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BPJ 75 May 2016

Best Practice Journal

Rosacea: seeing red in primary care

Rosacea is an inflammatory facial skin disease that can cause patients embarrassment and reduce their quality of life. There are several different subtypes of rosacea and multiple treatments may be required to achieve satisfactory symptom relief. Topical treatments are first-line with oral treatments reserved for patients with persistent and severe rosacea. It should be noted that there is a lack of subsidised topical treatments and oral treatments that are subsidised are “off-label”. View Article

Alcohol misuse: how to help patients in primary care

Approximately one in five New Zealanders over the age of 15 years drinks in a way that is hazardous to their health. Counselling and advice from a general practitioner can help people to cut down. Clinicians in primary care should ask patients about their alcohol intake and assess for alcohol misuse. People who are misusing alcohol can access online and telephone support, community help groups or be referred to Community Alcohol and Drug Services. Pharmacological treatment with disulfiram may be initiated in primary care for patients with moderate to severe drinking problems who have been unable to reduce their intake with non-pharmacological approaches. View Article

Managing patients with neuropathic pain

Neuropathic pain results from a lesion or disease affecting the somatosensory system. There are a range of causes of neuropathic pain including diabetes, surgery, multiple sclerosis, stroke, herpes zoster, cancer and chemotherapy; diagnosis can be challenging. A patient history and clinical examination focusing on sensory, motor or autonomic changes is the starting point of any investigation. The management of neuropathic pain aims to improve the patient’s quality of life if symptom resolution is not possible. Tricyclic antidepressants, gabapentin, either alone or in combination, and carbamazepine for trigeminal neuralgia or diabetic polyneuropathy are appropriate options for treating most types of neuropathic pain in primary care. Alternative medicines, e.g. valproate or lamotrigine may be trialled, however, there is limited evidence of effectiveness in patients with neuropathic pain. View Article

Out-of-clinic blood pressure testing in primary care

Out-of-clinic blood pressure monitoring is increasingly regarded as a routine component of cardiovascular risk management. This is because it is a better predictor of cardiovascular events and mortality than clinic-based measurements. General practices that use this technique can provide patients with more accurate cardiovascular risk assessments and help them to make better decisions about their health. Prescribers are also able to titrate blood pressure treatment regimens more accurately using out-of-clinic measurements than if management was guided solely by clinic-based blood pressure assessments. Only validated devices are recommended for the measurement of blood pressure. View Article

Use the New Zealand Formulary to access patient information leaflets

Patient information leaflets (PILs) are now available from the New Zealand Formulary (NZF). View Article

Hazards to Health: e-notification to your Medical Officer of Health

An electronic notification system has been designed for general practices to report cases of disease and injury related to exposure to hazardous substances, including lead absorption. View Article

Correspondence

How do we define valvular heart disease when considering warfarin or dabigatran in patients with atrial fibrillation? | Medical cannabis: an oxymoron or is there evidence of benefit? | Oxycodone prescribing in the community: What can primary care do? View Article

Peer Group Discussion

We look back at the key messages and practice points from selected articles in Best Practice Journals View Article