Clinical Matters Newsletter October 2022 28 Oct 2022
Welcome to the October Edition of Clinical Matters!
In this issue...
Sleep Service Staffing Issues - Delays to Review and Treatment
Two sleep physiologists have recently left the Hauora a Toi Bay of Plenty Sleep Service. Although the department is actively recruiting, at present they are working on skeleton staff.
As such, please be aware there are likely to be delays to your referrals for suspected sleep apnoea.
There are private sleep studies available in the Bay of Plenty.
If your patient is already known to the Sleep Service and has equipment, compliance or mask problems please advise them to contact the Sleep Disorder Unit Helpline on 0800 267 999
If you want to check the status of an existing referral to the Sleep Service, please telephone the Patient Information Centre instead of sending another referral, as this slows down the triage process greatly. The PIC is available on 0800 333 477 and is open to both GPs and patients.
National Bowel Screening Programme (NBSP) Pānui August 2022
The COVID-19 Care in the Community team would like to invite the primary care sector to join the rollout of the COVID-19 Pre-exposure Prophylaxis (PrEP) medicine Evusheld (tixagevimab and cilgavimab) from 3 October 2022.
This initiative is part of a suite of COVID-19 treatments, with Evusheld being the first funded Pre-exposure Prophylaxis treatment for at-risk people in our community.
A month ago, we sent out guidance to the health sector about the rollout of Evusheld, noting that eligible patients, approximately 10,000 (across the motu) or 2 per 1,000 in the population, are being identified and initially offered this treatment by hospital-based specialists.
We also noted our plan to extend this to include primary care in due course as a way of increasing accessibility for all those who meet Pharmacy Evusheld access criteria .
Please see attached the EVUSHELF - CLAIMING GUIDE FOR PRIMARY CARE and a flow chart that gives an overview of activities associated with Evusheld administration for circulation to your networks as appropriate. We acknowledge it may take some time for primary health organisations and district portfolio managers to make the arrangements needed to implement this new initiative and ask providers to defer invoicing until these arrangements are in place. We are grateful for your support with this initiative and for your ongoing mahi in the COVID-19 response.
Also, there is a range of information published in the Manatū Hauora Ministry of Health website about Evusheld on its COVID-19 advice for all health professionals  page in the Therapeutics for COVID-19 section, including the Guidance for COVID-19 Therapuetic - Evusheld (tixagevimab and cilgavimab), along with the Therapeutics Technical Advisory Group’s advice on use of Evusheld plus some frequently asked questions.
Community pharmacists will be able to order stock of Evusheld from Health Care Logisitics from 3 October 2022. Stock should only be ordered upon receipt of a prescription.
- For severely immunocompromised people who don't have COVID-19, but have certain medical conditions which put them at risk of an inadequate immune response to SARS-CoV-2 vaccination or infection
- For people who are unable to be vaccinated against COVID-19 due to medical contradiction (for example, a history of severe adverse reaction to a COVID-19 vaccine or its components) AND are considered at high risk of severe illness from COVID-19 infection.
Eligibility includes some transplant recipients, some people having treatment for cancer, and some people with HIV. Please refer to Pharmacies Evusheld access criteria  for the full eligibility criteria.
Please contact COVID19CareintheCommunity@health.govt.nz if you have any questions.
- Click here to view the Evusheld Primary Care Claiming Guide
- Click here to view the Evusheld Administration Process Overview Flowchart
Renewing Special Authorities for Rheumatology Drugs
In response to a helpful suggestion from one of our GPs, the Rheumatology Department has cut out the middleman (i.e., GPs) when it comes to renewing rheumatology drug SA numbers. Community pharmacists can now contact the Rheumatology Department directly on firstname.lastname@example.org. The Rheumatology department says 'We will contact the patient formally, either through a CNS phone consult, or just by checking that the patient has been seen/followed up sufficiently for us to renew SA. We need to do this as audits on SA approvals occur regularly, and therefore we need to document a virtual/ f2f FU within accepted guideline timeframes to comply with SA (audit) rules.'
Pharmacies have now been informed and provided with the email address above. No more need for GPs to be sending off letters to rheumatology asking for SA renewals!
Monkeypox Update from our Infectious Diseases Team
As you may have heard, there is an ongoing worldwide outbreak of Monkeypox (MPX) virus, inherently different previous incursions of MPX out of Africa in that the 2022 outbreak transmission has almost exclusively occurred in sexual networks of highly affected communities, particularly men who have sex with men (MSM).
We have had recently the first cases of locally transmitted infections in Aotearoa and as expected, with accelerated testing of contacts and risk populations, the numbers are rising - therefore, the National response is quickly gaining momentum and there is now ongoing collaboration between the Health agencies, sexual health clinicians, and the affected community (Burnett Foundation).
Please refer to the attached standard operating procedure for further information on this condition and what to do if you see a suspected case.
Hopefully we will soon have news to share regarding the availability in Aotearoa of antivirals (Tecovirimat, TPOXX) and vaccines (MVA - Jynneos or Imvanex).
- Antivirals: we understand approximately 500 courses of TPOXX are being procured. The access to this limited resource will likely involve discussion and approval from a relevant Specialist (Infectious Disease or Sexual Health Physician).
- Vaccines: the global market is highly competitive and here is an international shortage of vaccines. We understand the availability of any significant stock of vaccine might be at least a couple of months away. Therefore, in the meantime, early detection, notification, and isolation of cases and close contacts is paramount.
National Bowel Screening Update
- How to do the bowel screening test
- How to use the test kit
- The lowdown on bowel screening - 11 different languages
- A colonoscopy procedure
- Where to get free pamphlets/booklets on bowel screening - lots of different languages
Amoxicillin/Clavulanic Acid - Is it Necessary?
Amoxicillin/clavulanic acid (Amoxicillin/clavulanate; Curam®; Augmentin®) is an important and effective broad-spectrum antibiotic which is frequently used in hospital and community practice.
Due to a significant supply shortage, amoxicillin/clavulanic acid may not be available.
CLINICAL UPDATE: Transfusion Samples Labelling Process - October 2022
New Zealand Blood Service (NZBS) are updating their sample labelling for group & hold (transfusion) samples, as per below. Pathlab will also be moving to the same criteria effective Monday 7th November 2022 to ensure we can continue to refer samples to NZBS.
Please circulate this updated process to any staff who may collect samples.
Long-Term Adult Tracheostomy Patients in General Practice
Te Whatu Ora Hauora a Toi - Bay of Plenty are working on a project to improve the Adult Tracheostomy Care Pathway for adults with long-term tracheostomies. One of the workstreams is to investigate setting up regular outpatient clinics for follow ups and additional support for managing medical equipment.
In order to know how much FTE will be required we need to know how many patients are in our communities with long-term tracheostomies and this information is not easily accessed within the Hauora a Toi - BOP clinical systems currently.
We ask if you can please circulate the stock take in your general practices and kindly note any patient details in teh attached spreadsheet of those with long-term tracheostomies under your practice.
Once we have this information, we will then cross check with our clinical systems and tag the patient as having a tracheostomy for future reporting.
If the stock takes can please be emailed to Baynav@bopdhb.govt.nz by Monday 7th November.
A Message from Haematology: MGUS Audit in Progress
We know interpreting and managing monoclonal gammopathies (MGUS) can sometimes be difficult and confusing. Over the summer months we plan to investigate whether the current system of community monitoring is working for patients and our colleagues in primary care. We hope to feedback the results of our audit in due course and are always happy to hear comments of what does (or does not) work well for you.
Please email email@example.com with any feedback which will be incorporated and addressed in the audit process over the coming months.
PrEP Training Module Now Live
The Burnett Foundation training module for PrEP in primary care has gone live:
It takes about one hour to complete
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.Back to latest