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Published: 15 July, 2022


Contents

New article: Recognising and managing OCD in primary care

Intrusive thoughts are experienced by most people, maybe even frequently. However, for some people these thoughts are all-encompassing and destructive to their ability to function in their everyday lives. Obsessive compulsive disorder (OCD) is characterised by unwanted, repetitive, intrusive thoughts, images or impulses (e.g. contamination, losing control, harm) that are highly distressing, and often lead to the performance of compulsive behaviours (e.g. checking, hand washing, seeking reassurance, rumination) to resolve the anxiety caused by the obsession. OCD affects approximately 2% of the population and can have a significant impact on quality of life, including relationships, education and employment. Diagnosis can be challenging due to the variable nature of presentation. We interviewed psychiatrist Dr Caleb Armstrong from Anteris NZ to learn more about OCD, including advice on how to manage patients in primary care.

Read more here


COVID Care app: free for Medtech users

An application to assist general practices in managing their patients with COVID in the community has just passed 3000 uses. Most patients (81%) have been triaged into self-management, but 4% of cases have resulted in a recommendation for urgent referral.

The Covid Care app, which was developed by the BPAC Clinical Solutions team, is free-of-charge for practices using Medtech Evolution or Medtech 32. It is designed to work seamlessly within your patient management system, integrating relevant patient information and using decision support to triage care and follow-up based on the patient’s symptoms and signs.

Covid Care is available now in your Medtech bestpractice dashboard. For further information, including a link to an instructional video, see: https://bpac.org.nz/2022/covidcare.aspx

Covid Care is provided to you free-of-charge by the South Link Education Trust and BPAC, supported by Medtech Global, as part of our ongoing commitment and service to general practice.


Anyone for flu vaccine?

There are still many eligible adults and children who have not received their funded influenza vaccination. The national target is for at least 75% of adults aged 65 years or over to be vaccinated this ‘flu season’. Currently, the overall vaccination rate in this group is 68.2%, but this rate is lower for Māori (62.9%) and Pacific peoples (59.3%). This year, Māori and Pacific peoples aged 55 years and over are also eligible for funded influenza vaccination, however, currently the vaccination rate for Māori aged 55 to 64 years is only 33.2% and 36.2% for Pacific peoples.

High risk groups with underlying health conditions, e.g. adults and children with chronic respiratory disease, people with serious mental illness, and all children aged 3-12 years are now eligible for funded influenza vaccination. All healthcare professionals are urged to discuss influenza vaccination at any healthcare interaction and ensure that people who are eligible for funded vaccination are aware of this.

The Ministry of Health publishes data on uptake of vaccinations by DHB, updated weekly: check out how your area is doing.

Patient information and resources about influenza vaccination are available here.


Nitrofurantoin recommended for Pharmacist supply

In the recently published minutes of the April meeting of the Medicines Classification Committee (MCC), it was recommended that modified release nitrofurantoin (Macrobid) be re-classified to be able to be sold by pharmacists for the first-line empiric treatment of uncomplicated urinary tract infection (UTI). This would bring pharmacist treatment in-line with current best practice recommendations for antibiotic choice for UTI. Currently pharmacists who have undergone specific training are able to supply trimethoprim for the empiric treatment of uncomplicated UTI. However, resistance to trimethoprim is increasing in many areas and in recent years this has no longer been the first-line recommended treatment for UTI.

Read more about managing UTI in primary care here.

Don’t have time for that? See the B-QuiCK topic on UTI


Accuretic update

As reported in our previous Bulletin, patients taking Accuretic (quinapril + hydrochlorothiazide), and clinicians prescribing this medicine, were informed by PHARMAC on 30th June that they require a change in treatment due to contamination issues.


New ACE on the horizon

PHARMAC is currently consulting on a proposal to fund ramipril, an ACE inhibitor that is commonly used in other countries, including Australia, for hypertension, heart failure and chronic kidney disease. If the proposal is accepted, from 1 November, 2022 ramipril will be fully funded without restriction, and available in four strengths of capsule.

Cilazapril is due to be delisted from the pharmaceutical schedule in mid-2023; currently no new patients may be initiated on this medicine and prescriptions for current patients must be endorsed.


Bupropion is available again

Recent supply issues have meant that patients who require pharmacological treatments for smoking cessation have had few options to choose from. As reported in Bulletin 48, varenicline has been unavailable since mid-2021 due to a supply issue – thought to be the same contamination problem with nitrosamines as with the recent recall of Accuretic. Bupropion has been subject to supply restrictions due to demand and global shortages, leaving nicotine replacement therapy as the remaining funded option.

PHARMAC has announced that the supply issue with bupropion has now resolved and stock is once again available. Varenicline remains unavailable.

Read more about smoking cessation treatments here.


Paper of the Week: Are low calorie beverages ‘sweet as’ for improving cardiovascular risk factors?

Recently, Coca-Cola ditched two of its popular Coke varieties and replaced them with Coke Zero Sugar. The jury is still out on taste, especially among the fervent fans of each of the previous brands, but the bigger question is – do low calorie/sugar free drinks actually offer any advantage over their sugary big sisters? A recent study in JAMA attempts to answer that question.

McGlynn N, Khan T, Wang L, et al. Association of low- and no-calorie sweetened beverages as a replacement for sugar-sweetened beverages with body weight and cardiometabolic risk. A systematic review and meta-analysis. JAMA Netw Open 2022;5(3):e222092. https://dx.doi.org/10.1001/jamanetworkopen.2022.2092


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