Clinical Matters Newsletter December 2022 23 Dec 2022
Welcome to the December 2022 Edition of Clinical Matters!
In this issue...
EPiC Antibiotic News
EPiC Antibiotics, published by Pharmac-sponsored educators He Ako Hiringa, is now available online and highlights some areas in primary care that continue to see inappropriate use of antimicrobials, including treatment of urinary tract infection, unwarranted seasonal variation in antibiotic use, overuse of amoxycillin + clavulanic acid, and the use of topical antibiotics.
Changes to Cataract Threshold
The Cataract threshold is increasing from CPAC 59 to 60 effective immediately.
We are anticipating this is a temporary increase and will advise as soon as it changes.
Following a prescribing error involving a type 1 diabetes patient it was identified that the classification terms in MedTech could cause some confusion. Currently MedTech classifications use the READ system which is licenced in NZ by ACC. Diabetics are currently classified as IDDM (insulin dependent diabetes mellitus) or NIDDM (non-insulin dependent diabetes mellitus). MedTech will change the classification system it is using in the first quarter of 2023 (dates to be confirmed). The new system will be SNOMED-CT. When this is updated IDDM (C108.00) will be automatically mapped (changed) to the new SNOMED-CT term diabetes mellitus type 1 and NIDDM (C109.00) to the term diabetes mellitus type 2. There will also be other classifications such as insulin treated type 2 diabetes mellitus and latent autoimmune diabetes mellitus in adult.
The SNOMED-CT will offer more standardised classifications of disease that will help to improve patient care. Further information will be issued by MedTech before the planned update. Between now and the update there is a good opportunity for practices to make sure that we are using IDDM only for type 1 diabetes and NIDDM for type 2 diabetes whether they are on insulin or not. Individual information can still be typed in the notes section of the classification if needed.
Contacting the Medical Reg at Whakatāne Hospital
In the past there have been various phone numbers used to contact the medical Reg at Whakatāne Hospital. Some old numbers have now been discontinued and are no longer in use. If you wish to speak to the medical Reg please call Whakatane switchboard on the GP line on 07 579 8044 and they will connect you to via the correct number. As numbers and doctors change from time to time this is the preferred contact method to discuss acute admissions.
Identification and Notification of mpox (monkeypox) cases - advice for Bay of Plenty and Lakes Clinicians
As part of the mpox planning for case and contact management, Toi Te Ora Public Health has put together the attached guide for clinicians in the Bay of Plenty and Lakes districts.
- Groups disproportionately impacted by the current global mpox outbreak include: anyone with two or more sexual partners or any anonymous sexual partners in the previous 21 days, men who have sex with men (MSM) and people who have sex with MSM.
- To contact both the Medical Officer of Health and the Clinical Microbiologist when mpox is suspected and before carrying out mpox testing.
- The minimum level of PPE for healthcare workers when interacting with and providing care (including physical examination and collecting samples) to a person with suspected, probable and confirmed mpox includes; the use of eye protection, fluid-resistant level II R medical mask, fluid resistant gown and gloves. A P2/N95 mask is suggested for any aerosolising procedures, collection of oropharyngeal samples, prolonged close physical contact (e.g., showering) and handling contaminated linen, clothing and towels.
- A medical mask and adherence to hand hygiene is sufficient for the initial interview prior to clinical assessment.
- When notified of a mpox case, Toi Te Ora Public Health will follow up with the case to provide isolation advice and conduct source and contact tracing. Clinical oversight of the case (including clinical review, prescriptions, etc.) will need to be provided by the patient’s clinical team.
Maternity Patients Struggling to find an LMC? Remember, Primary Maternity Care Services are available!
Midland HealthPathways Update
New pathways for GPs on HealthPathways
The following pathways are now live on our HealthPathways site for you to use:
And remember there is up-to-date information on all matters Covid-19 for primary care on Health Pathways, including national as well as local information.
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.