Watch or listen to the September 2023 clinical update from Dr Jo Scott-Jones joined by Dr Dave Maplesden, Pinnacle GP liaison in this 43 minute podcast/video. (Written version below.)
Clinical snippets are now available as a podcast! Search on your favourite podcast platform for The New Zealand General Practice Podcast to listen, or click here to listen on Anchor.
A person lacks capacity if they are unable to:
From 12 September, 2023, HPV testing will become the primary cervical screening test in New Zealand. The National Cervical Screening programme has released a second information pack that contains information on training and responsibility changes for clinical and administration staff involved in the HPV primary screening process.
Key points from the pack include:
At the end of July 2023, the Ministry of Health acknowledged the importance of Cabinet making the decision to reduce the maximum limit for opioid prescriptions from 3 months to 1 month. This new limit will apply to both Class B and Class C opioids. This will bring the prescribing limit for Class C opioids – such as codeine and dihydrocodeine – in line with Class B opioids. Additional regulation changes will result in the re-classification of tramadol as a Class C2 controlled drug from 1 October 2023 although it is exempt from the requirement to be stored in a controlled drug safe. This means once the relevant legislative changes are enacted (later this year) both codeine and tramadol will have one month prescribing restrictions. However, methadone will be available as a three-month prescription when being used as part of an OST programme.
A September 2021 NZ Doctor article reviewed hypophosphataemia associated with iron infusion therapy. Key points included:
Issue 7 of GP Practice Review commented on a recent systematic review and meta-analysis that compared shorter (≤5 days) versus longer treatment with antibiotics for children diagnosed with CAP. The authors reported no significant differences between short and longer courses of antibiotics in the following areas;
The reviewer concluded: This study provides further evidence that there is no benefit to be gained from longer courses of antibiotic treatment for many infections that are managed in the community. In the case of paediatric community-acquired pneumonia, shorter treatments durations ≤5 days should be recommended with caregivers provided with education about the rationale, which may be counter to information they have previously received. Current HealthPathways and BPAC guidance refers to a 5-7 day course of amoxicillin with a longer course for alternative antibiotics (7 days for erythromycin and 7-10 days for roxithromycin).
A recent article in the British Journal of General Practice gives a succinct summary of key considerations for primary care physicians when prescribing menopause hormone therapy including a helpful algorithm. The four key considerations are listed as:
Drug names listed are different to NZ and not all formulations discussed are available here but the algorithm is a useful one-page reminder of issues to consider. Last month Pharmac announced a procurement opportunity that may result in a wider range of transdermal oestrogen products becoming available including a topical gel. With respect to testosterone therapy in menopause, Goodfellow Unit have a useful resource on this topic including reference to use of a commercially manufactured (not compounded) topical testosterone gel (Androfeme) which can be prescribed off-label under s29 of the Medicines Act at a cost of $153 for 100 days treatment at standard dose.
Issue 81 of Best Practice Bulletin comments on the importance of having a variety of blood pressure cuff sizes available at your fingertips. Most health professionals know that incorrectly sized cuffs can lead to inaccurate blood pressure measurements and the potential for misdiagnosis. A recent randomized crossover trial published in JAMA Internal Medicine reported on blood pressure measurements using an automated measuring device on 195 community-dwelling adults with a wide range of mid-arm circumferences. Use of a regular BP cuff resulted in a 3.6 mm Hg lower systolic BP reading among individuals requiring a small BP cuff. In contrast, among individuals requiring a large or extra-large BP cuff, use of a regular BP cuff resulted in 4.8 mm Hg and 19.5 mm Hg higher systolic BP readings, respectively. Many home-monitoring devices come with a standard size cuff which may not be appropriate for the patient. The AMA have produced a pamphlet to guide correct cuff-size selection based on mid upper arm circumference.
Issue 212 of Respiratory Research Review refers to a recent study validating a short six-item tool – Breathe VQ or the Breathing Vigilance Questionnaire - to assess ‘breathing vigilance’, an important component of dysfunctional breathing. The reviewer notes that dysfunctional breathing is common in clinical practice. It cannot be fully explained by organic disease and isn’t specific to any specific respiratory disorder with overlap with many conditions including anxiety, asthma, and post-COVID Syndrome (long COVID). The Nijmegen questionnaire is often used to assess dysfunctional breathing (although has some limitations in applicability) and the Breathe VQ adds another dimension to assessment.
HealthPathways section on Dyspnoea gives further advice on assessment of patients with persistent breathlessness following recovery from Covid-19 infection and who do not have known respiratory disease. There is recommendation to consider completing consider completing a 1MSTS test and mMRC score with recommendations for further management (respiratory specialist review, respiratory physiotherapist or respiratory physiologist) depending on results.
The Goodfellow Unit has a 20 minute podcast on Dysfunctional Breathing Disorders (2021) with a presentation by a physiotherapist on Understanding Breathing Pattern Disorders scheduled for 17 October 2023.
This week the Pinnacle Incorporated Executive Committee has written to Dr Ashley Bloomfield, Director-General of Health and Labour MPs across the Midland region asking them to reconsider lowering the screening age for Māori and Pacific people.
Read moreIn May last year, the National Bowel Screening Programme focused on promoting bowel cancer screening in primary and community care settings. It was a great success, 400 practices across the rohe took part, and there was a significant increase in kit requests for priority populations. Primary care providers are invited to take part in this focus again this May.
Read moreThis programme provides funding for Aclasta infusions for eligible patients. The infusion is to be provided in the community by the patient’s general practice.
View detailsNational Cervical Screening Programme screening updates.