Pinnacle Clinical Resources | Main / Welcome to Pinnacle

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.

News

For previous news items go to the News Archive.

Novel Influenza A (H1N1) 09

Attached is the latest Guidence on the diagnosis and management of Novel Influenza A (H1N1) 09 - Provided by the Ministry of Health 01 July 2009.

Guidance on the diagnosis and management of Novel Influenza A (H1N1) 09 in the Pandemic ‘Management’ phase No 2

Pinnacle Workforce Analysis

The third in a series of publications based on member surveys was released in December 2008. It includes results of the job satisfaction questionnaire, and compares demographic data with the previous year's survey. For a copy of the report go to Workforce Analysis Volume 3.

Diabetes – recent review

A recent article in Diabetes Care (Vaghela P et al Population intermediate outcomes of diabetes under pay for performance incentives in England from 2004 to 2008 – published on-line ahead of print Dec 23, 2008) looked at changes in proportion of patients achieving diabetes management targets since the introduction of provider incentives in 2004. The main results were as follows:

The median practice-specific proportion of patients achieving HbA1c 7.5% increased from 59.1% in 2004-5 to 66.7% in 2007-8
The proportion achieving blood pressure 145/85mm Hg increased from 70.9% in 2004-5 to 80.2% in 2007-8
The proportion achieving cholesterol 5mmol/l increased from 72.6% in 2004-5 to 83.6% in 2007-8
The number of practices considered to be low-performing (achieving less than the 25th centile for the HbA1c target) reduced from 57% in 2004-5 to 26% in 2007-8.

An average of 7.8% of diabetic patients were deemed to be ineligible for inclusion in the target totals.

Cardiovascular disease – recent review

Blood pressure self monitoring is becoming increasingly common in primary care as the cost of home monitoring devices decreases while accuracy increases. The outcomes from a recent conference on the topic have been published (McManus R et al Blood pressure self monitoring: questions and answers from a national conference BMJ 2008;337:a2732) with the summary points below:

Self monitoring of blood pressure is useful in the diagnosis and management of hypertension
Multiple measurements of blood pressure allow a better estimation of "true" blood pressure
Systematic reviews show that blood pressure is lower when self monitored
Self monitored blood pressure correlates better with risk of stroke than office readings
Patient education and clinically validated sphygmomanometers are prerequisites for effective self monitoring

Cerebrovascular disease – Stroke Guidelines

New guidelines for TIA and stroke management have been recently released by the Scottish Intercollegiate Guidelines Network (SIGN). The brief summary leaflet can be printed off as a useful resource. The Stroke Service at Waikato Hospital released a GP Update earlier this year which outlines local management guidelines – particularly acute referral. There are also local TIA Guidelines available.

Site of the Month – Medication Q&As

This area of the UK-based National Electronic Library for Medicines site contains answers to queries from primary care on a variety of medication related issues. Some recent topics include ‘Can topical steroids be applied at the same time as emollients?’ (Answer: there is conflicting advice from various sources and more research is needed) and ‘What practical issues need to be considered for the use and care of spacer devices?’ (Answer: they should be washed with dishwashing detergent, not rinsed and left to air-dry; priming is not necessary). Categories are searchable and answers can be printed off.

BMJ Best Treatments

BMJ BestTreatments is a patient-based website that gives clear, straightforward explanations of the most-up-to-date medical research, and outlines the benefits and side effects of treatments. BMJ BestTreatments can tell you which treatments really work and which don’t work. It is the only website that rates thousands of health and medical treatments, based on how well they work. The site is approved and supported by the Ministry of Health and the NZ Guidelines Group. BMJ BestTreatments has all the facts on:

The causes and symptoms of 180 common conditions
The benefits and side effects of more than 1500 treatments
The risks and benefits of 23 common operations and tests

Goodfellow Club

The Goodfellow Club site provides free continuing professional education and access to useful resources for GPs, primary health care nurses, physiotherapists and other primary health care practitioners. All clinical members of the general practice team are encouraged to register and use the site. Latest additions include a new ACC Online Case Study on Occupational Causes of Contact Dermatitis.

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 19 of the GP specific review is now available and includes reviews of articles on:

Treating fever in children
Inhaled anticholinergics and CV events
Tiotropium: longterm effects in COPD
Care seeking after stroke symptoms
Rural NZ general practice
NZ GP workforce

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

Clinical Knowledge Summaries

New this month on the CKS website are: Breast screening; CVD risk assessment and management; Diabetes Type 2; Feverish children - management; Lipid modification - CVD prevention; Migraine; Neuropathic pain - adjunct drugs; Tennis elbow
These are general practice oriented succinct summaries and some include links to patient information leaflets. Registration is required for outside the UK but is free.

Medsafe Prescriber Updates

This regular publication from Medsafe addresses current issues with medications commonly prescribed in New Zealand and is a valuable source for rapidly updating critical prescribing knowledge. The latest publication is available on the Medsafe website and includes 'watching brief' articles on:

Omeprazole and headaches
Tamoxifen and visual changes – investigate promptly
Amiodarone and lung toxicity – ongoing patient monitoring required
Roxithromycin-warfarin interaction of increased INR
Use of clozapine in older people requires extra care

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).

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 - they will put you in touch with your local office. All communications and discussions are treated as strictly confidential.