bpj-sce-august-2020

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CONTENTS SCE Issue 1 August 2020 27 37 42 27 32 37 42 47 Managing gout in primary care For many people, gout is a debilitating condition associated with poor health and reduced life expectancy. Too often, management is focused on controlling the patient’s symptoms in the short-term, while their risk of irreversible joint damage and negative health outcomes continues to grow, particularly among Māori and Pacific peoples. It’s time for a re-think. Suicide prevention: what can primary care do to make a difference? In 12 months through to August 2019, 685 people in New Zealand died by suicide; an increase for the fifth consecutive year and almost double the road toll. New Zealand has the highest rate of youth suicide among 19 developed nations. Clearly, we have a problem. We asked several experts around New Zealand for their guidance on consulting with patients in primary care who are experiencing suicidal thoughts or behaviour. Stopping medicines in older people: the flip side of the prescribing equation Older people are generally prescribed more medicines than younger people. Not all medicines are intended to be used indefinitely and the balance of benefits and harms associated with each medicine and dose can change over time. Best Tests? The principles of laboratory investigations in primary care Laboratory investigations are essential for the diagnosis and management of many conditions, however, they do not provide clinical value in every scenario, and in some cases, may even cause harm. Understanding the clinical situations where laboratory testing may be problematic can help to improve the overall approach to testing. Interpreting urine dipstick tests in adults A urine dipstick positive for haematuria or proteinuria is relatively common in primary care. For many patients there may be a transient or benign explanation for the result, however, persistent positive results require further investigation. 2 Best Practice Journal – SCE Issue 1 www.bpac.org.nz
Welcome to your Special Commemorative Edition of Best Practice Journal 2020 We are pleased to offer our readers a curated selection of ten of our most popular and influential articles published in Best Practice Journal, Best Tests and online over the last few years. We have chosen topics to cover a wide range of primary care practice and have edited and updated these articles to include the latest evidence and prescribing data. These articles reflect some of our major campaigns that our primary care audience have engaged with and supported to translate into meaningful changes in practice. This includes significantly reducing the volume of oxycodone prescribed in the community and halving the number of prescriptions for topical antibiotics. Many of you have been with us since our first edition of Best Practice Journal, published in 2006. We went on to publish 79 editions over 12 years, with our last edition hitting the presses in 2017. We never said it was over though! So many of you ask us when you will get your next edition of BPJ, so we have delivered. We would like to make this a regular occurrence; online and in print format. We will let you know all the details, after we ascertain our audience's needs and finalise the specifics. As we move into a new era of publishing, we are also excited to explore future possibilities for optimising the way that primary care receives and interacts with medical information and continuing education. For example, integrating guidance directly into the patient record, to provide an "auto-assist" at the point of care. Any technology advancement will be underpinned by the robust, evidence-based, high-quality guidance that you know, trust and expect from bpac nz . We trust that you will enjoy this complimentary edition of Best Practice Journal. If you have any feedback, please email: editor@bpac.org.nz Ngā mihi, best regards The Publications Team, bpac nz 3
Page 1 and 2: www.bpac.org.nz SCE Issue 1 August
Page 3: CONTENTS SCE Issue 1 August 2020 4
Page 7 and 8: oxycodone has increasingly been use
Page 9 and 10: Summary: The price of safety is ete
Page 11 and 12: Early onset results in worse health
Page 13 and 14: A glucagon-like peptide 1 (GLP-1) r
Page 15 and 16: Table 1: Effects of diabetes medici
Page 17 and 18: DERMATOLOGY ANTIBIOTIC RESISTANCE &
Page 19 and 20: Erythromycin can be used for patien
Page 21 and 22: The line between normotension and h
Page 23 and 24: suitability of antihypertensive use
Page 25 and 26: CHILD HEALTH MEDICINE INDICATIONS N
Page 27 and 28: Managing insomnia without medicines
Page 29 and 30: MUSCULOSKELETAL RHEUMATOLOGY Managi
Page 31 and 32: Corticosteroid (triamcinolone aceto
Page 33 and 34: Febuxostat and CVD risk. In 2019, t
Page 35 and 36: Questions about the patient’s lif
Page 37 and 38: However, if a patient who is acutel
Page 39 and 40: MEDICINES MANAGEMENT OLDER PERSON
Page 41 and 42: emphasise that withdrawing a preven
Page 43 and 44: Stepping down PPI treatment There a
Page 45 and 46: to a poor outcome can provide insig
Page 47 and 48: is worthwhile requesting a diagnost
Page 49 and 50: GENITOURINARY SYSTEM GYNAECOLOGY AN
Page 51 and 52: Haematuria on dipstick Non-visible
Page 53 and 54: Proteinuria on dipstick Positive ur
Page 55 and 56:
pacnz PRIMARY CARE UPDATE SERIES Ou
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