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Published: 19 March, 2021


New article on lung cancer diagnosis

In case you missed it, we have published a new article on early detection of lung cancer in primary care. Lung cancer is one of the most common cancers in New Zealand and the leading cause of cancer death. Increasing the early detection of lung cancer before it reaches advanced stage disease is key to improving survival outcomes. This is especially important in Māori and Pacific peoples, who have lung cancer incidence and mortality rates two to three times higher than the rest of the population. This article is part of our ongoing series on cancer detection and follow up surveillance in primary care, supported by Te Aho O Te Kahu – Cancer Control Agency. You can read our article on the Ministry of Health guidance for referral for suspicion of bowel cancer here.

Cilazapril: funding access to be restricted

Cilazapril use in New Zealand is high compared with other countries, such as Australia and the United Kingdom, where it is seldom used. As there is only one manufacturer of cilazapril internationally, we are highly vulnerable to supply issues, which has become especially apparent during the COVID-19 pandemic. To reduce this risk, PHARMAC has announced restrictions on access to funded cilazapril. From 1 May, 2021, no new patients will be able to be initiated on cilazapril. Patients currently taking cilazapril should ideally be switched to another ACE inhibitor or ARB when they next require a prescription (a range of funded options are available); if cilazapril does need to be continued, prescriptions will need to be endorsed after 1 May.

bpacnz will be publishing an updated article on ACE inhibitors and ARBs to reflect these recent funding changes, and to provide guidance on selecting an appropriate medicine.

Aqueous cream supply issue

As prescribers and pharmacists are likely to be aware, there have been recent supply issues with aqueous cream. Alternative brands were sourced but they have also faced supply issues and stock is now depleted. The original funded brand (Boucher Aqueous Cream) is expected to come back in stock late March, in the meantime if supply runs out, consider prescribing a different type of emollient, e.g. cetomacrogol cream.

COVID vaccination in special groups

The COVID-19 vaccination programme is now underway, and patients may have various questions. The Immunisation Advisory Centre has put together an information page covering some common queries.

People with special circumstances may wonder if it is safe for them to be vaccinated:

  • Vaccine in pregnancy/breastfeeding: It is recommended to delay vaccination until after delivery in pregnant women who are at low-risk of exposure to COVID-19, but for those at risk of exposure, e.g. border/MIQ worker, front-line health staff, vaccination may be offered at any stage of pregnancy. COVID-19 vaccine can be safely administered in women who are breastfeeding.
  • Vaccine in people with cancer: people with cancer have been prioritised to receive COVID-19 vaccine as part of Group 3. Vaccination is encouraged, even when receiving active cancer treatment, however, the timing of vaccine administration may vary depending on the type and stage of cancer treatment.

For more detailed information on the COVID-19 vaccine in people with cancer, see: https://teaho.govt.nz/reports/cancer-care

Reminder about provisional authorisation for vaccinators

As reported in Bulletin 18, the Ministry of Health is seeking healthcare professionals, e.g. doctors, nurses, pharmacists, other health professionals with vaccination as part of their scope of practice, retired healthcare workers or those not currently working in the health sector, to become registered as a vaccinator to increase the workforce for the three major vaccine campaigns this year: COVID-19, influenza and measles (MMR catch-up). An online Provisional Vaccinator Foundation Course must be completed as part of the authorisation process.

Provisional authorisation allows the administration of influenza and MMR vaccinations anywhere in New Zealand until 30 June, 2022. All qualified/authorised and provisional vaccinators will need to complete an online training module to be able to administer COVID-19 vaccines. This training module is not yet available, expect for those who were involved in the initial vaccine roll-out (see vaccinator information below).

For further details on the process of applying for provisional authorisation, click here

COVID-19 vaccinator information is available here

Where did I read that?

Now that we have published over 20 issues of Best Practice Bulletin (and eight COVID-19 bulletins), it can become quite difficult to remember exactly where you read that important piece of information you were certain you wouldn't forget. We are in the process of indexing all the bulletins so you can search through them by keywords/phrases. We hope to have this ready to go live by the time we publish our next bulletin in two weeks.

Paper of the week: BMJ Podcasts: speaking out about mental health in the NHS

Rather than profiling a research paper this week, we would like to share a presentation from the BMJ Podcasts series that focuses on mental health and wellbeing in healthcare professionals. Although the podcast is based on experiences in the National Health System in the United Kingdom, and in the present context of the COVID-19 pandemic, healthcare professionals in New Zealand are likely to be able to relate to many of the challenges and issues that are raised.

It is often difficult for healthcare professionals to speak about their own mental health concerns, particularly when they are usually the ones caring for others. There can be a perceived stigma of admitting to mental illness within the medical community, and fear of losing status. In the Podcast, Dr Ashling Lillis explains how speaking out about her mental health crisis encouraged others to share their stories too. Conversations about mental health need to be normalised, without fear of prejudice. If you are struggling, let someone know. Make it routine to ask your colleagues "Are you OK?". Treat your own mental health with the same kindness and attention that you would for a patient.

Listen to the full podcast here: https://soundcloud.com/bmjpodcasts/wellbeing-speaking-out-about-mental-health-in-the-nhs?in=bmjpodcasts/sets/the-bmj-podcast

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