The Diabetes Toolkit is now online
If you haven’t seen it already, take a look at our new Special Edition Best Practice Journal: The
In this edition we comprehensively cover all aspects of management of people with type 2 diabetes, including lifestyle interventions, oral glucose-lowering medicines,
a new injectable option, initiating insulin and monitoring for complications. We also review the latest evidence for diet and weight loss interventions in type 2 diabetes
and take a focused look at the rising tide of type 2 diabetes among young people in New Zealand. As a bonus, we have also included our new feature: Clinician’s
Notepad, which can also be viewed here.
For your convenience, we have loaded each of the articles within the eBook onto the general section
of our website,
where they can be viewed online or downloaded as a PDF and saved or printed.
If you would like to purchase a bound printed edition of the Diabetes Toolkit for yourself or your practice/workplace staff, please
email us for details at firstname.lastname@example.org.
Surge in cases of respiratory virus
data from ESR show a significant increase in cases of respiratory syncytial virus (RSV) across New Zealand in
recent weeks. For the week ending 27th June there were 538 cases reported. Case numbers began to increase rapidly
in late May and there have been 969 cases reported to date; this compares to an average number of 1,743 cases over
a 22-week period in 2015-2019.
Young children and infants are particularly susceptible to RSV as they are more likely to not have had prior exposure, and therefore immunity, to the circulating
RSV strain. RSV is usually self-limiting, but in some children it can lead to complications such as pneumonia and bronchiolitis; most cases of bronchiolitis are
caused by RSV. For further information on managing a child with suspected bronchiolitis see:
"Bronchiolitis: when to reassure and monitor, and when to refer".
Patient information on RSV is available from
Nurse prescribers now able to initiate Special Authority applications
of 1 July, 2021, registered nurse prescribers are now able to initiate and renew Special Authority applications for medicines they are eligible to prescribe
(currently there are 14 medicines that this applies to). This change increases access to medicines for patients, e.g. those who are unable to consult with a
general practitioner, nurse practitioner or secondary care specialist.
to the Ministry of Health, there are currently 372 nurse prescribers in New Zealand working in primary care and
speciality clinics. They can prescribe from a list of medicines for common and long-term conditions (including medicines
in cardiovascular, blood and blood forming, nervous system, diabetes, musculoskeletal and respiratory therapeutic
areas), and must be a part of a collaborative team.
New Zealand Formulary updates for July
New sections added to the NZF in the July, 2021, release include:
PHARMAC medicine funding and supply issues
The following issues relating to medicine funding and supply have been recently announced by PHARMAC:
Diclofenac sodium 100 mg long-acting tablets are to be discontinued. It is anticipated that stock
will run out in October, 2021 and these tablets will be delisted from the Pharmaceutical Schedule in May, 2022. Other
formulations of diclofenac sodium are not affected by this change.
- All formulations of
a beta blocker, are to be discontinued. No new
patients should be started on this medicine. From 1 August, 2021, pindolol will only be funded for existing patients
(pharmacists can endorse the prescription if they have a record of previous dispensing). Stock is anticipated to run
out by the end of 2021 and pindolol will be delisted from the Pharmaceutical Schedule in May, 2022. For information
on prescribing beta blockers, see: "Beta-blockers for
cardiovascular conditions: one size does not fit all patients".
- All formulations of prazosin,
an alpha blocker used for hypertension, Raynaud's disease and benign
prostatic hyperplasia, are to be discontinued. No new patients should be started on this medicine. From 1 August,
2021, prazosin will only be funded for existing patients (pharmacists can endorse the prescription if they have a
record of previous dispensing). Stock is anticipated to run out by the end of 2021 and prazosin will be delisted from
the Pharmaceutical Schedule in May, 2022. PHARMAC advises that doxazosin is a suitable alternative.
aqueous cream + glycerol is now back in stock. Shipping delays earlier in the year
meant that this product was unavailable and alternative products had to be prescribed.
Paper of the week: Data on suicide among users of mental health services
The Ministry of Health has recently published
a report on suicide among people who have used specialist mental health services. As cause of death due to suicide
is determined after a coronial inquiry, there is a lag in available data, therefore this report relates to deaths in 2016. An important message from the report
is that not all people who commit suicide have a mental health condition, nor do all those with a mental health condition, or significant distress, seek treatment.
Key findings from the report
- There were 524 deaths recorded as suicide in 2016
- 226 (43%) were users of inpatient mental health services; 4 died
while receiving inpatient care, 7 died within one week of discharge and 50 died within 12 months of discharge
- Average data from the previous five years showed that of those who committed suicide who were inpatients at
a mental health service 2% died while receiving inpatient care, 6% died within one week of discharge and 29%
died within 12 months of discharge
- 66% of mental health service users who committed suicide in 2016 were male; of those who committed suicide
who were not mental health service users 77% were male
- Among people using mental health services, the age-standardised rate of suicide by ethnicity was highest for
European/other (146 per 100,000 service users), followed by Māori (126) and Pacific (56); however, among people
who didn’t use mental health services the age-standardised rate of suicide by ethnicity was highest for Māori
(13.2 per 100,000 population), then European/other (6.2) and Pacific (4.7)
In 2017, bpacnz published an editorial, with guest commentary from mental health experts in New Zealand. The following is an excerpt:
Only a portion of the total number of people who die by suicide are seen in general practice, therefore it is crucial that any opportunity for intervention is acted on.
If in the course of a consultation a patient expresses verbally or non-verbally that their mood is low, they should be assessed for suicide risk. This can be done in a
formal manner, but it is often best approached as a conversation, using clinical judgement as to how far the questions go. There is no one right way to ask about suicide,
and the only wrong way is not to ask at all. The manner and tone of asking is more important than the words used. Be empathic, sensitive and non-judgemental, in a way
that invites the patient to share the depth of their concern and despair.
For further reading, see: "Suicide prevention: what can primary care
do to make a difference".
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