MRINZ: Audit supports primary health providers leading COVID-19 community management

With reports of whānau isolating in unsafe homes and Whakarongorau Aotearoa and Ministry of Health failing to conduct timely check-ins, South Auckland primary care professionals and their support teams stepped in to monitor and care for thirty-seven COVID-19 cases in their community at the end of last year.

An audit of the management of COVID-19 cases at the Papakura Marae Health Centre during late 2021, co-authored by Professor Matire Harwood and research colleagues at the Medical Research Institute of New Zealand and published in the New Zealand Medical Journal on 4 February, outlines how the Papakura Marae Health Centre became the default provider of medical and welfare care for COVID-19 cases isolating in a Tāmaki Makaurau community during October and November 2021 - in essence taking over the role of the Ministry of Health’s system in place at the time.

In October 2021, the New Zealand Government announced that COVID-19 cases in the community would no longer be exclusively managed in Managed Isolation and Quarantine (MIQ) facilities. With a significant growth in cases in Tāmaki Makaurau, the isolation model moved towards Community Supported Isolation and Quarantine (CIQ) where those diagnosed with COVID-19 could expect regular contact via a remote check-in service run by Whakarongorau Aotearoa, contracted by the Ministry of Health. Whakarongorau Aotearoa also manage the national COVID-19 helpline, vaccination bookings, and other telehealth services.

However, difficulties facing Whakarongorau Aotearoa and Ministry of Health were soon apparent, with reports of whānau isolating in homes that do not meet basic critera for safe isolation, and a failure to consistently perform timely check-ins and reviews. These delays in assessment and support, for both the clinical and general welfare needs of COVID-19 patients, resulted in primary health professionals, such as GP’s and Nurses, stepping-in to make house calls and offer basic needs, especially in the most at-risk communities.

In response to these reports and their own experience, the Papakura Marae Health Centre undertook an audit of their management of COVID-19 positive cases, using information documented in primary care records between 14 October and 18 November 2021. The aim of the audit was to determine how the Papakura Marae Health Centre might improve both the clinical care and welfare of their patients, with the goal of ultimately improving health outcomes and avoiding preventable deaths.

With clinical leadership from Dr Karim Alipour-Almachavan, Dr Matire Harwood, and Dr Jason Tuhoe, the Papakura Marae Health Centre is a primary health provider in South Auckland that serves a community of 3,200+, of whom 95 percent identify as Māori or Pacific Peoples. Its COVID-19 programme is led by nurse Nicole Waters, Practice Manager Barbara Betham, and CE Tony Kake.

The characteristics of the thirty-seven patients included in the audit highlighted their high risk in developing COVID-19 and the importance of delivering timely, comprehensive, and consistent high-quality medical and welfare care. Almost all patients were Māori or Pacific peoples, many living in areas of high socioeconomic deprivation. There were on-average six people per household with three positive COVID-19 cases per household. Only 15% of those eligible for vaccination had received two vaccine doses.

The audit showed that the level and quality of medical care provided by the Papakura Marae Health Centre through their clinical and support teams was of an extremely high standard. In addition to medical care, it was noted that the Papakura Marae Health Centre also provided extensive welfare support, in accordance with their holistic approach to healthcare. This included delivery of kai packages, medication, and hygiene packs to support their community members and whānau.

Professor Richard Beasley, Director of the Medical Research Institute of New Zealand says, “It is evident from this audit that the Papakura Marae Health Centre essentially undertook the role of the Ministry of Health’s system. Furthermore, the level, quality, and continuity of medical care provided by the Papakura Marae Health Centre was clearly better than that which could ever be achieved by a system based on remote monitoring by non-medical personnel, guided by decision support tools."

Dr Matire Harwood, General Practitioner at Papakura Marae Health Centre and Senior Clinical Research Fellow at the Medical Research Institute of New Zealand says, “As a GP with a deep commitment to my community, there was no question of stepping in and supporting our whānau, especially when systems they anticipate would support them, did not. Primary care professionals across Aotearoa are able to best support their people, and I would strongly encourage the Ministry to immediately forge ways in which these practitioners could be adequately resourced to take responsibility of the management of patients with COVID-19 in the community.

“An independent review panel stated that two of the deaths of COVID-19 cases in home isolation in Tāmaki Makaurau were potentially preventable. It's clear that more could have been done and needs to be done for our most vulnerable communities,” says Dr Harwood. “This audit publication is timely given there is now community spread of the highly transmissible Omicron variant. We have a clear and very real opportunity here for our health service systems to be stronger if there’s formal collaboration with local providers to best serve all New Zealanders through community focus."

“By sharing details of the Papakura Marae Health Centre’s mahi through this audit, it is hoped that the Ministry of Health will continue to consider alternative collective models that deliver best care for COVID-19 patients in their communities,” says Professor Beasley.

“This audit shows the extraordinary capability and strong community focus of Māori Health providers such as Papakura Marae Health Centre. It also gives an insight as to what might be further achieved with increased resourcing through the future Māori Health Authority.”

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