Adult Pneumonia Pathway

Acute Demand Service – Community Acquired Pneumonia Key purpose/benefit The Acute Demand Service for Community Acquired Pneumonia currently acknowledges the Adult Pneumonia Pathway on Bay Navigator but once developed this will be found on Midland Health Pathways. A key component of the pathway is the use of a CRB-65 score to determine the severity of Community Acquired Pneumonia for appropriate management in primary care.

Chest X-Ray A chest x-ray may be requested but is not routinely recommended in a community setting. A chest x-ray may be appropriate when the diagnosis is unclear, where there is dullness to percussion or other signs of an effusion or collapse, or when the likelihood of malignancy is increased, such as in a smoker over 50 years. Use the current Best Practice Acute Demand Radiology Referral for a chest x-ray request.

Eligibility criteria  

The Patient must reside within the Western Bay of Plenty It is preferred the patient is enrolled and funded through a WBOP PHO general practice

Follow-Up funding 

If a follow-up is required within 48-72 hours for a patient with Community Acquired Pneumonia then this can be funded under the Acute Demand Service

Not eligible for follow-up funding  

A follow-up that does not fall within the time-frame of at least 48 or within 72 hours after first appointment as per the Bay Navigator Community Acquired Pneumonia pathway A subsequent routine 6 week follow-up CXR is not funded

Updated Nov-19

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Referral process 1. Assess the patient’s CRB-65 score and include this in the referral clinical notes 2. Complete a referral to the Acute Demand Service using the Acute Demand Midland e-referral to the WBoP PHO

3. Mandatory referral details: • Must state the scheduled follow-up date • Include all relevant clinical information • If a CXR has been requested using the Best Practice Acute Demand Radiology form

Claim submission process 1. The patient presenting to the GP must pay for their first appointment. The claimable funding is for a follow-up appointment once the patient has been diagnosed with Community Acquired Pneumonia.

2. Currently invoicing is a manual process. Generate and print an invoice from your PMS same day the patient follow-up consult has been completed. Please ensure the invoice includes:  Acute Demand Service  Patient NHI  Follow-Up Date

Email the Invoice to lizzien@wboppho.org.nz or Post the invoice to Community Acquired Pneumonia Acute Demand Services WBOP PHO, PO Box 13226, Tauranga 3141

Updated Nov-19

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Payment Community Acquired Pneumonia (CAP) Follow-up *First consultation paid by the patient Follow-Up Consultation

Consultation Type

48 to 72 hours after first consultation

General Practitioner

WBOP PHO Fee Claim Inclusive of GST $ 70.37

Contact details: Lizzie Nicholls Acute Demand Service Administrator Phone: 07 571-7161

Updated Nov-19

Email: lizzien@wboppho.org.nz

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