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Published: 23 June, 2023


New article – Long COVID: an evolving enigma

Preventing SARS-CoV-2 infection and managing the acute phase of illness has been the central focus of our healthcare system since the beginning of the COVID-19 pandemic. While most patients are expected to recover from COVID-19 within two to four weeks, some continue to experience symptoms 12 weeks or more post infection; this is defined as long COVID.

Given the diverse clinical picture associated with long COVID, it is not a “natural fit” for any one medical specialty, and primary care is often tasked with leading the management of affected patients. To help support clinicians, we have recently published a new long COVID resource, including advice to guide a progressive and tailored diagnostic work-up, and management tips to address the diverse range of possible symptoms.

Care plans should consider and address the wider consequences of ongoing symptoms, including effect on quality of life, emotional distress and psychological implications for the patient and their family/whānau. Not adequately managing these factors can impede and prolong recovery.

Read the full article here

Watch this space

Long COVID is an evolving area of clinical research, and guidance is likely to change frequently. The perspectives and recommendations presented in this article are intended as a general guide and are current as of the publication date; they are largely based on content from the 2022 Ministry of Health "Clinical rehabilitation guideline for people with long COVID (coronavirus disease) in Aotearoa New Zealand". We will aim to provide updates as further evidence emerges.

Patient information on managing seasonal viral illness

Helping patients cope with seasonal viral illness, i.e. “cold and flu” is an inevitable part of general practice, particularly during the winter months. To help support primary care health professionals in providing advice, we have developed a patient resource on managing seasonal viral illness at home. This information sheet can be downloaded and emailed or printed, or a link sent via text message, for the patient or caregivers.

We have also recently updated our patient resource on managing COVID-19 at home

Candesartan with hydrochlorothiazide funded from 1 July

Pharmac has announced that candesartan cilexetil with hydrochlorothiazide tablets will be fully funded for patients with hypertension, from 1 July, 2023. As previously mentioned in Bulletin 75, this medicine will be funded without restriction. This decision gives prescribers a funded fixed-dose combination treatment following the recall and delisting of quinapril with hydrochlorothiazide (Accuretic; see Bulletins 53 and 61).

Two tablet strengths will be funded*: candesartan cilexetil 16 mg with hydrochlorothiazide 12.5 mg and candesartan cilexetil 32 mg with hydrochlorothiazide 12.5 mg.

*Candesartan cilexetil 32 mg with hydrochlorothiazide 25 mg is also available but will not be funded

For further information on the management of hypertension in primary care, see:

Folic acid in wheat-based flours

From mid-August, all non-organic bread-making wheat flour either produced or sold in New Zealand must be fortified with folic acid. Organic and non-wheat based flours are exempt. The transition process to fortified flour began in 2021. Folic acid fortification of bread aims to reduce the incidence of neural tube defects, and is a way to ensure that women of childbearing potential have some level of folate, should they become pregnant.

Folic acid supplementation for women planning a pregnancy, or who are pregnant, is still necessary even if folic acid fortified bread is consumed. The recommended dose is 800 micrograms daily for at least four weeks prior to conception and for the first trimester. A 5 mg folic acid tablet daily is recommended for women at high risk, e.g. personal or family history of a neural tube defect, taking anti-epileptic medicines, with diabetes, who are obese or with malabsorption, e.g. due to coeliac disease.

N.B. The 800 microgram tablet of the currently funded brand of folic acid is not gluten free, however, the currently funded 5 mg tablet is gluten free and should be prescribed to women who cannot tolerate or consume gluten.

For further guidance on folate and folic acid for reducing neural tube defects, see:

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 older to be vaccinated this flu season. As of 16 June, the overall vaccination uptake in this group is 61%, but rates are lower in Māori (53%), Pacific (50%) and Asian peoples (52%).

Māori and Pacific peoples aged 55 years and older are also eligible for funded influenza vaccination this year, however, the current level of uptake in people aged 55 to 64 years is only 27% for Māori and 30% for Pacific peoples.

Funded access has also been widened this year to include children aged six months to 12 years. Overall vaccination uptake in this group is currently 8%; higher in children of Asian ethnicity (16%), and lower in Māori (3%) and Pacific (6%) children.

Manatū Hauora, Ministry of Health, publishes data on uptake of vaccinations by district, updated weekly; check out how your area is doing here.

Encourage influenza vaccination opportunistically during routine appointments and ensure patients who meet eligibility criteria for funded vaccination are aware that they can receive a flu vaccine for free.

New Zealand-based online CBT course for health anxiety

Just a Thought is a New Zealand organisation that offers free online cognitive behavioural therapy (CBT) courses and hosts other resources for a range of mental health conditions. A new online CBT course has now been released for people with health anxiety.

The course uses CBT that has been specifically designed for this condition, and provides people with the necessary knowledge, skills and strategies to overcome anxiety associated with their health. The course can either be completed by the patient in a self-guided manner or through prescription by a clinician.

View all the courses available by Just a Thought here

Safe Access to Opioids: Engagement summary released

In March, 2023, Manatū Hauora, Ministry of Health, asked for public feedback regarding proposed approaches to the regulation of opioid prescribing in New Zealand. A summary of the feedback has now been published and will be considered when advising the Minister of Health on further amendments to the regulation of opioid prescribing. bpacnz and the New Zealand Formulary (NZF) provided a joint submission.

The full report can be found here

For further information on the state of opioid prescribing in New Zealand, see:

Pharmac seeking feedback on funding biosimilar trastuzumab

Pharmac has released a proposal to award Principal Supply Status to Herzuma (a biosimilar form of IV trastuzumab - Herceptin) from 1 December, 2023. This would result in Herzuma becoming the main funded brand of trastuzumab available in New Zealand. The proposal also includes widening access of trastuzumab to people with locally advanced or metastatic HER2 positive gastric cancer who meet Special Authority criteria. Proposed changes to the funding of trastuzumab will allow any relevant practitioner to apply for Special Authority (including renewal applications). Submissions are due by 30 June, 2023.

For further information on biosimilars, see:

Paper of the Week: Assessing children with short stature in primary care

The height of a child largely depends on genetics, hormones and nutrition. Nutrition is the predominant factor that determines height during the first two to three years of life, after which, growth hormone and thyroid hormone are the main determinants until puberty. During puberty, height is determined by growth hormone, oestrogen and testosterone.

The cause of short stature in children is most often familial. In some cases, it may be due to a constitutional delay of growth and puberty, which is initially managed with watchful waiting. However, for other children, short stature (or reduced rate of growth) may indicate an underlying health issue such as chronic illness, lack of adequate nutrition or psychosocial issues. Short stature is more prevalent in females and in children living in low socioeconomic areas.

Early detection and intervention are important to improve clinical outcomes. A 2023 article published in the British Journal of General Practice discusses practical recommendations for the assessment of a child presenting with short stature. They note that this is often overlooked in girls and children from ethnic minority groups, as it may be assumed that their short stature is not abnormal.

Storr HL, Freer J, Child J, et al. Assessment of childhood short stature: a GP guide. Br J Gen Pract 2023;73:184–6. doi:10.3399/bjgp23X732525

This Bulletin is supported by the South Link Education Trust

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