Published: 20 August, 2021
Primary care back to COVID-19 restrictions
The team here at bpacnz, several of whom also work in general practice, would like to acknowledge the efforts of all those who are working in primary care clinics,
hospitals, pharmacies, vaccination and swabbing centres and other essential health services through this lockdown period. We have done this before, so "know the drill",
however, there are some new challenges for primary care teams this time, including concerns about the increased risk of aerosol transmission with the
more infectious Delta strain and balancing the need to both swab and vaccinate.
A reminder that resources for primary care from the Ministry of Health on managing suspected or confirmed COVID-19 cases
be found here.
Bowel cancer follow-up article now online
Following on from our 2020 article on investigating patients with features
suggestive of bowel cancer, we have now published a second article
in this series on the role of primary care in managing people who have been treated for bowel cancer. Follow-up and surveillance of people who have
undergone curative treatment aims to improve outcomes through earlier detection of recurrence, which increases the chance that additional curative
treatment can be offered. A number of different healthcare professionals may be involved in providing this follow-up and ensuring that the overall
health needs of patients and their whānau/family are met.
A brief companion article
discusses follow-up and surveillance for people with polyps and people with inflammatory bowel disease.
New statin to be funded for patients at high CVD risk
PHARMAC has announced that from 1 December, 2021, rosuvastatin will be
with Special Authority Approval as a treatment for people with an increased risk of
cardiovascular complications associated with high lipid levels. Māori and Pacific patients are specifically listed in the Special Authority criteria and can access funded
treatment if they are “considered to be at high risk of cardiovascular disease” (CVD). Patients can also access funded treatment if they have a calculated
five-year CVD risk of ≥15% and high lipid levels, despite treatment with atorvastatin and/or simvastatin. Any relevant practitioner can apply for the Special Authority funding.
Statins are the recommended first-line lipid-lowering medicine in New Zealand and international guidelines, with the decision to initiate depending on individual CVD risk,
the potential benefit of treatment and the risk of adverse effects. Rosuvastatin is considered the most potent statin available and is
with a comparable safety profile to other medicines in this class; conferring no greater risk of myopathy or serious renal injury when dosed appropriately.
For further information on prescribing statins, including dose equivalency, see:
Medsafe seeking feedback on dihydrocodeine
Last month (12th July, 2021) Medsafe issued a notice to the suppliers of dihydrocodeine (DHC) to provide evidence of the safety and effectiveness of this medicine.
This is part of an overall review from Medsafe and the Medicines Adverse Reaction Committee (MARC) on the risks of misuse and dependence with opioids. As part of this review,
Medsafe is seeking feedback from health care professionals and patients on the use of dihydrocodeine. This may include reports of adverse effects, risks and concerns,
as well as benefits. Read
more about this here, including how to submit a response.
Addressing COVID-19 vaccine hesitancy - new Goodfellow podcast
The team at the Goodfellow Unit have just released a new 30-minute
podcast with Dr Nikki Turner from the Immunisation Advisory Centre, that discusses
reasons and potential solutions for people with vaccine hesitancy. Note that the podcast was recorded prior to the current re-emergence of community transmission of COVID-19.
- There are multiple reasons that can make someone resistant to getting a vaccine, or as Nikki puts it, "a
pile of barriers" that are all mixed together
- Stick to your own style when you communicate - it is the one you do best
- Be reassured by the science - the huge amount of safety monitoring for the COVID vaccines has made us aware
of the adverse effects and that these vaccines are over 90% effective
- Media, especially social media, has made a few "anti-vaccination" voices louder - the skill
is in not letting the myths become embedded
- Sell the story - lead with the assumption that they will be getting vaccinated, keep the messages clear, listen
and address questions using the trust and rapport that is already established
- "Access in the moment" can help address needle phobia
- Consider other barriers to access - help communities to have input into good solutions for them
- It is an individual decision, but it is a community response
Paper of the week: five-minute concussion test
Doctors and researchers at the Children's Hospital of Philadelphia (CHOP) have spent many years developing and perfecting a clinical assessment tool for identifying
concussion in children and adolescents: the visio-vestibular examination (VVE). It can be performed in under five minutes, in any setting, including virtually,
by any health care professional or even a sports coach. Read an interview
about the tool here with lead researcher Dr Daniel Corwin. This includes a link to
the tool and instructional video.
The VVE involves testing six areas of vision and vestibular function:
- Smooth pursuits (nystagmus) – observing the patient's eyes while they track the examiners finger moving horizontally
- Saccadic eye movements (fast saccades) – observing the patient's eyes while they switch rapidly between the
examiner's fingers held apart in a fixed position
- Gaze stability – observing the patient's eyes while fixed on the examiners thumb and then with their head
moving up and down and side to side
- Near point-of-convergence – assessing how close an object with letters can be brought to the patient's face
before the letters become doubled
- Monocular accommodation – same assessment as above, but with one eye covered at a time, assessing the distance
until the letters become blurry
- Balance – assessing the patient while they walk heel to toe forwards and backwards, with eyes open and closed
A video demonstrating how to perform the VVE,
and what are considered to be abnormal responses is available here.
of the VVE and responses is available here.
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