Published: 16 December, 2022
Contents
The Year in Review
It’s that time again, another year has passed. It seems like only yesterday that we were summing up 2021 and now it’s the end of 2022. We have had another successful year here at bpacnz Publications with multiple new resources published. However, what we are most grateful for in 2022 is you, our loyal audience, supporters and contributors. This includes our colleagues in primary care, the doctors, nurses and pharmacists, the trainees, consultants and surgeons and other hospital and secondary care specialists, the health sciences students learning the ropes, the managers, analysts and administrators that keep the engine running and all of the others who keenly follow our work. This bulletin is dedicated to you.
Let’s take a closer look at some of the highlights this year
- Liver function tests in primary care: a comprehensive guide to appropriate ordering and interpretation of LFTs, including a spotlight on key causes of liver disease
- Chronic kidney disease: the canary in the coalmine: an update on the latest evidence on managing CKD and preventing decline
- Cervical cancer: early detection and referral : the first of our series on gynaecological cancer examines the prevention of cervical cancer, including details of the new HPV screening programme. Subsequent articles in the series, to be published over the next few months, will cover ovarian, endometrial, vaginal and vulval cancers and follow-up in primary care after curative-intent treatment.
- Addressing heart failure in primary care: a two-part series covering diagnosis, initiation and escalation of treatment
- Managing concussion in primary care: a suite of resources including written guidance, a two-part narrated slide cast with guest expert Sports Physician Dr Stephen Kara, a patient case study and printable summaries
- Gut health: including a comprehensive guide on coeliac disease, a pragmatic approach to H. pylori investigation and treatment and an updated reference on the options and evidence for weight loss
- Acute low back pain: low back pain affects up to 80% of people at some stage during their lifetime and around half will seek medical advice or treatment – here’s what to do
- Recognising and managing OCD in primary care: a practical interview with guest expert Psychiatrist Dr Caleb Armstrong
- The medicinal cannabis guide for prescribers and pharmacists
B-QuiCK summaries are available for these articles here.
The top 10 resources viewed on www.bpac.org.nz by people in New Zealand in 2022 were:
Our offices are closed from 12pm, Friday, December 23rd and re-open Monday, January 9th.
We wish you all a very merry Christmas, Meri Kirihimete, and restful holiday for those able to take a break.
Changes...sort of
1 December, 2022 marked the end of an era for bpacnz and the wider organisation. Emeritus Professor Murray Tilyard stepped down as Chief Executive Officer for South Link Education Trust, which oversees bpacnz, BPAC CS, South Link Health Services and the South Link Health Group. We would like to express our sincerest gratitude to Murray for 20+ years of leadership, innovation and “getting the job done”. Over the years Murray has pioneered multiple programmes, projects, software and gadgets that have changed the face of primary care in New Zealand. He dreamed big and provided oversight and mentorship to the people who made those dreams become reality.
However, this is not a farewell. Murray remains an integral part of the organisation as the Chairperson of the South Link Education Trust board and Chief Clinical Advisor. We welcome Karl Andrews as our new CEO.
Christmas surprise: a review of NZ opioid data and your personalised prescribing snapshot
Opioids can be effective for relieving moderate to severe acute pain but carry a significant risk of harm with longer periods of use. Understanding the appropriate indications and reducing unnecessary opioid prescribing should therefore continue to be a key focus in New Zealand, as it is worldwide.
Just in time for Christmas, the Publications team at bpacnz has prepared a new resource looking at national trends in opioid use between 2017 – 2021. An editable and printable pain management plan and opioid treatment contract is also included as potential tools to support safe and effective use. In addition, if you are a primary care prescriber, you can log in to see your personalised opioid prescribing snapshot, including how your prescribing weighs up against your peers and national trends. So... how do you compare?
To view this resource, click here.
Common theme of 2022: referrals
Although the most obvious hot topic of 2022 was COVID, a common theme we have seen in feedback this year has been about referral to secondary care services, or more specifically, the difficulty of this. The general sentiment in response to
some of the advice in our articles is: “Those referral criteria aren’t realistic, there is no way that patient will be seen...”
Fair enough, and we understand. However, we are presenting what should happen, based on clinical trial data and consensus guidelines to improve patient outcomes. If we don’t refer based on the presumption that the referral will be declined due to resource constraints, the health system cannot measure unmet need. Te Whatu Ora in the October, 2022 “Planned Care Taskforce – Reset and Restore Plan” acknowledges that there is “no current effective measure of unmet need” and there is also no ability to measure the “not to refer” decisions that are based on a presumption that the outcome of the referral will be a denial of access. “Decline rates” are the simplest measure of unmet need, until other tools are developed to assess this.
EpiPen funded from February, 2023
Pharmac has announced that EpiPens will be funded from 1 February, 2023, for people who have previously experienced anaphylaxis or who are at high risk.
- EpiPen (0.3 mg/0.3 mL) and EpiPen Jr (0.15 mg/0.3 mL) adrenaline autoinjectors will be funded
- Funding restrictions include a maximum of two devices per prescription, and replacement of up to two devices prior to expiry or after a device is used
- Special Authority eligibility criteria include previous anaphylactic reaction which has resulted in presentation to an emergency department, or assessed by a relevant practitioner (including general practitioners, nurse practitioners and pharmacist prescribers) as being at significant risk of anaphylaxis; renewals of approval are not required
Update: Meningococcal B vaccination funded
Following a consultation process, as reported in Bulletin 62, access to the meningococcal B vaccine, Bexsero, will be widened from 1 March, 2023, to include all children aged up to 12 months and people aged 13 to 25 years in their first year of a specified close-living situation.
Read more about this decision from Pharmac here. N.B. as part of this decision Shingrix will continue to be the funded vaccination for the prevention of shingles, with no changes to the current criteria.
Reminder: Abortion training modules now available
The New Zealand College of Sexual and Reproductive Health (NZCSRH) has developed a series of four abortion theory training modules available now on the bpacnz website. For further information, refer to the news item in Bulletin 63.
Click here to view the modules.
Making the most of telehealth
Like it or lump it, it looks as though telehealth is here to stay. Rapidly pushed into the forefront of medicine by the COVID pandemic (and subsequent waves), telehealth has become a day-to-day reality for many in primary care. It can be a valuable tool but does need to be done well to be effective and safe.
The Royal New Zealand College of General Practitioners (RNZCGP) has recently published a position statement to assist clinicians with making the most of telehealth. There are also other resources available on the newly designed RNZCGP website that aim to assist health care workers; one that is worth a look is the “Tips and tricks sheet” developed after the 2022 RNZCGP conference with input from conference attendees.
Results from the 2021/22 Health Survey released
Results from the New Zealand Health Survey 2021/22 have been released by Manatū Hauora, Ministry of Health. This annual survey provides population-level data on health status, long-term conditions, heath behaviours, risk factors, health service utilisation and barriers to accessing healthcare.
Key findings
From July, 2021, to July, 2022, 4,434 adults and 1,323 children (aged 1 – 14 years) participated in the survey. The results show that:
- Smoking rates continue to decline; 8.0% of adults were daily smokers in 2021/22, down from 9.4% in the previous year
- Vaping/e-cigarette use has increased; 8.3% of adults were daily vapers/e-cigarette users in 2021/22, up from 6.2% in the previous year, and daily use was highest in those aged 18 – 24 years (22.9%)
- Nearly one in five adults (18.8%) has a hazardous drinking pattern (similar to the years before)
- Almost one in four young people (23.6%) experience high levels of psychological distress, and the unmet need for professional mental health support has increased over time
- Household food insecurity is more common in deprived neighbourhoods; 12.5% of children live in households where food ran out sometimes or often
- Just over half of adults meet physical activity guidelines
- Approximately two-thirds of adults and children brush their teeth with fluoride toothpaste at least twice per day*
- Time taken to get an appointment is the most common reason for not seeing a general practitioner, followed by cost
- 94.2% of adults identified as heterosexual or straight, 2.0% as gay or lesbian, 3.1% as bisexual and 0.8% as another sexual identity (similar to the years before)
*Remind patients on a low income or benefit, that they may be eligible to receive up to $1,000 per year to help with immediate and essential dental treatment, e.g. fillings, treatment of periodontitis
Further information, including an interactive web tool, is available here. There is also an associated press release detailing some of the key findings.
Manatū Hauora, Ministry of Health has also recently published the Health and Independence Report 2021, which details population measures such as life expectancy, morbidity and mortality, the impacts of COVID-19 and a range of other health measures, e.g. immunisations, long-term conditions, primary care.
Paper of the Week: group A strep and scarlet fever on the rise in the UK
This week rather than reviewing an academic paper, we share an update from the UK Health Security Agency on a concerning trend developing in the United Kingdom in the northern hemisphere winter. To date there have been 60 deaths due to invasive group A streptococcus (GAS), including 13 children. The number of cases of GAS and scarlet fever (caused by GAS) are increasing sharply and at a rate higher than during previous outbreaks. Between 12th September and 11th December, 2022, there were 7,750 notifications of scarlet fever, compared to 2,538 during the same period in 2017 (the most recent comparably high season was in 2017/2018).
It is speculated that social distancing measures during the COVID-19 pandemic, and therefore fewer circulating GAS infections, have resulted in increased susceptibility to GAS infections now that restrictions have relaxed. Exposure to GAS, in conjunction with other circulating respiratory viruses, is increasing the risk of children becoming seriously unwell.
The situation in the UK may predict an increasing threat for “flu season” in New Zealand in 2023. GAS sore throat is a significant concern among Māori and Pacific families, where it can develop into rheumatic fever and in turn, rheumatic heart disease. GAS sore throat needs to be managed promptly with antibiotic treatment in high-risk individuals. We may need to start early with messaging for families/whānau about infection prevention in winter 2023.
Surveillance data from the UK Health Security Agency is available here.
This Bulletin is supported by the South Link Education Trust
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