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RAPHS - Extended Care Support Team

Community Health Service

Today

Description

The RAPHS Extended Care Support Team was established to provide support, advice and guidance to RAPHS practices and community organisations.

The team combines the resources of nursing, pharmacy, hospital and community-based health and social services through an integrated multidisciplinary team.

The service aims to:

  • Reduce unnecessary ED/hospital admission/readmission for at risk patients.
  • Support transitional care for complex patients discharged from the hospital setting to home.
  • Support complex patients to better self-manage their personal health in their own environments.

Ages

Adult / Pakeke

How do I access this service?

Referral

For practitioners:

If you have patients who you consider would benefit from the RAPHS team input, please refer using the ‘Extended Care Support Team’ referral form available on BPAC or send a quick email to provider services with the patient's details.

Email:

If you have any questions please phone RAPHS on: 07 349 3563

Fees and Charges Categorisation

Free

Hours

Mon – Fri 9:00 AM – 4:00 PM

Languages Spoken

English

Services Provided

Clinical Assessment and Care Coordination

In collaboration with the GP practice, the team will assist with clinical assessment and care coordination of complex patients in their home, outreach visits or at RAPHS. This may include: Written care plans Facilitation of patient's care, compliance/adherence Pharmacist clinics within your GP practice Medication reviews and/or education Optimisation of patient’s medicines Medicines reconciliation/support post hospital discharge Clinical audits to identify patients in whom pharmacotherapy can be improved for example patients on ‘triple whammy’

Service types: Home support, Home visits, Needs assessment, Community nursing, Self management support, Medication administration.

In collaboration with the GP practice, the team will assist with clinical assessment and care coordination of complex patients in their home, outreach visits or at RAPHS. This may include:

  • Written care plans
  • Facilitation of patient's care, compliance/adherence
  • Pharmacist clinics within your GP practice
  • Medication reviews and/or education
  • Optimisation of patient’s medicines
  • Medicines reconciliation/support post hospital discharge
  • Clinical audits to identify patients in whom pharmacotherapy can be improved for example patients on ‘triple whammy’
Patient Access to Community Service Providers

In collaboration with the GP practice, the team will assist in improving patient access to community service providers, e.g. community dietitians, heart failure nurses, WINZ, etc.

Service types: Information & support, Home support, Immunisation, Pregnancy vaccinations, Childhood immunisation programme, Adult flu vaccine, Workplace flu vaccinations, Advocacy, Family / whānau support, Cervical screening, Health screening.

In collaboration with the GP practice, the team will assist in improving patient access to community service providers, e.g. community dietitians, heart failure nurses, WINZ, etc.

Community nursing

Case management, CVD self-management education, Diabetes self management, Respiratory, Stop smoking, Self management support

  • Case management
  • CVD self-management education
  • Diabetes self management
  • Respiratory
  • Stop smoking
  • Self management support

Additional Details

Face to face / Kanohi ki te Kanohi

Region

Lakes

Contact Details

Level 1
1165 Tutanekai Street
Rotorua 3010

Information about this location

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Street Address

Level 1
1165 Tutanekai Street
Rotorua 3010

Postal Address

PO Box 1626
Rotorua

This page was last updated at 11:22AM on July 22, 2024. This information is reviewed and edited by RAPHS - Extended Care Support Team.