Clinical Matters

Clinical Matters

Welcome to the July Edition of Clinical Matters

In this issue Shortage of CPAP Machines

Message from PHARMAC:

Affecting Sleep Service

Lorazepam 1mg tablets: supply issue

Tamiflu in Pregnant Women Midland Health Pathways Update

Shortage of CPAP Machines Affecting Sleep Service There is a global shortage in supply of CPAP machines with remote connectivity.

Both ResMed and Fisher&Paykel are not able to supply Tauranga Hospital Sleep Service with their devices as a consequence of discontinuation of supply of microchips which are used in the production of CPAP equipment. This situation is looking as if it may last for some time, even months.

The Sleep service is now approaching ‘old’ patients who are noncompliant with their CPAP therapy to try and recycle their machines to be able to start new urgent patients on treatment.

Also the Sleep service may have to go back to the old type of CPAP machines without remote connectivity but unfortunately does not have sufficient staff to monitor progress with the therapy with this type of devices.

The public and private sectors are affected in the same way.

There is currently a long wait for sleep diagnostics but in view of the above the wait

time for initiation of CPAP therapy will increase significantly. As of a few days ago, the Sleep service had only 10 CPAP machines in stock for both Tauranga and Whakatane, while they receive approximately 20-25 sleep referrals per week.

Thank you for your patience and understanding. We [the Sleep service] will try hard to keep our services going. Resmed and Fisher&Paykel are doing everything they can to resolve this and or limit the impact.

Tamiflu for Pregnant Women We have sought clarification from the Infectious Disease team at Tauranga Hospital regarding access to funded Tamiflu for pregnant women.

Tamiflu is not funded on the community schedule, and is on the HML schedule to be targeted at the more unwell group of pregnant women who require hospital admission.

It is not necessary to undertake Influenza A PCR testing in the community for the purpose of case finding as there are many winter viruses in circulation currently outside of COVID and influenza.

There can be exceptions made case-by-case after discussion with AN ID physician, if necessary, for those who are particularly high risk within the community with confirmed influenza OR are household contacts of confirmed influenza AND within 48 hours of symptom onset. We anticipate those who meet this strict criteria will be very few and far in between, and we do not want to encourage all pregnant women being sent across to the hospital unless there is a clinical need.

Message from PHARMAC: Lorazepam 1mg tablets: supply issue

Kia ora koutou

The supplier of lorazepam 1 mg tablets (brand name Ativan) has notified Pharmac of a supply issue affecting this medicine.

There is currently a two-week supply or lorazepam 1 mg tablets in Aotearoa New Zealand. The supplier has advised Pharmac that supply is not expected to resume until early to mid-August 2022.

What we are doing To help distribute the remaining supply of lorazepam 1 mg tablets as fairly as possible throughout Aotearoa New Zealand, we have asked pharmacists to dispense a maximum of 7 days’ supply at a time. This limit will be in place until 31 August 2022.

We are working to secure stock of lorazepam 1 mg tablets from a different supplier. Due to complexities with import and export licenses that affect controlled drugs such as lorazepam, we are not able to provide a firm timeframe for resupply at this stage.

Clinical advice Our clinical advisors inform us that most patients use lorazepam for short periods of time. We are also advised that alternative funded treatments might be suitable for some patients. These may include diazepam and clonazepam.

Some clinicians may consider temporarily transitioning patients to half a 2.5 mg tablet, although this represents a 25% increase in dose-per-tablet. (The 2.5 mg tablets are scored for simpler halving.) This will require a new prescription.

Actions for healthcare professionals •

Avoid starting new patients on lorazepam 1 mg tablets until this medicine is resupplied

•

Consider alternative treatment options for patients who are using lorazepam 1 mg tablets for longer periods

We acknowledge the inconvenience that this supply issue causes. Thank you for your assistance with the management of this issue.

Why is this happening?

Aotearoa New Zealand, like other countries, is experiencing some constraints on its supply of medicines. The number of medicine supply issues for 2022 has remained relatively stable despite the pressures on the supply of goods caused by the COVID-19 pandemic and other local and global events.

When faced with a disruption to the supply of a medicine, Pharmac tries to ensure that there is a funded medicine available for those New Zealanders who need treatment. We work with our suppliers, and our colleagues across government, to expedite deliveries, and fund alternative brands or medicines to ensure suitable products remain available for treatment.

Pharmac will be investigating the reason for the supplier’s shortfall in supply. Our contracts require suppliers to hold at least a two-month supply of medicine in the country.

Further information We will keep the medicine notices section of the Pharmac website up to date as information about this supply issue becomes available.

Medicine notices - Pharmac website

Please share this information We want to make sure that everyone who needs to know about these changes is aware of them. Please share this information with your colleagues.

Midland HealthPathways update

New pathways for GPs on HealthPathways The following pathways are now live on our HealthPathways site for you to use: •

Family Violence

•

Suicide Prevention in Young People

•

Acute Asthma in Adults

•

Diabetes Screening and Diagnosis

•

Kidney Disease in Diabetes

•

Deliberate Self-harm

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.

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

Email the Bay Navigator team

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