HAURAKI PHO
  • Home
  • About us
    • Our People
  • Services We Offer
    • HPHO Practices
    • After Hours Services
    • Breast and Cervical Screening Support
    • Diabetes Management
    • Heart Check
    • Ngā Kaitiaki Manawanui Whai Ora
    • Outreach Immunisation Service
    • Primary Options
    • Patient Portal
    • Primary Mental Health Services
    • Shared Electronic Health Record
  • News & Support
    • Education and Training
    • Coronavirus Updates >
      • COVID-19 Vaccine Updates
    • Join the Team!
  • Hauraki Locality
  • Contact
  • Home
  • About us
    • Our People
  • Services We Offer
    • HPHO Practices
    • After Hours Services
    • Breast and Cervical Screening Support
    • Diabetes Management
    • Heart Check
    • Ngā Kaitiaki Manawanui Whai Ora
    • Outreach Immunisation Service
    • Primary Options
    • Patient Portal
    • Primary Mental Health Services
    • Shared Electronic Health Record
  • News & Support
    • Education and Training
    • Coronavirus Updates >
      • COVID-19 Vaccine Updates
    • Join the Team!
  • Hauraki Locality
  • Contact

Ngā Kaitiaki Manawanui Whai Ora

Picture

“Pathway to Wellness Support Team”

The purpose of the Ngā Kaitiaki Manawanui Whai Ora (NKMWO) programme is to walk alongside and empower individuals, and their whānau, who have long term health conditions (LTC) to successfully self-manage their conditions.

We provide a mobile nurse and kaiāwhina partnership working together with Hauraki PHO general practice teams, community agencies and hospital based health service provider colleagues. 

Having a nurse and kaiāwhina partnership gives the individual/whānau support with clinical aspects and social issues that may be effecting their health.

Some of the services that are provided are as follows:
  • Mobile/home based service;
  • Support, advice and education around health conditions;
  • Development of a personalised care plan;
  • Advocacy/navigation support to clinical (e.g. hospital, general practice, community) and social (e.g.  WINZ, budget, housing, transport) appointments;
  • Connecting you with other services that are available;
  • Encouraging whānau involvement and support; and
  • Lifestyle advice

​The NKMWO model of care is patient/whānau centred and provides care that is respectful, responsive and meaningful to the individual patient preferences, needs and values.  We encourage high quality and sustainable long term condition management within the community that empowers individuals and their whānau to take control of their wellbeing.  

The NKMWO team understand the importance of whanaungatanga and getting to know individuals and their whānau.  Our team will discuss with the individuals/whānau what is important to them and strive to support them in anyway they can.

This service is free for patients enrolled with a Hauraki PHO general practice and has an expected enrolment period for each individual of up to six months to assist them to move to self-management.  General Practices refer patients who they believe will benefit from more intensive assessment and intervention. 

The main criteria for entry into the programme is as follows:
  1. Two of eight identified long term conditions including diabetes, heart disease, asthma, COPD, ischaemic heart disease, renal impairment, depression and anxiety;
  2. More than two hospital visits concerning your long term condition in the last year;
  3. More than eight general practice visits concerning your long term condition over the last year;
  4. Frequent or non attendance at a medical practice/doctors surgery.

​Patients are referred by utilising the Medtech/Evolution Outbox document called MWOK Referral.

nga_kaitiaki_manawanui_whai_ora__servicce_brochure_17032022.pdf
File Size: 323 kb
File Type: pdf
Download File


THAMES
106 Sealey Street, Thames 3500
phone 07-868-9686
Send us a message
HAMILTON
​16 Patikitiki​ Street, Hamilton East
​Hamilton 3216

phone 07-868-9686
Send us a message
Picture
Copyright © Hauraki Primary Health Organisation  |  2020