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Published: 27th March, 2026
Contents
New from bpacnz - Chronic kidney disease: the canary in the coal mine
National Kidney Month is currently in full swing, and in celebration of the theme, bpacnz is pleased to present a full update of our resource on the diagnosis and management of chronic kidney disease (CKD).
CKD is a growing issue in New Zealand. Māori and Pacific peoples continue to be overrepresented which is concerning as CKD is a major driver of cardiovascular disease (CVD), and these groups are also disproportionately affected by risk factors such as diabetes and hypertension. Early detection of CKD through regular testing of at-risk patients enables timely interventions to slow the rate of CKD progression and modify the associated increased CVD risk.
The management of CKD has advanced in recent years, encompassing a whole system “cardio-renal-metabolic” approach. Treatment is achieved through lifestyle interventions and a combination of medicines targeting different aspects of risk; the “four pillars” approach. In New Zealand, medicines availability and Special Authority funding restrictions influence the ability to adopt the “four pillars” for patients with CKD, however, use of these medicines should be prioritised wherever possible.
Read the article here. A B-QuiCK summary is also available.
We will be releasing further components to the CKD resource over the next few months, including CPD activities and a podcast panel discussion. This is an opportunity to explore all aspects of the diagnosis and management of patients with CKD and seek answers where clarification is needed. We encourage readers to send any queries or feedback so we can incorporate this in our development. Email: editor@bpac.org.nz.
Upfront: Reporting adverse reactions – the easy way
Reporting suspected adverse reactions helps Medsafe and the Centre for Adverse Reactions Monitoring (CARM) monitor the safety of medicines and vaccines in New Zealand. Did you know that you can report adverse reactions using an electronic tool in your practice management system? The tool, developed by BPAC Clinical Solutions, makes reporting simple and efficient as it pre-populates key details from the clinical record. This is a timely reminder about the importance of reporting adverse reactions, and the simple way you can do this.
Read the article here
Book Competition: Win a copy of “What Was I Thinking”, by Greg Judkins
“Doctors are expected to bring their authentic selves and their humanity to their consultations, but paradoxically the system in which we work expects our humanity to not include fallibility.” – Dr Greg Judkins
From his life as a new doctor, working and raising his young family in a remote area of Nepal, to settling back into New Zealand as a general practitioner in multicultural South Auckland, Dr Greg Judkins weaves a scrapbook of memories, reflecting on a life of challenge and adventure, and the hazards and mistakes that are an inescapable part of professional and personal life.
One of the experiences that Greg recounts in his memoir was how it felt to be on the receiving end of a complaint. In the week that Greg sold his practice in preparation for retirement, he received notice that one of his longstanding patients had lodged a complaint against him to the HDC.
By providing care to a person, healthcare professionals are open to scrutiny of their actions every day. What is offered with good intentions, may not always be received in the same way. What does it feel like when you realise, or are informed, that a patient is not satisfied with your care?
Email us with your account of what it felt like to be on the receiving end of a formal complaint and what strategies you used to cope during the process (details of the complaint itself are not necessary). The top three responses will be sent a copy of “What Was I Thinking”, kindly donated by Dr Greg Judkins.
Email your story, with the subject "Book Competition", by Friday, 17th April to: editor@bpac.org.nz.
Rewind: Wrap-up of recent key messages
Key dates and updates on news items from recent editions of Best Practice Bulletin:
- Humulin R (insulin neutral) 10 mL vials are being discontinued from the end of March. See Bulletin 141 for more details, including dates for discontinuation of other selected insulin products.
- Stock of chloramphenicol eye ointment is available again; another shipment is due in April. This follows a period of limited supply (as reported in Bulletin 142).
In case you missed it: New article on managing UTIs in children. A B-QuiCK summary is also available for this topic.
Flu season starts next month
The 2026 Influenza Immunisation Programme is right around the corner, beginning Wednesday, 1st April. Influvac Tetra (quadrivalent vaccine) is the sole funded influenza vaccine for children aged six months and over and adults who meet eligibility criteria. Eligibility criteria for vaccination have not changed in 2026, and include: people aged ≥ 65 years, people aged < 65 years with long-term conditions or specific mental health conditions or addictions, people who are pregnant and children aged ≤ 4 years who have been hospitalised for, or have a history of, significant respiratory illness (click here for details).
Non-funded vaccines (available for purchase)
Influvac Tetra is available to purchase for those not eligible for funded vaccination. Three other non-funded influenza vaccines are also available for purchase this year: Fluzone and Flucelvax for use in children aged six months and over and adults and Fluad for use in adults aged 50 years and over. These three vaccines are trivalent formulations; the absence of a fourth strain is not expected to impact safety or effectiveness.
Included strains
Strains have been updated across all vaccines available in 2026.
Influvac Tetra:
- A/Missouri/11/2025 (H1N1) pdm09-like virus (new)
- A/Singapore/GP20238/2024 (H3N2)-like virus (new)
- B/Austria/1359417/2021-like virus
- B/Phuket/3073/2013-like strain (B/Yamagata lineage)
Fluad and Fluzone:
- A/Missouri/11/2025 (H1N1) pdm09-like virus (new)
- A/Singapore/GP20238/2024 (H3N2)-like virus (new)
- B/Austria/1359417/2021-like virus
Flucelvax:
- A/Missouri/11/2025 (H1N1) pdm09-like virus (new)
- A/Sydney/1359/2024 (H3N2)-like virus (new)
- B/Austria/1359417/2021-like virus
Dosing and post-vaccination wait times
One dose is given for all vaccines.
A second dose is recommended for children aged six months to three years at least four weeks after their first dose if they have not previously been vaccinated. N.B. This has changed from previous guidance. Two doses used to be recommended for unvaccinated children aged < 9 years.
Any of the influenza vaccines may be administered at the same time as a COVID-19 vaccine or other vaccines available on the National Immunisation Schedule.
The post-vaccination wait time is now 15 minutes for all vaccinations or this can be reduced to five minutes for people who meet certain criteria (as reported in Bulletin 142).
A summary of the influenza vaccines available in 2026 can be found here. The 2026 Winter Preparedness Kit (previously termed “Flu kit”) is also available here.
National HbA1c thresholds changing
Te Whatu Ora, Health New Zealand, has announced that new HbA1c diagnostic thresholds for diabetes and pre-diabetes will be introduced from 1st July, 2026, to align with international standards.
- Diabetes: HbA1c ≥ 48 mmol/mol (currently ≥ 50 mmol/mol)
- Pre-diabetes: HbA1c 42 – 47 mmol/mol (currently 41 – 49 mmol/mol)
- Normal: HbA1c < 42 mmol/mol (currently ≤ 40 mmol/mol)
- No confirmatory test required if HbA1c ≥ 53 mmol/mol (currently a confirmatory test is recommended if the first result is ≥ 50 mmol/mol)
- A confirmatory test is required as soon as practical if HbA1c is 48 – 52 mmol/mol
The new thresholds can be adopted any time from now and can be applied to historical results. Updates to laboratory reporting, local HealthPathways and the New Zealand Society for the Study of Diabetes (NZSSD) guidance will be released on 1st July.
What do these changes mean in practice?
Two patient groups will be affected by these changes:
- Some people previously diagnosed with pre-diabetes, will soon be categorised as having diabetes; if patients have a current HbA1c of 48 – 49 mmol/mol, a confirmatory test is not required if two or more HbA1c results were ≥ 48 mmol/mol in the last year or if glucose diagnostic criteria are met
- Some people will soon no longer meet criteria for pre-diabetes and therefore annual HbA1c testing will not be required unless otherwise indicated (i.e. patients with a current HbA1c of 41 mmol/mol)
Health New Zealand, Te Whatu Ora, advises that the initial focus should be on ensuring that patients aged under 60 years who will be newly categorised as having diabetes are receiving optimal treatment. Review of affected patients and confirmation of diabetes (if required) can generally occur when they are next due for follow-up, or opportunistically during appointments for other reasons. However, there may be clinical situations where this is not appropriate and review should occur earlier. Alternatively, consider actively identifying those affected and sending them a letter or text message suggesting they come in for review.
Retinal photoscreening can be deferred for three years in people newly diagnosed with diabetes (i.e. HbA1c 48 – 49 mmol/mol), unless there are clinical concerns.
Medicine news
The following news relating to medicine supply has recently been announced. These items are selected based on their relevance to primary care and where issues for patients are anticipated, e.g. no alternative medicine available or changing to the alternative presents issues. Information about medicine supply is available in the New Zealand Formulary at the top of the individual monograph for any affected medicine and summarised here.
Dexamfetamine limited supply
There is a supply issue affecting dexamfetamine 5 mg tablets (Noumed), used for the treatment of ADHD (unapproved) and narcolepsy, due to manufacturing delays. Re-supply is currently expected in June. An alternative brand (Dexamfetamine Aspen) will be listed on the Pharmaceutical Schedule from 1st April (it is Medsafe registered). The active ingredient is the same, but it contains gluten, so will not be suitable for all patients.
For information on alternative medicines for ADHD, see: https://bpac.org.nz/2026/adhd-brief.aspx
Proctosedyl suppositories out of stock
There is a supply issue affecting stock of Proctosedyl (hydrocortisone with cinchocaine) suppositories due to shipping delays. Re-supply is expected mid to late April; stock of Proctosedyl ointment is currently unaffected. Supply issues affecting stock of Ultraproct (fluocortolone caproate with fluocortolone pivalate and cinchocaine) suppositories and ointment remain ongoing (reported in Bulletin 129). Proctosedyl and Ultraproct are used for haemorrhoids, anal pruritus, anal fissures, perianal eczema, pre- and post-haemorrhoidectomy and for non-infective proctitis.
An alternative suppository (Scheriproct; prednisolone hexanoate with cinchocaine hydrochloride) has been listed on the Pharmaceutical Schedule and is expected to be available to order by the end of March. This product has different ingredients than Procotosedyl and Ultraproct and is not registered by Medsafe, therefore, needs to be prescribed for supply under Section 29A of the Medicines Act 1981.
Rosuvastatin supply issue update
Supply issues affecting all strengths of rosuvastatin (Viatris) are expected to continue over the coming months. An alternative brand of 5 mg and 20 mg strengths (Sandoz) was funded earlier this year; 10 mg and 40 mg strengths of the Sandoz brand will be funded from 1st April. Patients can be reassured that there has been no change to the active ingredient, however, the colour of the Sandoz brand tablets will be different to Viatris (brown instead of pink or yellow).
An information sheet for patients about the supply issue is available here
Mometasone furoate lotion out of stock
Clarification of enoxaparin strength that is available on PSO
In a recent email to the sector, Pharmac has clarified that only the enoxaparin injection 100 mg per mL (1 mL syringe) strength is funded on PSO if endorsed for a PRIME service; other strengths of enoxaparin are not available on PSO. Since 1st March, a range of medicines for trauma and medical emergencies and ketamine for palliative care in the community have been funded (as reported in Bulletin 141).
Updated referral guidelines for consultation with obstetric services
Te Whatu Ora, Health New Zealand, has published updated referral guidelines for consultation with obstetric and related medical services. These guidelines are intended to help healthcare professionals determine when a person during pregnancy, birth and post-partum, or their baby, should be referred:
- For consultation with a primary care (e.g. general or nurse practitioner) or allied health service provider (e.g. Kaupapa Māori service, lactation consultant) – termed “Primary” referral
- For specialist consultation – termed “Consultation” referral
- For transfer of clinical responsibility for care – termed “Transfer” referral
- For emergency treatment or transport – termed “Emergency” transfer
Healthcare professionals should use their clinical judgement alongside the recommendations in the guidelines, e.g. the presence of multiple conditions might warrant referral for consultation or a transfer of clinical responsibility for care, rather than primary referral.
A webinar explaining the guidelines and some of the key changes compared to the 2012 edition is available here.
MCNZ seeking feedback on fees
The Medical Council of New Zealand (MCNZ) is seeking feedback on proposed changes to fees, including for practising certificates and disciplinary levies. Introduction of a practising certificate fee and disciplinary levy for Physician Associates has also been proposed. View all proposed changes here.
Consultation closes Friday, 10th April. Feedback can be emailed directly to: feeconsultation@mcnz.org.nz.
Pharmac review of the Exceptional Circumstances Framework
Pharmac is seeking feedback on a review of the Exceptional Circumstances Framework. The Framework outlines how requests for medicines funding (including the Named Patient Pharmaceutical Assessment [NPPA] process and Special Authority waivers) are considered by Pharmac for people with exceptional clinical circumstances who do not meet funding criteria in the Pharmaceutical Schedule.
Pharmac is seeking feedback on the following areas in particular:
- How the Framework works in practice
- Any gaps, barriers or unintended consequences observed
- Does the Framework ensure fair access to medicines for those whose clinical needs are not met through the Pharmaceutical Schedule
- Does the Framework fit with the statutory objectives and priorities of Pharmac
- How clarity, transparency and consistency in decision making could be improved
Consultation closes Sunday, 7th June. Feedback can be submitted here.
Podcast of the Week: Caring for patients with intellectual disability
The National Centre of Excellence in Intellectual Disability Health is an Australian-based organisation that promotes better health care for people with intellectual disability. Training for healthcare professionals regarding intellectual disabilities can often be limited. The team hosts a series of podcasts via YouTube (Excellence in Practice: Voices for Better Care) with guest speakers on different topics aimed at assisting healthcare professionals to improve their practice when working with patients with intellectual disability. While the podcast series is intended for an Australian audience, the principles discussed are likely to also be relevant in New Zealand. Recent episodes include challenging bias in health care, effective communication in health care, improving mental health care and understanding and advancing health care for women.
Top tips from the Challenging Bias in Health Care for People with Intellectual Disability podcast
- Healthcare professionals are generally only taught one approach to clinical method which can result in assumptions and bias. Resource limitations and time pressures, characteristic of the current health system, can further disadvantage people who require more individualised approaches.
- Not all people with disability have intellectual disability, e.g. people who are non-verbal may have an alternative way of communicating
- Some people with intellectual disability have complex communication needs but this does not mean they cannot understand health information or make decisions about their health, e.g. consent to treatment
- People who are minimally verbal or non-verbal who display a change in behaviour (responsive behaviour) are often referred for a mental health assessment without investigating other possible underlying causes, e.g. a change in physical health
- Just because a person cannot do something, e.g. undergo a blood test, this does not mean they do not want to do it
What can healthcare professionals do?
- Acknowledge and challenge your own unconscious biases – do not wait for patients or their caregivers/advocates to do it for you
- Build trust:
- Actively include patients in conversations about their own health. This may mean modifying your communication style, e.g. speaking directly to the patient rather than their carer.
- Small accommodations can make patients more comfortable, e.g. meeting in the medical centre car park instead of the clinic, sitting on the floor with the patient
- Ensure the patient knows they are in control. Regularly check in with them and pause or stop conversations or procedures if they are not comfortable or feeling overwhelmed.
- It can be helpful to role play investigations and examinations with a caregiver or someone the patient trusts beforehand
- When issues relating to health procedures are identified, take the time to ask questions and fully understand how these issues arose
- Be creative and think outside the square – examine approaches to services or procedures in your own practice, e.g. performing examinations, administering vaccines, and investigate whether these can be adapted or modified to meet the needs of a wider range of people
- Familiarise yourself with available resources and specialist services in your region that you can refer patients with intellectual disabilities to or who you can ask for advice
IDEA Services, a subsidiary of IHC, is a New-Zealand based support provider for people with intellectual disability and their family/whānau. The national clinical team at IDEA Services primarily helps to support people with intellectual disability to live within community residential services by providing advice to staff and healthcare professionals involved in the care of people accessing these services. IDEA Services are funded for some people with intellectual disability through the Ministry of Health and Ministry of Social Development. Other support providers and services are also available that patients with intellectual disability may benefit from.
Patients can be referred to a local Needs Assessment and Service Co-ordination (NASC) service for a needs assessment to determine whether they qualify for funded supports and which providers are available for them: click here for a list of local NASC providers.
Paper of the Week: Are liquid formulations of medicines still the best choice for children?
Administering medicine to children is not always easy. For every child that loves the taste of paracetamol suspension (team orange or team strawberry), there is another child who refuses no matter how much their parents beg or bribe them. Perhaps it is these experiences, along with the perceived challenges of teaching children to swallow pills, that make many parents tentative to move away from liquid formulations. Most prescribers ask parents which formulation type their child prefers, or just assume that liquid will be most suitable, therefore the decision on what to prescribe is often predetermined. However, when we weigh up the pros and cons of liquid formulations, do they still come out on top for all children? Should prescribers be less hesitant to suggest tablet or capsule medicine formulations for younger patients?
A short analysis published in the British Journal of General Practice questions whether liquid formulations should remain the default choice for children’s medicines in primary care. Liquid formulations have several disadvantages including potential for inaccurate dosing, storage considerations, impracticality of dose administration in some situations, e.g. daycare or school, and dental effects of excipients. Reliance on liquid formulations can also be problematic if supply shortages occur, e.g. brand changes and supply issues affecting liquid paracetamol caused significant disruptions in New Zealand a few years ago. In most cases, tablets and capsules provide more accurate and convenient dosing, and with the appropriate training, many younger children can learn to swallow them. However, ultimately, the best choice of formulation remains the one that the child will take consistently (and the parent/caregiver will administer correctly).
At what age do you generally stop prescribing liquid formulations to children? Have you experienced a situation in which a liquid formulation was not available for an indicated medicine in a child? What was your solution? Do you actively educate children about how to swallow pills or usually leave this up to the parents/caregivers?
Read more
Disadvantages of liquid formulations of medicines
- Potential for dosing inaccuracy. Ideally, parents/caregivers will shake the bottle (for suspensions) and measure the dose using an oral syringe, however, measuring cups or household teaspoons are reportedly still widely used, increasing the risk of under- or over-dosing.
- Some liquid formulations must be stored in the fridge to maintain stability, e.g. reconstituted antibiotic suspensions. This can lead to doses being missed (because the medicine in the fridge was forgotten about) or children receiving doses of a medicine that was incorrectly stored (and stability has potentially diminished). Not all families have access to stable accommodation and power supply either.
- Impracticality of dosage administration or storage in some situations, e.g. needing teachers or carers to measure, administer and appropriately store liquid formulations at daycare or school
- Non-adherence due to children not liking the taste of liquid formulations, e.g. flucloxacillin suspension is notoriously bitter
- Liquid formulations often include excipients, e.g. sugar, sorbitol, to improve palatability/acceptance with children, but these can have dental or gastrointestinal effects, especially for children who require treatment long-term
Solid dosage forms of medicines should be considered for children
- Tablets and capsules provide accurate dosing without the need for measuring. They are more convenient when taking to school/daycare or travelling and generally do not require special storage (outside of normal efforts to keep medicines out of reach of children).
- Many younger children, e.g. from around age four years, can safely learn to swallow tablets and capsules with the help of brief, structured coaching. Resources to aid prescribers/parents/caregivers include:
- Be aware, not all medicines will have tablet or capsule formulations available that align with weight-based dosing for younger children
- Splitting or crushing tablets or opening capsules (and sprinkling on food) could be considered in some clinical situations where no appropriate formulations are available. N.B. Altering modified-release tablets or capsules affects the pharmacokinetics. Check with a pharmacist or refer to the NZFC or New Zealand Data Sheet to see if a medicine is suitable for splitting or crushing.
Choosing a formulation type when prescribing to children
- A pragmatic tiered approach is suggested:
- Consider tablets or capsules in children aged around four years and over who can consistently swallow or be easily taught
- Liquid suspensions remain appropriate for:
- Neonates and infants (and some toddlers), i.e. children aged under four years
- Children who cannot consistently swallow, or when available tablet/capsule strengths do not align with weight-based dosing
- Children with complex needs, e.g. those with a developmental disability, swallowing disorder or severe allergies
Elkhazragy A, Jonroy A, Payne RE. Tablets before liquids? Rethinking paediatric prescribing in primary care. Br J Gen Pract 2026;:BJGP.2025.0652. doi:10.3399/BJGP.2025.0652.
For further information about encouraging children to swallow tablets or capsules, including a training guide for parents, caregivers and children, see: https://bpac.org.nz/Supplement/2014/September/pillswallowing.aspx
This Bulletin is supported by the South Link Education Trust
If you have any information you would like us to add to our next bulletin, please email:
editor@bpac.org.nz
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