What is in this Issue?
PRIMARY CARE CLINICAL DIGEST
COVID 19 Antiviral Medicines: Public Campaign for Hauora Providers
COVID 19 Antiviral Medicines: Public Campaign for Hauora Providers
2. Brand Change for Paracetamol Oral Liquid: Paracare Double Strength
3. EPiC Educational Resources: Peer Group/Quality Evaluation Session
Advert for NZREX Primary Care Pathway for General Registration Pilot
WAI23028) Posted
Update on Cilazapril and Listing of Ramipril
6. Manatū Hauora: Invitation to contribute to Health Workforce discussions
7. Register for the First Trimester Abortion Training Webinar
ACC Primary Care Concussion Pilot Expansion
Health Quality & Safety Commission Report into COVID 19 Impacts Released
10. Peer Group/Quality Evaluation Session
11. Osteoarthritis Aotearoa New Zealand (OAAoNZ) 2022 Summit
National Immunisation Programme Operating Guidelines
The 23rd International Conference on Integrated Care (ICIC23) Call for Papers
14. Pharmac Consultation: Proposal to widen access to Meningococcal B Vaccine and secure supply of the Shingles Vaccine
15. Pharmac Notification: Decision to list the ACE Inhibitor Ramipril
16. Pharmac Update: Primary Care Prescribers for the week ending 21 October 2022
• Te Whatu Ora is working with Department of Prime Minister and Cabinet (DPMC) and Te Puni Kōkiri (TPK) to promote this important message on raising awareness of COVID 19 antiviral medicines, with a focus on Māori and other priority populations at risk of getting severely ill from COVID 19. COVID 19 antiviral medicines are free for people eligible under Pharmac’s access criteria, which was expanded in September and now includes:
o Māori or Pacific people aged 50 years or older
o everyone aged 65 years and older
o anyone aged 50 years or older with fewer than two COVID 19 vaccinations
o anyone with a severely weakened immune system
o anyone with Down syndrome
o anyone with sickle cell disease
o anyone previously in critical or high dependency hospital care from COVID 19
o anyone with three or more high risk medical conditions.
• To be eligible, a patient must have COVID 19 and be experiencing symptoms, or be a household contact of someone with COVID 19 and be experiencing symptoms. You can find information on the criteria
Brand Change for Paracetamol Oral Liquid: Paracare Double Strength
and the list of high risk medical conditions on the COVID 19 Health Hub
• Antiviral medicines can be prescribed by GPs and nurse practitioners. They are also available from many pharmacies without a prescription, after the pharmacy confirms the person is eligible and the medicines are safe for them to take.
• The Te Puni Kōkiri campaign will ask people to speak with their hauora and Māori health provider if they have questions about their eligibility, think they need antivirals, or want to know where they can get free rapid antigen test (RAT) kits.
• Not all hauora providers will be able to provide eligibility assessments for patients or prescribe COVID 19 antiviral medicines. Hauora providers who are not able to provide eligibility assessments for patients or prescribe COVID 19 antiviral medicines can direct people to contact their nearest GP or pharmacy, which can do assessments over the phone and provide COVID 19 antiviral medicines if people are eligible. Home delivery can be arranged.
• A list of pharmacies that offer antiviral medicines can be found on the Healthpoint website or Karawhiua website
• The Healthpoint website also includes a list of RAT collection sites if you don’t provide these and need to find the nearest one for a patient. RATs can also be ordered for free from RequestRATS.covid19.health.nz or by calling 0800 222478 and choosing option 3.
• If you have any questions, please feel free to get in touch with the COVID 19 Care in the Community team: COVIDCareintheCommunity@health.govt.nz
• The funded brand of paracetamol oral liquid 250 mg per 5 ml is changing from Paracare Double Strength to Pamol. Paracare Double Strength is supplied by API, who have notified Pharmac that they have exited the New Zealand market. An alternative brand through our Tender process.
• Pamol, supplied by Aspen Pharma, is approved by Medsafe for use in New Zealand, and will be funded from 1 November 2022.
• People using Paracare Double Strength will need to change to the Pamol brand to continue to access this medicine.
• Key information for Pamol 250 mg per 5 ml:
o A smaller pack size (1000 ml to 200 ml glass bottles) with a child resistant cap
o A change in colour from orange to colour free
o Remains orange flavour
o Alcohol and sugar free
• Dispensing data suggests that 200 ml is the most common amount dispensed, so changing to a 200 ml pack size means most dispensing can be in the original packaging. This allows for Pamol to be dispensed with clear strength information resulting in less confusion when it is taken, and reducing the chance of dispensing errors in the pharmacy.
• Similarities with other liquid analgesics:
o The currently funded lower strength paracetamol oral liquid (Avallon 120 mg per 5 ml), and ibuprofen liquid are colour free.
EPiC Educational Resources:
Peer Group/Quality Evaluation Session
Advert for NZREX Primary Care Pathway for General Registration Pilot (ID: WAI23028)
Posted
Update on Cilazapril and Listing of Ramipril
When prescribing and dispensing, this similarity may need to be specifically highlighted to patients, whānau or caregivers.
• Schedule restrictions:
o The dispensing restrictions in place since 1 June 2022 to help manage the current stock levels will continue to apply to Pamol over the transition period, and will be reviewed at a later date. further details about this.
o Further details will be updated on the website.
• Further information:
o He Ako Hiringa have developed a resource with additional information for healthcare professionals which can be found on the the He Ako Hiringa website
o As previously communicated, there are currently two funded brands of paracetamol oral liquid 120 mg per 5 ml. To ensure continued availability of a low strength paracetamol oral liquid over the transition period, Avallon 120 mg per 5 ml, supplied by Noumed, was funded and has been available since 1 September 2022.
o There will be a further brand change to the long term brand, Paracetamol (Ethics) 120 mg per 5 ml from 1 January 2023. Further information about this brand change will be provided in advance of January 2023.
o The website will be kept up to date as these changes are made.
• He Ako Hiringa are offering a free one hour, certificated, training for health professionals on EPiC.
• You can book your training here, or email Varun Vartak on varun@akohiringa.co.nz or 027 305 1159.
• Applications are invited for the NZREX Primary Care Pathway for General Registration pilot being run by Te Whatu Ora Waikato, in conjunction with Lakes and Taranaki.
• Closing date is 11 November and candidates can access details and eligibility criteria here
• All candidates will spend 6/12 in hospital, then have 3 6/12 attachments in CBAs, with one rural, one urban and either one Māori provider or a practice with high Māori enrolment.
• Over the past year the health sector has been informed about changes to availability of ACE inhibitors. In July 2022 the sector was advised of the plan to delist cilazapril mid 2023. The intended timing for delisting cilazapril will depend on how quickly people transition to alternative treatment options and how this impacts stock levels.
• See the website to keep up to date with the availability of cilazapril.
• Pharmac have announced that ramipril,, another angiotensin converting enzyme (ACE) inhibitor used to treat hypertension, heart failure, diabetic renal disease and post myocardial infarction, will be funded from 1 December 2022. Ramipril will be funded with no restrictions. Perindopril 8 mg tablets have also been added to the Pharmaceutical Schedule with no restrictions from 1 October 2022, providing an opportunity for effective treatment with one tablet once a day.
• Prescribers are encouraged to start transitioning patients currently on cilazapril to alternative treatments as soon as practical.
• This is happening as currently cilazapril is used in New Zealand more than any other country, and there is only one place in the world that makes the active ingredient for cilazapril. This means if there were a supply issue that affected cilazapril, it would be difficult to be able to find an alternative for everyone who takes it. To reduce the impact there has been active support to move people away from using cilazapril. From 1 May 2021, an endorsement was placed in the Schedule meaning no new patients could start on the medicine. Since then, nearly 50% of people on cilazapril at that time have transitioned to alternate medicines.
• Prescribers should start transitioning patients currently on cilazapril to alternative treatments as soon as practical.
• Prescribers can learn more about the clinical advice Pharmac has received on appropriate treatment alternatives in the resources below:
o Switching blood pressure medications it’s time to break the cilazapril habit He Ako Hiringa
o Read BPAC’s advice on prescribing ACE inhibitors
o Read about treating hypertension and heart failure in the NZ Formulary
o Read advice from Dr Richard Medlicott, former Medical Director of the Royal New Zealand College of General Practitioners
• Further information about this discontinuation, anticipated timeframes, and resources for prescribers and patients is available on our website Cilazapril: No new patients from 1 May 2021 Pharmac | New Zealand Government Manatū Hauora:
Invitation to contribute to Health Workforce discussions
• Manatū Hauora has set up a series of webinars where you can hear directly from senior leaders on health workforce initiatives.
o WEBINAR 1 November 4:30pm Te Whatu Ora will lead a discussion on the short to medium term workforce initiatives. Register here
o WEBINAR 7 November 3:30pm, hear about issues and opportunities for the Māori Health workforce. An invitation to this online hui will be issued through Manatū Hauora’s partners at Te Aka Whai Ora.
o WEBINAR 10 November 11:00am, hear from Manatū Hauora on the legislative and regulatory environment, and the strategic framework development. Register here
• You can also register to join and contribute your ideas to the health workforce challenge conversation online at Tātou
• If you have any questions about the webinar series, want to contribute a question for a webinar or need more information about Tātou, please email strategies@health.govt.nz.
Register for the First Trimester Abortion Training Webinar
• TRAINING WEBINAR 16 November 7 8pm on first trimester abortion.
• Manatū Hauora (the Ministry), Te Whatu Ora and NZ College of Sexual and Reproductive Health (NZCSRH) are hosting a webinar of the new first trimester abortion training that has been developed by
ACC Primary Care Concussion Pilot Expansion
NZCSRH. The training is aimed at a wide range health practitioners (medical, nursing, midwifery, and pharmacist prescribers) planning to provide first trimester abortion services in a range of settings, including primary care and community based services. The training is also suitable for those currently providing abortion services who may be looking to refresh their knowledge, build their cultural safety or further develop their skill set in areas such as of point of care ultrasound or early surgical abortion care. Those completing the training will gain a certificate confirming they have completed nationally recognised abortion training developed specifically for the context of Aotearoa New Zealand.
• The training will be available by early November on the BPAC website (check the NZCSRH website abortion training for the link) and includes modules on:
o Consultation communication and decision making*
o Early Medical Abortion (EMA)
o Early Surgical Abortion (ESA)**
o Point of Care Ultrasound (POCUS) for dating early pregnancy**
o *Please note the consultation module provides a firm grounding in providing culturally safe care and is required to be completed in order to obtain your certificate in EMA, ESA or POCUS theory.
o ** Please also note that ESA and POCUS competency to practice requires a practical assessment. Details of practical requirements are covered within the training.
• To register for the Abortion Training webinar, please click here
• Earlier this year, ACC launched a concussion pilot designed for use by clinicians working in general practice. Initially, the pilot was available with ProCare and Pegasus. ACC are now opening the pilot to other practices in the upper North Island and South Island who utilise MedTech practice software.
• Click here for information on background and details for the opportunity to participate in this pilot.
Health Quality & Safety Commission Report into COVID 19 Impacts Released
Peer Group/Quality Evaluation Session
• The Health Quality & Safety Commission (the Commission) has released part 2 of its investigation into the effects of the COVID 19 pandemic on health care services in Aotearoa New Zealand.
• Read the full report here
• He Ako Hiringa offer a free one hour, certificated, training for health professionals on EPiC.
• If your team would take a look at how medicines are used by your enrolled patients, book your training here, or email Varun Vartak on varun@akohiringa.co.nz or 027 305 1159.
• If non prescribers (PNs, coaches, HIPs, close friend pharmacist or practice manager) would like access to your team data, then the Requester can apply here, this will send an email to a Approver within the practice telling us we can supply this to the named person. We will undertake a manual verification that the person named as Approver is correct.
• To start this process click here: https://form.jotform.com/221359317975869
Osteoarthritis Aotearoa
New Zealand (OAAoNZ) 2022 Summit
• Following the success of the inaugural Osteoarthritis Aotearoa New Zealand Base Camp in 2021, the Osteoarthritis Aotearoa New Zealand (OAAoNZ) 2022 Summit builds on the foundations laid by this towards:
o Continuing to co create a national Model of Care for Osteoarthritis care for Aotearoa New Zealand.
o Developing a list of national priorities in osteoarthritis research.
• Speakers include Dr Andrew Connolly (Counties Manukau Chief Medical Officer and Chair of Planned Care Taskforce), Rebecca George (HIRA Director Data and Digital, Ministry of Health), Timi Tapara (Founder and Clinical Director, Tū Tonu Health Centre, Hamilton), Dr Martin Chadwick (Ministry of Health), Catherine Willis (Te Whatu Ora BoP), Dr Ben Hudson (Otago University and practicing GP) and Philip Kearney (Arthritis NZ Mateponapona Aotearoa).
• For more information see here
National Immunisation Programme Operating Guidelines
The 23rd International Conference on Integrated Care (ICIC23) Call for Papers
Pharmac Consultation:
Proposal to widen access to Meningococcal B Vaccine and scure supply of the Shingles Vaccine
Pharmac Notification:
Decision to list the ACE Inhibitor Ramipril
Pharmac Update: Primary Care Prescribers for the week ending 21 October 2022
• Please click here for information on the updated Operating Guidelines which has also been updated on the website
• Deadline for submitting a paper for ICIC23 taking place in Antwerp is 31 October 2022. Further information is available on the website
• Pharmac are requesting feedback on a consultation regarding a proposal to widen access to widen access meningococcal B vaccine (Bexsero) and secure supply of shingles vaccine (Shingrix).
• To provide feedback, please submit it in writing by 5pm on Tuesday 8 November 2022 to vaccines@pharmac.govt.nz
• Please follow this link to the Pharmac notification regarding a decision to list the ACE inhibitor ramipril for the treatment of hypertension.
• Morphine ampoule: Brand change – See full notice in Practice News.
o The funded brand of morphine sulphate ampoules is changing from DBL Morphine Sulphate to Medsurge. Expect stocks of DBL Morphine Sulphate to begin running out some time in December 2022. The Medsurge brand has been listed in the Schedule from 1 October, and both brands will be funded until March 2023.
o Packaging of the Medsurge brand will look different. Both brands of morphine ampoule use colour coding to differentiate between strengths, and the colour coding is not the same between brands. The Medsurge individual ampoules will also be colour coded, matching the corresponding packaging.
o The Medsurge 15 mg per mL and 30 mg per mL ampoules have similar shades of brown colour coding on the packaging and individual ampoules. Attention is required to ensure the correct strength is chosen for administration.
o He Ako Hiringa have developed an educational resource to support healthcare professionals with this brand change: Morphine ampoules | He Ako Hiringa
• COVID 19: Information for prescribers
o Managing supply of other medications
▪ Please prescribe normally and encourage patients not to stockpile medicines.
▪ Pharmac, pharmacies and suppliers are working closely to maintain medicines supply, and to minimise disruption and fairly distribute any medicines in short supply.
• Lisinopril 5,10 and 20mg tablets: New look
o Earlier advice was that Teva is changing their brand from Ethics Lisinopril to Teva Lisinopril. All strengths of Teva Lisinopril are now in the supply chain. The Ethics brand will likely run out by mid to late November.
• Sodium Citro tartrate (Ural) Grans: Supply issue
o The supplier has advised a temporary delay affecting re supply of Ural sachets. The next shipment of Ural is expected by the end of October 2022.
• Levomepromazine (Nozinan) Injections: Supply issue
o Due to delays with the manufacturer of levomepromazine hydrochloride, there is an out of stock of levomepromazine hydrochloride (Nozinan) Inj 25 mg per ml, 1 ml ampoule.
o The French Formulation Nozinan s29 will be supplied until the new supplier enters the market on 1 November 2022.
• Nutricia Food Products: Supply issue affecting multiple products
o Most of the supply issues affecting Nutricia special foods products have been resolved but there will continue to be supply issues for some products throughout 2022.
• Keep up to date on supply issues and brand changes
o Pharmac regularly updates its website, information about changes in brand and any current or emerging supply issues can be found on the Pharmac website