Primary healthcare news, information & resources

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

RACP integrated care: physicians supporting better patient outcomes discussion paper - thoughts from Dr Jo Scott-Jones

Mrs Tiny has been admitted to hospital. Her femur has fractured when she was hanging out her washing. The specialist services work their magic and she is hoping to get home. The district nurse has been organised. The OT is confident she will cope. She has a follow up appointment booked for six weeks time and is discharged.

What's wrong with this picture?

Why do patients not talk about integration of services and the benefits it brings? This The Royal Australasian College of Physicians (RACP) discussion document defines integration in much the same way GPs experience it all the time - it's about teamwork; cross-disciplinary shared knowledge and actions. They argue that some of the key ways the system (and out patients) will benefit from integration is by bridging the "third space" between hospital and community care. They emphasise the importance of ensuring that integration is properly resourced, and is driven by collaboration and co-design. They place importance on evaluation and research.

If integration of specialist and community based generalist teams is going to happen with our DHBs we have a lot to learn from papers like this about the important elements we need to address.

If we did this consistently we wouldn't have DHB imposed processes developed, our HealthPathways would be used and our patients wouldn't spend so long in hospital. 

Recent studies - thoughts from Dr David Maplesden

Racism the reason for rheumatic fever in NZ, says study. This is a confronting and thought provoking interview with Dr Anneka Anderson, lead author of the just released report on M?ori and Pacific wh?nau experiences of recurrent rheumatic fever and unexpected rheumatic heart disease in New Zealand. 

Prescribing contraindicated drugs with statins not uncommon, finds NZ study. This article is another interesting one I think worth dispersing (and I have done a couple of HDC cases where such prescribing led to patient deaths). A New Zealand study has found nearly one in five patients on a common statin are also prescribed contraindicated drugs that could increase the risk of side effects. 

This story was also covered by NZ Doctor. "Dr Parkin identifies two areas where GPs could make changes to their prescribing practice. One option may be to switch to another funded statin, atorvastatin which isn't as affected by other drugs. Another option is to prescribe an alternative calcium channel blocker that doesn't interact with simvastatin. Ignoring the guidelines for simvastatin prescribing isn't an uncommon problem Dr Parkin says. It is occurring worldwide and there might be very good reasons why doctors are doing it having weighed up the risks versus benefits. "But it's always worthwhile to think about the drugs you're prescribing, and, if there's a better alternative, why not use it?"

The complexities of depression in cancer - thoughts from Dr Jo Scott-Jones

Listening to this recent BMJ podcast (subscribe on iTunes or find it on SoundCloud here) I was struck by the fact whilst symptoms of depression affect 20 per cent of people who have been recently diagnosed with cancer, 73 per cent of patients don't receive effective psychiatric treatment. 

This infographic illustrates the complexity of the potential aetiology of neuropsychiatric symptoms associated with treatments, and specific cancers. (Click the image to see the large view, which can be downloaded and printed.)

Reflecting on the patients I've dealt with over the past 26 years I think I have been as guilty as everyone else probably is in thinking that the lack of energy, poor sleep, low mood and tears are all part of the adjustment that people are making in their lives to the diagnosis and its implications. 

Sertaline and citalopram have the least interactions with chemotherapeutic agents and are generally well tolerated. 

Ostuzzi G, Matcham F, Dauchy S, et al. Antidepressants for the treatment of depression in people with cancer. Cochrane Database Syst Rev. 2018 Apr 23;4:CD011006. doi: 10.1002/14651858.CD011006.pub3. (Review) PMID: 29683474

This latest review of use of antidepressants in patients with cancer that was pushed to me through the DynaMed plus free subscription (which we all have access to) suggests evidence is lacking for the use of antidepressants, but I don't think this would stop me trying. The main outcome of this review is the studies looked at are inadequate to give an answer. 

I think I will be looking out for symptoms more in the future, thinking more carefully about talking therapies, considering medication and not putting everything down to an assumption that symptoms are related to the cancer, the treatment, or a normal reaction to a bad situation. 

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