Published: 21 July, 2023
Contents
New launch date and funding announced for HPV testing
HPV testing will become the primary cervical screening test in New Zealand from 12th September, 2023, replacing the previously announced date of 26th July. As recently reported by Te Whatu Ora, Health New Zealand, cervical screening will be funded for some people when HPV Primary Screening is implemented.
People will be eligible for funded cervical screening if they are:
- Unscreened (i.e. have never had cervical screening)
- Under screened (i.e. no cervical screening in the past five years)
- At higher risk requiring surveillance/follow-up
- Māori or Pacific
- A community service card holder
N.B. Criteria for participation in the National Cervical Screening Programme remain the same, i.e. people with a cervix or vagina aged 25 – 69 years who have ever been sexually active.
Patients who are due or overdue for cervical screening should continue to be recalled and encouraged to undergo liquid-based cytology rather than delaying until the new test is implemented.
Name change for “fatty liver disease”
The American Association for the Study of Liver Diseases (AASLD) has announced a new overarching term to describe the various forms of steatosis influenced by metabolic processes. Non-alcoholic fatty liver disease (NAFLD), also referred to as metabolic dysfunction-associated fatty liver disease (MAFLD), will now be known as metabolic dysfunction-associated steatotic liver disease (MASLD; pronounced 'ma-zuld').
Read more
MASLD is used to describe patients who have hepatic steatosis (i.e. fat accumulation in the liver), in addition to meeting criteria for at least one of five cardiometabolic risk factors, without other potential causes. The qualifying thresholds for these cardiometabolic risk factors differ between adults and children. Analysis of European registry records indicates that 98% of patients currently identified as having NAFLD/MAFLD fit the new criteria for MASLD.
If an additional cause of hepatic steatosis is identified outside of a confirmed cardiometabolic driver, the patient is labelled as having a combination aetiology, e.g. MetALD in the case of alcohol, which is distinct from alcohol-related liver disease (ALD). If no cardiometabolic criteria are fulfilled, the patient is defined as having either:
- Liver disease defined by any other cause identified, e.g. ALD, drug-induced liver disease
- Cryptogenic steatotic liver disease if no other cause is identified. Alternatively, if there is strong clinical suspicion of metabolic dysfunction despite the absence of cardiometabolic risk factors, the patient can be labelled as having “possible MASLD” while awaiting the results of additional testing.
Metabolic dysfunction-associated steatohepatitis (MASH) is also now accepted as the replacement term for non-alcoholic related steatohepatitis (NASH).
Why the change?
There have previously been concerns that the term “non-alcoholic” used in NAFLD and NASH does not accurately describe the associated disease aetiology, which is more accurately linked to metabolic dysfunction. Categorisation into these subtypes also depended on specific exclusion criteria (e.g. strict alcohol consumption thresholds). The new terminology and associated cardiometabolic criteria are intended to be affirmative, and recognises there can be overlapping biological processes contributing to disease progression. The term “fatty” has also been removed from the title as it was considered by some to be stigmatising.
This nomenclature review involved input from 225 stakeholder panel members across three major international societies, including AASLD, ALEH (Latin American) and EASL (European). Following its announcement, over 60 global hepatology and gastroenterology societies, patient and patient advocacy groups have endorsed the new criteria.
For further information about the new terminology, click here
To read more about key causes of chronic liver disease, see: https://bpac.org.nz/2022/cld.aspx
Direct referrals to ACC concussion service providers
As of 1st July, 2023, primary care clinicians (and other providers) referring patients to ACC Concussion Services no longer have to seek prior approval from ACC. The referral can be sent directly to a concussion provider of choice. For a list of providers in your area, click here.
For resources on managing concussion/mild traumatic brain injury in primary care, see: https://bpac.org.nz/2022/concussion.aspx
Invoicing ACC for Cost of Treatment Regulations
Several new rates were introduced in April for providers invoicing ACC under the Cost of Treatment Regulations; this includes general practitioners, nurse practitioners or nurses working in an urban general practice. Contract variations also took effect on 1st July. Make sure you are invoicing with the correct rates. For further information, click here.
ACC is hosting a webinar on Thursday 27th July, 12:30 – 1 pm, for medical practitioners, nurse practitioners, nurses, practice managers, practice administrators or anyone else involved in invoicing ACC, to explain the process and codes for invoicing under Cost of Treatment Regulations.
Birth Trauma Awareness Week: 16th – 22nd July
Birth Trauma Awareness Week highlights the challenges faced by families affected by birth trauma across Australia and New Zealand. There is a need to reduce the stigma and isolation associated with birth trauma experiences, increase knowledge of health professionals about birth-related trauma and improve care pathways for affected people. The theme for this year is postnatal post-traumatic stress disorder (PTSD).
As reported in Bulletin 60, since October, 2022, birthing parents who are injured during labour or childbirth are now eligible for support from ACC. The full list of birth injuries that are covered by ACC can be found here.
For additional reading on managing perinatal depression and anxiety, see: https://bpac.org.nz/2019/perinatal-depression.aspx
Webinar on aseptic technique
As part of National Wound Awareness Week (24th – 30th July), the New Zealand Wound Care Society is hosting a free webinar on Monday 24th July, 6.30 – 7.30 pm, on the appropriate use of aseptic technique by healthcare professionals. The webinar will cover the definition and principles of asepsis and aseptic technique and healthcare acquired infections, performing simple wound dressings, recommendations and resources, concluding with a live Q&A. For further information and to register, click here.
Consultation on regulating physician associates
Manatū Hauora, Ministry of Health, has released a targeted consultation to stakeholders on a proposal to regulate the physician associate (or physician assistant) profession under the Health Practitioners Competence Assurance Act 2003.
As one of the relevant stakeholders, the Medical Council of New Zealand has indicated that it would like to seek the views of all doctors before making its response. The Medical Council consultation closes on Thursday 27th July, 2023 and responses can be submitted here.
Latest publications from Manatū Hauora, Ministry of Health
Manatū Hauora, Ministry of Health has recently published the 2022 Health and Independence Report, and several policy documents associated with Pae Ora, Healthy Future Strategies on the state and future of the New Zealand Health System over the next five to ten years:
Registrations still open for South GP CME conference 2023
The South GP CME conference 2023 is being held at the Te Pae Christchurch Convention Centre, 10th – 13th August, 2023. Register now to secure your place.
The conference caters for the diverse interests of primary care health professionals with a wide range of sessions and workshops available; for the full agenda click here.
The South Link Education Trust is the Diamond Sponsor of the GP CME conferences, and is home to South Link Health Services, BPAC Clinical Solutions, bpacnz Publications and the New Zealand Medicines Formulary (NZF and NZFC). The team will be presenting the new Smart Care products, along with showcasing the full range of activities and services available.
Paper of the Week: Do you mind if I double check this?
With the ever-increasing volume of medical literature and limited time available in general practice to upskill, keeping up to date with the latest clinical recommendations can be challenging. Accessing information at the point of care, i.e. in the consultation room with the patient, is becoming more common. But could this undermine the confidence that the general public have in highly trained health professionals?
Research shows us that no, patients are generally accepting when a clinician needs to search for information, but establishing trust through communication, honesty and actively involving the patient is needed for this to occur. Searching for information during a consultation has been found to improve patient outcomes through more accurate answers to clinical questions and greater confidence by clinicians in decision-making. An article published in the Australian Journal of General Practice details a practical approach to searching for information during consultations, based on interviews with patients.
Read more
Set the consultation space up to facilitate information-seeking
If possible, set the consultation room up so that patients can view the computer screen. Screen sharing has been reported to improve shared decision-making and trust. It also enables patients to engage when clinicians are searching for information.
Understand the foundation of the consultation
Factors that can influence a patient’s tolerance and acceptance of a clinician searching for information online include:
- The level of rapport built during the consultation or previously with the patient
- Their emotional state, e.g. anxiety, vulnerability, and whether focusing attention on seeking information rather than on the patient would be acceptable at that time or not
- Their cultural/ethnic background; different values, beliefs and expectations may mean that it can be harder to gain trust and understanding of the need to search
- Their general trust in medicine, and whether this is high enough for them to be accepting of information-seeking by a clinician
In some cases, information-seeking may need to be delayed until towards the end of the consultation, or it may not be appropriate at all, and need to occur after the consultation or in another space.
Communication skills: ‘Earning the right to search’
Five key communication skills that improve patient satisfaction and trust are: (1) active listening; (2) focused attention; (3) appropriate phrasing about the need to search; (4) patient-centred discussions and; (5) open body language, e.g. eye contact.
There is usually an expectation by patients that a history is taken, and an examination is performed (if relevant) first before searching for information. The timing is generally guided by ‘reading the room’ – how well you know the patient and how the consultation has gone so far. Phrasing the need to search using terms such as ‘double-checking’ or ‘confirming’ is preferable. Remember that communicating with patients about the search is more significant than the actual skill of searching.
Involve the patient in the search
Ask the patient for their ideas and understanding on the topic before searching for information if relevant/appropriate. Some patients will have searched for information themselves prior to the consultation. Asking patients about this can be useful as it validates them as being engaged in their healthcare. Try not to make the patient feel embarrassed that they searched or discredit their information, but respectfully correct information and recommend reliable sources (see below).
Sharing your screen when searching can be an opportunity to educate patients on how to find reputable sources of health-related information online and how to recognise information that may be of poor quality.
Search well
- Use appropriate sources when searching. Consider compiling and saving shortcuts/bookmarks of databases or reliable websites for easy access.
- Be mindful of the length of time spent searching. If you cannot find the information quickly, defer until later rather than spending a long time searching with the patient.
- Interpret and apply the information to the patient instead of reading directly off the screen; this can also improve shared decision-making and trust
Be transparent
Transparency is important in terms of being honest and comfortable in sharing a gap in knowledge or uncertainty with a particular topic. It is better to confidently search for accurate information than to potentially give incorrect information which can lower a patient’s trust and result in harmful decision-making.
Build the blocks for the next consultation
Clinicians can refine their method for information-seeking over time; patient acceptance is also likely to increase with positive experiences. Consider how the information-seeking went in the consultation, observe how the patient responded during the session and if appropriate, seek direct feedback, e.g. did that help you to better understand your condition?
Tranter I, Van Driel ML, Mitchell B. How to ‘Google’ in front of the patient: A practical approach to information seeking during the consultation. Aust J Gen Pract 2023;52:490–3. doi:10.31128/AJGP-09-22-6562
This Bulletin is supported by the South Link Education Trust
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