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COVID Fast Facts

27 October 2021

The information contained in this Fast Facts Edition is the best information we have right now. Apologies for double ups.
CONTENT - NON COVID - PRACTICE INFORMATION
CONTENT - COVID
Introducing our latest Auckland PHO team member, Tracey Gilling – Kaiawhina Hauora – PHO Primary Care Support
We are delighted to welcome Tracey, whose role is to ensure the administration component of Practice Management hums along smoothly. Tracey has been a Practice Manager for the past 10 years and brings practical, hands-on experience to support practice administrators and managers across the Auckland PHO network.  She has a strong connection with the philosophy of helping people and supporting General Practice to deliver excellent health care.
Practices will get to meet Tracey, either in person or by zoom in the next few weeks and she will be in touch with each practice soon. She has a 6-year-old son and in her spare time she enjoys being with family and is Club Captain for Ripper Rugby in Mount Roskill.
Tracey’s contact details will be circulated next week.

 
N95 Fit Testing
P2/N95 particulate respirators are worn to protect against exposure to airborne pathogens smaller than droplets (< 0.5 microns). They work by filtering particles out of the air as you breathe. To be effective, a tight facial seal covering the nose, mouth and chin is required. 

Prior to the August COVID-19 lockdown, general practice workers were required to undergo a fit test by an appropriately trained person and a practice declaration that fit testing had been completed was required by the MoH to enable N95 ordering via Onelink.  There is currently an exemption for Auckland based general practices to supply a declaration during Levels 4 and 3.
 
Many Auckland PHO teams completed fit testing using the ‘smell and sniff’ test under an exposure hood, however, this test is not recommended in the current Delta environment. 

We now have access to a Portacount machine and a dedicated Auckland PHO staff member, Aaron Piano, a registered nurse has completed the fit test training and is available to undertake fit tests for our clinical teams.

New staff, GPs, nurses not yet fit tested and those unsure if their N95 mask is a secure fit will be a priority for fit testing and Aaron will contact these people over the next few weeks.  In the meantime, if you have any questions or would like to book a fit test, please contact Aaron by email, aaron@aucklandpho.co.nz


Connecting with Practices via Zoom
There is so much going on in the health sector at the moment, and we understand there is a myriad of information being sent in all directions which can be overwhelming. We would like to connect with your practice team by zoom at a time/day that suits you where you can check in with the relevant PHO team member(s) for information and clarification of COVID-19 and other matters you would like to discuss. Priscilla will send an email to practices tomorrow, inviting you to a zoom meeting. 
COVID-19 Important Information for Primary Care
COVID-19 Testing and Assessment e-Notification Update
Published by Auckland, Counties Manukau and Waitematā DHBs on 27/10/2021 9:08:52 AM.

As of today (27 October 2021), the e-Notification for COVID-19 Testing and Assessment has been updated to reflect the revised funding framework.

The main changes of the funding framework are:
  • The patient categories for full assessment have been broadened and now comprise symptomatic patients for whom any of the following apply: HIS/Contact; residing in Alert Level 3 or 4; clinical suspicion; and testing according to local DHB guidance.
  • Removal of a “chest exam” from full assessment. The requirement now reads a “documented full patient assessment, including a history, consideration of pre-existing medical conditions, clinically appropriate examination and management plan”.
The current funding levels continues to apply:
  • Virtual COVID-19 consult/Declined COVID-19 swab - $60
  • COVID-19 swab +/- limited examination - $120
  • Full assessment of a COVID-19 patient with swab or full assessment of a COVID-19 patient who requires hospital admission without a swab - $250.
For further information please see COVID-19 Funding and Supplies.

We are continuing to work on funding and claiming mechanisms for care provided to COVID-19 cases and vaccination adverse events. A further Medinz will be published once we have more details. 

Please send feedback to Stuart.jenkins@waitematadhb.govt.nz
 
Further Update: COVID-19 Case Management in the Community
Published by Auckland, Counties Manukau and Waitematā DHBs on 26/10/2021 8:24:13 AM.

Section 70 has been changed so that the Medical Officer of Health (‘Public Health’) can decide the appropriate place of isolation of a patient with COVID-19.  For some patients this may enable them to isolate in the community at their usual residence (i.e. Community Supported Isolation and Quarantine (C-SIQ)).

Additional Primary Care Funding
Funding published last week (Thursday 21 October) enables primary care to claim funding if Public Health refers a COVID-19 patient for full management by primary care teams.
The C-SIQ clinical team is looking after patients with COVID-19 who are isolating in the community, with support available 24 hours a day. At this stage, primary care will not be approached to take over full care, but may be asked to contribute to the care of people with COVID-19 in the community.

Funding has been made available to include COVID-19 related care provided by primary care for a patient with COVID-19 on request from Public Health, the C-SIQ clinical team, or the patient. This is irrespective of where the patient is in their journey. Non-COVID-19 related care (e.g. prescription repeats, pre-existing conditions) and proactive activity (e.g. welfare calls) is not included in this funding and co-payments should be charged if appropriate.

Claiming will be available via POAC; further details on funding and how to claim will be published when available. Retrospective claims will be allowed to 18 October 2021 so please keep records of activity.

A full patient assessment should be documented, including a history, consideration of pre-existing medical conditions, clinically appropriate examination, and management plan. This should be included in any claim.


Current Journey for People with COVID-19
  • Public Health will contact the patient to inform them of their COVID-19 status and assess the patient’s public health risk.
  • This assessment is used to inform the decision on whether the patient meets the criteria to isolate at home or needs transfer to a Managed Isolation and Quarantine (MIQ) facility.
  • Public Health will make a manaaki/welfare referral to support further needs if indicated (e.g. food, pets). Referrals can be made at any stage if the whānau indicates an urgent need. If you identify a manaaki need, please contact the dedicated C-SIQ helpline (0800 687 647).
  • If a patient can safely isolate at home, C-SIQ will complete an initial assessment, send a pulse oximeter if indicated, and monitor the patient’s symptoms virtually.
  • If a patient cannot safely isolate at home, they will isolate at their residence until their transfer to MIQ can be completed. Public Health will continue to monitor their symptoms in the interim. Any acute deterioration will be escalated to primary or secondary care as appropriate.
  • Public Health cannot provide personal health advice to COVID-19 cases. Therefore, the enrolled general practice may be contacted by Public Health or by the patient to provide usual primary care.
  • People with COVID-19 are also advised to contact their general practice for their non-COVID-19 related health needs. Charge the patient as normal for this care.
  • The patient will be cleared for release from self-isolation once they have met the relevant criteria – in most cases this is 10 days post symptom onset and 72 hours symptom-free.
  • We are working on an IT interface to enable GPs to be notified routinely at each major step of the patient journey.
Note: this is the pathway under current public health settings and model of care, and is likely to change as Auckland transitions from elimination to suppression. There may be some delays in transition of care between Public Health and MIQ teams.

Advice to Primary Care
  • Please endeavour to provide all care to patients with COVID-19 virtually.
  • If a patient calls for their COVID-19 test result and it’s positive, please advise them to isolate at home and Public Health will contact them within the next 24 hours.
  • If you are caring for a COVID-19 patient in the community, please refer to COVID-19 Case Management in Adults for triggers for considering admitting a patient to hospital (see Subsequent Assessment, #6).
  • A dedicated Healthline number 0800 687 647 (0800 OUR MIQ) has been set up to assist patients with questions about C-SIQ. Primary care may direct patients to this helpline.
  • The COVID-19 Clinicians Advice Line (0800 177 622) is available to provide peer-based assistance to navigate information regarding COVID-19. This number is not publicly available and should not be given to the public. It is available 8am to 8pm, 7 days a week. Note: this line is not a source of information about access to equipment, staffing or funding.
  • Refer to Acute COVID-19 Assessment on HealthPathways if your patient requires admission to hospital.
  • Refer to COVID-19 Advice on HealthPathways if you require specialist  advice on COVID-19. This includes options to contact the MIQ Clinical Teams.
Managing COVID-19 in the Home Webinar
The Goodfellow Unit is facilitating a webinar on managing COVID-19 in the home in conjunction with the NRHCC. The webinar will be held on Thursday 28 October 7.30 to 8.45pm. The webinar will cover what has been done in London and Canada around home management of COVID-19 patients, current experience from the MIQ team, and current planning and modelling for Metro Auckland. To register visit the Goodfellow Unit.

To send feedback, please email Stuart.jenkins@waitematadhb.govt.nz
COVID-19 Vaccination Programme Update
In-home COVID-19 vaccinations
Published by Auckland, Counties Manukau and Waitematā DHBs on 26/10/2021 11:29:00 AM.

Following the Medinz message on Wednesday 6 October regarding the availability of a home-visiting fee for home-bound clients who require a COVID-19 vaccination, we would like to remind General Practices they must be approved as an outreach provider by their PHO prior to conducting in-home COVID-19 vaccinations.

The home visiting fee of $163.95 (excluding GST) is in addition to the vaccination fee of $36.05.

Patients are eligible for a funded in-home COVID-19 vaccination when they are clinically or physically unable to leave the house. Practices are able to deliver this service to their enrolled patients only.  Please note only one home visiting fee is available per household despite the number of vaccinations administered at the home.  Rest homes are defined as one household.

Payment for this initiative is via POAC. Please complete the customised POAC electronic form by selecting the drop down option “COVID-19 Vax Home Visit: Clinically and/or physically unable to leave the House”, and submit the vaccinator and general practice name along with the usual patient information. The reason the patent needs an in-home vaccination must be included in the free text box.

Please refer to the COVID vaccination home-based SOPs for further clinical guidance. See HealthPathways. In-home COVID-19 Vaccination – Standard Operating Procedure.  Located on HealthPathways: COVID-19 Vaccination Resources under Local guidance > Health professional resources.

If you know of home-bound patients who still require COVID vaccinations and your practice is not able to deliver this service, please call the COVID Vaccination Healthline on 0800 28 29 26 or email nrhccvaxenquiries@adhb.govt.nz to register their details. The NRHCC outreach team will then get in contact with the patient to book a home visit.

Mandatory vaccinations
The extended COVID-19 Public Health Response (Vaccinations) Amendment Order 2021 requires workers who face a high risk of exposure to COVID-19 and who work in the health and disability and education sectors or in prisons to be fully vaccinated.

The Order requires all health and disability workers and education workers to have received their first dose of the COVID-19 vaccine by 15 November 2021. Both the health and disability workers and the education sector workers must be fully vaccinated by 1 January 2022.

Correctional facilities workers are required to have their first dose by 6 November, and be fully vaccinated by 8 December.

More information is available on the Ministry of Health website.

Booster doses
Booster shots have not been approved as yet by Medsafe and therefore, are not to be administered by COVID vaccination providers.  Booster doses are different to third primary extension doses recently approved for immunocompromised patients. 

Medsafe is currently reviewing the research about booster doses as it becomes available and it is expected that the government will make a decision about this in the near future.

Please send feedback to Sarah.Hartnall@waitematadhb.govt.nz
Update on funding COVID-19 vaccination conversations
Published by Auckland, Counties Manukau and Waitematā DHBs on 26/10/2021 6:17:24 PM.

Further to the earlier Medinz messages on 30 September and 7 October, virtual COVID-19 vaccination consultations are proving effective and the funding ($60 plus GST) will now be extended to include Nurse Practitioners.

These virtual consultations are to provide Māori and Pacific patients with the opportunity to ask questions, address any concerns they may have and help them get vaccinated.

Key things to note:
  • The funding is for proactive virtual consultations (i.e. in-depth phone conversations) with enrolled Māori and Pacific patients to encourage vaccination. A brief vaccination conversation within an unrelated booked consultation does not meet the intent of this initiative.
  • These virtual consultations must be conducted by General Practitioners and Nurse Practitioners.
  • It is important that the record of the consultation notes includes the specific concerns raised by the patient as the basis for the discussion.
  • This initiative is for Māori and Pacific patients that are unvaccinated and don’t already have a booking for their first dose.
  • This should be claimed using the usual POAC claiming process via your PMS. Use the drop down “GP Vaccination Conversation (Māori and Pacific patient only)”.
  • The claim must be accompanied by supporting information about the quality of the conversation with the patient, e.g. a mention at the end of an unrelated consultation is not suitable for funding.
  • A claim can only be made when a conversation has taken place with a patient or member of their family. If the claim is for a family member of a patient, please include their NHI number in the claim.
Please send feedback to Sarah.Hartnall@waitematadhb.govt.nz
Other Important Information for Practices
Medication Alert – Baclofen Oral Liquid
 
The National Medication Safety Advisory Group (NMSAG) and the Compounding Working Group (CWG) are aware of a number of serious overdose and underdose medication errors related to the inconsistency in the concentration of baclofen suspension and liquid used across hospital and community healthcare settings.
 
The standardised baclofen oral suspension batch sheet will change to a 1 mg/mL concentration, effective 1 November 2021. This change will promote consistency and help to reduce harm from medication errors, especially at transitions of care.

Please refer to the medication alert for more information and for actions to be taken (attached). The medication alert is also available online on the Commission website at https://bit.ly/3B3E6la

Please share this medication alert with relevant staff and members of your organisation and any other relevant organisations who may have been missed in this mail out.
Pharmacists, please also share this alert with care facilities that baclofen suspension is provided to.
 
This alert will be circulated to DHB CEOs, DHB Pharmacy Managers, DHB CMOs, DHB DONs, DHB Quality Leads, DHB Pharmacy portfolio managers, Pharmaceutical Society of New Zealand, Pharmacy Council, Royal New Zealand College of General Practitioners, Primary Health Organisations. The alert will also feature in the Commission’s e-digest, to be published on Thursday 28 October 2021.

Baclofen_medication_alert_Oct2021_FINAL.pdf
 
Get involved in transforming mental health legislation in Aotearoa New Zealand

One of the recommendations in He Ara Oranga was to repeal and replace the Mental Health (Compulsory Assessment and Treatment) Act, and Ministry of Health has opened consultation to gather information and feedback that will inform the design of the new legislation.

Read more about this consultation on the Ministry of Health website

The Mental Health Act became law in 1992. It has not kept pace with new approaches to care, and statistics show that Māori, Pacific peoples, and disabled people experience a range of inequities under the Act.

MoH has heard why change is needed, and the next step is to get clear direction for what mental health legislation in New Zealand should look like. MoH has an opportunity to create new mental health legislation that protects human rights, recognises Te Tiriti o Waitangi, and improves equity.

Although the current Mental Health Act is only used for a small proportion of people each year, it has a big impact on the lives of those who do experience it, and their family and whānau. In particular, MoH wants to hear from people and communities who have been impacted by the legislation.

MoH is transforming Aotearoa New Zealand’s approach to mental health and addiction, so that people can get the support they need, when and where they need it. Ensuring MoH has fit for purpose legislation is one part of this transformation, and we encourage you to get involved, and to share this consultation through your networks.

Changes to Middlemore Radiology Walk In Xrays
Published by Counties Manukau Health on 21/10/2021 11:37:45 AM.

From 26 October all walk in X-rays must be requested via e-Referrals.

Where possible, a copy of the submitted e-Referral form should be printed and given to the patient to take with them to Middlemore Radiology Reception.

If a patient walks in for an X-ray and there is no corresponding e-Referral request in the system you will be contacted and asked to put one through.

The walk in service at Middlemore is for CXR only.

All other X-ray requests must be discussed if they are required urgently - phone 276-0044 ext 58919 or 58610.

If the urgent request is accepted, a time will be given to the patient for their X-ray.
Please see HealthPathways – Plain X-ray Requests for full details. 

Please send feedback to danielle.gerrard@middlemore.co.nz
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