Primary and Capitation funding to PHO ensure

Primary health care contribute greatly to community
health. This essay will discuss vision and key direction of primary health care
strategy with NewZealand Cancer Care plan contribution to development of primary
health care system .This essay focuses on smoking as a modifiable risk factor
for lung cancer. Primary health care nursing intervention to manage effect of
lung cancer on patient, family and community will also be discussed.

Primary Health Care strategy (2001) comprises clear
vision and directions for improvement of primary health care which aimed to be
achieve within 10 years of period. The
vision of primary health care Strategy focused on Population Health Approach.
(Ministry Of Health MOH, 2017a).
 Firstly vision aims at active contribution
of local community in primary health services by development of Primary Health
Organization (PHO), working toward voluntary enrolment of people and involving
people in making own health decision. To make health services easily accessible
in coordination with ongoing care, Primary Health Care deliver range of
promotion and preventive health services, with the help of range of health
professionals (multidisciplinary teams). (Pack, Minister,Churchward &Tanuvasa,2013)

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Another part vision mainly to work toward making all
primary health care services accessible to all community group equally. Measures
included such as Fair allocation of funding to provide high quality services to
underprivileged groups (Maori and Pacific) and Capitation funding to PHO ensure
equality in health status of all community group.( May&Blick,2008) .
Encouraging Involvement of Maori and pacific provider in primary health care
services to reduce disparity in health status (MOH, 2001a)

To accomplish these vision, six directions been laid
out in Primary health care strategy. First key direction focuses on active
participation of local communities and enrolled population.  Primary health organizations(PHO) need to
promote community participation by responding to their needs, encouraging PHO
enrolment, providing thorough information about available health resources. (MOH,2001b).
Patient engagement in health services also encouraged through interventions such
as patient’s access to own health record information resources though
patient portal, seeking patient’s perception toward care delivery services. (Health quality and safety commission
Newzealand, 2017). Second direction is to reduce inequality in health
status of different groups. This is being achieved by PHO by identifying underprivileged
group (Maori and pacific), encourage their enrolment in PHO and implementing
community specific interventions to address their needs. (MOH, 2007a).Measures implemented:
consultation fee reduced for Pacific patients by 12% and for M?ori by 10%. Pacific
led PHO and access PHOs has been developed (Cumming & Gribben ,2007).

Third direction emphasise on provision of accessible
and comprehensive health services. PHO contribute to this by providing screening
and preventive service, supporting patient with chronic illness, fair
allocation of funding and education regarding optimal use of all services.
Report published by Health Services Research Centre, on evaluation of primary
health care strategy in 2005 shows that Government funding for primary health
care has been increased to make services cost effective also more people
getting subsidies.

Fourth direction focuses on providing coordinated
care to enrolled population. PHO and District Health Board (DHB) will
collaborate with local bodies, education, welfare, housing and public transport
primary public health, and mental health and disability services. (MOH 2017b)
with this direction Ministry of social development developed Joint strategic
Planning approach to ensure cross-sectoral coordination in 2003(MOH 2009).Fifth direction involve
Primary workforce development & strategic plan to attract and retain workforce
in rural health MOh.2008) The Public Health Workforce Development Plan
(2007-2016) adopted this direction by focussing on providing emergency training
and health promotion skill development to primary care staff. (MOH, 2007b)

Sixth direction is improving quality of service by
periodical audit to review the PHO workers knowledge and work. Effective collection
and storage of information of public with maintain confidentiality to easy and
cost-effective access of patient information to health professional under
secure guideline and government agencies to decide reforms to be done
formulating future strategy. (MOH,


In 2012, 21,235 diagnosed and 8500 died with cancer
in New Zealand (MOH, 2015). New Zealand Cancer Plan 2015-2018 is developed by
Ministry of health to curb the high prevalence of cancer in newzealand. Main
focus of the plan is to provide high quality, effective, accessible and
equitable cancer services for early diagnosis and better recovery (MOH, 2014a).

The objectives are to reduce incidence of cancer by
introducing health promotion measures like healthy nutrition and lifestyle modification,
to encourage early detection and prevention by easy access to information
resources, to develop primary health care services& screening services
closer to community. Also to Increase chances of recovery immediate referral to
specialist services equipped with high end equipment and trained
professionals.) and to ensure fair allocation of fund to cancer services (MOH,2014b)

In order to evaluate contribution of at primary
health care level can be seen by the new target introduced in plan is patient with
high suspicion cancer need referred urgently to enhance recovery. To meet this
target PHO has adopted guideline of clinical pathway approach (early detection
prevention, diagnosis and treatment and follow up care) to streamline the
process of r referral to higher centre. (Central PHO, 2018). The contribution of primary
health care services can be seen as 90% of patient referred
with symptoms of cancer recived treatment within 62 days ,in year 2016-2017.(MOH,2017a)

Health promotion measure under this plan is Implementation
of the Better help for smokers to quit health target 2016/2017.under this
different measures introduced to help people quit smoking like free NRT and community. Efficacy of this initiative can be seen as  In fourth quarter of 2017,Sixteen PHOs have
met the 90 percent target. 86.6% of PHO enrolled patients quit smoking (MOH,2017b).

Strengthening Cancer Nurse Coordinator Initiative allow
community an access to nurse cancer specialist at primary level care. CNC is
source of information regarding cancer and available resources, treatment
modalities for community. (Kerr,C.2016).).
The main role is to equip community with knowledge to help them to take
informed decision about cancer treatment. As per MOH 2016 evaluation report
CNCI has improved Patient’s access to diagnostic and treatment services,
improved patient experience of coordinated clinical pathway.

In prostate cancer services, prostate cancer
management and referral clinical guidelines were released in July and September
2015 to help Primary health care professionals to monitor the side effect of
unnecessary treatments for men with low-risk prostate cancer. It will also help
community to acknowledge about possible damages and benefits of testing
treatment options. so patient, family and community can make informed decisions.(Prostate cancer Foundation Of

Regional Cancer Networks have restructured their
strategic plans in align with new objective of this plan. For example Midland
strategic plan (2015-2020) included new initiatives like modified screening
services, early referral, more coordination between PHO, DHB and Specialist
oncology services.(Midland Cancer Network,2016)





The main modifiable risk factor for lung cancer is
considered as smoking. Among lung cancer patients 80% are smoker in New Zealand.90%
of lung cancers are attributable to tobacco smoking. Around
5000 people die each year in New Zealand because of smoking or second-hand
smoke exposure (MOH, 2017c)

Tobacco smoke contains many carcinogenic factor. The
strong correlation between smoking and susceptibility to lung cancer due the
smoke associated respiratory carcinogen. (Adam & Chandrakumar 2015) A smoker
increases their risk of cancer because the chemicals in cigarette have
mutagenic property damage DNA and immune system. DNA controls normal cell
growth. Smoking causes some mutation in DNA. Weakened immune system fails to
protect lungs against this resulting in destruction of lung epithelium and
cilia which are protective structure of lung, eventually Lung loses its
functionality and structure due to effect of carcinogen of smoking. ( Xue ,Yang & Seng 2014)

To reduce the prevalence tobacco smoking in New
Zealand, Tobacco Control Program came into action in 2005.Tobacco control
program aim to prevent initiation of smoking, early intervention among smoker,
helping to quit and stick to it. Interventions included in tobacco control plan
community based smoking cessation services like Nicotine Replacement Therapy and
behavioural counselling therapies through DHB and PHO, QUITLINE and other mass
media campaign to target adolescent, e-cigarette to avoid second hand smoking
and Smoke-free Environments Regulations 2007 enforcement. (MOH, 2016b)


To evaluate contemporary nursing management in this
initiative is delivering community based health promotion services. PHO using Occupational
Health Nurses to reach out to the people in community. PHO provide them training,
resource, referral and follow up guideline to approach people for smoking cessation.
They mainly intervene with the workers who may not visit their GP. Occupational
Health nurses does Screening for tobacco use, encourage and support smokers to
quit. Occupational also make sure that smoke free environment regulation
followed at workplace (MOH, 2015).

The Target of Better help for smokers to quit has
been incorporated in this program. Primary health care nurses provide
counselling Using ABC (Ask,brief advice, cessation) approach for smoking
cessation and Provide Nicotine replacement treatment. The success of this program
can be seen as Better Help for Smokers to Quit 2016/2017 target nearly 90%
percent of PHO enrolled patients who smoke have been offered help to quit
smoking.  Sixteen PHOs have met or exceeded
the 90 percent target and five PHOs have improved their performance by more
than five percent.(MOH,2017d).Primary health care nurse also work mainly with
pregnant women who smoke providing medication and counselling regarding adverse
effect of smoking on pregnancy(McRobbie, 2013)

Effect of smoking cessation interventions, smoking
rate for adults has declined from 20 percent in 2006 to 16.6 percent in 2014
likewise in adolescent students.  The gap
between the M?ori (7.17 percent) and non-M?ori (2.81percent) rates of smoking
is reducing. Adult per capita consumption of tobacco has dropped by
approximately 23 percent between 2010 and 2014. (MOH,2016c).

While, Even after all this measure some pitfalls has
been identified in thi program. Massey university Published program evaluation report in 2014 on
effectiveness community services, it has been noticed that some community group
like Maori, Pacific and pregnant woman still had quit rate at its lowest around
4% 7% and 2014 . To address this program need to be reviewed with
emphasis on community based services like face to face counselling and
behavioural support by primary health care professionals. Funding to community
based services to get free smoking cessation support has been increased. These measures
contribute to address identified issues in program. (MOH, 2014)

Smoke free nurses New Zealand is initiative of New
Zealand practicing registered nurses to reduce smoking not only in community
but among nurses. Strategies implemented under this initiative are, Collaboration
of nurses working in DHB,PHO and tertiary institution, maintaining equity by
formulating Maori and pacific oriented strategy. It also involve different
nursing intervention like supporting and conducting Smoking cessation research
and campaign,providing Support tobacco control activities and MOH target
Smokefree 2025, reduce smoking among nurses.(smokefreeNurses,2010)

Under this initiative Primary health care nurses
involvement to target smoking cessation in community setting is fostered.
Nursing intervention include nurse prescribing of stop smoking medications, and
nurse-led stop smoking clinics with individual and group-based treatment. The
smoke free nurses developed website to provide one stop-shop source for information
for Primary health care to deliver effective smoking cessation interventions.(Smokefree

To support the Effectiveness of Program there has
been increase in knowledge of GP clinic staff regarding smoking cessation
intervention. Many students admitted that online website has useful information
tailored to student smoking cessation need. An online campaign what smoker
really want which focus on teaching nurses
to find out real need of smoker & intervention to meet those need received
award for professional development . It is reported the advice and support from
nursing staff increased people’s success in quitting smoking. (Smoke-free
Nurses, 2010)

However, this initiative still lacking in coverage
of primary health workforce in rural setting. Intervention needed to address
smoking incidence in Maori & pacific smoking. ( T.Rangahau,2015) In Response to this,smokefree
nurses has set vision ‘Primary Health Care Nurses leading Smokefree Aotearoa
into 2025’ which aim to train Maximum Primary health care nurses to implement
different health promotion measures like smoking cessation campaign in
community. Also to promote primary health care nurses to work with community
like Maori, pacific, mental health and pregnant patient to reduce smoking
prevalence. (Mary


Primary health care nurses are responsible to meet
physical and psychological demand of individual, family and community group
impacted by lung cancer.(Mcmurry and Clendon,2010). Important intervention
registered nurse working in primary health care for lung cancer patient toward providing
symptomatic treatment. Interventions involve Assessment, Management and
monitoring of symptoms in lung cancer Patient’s Symptoms prevalent in lung
cancer patient Breathlessness and cough in lung cancer patient teaching
breathing exercises, positioning, pacing ,huff coughing techniques at home,.
Primary Health Care Nurses should identify medical emergency and need for
immediate referral to specialist services (Wisemen, 2012). Another symptoms
Pain need to assess try to manage by teaching complementary method like
relaxation & distraction technique, need to refer to  primary health care practitioner to prescribe
analgesic like opioid for chronic pain.(Leader,2015)

Primary care nurses should keep Palliative care
approach while managing lung cancer patient. Nurse need to recognise an ill
patient after chemotherapy and implement a plan. The plan need to be outlined
in coordination with specialist cancer nurse to manage symptoms of adverse
effect of chemotherapy. For example nausea, bowel distress, fatigue to drug can
be manage by advising patient to take prescribe drug like ondansetron ,
encouraging fluid intake and diet modification(Tariman & Szubski,2015).

Nurses need to consider holistic approach while
dealing with the patient with lung cancer, In order to support cancer patients,
nurses need to identify different psychological, social, emotional needs of
patients to improved chances of positive outcome. Being diagnosed as cancer
patient itself is disastrous for patient nurses need to invest time in building
a trusting relationship with their patients. Using Good communication skills
and empathetic approach can identify the special needs of patients Build
strong support system around patient involving family and community member (.O’conner ,2017) Also identify
spiritual needs, Promote cultural practices like prayer to strengthen coping
mechanism.(  Hatamipour,&
Rassouli 2015 )


Intervention needed to manage family member of lung
cancer patient as they also suffer with stress and uncertainty related to newly
diagnosed lung cancer. Around 80% of lung cancer patient’s family experience
some level of psychological distress throughout process. (Mosher & Champion, 2016).
Primary health care nurses have the opportunity to reduce anxiety due to
uncertainty about disease by giving information about treatment course,, side
effects of treatment and their management, emergency management,
exercise-related information, resources available to make family member fully
equipped to care for lung cancer patient. Support and assistance dealing with symptoms.
It has been noted that providing appropriate information and psychosocial
support to family member associated with less unmet need in patients and increased
shared informed decisions regarding treatment. (A. Skufca-Smrdel, 2017)

Nursing intervention for family needed to manage
financial burden in family due to anticipated high cost of lung cancer
treatment. Nurse should advocate for best and cost-effective possible options delivery
to patient as nurse is most trusted health team member. Nurses need to raise
aware ness regarding different policies and program  available in health setting to reduce
financial burden of cancer treatment on family.(WHO 2008a ) For example in new
Zealand Tarceva funding is available to people with locally advanced or
metastatic non-squamous, non-small cell Lung Cancer (Hicks & Wong, 2013).

Lung cancer rates were significantly higher in Maori
Contributing 50 % excess deaths per year. Lung CancermDeath rate is higher in
pacific men.(Teng Atkinson,), Nurses working with these communities need
to raise awareness regarding, importance of screening for early detection,
cancer treatment and Palliative care options available for community As stated in
report Many Maori patient are ignorant that hospice care is free of cost in New  Zealand. (MOH, 2005) .Nurses need to modify this information
resources in community specific language to reduce communication barrier. Nurses
can collaborate with Maori and Pacific community member to provide effective
interventions in community setting. Survey Result of contribution of Maori Health
Provider s contribute to cancer prevention, screening and care by delivering a
wide range of programmes, including health promotion, advocacy, information and
support alongside clinical care. ( Slater,Matheson, Davies,Goodyer, 
Holdaway, Loschmann 2016)


This essay has discussed vision and key direction of
primary health care strategy along with effect of New Zealand cancer plan
2015-2018 on development of primary health care. Smoking has been considered as
most prevalent risk factor for lung reduce incidence of smoking
tobacco control initiative and smoke free nurses initiative has discussed.
Primary health care nurse interventions for lung cancer as a health promotion,
advocating best treatment, community specific measure and cancer symptoms
management has been discussed.