Curriculum for General Practice - The Royal New Zealand College ...

Cardiovascular
C
We know that after a CVD event patients are at increased
risk for progressive disease so secondary prevention, using
all the same interventions as above, is vital. This must not
be overlooked.
It does not take long in practice to realise that atrial
fibrillation is extremely common and a significant risk
factor for embolic stroke, so optimal management of this
is very important to our patients. As our population ages,
increasingly more patients present with heart failure but,
fortunately, the ability to manage this more competently
in the community has advanced enormously over the past
few decades.
Finally for this topic, acute rheumatic fever (ARF) is a
disease that is endemic in some North Island areas of
Aotearoa, particularly in the Northland, Counties Manukau,
Hawke’s Bay and Capital and Coast District Health Board
areas. 10 It is almost exclusively a disease of Māori and
Pacific people, who respectively have a 23-fold and 50-
fold increase in risk of ARF over all other ethnicities. 11 ARF
rates in New Zealand are markedly elevated compared to
other developed countries. In recognition of this, in 2011
the Government began funding a range of programmes to
combat rheumatic fever. 12
Cardiovascular disease – largely preventable, diagnosable
and treatable – is still a huge burden on our society and
highlights inequity in Māori and Pacific health and is a
central focus of general practice in New Zealand.
Communication
The GP will demonstrate the ability to:
• communicate information about the screening process
and risk factors in a relevant and clear way to patients,
such that they can understand their chance of developing
CVD, and how modification of risk factors will benefit
them and their family/whānau
• apply knowledge and confidently undertake brief
intervention and motivational interviewing techniques
to address modifiable lifestyle risk factors
• develop a non-judgmental relationship and rapport with
their patient, enhancing their ability to facilitate change,
and recognise other life events and factors that may be
influencing the patient’s ability to make lifestyle change
• discuss pharmaceutical interventions, including benefits
and side effects, for cardiovascular disease, atrial
fibrillation, TIA and diabetes
• confidently use consultation screening methods and
tools for opportunistic screening and brief intervention
• understand the need, willingness and ability to involve
family/whānau when addressing risk factors in Māori
patients.
Specific to rural general practice
The GP will demonstrate the ability to:
• communicate the benefits and risks of pre-hospital
thrombolysis to a patient, and the patient’s family/
whānau, experiencing an acute MI in a rural setting
• communicate clearly the results of any assessments
in a way that makes sense to patients, recognising
their level of health literacy, and adjust explanations
accordingly.
• communicate the risks and benefits of staying in rural
hospital versus transfer to a base hospital to an elderly
patient, and the patient’s family/whānau, experiencing
a stroke in a rural setting
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Curriculum for General Practice
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