Pegasus 2025: General Practice - 9 June 2022

9 PIRIPIRI / JUNE 2022

PUTANGA / ISSUE 2

PEGASUS 2025 K ia at awhai ki te tangata

Men’s Health Month

CO N T E N TS Spotlight on education . . . . . . . . . . . . . . . 4 Local Oscar winner overcomes prostate cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 Pegasus Health advocating for health outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Pegasus Workforce Development Scholarship marks 22 years . . . . . . . . . . . 8 Health reforms update. . . . . . . . . . . . . . . 10 A message of thanks to Canterbury GPs. 10 Former Eritrean refugee learns health and lifestyle tips . . . . . . . . . . . . . . . . . . . . . . . . 11 ERMS celebrates five million referrals . 12 Getting the flu vaccine for winter . . . . . 13 Rural nurse practitioner shares his passion for nursing . . . . . . . . . . . . . . . . . . . . . . . . . 14 What‘s on in June . . . . . . . . . . . . . . . . . . . 15 Pegasus Health Acute Demand Service. .

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Tukua kia tū takitahi ngā whetū o te rangi.

Let each star in the sky shine its own light.

June is Men’s Health Month. Men live, on average, four years less than women. Men’s Health Month is about encouraging men to take better care of themselves; whether that’s taking better care of their nutrition and sleep, getting their flu shot, or seeing a health professional for preventative care. In this issue we chat to men who have accessed Pegasus Health services in order to take better care of their health and wellbeing.

Last month I had the privilege of attending the Pegasus Health Workforce Development Scholarship awards and meeting some of the 28 incredible recipients. Our purpose is ensuring that all people living in Canterbury lead healthy lives, and these scholarships play an integral part in making this happen. The fact stands that Māori, Pasifika, and our culturally and linguistically diverse populations are not achieving equitable health outcomes. Supporting the creation of an equitable health workforce through these scholarships is one of the ways we work towards achieving our purpose.

June sees the beginning of Matariki. This is a time of togetherness and connection and I encourage you to spend time with friends and whānau this month as you reflect on the past year and look to what the coming months are bringing for you.

You will be aware of the work that GPNZ and others are doing to negotiate a fairer increase in capitation rates. I would like to reassure you that we are working closely with GPNZ, and through our role in the negotiations, on this issue. We recognise the pressure that you are under and will continue to push for a fairer deal. I will keep you updated.

MARK LIDDLE

MANUKURA | CHIEF EXECUTIVE OFFICER PEGASUS 2025 |

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SPOTLIGHT ON EDUCATION

This monthly column takes a look at current and upcoming education for health professionals.

TYPE 2 DIABETES: UPDATE ON ORAL ANTIHYPERGLYCAEMICS The Pegasus Clinical Quality and Education team recently published a bulletin on two new classes of antihyperglycaemics that are now funded via Special Authority. This bulletin was developed in response to feedback from Canterbury clinicians who wanted more information about these new treatments.

Empagliflozin is a sodium-glucose cotransporter-2 (SGLT-2) inhibitor that is taken orally, while dulaglutide, a glucagon-like peptide (GLP-1) receptor agonist, is administered by subcutaneous injection.

Evidence indicates that SGLT2 inhibitors and GLP-1 agonists reduce the risk of death and improve cardiovascular and renal outcomes in patients with type 2 diabetes who

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are at increased risk of cardiovascular disease. As such, Special Authority funding is prioritised for those of Māori or Pacific ethnicity, or those who are at high risk of cardiovascular disease or who have diabetic kidney disease.

Pegasus Health Clinical Facilitator and Medicines Information Pharmacist for the Clinical Pharmacology Department at Christchurch Hospital, Tracey Borrie, recommends taking a shared-care approach before prescribing.

“As always, deciding to prescribe these treatments should be considered in light of pote ntial adve rse e ffe cts and the patie nts’ overall health, goals and preferences. Take the opportunity when with the patient to conduct a cardiovascular risk assessment to determine which treatment is right for them,” Tracey says.

More information about these treatments and the Special Authority funding can be found here.

1st-line

Route

Metformin

2nd-line

SGLT-2 inhibitor Empagliflozin

GLP-1 agonist Dulaglutide

DPP-4 inhibitor Vildagliptin

3rd-line

Sulfonylurea Gliclazide Glipizide

Oral

Oral

Subcut

Oral

Oral

Efficacy (HbA1c)

High

Medium

High#

Medium

High

Hypo Weight

No

No

No

No

Yes

↔↓

↓

↓↓

↔

↑

Renal benefit

↔

Yes

Yes

↔

↔

CV Benefit CVD ?Yes

Yes

Yes

↔

↔

Other info

HF ↔

Caution: eGFR <60mL/min/1.73m2 - dose adjust, sick day management Contraindicated: eGFR<15mL/min/1.73m2; liver or heart failure

Yes

Caution: risk of DKA (withhold in acute illness or surgery), sick day management, patients at risk of volume depletion, hypos with insulin and sulfonylureas Contraindicated: eGFR <30mL/min/1.73m2, under 18yo, pregnancy, breastfeeding, previous severe genitourinary infections

↔

Caution: eGFR<15 mL/min/1.73m2 - seek specialist advice, monitor eGFR, sick day management Contraindicated: <18yo, pregnancy, breastfeeding, severe GI disease, DPP-4 inhibitor use, history of pancreatitis, medullary thyroid carcinoma, MEN2 syndrome

↔

Caution: eGFR<50mL/min/1.73m2 - reduce dose; ACE inhibitor use (rare reports of angioedema), history of acute pancreatitis, GLP-1 agonist use, hypos with sulfonylureas Contraindicated: <18yo, pregnancy, breastfeeding, unstable CHF

↔

Caution: Renal impairment – dose reduce, sick day management, hypos, G6PD deficiency Contraindicated: <18yo, pregnancy, breastfeeding, renal or liver failure, ketoacidosis

Glitazones Pioglitazone

Oral

High

No

↑

↔

?Yes

↑ risk

Caution: Fluid retention - avoid in HF, sick day management, hypos with insulin or sulfonylureas, monitor LFTs Contraindicated: osteoporosis, oedematous conditions, history of bladder cancer

Insulin

Subcut

Highest

Yes

↑

↔

↔

↔

Caution: Lower doses required in renal impairment, hypos, sick day management Contraindicated: hypoglycaemia

# Effect is greatest when HbA1c is high. Glycaemic efficacy was found to be similar or greater than basal insulin in comparative trials. *As per NZSSD guidelines. Sulfonylureas and glitazones are suggested as third-line since they cause weight gain and hypos.

Hypo = hypoglycaemia PEGASUS 2025 |

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LOCAL OSCAR WINNER OVERCOMES PROSTATE CANCER

During a check-up in 2019, Hammond’s GP detected elevated levels of PSA in a blood test used to screen for prostate cancer. The levels did not drop following a further PSA test seven weeks later, so the GP referred Hammond to a specialist, who diagnosed cancer that was contained within the prostate.

“I was keeping in touch with the GP and regularly having blood tests and digital examinations, so my doctor knew what was going on with me. These regular check-ups meant when the cancer was detected it had not spread outside the prostate. Once it gets outside [the prostate] it can be hit and miss whether it spreads throughout the body and makes treatment much tougher,” says Hammond.

After speaking to the specialist and doing his own research into his treatment options, Hammond chose to have surgery to remove his prostate.

More than two years on from the diagnosis, the retired production sound mixer/sound recordist (and two-time Oscar winner for his work on King Kong and Lord of the Rings) says he is doing well and making use of available support from other cancer survivors and community groups such as the Prostate Cancer Foundation.

“As I went through my cancer journey, I found there were so many support groups who could ‘give you the goss’.

For example, I now go to a weekly fitness group where those of us recovering, and others in a different stage of their journey, get together and talk over coffee after the workout. It is so useful to talk to others with the same experiences and discuss what can be rather sensitive topics.”

Hammond is grateful he had regular checks and that his GP was proactive in monitoring and referring him promptly for specialist care.

Mount Pleasant prostate cancer survivor Hammond Peek (Ngāi Tahu) views his body like a car. Regular check-ups with his GP mean it stays in good order and major problems can be picked up and addressed early.

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“The outcome could have been quite different without that regular contact with my GP,” Hammond says.

PEGASUS HEALTH ADVOCATING FOR HEALTH OUTCOMES Pegasus Health not only supports the delivery of primary health services, but also focuses on advocating to achieve health equity across Canterbury.

Currently, Pegasus’ public health advocacy efforts prioritise areas that affect our communities with poorer health outcomes. To support this mahi, Pegasus has established an Advocacy Group to identify relevant and important advocacy opportunities for the organisation to undertake.

Some recent advocacy opportunities to support our tamariki include responding to the Ministry of Education’s proposed changes to healthy drinks in school and signing a consensus statement developed by the Protect Kids from Junk Food Marketing group to help protect children from unhealthy food and drink marketing.

Katie Brown, Population Health Specialist at Pegasus, says that advocating for these opportunities can create a real impact on health equity.

from Class 4 gambling (pokies), with Māori and Pasifika people living in high deprivation and young people experiencing great burdens from gambling-related harm.

Pegasus also submitted a response about the Sale and Supply of Alcohol Act 2012, pointing out that Pasifika, Māori and young people are disproportionately impacted by the harms of alcohol and that the cost of alcohol related harm to our health system is significant.

“We recognise the significant and sustainable impact policy change can have on health outcomes, which is a motivation for Pegasus to continue to invest in advocacy for healthy public policy,” says Katie.

There are many other advocacy opportunities that Pegasus has been involved in recently. These include: • supporting a proposal for the influenza vaccine to be funded for Māori and Pasifika aged 55 and those with mental health and addiction issues • submissions on the Pae Ora (He alth Futures Bill) • continuing to support the fluoridation of Drinking Water Amendment Bill • signing the Project Sunset’s letter to end smoking within a generation.

“By advocating on areas like tobacco control, alcohol harm and water fluoridation, we can he lp cre ate healthier environments for our young people, particularly those that already experience poorer health outcomes,” says Katie.

Pegasus’ commitment to supporting health equity was also demonstrated through responding to the Department of Internal Affairs’ consulation to strengthen regulations to minimise harm PEGASUS 2025 |

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PEGASUS WORKFORCE DEVELOPMENT SCHOLARSHIP CEREMONY MARKS 22 YEARS The ‘highlight of the year’, the Pegasus Health Workforce Development Scholarship ceremony was held at Tūranga (Christchurch Main Library) on Thursday 18 May. The scholarships were established

by Pegasus Health in 2001 to support members of our priority communities in their journey to working in health care. Pegasus continued this commitment to creating an equitable health workforce to assist Aotearoa towards equitable health outcomes by awarding 28 scholarships in 2022.

In an emotional speech from keynote speaker, Suzanne Pitama, she acknowledged that achieving health equity was the responsibility of all the health workforce.

“There will be a lot of pressure on you when you graduate to meet our equity goals, but every single graduate is supposed to contribute to health equity, it does just not rest on your shoulders. So, I want to honour your dreams and aspirations for yourself. I want you to choose the field that most stimulates you, that makes you excited. Because the 8

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more you follow your own passions, the more we will retain you in our health workforce and that is really our overall goal,” says Suzanne.

Third year nursing student, Kirstyn Macdonald (Ngāti Kahungunu), knows first-hand the challenges Māori women experience.

“As a young Māori mother, I experienced discrimination from health care services and as a result I was afraid of judgment when attending the Well Child Checks which is crucial for monitoring your pēpi’s growth and development,” Kirstyn says.

“Unfortunately, I am not alone in experiencing discrimination from health care services. Discrimination is a contributing factor to why Māori have poorer health outcomes,” she says.

This has motivated Kirstyn to study nursing, so she can have an active role in improving health disparities in Māori health.

Akerita Alatimu (Samoa) is in her second and final year of a Master of Health Science. Akerita took time to acknowledge the professionals that have worked for equity in health. “I chose this course, not only because I wanted to see change in our communities, but I also wanted to be part of that change to better our health outcomes. I know that it is not going to be easy, but we are preceded by so many warriors in our individual fields that I know it is doable with a whole lot of grit,” she says.

2022 SCHOLARSHIP RECIPIENTS Māori Marjorie Carran Ngāti Haua 4th year Bachelor of Social Work

Te Rina McGregor Ngāti Kahungunu ki Wairoa, Ngāti Tūwharetoa, Ngāti Mutunga, Ngāti Mutunga o Whare Kauri 4th year Bachelor of Social Work

Tiana Mihaere Ngāi Tahu, Ngāti Mamoe, Waitaha, Ngāti Kahungunu, Ngāti Maniapoto, Ngāti Porou, Rangitāne, Ngāi Tāmanuhiri 4th year Bachelor of Medicine

Sam Cameron-Dunn Ngāi Tahu 5th year Bachelor of Medicine

Ben Shine Ngāi Tahu 2nd year Post Graduate Diploma in Clinical Psychology

Caitlin Bland Cook Island Maori 5th year Bachelor of Medicine

Zoe Honeyfield Te Ātiawa 5th year Bachelor of Medicine Leah Ruha Ngāi Tahu, Te Whānau a Apanui 2nd year Bachelor of Nursing Iwitea Ataria-Ivannikova Rongomaiwahine, Ngāti Kahungunu, Ngāti Tūwharetoa 3rd year Bachelor of Nursing Nasya Thompson Ngāti Raukawa 5th year Bachelor of Medicine Kirstyn MacDonald Ngāti Kahungunu 3rd year Bachelor of Nursing Ariana Walker Te Ātiawa, Ngāi Tahu 3rd year Bachelor of Midwifery Ariana Ashby Ngāpuhi 3rd year Bachelor of Midwifery

Pasifika

Tatila Helu Tongan 5th year Bachelor of Medicine Leon Haiu Uvean 2nd year Bachelor of Nursing Akerita Alatimu Samoan 2nd year Bachelor of Nursing Masters of Health Sciences Professional Practice Maca Vuniwaqa Fijian 4th year Bachelor of Social Work Emily Tagicakibau Fijian, Tongan 4th year Bachelor of Social Work

Wikitoria Kurene Samoan, Māori 2nd year Bachelor of Applied Science (Health Promotion)

CALD Kanwal Yousaf Pakistani 2nd year Bachelor of Arts in Psychology Dena Makarious Middle Eastern, Egyption 2nd year Postgraduate Diploma in Clinical Psychology Masters of Psychology Angelin Perumbally Indian 4th year Bachelor of Speech and Language Pathology Miron Habte Ethiopian 4th year Bachelor of Social Work Samuel Hidray Equbazgi African, Eritrean 3rd year Bachelor of Social Work with Honours Nasteho Mohamed Somali 2nd year Bachelor of Social Work Minien Cheng Taiwanese 3rd year Bachelor of Nursing Jennifer Micere Ngondi African, Kenyan 2nd year Masters in Nursing

Danielle O’Halloran Samoan 3rd year Rongoa Māori and Pacific Leadership in Mauli Ola

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HEALTH REFORMS UPDATE May has seen some significant senior appointments to Health New Zealand and the Māori Health Authority. Canterbury DHB CEO, Dr Peter Bramley, has been appointed as Interim Regional Director for Te Waipounamu/the South Island from 1 July. This is in line with similar appointments for the CEOs from the Nelson Marlborough, South Canterbury and Southern DHBs.

a taskforce to tackle waiting lists across the health system. Chaired by Andrew Connolly, Chief Medical Officer at Counties Manukau DHB, the taskforce will provide short term advice for managing wait times while developing a longterm plan to strategically manage planned care and surgical wait times.

Margie Apa, Interim Health NZ Chief Executive, announced a review into the National Breast Screening Programme. The main reasons for the review are waiting times in certain regions and ensuring equitable access to screening for Māori and Pasifika.

The other major project announced recently is the establishment of

Mr Andrew Connolly (centre) with Dr Jeff Lowe (left), and Health New Zealand Chief Executive Margie Apa.

A MESSAGE OF THANKS TO CANTERBURY GPs Dear Colleagues We in the Emergency Department (ED) want to acknowledge the amazing job that Primary Care has done over the last few months as COVID-19 has hit.

We know that you, like us in ED have been extremely busy and have had to cope with so much information and change.

From an ED perspective we have noticed that nearly every referral here is appropriate, with the suitable person having been contacted prior to sending the patient. This allows us to avoid duplication and to get the patients to the right people and place sooner, so once again please accept our thanks and appreciation.

No doubt this winter will be a challenging one and we look forward to the same amazing levels of collaboration so that we are all being as efficient as possible and getting the right care to the right patients.

Best wishes and thanks again Mark Gilbert Clinical Director Christchurch Emergency Department 10

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FORMER ERITREAN REFUGEE LEARNS HEALTH AND LIFESTYLE TIPS

As a full-time social work student and parttime worker with the Red Cross, Samuel Hidray Equbazgi struggled to prioritise his health and wellbeing. The former refugee and others from Christchurch’s Eritrean community took part in a Puāwai-Kai healthy lifestyle and cooking course.

Samuel says since doing the free 8-week course he is cooking healthier food for himself and prioritising good habits such as exercise and a healthy sleep routine.

“Life was not easy but little by little I am making the progress I am wishing. So far so good,’’ he says.

Samuel says that he would recommend this course to anyone that is wanting to make healthier improvements in their life.

“It is every little thing that would help you improve the lifestyle that you wish to have. Besides the cooking training, there was some stuff as well like how to manage your sleep, your engagement with sport and communication. It is kind of about everything related to your health. I 100% recommend this kind of training for everyone,” says Samuel.

Learn more at Puāwai.org.nz.

(L- R) Zeynab Faitinga, Freweini Berhe and Samuel Hidray Equbazgi.

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ERMS CELEBRATES FIVE MILLION REFERRALS A Christchurch patient requiring prompt referral from their GP for a knee x-ray was the 5 millionth ever referral via Electronic Referral Management System (ERMS).

That request was a vital step in getting the right care promptly for the patient who represents the millions of New Zealanders who have benefited from the ERMS system over more than 15 years.

ERMS was developed in the early 2000s in a partnership between Pegasus Health and the Canterbury DHB to answer the clear clinical need for a more consistent, dependable, and faster referral system, and

provide a single point of referral to any part of the broader health system including community providers, and both public and private sectors.

In 2010 ERMS was confirmed as the primary eReferral system for all five South Island health boards and in late 2021 was adopted by the Whanganui DHB. ERMS Programme & Product Manager Joanna Jordan says the team is thrilled to share news of the significant milestone of five million referrals.

“We feel this milestone is very much worth celebrating because it reflects the vast number of patients who have benefited from the ERMS system. Professionals across the spectrum of the health system have also benefited from having a system that is easier and more reliable. From its inception, the system has been developed in partnership with senior primary and tertiary care professionals to ensure its usability and relevance for them and their clients,” says Joanna.

415 referral types

5M

referrals in 2022

To find out more go to: https://erms.health.nz

1M

referrals in 2016

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3M

referrals in 2019

GETTING THE FLU VACCINE FOR WINTER Getting the influenza vaccine was a no brainer for Banks Peninsula resident, Digital Capability Manager for Careerforce, Ian Moir. With the move to the orange traffic light setting and workplaces and activities opening again, Ian knows getting his flu jab is the best way to protect himself and those around him.

“I have been primarily working from home for two years now, but my workplace has opened up again and more people are returning to the office,” says Ian. Ian’s role sees him travelling to Wellington often as well as frequent meetings with his team and suppliers.

“Getting the flu vaccine is not only about protecting myself but making sure that I am not going to spread any bugs to others,” he says.

Ian chose Barrington Medical Centre’s Vaccination Hub to get his vaccine. He found the process to be very quick and friendly.

“I went to Barrington on my lunch break and got my vaccine straight away with no waiting. Everyone was helpful, particularly the vaccinator who was cheerful and really put me at ease,” Ian says.

Yearly flu vaccinations are free for: • Pregnant people • People aged 65 years and over • Māori and Pacific people aged 55 years and over • People who have a long-term medical condition such as diabetes, asthma, or a heart condition (ages 6 months+) • Children 4 years old or younger who have been in hospital with respiratory illness such as asthma.

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RURAL NURSE PRACTITIONER SHARES HIS PASSION FOR NURSING With International Nurses Days being celebrated globally last month, we sat down and had a chat to Jason Williams, Nurse Practitioner (NP) at Oxford Health to hear about his passion for nursing.

Growing up in Florida, Jason graduated from Nursing School in 1995 from the University of Florida before moving to New Zealand in 2005 to complete his Master’s Degree at Massey University.

Jason has an extensive background in a variety of intensive care specialities working in hospitals in the US and New Zealand. He is currently working as a Rural Nurse Specialist at Oxford Medical Centre; an opportunity which allows him to be closer to his home and family.

“The best part about this role is the team I work with and getting to serve the community I call home,” says Jason.

After five years in this role, it was a massive cornerstone to becoming an NP. Becoming an NP was not an initial goal for Jason but after the passing of his wife, who also worked at Oxford Medical, he wanted to finish what she could not.

“At that time there was no formal NPTP programme, so it felt like a ‘sink or swim’ challenge. With great support from the Oxford Medical Centre, I completed my NP application and interview three years ago and have not been happier.”

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A highlight of Jason’s career so far is “being able to teach and give back to future potential NP’s. I enjoy sharing what I have learned over my years of nursing and seeing the future of our profession thrive,” says Jason.

International Nurses Day is a “day for all of us to celebrate our profession and appreciate the contributions we have made to patient outcomes. “More importantly, knowing that no matter where you are in the world you can work almost everywhere with your skill set, whether that’s the US, New Zealand, South America or even Antarctica. Our profession allows us to do anything!” he says.

The Acute Demand Service is all about lightening some of the load on hospital services, GPs, and patients. Under the leadership of Senior Medical Officer of Acute Demand, Dr Andrew Meads together with SMOs Dr Belinda van Gruting and Dr Martin Gardner, as well as a dedicated nursing and administrative team, Acute Demand supports patients to remain or return to the care of their GP and stay out of hospital and ED. “We assist GPs with a lot of diagnostic work, including electrocardiogram (ECGs), blood tests or organising radiology,” says Martin. “As long as it potentially keeps someone out of hospital, we can help. For example, we are very happy to see heart failure patients when GPs are scarce of time,” he says.

Along with support and monitoring for heart and chronic obstructive pulmonary disease (COPD) patients, anticoagulation monitoring and other therapeutic services, such as intravenous (IV) antibiotics, acute demand is preparing to launch an atrial fibrillation pathway as well.

“Patients presenting with atrial fibrillation to the hospital, will receive acute treatment and then be handed over to us for follow up the next day to ensure their heart has returned to normal rhythm. If not, they are then referred for cardioversion.

This keeps them out of a hospital bed and saves them having to return to hospital for follow-up monitoring,” says Martin.

PEGASUS HEALTH ACUTE DEMAND SERVICE Self-employed plumber, Tom Thompson, is not looking to retire any time soon. At 67, he says he is always got to be doing something, which makes the Acute Demand Service the perfect outpatient solution for him.

Tom has been a patient of Acute Demand twice now. Ongoing health issues mean he is prone to internal infections which require IV antibiotics. On this occasion, Tom was referred to Acute Demand

by Christchurch Hospital.

“I am not one for sitting still,” says Tom. “I know the hospital is a good place to be when you are not well, but after I was diagnosed and waiting for treatment, I would rather get out to you guys [Acute Demand] and travel there once a day to get my treatment,” he says.

As well as the ability to get back to work and stay productive, Tom appreciates the friendly approach of the clinical staff at the Acute Demand Service. “The staff are lovely and accommodating. They are telling me what they are doing while they are going through the procedure so it is all very clear and I know I am in good hands,” says Tom.

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WHAT’S ON IN JUNE 5

World Environment Day

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World Oceans Day

14

16

World Blood Donor Day

13-19

Light it Orange for Shine

17-28

Christchurch Pride

20

World Refugee Day

21

Global Motor Neurone Disease Awareness Day

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MEN’S HEALTH MONTH

MATARIKI 21 June-16 July

Pegasus Health 2025 is produced by the Communications Team at Pegasus Health (Charitable) Ltd. Content within Pegasus Health 2025 newsletters has been included with the approval of content providers therefore please contact us if you wish to reproduce or alter and transmit any of the information or images contained within. Contact communication@pegasus.org.nz

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