Published: 19 May, 2022
Our 50th edition!
This month we celebrate the publication of our 50th edition of “Best Practice Bulletin”. A little over two years ago when our Publications Team (like the rest of New Zealand) were experiencing our first lockdown, we decided to start our COVID-19 bulletins. The aim was to summarise the news for primary care – things were changing rapidly with COVID-19 and we wanted to help in getting the right information out there. Eight editions of the COVID-19 bulletins were produced and then as the situation became more “normal” we broadened our approach into the current style of bulletin. Issue one was published on 28th May, 2020. We hope that the content of our bulletins remains useful and relevant. We appreciate that primary care is under a great deal of pressure right now due to the onslaught of other respiratory infections that has arrived, but if you have time, please consider providing feedback if you have thoughts or comments. We also welcome ideas on topics you would like covered, or information you would like to get out to your primary care colleagues: email - email@example.com
New article: Acute low back pain
Low back pain is a leading contributor to disability in New Zealand; it is only rarely, a life-threatening condition, but it represents a significant health burden both to patients and the healthcare system. Primary care clinicians have a key role in implementing early interventions to reduce the likelihood of patients progressing to chronic low back pain and associated disability.
In this article we are delighted to feature expert commentary from Musculoskeletal Medicine Specialist and General Practitioner, Dr Jeremy Steinberg. Click here to read more.
Short-term funding for palivizumab for RSV
PHARMAC has announced that from 1 June, 2022 until 31 December, 2023, palivizumab, a humanised monoclonal antibody, will be funded in selected children aged under two years for use as a preventative treatment to reduce the chance of severe respiratory illness and hospitalisation due to respiratory syncytial virus (RSV). It is expected that an increased number of infants and children will be affected by RSV this year, as was the case in 2021. Those eligible for treatment include infants who were born prematurely (additional criteria to be met) or with chronic cardiac or lung disease. The full eligibility criteria can be found here. Palivizumab is administered as a once-monthly intramuscular injection during the expected RSV season (usually May-October).
Changes to the COVID-19 Public Health Response (Vaccinations) Order 2021
COVID-19 vaccination exemptions for mandated workers
There is now a new process for mandated workers to get a temporary COVID-19 vaccination exemption. It is currently recommended to wait three months after testing positive for COVID-19 before receiving the next COVID-19 vaccination; some workers who are required to be vaccinated or boosted to carry out their work are adversely affected by this advice. Under the new process, mandated workers who test positive for COVID-19 are exempt from receiving their next booster dose for 100 days after receiving a positive COVID-19 test result. Workers must provide evidence of their test result to their employer. Further information on temporary medical exemptions can be found here.
It is now the employer’s responsibility to recognise and administer exemptions for mandated workers, i.e. a medical or nurse practitioner will no longer need to apply for a temporary vaccination exemption on the person’s behalf unless the person is self-employed or vaccination is not mandated for them. However, if a worker tests positive for COVID-19 a second time, after recovery from the first infection, workers must apply for a further temporary vaccination exemption to the Ministry of Health via a medical or nurse practitioner. These changes are summarised in an algorithm available here.
More COVID-19 booster vaccines are now recognised
The recognised list of COVID-19 booster vaccines in New Zealand has expanded under the COVID-19 Public Health Response (Vaccinations) Order 2021. In addition to Pfizer and AstraZeneca, the following COVID-19 vaccines are now recognised:
- Half or 1 dose of Moderna (Spikevax, mRNA-1273)
- 1 dose of Novavax (Nuvaxovid, NVX-CoC2373)
- 1 dose of Covovax (Serum Institute India Novavax formulation)
- 1 dose of AstraZeneca (Covishield, Serum Institute India formulation)
- 1 dose of Sinovac (CoronaVac, PiCoVacc)
- 1 dose of Sinopharm, Beijing (BBIBP-CorV, BIBP vaccine, Covilo)
- 1 dose of Bharat Biotech (Covaxin, BBV152)
- 1 dose of Janssen/Johnson & Johnson (Janssen COVID-19 Vaccine, Ad26.COV2.S1, JNJ-78436735)
National Immunisation Programme: reminder
It’s all go for the National Immunisation Programme as influenza, MMR and COVID-19 campaigns are in full swing, and with the borders re-opening this year we can expect to see more cases of these illnesses within our community.
Health professionals are encouraged to follow a “no opportunity missed approach” and to proactively check the vaccination status of all patients, particularly for MMR, and to give vaccinations concomitantly, if possible. Click here for some conversation tips to encourage people to get vaccinated.
For further information on MMR, see: https://bpac.org.nz/2021/mmr.aspx
Don’t forget about HPV
The Ministry of Health is also encouraging general practitioners to continue recalling children who may have missed out on school-based HPV vaccination programmes during 2020 and 2021. HPV vaccinations are free for all people aged 9 to 26 years (including non-residents aged under 18 years), non-residents aged over 18 years who had their first dose prior to age 18 years, and for adults aged over 27 years who had their first dose before age 27 years.
New Cancer Society campaign: the link between alcohol and cancer
The Cancer Society has launched a campaign to raise awareness of the link between alcohol and cancer; a survey found that people’s awareness of this association was relatively low.
The survey, which included over 800 people, found that one-third of respondents said “small regular use of alcohol is safe” in terms of cancer risk and it was also found that breast cancer was the least well-known alcohol-related cancer. The findings from this study highlight the need for greater awareness and education on the health risks associated with alcohol use. A patient tool to self-assess drinking habits is available here.
Although the occasional alcoholic drink is enjoyed by many of us, there is no level of alcohol intake that can be considered safe. Even having one alcoholic drink per day is associated with an increased risk of cancer of the oral cavity and pharynx, liver and female breast. Not drinking, or reducing the quantity of alcohol consumed, reduces the risk of multiple cancers including, oral, pharyngeal, oesophageal, laryngeal, liver, bowel and female breast.
For further information on the link between alcohol and cancer, see: https://www.cancer.org.nz/cancer/reducing-your-cancer-risk/alcohol-and-cancer-risk/
For information on the assessment and management of alcohol misuse by primary care, see: https://bpac.org.nz/2018/alcohol.aspx
F.A.S.T. campaign evaluation
The Health Promotion Agency has released an interim report on the effectiveness of the F.A.S.T. campaigns for identifying stroke, between 2019 – 2021. These campaigns were first launched in 2016 and have been successful in helping people to recognise the key signs of stroke and to call 111 immediately.
The 2019/2021 campaign was most successful in increasing the awareness of signs of stroke for people of Pacific ethnicity. Awareness is now similar across Māori, Pacific and non-Māori/non-Pacific respondents. In terms of the FAST acronym, knowledge that ‘T’ stands for ‘Time/Take action’ has the lowest awareness, in line with previous campaigns. Although awareness did increase that only one sign of stroke is required before calling 111, 41% of people still believe that more than one sign of stroke is required before acting or are unsure. Future work will aim to raise awareness on the need to act fast and call 111.
Read the full interim report here
Coming soon: The medicinal cannabis guide for pharmacists
Recently, we published a medicinal cannabis resource for medical practitioners, supported by the Ministry of Health. This provided an overview of the new regulatory requirements for prescribing products under the Medicinal Cannabis Scheme, as well as a discussion on the potential indications and safety considerations. We will soon be releasing a follow-up article aimed at pharmacists, which more specifically focuses on their integral role in ensuring all legal requirements for prescriptions are met, and how they can co-ordinate the procurement and dispensing of products. We hope that this resource will deliver some much-needed clarity around these processes, particularly given the challenges faced by some pharmacists under previous legislation.
Pharmacists, watch your Inbox for further details!
Paper of the Week: Helping to engage young people in treatment for mental health issues
A recent article published by NPS Australia has highlighted practical steps that a GP can take to help young people with mental health issues. More than 50% of young people will experience some form of mental health problem by the age of 25 and 75% of adults with a mental health disorder experience onset before age 25 years; early interventions are essential to reduce the risk of chronicity.
The first appointment can be critical for the patient’s long-term engagement with treatment and services. In this initial appointment it is important to build a personal connection, understand the patients’ needs and develop a plan for ongoing contact. The relationship between a young person and their GP is one of the most important factors in successful management.
Tips for connecting with a patient include
- Connect relationally. Young people are often more comfortable with clinicians who connect with them through humour, or over shared interests.
- Where possible, slow down, make eye contact and be present
- Demonstrate an interest in the patient, suggest regular appointments and remember personal details about them
- Be aware of the impact that stigma or shame could have on the patient
- Ask the difficult questions in a caring manner. Sometimes, the term ‘safety assessment’ could be used instead of ‘risk assessment’.
- Take a needs-based and strengths-based approach rather than focusing on the diagnosis
- Ask about coping strategies – many young people are more resilient than they may realise, therefore encouraging them to use strategies they already have can be empowering to them
- If caregivers are involved, discuss with the patient about the level of information they would like shared with their caregivers
Read the full article here
Further resources by bpacnz about addressing mental health and wellbeing in young people can be found here.
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