What is the recommended initial assessment and management plan for a new patient enrolled in a General Practice (GP) in New Zealand?

Initial Assessment for New Patients Enrolled in New Zealand General Practice

For new patients enrolling in a New Zealand general practice, a standardized comprehensive assessment should be conducted, focusing on screening for serious conditions, physical examination, psychosocial factors, and establishing a patient-centered care plan.

Core Components of Initial Assessment

Medical History

• Complete medical history including current and prior diagnoses, procedures, and comorbidities 1
• Medication review (prescription, over-the-counter, and complementary/alternative therapies) 1
• Family history of medical conditions
• Screening for serious pathology/"red flag" conditions 1
• History of alcohol, illicit drug use, and substance use 1

Physical Examination

• Comprehensive physical assessment including:
  • Vital signs (blood pressure, pulse, respiratory rate, temperature)
  • Height, weight, and BMI calculation 1
  • Orthostatic blood pressure changes 1
  • Cardiopulmonary examination 1
  • Musculoskeletal screening including mobility and strength assessment 1
  • Neurological screening tests as appropriate 1

Laboratory and Diagnostic Testing

• Complete blood count 1
• Urinalysis 1
• Serum electrolytes (including calcium and magnesium) 1
• Blood urea nitrogen and serum creatinine 1
• Fasting blood glucose (glycohemoglobin) 1
• Lipid profile 1
• Liver function tests 1
• Thyroid-stimulating hormone 1
• 12-lead electrocardiogram 1
• Chest radiograph (PA and lateral) if clinically indicated 1

Psychosocial Assessment

• Screening for psychosocial factors including mood/emotions (depression and anxiety) 1
• Assessment of patient's ability to perform routine and desired activities of daily living 1
• Evaluation of social support systems
• Occupational history and work status 1

Management Plan Development

Patient-Centered Care Plan

1. Document assessment findings to guide development of a treatment plan 1
2. Prioritize goals and outline intervention strategies for risk reduction 1
3. Develop a follow-up plan that reflects progress toward goals 1
4. Communicate the treatment and follow-up plans with the patient and appropriate family members 1

Education and Self-Management

• Provide patients with education/information about their condition and management options 1
• Encourage self-management and involvement in problem-solving 1
• Discuss physical activity and exercise recommendations 1

Follow-up Planning

• Schedule appropriate follow-up visits based on identified health needs
• Establish a plan for monitoring progress using validated outcome measures 1
• Create a clear referral pathway for specialist care if needed

Special Considerations

Imaging Recommendations

• Radiological imaging is discouraged unless: 1
  • Serious pathology is suspected
  • There has been an unsatisfactory response to conservative care
  • It is likely to change management

Medication Management

• Review and reconcile all medications
• Ensure appropriate doses of essential medications 1
• Consider medication interactions and side effects

Cultural Considerations

• New Zealand practices should emphasize biculturalism in healthcare delivery 2
• Adapt communication and care plans to respect cultural preferences and needs

Practice Implementation Tips

• Use a standardized assessment form to ensure consistency
• Consider the geographical context of your practice (rural practices are typically further from hospitals and other healthcare resources) 3
• Implement validated outcome measures to track patient progress 1, 4
• Discuss with patients how their health information will be stored and shared electronically 5

By following this structured approach to new patient enrollment, New Zealand general practices can ensure comprehensive initial assessment, establish appropriate care plans, and build strong therapeutic relationships with patients from the beginning.