Please see below, the Primary Care Clinical Digest for this week. Happy reading and have a great weekend!
PRIMARY CARE CLINICAL DIGEST September 26-30 2022
Te Whatu Ora
COVID 19 Message from the Director General Dr Diana Sarfati
● This update from the Director General is on some important new research carried out by Manatū Hauora; an analysis of the deaths from COVID 19 that have occurred in Aotearoa New Zealand this year. The analysis examined 1,797 deaths that have been attributed to COVID 19, and which occurred between 1 January and 26 August 2022. This included 1,458 people of ‘European or Other’ ethnicity, 158 Māori, 111 Pacific people, and 60 people of Asian ethnicity.
● Thanks to lower levels of community transmission early in the pandemic and high vaccination rates, we have had a lower rate of deaths from COVID 19 since the start of the pandemic compared to most countries.
● But sadly, despite that more than 2000 people have died from COVID 19, either as an underlying or contributing cause of death.
● Amongst its other findings, the analysis highlights the fact that vaccines are the single best way to reduce the risk of dying from COVID 19.
● It also highlighted that, as well as older age groups being at a higher risk of death from COVID 19, there is excess risk for Māori and Pacific peoples, those faced with higher levels of deprivation, and those with pre existing health conditions.
● This work was carried out to better identify these risk factors, and help establish how they can be reduced.
● You can find more about the analysis below, along with a link to the full details on their website.
● The Director General has emphasised that she is fully committed, along with her colleagues in Manatū Hauora and the other health agencies, to ensuring that those most at risk from COVID 19 are prioritised in their ongoing response.
COVID 19 Death Analysis
The COVID 19 death analysis carried out by Manatū Hauora found:
● Age is the single biggest determinant in the risk of death from COVID 19.
● Vaccination is one of the most effective steps people can take to reduce their risk of death from COVID 19. A 62% reduction in the risk of death from COVID 19 was seen among people who had two or more doses compared to those who had received one dose or no doses. There is evidence that boosters further reduce the risk of death from COVID 19, and this will be the subject of future study.
● There was an increased risk of death from COVID 19 for Māori and Pacific people, who were respectively at 2.0 and 2.5 times greater risk than people in the ‘European or Other’ group. While the risk of death was much lower for all groups under 60 than for older groups, the inequity was more pronounced amongst those under 60, with the risk of death 3.7 and 2.9 times higher respectively. Of the 78 people under 60 who died from COVID 19, 35 were in the European and Other group, 24 were Māori, 13 were Pacific people, and six were Asian people.
● There is increased risk for those in socio economically deprived groups, with the most deprived 20% of New Zealanders having three times the risk when compared to the least deprived 20%.
● Having one or more pre existing health conditions was also a substantial factor in an increased mortality risk, especially for people under 60, associated with an increased risk of death 6.3 times higher than someone with no pre existing health conditions.
Te Whatu Ora:
Hepatitis A Comms for General Practice
Te Whatu Ora: Evusheld Primary Care Funding Update
● The take home from this work is that the burden of COVID 19 has fallen unevenly across Aotearoa New Zealand.
● Some of this excess risk for Māori and Pacific people can be explained by higher rates of socio economic deprivation, pre existing conditions, and lower vaccination rates. Inequities in vaccination rates alone accounted for around a quarter of the excess risk for Māori and Pacific peoples. However, even controlling for these factors, the analysis shows Māori and Pacific people are still at a significantly higher risk of death from COVID 19.
● These findings are not unexpected, which is why protecting Māori and Pacific peoples is an integral part of the ongoing COVID 19 response. The Ministry has always taken a collaborative and comprehensive approach, engaging at multiple levels to support Māori and Pacific communities.
● Te Manatū Hauora, Te Whatu Ora, and Te Aka Whai Ora will continue to engage with Māori through the National Iwi Chairs Forum, Māori health providers, community groups, and other organisations to inform the overall COVID 19 response, and promote equitable outcomes for Māori.
● Health districts and Māori and Pacific providers are providing tailored outreach services, such as provision of after hours and weekend services, and increased numbers of vaccination sites, such as pharmacies, and pop up clinics in community locations including marae and places of worship.
● The delivery of multiple vaccines at diverse vaccination sites is happening through a whānau centred approach in partnership with health districts, Māori, and Pacific health providers.
● The vaccinator workforce is being expanded to build localised and culturally competent capacity to administer vaccines to people aged 5 and up. This will support relationship building at the local level and removes barriers for whanāu accessing services.
● The Government has recently expanded access at a lower age of antiviral medicines and Pharmac has secured agreements to purchase 40,000 more antiviral medicine courses. Anyone over 65, Māori and Pacific people over 50, or anyone who meets Pharmac’s requirements, can now access these treatments in the early stages after contracting the virus.
● There is work underway by all three health agencies Manatū Hauora, Te Whatu Ora, and Te Aka Whai Ora to encourage more eligible Māori and Pacific people to get their first booster.
● The Ministry is continuing with its targeted support to communities around the country where vaccination rates are comparatively low.
● The full analysis is available on the Ministry’s website, here.
Vaccination Mandates
● As you might know, the Government’s requirement for health and disability workers to be vaccinated ended on Monday. Some employers may still require workers to be vaccinated, and individual workplace policies will reflect this. And despite the removal of the mandate, you are strongly recommended to stay up to date with your vaccinations, to keep up your immunity levels. This will reduce the risk of you needing hospital care if you get COVID 19 (which you may be more likely to contract if you work in the health and disability sector).
● Please click here for a document with a warning of potential Hepatitis A risk associated with frozen berries.
● Please forward this important message to your colleagues where appropriate.
● 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.
Te Whatu Ora:
Primary Care Guidance on COVID 19
Reinfection/rebound/ persistent infection and Long COVID-19
● 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, guidance to the health sector about the rollout of Evusheld was sent out, 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.
● It was also noted the plan to extend this to include primary care in due course as a way of increasing accessibility for all those who meet Pharmac’s Evusheld access criteria.
● Please click here for the EVUSHELD 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 on 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 Therapeutic 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 Logistics from 3 October 2022. Stock should only be ordered upon receipt of a prescription.
Evusheld is:
● 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 OR
● For people who are unable to be vaccinated against COVID 19 due to medical contraindication (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 Pharmac’s Evusheld access criteria for the full eligibility criteria.
● Please contact COVID19CareintheCommunity@health.govt.nz if you have any questions.
● The Outbreak Response Clinical team in consultation with subject matter experts have developed primary care guidance on COVID 19 Reinfection/Rebound/persistent infection and Long COVID
● It is hoped this will help clinicians at the frontline inform on the current evidence that is available on these matters, to assist in managing their patients with COVID illness. The evidence continues to evolve in this area and therefore some of the information is likely to change over time.
● This information will be available in your local Health Pathways page.
Te Whata Ora: National Immunisation Programme Operating Guidelines
● Please see the updated COVID 19 Vaccines and General Operating Guidance document here
● This has been updated on the website
Pharmac Supply Issue : Global Supply Issue affecting Dulaglutide (branded as Trulicity)
● Pharmac has been made aware of a global supply issue affecting dulaglutide (branded as Trulicity), which may mean Aotearoa experiences constrained supply until mid 2023. Our team is talking with the supplier, Eli Lilly, about the implications of this issue and how we can work together to find a solution.
● Dulaglutide (Trulicity) is a medication used in the treatment of type 2 diabetes. It also reduces the risk of heart attack or stroke in people with type 2 diabetes. We have sought clinical advice from our Diabetes Advisory Committee, which said that stock should be prioritised for those already using this medicine, along with having alternative diabetes treatments available.
Actions for healthcare professionals
● While we work to find a solution, to safeguard stock for people currently using dulaglutide, we are asking health professionals to strongly consider not starting new people on this medicine.
● We appreciate it is frustrating when there are supply issues with medicines. Empagliflozin (with or without metformin) is the primary funded alternative treatment that both lowers blood glucose and reduces the risks of heart attack and stroke in people with type 2 diabetes. We have been advised there is plenty of stock of empagliflozin (with or without metformin) to meet an increase in demand.
Head to our website for more information on other alternative funded treatments for lowering blood glucose.
We want to hear from you
● As a key stakeholder, we would like to meet with you to discuss the supply issue and what we are doing to minimise the impact on the people affected. We have planned two hui:
o Wednesday 5 October: 9:30 10:30 am Zoom meeting, Passcode: 077883
o Thursday 6 October: 1:00 2:00 pm Zoom meeting, Passcode: 518755
o For a calendar invitation, please contact Isobel Weeks, email Isobel.weeks@pharmac.govt.nz
o If you have questions about this supply issue, and are unable to attend one of the hui, please email enquiry@pharmac.govt.nz
Please share this information with your colleagues to make them aware of this supply issue.
Pharmac Consultation:
Proposal to fund Nusinersen (Spinraza) for Spinal Muscular Atrophy
Health Quality & Safety Commission: Nominations invited for New Patient Experience Survey Topics
● Pharmac is pleased to announce that it is proposing to fund nusinersen (Spinraza) for spinal muscular atrophy (SMA). Please follow this link to the consultation.
● Feedback is welcome on this proposal. Please circulate this to those who may be interested.
● To provide feedback, please submit it in writing by 4pm Monday 24 October 2022 to consult@pharmac.govt.nz
● The Health Quality & Safety Commission (the Commission) invites you to help identify and prioritise new topics for the national patient experience survey programme.
● Evidence shows that patient experience is a good indicator of the quality of health services. Survey feedback is expected to guide quality improvement activity for health services and to provide measures of performance regionally and nationally.
● The Commission regularly conducts two national surveys to collect, measure and use patient experience information:
o The adult hospital inpatient experience survey gathers information about the experience of care received in Aotearoa New Zealand's public hospitals.
o The adult primary care patient experience survey gathers information about patients' experiences in primary care and how their overall care is managed between their general practice and other parts of the health system.
Cervical Cancer Screening Changes
● The Commission has received additional budget to expand the survey programme over the next four years. This involves developing new patient experience surveys.
o Alongside this process, the Commission is also reviewing the content of the adult hospital inpatient and primary care patient experience surveys to ensure they continue to capture relevant information.
o More information on the current patient experience survey programme is available here: https://www.hqsc.govt.nz/our data/patient experience/
● To nominate new survey topics, please complete the topic nomination form
● If you wish to provide feedback on the current surveys, please complete the feedback forms:
o Adult hospital inpatient experience survey
o Adult primary care patient experience survey
● Please submit your completed forms by Friday 14 October 2022.
● Please forward this invitation to anyone in your networks who might be interested.
● Thank you in advance for your valuable time and feedback. If you have any questions, please contact Joanna.Swanson@hqsc.govt.nz or (Catherine.Gerard@hqsc.govt.nz).
● Please click here for the update from NSU around HPV test screening to prevent cervical cancer.
● Dr John McMenamin will be chairing 3 lunchtime zoom meetings, one for each of the 3 research projects informing the HPV implementation, the first one is Tuesday next week 7 October 1230 1330 (see attached).
● Please share this information with your colleagues.
Ngā mihi Janice Janice Hull EA to CEOGeneral Practice New Zealand
Mobile: 027 279 0906 www.gpnz.org.nz
