Clinical Matters Newsletter - August 2022 31 Aug 2022

Welcome to the August Edition of Clinical Matters!

Maxillofacial/Community Dental High Suspicion of Cancer Referrals

Following feedback from a GP about the length of time it took for Maxillofacial high suspicion of cancer referrals to be processed, the Maxillofacial/Community Dental team has improved the way they receive electronic referrals. High suspicion of cancer referrals will now automatically notify the specialist clinician responsible for that service there is an urgent referral waiting. This will cut down on the time it takes for patients to be seen.
 
In order to further improve the process the Maxillofacial/Community Dental team have asked that GPs upload digital photographs with the referral where possible.  

Advance Prescriptions for Oral COVID-19 Antiviral Medicines

Guidance for relevant appropriately qualified prescribers and pharmacists

On 14 July 2022, the Minister for COVID-19 Response Hon Dr Ayesha Verrall announced that eligible patients could receive an advance (“back pocket”) prescription for the following oral COVID-19 antiviral medicines - Nirmatrelvir with ritonavir (Paxlovid) and Molnupiravir (Lagevrio).

The purpose of this guidance document is to:
1. Clarify when and why this may be appropriate; and
2. Provide additional guidance and support for prescribers and pharmacists.

Click here to read the full document

Updates from the National Immunisation Programme

HSU dataset change
Yesterday we advised Stats NZ had published peer review into Health Service User (HSU) data use for COVID-19 vaccination reporting. You can find more information about the review on this webpage.
 
We also confirmed that from Monday 8 August, we will be using 2021 HSU data for our reporting. While this means a technical decrease in reported vaccination rates overall due to the larger number of eligible New Zealanders being identified, it does not mean any fewer people have been vaccinated. Read the media release here:
Updated health user information informs COVID-19 vaccination programme – Te Whatu Ora | Health New Zealand

Changing from Zostavax to Shingrix
Pharmac recently advised that the vaccine funded to treat shingles will soon switch from Zostavax to the Shingrix brand for currently eligible people. You can find out more here.
 
COVID-19 Vaccination booths
From today (Friday 5 August) the cost of vaccination booths ordered via Bluestar will no longer be covered by the National Immunisation Programme. The booths will still be available (via the Bluestar portal), but in a ‘user pays’ format. If you wish to order a booth, you will need to email dhbsupport@servicecentral.net.nz. Please pass this message on to your networks.
 
Weekly vaccination data
Our latest Māori and Pacific COVID-19 vaccination data is now available here.
Recent flu vaccination data is available here.
 
Update on collateral on Dropbox
Don’t forget we have a range of collateral you and your providers can use to promote vaccinations. Please feel free to share this link and the collateral widely: Dropbox NIP – vaccine resources. 
 
We have had a reshuffle and are now sharing the consent forms and policy statements for health professionals in a separate folder in the above link. Please note we have recently added te reo Maori translations for Flu, Covid-19 and MMR consent forms.

PATHLAB CLINICAL UPDATE - HbA1c Testing Issues

Due to significant issues with reagent supply, HbA1c tests are currently not able to be processed.

We are working diligently to source the required reagent and hope to have this within the week.

You can continue to request HbA1cs, however there will be a delay of up to 6 days before they will be tested.

We would be grateful please that no add-on HbA1cs are requested until the week of 29th August, to ensure they can then be processed within the required timeframe.

We sincerely apologise for the inconvenience caused with this supply issue.

Click here to view the clinical update

Tracking the status of Patient Referrals: Please Remember to use the Patient Information Centre

The situation is common: a referral has been made to a Hauora a Toi service, but your patient hasn’t yet received an appointment letter. They come to you wanting to know what is happening.
 
Whilst it is tempting to send a follow-up referral to ask when a patient can be seen, if there has not been a change to the patient’s status, the follow-up referral has to go through the entire grading process again, taking up a significant amount of our SMO colleague’s time.
 
If we just want an update on a patient’s status on the waiting list, instead please call the Patient Information Centre on 0800 333 477.
 
A second referral only needs to be sent where new clinical information is being provided.
 
Please contact the GP Liaison team if you have any queries: baynav@bopdhb.govt.nz.

Pulmonary Function Testing During SARS-CoV-2: An ANZRS/TSANZ Position Statement

Performing spirometry in the community is important to help ensure that patients have access to timely diagnosis and treatment. It is recommended that practices performing spirometry ensure their facilities and procedures are meeting the new Australasian Guidelines for pulmonary function testing during SARS-CoV-2. Engineering controls and staff training have been identified as key aspects of the Guideline, along with the usual requirements of physical distancing, vaccination, PPE and not attending work or being tested when sick.
 
Pulmonary function testing during SARS‐CoV‐2: An ANZSRS/TSANZ position statement - Borg - 2022 - Respirology - Wiley Online Library

NEW Fast-Track Giant Cell Arteritis Clinic

A Fast-Track Giant Cell Arteritis Clinic has been created by Bill Frederiksen, one of Hauora a Toi’s new rheumatology consultants.
 
The aim of the service is to provide fast-track assessment of patients with suspected giant cell arteritis (GCA). The patient will be assessed by a rheumatologist within 1-4 days. This will include a bedside vascular ultrasound for GCA, which is less invasive and provides more rapid diagnosis than temporal artery biopsy in some situations. However, the rheumatologist can refer the patient for temporal artery biopsy if necessary.
 
You can find the BPAC eReferral form under: BOPDHB – Public, Medical, Rheumatology - Fast Track Giant Cell Arteritis Clinic.
 
If your patient has visual symptoms, please also refer them acutely to ophthalmology via: BOPDHB – Public, Surgical, Ophthalmology (Park Street).
 
This service covers both WBOP and EBOP where the patient is able to attend Tauranga Hospital for the fast-track appointment. It generally supersedes the previous temporal artery biopsy referral/pathway. However, if the patient is in EBOP and is unable to travel to Tauranga, use the historic process instead for the time being (transport options are being considered):
 
EBOP, patient with visual symptoms, unable to travel to Tauranga fast-track clinic – speak to APU SMO (via switchboard 07 579 8044) or duty rheumatologist to discuss request. If approved, acutely refer patient to Dr David Langston (or WHK surgeon on-call if Dr Langston unavailable) via telephone call to Whakatane Hospital (07 579 8044).
 
EBOP, patient without visual symptoms, unable to travel to Tauranga fast-track clinic – refer to general surgery via BPAC eReferral form. Mark as ‘urgent’.

Midland HealthPathways update

In response to feedback from users of HealthPathways a separate COVID-19 Therapeutics in Adults page is now available on HealthPathways.
This page offers quick access to

• Criteria tools
• Direct access to the Liverpool interactions checker via a key link
• Information about the  available medications.
• Prescription and supply information (advanced scripts, Pharmacy supply and non-residents supply).

The COVID-19 Case Management in Adults pathway still provides the contextual information you need to meet the full spectrum of your patients’ needs.
The information to support prescribing to children remains unchanged in the COVID-19 Case Management in Children pathway. 

HealthPathways is a collection of management guidelines specifically tailored to primary care.  Our GP Liaison team is in the process of 'localising' these pathways to the Bay of Plenty, i.e, making them relevant to GPs and other primary care providers specifically in the Bay of Plenty.  You'll find valuable pointers on history, examination, treatment and of course when and how to refer patients on to other services.  These pathways will, over time, be replacing the Bay Navigator pathways

Dr Chris Tofield, Dr Dan Jackson, and Dr Paula Taylor