Bart (67) lives alone with some support from friends. He was referred to a Southern Inland Health Initiative (SIHI) primary health nurse practitioner by his local Men’s Shed.
Bart explained, “My life is becoming increasingly dysfunctional – I can’t walk more than 10 metres without getting breathless and dizzy.”
Bart has the impression that his lungs are tired and there isn’t much that can be done to help him.
Bart’s presenting health problems
- chronic lung disease
- very overweight (Body Mass Index = 46)
- high blood pressure (165/90)
- type 2 diabetes
- high cholesterol.
Recent history related to presenting problems
Bart has seen his local GP a number of times over the last 2 years seeking help for:
- waking at night choking and struggling to breathe (he snores heavily when he is asleep)
- feeling exhausted for most of his waking hours
More recently, Bart reached a crisis when he felt his trouble breathing was unbearable.
He went to his local emergency department and was administered oxygen.
Once he was past the crisis, he was discharged and instructed to return to his GP.
“I feel in control and now I can breathe. The CPAP mask irritates my face and I have an occasional blood nose but that’s the least of my problems. This is the first time I have slept in years and I feel more energy. I know now when my oxygen is down. I feel less angry and aggressive.”
Key principles for SIHI primary health highlighted by this case
A fresh assessment of Bart’s health needs gave him access to more effective health care. A SIHI primary health nurse practitioner helped plan Bart’s care by coordinating between the hospital, medical specialist, GP, dietetics, and home help for Bart.
Connecting Bart to a network of community-based services means he is now better able remain living independently at home and to access the right level of care when he needs it.
This will help him reduce complications that could result in him needing urgent help from the emergency department or spending time in hospital.
In the future, Bart will be able to have his review appointments with his respiratory and sleep physician via videoconference with the support of a SIHI nurse practitioner.
This will save him having to travel to Perth for treatment.
This case study shows how SIHI primary health is improving coordination and integration between services to enable people living in country WA to access:
- client, family, and community focused care across the continuum of health services from hospital to home
- the right care by the right team, in the right place
- equitable care – equal life and health chances
- accountable care – quality of care, not quantity.
Role of the SIHI funded primary health nurse practitioner in this case
- Bart is referred for specialist review by a respiratory and sleep physician.
Intervention: When I first saw Bart, he was in respiratory failure. His lungs couldn’t keep his oxygen and carbon dioxide levels in normal range and they needed help.
Outcome: I got in touch with Bart’s GP to learn more about his case, referred Bart for tests (a chest X-ray and blood gases), and arranged for him to see a specialist doctor ( a respiratory and sleep physician).
- Bart is given new treatments to stabilise his breathing.
Intervention: The respiratory and sleep physician admitted Bart to Sir Charles Gairdner Hospital to assess and stabilise his lung condition.
Outcome: Bart went home with oxygen to use during the day and a continual positive airway pressure (CPAP) mask for sleeping to help keep his oxygen and carbon dioxide levels in normal range.
- Bart gets daily home help and transport support.
Intervention: The Respiratory and Sleep Physician asked Bart not to drive until his first check up to make sure the new treatment was working. This meant Bart needed help with transport for daily tasks like shopping.
Outcome: I helped Bart access home help for cooking, shopping, and housework and arranged with his GP for support for his travel to and from Perth to see the Respiratory and Sleep Physician.
- Bart learns to take a more active role in managing his own health.
Intervention: After Bart returned home, I made sure he knew how to monitor his oxygen and carbon dioxide levels. I helped him understand his symptoms and how his diabetes and chronic lung disease can work together to make him feel worse if he doesn’t keep them under control. I explained the importance of preventing lung infections (forexample, through a yearly flu shot).
Outcome: Bart now knows the steps he can take to manage his health. He also knows when to call for extra help, and who to call.
- Bart connects to community health services to support him to stay well at home.
Intervention: I referred Bart to a dietitian to learn healthy eating to help manage his weight and his blood sugar levels. I also arranged with the pharmacy to pre-package Bart’s daily medications in a Webster-pak® to help him keep track of them.
Outcome: Bart feels more confident that he can take an active role in managing his health and feels better more often.
WA Country Health Service