Welcome to the home of Pinnacle General Practice resources. The vision for this site is that it becomes a useful source of resources and information on local and general clinical and business issues, CME and professional development, and specific Pinnacle clinical issues or projects. Any suggestions on sites or content that could be included are welcomed. Please forward with a brief review comment to the General Practice Support Team.

AUGUST 08 News

For previous news items go to the News Archive.

Waikato GP DVT Diagnostic Pathway Pilot

This pilot, which is a joint venture between Waikato Primary Health and Waikato DHB, is operational from Monday 4th August. Eligible practices (at this stage only those that use Anglesea Clinic to provide after-hours care) should have received their information packs by now. Access to all project material including downloadable Medtech and VIP electronic referral forms is available via the Projects page (Projects>Waikato PHO>GP DVT Diagnostic Pathway) - your Pinnacle password is required. For anyone who would like further information on the project a recorded Breeze session will be available on the same page from August.

Bold Promise Utility Tool

Medtech users who have recently upgraded to version 17 may have noticed that the Bold Promise utility tool demonstrated in the recent Pinnacle Cardiovascular Risk Symposia has disappeared. This situation was beyond our control but the utility is now available to download from the Pinnacle website with instructions regarding installation: Go to the Projects page then access your PHO page using your Pinnacle password. A training session regarding use of the tool has been recorded and is available on the Projects page also. Bold Promise is a utility tool enabling identification of the population eligible for CVRA and monitoring of numbers screened and screening results at a practice population level 每 it is separate to best practice which is the electronic clinical decision support CVRA software.

Prescribing for self-limiting respiratory tract infections

The National Institute for Health and Clinical Excellence (NICE), has issued guidance for prescribing antibiotics for self-limiting respiratory tract infections (RTI) in adults and children in primary care. The guideline provides a care pathway which advises on when a no antibiotic or delayed antibiotic prescribing strategy is appropriate and consideration of an immediate prescribing strategy for other situations. The full guideline is 120 pages but a useful summary algorithm can be downloaded here. However issues still arise over the management of patient expectations and the risks associated with 'back pocket script' prescribing e.g. patients stockpiling antibiotics and self-medicating for other conditions (see GP Research Review below).

Closing 31 August

Disruptive behaviour by doctors - Medical Council Feedback

Disruptive behaviour can include bullying, sexual harassment, racial slurs and passive aggression. The Medical Council have released their revised guidelines for Managing Disruptive Behaviour, defining it as 'a chronic and repetitive pattern of inappropriate behaviour that adversely affects the effective functioning of other staff and teams'. The seven-page document suggests some strategies for dealing with disruptive behaviour in doctors. The RNZCGP will be making a submission, and welcomes your thoughts via the College policy e-mail. The draft guidelines can be viewed on the Medical Council website. On a related issue a Professor of Health Care from the UK, Celia Davies, writes in the British Medical Journal about new models of collaboration between health professionals that improve work satisfaction, productivity and outcomes.

NZ GP Research Review

This publication gives a summary of what the reviewers think are ten of the most significant new papers affecting primary care, plus a local commentary on why they potentially affect practice. Reviews are avalable in a variety of areas in addition to general practice. Access requires a log-in but the subscription is free. Issue 15 of the GP specific review is now available and includes reviews of articles on:

Overuse of inhaled steroids in primary care
Prescription sharing
Poor adherence to medication in hypertensive patients
Use of Prednisone for acute gout

To subscribe and receive the review electronically visit the publication website.

CVRA Hints

With the drive towards systematic screening of cardiovascular risk in patients groups defined in the NZ Guidelines well underway we will continue to provide supporting information and resources to practices wherever practicable. All practices should have access to the National Heart Foundation One Heart Many Lives resource pack and the at the start of the manual is some useful advice on practice readiness and processes for undertaking systematic screening. Some additional points:

for an 'average' practice size and makeup, to achieve the goal of screening all eligible patients over a five year period you need to be screening approximately one patient every second day
spreading your screening effort evenly over five years is desireable as many patients will need re-screening five years after the initial contact (annually for patients with risk >= 15%) so if you screen 50% of eligible patients in one year you will have a similar screening burden in five years time
all patients with a pre-existing cardiovascular event or confirmed disease, and many patients with diabetes, will automatically have a risk of >20%. While they will still feature in screening statistics emphasis should be on optimising management of these patients by treating to target as per the NZ Guidelines
in order to lessen disparities in access and outcomes you may want to target eligible Maori patients as a priority group. A bpac publication discusses ethnic specific approaches to screening and risk management for Maori
patients with risk >= 15% generally require medical treatment in addition to lifestyle modification. Adherence can be a problem and the following charts may be useful to help explain the benefits and risks of statin medication: 5 year risk 15%, 5 year risk 20% and 5 year risk 25%.

CVRA management resources

The assessment and recording of cardiovascular risk leads inevitably to the need for appropriate management. Patients will have varying needs and abilities to self manage and provision of lifestyle modification information in an accessible fashion will be useful for many. There are many resources available to assist with this and sources will be reviewed over the next few months. This month we have:

National Heart Foundation - this site has a large variety of information sheets and pamphlets on cardiovascular health topics including exercise, diet etc. Pamphlets may be downloaded for printing or ordered online (free for volumes up to 50).
Sport Waikato - this site has made available the resources used in the Te Wai O Rona diabetes study and includes simple health messages in Maori and English on exercise, diet and lifestyle changes. These are available for downloading and printing 每 from the Home page go to Te Wai O Rona, Resources, General Resources.
Horticulture NZ - this site contains excellent resources on all aspects of vegetable consumption for various age groups. May be downloaded or ordered for free.
Te Hotu Manawa - resources developed specifically for Maori on topics such as smoking cessation, dietary and lifestyle changes are available for ordering
Activesmart - this award winning New Zealand site enables your patient to create a healthy living plan to suit their lifestyle and fitness needs

Burns and Scalds - new ACC Guidelines

Burns and scalds of varying degrees of severity are seen commonly in primary care. ACC released a guideline document last year which contains some helpful algorithms and management advice for this type of injury. A copy of the guideline is available for reference or downloading here.

Clinical Knowledge Summaries

New this month on the CKS website are updates on the diagnosis and management of:

ankylosing spondylitis
dyspepsia
eczema
seborrhoiec dermatitis
sprains and strains

These are general practice oriented succinct summaries and some include links to patient information leaflets.

Grand Round Streaming

As part of a strategy to increase access to CME, Pinnacle has collaborated with Waikato DHB to provide the Waikato Hospital Grand Round presentations on this website in a streaming format with accompanying powerpoint. The presentations will remain on this site for six - nine months. Access for members is via the CME/CNE page and your Pinnacle password is required (Contact Pinnacle if you do not have a password). Recently added sessions include: Amyloidosis, Sex, viruses and oropharyngeal cancer, and a fascinating presentation on plastic surgery in Zambia.

Who are you logged in as in the practice management system????

If you are not logged in as you, how would you validate your practice in a court of law or in a disciplinary tribunal? Check out the New Zealand Health Network of New Zealand Security Policy for General Practitioners and other Health Professionals by clicking on the link.

BACKUP Pinnacle Pastoral Care Support

Just a reminder regarding BACKUP which is a free, voluntary confidential counselling service for Pinnacle general practice staff. This service helps people deal with personal and work issues which can affect work performance. These issues may include relationship and family problems, alcohol and drug abuse, stress and emotional distress and interpersonal conflicts. Through the programme you have access to confidential and professional counselling provided by EAP services, an independent counselling organisation. You can access BACKUP and an EAP Services counsellor by phoning 0800 327 669 who will put you in touch with your local office. All communications and discussions are treated as strictly confidential.

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