Primary healthcare news, information & resources


What we've been reading - June 2018


Keeping up with medicine is made easier when we share clinical stories with our colleagues. On this page we share brief learnings and articles that have interested our GP liaison team during the month of June. If you come across an article, video or resource you think clinical and management teams should know about, send it to newsletters@pinnacle.health.nz.

Off label or on trend: a review of the use of quetiapine in New Zealand - thoughts from Dr David Maplesden, Pinnacle MHN GP liaison

This paper reviews the use of quetiapine in New Zealand and is a really good read. 
Quetiapine,a dibenzothiazepine derivative, is a second-generation antipsychotic, licensed in the US by the FDA for the treatment of schizophrenia and bipolar disorder and as adjunctive treatment for major depressive disorder. In New Zealand, quetiapine is approved for the treatment of schizophrenia, acutemania associated with bipolar I disorder and maintenance treatment of bipolar I disorder. However, in New Zealand and in a number of other countries, there is growing evidence that quetiapine is largely prescribed 'off-label', ie, not for the licensed indication.

The adverse impact of the physician hero - thoughts from Dr Maree McCracken, Pinnacle MHN clinical director primary mental health

An article on the physician hero and team based care had me reflecting on these tendencies in myself and my colleagues in both primary and secondary care. 

The physician hero focus on controlling care and decision making comes from a deeply ingrained sense of personal responsibility and they will work tirelessly to deliver excellent clinical outcomes. Sound familiar? Such attributes, however admirable, are also a barrier to team based care - which may be better placed to make timely and responsive decisions about patient care. The physician hero approach also fails to fully appreciate the diversity in a team and utilise the collective intelligence teams bring to patient care.

General practice once the realm of the sole GP and their receptionist has welcomed and encouraged the formation of teams with addition and upskilling of the all important practice nurse role. New ways of working are developing, bringing more members to the team and allowing GPs to share the responsibility of patient care and allow the physician hero to take a well earned break. Ultimately though, the patients reap the benefits from the collective skills of the diversity in these new clinical teams.

Sick at heart - thoughts from Dr David Maplesden

Cardiovascular disease research findings published recently highlight an urgent need for information on prior heart-related hospitilisations to be shared with the patient's primary care team

A leading Auckland cardiologist has described the results of cardiovascular disease (CVD) research published recently as "staggering". 

He was commenting on findings published in The New Zealand Medical Journal, which found that 39 per cent of patients who had previous hospitalisations for major CVD events had 'no' indicated for prior CVD in the PREDICT algorithm (similar to the BPAC tool we use), particularly where the patient had had an admission related to peripheral vascular disease.

Such an omission results in significant under-estimation of cardiovascular risk and possible under-treatment of a particularly high-risk population. Perhaps this could be a useful topic for a practice audit... 

Pharmacogenomics is likely to become more widespread in the future, Medsafe - thoughts from Dr Jo Scott-Jones

In the latest Medsafe newsletter (June 2018), the issue of pharmacogenomics is raised in relation to reducing the incidence of significant side effects to commonly prescribed drugs

Many of us will recall HLA B27 being an association with ankylosing spondylitis, but for GPs of my generation (and I am younger than the average) that's probably about as much as we know about human leukocyte antigen (HLA) alleles. 

Most of us will know of the association of cytochrome P450 and drug metabolism, but probably to the extent that its part of the scientific obfuscation that occurs when the chemist tells people not to eat grapefruit when they are taking Felodipine.

It's got a lot more complicated. The impact of polymorphisims of drug metabolising enzymes in relation to prescribing of medications such as tamoxifen, phenytoin and warfarin has probably passed most of us by. 

I don't think this is our fault. New Zealand is well behind other countries in applying this growing body of knowledge, but we are catching up. Medsafe has established a group with the nemonic UDRUGS (Understanding adverse Drug Reactions Using Genomic Sequencing) to establish a DNA bank linked to clinical information from patients who have experienced significant side effects, and to explore the range of variations that may contribute to observed phenotypes. 

It's important we continue to use the Reporting Adverse Drug Reactions process to help identify significant side effects of medications. Look out for updates on genomics for CPD. There are a growing number of opportunities online, look out for this topic at upcoming conferences.  

Pinnacle is here to help you adapt to be future fit. Ventures is exploring a specific service that will help you to guide your prescribing according to the genetic profile of your patients. We are working to understand the impact and implications of genomic testing and how we can help you both understand and apply this to patient care. Watch this space!

Vaping: the rise in five charts - thoughts from Dr Jo Scott-Jones

Did you know there are two systems for vaping? This article made me think, I've got to learn more about this issue. I saw this on the BBC News app and thought you should see it, spending on e-cigarettes is increasing. The BBC looks at what's behind the rise.

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