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Published: 18 November, 2022


New: Liver function tests in primary care

Liver function tests (LFTs) are among the most commonly requested laboratory investigations in primary care. However, as with all other laboratory tests, it is essential that clinicians consider whether LFTs are being requested for the right patient at the right time, and have a clear understanding of how results will be interpreted based on the specific clinical context.

This is a comprehensive resource on understanding and interpreting LFTs (and yes, we do discuss the use of this misnomer), along with a spotlight on the key causes of liver disease: metabolic-associated fatty liver disease, alcohol-related liver disease and hepatitis B- and C-related liver disease.

Need your answer now? B-QuiCK summary available here.

In case you missed it: Chronic kidney disease; the canary in the coal mine

Chronic kidney disease (CKD) is a growing issue in New Zealand. Māori and Pacific peoples are overrepresented in our CKD statistics which is concerning as it is a major driver of cardiovascular disease (CVD), and these groups are already disproportionately affected by risk factors such as diabetes, obesity and hypertension. Early detection of CKD can be achieved via regular testing of at-risk people; this permits timely interventions to lower CVD risk and slow or prevent the rate of kidney function decline.

This is an update of a previous bpacnz article that includes considerations when interpreting eGFR and ACR results and updated blood pressure targets, as well as discussing the place of SGLT-2 inhibitors in CKD patients and the usefulness, or not, of low protein diets.

World Antimicrobial Awareness Week (WAAW) – 18th – 24th November

The theme for this year’s WAAW is “Preventing antimicrobial resistance together”. Details of this global initiative from the World Health Organization are available here.

WAAW is a chance for healthcare professionals to reflect, and act, on the multidisciplinary responsibility for antimicrobial stewardship (AMS). The overarching goal of AMS is to improve the appropriate use of antimicrobials and minimise antimicrobial-related harms, including resistance and adverse effects.

The Pharmaceutical Society of New Zealand (PSNZ) are taking part in an “Antibiotic Amnesty” as part of WAAW. People are invited to return any unused antibiotics to their community pharmacy for disposal.

For resources and further information on this initiative, click here

Local resources for antibiotic awareness including posters and patient education are available from the Ministry of Health website.

The bpacnz Antibiotics Guide is a widely used resource among primary care clinicians to assist in making treatment choices for infections commonly managed in the community. The Guide is currently undergoing a full revision and we will let you know when the new version is available.

NZCSRH abortion training modules are now live

The New Zealand College of Sexual and Reproductive Health (NZCSRH) has developed a series of four abortion theory training modules with support from the Ministry of Health. This includes information for healthcare professionals on: (1) Consultation – communication and decision making, (2) early medical abortion using mifepristone and misoprostol, (3) early surgical abortion using vacuum aspiration and (4) point of care ultrasound. The development of these training modules was supported by bpacnz and they are hosted on our website. Any questions about the content of the modules should be directed to NZCSRH:

Click here to access the training modules.

Changes to COVID-19 second booster vaccine eligibility

From today (18th November, 2022), Māori and Pacific peoples aged 40 – 49 years will be eligible to receive a second COVID-19 booster vaccine. People will still need to wait six months from their first booster dose. It is estimated more than 63,000 people will be eligible for the second booster vaccine. Read more about second boosters here.

As reported in Bulletin 53, the second COVID-19 booster vaccine is also available for all people aged over 50 years and for those aged over 30 years who work in health, aged and disability care.

Access to PCV13 pneumococcal vaccine to be widened

From 1 December, 2022, pneumococcal conjugate vaccine PCV13 (Prevenar 13) will be included as part of the childhood immunisation schedule, instead of the currently funded PCV10 (Synflorix). The timings of PCV13 dosing are identical to the PCV10 regimen. PCV13 is currently only funded for people who meet high-risk criteria.

Infants who have received one or more doses of PCV10 will be able to complete the course with PCV13. The Immunisation Handbook will be updated to reflect these changes.

Vaccinators should start administering PCV13 for childhood immunisations immediately from 1 December, 2022. Use of PCV10 after 1 December, 2022 is considered a medication error and if this occurs The Immunisation Advisory Centre (IMAC) should be contacted on 0800 IMMUNE for advice. However, PCV10 will continue to be listed in the Pharmaceutical Schedule and if administered, will be funded. Any unused PCV10 can be returned to ProPharma.

IMAC has produced both a written resource and a webinar explaining the change from Synflorix (PCV10) to Prevenar (PCV13) for health professionals.

Pamol brand of liquid paracetamol now available

As previously reported in Bulletin 58, changes are being made to liquid paracetamol as the supplier of the Paracare brand is leaving the market. On 1 November, 2022, the funded brand of paracetamol 250 mg/5 mL oral liquid changed to Pamol; remaining stock of Paracare may be used up first by some wholesalers or pharmacies.

A pamphlet for consumers detailing the change from Paracare to Pamol is available here

Key differences between Pamol and Paracare Double Strength:

  • Pamol is a smaller bottle size (200 mL compared to 1000 mL for Paracare)
  • Pamol is orange flavoured but colour-free (Paracare Double Strength is orange flavoured and orange coloured); N.B. this means that both strengths of liquid paracetamol (120 mg/5 mL and 250 mg/5 mL), as well as the currently funded brand of ibuprofen will now be colour-free, so this similarity should be highlighted to caregivers, along with a reminder to read labels carefully, to avoid dosing errors

To read more about upcoming changes to liquid paracetamol, click here.

Funding restrictions removed from Zoledronic acid

Pharmac is removing all Special Authority funding restrictions from zoledronic acid from 1 March, 2023, e.g. there will no longer be a requirement for bone mineral density scanning. The bisphosphonate zoledronic acid is indicated for people with osteoporosis and Paget disease, as well as some cancer-related indications. It is given as an intravenous infusion over 15 minutes and can be administered by health professionals as part of the community-based infusion service.

For further information about prescribing bisphosphonates, see:

Effect of the COVID-19 pandemic on healthcare services: a HQSC report

The Health Quality & Safety Commission has released Part 2 of its investigation into the effect of the COVID-19 pandemic on healthcare services in New Zealand.

  • Part 1, published in December 2021, focused on the effects of the COVID-19 pandemic on aspects of the functioning of the New Zealand health system, including the impact on primary care, immunisations and cancer screening and delays in elective procedures and cancer care. An executive summary can be read here.
  • Part 2 expands on some of the aspects covered in part 1, and examines the impact that the pandemic had on mental health, healthcare workers and experience of care for people with a disability. An executive summary can be read here.

Paper of the Week: Before prescribing a PPI, ask yourself PPWhy?

Proton pump inhibitors (PPIs) are widely used in New Zealand and use is increasing over time. In 2020, omeprazole was the third most commonly dispensed medicine in New Zealand. A recent observational study published in the British Journal of General Practice, including nearly 150,000 patients across 27 general practices in the Netherlands from 2016 to 2018, found that more than half of patients prescribed a PPI had an inappropriate indication. The study also found a large number of patients continued to be prescribed PPIs beyond their recommended duration of use.

PPIs are generally safe and well tolerated, however, long-term use is associated with an increased risk of adverse outcomes, e.g. Clostridium difficile colitis, osteoporosis, kidney disease. Continuing PPI use without a current clinical indication exposes patients to these risks unnecessarily and may add to the complexity of their medicines regimen, increasing the risk of interactions and poor adherence.

This Bulletin is supported by the South Link Education Trust

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