Primary healthcare news, information & resources

What we've been reading - March 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 March. If you come across an article, video or resource you think clinical and management teams should know about, send it to

Little Kakapo - thoughts from Dr Jo Scott-Jones

Little Kakapo is a company run by a local cardiothoracic surgeon and his wife, and specialises in adaptive clothing for children with disabilities and physical, behavioural and developmental challenges. The company combine the scientific approach to research with the compassion and drive needed to help deliver useful and functional garments for children to wear. Their current focus is on adaptive clothing for children with eczema, feeding tube users, and sensory challenges.

The AMA Doc Talk podcast series- thoughts from Dr Jo Scott-Jones

This is an American resource but focuses on communication skills that are universal. A huge part of our job involves skilled communication and education of our patients. This 20 minute weekly podcast is a great way to help reflect on these skills and how we hone them.

We all understand the pressure we are under in the health system, and we all understand how important it is to find different ways to cope. One important action we can take is to share the burden of care with colleagues in our teams and with our patients.

The AMA Doc Talk podcast series is a great way to follow up on the recent education opportunities Pinnacle presented with the help of Health Navigator around health literacy and the key skill of self management, which we need our patients to learn to help unburden the health system.

Download Apple iTunes to listen to 'The placebo effect' and 'Patient plays doctor' from AMA Doc Talk. 

North America - A social-contextual investigation of smoking among rural women: multi-level factors associated with smoking status and considerations for cessation - thoughts from Jo Scott-Jones

We all know that smoking, and the decision to stop or continue, is complex and influenced by physical as well as social factors.
In this study in rural women in America the authors show that whilst people give up smoking as they get older, the chances of them making this decision worsens with each point they deteriorate along a depression score, and that five interpersonal factors were associated with smoking status.

If smoking is perceived as more acceptable within local groups, the odds of being a former or never smoker decreased by 23 per cent and 30 per cent, respectively. For every 10 per cent increase in the percentage of social ties in the participant's advice network who smoked, the odds of being a former or never smoker were 24 per cent and 28 per cent less, respectively. On a measure of how many people smoke in a patient's social network, the odds of being a former or never smoker were 20 per cent and 24 per cent less, respectively, in the time network, and 18 per cent and 20 per cent less, respectively, in the advice network.

If smokers are engaged in one additional activity type in the past year - sports, a book club, school parent activities - the odds of being a former or never smoker increased by 17 per cent and 36 per cent, respectively. At the neighborhood level, for every one unit increase in neighborhood cohesion score, indicating increasing cohesion, the odds of being a former smoker or never smoker were 12 per cent and 14 per cent less, respectively.

As a GP there are lots of reasons for me to try and engage patients in positive involvement with social groups in the community, and to support the building of social coherence in my community. It would be great to be able to ensure the groups I recommend to patients were all smoke free. We need our public health messages, and along with our PHOs and DHBs to get involved in creating communities where smoking is seen as unacceptable.

Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis - thoughts from Dr Jo Scott-Jones.

There has been concern that evidence did not support the use of antidepressants, despite the common experience of many of us that along with GP level or other counselling, the use of medication was an important part of therapy for this common condition.

This large meta analysis* has provided some reassurance that what we see in practice is backed by the evidence available.
The authors found that all antidepressants provide some benefit over placebo, some are better tolerated than others, and some seem to work better than others.

I was surprised to see how efficacious Amitryptilene is in this study, but for me I will continue to prescribe Fluoxetine as a first line SSRI, because of its tolerance, even if Citalopram is more effective.

Thank you Dynamed Plus.

*Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. Lancet. 2018 Feb 20. pii: S0140-6736(17)32802-7. doi: 10.1016/S0140-6736(17)32802-7. (Review) PMID: 29477251.

Chronic obstructive pulmonary disease and the New Zealand Formulary - thought's from Dr Jo Scott-Jones

Chronic obstructive pulmonary disease (COPD) is a common condition and whilst reading the TRIBUTE paper, I was alerted to the fact that I didn't know if 'extrafine inhlaed triple therapy' was available in New Zealand. It isn't, as a review of the NZ Formulary (NZF) told me.

I was however reminded of what a fantastic resource the NZF is - a quick scan of the COPD overview page reminded me again of the importance of spirometry in making a diagnosis; the limited role of inhaled corticosteroids in this condition, and when they should be prescribed; the importance of stratification of COPD patients based on symptoms and exacerbation and what is available in New Zealand to treat these patients.

The best practice COPD prescribing tool that was linked to from NZF was a bit of a revelation I have to be honest - I hadn't come across it until today and it neatly explains the role of LABA/LAMA combinations and the current, to me slightly confusing, range of choices.

I'll definitely be adding a review of the NZ Formulary to my "sources of truth" browser favourites.

The NZF is directly integrated into Indici - so for our Indici users out there, you just need to click on the NZF icon or do a medication search to find this information.

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