WellInformed October 2019
Clinical Updates Clinical Update by Dr Stephen Graham Dear Primary Care Workforce, 1. Measles. I know from speaking to many of our General Practices that a great deal of time and resource has been taken up with issues around the recent (ongoing) measles outbreak. This is obviously particularly the case in Queenstown who have been giving hundreds of vaccines in recent weeks, but it is true of all or most of practices dealing with patient requests. I know that the messaging to practices has at times been mixed. I know that this causes stress and uncertainty dealing with patients who are enquiring about the vaccine. The aim of WellSouth’s input has been primarily at working with our DHB colleagues get messages to you (and to patients) that: • Are consistent (or when they change are clearly signposted). • Allow you to access written information and guidance (this is why we have been trying to keep HealthPathways updated and advertising it as the source of information). • Give clear guidance on how and where to seek advice (having too many sources of advice can create mixed messaging itself). • Minimise extra work upon practices. I wouldn’t pretend it has been totally successful. It is no secret that access to MMR vaccine has been less than most of you want. I know this because you have been telling us. Knowing the difficulties practices are experiencing has been useful to feed back to the Emergency Operating Centre. I’m going to take my own advice and refer you again to the measles site on HealthPathways to see what the situation is today. It will have changed between when I write and when you read this. Our system will benefit from a review of the measles response (at the right time) and we’ll ensure you all have the chance to feed into it. 2. Rheumatology. Jo Mitchell has updates on the service. This appears on the following page. Many of you will be aware that she has made a large effort getting out to practices in the past speaking to GPs about the service. My opinion is that this is a great example of improving the relationship between that service and primary care. I welcome any feedback. Dr Stephen Graham Medical Director WellSouth PHO stephen.graham@wellsouth.org.nz
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
1
Rheumatology Department Dunedin Hospital 201 Great King Street, Private Bag 1921, Dunedin 9054 Phone: (03) 470 9252 Fax: (03) 470 9921
21 September 2019
Dear GP Colleagues
This letter is to update you regarding important issues in the Rheumatology Service which are impacting our current capacity and service: Departure of Dr Annie Cooper Dr Cooper, has returned to the UK and whilst we are actively recruiting, until the position is filled, we have reduced capacity (with only some limited locum cover available). Dr Cooper’s patients may have delayed follow up. If you have concerns about any of Dr Cooper’s patients, please contact either the on call Rheumatologist, or send a referral to the department. First Specialist Assessments Because of reduced capacity, we are reluctantly (and hopefully temporarily) not currently accepting patients with a 3 (semi-urgent). Please see the attached prioritisation criteria. These patients tend to be those who are unlikely to have an inflammatory condition, but where a specialist review is desirable to fully exclude this and where possible are being managed with GP advice. If you have any concerns about a patient who has been declined then please contact the grading rheumatologist, to further discuss the situation and reason for concern. Please do not let this alter your referral patterns. It is our view that we have an important role in reviewing these patients to assist with diagnosis and treatment decisions. I am hopeful that we can restore our full service once a full complement of SMO staff is available. Lab Results Please be aware that any blood test results copied to the “Rheumatology Clinic” are not being seen, as we cannot access copy to results for anyone other than ourselves on HCS. This has been communicated in the past but the lab advises there are still a number of results being sent to the Rheumatology Clinic in the copy to format. Please do not request any lab tests in the name of the Rheumatology Clinic, as these are not seen. Because ‘copy to’ results are not able to be reviewed within the rheumatology service, if you have any concerns about any results we happy to advise either by phone or with a request for written advice. Finally, if you have any suggestions that may improve our service, or any concerns regarding our service delivery, then I would very much like to hear from you in person. We are working hard to ensure our service is well integrated across primary and secondary care. I can be contacted by e-mail: jo.mitchell@southerndhb.govt.nz, or by phone through Dunedin Hospital Operators. Thank you. Kind regards. Jo Mitchell Clinical Director Rheumatology
-1-
Contents Clinical Updates 1 Inspirtional Stories from Southern Stop Smoking Service
3
Message from the Chief Executive 4 Syphilis diagnoses increasing 4 Workforce Development 5 (Austin) Power(s) in the Profession 6 Bowel screening Update 7 Online lab requests 7 What do you need to know about measles?
7
Sisters in arms 7 Updates on Southern HealthPathways 8 Nau mai, haere mai, welcome to Southern Health!
9
Alliance South Update from the Alliance Leadership Team Chair - September 2019 10 Green Prescriptions 10 Portals are the key 11 Health Promotion 12
Inspirtional Stories from Southern Stop Smoking Service http://www.kaitahu.maori.nz/southern-stop-smoking-inspirational-stories/ giving-up-a-60-year-habit-was-easier-than-we-thought http://www.kaitahu.maori.nz/southern-stop-smoking-inspirational-stories/ smoking-was-sexy-and-cool
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
3
*
Message from the Chief Executive Just a Thought Better access to mental health services is important to us all, so I was honoured to have been invited to attend the launch of Just a Thought in Hamilton recently. This new, free online therapy tool helps provide access to immediate and effective mental health support for mild and moderate conditions. Based on Cognitive Behavioural Therapy, the site offers support for depression and anxiety and in the coming months and years will also include courses for Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, chronic pain, and other conditions. In the largest health district in the country, we know equity of access is beyond challenging, and such tools and other emerging technologies can be important resources in helping us deliver care to the people and communities we serve. Please check out the web site: https://www.justathought.co.nz/ and if appropriate refer your patients as well. I welcome your views on this or any other online services or resources that you are using to better support patients and their whānau.
Andrew Swanson-Dobbs, CEO asd@wellsouth.org.nz
Syphilis diagnoses increasing Syphilis diagnoses are up markedly in the Southern district in 2019 and GPs are encouraged to test patients. So far this year, 33 cases have been diagnosed, an increase from 11 last year, 16 in 2017 and four in 2016. Congenital syphilis is also on the rise nationally, though there is no specific data available for the Southern district. “Syphilis symptoms can be hard to notice and come and go over time, so it is important for clinicians to be aware and to think to test,” recommends Alison Stewart-Piere, Nurse Practitioner/Shared Clinical Lead, Sexual Health Service, Southern DHB. Syphilis HealthPathways are being updated at present and current advice to GPs in the district is: • Test for syphilis and HIV with any STI check, all ages. • Ask about sexual behaviour, multiple partners, gender of partners, etc, of all patients, to identify those at risk who might slip under the radar (swingers, bisexual men, sex workers). • Ask about and encourage condom use for all sexual activity, including for oral sex. • Consider syphilis in the differential list with anything odd; rashes, alopecia, persistent malaise and lymphadenopathy, altered liver function etc. • Ensure testing in all pregnant women and retesting of any pregnant woman at ongoing risk, eg. Change of relationship, uncertain of partner’s fidelity, multiple partners.
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
4
Workforce Development Upcoming Education and Training Opportunities GP CME (Register via WellSouth website unless alternative address supplied) 08 Oct 29 Nov
Otago Faculty RNZCGP CME “Privacy and Cybersecurity” Dunedin (Register to CME RMIP cme.rmip@otago.ac.nz) Focused Acceptance and Commitment Therapy Workshop (5.25 CME points) Invercargill Register at (https://event-fact-inv.lilregie.com/booking/attendees/new) Southland Faculty members eligible for discount email Cheryl.moeke@wellsouth.org.nz for code
GP CME, NP and Nurses 23 Oct Immunisation Conversations for GP’s and Practice Nurses Dunedin RSVP & queries contact: Jillian Boniface@southerndhb.govt.nz 24 Oct Well Child Symposium Dunedin Register at https://www.immune.org.nz/2019-well-child-symposium
Did you think that polio in NZ was yesterday’s problem? Not so… University of Otago, Wellington and Polio NZ invite you to our one-day symposium for health professionals at the University of Otago, Wellington, on Friday 18 October 2019, 9.30am-4.30pm. • There are approximately 10,000 polio survivors in NZ. About 35-40% experience Late Effects of Polio (LEoP). • Polio NZ members report a very low level of awareness among the health professionals about LEoP which significantly impacts on their ability to access effective health services. • To address this gap, University of Otago, Wellington and Polio NZ are jointly offering a one day symposium on LEoP. • The symposium is designed for physiotherapists, occupational therapists, orthotists, podiatrists, anaesthetists, orthopaedic, neurology, respiratory, pain, sleep and rehabilitation specialists, nurses, psychologists, counsellors and speech therapists and GPs. For further information and to register, go to www.otago.ac.nz/polio2019.
Nurses 26 Nov Advance Care Planning Dunedin 04 Dec Advance Care Planning Invercargill
Nurse Practitioner Nurse Practitioner Training Programme (NPTP) Applications for 2020 close by 5pm Monday 7th October 2019. Check out www.wellsouth.org.nz for more details and application forms. Did you miss out on “Implementation of Shared Care Plans from a clinician’s perspective” – watch the Cromwell recording on our website (NB: low quality sound) Once you log in or register on our website, click on “Other Podcasts for General Practice” WellSouth Website.
To find out more info on the events and to register go to http://training.wellsouth.org.nz/upcoming-events/
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
5
(Austin) Power(s) in the Profession Let’s be perfectly clear: WellSouth’s Practice Nurse Conference 2019: Power in the Profession - held in Queenstown, 27 & 28 September - was an important professional development opportunity for practice nurses in the district. Leaders in the health care sector delivered important messages with their keynote presentations, there was an abundance of learning and networking opportunities and considerable intellectual discourse. But we can talk about all that later, because there was also dancing and FUN!! Check out the awesome photos from Friday night’s 60s themed dinner and dance-a-thon with Austin Powers! Yeah, Baby!!!
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
6
Bowel screening Update Bowel screening detects more than 100 cancers More than 100 cases of bowel cancer have been identified through the Southern DHB’s National Bowel Screening Programme, a significant milestone that illustrates the programme’s important role in reducing the burden of bowel cancer across the district. In addition to the 101 cancers detected since the Southern DHB programme’s inception in April 2018, a further 726 people have been found to have polyps, which can develop into cancer over time. www.southernhealth.nz/publications/southern-bowel-screening-diagnoses-more-100-cancers
Online lab requests
Create and send laboratory requests online with greater accuracy and efficiency. Visit https://eorder.co.nz/ for more information or email helpdesk@eorder.co.nz. Want to know more, contact SCL Customer Liaison: Tash Bambry tash.bambry@sclabs.co.nz.
What do you need to know about measles?
The Southern DHB have answered some frequently asked measles questions on their website: https://www.southernhealth.nz/living-well/measleswhat-you-need-know
Sisters in arms
When the Southern district needed vaccinators to staff its Queenstown measles clinic last month, WellSouth’s staff jumped in to help out. Thanks so much for going above and beyond, helping out as you always do!
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
Back row(l to r): Nicola Stout, Rachel Hall, Karen Williams (all registered nurses) Front: Angela Ryley (Practice Relationship Manager) Mirriam Mackay (Administrator)
info@wellsouth.org.nz www.wellsouth.org.nz
7
Updates on Southern HealthPathways SOUTHERN COMMUNITY HEALTHPATHWAYS August 2019 Total Live Pages 635
Total Reviews Completed 155
Southern HealthPathways had 32,361 page views in August 2019 with an average page view per session of 4.15. Of the 1,845 users who viewed pages on HealthPathways, 1,219 of these were new users to the site. The number of sessions per user was 4.2342. To keep up to date with pathway activity check out our home page- Southern HealthPathways.
Top 10 (Localised) viewed pathways for the month of August:
Top 10 (Unlocalised) viewed pathways for the month of August:
1. IV Iron Infusion 2. Abnormal Uterine Bleeding (AUB) 3. Headaches in Adults 4. UTI in Adults 5. Rhinosinusitis 6. Deep Vein Thrombosis (DVT) 7. Tonsillitis 8. Atrial Fibrillation (AF) 9. Acute Otitis Media 10. Polycystic Ovarian Syndrome (PCOS)
11. Anxiety in Adults 12. Acute Spinal Pain in Adults 13. Chronic Kidney Disease (CKD) in Adults 14. Breast Symptoms 15. Varicose Veins and Chronic Venous Insufficiency 16. Carpal Tunnel Syndrome 17. Haemorrhoids 18. Diverticular Disease 19. Gallstones 20. Osteoarthritis (OA)
Measles: For up-to-date information on the measles outbreak in the Southern district please continue to visit the homepage. The link will take you to the up to date information Southern HealthPathways
Request for Expressions of Interest to be part of HealthPathway workgroups: We are keen to hear from interested General Practice staff and community providers who would like to be involved in work groups in the following areas: • • • •
Oral Health Urology Breast Carpal Tunnel
If you would like to know more or are interested then please contact Bridget-Mary, Bridget.McGown@southerndhb.govt.nz.
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
8
*
Introducing Rod McDonald- HealthPathways Coordinator: Rod grew up on a farm in Central Southland before completing a degree in Computer Science at the University of Otago. The majority of his working career has been involved in the development and implementation of Health Information Systems in Australasia and the UK. He has held varied roles ranging from application development and solution architecture through to business analysis. Rod has a passion for developing and implementing information systems that support improvements in patient outcomes “this requires seamless integration of different health and social services as well as increasing the population’s health literacy levels - HealthPathways and HealthInfo are a critical medium for achieving these goals”. We are pleased to welcome Rod to the team. Contact details: Rod.McDonald@southerndhb.govt.nz or 027 320 1121 If you would like a visit to your General Practice from the HealthPathways Team then please contact us and we will organise this with you. If you do have any queries then please contact: Bridget-Mary McGown, E: Bridget.McGown@southerndhb.govt.nz PH: 0274331711 Don’t forget that you can also contact us by hitting the send feedback button on any HealthPathways page.
Nau mai, haere mai, welcome to Southern Health! www.southernhealth.nz Did you know there is a new, all-in-one website for health care services in the Southern district? Created by Southern DHB and WellSouth, its aim is to make it easier for the public to understand our health system and find the health services they need. We will maintain our WellSouth website as the place to go for practice staff to find information relevant for you (e.g. education calendar). More than 500 health providers have provided information, to help make finding care even more accessible.
With this new website comes a new logo – which is available for those providing care in the Southern district to present themselves as part of this wider health system. The logo represents the golden landscapes of Otago, the greens of Southland, and the Clutha Mata-Au river that – like the health services in our district – reaches from mountains to the coast. It is underscored by a kiwaha gifted through our kaumatua: He hauora, he kuru pounamu – good health is a great treasure. Enjoy exploring the new website! Any questions or feedback, email communications@southerndhb.govt.nz.
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
9
Alliance South Update from the Alliance Leadership Team Chair September 2019 Kia ora colleagues The survey to capture your experience as a health care team member is now live! The health provider experience survey is part of evaluating the implementation of the Primary and Community Care Strategy (PCCS). The survey is looking at the experience of those working in general practices and rural hospitals in the Southern health system. It is now running, and will run through to the end of October. People have begun filling in the online survey, and we are posting paper copies to those practices who have indicated they would prefer the good old pen and paper approach. The survey explores your views about integrated care, team work and staff morale. The findings will help us fine tune how the PCCS is implemented in the district. So your input is vital. In addition, where 10 or more people from any practice participate (to preserve anonymity), we can provide a summary value for the practice for the integrated care, teamwork and staff morale parts of the survey, compared to the average for general practices in WellSouth Primary Health Network. So as long as 10 people in your practice participate, you will get some direct anonymised feedback of how your practice is doing. Your views will make a difference. We are asking practice managers to pass to the study team the email contacts of the GPs, nurses and administration staff at their practice. We will then email you to ask you to take part in the 15 minute online survey, which will be live until the end of October. We can post out paper copies of the survey with self-addressed envelopes, for those who prefer this method. So please look out for the email invite or paper survey and take the time to complete the survey. If your practice would like to be involved but has not been yet, please contact Helen Owen, the post-doctoral research fellow involved in the project, helen.owen@otago.ac.nz. She will be able to get the ball rolling so you can be involved. Ngā mihi nui Dr Carol Atmore carol.atmore@southerndhb.govt.nz
Green Prescriptions Green Prescription and Active Families are both highly valuable and effective programmes, nurse practitioner Rebecca Grant believes. Rebecca works at two busy Invercargill medical centres, she knows first-hand the value of having support from outside programmes when it comes to the health journeys of her patients. You can read more about Rebecca’s experiences with Green Prescription and Active Families here.
To refer to Green Prescription Sport Otago (03) 474 6350 Sport Southland (03) 211 2253 ERMS – ALLIED HEALTH – GREEN PRESCRIPTION
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
10
Portals are the key Dr Prue Murdoch of Dunedin’s Amity Health Centre says patient portals are the heart of Health Care Home, but just as useful for all general practices “I love when I see that little green icon.” So says Amity Health Centre’s Dr Prue Murdoch of the digital marker on a patient’s records indicating they’ve signed up for a patient portal. “Portals are such a useful tool for a clinician,” says the Dunedin general practitioner. “But it’s even more beneficial for patients. It’s empowering.” Amity Health Centre in Roslyn, Dunedin has been using portals since 2010, and has 75% of their patients over 18 years signed on for patient portals, one of the highest rates in New Zealand. With nearly 4,000 enrolled patients, Amity was among the first to become part of the Health Care Home programme in the Southern district, an initiative now including 15 practices in Dunedin, Invercargill, Central Otago, Balclutha, Gore and Oamaru. Dr Murdoch says access to secure online health records via portals is vital for engaging patients more fully in their own health care. Portals enable patients to see lab results, order repeat scripts, communicate via secure email and make appointments. With online access to consultation notes now also available through a portal there is a greater level of interaction as they see their doctor’s observations and clinical instructions. ‘’We recognise that some clinicians are wary of Open Notes, but we haven’t changed what we do or how we work. I still use medical jargon, as this is efficient. Patients are able to clarify what I have written, however, and to request correction of perceived errors in their medical information – a positive thing.” Because patient portals support other important aspects of Health Care Home that enhance patient care and improve practice operations – GP triage, extended practice hours and services among them – Amity works to encourage portal uptake among patients whenever possible. “It is an adjustment for clinicians and patients – the patient-doctor barrier shifts, but overall, it is a positive move that is better for the patient, better for the doctor, and means better care,” Dr Murdoch says. This seems to be the view of local clinicians and patients as well, as a recent survey by final year medical students indicates largely positive attitudes towards Open Notes by both groups.
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
11
Health Promotion Celebrate Health Literacy Month Throughout October, all of us – both organisations and individuals – can look at ways to actively promote and champion easy to understand health information. As many Kiwis spend 60% of our days at work, it makes sense to promote health literacy in our workplaces, such as how we communicate health information and messages. “Be a Health Literacy Hero" is the 2019 theme. Health Literacy Heroes are individuals, teams, or organisations who not only identify health literacy problems but also act to solve them. What can you do to be a health literacy hero? How can you help make it easy for every day kiwis to navigate the often complex health system? For more details check out http://www.healthliteracymonth.org/
How much do YOU Love Your Bones? October 20 marks World Osteoporosis Day – an ideal time to check your bone health and take action! The great news is that osteoporosis and fractures can be prevented by taking some simple steps to build and maintain strong bones throughout life, but the earlier the better! While there are risk factors we can’t change, there are some things we CAN control to help our bones, such as these 5 easy steps….
The International Osteoporosis Foundation also has a short Risk Check tool available online for free use (http://riskcheck. iofbonehealth.org/) so give it a go today!
It’s Time to Spring into Action! As we find ourselves now in October, Spring has well and truly arrived. The warmer weather and longer days provide a great opportunity to spring back into action and be more physically active again after hunkering down over winter. So why not get the whānau together and spend some quality time together moving in the outdoors - whether that is at the beach, the playground or the local sports field, the choice is yours so do what you enjoy!
WellSouth Primary Health Network Hauora Matua Ki Te Tonga
info@wellsouth.org.nz www.wellsouth.org.nz
12
Save the date
Contact: Megan.Barrett@southerndhb.govt.nz DDI: 55807 or 027 801 3613 or Debby.Newton@southerndhb.govt.nz DDI: 55813 or 027 685 4911
Agenda Smokefree legislation update Ministry of Health Vaping research - Hapai Te Hauora Increasing public awareness - Health Promotion Agency Smokefree / Vapefree environments Vaping masterclass
1-day vaping seminar Hear the evidence that suggests vaping can help people stop smoking.
Invercargill 20 November Dunedin 21 November