Primary healthcare news, information & resources


What we've been reading - October


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 October. 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.

Potential bariatric surgery benefits for patients with diabetes/pre-diabetes - thoughts from Dr Jo Scott-Jones

I was recently asked to use the data we receive from practices to help the Tairāwhiti DHB look at the potential for patients with diabetes/pre-diabetes to benefit from bariatric surgery, if they were to invest in this programme (between 500-3000 depending on the parameters you use - I'm not sure what their next move will be on this).

The reading took me to DynamedPlus and reviewing the evidence around not just bariatric surgery, but lifestyle changes, diet and exercise. 

In summary it's hard to embed long term lifestyle changes (who knew?), it's a combination of reduced intake of calories and increased output of calories that works (not rocket science)  but a 7 per cent weight loss held persistently has a significant effect and is worth aiming people at. 

Bariatric surgery may be appropriate for patients with:

  • body mass index (BMI) ≥ 40 kg/m2 without coexisting medical problems and without excessive surgical risk (strong recommendation)
  • BMI ≥ 35 kg/m2 with at least one severe obesity-related comorbidity (strong recommendation)
  • BMI ≥ 30 kg/m2 with at least one severe obesity-related comorbidity or type 2 diabetes (weak recommendation). 

Access to these treatments through the public hospital system is notoriously poor despite the evidence. I would love patients to have access to these procedures more easily, and I'd very much prefer this happened sooner rather than amputations and renal dialysis later in life.

Having said this it feels like we are fighting a rear guard action with our funders to simply have sustainable primary care services which feels like a higher priority to me at the moment. 

The high potassium: after hours - thoughts from Dr Jo Scott Jones

I was driving home after a long day grafting at the patient coal face when I received a phone call from Pathlab - I was told one of the patients I had seen that morning had a potassium of 6.2.

Firstly, I should be very pleased that as a locum GP working in an isolated solo rural practice Pathlab could contact me on my cellphone!

They rang the surgery after hours number, were put through to Homecare Medical Ltd (HML) who I had contacted during the day to let them know the regular GP was away and given them my number. This was great - they could pass on the news to me of this potentially serious problem, that otherwise they would have had to "sit on" until the following day. 

I know the Health and Disability Commissioner (HDC) are pretty clear that when we order a test we should be able to react to the result, or know who can. I know we all want to do the best we can for our patients, so it's worthwhile thinking it through - who would Pathlab contact if a result of a test you ordered was urgent and critical for your patients?   

My next problem was what to do with the result. I had no way of contacting the patient. No remote access to the PMS. A name and address but no phone number listed (they had a mobile), and I hadn't made sure the mobile number was printed on the label stuck on the form or the test tube.

I woke at 4am thinking about this patient - never a good sign.

I was able to contact him the next day and arrange an urgent repeat test. But it made me think - if you get told the INR is 12, the troponin positive, the potassium 7 - are you sure you can contact the patient and make something happen? 

The simplest solution is to make sure the Pathlab form has a patient cellphone number on it - just in case. It turns out they keep a record of all the contact details they receive for this very purpose!

So, I've been reading about management of potassium levels.

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