to protect against Pneumococcal disease

From June 1st   2008 New Zealand babies are eligible for a free vaccine – Prevenar conjugate vaccine.  This vaccination provides protection against pneumococcal disease caused by the 7 most common strains of the Streptococcus pneumoniae bacteria (pneumococcal bacteria).

How is the disease spread? 


This disease is spread from person to person, usually by coughing or sneezing.

What does the Prevenar vaccine protect against?

Infection with the pneumococcal bacteria can cause pneumonia and bacteraemia (blood poisoning) in all age groups, and meningitis (infection of brain membranes) in very young children. Pneumococcal infections can also cause otitis media (middle ear infection which can sometimes lead to deafness) and sinusitis (inflammation of the suinuses). The effects of pneumococcal disease are most severe in children under age two years, and in the elderly.
 
Who is eligible to get the funded vaccine from June 1st 2008? 

Click here for more information



 
 
 
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