Proactive respiratory care programme

Any practice in Waikato can offer and claim for this service.

This service includes funding for two consultations with a practice nurse and one consultation with a GP/NP/clinical pharmacist.

This will enable full review of the patient’s respiratory condition, identification of any unmet needs or education requirements, development of a management plan and follow up to evaluate the patients understanding of their self-management.

The key outcomes from these extended consultations should include the following.

• Full review of the patients’ respiratory condition including ACT/CAT assessment.
• Spirometry testing if appropriate.
• Review of medications which may include a referral to pharmacy for further detailed medication education.
• Education of inhaler technique.
• Development of written patient self-management/ action plan.
• Provision of subsidised vaccine (such as influenza, shingles). Note patients can be charged for non-subsidised vaccines such as pneumovax if clinically indicated. 
• Discussion of eligibility for antivirals should the patient test positive for COVID-19.
• Referral to relevant services which may include:
  • smoking cessation support
  • healthy homes service
  • pulmonary rehab
  • social services
  • health improvement practitioner

Patients diagnosed with a chronic respiratory condition who have been identified by the practice as being at high risk of respiratory exacerbation during the winter months. You may choose to search for a list of eligible patients.

This includes but is not limited to:

• Māori, Pacific, Q5 and CSC holders
• patients who have a respiratory related hospital admission in the last year
• patients who have had a respiratory related after-hours presentation to either ED or urgent care in the last 12 months
• patients with frequent acute on chronic exacerbations of their respiratory condition
• patients who make frequent requests for reliever inhaler prescriptions.

You cannot claim under the service for a patient who is acutely unwell at the time of consultation.

The programme will fund a total of three consultations per patient per calendar year.

Pinnacle can help you with identifying eligible patients or you may choose to do your own search.

• Patients not enrolled in a Te Whatu Ora Waikato general practice.
• Out of region patients do not have funding provided under this programme.
• Patients with long COVID-19 symptoms that have not resulted in a diagnosis of asthma, COPD or bronchiectasis.

• The episode of care ends when the outcome and claim are submitted.
• Payment will be made once an outcome has been lodged for the case.

The prices listed below are GST inclusive.  

Proactive Respiratory RN review - In person (once only): $79.00 
Full review of the patient’s respiratory condition to include ACT/CAT assessment, spirometry testing as appropriate, review of medications, development of a management plan, inhaler and condition education, referrals as appropriate. This consultation should be a face to face.

Proactive Respiratory Prescriber review - In person or virtual (once only): $79.00 
To include medication review, authorisation of a management plan, prescriptions for medications to treat exacerbations. The programme will fund a total of three consultations per patient per calendar year.

Proactive Respiratory RN follow-up - In person or virtual (once only): $39.00
Follow up consultation to ensure the patient is comfortable managing their respiratory condition, including appropriate inhaler use and provision of further education. 

These consultations cover all time and consumables and there can be no extra charge to the patient. Submit your referral via Primary Options using the initial condition coding: Proactive Respiratory Care.

When invoicing for the service please lodge an ‘outcome and invoice’ form and select the appropriate invoice(s).

If the patient meets POAC criteria, please initiate a separate referral for any invoices claimed under that POAC pathway.

Practices are required to provide sufficiently detailed consultation notes to determine appropriate use of funding.

The key outcomes from these extended consultations should include the following.

• Full review of the patients’ respiratory condition including ACT/CAT assessment.
• Spirometry testing if appropriate.
• Review of medications which may include a referral to pharmacy for further detailed medication education.
• Education of inhaler technique.
• Development of written patient self-management/ action plan.
• Provision of subsidised vaccine (e.g., influenza, shingles). Note patients can be charged for non-subsidised vaccines such as pneumovax if clinically indicated.
• Discussion of eligibility for antivirals should patient test positive for COVID-19.
• Referral to relevant services which may include:
  • smoking cessation support
  • healthy homes service
  • pulmonary rehab
  • social services
  • health improvement practitioner.

Yes, please claim as usual for cases where a patient presents acutely with an exacerbation of their existing condition and the treatment provided in general practice is preventing an admission to the emergency department.

This cannot be claimed on the same day as any of the above consultations.

No. A patient co-payment cannot be charged.

The service is funded by Te Whatu Ora.