WellInfromed May 2019 by WellSouth

WellInformed May 2019

From the Chief Executive As I continue to travel the region, I am impressed with the desire of motivated people in primary care to deliver high quality care and be involved in new and improved models of service delivery. There is no better example than the rollout and implementation of the Health Care Home program in the Southern region which is showing very promising outcomes for practices and patients. Of note: • Three practices (16,475 patients) have opened doctors’ notes to patients. • 1,485 additional patients have been registered on portals in first tranche practices . • 35% of same day appointment requests have been resolved by phone, saving the patient from coming to the practice and giving the practice increased capacity. • Over 4,500 patients have had CLIC comprehensive health assessments. • A practice in Gore has successfully begun multi-disciplinary team meetings on Palliative and Level 3 CLIC patients. One of the key roles of an organisation such as WellSouth is to advocate for primary care and ensure that general practice has access to funding to support their enrolled patients. Primary Options for Acute Care (POAC) is one such example where funding has been found for the extended care that practices are able to undertake to keep their patients out of hospital. We will be working with practices to better understand what other services can be added to the list of POAC pathways. Again thank you to those that have invited me to their place of work. I have really enjoyed the visits and have learnt a lot. Keep the invites coming so I get to better understand how the system here works!

Andrew Swanson-Dobbs, CEO Andrew.Swanson-Dobbs@wellsouth.org.nz

WellSouth Primary Health Network Hauora Matua Ki Te Tonga

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Contents

From the Chief Executive 1 Clinical Updates 3 Alliance South Chair Update 4 IT Helpdesk 5 Advance Care Planning Day: Southerners encouraged to think about what matters to them 6 Certificate of Advanced Dermatoscopy 8 Health Promotion 9 Whakaaro of the week 9 World Smokefree Day 31 May 9 Health Conversation Skills -Southland 11 Workforce Development 12 Upcoming Education and Training Opportunities 12 Winton Wonder Strikes Again 13 Introducing Laura Lagan – Paediatric Educator - Southland 13 South Island Māori and Pasifika women’s experiences of breastfeeding 14 Notices 16 Police Vetting 16 WellSouth Reception Email Changes 16 News Tips 16 Smoking Was Like Breathing 17 Bowel screening resources for Asian residents 18 Chinese community session well-received 18 Updates on Southern HealthPathways 19 New Clinical Editor appointed 19 4 pathways went live in March 19 Pathway Reviews 19 The 10 most frequently viewed pathways for the month of March 19 The 10 most frequently visited pathways not yet localised for the month of March 19 What to look out for 19 Green Prescriptions 20 Update to Primary Care from the NCSP May 2019 21 Teddy Bear Hospital 23

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Clinical Updates Clinical Update by Dr Stephen Graham Dear Primary Care Workforce, In rural areas primary care also includes emergency and afterhours medical cover. So, over the holiday period, Easter and Anzac Day, rural areas are still involved with medical care. In rural areas GPs and nurses often work with the extended services in the community. Often ambulance, medical and other services are effectively part of the same team. Really, I’m just putting this background here because I want to talk about the recent helicopter crash on Auckland Island on 22 April 2019. The survival of the 3 crew of the Te Anau helicopter team on the Auckland Islands, pilot Andrew Hefford, winchman Lester Stevens and medic John Lambeth appears to have been a miraculous event. As I’m sure most are aware this medivac helicopter crash-landed in water at night in a truly isolated and hostile wilderness. It has no doubt been a difficult, uncomfortable, frightening event for the crew. It has also been an emotional rollercoaster for all the families, helicopter Search and Rescue, ambulance and medical teams in Te Anau (and a lot of the wider population I’m sure). All of this crew are well known and popular and routinely part of ambulance and wider medical team in Te Anau. Many of the people in these teams know it could just as easily have been them in the helicopter.

I’ve been thinking about this a lot. Of course, it isn’t just blind luck. I see the lessons of risk mitigation here. Prepare for what you can prepare for. In this case preparation involves appropriate training and equipment (like immersion suits), and repeated practice for adverse scenarios. This has included practicing escaping from a helicopter in water with a blind fold on. Don’t assume the worst and take all actions to remedy the situation. In this case the Search and Rescue has been done as professionally and promptly as it can be done (I would have expected no less). This all reduces the risk of an adverse outcome. I guess this is good health and safety in action. There will be no families and community deprived of valued and loved members. That is the main thing. I do suspect that there is a significant effect upon the crew, teams, families and others despite all that, but survivor’s guilt happily is not one of the issues! The emotional roller coaster associated with something like this will affect different people in different ways. The “what might have been” ideas are difficult to avoid. For anyone who knew about this before the crew were found they will have been through all the horrible scenarios mentally already. An experience like this tends to make some rethink their priorities also.

I know that debriefing and active support of all affected people will have been started and will be ongoing. I personally think right now that counting one’s blessings Overnight and in the morning the scenario looked and celebrating a good outcome are the correct very bleak, a helicopter lost at night over the Southern responses to this incident. This has been a potentially Ocean lost to all contact with wreckage found in the terrible event with a fantastic outcome. How often do water. The truth is few would expect the crew of a you get to celebrate in these circumstances? helicopter ditching in the Southern Ocean to be picked up alive the next day as ultimately happened after the crew extracted themselves from the helicopter in darkness, swam to nearby shore (and Auckland Thanks Island is extremely exposed and steep in most places) and sheltered themselves in what sounds like storm Dr Stephen Graham conditions overnight until help in the form of Search Medical Director WellSouth PHO and Rescue arrived. It really does appear to be a highly unlikely statistical event, which is why the term stephen.graham@wellsouth.org.nz miraculous is being attached to this.

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Alliance South Chair Update April 2019 At our Alliance Leadership Team meeting this month we considered the progress that has been made in the first year of implementing the Primary and Community Care Strategy across the Southern Health System. The spirit of working collaboratively across WellSouth Primary Health Network and general practices in the district, Southern District Health Board hospital and community based providers is evident. A key area of focus has been on implementing the Health Care Home initiative in the first group of practices, including practices in Gore, Dunedin, Invercargill and in the Central Lakes area. In the first year, practices are focused on establishing and improving processes, and in years two and three they use these improved processes to concentrate on patient outcomes. Some great new processes are in place: 16,718 patients have online access to their consult notes, and over 700 people (and increasing quickly) have benefited from GP and nurse practitioner telephone triage. The feedback from participating practices has been positive, and the sharing of ideas and solutions between practices has been a hallmark of this initiative. The CLIC programme (Client-Led Integrated Care program) is well underway, with 48 general practices using it to support people living with multiple long term conditions to live well. Primary Options in Acute Care has been expanded. The Home Team of nurses, physiotherapists, occupational therapists and rehabilitation assistants working out of Dunedin Hospital has enabled patients to return home earlier and be supported in rehabilitation at home, or not be admitted at all. This service has also recently started in Invercargill. We are finalising the composition of our first Locality Network to be based in Central Lakes. This network will advise the Alliance Leadership Team on the local health needs and priorities of local communities. Early thinking is underway on developing Community Health Hubs across the district, with initial focus on Dunedin. The opportunity to reflect on what we have achieved makes me realise that this is only possible through the effort and goodwill of all of you and your colleagues committing to work together, being gracious when needed and keeping your eye on the goal of improving the health and well-being of people in our communities. Thank you. Best wishes Nga mihi nui As-Salaam Alaikum Dr Carol Atmore carol.atmore@southerndhb.govt.nz

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IT HelpDesk Phone: 0800 935 575 Email: it.helpdesk@wellsouth.org.nz What services does our Helpdesk look after? HealthONE Health Cloud Reporter Patient Dashboard Web Portal (Claiming) ERMS WellSouth Medtech Evolution Health Cloud Internet Services* *Applicable to Health Cloud customers only for Internet, Connected Health and Firewall

Options for Help Its important to use these options so we can track your tickets and monitor the timeline to resolution 0800 Option: 0800 935 575 Email: it.helpdesk@wellsouth.org.nz Expected Service Levels Normal Same Day response | 3 day resolution Urgent Same Day response | 1 day resolution Critical 1 hour response | 4 hour resolution Service Level Guide Normal I can still work but need this looked into Urgent I can still work but need this soon Critical I can't work and I'm freaking out

Not Resolved lets Escalate Phone: Stephen Murphy IT Manager - 0272457361

Not Satisfied? Mediation Required

For IT Services excluding Health Cloud Reporter Phone: Stephen Murphy IT Manager - 0272457361

Phone: Kyle Forde Chief Information Officer TXT Keyword: ITHELP and issue to 0275500033

For Health Cloud Reporter Escalations Phone: Chris Mitchell - IS Manager - 0212256445 Updated: 07/11/2018

Advance Care Planning Day: Southerners encouraged to think about what matters to them WellSouth and Southern DHB encouraged everyone, regardless of their age or health condition to think about, talk about and share what matters to them for their future health care on Advance Care Planning Day on Friday 5 April. “Advance care planning is about exploring what matters to a person and can be completed by anyone at any time. Advance Care Plans are often thought to be for people at the end of life, however it also becomes important if you have some health problems, are getting older, or simply have strong views about what you do and do not want,” says Southern DHB Palliative Care Clinical Nurse Specialist and Clinical Advisor ACP, Helen Sawyer. “This information is shared with their loved ones and healthcare teams so treatment and care plans can support what matters most to them in the event they become unable to make decisions for themselves.” General practices, aged residential care facilities, hospitals and hospice services across the Southern Region displayed and distributed posters, pamphlets and information to the general public and staff to help raise awareness of the day and help prompt important conversations.

Patient Case Study Making an Advance Care Plan (ACP) was a priority for Dunedin resident Liz Harris who suffers from a respiratory condition. Liz wants to make sure that her family and healthcare providers know what is important to her when she can no longer speak for herself and is encouraging everyone to make an ACP.

Photo above; Patient Liz Harris and Marryllyn Donaldson, Musselburgh Medical Centre Practice Nurse Team Leader Marryllyn Donaldson discussing Liz’s ACP

Liz’s mother didn’t have an ACP when she died and this highlighted the importance of having one in place for Liz. “We had to make decisions that we were unsure about as my mum had not told us her wishes. I don’t want that to happen to my family.” says Liz. “For me, having an ACP in place is one of the most important things I need to do. It gives me peace of mind - it’s a gift to my family so they know my wishes and they don’t have to think about what I would have wanted.”

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ACP champion, Marryllyn Donaldson who is Musselburgh Medical Centre Practice’s Nurse Team Leader says so far about 80 patients at the Practice are in the process of completing, or have completed an ACP. Most of these patients are on the Client-Led Integrated Care (CLIC) programme which ensures patients with long term conditions get the right care, close to home, and are supported to manage their own health. Marryllyn encourages everyone to have an ACP in place, and to start by having a conversation about completing an ACP with their healthcare professional, family, or even friends over lunch. “Talk about what matters to you as you get older, how you want to live the rest of your life and your future healthcare needs. It’s important to know that they can complete an ACP at any age and any time – the sooner the better,” she says. “It’s simple to complete online or with the help of a healthcare professional and it gives you peace of mind that your wishes are taken into account when you can’t speak for yourself. It doesn’t have to be completed all at once and it can be updated at any time. “We’re here to help and we can explain details of medical treatment if a patient is very ill or injured, and discuss the benefits and risks of those treatments,” says Marryllyn. South Island residents can now have their ACP stored with their electronic medical records and it can be shared with other clinicians if and when it is needed, for example, if a patient is in hospital seriously ill or injured. “Having a single, consistent, easy-to-use electronic form provides peace of mind. If someone falls sick outside their hometown, their ACP is available and recognisable to everyone involved in their care. No matter where they are in the South Island, their wishes will be respected,” says WellSouth Clinical Services Manager, Katrina Braxton.

Equipment For Sale: AED: 3 years old, [never used !] fully maintained/ “RESCUE SAM” new price approx. $3,000 PHONE SYSTEM : LG-EMG80 KSUO digital system; PABX Senior tech; 2 Headsets; 6 ELG EMG80 VOLP channel; Ericsson LG IPECS EMG80 8 port Hybrid; and 14 LG-LDP-9224DF 24 button Digital phones One year old excellent system [cost new approx. $10,000] Contact: gaston@xtra.co.nz for further information

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Certificate of Advanced Dermatoscopy Certificate of Advanced Dermatoscopy course From Skin Cancer Symposiums (https://www.skincancersymposiums.com)

Date: 27-28 July 2019 Time: 8.15 am – 5.00 pm Venue: Owen Glenn Building, University Auckland City Campus, Auckland Skin Cancer Symposiums are delighted to invite you to the upcoming Certificate of Advanced Dermatoscopy course at the University of Auckland, City Campus on 27 – 28th July 2019. Our course is accredited by the Royal New Zealand College of General Practitioners, the Royal College of General Practitioners (UK) and the Royal Australasian College of Surgeons. This symposium is an interactive two-day course designed for GPs and Nurses to take you from “zero to hero” (no pre-requisite course required) with our world-leading professors. We have a carefully structured learning process, using simple to understand dermatoscopic terminology, lots of interactive quizzes and time for questions. That is why our symposiums are rated 4.7/5 by hundreds of attendees (surgeons, GPs and nurses) with courses taught in the UK and NZ. Our international world-leading speakers include Professor Cliff Rosendahl from the University of Queensland in Australia. Cliff is the co-author of ‘Chaos and Clues’ and ‘Prediction without Pigment’. These algorithms will provide you with a quick, easy and safe way to decide which lesions can be left and which require excising (this is achieved without needing to diagnose exactly what the lesion is). Cliff will be ably joined by Professor Amanda Oakley from the University of Auckland. Would you like to be more confident diagnosing benign and malignant skin cancers including melanomas? The early bird special for the 2-day dermatoscopy course is $1695 + GST with GPEP registrars having discounted rate of $1495 + GST. All participants will receive a free 12-month Dermengine subscription to store and analyze your dermatoscopic images (worth $1080). We offer discounts if you would not like to take advantage of our dermatoscope offer or if you have your own dermatoscope already. To learn more or register please go to our website at www.skincancersymposiums.com or call us on 09 443 6266. Kind Regards,

Dr Chris Boberg FRNZCGP, Deputy Chair Melnet Chair NZ Skin Cancer Doctors Convener of Skin Cancer Symposiums Tel: 09 443 6266 Email: info@skincancersymposiums.com

WellSouth Primary Health Network Hauora Matua Ki Te Tonga

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Health Promotion Whakaaro of the week With equity and reducing social injustice being a key principle of health promotion, and currently featuring in many conversations across our country, the following quote is a timely reminder for each of us to consider what our own part is working towards the New Zealand we aspire to live in. “I must play my part, even if the end goal doesn’t look like something that benefits me, or people that look like me. Ultimately, I think it would look like justice. When we have justice, everyone benefits”. https://thespinoff.co.nz/atea/06-02-2019/te-tiriti-voices-maori-and-pakeha-on-what-the-treaty-means-to-them/

***

World Smokefree Day 31 May It’s the ideal time to celebrate our smokefree successes as we move towards the Government’s goal of a Smokefree Aotearoa 2025. • More than 1.9 million of New Zealanders have never smoked • 96% of 15 to 17-year olds are smokefree (84% in 2008). It’s critical we keep encouraging young New Zealanders to stay smokefree. • Smokefree Cars legislation will be introduced this year banning people from smoking in cars if young people under 18 are present. • Local authorities and businesses are taking notice of changing attitudes towards smoking. Councils are declaring public places, spaces and events to be smokefree, including outdoor eating spaces. 1. Invercargill CBD is Smokefree. 2. Five Mile Retail Frankton is Smokefree. 3. The Fresh Air Project has supported hospitality venues in Otago-Southland regions to have outdoor dining areas that are totally smokefree and vapefree. We can have a smokefree Aotearoa by 2025 if we work together to help our friends, whānau and workmates become smokefree. The Smokefree work we do at WellSouth helps influence positive action around supportive environments that promote and encourage being smokefree, and it is snowballing, creating an Aotearoa where being smokefree is the normal way of life. Having less exposure to smoking around you, and having a positive smokefree attitude continuously reinforced, means it’s easier to not only give up smoking, but to stay smokefree. Crucially, people are also less likely to start using tobacco. The Health Promotion Agency (HPA) has some great World Smokefree Day resources on their website https://order.hpa.org.nz/ collections/smokefree that are available any time of the year so take a few minutes to check out what is available, and celebrate the smokefree stories and opportunities.

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Do you want to have more effective conversations with clients to support lifestyle behaviour change?

Workshop coming up in Southland: A Healthy Conversation Skills workshop gives you tools to support clients to make lifestyle behaviour changes for long-term health. The skills youâ&#x20AC;&#x2122;ll learn are simple, time-saving and practical to strengthen your everyday practice. We recommend you complete the Healthy Start Workforce online education programme before the workshop.

â&#x20AC;˘ Thursday 12 September 2019 Southland Hospital

Workforce Development Upcoming Education and Training Opportunities GP and Nurses 08 May 09 May 22 May

National Bowel screening Programme 1 Year On National Bowel Screening Programme 1 Year On National Bowel Screening Programme 1 Year On

Dunedin Invercargill Wanaka

More Care Planning Session dates will be available throughout 2019. We’ll let you know when they are scheduled.

Nurses 27 - 28 Sep Nursing Conference Queenstown Detail coming soon – reserve the dates 13 May Pregnancy Care in General Practice Balclutha 13 May Pregnancy Care in General Practice Gore 13 May Pregnancy Care in General Practice Invercargill 14 May Pregnancy Care in General Practice Tuatapere 14 May Pregnancy Care in General Practice Te Anau 15 May Pregnancy Care in General Practice Queenstown 15 May Pregnancy Care in General Practice Wanaka 15 May Pregnancy Care in General Practice Alexandra

Reception/Call Handlers (Practice Managers Welcome) 15 May 20 Jun 25 Jun

Telephone Triage Training for Receptionists/Call Handlers FULL Telephone Triage Training for Receptionists/Call Handlers Telephone Triage Training for Receptionists/Call Handlers

Dunedin Invercargill Dunedin

GP (Please note the start time differences in Southland) 13 May 23 Jul 26 Aug

Pearls from Paediatric surgery-the wisdom & experience of Mr Kiki Moate (start time 7pm) “Equity in the Office” Dr Sue Crengle (start time 7:30pm) “The ABCs of oncology- alphabet soup and newer cancer treatments in New Zealand” (start time 7pm)

Invercargill Invercargill Invercargill

HealthCare/Primary Care Assistance 11 Nov HealthCare Study Day Invercargill

People Managing People TBC Conflict Management Training for General Practice Staff Invercargill, Dunedin, Central Otago Conflict Management training coming soon. If your role requires you to manage people you need to attend. Limited to 25 people per course. WellSouth will kindly sponsor part of the attendance cost and attendees will be responsible for the balance – tbc. Dates confirmed shortly. This training is being provided by Free Spirit Training http://www.freespiritnz.com/.

To find out more info on the events and to register go to http://training.wellsouth.org.nz/upcoming-events/

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Workforce Development

Winton Wonder Strikes Again Dr Aisha Paulose has been continuing to deliver Triage Training to Southland, Otago and Central Otago general practice staff and Dunstan Hospital Nurses. This time Receptionists, Call Handlers and Practice Managers have been taking advantage of this fantastic training which delivers practical outcomes. In such high demand, WellSouth has put on two more courses, one in Dunedin and one in Invercargill. Register now as course numbers are limited and filling up fast. See WellSouth website for more details.

** Introducing Laura Lagan â&#x20AC;&#x201C; Paediatric Educator - Southland Laura Lagan has been appointed as Paediatric Educator at Southland Hospital. Laura has a wealth of wide paediatric experience both here and in Christchurch, including Childrenâ&#x20AC;&#x2122;s Haematology, Oncology Centre, Acute Assessment Unit and general paediatric Nursing. Laura has a passion for sharing knowledge and is currently undertaking her Masters studies. Laura starts on the 29 April.

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South Island Māãori and Pasifika women’s experiences of breastfeeding A new report from the South Island Alliance explores why more Māori and Pasifika women stop breastfeeding in the first six months. While New Zealand has a relatively high rate of exclusive breastfeeding initiation, there remains a significant drop-off in breastfeeding nationally in the first six months, particularly among Māori and Pasifika communities. To address this inequity, the South Island WCTO Quality Improvement Steering Group decided to explore Māori and Pasifika women’s experiences of breastfeeding, by interviewing 28 women across the South Island, from Blenheim to Invercargill. The findings have been collated into a report, Māori and Pasifika women’s experiences of breastfeeding across the South Island. The findings showed breastfeeding outcomes cannot be improved in isolation nor solely by the health system/services. “Māori and Pasifika women’s experiences of breastfeeding are varied and influenced by many social and cultural factors, so wide reaching and multi-pronged approaches are needed to address the inequities,” says WCTO QI project manager Anna Foaese. “By gaining a better understanding of their breastfeeding experiences, we can work towards reducing the disproportionate outcomes that currently exist, ensuring that services are more accessible, user-friendly and best meets the needs of whānau. The voices of consumers can be an effective and powerful tool.” Breastfeeding is often considered a cultural norm and expectation of infant feeding. For many women, the first few weeks are crucial and will set the foundation for successful breastfeeding outcomes. This includes identifying primary birthing units, supportive inpatient maternity care and regular LMC home visits during the postnatal period. Hospital and community-based breastfeeding support services are largely varied across the South Island. Anna says one of the main themes that emerged from the interviews was the importance of a support network that can ‘mother the mother’ and that it takes a village to breastfeed. “This is identified in the South Island as the most protective factor for women to be able to successfully breastfeed.” Family members are commonly regarded as the first point of contact for women experiencing breastfeeding difficulties, therefore women strongly suggested that breastfeeding education and information needs to extend to the wider whānau. The project also showed more emphasis needs to be placed on organisations and industries to support and promote breastfeedingfriendly workplaces. Supportive workplace environments, employer’s knowledge and understanding of breastfeeding, flexible working conditions and paid expressing/breastfeeding breaks were identified as enablers. “It’s hoped that this report does not sit on a shelf, but listens to the powerful voices behind these stories and provides a practical tool that is used to drive change and influence breastfeeding outcomes for generations to come.” Read the Māori and Pasifika women’s experiences of breastfeeding across the South Island report.

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Nga Kupu o te Marama Words of the Month Mātahi-ā-te-tau - May Waka topatopa – Helicopter Maungahuka – Auckland Islands Whakarauora – to save someone’s life, rescue Whakaaro – Idea Auahi kore – Smokefree Iwikatea – Balclutha Hainamana – Chinese Whēkau - Bowel Tākuta, rata - Doctor

WellSouth is including Māori Words of the Month that are related to relevant health topics covered in WellInformed

Notices Police Vetting Vulnerable Children’s Act 2014 From 1 July 2015: new core workers must be safety checked before they start work. From 1 July 2016: new non-core workers must be safety checked before they start work. By 1 July 2018: existing children’s core workers (ie those currently employed or engaged as a contractor) must have been safety checked. By 1 July 2019: all existing non-core workers must have been safety checked.

Definitions Child – a person who is under the age of 14 years. Young Person – a person who is aged between 14-17 years. Children’s Workers –people providing a regulated service and whose work may involve regular or overnight contact with children, taking place without a parent or guardian present. Core Workers – a children’s worker whose work requires or allows them to be the only children’s worker present, or has the primary responsibility for or authority over, children (section 23 of the VCA) . Non-Core Workers – those who are not registered medical professionals, eg courtesy van drivers, receptionists, office workers, foster carers. Although there is a national rollout period, WellSouth would like all practices to start completing the new police vetting as per the Vulnerable Children’s Act 2014 before these dates and preferably this year. Please send police vetting forms via email, fax or post to karin.little@wellsouth.org.nz. Tel: 03 477 1163 Fax: 03 477 1168 Post: WellSouth, PO Box 218, Dunedin 9054 For further information about the Vulnerable Children’s Act and police vetting, please see: https://www.health.govt.nz/our-work/ health-workforce/childrens-action-plan-childrens-worker-safety-checking-and-child-protection-policies.

WellSouth Reception Email Changes WellSouth have generic email addresses for reception. This is to ensure any one of our administration team can access and action requests promptly should our formal reception staff be unavailable. Please use the new email addresses to contact our reception:Dunedin: Invercargill:

Dunedin.Reception@wellsouth.org.nz Invercargill.Reception@wellsouth.org.nz

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News Tips

If you have any news items or are starting a new initiative that you would like to see in WellInformed, please email karin.little@wellsouth.org.nz or call on 03 477 1163.

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Smoking Was Like Breathing Liz Dickey, Balclutha Impressing a guy as a teenager led me to start smoking, but it’s taken me a lifetime to give it up! I had my first cigarette at about 14-years-old. Friends and I would steal tissues from our parents and we’d roll grass and smoke it. It made us feel sick but we kept going back. At 15 or 16-years-old I had my first proper cigarette because I was trying to impress a guy I was dating. He asked if I wanted a smoke and I remember thinking, I had better if I want to impress him! I remember coughing and feeling sick and my throat was burning. That should have been my warning! But instead, I never looked back. Back then, smoking wasn’t a bad thing and it quickly became a part of me. It was ingrained in my lifestyle. It was like breathing! I would never count how many cigarettes I was smoking or how many times I would empty the ashtray during the day. I didn’t really think about the money I was spending either while I was smoking, but of course I noticed the increase. When I first started they were about $.50c a packet for 20, now they’re $30! I would go through a packet a day usually, sometimes I would have a couple left over. I gave up once for about three years. My son was shifting away and everyone in the family had a phone, but I didn’t. I was desperate to stay in touch with my son. I remember there was a sale on at the Warehouse for a phone. I had a decision to make – do I buy a phone or another pouch of tobacco? I decided the phone was more important and, after years of smoking, I quit cold turkey. I remember contacting Quitline and they referred me on to the Southern Stop Smoking Service. That was about six years ago now. (It may be a “brick” now, but I still have the phone!) Three years later, a series of traumatic events sprung up in close succession in my life and so, as a way to deal with the stress, I started smoking again. But a year or two later I was getting sick of smoking again. The smell of dirty ashtrays and having to constantly empty them was becoming too much. I knew smoking was my life but that wasn’t what I was put on this earth for. I remembered the support I received from Anita Clouston the first time I stopped so I decided to get back in touch. One-on-one contact is much better than a phone call and I found the Co monitor to be a real eye opener! I used patches and they worked for me and I chew chewing gum (not nicotine gum). I have been smoke free for about two months now and I’m loving it! I am starting to notice the extra money – bills are getting paid off faster! My teeth are still stained, and I will leave it that way for the moment because they are a constant reminder not to start smoking again! Eventually I will have them cleaned professionally – I never thought about white teeth before but I do now. I don’t miss smoking and I’m definitely sleeping better. I will continue to do my best to stay off it. I am taking it day by day and trying not to put pressure on myself. I haven’t promised anyone anything, I am just doing it – the worst person you can break a promise to is yourself!

WellSouth Primary Health Network Hauora Matua Ki Te Tonga

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Bowel screening resources for Asian residents In an effort to support and increase bowel screening participation among Asian residents here in the Southern district, a series of new, translated resources is available for primary care use. Three documents are available in Chinese: a quick guide overview of the screening programme; a flyer about undertaking the test; and information about further investigation in the event of a positive test result. Please contact emma.bell@southerndhb.govt.nz if you would like printed copies of these documents. In addition, a video demonstrating how to take the screening test has now been translated into Hindi, Korean, Mandarin and Cantonese. Full links for print edition if desired: Hindi: https://www.youtube.com/watch?v=xL-2MaI1Q1w Korean: https://www.youtube.com/watch?v=Y8oCPSr9wTI Mandarin: https://www.youtube.com/watch?v=XKYJkUeyBy8 Cantonese: https://www.youtube.com/watch?v=W1zXV9rREV0] Ministry of Health figures to the end of January show bowel screening participation among Asian residents in the Southern district currently sits at 52.2%, below the national target of 60%.

Chinese community session well-received There was a strong turnout at the first National Bowel Screening Programme education session for Chinese residents in Dunedin earlier this month. About 20 residents attended to hear presentations from Clinical Lead, Dr Jason Hill, and Programme Manager, Emma Bell. Former Dunedin mayor, Peter Chin, also spoke, urging those in attendance to share the importance of bowel screening with their families and communities. For a number of those present who did not speak English, Dunedin GP Dr Argy Song interpreted throughout the presentation. Attendees watched the screening test video in Mandarin, and the translated flyers and evaluation forms were also available.

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Updates on Southern HealthPathways New Clinical Editor appointed We are pleased to welcome Dr Aisha Paulose to the HealthPathways team as a Clinical Editor based in Southland. Aisha will be well known to a number of you and brings a wealth of experience to the role. Look out for a profile on Aisha next month.

4 pathways went live in March 1. Advance Care Planning 2. Birth after Caesarean Section 3. Spondyloarthritis 4. Entering and Sharing an Advance Care Plan A total of 609 pages are now live

Pathway Reviews The review programme of work is moving forward with the review of 12 pathways completed in March bringing the total number of pathways reviewed to 40.

The 10 most frequently viewed pathways for the month of March 1. 2. 3. 4. 5. 6. 7. 8. 9.

Measles IV Iron Infusion (10) Sexual Health Cognitive Impairment COPD (8) Hip and Knee joint replacement Urinary Incontinence in Women Emollients (moisturisers) Falls Prevention

10. Asthma (Non-acute) in Children * Figure in brackets denotes previous month

The 10 most frequently visited pathways not yet localised for the month of March 1. Oral Nutrition Supplements (17) 2. Chronic Pain (26) 3. Chronic Pain Medications (33) 4. Acute Ankle Injuries (41) 5. Hernia in Adults (50) 6. LMC to General Practise Referrals (55) 7. Mental Capacity (58) 8. Mild Traumatic Brain Injury (Concussion) (60) 9. Antipsychotic Medication (79) 10. Practical Prescribing Guide (127) * page views in brackets Analysing this information helps us to identify localisation priorities. Southern HealthPathways had 32,127 page views in March 2019 with an average page view per session of 4.45. Of the 1,778 users who viewed pages on HealthPathways, 952 (53%) of these were new users to the site. The number of sessions per user was 4.06.

What to look out for • A new look HealthPathways Home Page launched June/July • HealthPathways Mobile App launched July • System news being updated regularly on the HealthPathways Home Page • Southern HealthInfo anticipated launch June/July • Pregnancy – Care in General Practice Roadshow 13th May -15th May 2019 If you do have any queries then please contact either BridgetMary McGown, E: Bridget.McGown@southerndhb.govt.nz PH: 0274331711 or Jolene Jones, E: Jolene.Jones@southerndhb.govt.nz PH: (03) 214 7243. Don’t forget that you can also contact us by hitting the send feedback button on any HealthPathways page.

WellSouth Primary Health Network Hauora Matua Ki Te Tonga

info@wellsouth.org.nz www.wellsouth.org.nz

“Honest communication, genuine support, and no judgement.”

“Don’t make excuses, just do it...” Read Gerry’s story > To refer to Green Prescription: Otago click here to make an online referral Southland click here to make an online referral

Sport Otago Sport Southland

03 474 6350 03 211 2253

Update to primary care from the NCSP May 2019 Cervical screening start age to increase from 20 to 25 years The National Cervical Screening Programme (NCSP) is planning to increase the eligible start age for cervical screening from 20 to 25 years. This change to the start age is being made because there is strong clinical evidence and advice that screening women in this age group has minimal benefit but has potential to cause harm (in both cytology or HPV-based screening programmes), as found in a review undertaken by the International Agency for Research on Cancer (IARC)/World Health Organisation in 20051. Increasing the start age for cervical screening from 20 to 25 years will reduce investigation and treatment of cervical abnormalities in young women, where the majority of abnormalities would resolve without treatment. This programme change was originally proposed as part of the wider HPV primary screening implementation, however it has been decided that the change in the screening start age can be progressed as an independent project. This age change is currently planned for late 2019.

Key messages The National Screening Unit (NSU) recommends the following approach: Prior to the change in the screening start age:  Until the age of screening is raised to 25, women between 20 and 24 years should continue to be screened, according to the current pathway. After the change to the screening start age to 25 years:  Women between 20 and 24, who have already been screened, should continue with screening  Women under 25, who have not started cervical screening, can commence screening at 25. It is important to note that any women, including those outside the screening age range, who have concerning symptoms such as unusual vaginal bleeding should see their health care provider who will arrange appropriate tests.

Activities underway to support the age change 1. Primary Care Practice Management System (PMS) Analysis It is recognised that changes to PMSs will be required to support the age change for the first cervical screening invitation to be increased from 20 to 25 years. The NCSP has undertaken the initial scoping for these changes and we will be consulting on this further in the coming months.

IARC. 2005. IARC Handbooks of Cancer Prevention Volume 10: Cervix Cancer Screening. Lyons, France: IARC Press.

National Cervical Screening Programme Freephone 0800 729 729 • Web www.timetoscreen.nz

2. Independent Evaluation and Research Consumer research (a literature review and qualitative research) has been conducted to identify the most effective messages, channels and communication strategies to engage MÄ ori, Asian and Pacific women aged 20 to 30 years on the topic of cervical screening and cervical health. This research provides valuable insights into the barriers for engaging young women in the cervical screening programme and will inform the communications strategy regarding the age change. 3. Sector feedback It is our intention to initiate discussions with the sector between May - August 2019. These discussions will help inform the approach to this programme change.

Queries Frequently Asked Questions related to the change in the screening start age to 25 can be found on the NSU website: https://www.nsu.govt.nz/health-professionals/national-cervical-screening-programme/agerange-change-cervical-screening-0

National Cervical Screening Programme Freephone 0800 729 729 â&#x20AC;˘ Web www.timetoscreen.nz