P4.48: Evaluating psychological support services available for intestinal failure patients nationally

Abstract

Introduction: New Zealand (NZ) has a population of 4.9 million with a publicly funded health system. The NZ Health Strategy 2016 requires care to be delivered close to home. A multidisciplinary team approach for patients with intestinal failure (IF) is widely accepted and a standard of care (SOC) endorsed by NZ National Intestinal Failure Service (NIFS), this includes access to psychological support services. Clinical network (CN) feedback indicated aspects of the SOC were unable to be delivered due to variability and availability of psychological care. In order to advocate for appropriate services, it was necessary to understand the current psychological and psychiatry services for IF patients. Method: A web based survey was developed to identify psychological services, referral pathways, appropriateness and desired levels of service provision for IF patients in NZ. The survey contained questions allocated to five categories including occupation details, current psychological care services, access to psychological care and NZ NIFS SOC. The survey was sent to 502 members of the NZ NIFS CN in August 2017. Responses were collated and analysed using Microsoft Excel to identify themes and regional variance. Results: Forty-one clinicians from 13 of 20 District Health Boards (DHB) completed the survey representing a response rate of 8.2%. Of note, most DHBs contribute multiple staff to the CN and collated responses were sent on behalf of their DHB. Responses confirmed that there is a lack of psychological care services available nationally. This applied equally to both adult and paediatric IF services. It is particularly concerning that respondents identified mental health deficiencies as a reason that 2 of the 10 NZ NIFS SOCs could not be met. Themes highlighted include inconsistencies in availability and adequacy of services between and within DHBs. There is a lack of knowledge of access and referral pathways available for psychological care services. Conclusion: Findings highlight a disparity in provision of psychological care services in NZ which represents a risk to the NZ Health Strategy 2016 close to home model of healthcare. Every IF patient requires appropriate psychological care as a minimum SOC. Whilst acknowledging that current services have limited capacity the NZ NIFS will continue to advocate for the provision of appropriate and equitable psychological care and engage the CN to identify local psychology and psychiatry services in their DHB.