Published: 11th July, 2025
Contents
New from bpacnz: Recommended vaccinations for healthcare workers
Healthcare workers are exposed to many vaccine-preventable diseases in their day-to-day work, so it is important to maintain full immunisation coverage. Vaccination not only helps to reduce personal disease risk but may also lower the risk of transmission to patients. There is a baseline set of vaccinations recommended for all staff working in a healthcare setting (Tdap, MMR, varicella, hepatitis B, influenza and COVID-19); additional vaccination requirements depend on their specific area of work and exposure risks.
Did you know… Influenza vaccination is funded for Health New Zealand, Te Whatu Ora, employees. Employers of non-Health New Zealand health and disability workers in patient-facing roles, including primary care, can claim the cost of annual influenza vaccinations for their staff too. Click here for further information.
Read the full article here.
In case you missed it: Acute coronary syndrome; UTI clinical audit; Angina quiz
The immediate management of patients with acute coronary syndrome
Most patients who present to primary care with chest pain are unlikely to be experiencing acute coronary syndrome (ACS). However, the consequences of missing ACS are significant, therefore, chest pain should always be considered as if it is an emergency, until another cause can be established. If symptoms and signs consistent with ACS are identified, the next steps are crucial and dependent on the anticipated time for the patient to reach hospital.
Read the full article here. A B-QuiCK summary is also available.
Clinical Audit – The appropriate requesting of laboratory urinalysis in patients with a suspected UTI
Obtaining a midstream urine sample for microscopy, culture and sensitivity analysis is often unnecessary for most adult patients with an uncomplicated UTI, as it is unlikely to affect treatment decisions. This audit helps healthcare professionals identify whether laboratory requests for microscopy, culture and sensitivity analysis of urine samples were clinically appropriate in adult patients with a suspected UTI. View the audit here.
Quiz: Management of stable angina pectoris
Stable angina is predictable or reproducible chest pain (or discomfort) caused by transient myocardial ischaemia that occurs when cardiac oxygen supply cannot meet demand. Previously only considered a manifestation of obstructive coronary artery disease; the understanding of angina pathophysiology is changing. Are you up to date? This quiz is designed to optimise learning from our recent article on stable angina.
Test your knowledge here and earn CPD points – can you answer the “extra for experts” bonus question?
N.B. You will need to log-in to your “My bpac” account to complete the quiz; sign up for a free account, here.
Confirmed measles cases in the Wairarapa region
Three cases of measles have been confirmed in New Zealand. The cases are related to each other and involve overseas travel, however, they were not infectious on their return flight to New Zealand. Exposure events have been reported in Masterton and Carterton and are listed here in more detail.
Te Whatu Ora, Health New Zealand, is advising healthcare professionals to be alert for symptoms and signs of measles in patients (e.g. generalised maculopapular rash, fever > 38℃, cough, coryza, conjunctivitis or Koplik spots), particularly those who are not vaccinated or are immunocompromised, and have a history of recent overseas travel.
Notify all suspected cases of measles to the local Medical Officer of Health. Do not wait for laboratory confirmation before notifying.
Information about measles from the Immunisation Advisory Centre is available here.
Is your patient population up to date with MMR vaccinations?
Opportunistically check whether patients have received both doses of the MMR vaccine and offer vaccination where appropriate. Also ensure that patients with upcoming international travel or those planning a pregnancy are fully vaccinated with MMR. N.B. MMR vaccination is contraindicated during pregnancy.
See the Immunisation Handbook for details.
For further information on MMR, see: https://bpac.org.nz/2021/mmr.aspx
In brief: Improved access to budesonide with eformoterol inhalers, Mirena and Jaydess
Improved access to budesonide with eformoterol inhalers
Pharmac has announced that from 1st August, 2025, patients prescribed selected budesonide with eformoterol inhalers (see below) will be able to collect up to three months’ supply at once. Currently, patients can only collect one months’ supply from the pharmacy at a time for inhalers.
These strengths of budesonide with eformoterol inhalers, which are used in AIR/SMART therapy, will also be available on PSO in quantities of up to 120 doses, i.e. one inhaler per PSO. This allows primary care clinicians to demonstrate correct inhaler technique during the consultation and supply medicines in an emergency or “when an individual prescription is not practicable”.
The changes only apply to the following inhaler strengths:
- 100 micrograms budesonide with 6 micrograms eformoterol fumarate (100/6)
- Symbicort Turbuhaler 100/6 (powder for inhalation)
- Vannair (pressurised aerosol)
- 200 micrograms budesonide with 6 micrograms eformoterol fumarate (200/6)
- Symbicort Turbuhaler 200/6 (powder for inhalation)
- Vannair (pressurised aerosol)
- DuoResp Spiromax (powder for inhalation)
These changes follow consultation on a proposal in April (as reported in Bulletin 121) and were recommended in response to the shift in asthma management towards AIR/SMART therapy based on 2020 updates to the NZ Asthma Guidelines.
For further information on asthma management in primary care, see: https://bpac.org.nz/2020/asthma-children.aspx and https://bpac.org.nz/2020/asthma.aspx
Mirena and Jaydess to be funded on PSO
A decision has been made by Pharmac to fund the levonorgestrel intrauterine systems, Mirena and Jaydess, on PSO from 1st August, 2025. This change follows consultation on a proposal in April (as reported in Bulletin 120). It is intended to improve access by removing the need for patients to first collect the prescribed intrauterine system from a pharmacy and make another appointment to have it placed. Clinicians will be able to order up to 25 Mirena devices on PSO, and up to ten Jaydess devices. As part of this decision, the number of Jadelle subdermal implants that can be ordered on PSO has also increased from three to 20 packs (each pack contains two rods for implant). The PSO lists each individual rod, therefore this will be listed as 40 implants.
For further information on long-acting contraception options available in primary care, see: https://bpac.org.nz/2021/contraception/long-acting.aspx
NZF updates for July
Significant changes to the NZF in the July, 2025, release include:
- Contraception advice for anti-seizure medicines updated in the individuals of reproductive potential and pregnancy therapeutic notes
- General update to the therapeutic notes for sex hormones and hormone antagonists in malignant disease, including a new section on anti-estrogens
- Dosing regimen and directions for administration information updated for benzathine benzylpenicillin tetrahydrate for acute rheumatic fever based on the latest national guidelines (as reported in Bulletin 123)
- Nicorandil-induced ulceration (gastrointestinal, dermal, mucosal and ocular) has been added as a caution and adverse effect to the nicorandil monograph (for further information, see: “Management of stable angina pectoris”)
- “Not suitable for application to genital region” has been added to the cautions section in the hydrocortisone + natamycin + neomycin (Pimafucort) monograph and rash and ulceration have been included as adverse effects
- General update to the dimeticone (head lice lotion) monograph
- A new monograph has been added for duloxetine (Section 29, unapproved medicine, not funded), indicated for depression, generalised anxiety disorder and neuropathic pain
- A monograph for semaglutide (not funded); indicated for weight management, is currently under development and will be published 14th July, 2025
You can read about all the changes in the July release, here. Also read about any significant changes to the NZF for Children (NZFC), here.
Telehealth service factsheet for primary care clinicians
Health New Zealand, Te Whatu Ora, has published a factsheet for primary care providers about the national telehealth service that launched throughout New Zealand on 1st July, 2025. This includes information about services that are provided, fee structure for patients and implications for individual medical practices and the wider primary care workforce. The telehealth service will undergo a review after six months to assess its contribution to the primary care landscape.
Read more
The Government recently announced the launch of a new 24/7 online digital health service which it says is targeted at people who cannot access timely appointments with their regular primary care provider, are not enrolled with a primary care provider or require care after hours. The service is intended to complement primary, urgent and after-hours care by enabling video consultations with New Zealand registered general practitioners, nurse practitioners and emergency medicine doctors 24 hours a day, seven days a week.
Key points from Health New Zealand about the service include:
- People should contact their enrolled primary care provider first (if they have one) when they require medical care – the cost of using the telehealth service has been priced higher to encourage this
- Costs for children aged under 14 years, people aged 14 to 17 years and people with a Community Services Card (CSC) are subsidised
- The approved telehealth providers are: Bettr Online, CareHQ, Emergency Consult, MedOnline, Pocket Lab, Practice Plus, Tend and The Doctors Online. N.B. Not all of these organisations provide telehealth services 24/7.
- Medical notes from any telehealth consultation must be shared with the person’s enrolled primary care provider (if they have one)
- Follow-up and communication of the results of any investigations arranged during a telehealth consultation, e.g. laboratory tests, is the responsibility of the clinician who requested them
- Clinicians conducting telehealth consultations will have access to existing shared electronic health records – comprehensive access will be introduced in the future
Click here to read the factsheet.
ESR rebrands as PHF Science
The Institute of Environmental Science and Research (ESR) has undergone a name change to the New Zealand Institute for Public Health and Forensic Science (PHF Science). This rebrand has been in effect from 1st July, 2025, and is intended to reflect a renewed focus on its core functions including responding to infectious diseases and environmental health hazards, as well as forensic science services. Click here to read more about the name change.
Cyber security guide for primary care
Health New Zealand, Te Whatu Ora, has published guidance on managing cyber security incidents for primary care organisations. Strengthen Your Digital Defence: A Guide to Cyber Security Incident Response for New Zealand Primary Health Sector is one of several resources developed to help healthcare organisations prepare for and respond to worst-case cyber security incidents. This includes reducing cyber security risks, preparing for future incidents, responding to a cyber security incident and how to recover and return to normal operations in the aftermath. The guide is intended as an educational tool and does not contain exhaustive advice; it should not replace any legal, technical or professional cyber security advice your organisation already has. Click here to read the full guide.
Suicide Prevention Action Plan 2025 – 2029
The Ministry of Health, Manatū Hauora, has released the Suicide Prevention Action Plan 2025 – 2029. The plan focuses on four key areas of health: (1) Improve access to suicide prevention and postvention (after death by suicide) supports, (2) Grow a capable and confident suicide prevention and postvention workforce, (3) Strengthen the focus on prevention and early intervention, (4) Improve the effectiveness of suicide prevention and our understanding of suicide. A summary is also available, here.
Suicide rates in New Zealand have fluctuated over time. There were 617 suspected self-inflicted deaths in New Zealand in 2023/24 (11.2 per 100,000 population); a 3.6% decrease from average over the past 15 years (not statistically significant). Māori die by suicide at a higher rate than non-Māori. Young people are also over-represented in suicide statistics.
In 2017, bpacnz published an editorial on suicide prevention in primary care with guest commentary from mental health experts in New Zealand: read the article here.
New treatment hierarchy for restless legs syndrome
An updated international guideline from the American Academy of Sleep Medicine published in January this year has recommended a new treatment hierarchy for managing patients with severe symptoms of restless legs syndrome. One of the most significant changes is that dopamine agonists, previously first line for patients with severe symptoms, are no longer recommended due to concerns with augmentation syndrome (worsening of restless legs symptoms over time). The importance of iron supplementation in people with low ferritin levels is also strongly emphasised.
Read more
Restless legs syndrome is a common neurological disorder, characterised by throbbing, pulling, creeping or other unpleasant sensations in the legs and an uncontrollable, overwhelming urge to move them. Low-dose dopamine agonists (e.g. pramipexole, ropinirole [unapproved indication]) have conventionally been first-line treatment for patients with severe symptoms, however, they are now no longer recommended due to concerns with long-term use, e.g. augmentation syndrome. First-line treatments for severe symptoms recommended in the updated US guideline are gabapentin and pregabalin (unapproved indications in New Zealand), and there is a particular focus on the importance of iron supplementation. Lifestyle changes remain a core component of symptom management for all patients with restless legs syndrome, e.g. reviewing possible pharmacological causes and making appropriate medicines changes, avoiding or limiting caffeine and alcohol consumption, sleep hygiene.
Low iron levels in the brain resulting from overall depletion of iron stores is a common underlying cause of restless legs syndrome. Iron studies (including ferritin and transferrin saturation) are therefore recommended to be monitored regularly in symptomatic patients. The US guideline recommends levels at which iron supplementation should be initiated for patients with restless legs syndrome, which are different from the level of iron deficiency that would be treated in the general population: patients with a serum ferritin ≤ 75 micrograms/L (ng/mL) or transferrin saturation < 20% should be given intravenous (IV) or oral iron and patients with a serum ferritin of 75 – 100 micrograms/L should be given IV iron. It is noted that IV rather than oral treatment is preferable at higher serum ferritin levels due to potential changes in iron absorption physiology.
These recommendations do not align with usual treatment guidelines for patients with iron deficiency in New Zealand, including criteria for funded IV iron infusion (see below). A pragmatic approach may be to offer a trial of oral iron supplementation for patients with restless legs syndrome and ferritin levels < 100 micrograms/L and assess whether symptoms improve. Some patients may be willing to self-fund IV iron infusion.
N.B. Special Authority criteria for funded access to IV iron supplementation in New Zealand requires a diagnosis of anaemia and a serum ferritin level ≤ 20 micrograms/L (or a serum ferritin level between 20 – 50 micrograms/L and CRP ≥ 5 mg/L), therefore people with restless legs syndrome may not qualify.
For further information on restless legs syndrome, see: https://bpac.org.nz/BPJ/2012/december/restlesslegs.aspx (published in 2012; this resource has not yet been updated to reflect the new guidance, however, much of the information remains relevant, e.g. prioritise lifestyle changes and reserve pharmacological treatment for those with severe symptoms)
Paper of the Week: Keeping an eye on the -tides: ocular-related adverse effects associated with GLP-1 receptor agonists
Glucagon-like peptide-1 (GLP-1) receptor agonists have become key tools in the therapeutic arsenal for the management of patients with type 2 diabetes, in part due to their established cardiac and renal protective effects in high-risk groups. Dulaglutide and liraglutide are funded for people with type 2 diabetes who meet Special Authority criteria; another brand of liraglutide is also approved for weight management (not funded). Following the recent approval in New Zealand of semaglutide (Wegovy) for weight management, GLP-1 receptor agonist prescribing is likely to increase. But, with so many apparent therapeutic benefits, one cannot help but wonder: are these medicines simply too good to be true?
Evidence is emerging regarding the long-term safety profiles of GLP-1 receptor agonists. Reports of increased rates of diabetic retinopathy and ocular neuropathy associated with semaglutide in phase three trials have raised concerns about a potential association between GLP-1 receptor agonist treatment and ocular complications.
Age-related macular degeneration is a leading cause of blindness. The neovascular form (nAMD) accounts for approximately 10 – 15% of cases, but 90% of severe vision loss. A study published in JAMA Ophthalmology investigated the association between GLP-1 receptor agonist exposure and nAMD incidence in older patients with diabetes. The incidence of new nAMD diagnoses within the three-year trial period was two-fold higher in those who used GLP-1 receptor agonists for at least six months compared to the unexposed group. Additional patient-specific factors associated with increased risk of nAMD included increasing age and a history of stroke. Of note, the risk of nAMD increased with GLP-1 receptor agonist treatment duration. Clinicians should therefore be aware of the potential for ocular complications associated with GLP-1 receptor agonists, particularly in patients with diabetes and pre-existing risk factors, e.g. older age, previous history of stroke, and report any suspected adverse events associated with GLP-1 receptor agonist use to the Centre for Adverse Reactions Monitoring (CARM).
Have you noticed an increase in patients interested in using a GLP-1 receptor agonist for weight management? Are potential adverse effects and long-term risks a frequent concern for patients who enquire about GLP-1 receptor agonists? What specific adverse effects do you discuss with patients before prescribing them? Have you observed any adverse effects, beyond usual tolerance issues, among patients taking these medicines?
Read more
- This population-based, retrospective cohort study consisted of a 1:2 matched cohort of 139,002 patients with diabetes aged ≥ 66 years (47% female, mean age 66.3 years) from Ontario, Canada
- The mean duration of diabetes since diagnosis in the study population was 6.2 years
- A total of 46,334 patients received GLP-1 receptor agonist treatment for ≥ 6 months, of which 97.5% were prescribed semaglutide, and 2.5% were prescribed lixisenatide (not available in New Zealand; mostly used in combination with insulin glargine)
- The incidence of nAMD was two-fold higher in patients treated with GLP-1 receptor agonists for ≥ 6 months relative to the unexposed cohort (0.2% vs. 0.1%)
- Additional factors that increased the risk of nAMD included increasing age (hazard ratio [HR] = 1.12; 95% confidence interval [CI] = 1.07 – 1.18) and history of stroke (HR = 1.96; 95% CI = 1.15 – 3.34)
- Increased duration of GLP-1 receptor agonist treatment was associated with increased risk
- The risk of developing nAMD was more than three-fold higher in patients who used GLP-1 receptor agonists for ≥ 30 months (HR = 3.62; 95% CI = 2.56 – 5.13) compared to those not exposed
- These findings contribute to the growing body of evidence raising concerns about the ocular safety of GLP-1 receptor agonists
- This is contrary to the protective effect against retinal neurodegeneration of other medicines used in diabetes management, e.g. metformin, SGLT-2 inhibitors
Limitations
- This study examined associations at a population level; a causal relationship between GLP-1 receptor agonists and nAMD has not been established
- Smoking status and history, sun exposure, and dose, route and frequency of GLP-1 receptor agonist administration were not accounted for, presenting potential sources of residual confounding
- This study examined patients with diabetes taking a GLP-1 receptor agonist for glycaemic control; this association may not be relevant for all patients taking GLP-1 receptor agonists, e.g. those using the medicines for weight management
- This study cohort only included individuals taking semaglutide and lixisenatide, and results were not stratified by medicine
- Lixisenatide is not approved or available in New Zealand, and semaglutide (not funded) only recently received approval for weight management
- It has not been established whether this association is medicine-specific to semaglutide and/or lixisenatide, or class-specific and therefore relevant to all GLP-1 receptor agonists (including liraglutide and dulaglutide which are widely prescribed in New Zealand for patients with type 2 diabetes)
- The relevance of these results to New Zealand patient populations therefore remains unclear
Shor R, Mihalache A, Noori A, et al. Glucagon-like peptide-1 receptor agonists and risk of neovascular age-related macular degeneration. JAMA Ophthalmol 2025. doi:10.1001/jamaophthalmol.2025.1455.
For further information on the use of GLP-1 receptor agonists in type 2 diabetes, see: https://bpac.org.nz/2021/diabetes.aspx
For further information on the use of GLP-1 receptor agonists in weight management, see: https://bpac.org.nz/2022/weight-loss.aspx
This Bulletin is supported by the South Link Education Trust
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