Christchurch is one of the 4 major cities in New Zealand and is the main city within the Canterbury region of the South Island. All public hospitals in NZ are known as District Health Boards (DHBs). This presentation will focus on the programme between Christchurch Women's DHB and the NZEF.

This project was initiated because of the disturbing facts associated with endometriosis which are common to all, but especially because of:
• diagnostic delay
• high prevalence
• repeat visits to doctors and specialists
• compromised patient lifestyle and function
• the disease still generally being poorly diagnosed, treated and understood

Background
Quite specific and peculiar to the Canterbury region though, has been the introduction of major NZEF educational and awareness campaigns over the last 8 years:

1. The ‘Me’ (Menstrual Health and Endometriosis) adolescent education programme in schools which has been operational for 7 years
2. The GP education programme
3. Public awareness initiatives
4. The Oxford Clinic Women’s Health and Endometriosis Centre which is a private health provider in Christchurch.

Each of these unique programmes has contributed to a significant increase in the numbers of girls and women presenting with symptoms suggestive of endometriosis, which have required additional resources/facilities to ensure adequate and appropriate treatment. The NZEF’s breakthrough strategy was subsequently to develop and establish a specifically tailored patient partnering programme at the Christchurch Women’s Hospital.

Thus, the NZEF initiative to provide the focus services of education, information and support at the hospital evolved.

The trial programme
An initial proposal was introduced and accepted by hospital general management in November 2003. As DHB funds were unavailable, the NZEF sourced funding privately to undertake the trial programme.

A comprehensive financially viable joint venture contract between the NZEF and Christchurch Women's DHB was formally accepted and the trial programme began in March 2004 with audit and evaluation in December 2004.

The services in the three areas of focus provided by the NZEF (all paid for by the DHB) are:

• educational forums and follow up workshops for all gynaecology staff
• patient seminars (including family, friends, colleagues)
• specifically designed information wallets for wait-listed and diagnosed patients.
• access to the free phone helpline
• NZEF membership to patients
• outreach

The project had a multi-pronged outreach with NZEF also providing education and resources to health professionals, women’s health organisations (eg. the Family Planning Association) and cultural groups (mainly Pacific and Maori health providers) so that all stakeholders were recognised with the patient at the forefront.


The results
The staff and patient evaluations (project satisfaction surveys) were so positive it enabled the NZEF to return to the hospital management in January 2005 with a proposal requesting Christchurch Women's Hospital DHB fund the project. The NZEF was advised in February 2005 that the proposal had been accepted by the DHB and the programme began in June.

Affirming outcomes
• young women from the ‘Me’ school programme presenting with symptoms suggestive of endometriosis are being diagnosed in over 90% of laparoscopic cases.
• patient knowledge and demand strengthens multi-disciplinary 'team' treatment approach offered by gynaecologists
• The Oxford Clinic gynaecologists also operate clinics at Christchurch Women’s Hospital and undertake surgical skills training courses in advanced laparoscopic excision of disease.
• NZEF programme complements best practice offered by the DHB providing a win/win for patients and hospital with the added benefit that NZEF is being paid.

The trial project has resulted in the Christchurch Women’s Hospital DHB being upheld as the ‘model’ and has initiated discussions with other DHBs throughout New Zealand. The programme has been formally accepted by 6 further DHBs since June this year.

The future
It is our aim to introduce this programme into all DHBs in New Zealand.

The downstream effect is resulting in:
• Gynaecologists in private practice buying the NZEF resources for their patients
• Improved patient understanding about what constitutes best practice and choosing a gynaecologist who specialises in endometriosis
• Pressure on gynaecologists to provide a multi-disciplinary treatment regime or for them to refer to a tertiary centre which does
• Profile and credibility for the NZEF
• Specialised laparoscopic training in advanced excision of disease
• NZEF lobbying government on behalf of patients
• Increased awareness and media coverage.

In effect, the NZEF is creating the ‘tipping point’ where the idea to promote and provide best practice in a multi-disciplinary, holistic manner is crossing a threshold and taking off. The NZEF is playing a pivotal role in really making a difference. The public, patients, doctors and specialists now have a programme which provides each with an irresistible benefit, but most importantly, gives our patients the treatment they deserve.