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Published: 13th October, 2023


In case you missed it: latest from bpacnz

We regularly add new content to our website – browse resources under the “articles” tab or search for a topic you are interested in. Here are some of our most recently published resources:

Last chance to have your say. In the previous bulletin we asked for feedback on aspects of care in the last days of life that you would like us to explore in more detail or any personal experience you would like to share. Thank you to those who have responded, your feedback has been valuable. If anyone would still like to have their say, send us your questions now; responses will be anonymised if published. Email:

Breast Cancer Awareness Month

October is Breast Cancer Awareness Month. In New Zealand, breast cancer is the most commonly diagnosed cancer in females, and it can also rarely occur in males. The overall ten-year survival rate for females diagnosed with breast cancer if a lump is the first sign is 85%, and this rises to 95% if breast cancer is detected via mammogram screening.

Take this opportunity to encourage patients to perform regular self-checks, and to book a consultation if there are any concerns. Check that you have a system in place to invite eligible patients to participate in the national breast screening programme (BreastScreen Aotearoa). Remind women aged between 45 and 69 years that they are eligible for free mammogram screening every two years, tell them how to enrol in the programme if they haven’t yet, and record their breast screening status in their clinical notes. Patients can phone BreastScreen Aotearoa (0800 270 200) to book a mammogram or self-enrol here.

For further information on BreastScreen Aotearoa, see:

October is also Health Literacy Month

Health literacy is defined as the capacity to obtain, process and understand basic health information and services in order to make informed and appropriate health decisions. Many adults in New Zealand have low health literacy and this can have wide ranging implications for their wellbeing and the provision of health services. Older people, people with limited education or language proficiency and those with socioeconomic deprivation often have lower levels of health literacy. Māori and Pacific peoples tend to have lower heath literacy than non-Māori and non-Pacific peoples, which contributes significantly to health disparities.

Health literacy month is an opportunity to consider how you communicate health information. Effectively communicating health information in a way that confirms and builds on people’s knowledge and understanding, in a context that is relevant to them, is key. Improving health literacy is about more than enhancing the readability of information. It is about developing the skills and knowledge of individuals, whānau and communities so that they can evaluate, synthesise and act on the information they receive, to improve their health outcomes.

For information on what healthcare professionals can do to develop people’s health literacy knowledge and skills, see:

Additional resources on health literacy are also available from Te Whatu Ora|Health New Zealand, Health Quality & Safety Commission, Healthify and Health Literacy NZ.

Changes to online ACC45 claim submissions

ACC has made the following changes to its online ACC45 claim submissions:

  • The choice of “bilateral” has been added to the existing left and right injury side options
  • “Another gender” has replaced the previous “Gender Diverse” category
  • The character limit in the patients first, middle and surname fields has doubled
  • “Admitted to Hospital” field is now visible to frontline teams

These changes will be active once your PMS provider has updated their software.

Medicine supply news

The following issues relating to medicine supply, of particular interest to primary care, have recently been announced. This information is also available in the New Zealand Formulary at the top of the individual monograph for any affected medicine and summarised here.

Change of brand causing oral contraceptive pill colour confusion

Since August, 2023, the funded brand of levonorgestrel 150 microgram + ethinyloestradiol 30 microgram + inert tablets has changed from Levlen ED to Oralcon 30 ED. Oralcon contains different coloured pills than Levlen which has reportedly caused confusion among people taking this oral contraceptive.

Patients should be advised that their Oralcon 30 ED active pills are white, and the inactive pills are tan/yellow coloured (this is the opposite to the Levlen brand). Unlike Levlen, all Oralcon pills are the same size. A patient handout is available here to help with these changes.

For further information on oral contraceptives, see:

Measles outbreak update

The latest measles outbreak, reported in Bulletin 84, has escalated. Te Whatu Ora, Health New Zealand, has issued a nationwide alert after a student with measles attended several activities in Wellington and then flew to Auckland. Exposure events can be found here.

Healthcare professionals should be alert for symptoms and signs of measles in patients, particularly those who are not vaccinated or are immunocompromised, and have a recent history of overseas or domestic travel to locations of interest.

All suspected cases of measles must be notified 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.

Additional COVID-19 booster guidance

The Immunisation Advisory Centre (IMAC) has released guidance on who is most likely to benefit from a further COVID-19 booster dose in the coming months. People at risk of severe COVID-19 likely received their last additional booster dose in April, which means they will almost be due to receive another. Additional booster doses are usually given at least six months apart, or six months after a positive COVID-19 test, however, clinical discretion can be applied (but there should be a minimum of five months between the primary course and first booster, four months between booster doses and a minimum of three months after infection with COVID-19). Eligibility criteria for an additional booster dose are available here.

Webinar on skin problems in people living in aged residential care

The Health Quality & Safety Commission is hosting a webinar on preventing and managing skin problems in people living in aged residential care facilities. This free webinar, which is aimed at all health professionals who are involved in the care of residents in these facilities, will cover:

  • How to prevent and manage skin tears
  • Pressure injuries
  • Incontinence dermatitis
  • Fungal infections
  • Defining skin infections

The webinar will be held on 15th November, 2023. To register, click here.

Paper of the Week: Insomnia and sleep apnoea – a double whammy

Insomnia and sleep apnoea are two common sleep conditions, and some people experience both concurrently. Global estimates suggest 30 – 40% of people with insomnia also have sleep apnoea and 30 – 50% of people with sleep apnoea have some form of insomnia. Compared to the general population, people with co-morbid insomnia and sleep apnoea (COMISA) experience reduced overall sleep duration, and the limited sleep they do get is often of poor quality and not refreshing, creating a vicious cycle. COMISA is associated with a 50 – 70% increased risk of all-cause mortality over 10 – 20 years of follow-up, compared to people without insomnia or sleep apnoea.

An article published in the Australian Journal of General Practice provides an overview of the diagnosis and management of people who experience both insomnia and sleep apnoea. While continuous positive airway pressure (CPAP) is accepted as the first-line management for severe sleep apnoea (alongside lifestyle advice and weight management), wearing a face mask to bed is often a significant adjustment. There is potential for an initial reduction in sleep quality and people who also experience insomnia may be more likely to reject CPAP as they considered it to be another barrier to falling asleep. Initiating cognitive behavioural therapy for insomnia (CBT-i) before introducing CPAP may improve the initial acceptance and long-term use of the face mask, while improving insomnia as well.

How do you approach patients with sleep disruption in your practice? Do you always consider and assess for sleep apnoea in patients with insomnia (and vice versa)? What interventions have you found effective for increasing CPAP adherence?

Sweetman A, Frank O, Stocks N, et al. General practitioner management of comorbid insomnia and sleep apnoea. Aust J Gen Pract 2023;52:607–21.

For a free online cognitive behavioural therapy resource for people with insomnia (produced in New Zealand), see:

For further information on diagnosing and managing insomnia in primary care, see: and

An article on obstructive sleep apnoea in primary care is also available, however, some content may no longer be current:

This Bulletin is supported by the South Link Education Trust

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