What is in this Issue?
PRIMARY CARE CLINICAL DIGEST October 14th, 2022
1. COVID 19 Care in the Community update for primary care
2. First Responder Shock Trial (FiRST)
3. Pharmac Update: Primary Care Prescribers for the week ending 07 October 2022
4. Pharmac consultation: proposal to fund ustekinumab for inflammatory bowel disease and infliximab for IBD associated arthritis
5. ACC Cultural Competency guidance webinars
6. REMINDER: The eHealth Nursing & Midwifery workshop
7. Health initiative for the 2022 Special Ukraine Visa holders
8. Editorial Article Attached New dawn or false dawn? what are the challenges in implementing Localities?
9. Latest news and updates from Te Whatu Ora and Te Aka Whai Ora
COVID-19 Care in the Community update for primary care
• Monkeypox (MPX)
o Community transmission of Monkeypox (MPX) in Aotearoa New Zealand was announced by Te Whatu Ora Health New Zealand last Friday, 7 October 2022, after two new cases were confirmed. An interim funding framework was also shared with primary care last Friday to support the sector’s response to MPX. For any queries, please contact COVIDcareinthecommunity@health.govt.nz.
• COVID-19 response
o A weekly COVID 19 Trends and Insights report is now published on the Manatū Hauora Ministry of Health website, which summarises and comments on trends in New Zealand’s COVID 19 outbreak.
o A planned outage on the RAT ordering site Request a RAT | Ministry of Health NZ (covid19.health.nz) will occur tomorrow, 11th October, between 8am and 9am for about 30 minutes to implement some technology changes.
• COVID 19 Care in the Community
• New information for health professionals about the COVID 19 Pre exposure Prophylaxis (PrEP) medicine Evusheld has been published, including a stakeholder letter and administration flow chart, which were sent to the primary care sector recently.
Extra information and clarity on advance therapeutics funding
• Advanced prescriptions are meant to be given to those who are eligible before getting an infection with covid, so that when they do get it and are isolating, they can arrange for it to be delivered in short time. They will still need to meet the criteria of being symptomatic and be within 5 days of onset of symptoms.
• As the prescriptions are valid for 3 month period in these instances and things can change with patient circumstances. In which case, there will have to be a usual proactive consultation with the patient assessing eligibility and ensuring that the medication is still safe for the patient.
• It would not be appropriate to claim for advanced prescription while the patient has the infection. There are other funding lines that should be utilised. If the patient is eligible, they should be getting a proactive initial assessment in this instance.
• Advanced prescription is meant to improve access for antivirals for most vulnerable, who may not have opportunity to connect with their healthcare provider when they do get an infection.
• It is meant to be done before an eligible person who gets the infection, but for the patient to get the medicines dispensed, they will still need to meet the criteria at the time (symptomatic and within 5 days) which the dispensing pharmacist will check and if
necessary, will contact the prescriber to ensure safety and any dose adjustments and address any other concerns at the time.
• This consultation is also funded in primary care when a GP receives call from pharmacist. First Responder Shock Trial (FiRST)
• In September 2022 we launched the First Responder Shock Trial (FIRST). This trial aims to determine whether equipping GoodSAM responders with an ultraportable defibrillator can increase the proportion of survivors to 30 days following cardiac arrest, compared with the current strategy of retrieving the closest AED in the community. Those who are active GoodSAM responders may have already received an invitation via email to join the trial.
• You can find out more information on the FIRST trial and watch an introductory video at: https://www.ambulance.vic.gov.au/first/.
• You can sign up for our FIRST updates mailing list at: https://forms.office.com/r/um62ir0Csq
• To find out more about GoodSAM or to join visit: https://www.stjohn.org.nz/first aid/goodsam/. To update your GoodSAM profile information, visit: www.goodsamapp.org
Pharmac Update: Primary Care Prescribers for the week ending 07 October 2022
• Supply issue: Dulaglutide (Trulicity)
o Pharmac has been informed by the supplier of dulaglutide (Trulicity), Eli Lilly that there are supply issues with the diabetes medicine due to unanticipated increases in global demand and an out of stock of another supplier’s GLP 1 receptor agonist. This may mean Aotearoa experiences constrained supply until mid 2023
o Eli Lilly has committed to maintaining supplies of Trulicity at levels that will support existing patients already on treatment in Aotearoa. They tell Pharmac that, while the supply situation remains dynamic, existing patients in Aotearoa should be able to fill their dulaglutide prescriptions without interruption
o To safeguard stock for people currently using dulaglutide, we are asking health professionals to strongly consider not starting new people on this medicine. Pharmac is actively exploring all options to minimise the impact on patients from this supply issue and we will continue to update patients and healthcare providers as further information comes to hand.
• Cancellation of existing Humira (adalimumab) Special Authority numbers from 1 October 2022
o From 1 October 2022, Amgevita will be the main funded brand of adalimumab for all uses (current and new). From this date, all existing Humira Special Authority numbers will expire, and new Humira Special Authority criteria will come into place. If you have submitted a Waiver request for a patient to remain on Humira and it has been approved prior to 1 October, this will not be cancelled.
o Repeat dispensing for Humira with an expired Special Authority will still be funded if the initial dispensing on that prescription occurred before 1 October
o Identify patients using adalimumab and discuss the continuation of their treatment with Amgevita either when their Humira Special Authority is due for renewal, or before 1 October 2022 (whichever comes first)
o For patients who require ongoing funded access to Humira after 1 October, a new initial Special Authority must be completed
o For patients who have not yet trialled Amgevita, but their automatically issued initial Special Authority for Amgevita has expired, a Waiver for an initial application can be completed
o Ensure you prescribe adalimumab by brand (either Amgevita or Humira)
• Evusheld: Available to be administered in general practice
o From 3 October 2022 Evusheld (tixagevimab with cilgavimab) is available for community supply and primary care administration to those who meet Pharmac’s access criteria. Evusheld is used for COVID 19 pre exposure prophylaxis. Guidance on Evusheld and its use is available on the He Ako Hiringa website and Ministry of Health website.
• Supply issue update: Docusate sodium with sennosides (Laxsol) tablets and other laxatives
o The Laxsol supply issue was caused by a lack some of the raw materials used to make the product. This issue also affects Coloxyl.
o Shipments are being released as they arrive. We expect some stock to be released to wholesalers on 25 September 2022. We're working closely with the supplier to understand when Laxsol supplies will return to normal. Both the supplier and Pharmac are aware of the critical nature of this product.
o Konsyl D and the alternative we listed, Macro Organic Psyllium Husk, are out of stock. Resupply of Macro Organic Psyllium Husk is expected mid September, and Konsyl D in October. Senna (Senokot) is out of stock. Stocks of Micolette are low, new section 29 stock is arriving soon. It will take time for stock to make its way through the supply chain to individual pharmacies once it arrives in the country.
• Paracetamol oral liquid: Brand change
o From 1 September 2022, we have listed a temporary new brand of paracetamol liquid.
o Supplies of Paracare (120 mg per 5 ml) are likely to run out during September. Supplies of Paracare Double Strength (250 mg per 5 ml) are likely to begin running out during October. To cover the gap before the new contracted brands can enter the market, we’ve listed the Avallon brand.
o A temporary supply of a paracetamol oral liquid 120 mg per 5 ml has been organised, and a 240 mg per 5 ml strength has been listed in case it is needed in a couple of months as a contingency option. Due to increased global demand, we were not able to source a 250 mg per 5 ml product, despite our strong preference for this.
o Key differences with the Avallon brand
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Flavour is strawberry vanilla for both strengths (previously strawberry and orange)
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Colour is off white for both strengths (previously pink and orange)
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A smaller pack size, 200 ml glass bottles with a child resistant cap
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If the Avallon 240 mg per 5 ml paracetamol oral liquid is required, this would mean a temporary strength change to a 240 mg per 5 ml presentation. We are working on ways to support the health care sector if this is needed.
o The 120 mg product has Medsafe approval. Restrictions will continue for these temporary brands to ensure everyone who needs paracetamol liquid can access this medicine. We apologise for any inconvenience this may cause. We will communicate further with the sector if the 240 mg product is required.
• Citalopram 20 mg: Brand change
o From October 2022, a new brand of citalopram, Celapram, will be funded. The current supplier, API, is leaving the New Zealand market and their PSM brand of citalopram is no longer being manufactured.
o PSM citalopram is expected to begin running out in December 2022. People using PSM citalopram will need to change to Celapram sometime before December 2022 to continue to access funded treatment. From 1 March 2023, Celapram will be the only funded brand of citalopram.
o The new tablets will look different, but the tablets have the same active ingredient and work in the body the same way as the currently funded citalopram, PSM citalopram.
o We know that moving people from one brand to another can be difficult. To support this, we are covering the cost with a brand switch fee. This will be in place from 1 March 2023 to 1 June 2023.
• COVID 19: Information for prescribers
o Pharmac website COVID 19 oral antivirals: Access Criteria
o Aotearoa's COVID 19 treatment portfolio
o Anti viral Access Criteria Assessment Tool
• Sodium citro tartrate (Ural) Grans: Supply issue
o The supplier has advised us of a temporary delay affecting re supply of Ural sachets. The next shipment of Ural is expected by the end of October 2022.
• Cefuroxime axetil (Zinnat): Discontinuation
o Due to a significant decline in usage of this product in Aotearoa, GSK (the supplier) has advised that it will discontinue cefuroxime (Zinnat) tablets. Existing stock of Zinnat tab is expected to be exhausted 31 August 2023. Zinnat tab will be delisted from the Pharmaceutical Schedule 1 March 2024.
• Pregabalin 25 mg capsules: supply issue
o There is a supply issue affecting the pregabalin 25 mg capsules. The supplier has advised that due to delays at the manufacturing site, exacerbated by some freight challenges in New Zealand, they may have a brief out of stock of pregabalin 25 mg capsules.
o Stock was released to wholesalers last week. We continue to monitor the availability of this product.
• Nutricia foods products: Supply issue affecting multiple products
• Please follow this link to the Pharmac consultation to fund ustekinumab for people with inflammatory bowel disease and infliximab for people inflammatory bowel disease associated arthritis.
• Consultation is open until 4pm 26 October 2022. Please circulate this email to others who may be interested
o Most of the supply issues affecting Nutricia special foods products have been resolved. There will however continue to be supply issues for some products throughout 2022. Pharmac consultation: proposal to fund ustekinumab for inflammatory bowel disease and infliximab for IBD associated arthritis
ACC Cultural Competency guidance webinars
• On 27 October, ACC launching our updated ACC Cultural Competency guidance Te Whānau Māori me ō mahi (which replaces our existing competency document, Te Tūroro Māori me ō mahi).
• Mauri Ora Principals and health sector experts Dr Peter Jansen and Dr Riripeti Haretuku will join us to present two (one hour) webinars. They'll outline changes within the guidance that align with current cultural safety approaches across Aotearoa and bring a te ao Māori lens to its application to our health and rehabilitation services. We’ll also share insights into our Cultural Safety policy which is currently in development.
• Two webinar slots are available on October 27 12 1pm and 7 8pm link below
• Register here to reserve your place in our lunchtime or evening webinar (spaces are limited).
REMINDER: The eHealth Nursing & Midwifery workshop
REMINDER: The eHealth Nursing & Midwifery workshop is on Tuesday 6 December 2022 in Rotorua. Spaces are limited so if you wish to attend, please register now
Here are a few tips:
• To read more about the workshops, please go to the workshops page. From here you can navigate to the agenda, list of speakers and registration prices.
• To read more about the conference, please go to the conference home page
• If you have already registered for the December 2022 conference and you wish to ADD a workshop to an existing registration, please email Gloria on registrations@hinz.org.nz
• If you previously registered for the workshop last year (when we had to postpone them due to the lockdowns), please note that your registration record was unable to be automatically transferred inside their registration software after the previous event date was cancelled. This means, if you wish to attend on 6 December, you need to fill in a new registration form. If you have any questions about a registration transfer, please email Gloria on registrations@hinz.org.nz
NEW Scholarship Offer!
Health initiative for the 2022 Special Ukraine Visa holders
• This Thursday, in the HiNZ eNewsletter, HiNZ will announce a scholarship offer for the workshop.
• To apply in advance of the public announcement, please fill in the application form on the HiNZ scholarship page
• In response to the conflict between Russia and Ukraine, the New Zealand Government announced the 2022 Ukraine Special Policy Visa, which allows Ukrainian born citizens and residents in New Zealand to sponsor family who ordinarily reside in the Ukraine. All Visa holders are granted either a temporary two year working visa or two year student visa and have full access to publicly funded health and disability services.
• Te Whatu Ora is seeking your participation in rolling out the health assessment for 2022 Special Ukraine Visa Holders (Ukrainian Visa holders), to be delivered from 17 October 2022 to 30 June 2024.
• This initiative will offer a one off, fully funded health assessment to the Ukrainian Visa holders who are in New Zealand to assess and mitigate any public health risks, and support enrolment into general practice for any ongoing health care. The health assessment will be made accessible via general practices and Whakarongorau Aotearoa (Healthline).
• With this initiative, the Ukrainian Visa holders will: o have an initial assessment for tuberculosis (TB) and be offered testing to screen for TB, and a follow up consultation if required o be supported to enrol with a general practice if they don’t already have one o be provided information on vaccinations they may be eligible for, as per New Zealand’s National Immunisation Schedule requirements
• Te Whatu Ora has sought input from primary care clinical leaders including PHO Clinical Leads, RNZCGP and GPNZ. Te Whatu Ora has been working with the Public Health Agency in the Ministry of Health, Immigration New Zealand, MBIE and the Ukraine community to design the service offering.
• The pricing schedule has been determined based on payments for other similar health activities delivered by the primary care sector. Considering the expected (small) size and scope of this health response, Te Whatu Ora has taken a lean approach by keeping the reporting and claiming requirements minimal.
• Please click here for information on the health response (Health pathway resource). CEs have received the letter of agreement.
• Information for Ukrainian Visa holders and their sponsors about the free health assessment will be made available on the Te Whatu Ora website, alongside common Questions and Answers. Information (including translated information) will also be made available to Immigration NZ and Ukraine community groups to ensure communications about the free health assessment are well received by the Ukraine Visa holders and their sponsors.
• Clinical guidance on the health response is also available on HealthPathways for frontline professionals.
Consultation on ACC regulated payments for treatment
• The Ministry of Business, Innovation and Employment (MBIE) is consulting on updates to the regulated payment rates for ACC treatment.
• ACC is required to undertake a regular review of the regulated amounts it is liable to pay towards the cost of injury treatment, given cost pressures in the health sector, and make a recommendation to the Minister for ACC.
• The Minister has received ACC’s advice on proposed increases to treatment rates of between 4.6% to 9.36%, apart from a nil increase for audiologists, and also the introduction of a nurse practitioner and registered nurse combined treatment rate. MBIE is now consulting on these proposals on behalf of the Minister.
• MBIE is accepting submissions on the proposals from 21 September until 5pm Tuesday, 18 October 2022.
• https://www.mbie.govt.nz/have your say/consultation on acc regulated payments for treatment 2022/ New dawn or false dawn? what are the challenges in implementing Localities?
Latest news and updates from Te Whatu Ora and Te Aka Whai Ora
• Click here for an editorial on the challenges of implementing localities. A great morning tea read!
• Full email newsletter attached, key points below
o Fionnagh Dougan joins us into the permanent role of National Director, Hospital & Specialist Services
o Jeremy Holman, joining Te Whatu Ora on Monday 5 December as Chief Infrastructure and Investment Officer
o Juanita Te Kani DCE Strategy, Policy and Monitoring, Te Aka Whai Ora
o TWO are working hard to encourage internationally qualified nurses to join our team. New resources and information to promote the recruitment campaign will be published by the Nursing Council, along with additional immigration support and guidance, to allow the message to be spread as wide as possible
▪ Other workstreams include the return to nursing programme, increased funding for NPs and encouraging GP trainees with better support and salaries
o Te Whatu Ora Waitematā, which covers about 630,000 Aucklanders in the north and west, is providing a service which allows people to book appointments and receive confirmation emails in te reo Māori. People can now swap English to te reo Māori as the default language at the click of a button. The online booking service was launched to mark Te Wiki o Te Reo Māori (Māori Language Week). There are plans for the initiative to be rolled out across the metro Auckland region.
o Read more about national Kaupapa hui
o Read more about successful cervical screening initiatives in the regions.