News & Updates

Measles Alert!

The following advice has been communicated via Virus Watch dated 25th March 2018:

Four unrelated overseas-acquired cases have now been notified in WA residents over the past 10 days (two infected in Bali, one in Malaysia and the other most likely in Thailand or Malaysia).

People could potentially have been exposed to these cases at health-care facilities (including Bentley, Royal Perth and Joondalup Hospitals, GP surgeries, and pharmacies) and other sites around Perth.  

Secondary cases might present up until around mid-April. Moreover, there may be an ongoing increased risk of measles infection in Bali at present.

It is recommended that measles vaccine be considered for people travelling overseas who were born after 1965 and who do not have documentation of having had two doses of measles vaccine.

Current and archived issues of Virus Watch http://ww2.health.wa.gov.au/Articles/F_I/Infectious-disease-data/Virus-WAtch
 

New clinical guidelines for care during pregnancy

The Australian Government Department of Health has released a revised version of the Pregnancy Care Clinical Practice Guidelines. 

The 2018 edition of the guidelines combines Module 1 and 2 of the Antenatal Care Guidelines, published in 2012 and 2014 respectively. A number of chapters were reviewed and updated for this edition, in accordance with NHRMC requirements for guideline development.

The guidelines provide evidence based recommendations to support health professionals to provide high quality, safe antenatal care in all settings. They highlight specific approaches to pregnancy care for Aboriginal and Torres Strait Islander women, migrant and refugee women, and women with severe mental illness.

Among the changes is a new recommendation to encourage routine Hepatitis C testing at the first antenatal visit. Routine testing for Vitamin D status is now discouraged, unless there is a specific indication.

The guidelines recognise body mass index prior to pregnancy and weight gain during pregnancy as important determinants of health for both mothers and babies. The guidelines are designed for all health professionals caring for pregnant women, including midwives, obstetricians, general practitioners, Aboriginal and Torres Strait Islander health workers and allied health professionals. 

The Pregnancy Care Guidelines can be downloaded here

Medical Alert! Severe euglycaemic ketoacidosis with SGLT2 inhibitor use in the perioperative period

There have been a number of reports of severe euglycaemic ketoacidosis in patients with type 2 diabetes who are taking sodium-glucose co-transporter-2 inhibitors (SGLT2i) during the perioperative period. SGLT2i's are oral medications that promote glucose excretion in the urine for the treatment of type 2 diabetes. 

Diabetic ketoacidosis (DKA) should be considered in patients taking SGLT2i who: 
  • Develop abdominal pain, nausea, vomitting, fatigue or unexplained acidosis -  a normal plasma glucose level does not exculude the diagnosis
  • Have fingerprick ketone (or blood beta-hydroxybutyrate) levels >0.6 mmol/L in the perioperative period or >1.5 mmol/L at any other time
  • Have low pH on VBG or ABG, and low bicarbonate with a high anion gap, indicating metabolic acidosis
SGLT2i agents include dapagliflozin (Forxiga), empagliflozin (Jardiance), or a combination with metformin (Xigduo, Jardiamet)

Recommendations for Practice:
  • SGLT2i be ceased at least 3 days pre-operatively (2 days prior to surgery and the day of surgery) or in other physically stressful situations. This may require an increase in other glucose-lowering drugs during this time 
  • Strongly consider postponing non-urgent surgery if SGLT2 inhibitors have not been ceased prior to surgery and either blood ketones are >0.6 mmol/L, or HbA1c is >0.9%, as these are indicators of insulin insufficiency and a higher risk of DKA 
  • Routinely check both blood glucose and blood ketone levels in the perioperative period if the patient is unwell or is fasting or has limited oral intale, and has been on an SGLT2i prior to surgery 
  • It is strongly recommended that all patients with DKA are reviewed by an endocrinologist or physician on-call. If required contact your referral tertiary hospital for advice 

Please read the alert here for further information about the symptoms and recommendations for practice. 

Changes to the Practice Incentive Program Quality Improvement (QI) Incentive delayed until 1 May 2019

The Practice Incentive Program (PIP) has been a key driver in quality care in the general practice sector and the PIP QI Incentive will continue to build on this important work, further strengthening quality improvement in primary health care.

As announced in the 2017-18 Federal Budget measure Quality Improvement in General Practice, the design of the new QI Incentive will support general practice to better understand the quality of care being delivered, leading to better outcomes for patients.

However in a statement released to Primary Health Networks (PHNs) this week, the Australian Government stated that the additional 12 months will enable the Department to ensure that any implementation issues are identified and addressed and that general practices have adequate opportunity to prepare. 

Through practice support teams, such as Practice Assist in Western Australia, PHNs are already working closely with many practices to implement quality improvement – this work will not be slowed due to the new implementation date. The additional time frame will also allow the Department to have more detailed conversations with your practice support staff on how quality improvement is delivered in each of your respective regions. 


The changed time frame will mean that the following five incentives which were to cease on 1 May 2018, will now continue through to 30 April 2019. 

The five incentives are:

  • Asthma Incentive
  • Quality Prescribing Incentive
  • Cervical Screening Incentive
  • Diabetes Incentive, and 
  • General Practitioner Aged Care Access Incentive.

The six PIP Incentives that continue to remain unchanged are:

  • eHealth Incentive
  • After Hours Incentive
  • Rural Loading Incentive
  • Teaching Payment 
  • Indigenous Health Incentive, and 
  • Procedural General Practitioner Payment

For more information on the current PIP incentives, visit our Resource Library for fact sheets, or contact the Practice Assist Help Desk on 1800 2 Assist [1800 2 277 478] or email support@practiceassist.com.au

Cervical screening not recommended for women under 25 years under new programme

Cervical screening is not recommended in the renewed program for women under 25 years. Some women under 25 will present with an expectation for screening, having had previous Pap tests. 

Pathology Laboratories are reporting that a significant number of samples are being submitted from women under 25 years of age. Medicare does not fund routine HPV screening tests in women under 25 and testing of these samples will either need to be privately funded by the patient or, with the consent of the referring practitioner, not be processed. 

Commencing screening at age 25 will reduce the investigation and treatment of common cervical abnormalities that would usually resolve by themselves. It can take 10 to 15 years for cervical cancer to develop from persistant HPV. 

Women under 25 years who are currently under clinical management for a cervical abnormality should be managed according to the recommendations on transitioning individuals in the 2016 Guidelines

Symptomatic women at any age 
Women at any age who have signs or symptoms suggestive of cervical cancer (such as abnormal vaginal bleeding) should have a HPV and LBC co-test and be referred for the appropriate investigation to exclude genital tract malignancy. 

Routine cervical screening is not recommended in women under the age of 25 years
However, for women who experienced early sexual activity at a young age (<14 years) and who had not received the HPV vaccine before sexual debut, or those that have been victims of sexual abuse, a single HPV test between 20 and 24 years of age could be considered on an individual basis.

To avoid out of pocket fees for your patients, please familiarise yourself with the Pathology Test Guide for Cervical and Vaginal Testing

Further information on the Renewal of the National Cervical Screening Program is available at www.cancerscreening.gov.au/cervical

Get your NPS MedicineWise Virtual Visit

NPS MedicineWise Clinical Service Specialists (CSS) travel throughout WA metro and regional areas to deliver free, evidence based CPD to GP practices. However, regional practices don’t have to wait for an NPS CSS visit, because NPS CPD can be delivered at any time, via the internet as an interactive Skype Virtual Visit. 

Virtual Visits give general practitioners more options to book NPS CPD at a date and time that suits them.
 
Virtual visits are interactive discussions or topic content and as such, they qualify for RACGP and ACRRM accreditation, typically;

  • 2 Category 2 RACGP points in the QI CPD Program for the 2017-2019 triennium and
  • 1 Core point in the ACRRM PD Program for the 2017-2019 triennium.

 The topics available are posted on the NPS website.
 
General practitioners and practice managers who would like to book an NPS Virtual Visit can book through the website or contact Nicole Humphry at WAPHA on 08 6272 4921 or email Nicole.Humphry@wapha.org.au.

The mandatory Notifiable Data Breach Scheme has now commenced - Is your practice ready?

A Notifiable Data Breach is a data breach that is likely to result in serious harm to any of the individuals to whom the information relates. A data breach occurs when personal information held by an organisation is lost or subjected to unauthorised access or disclosure.

Examples of a data breach include when:

  • a device containing customers’ personal information is lost or stolen
  • a database containing personal information is hacked
  • personal information is mistakenly provided to the wrong person.

The Privacy Amendment (Notifiable Data Breaches) Act 2017 established a Notifiable Data Breaches (NDB) scheme in Australia. The NDB scheme requires organisations covered by the Australian Privacy Act 1988 (Privacy Act) to notify any individuals likely to be at risk of serious harm by a data breach.

This includes ‘Health service providers’ which provide a health service and hold people’s health information. This generally includes general practitioners (GPs), pharmacists, therapists, allied health professionals, gyms and weight loss clinics, and childcare centres among others.

This notice must include recommendations about the steps that individuals should take in response to the data breach. The Australian Information Commissioner (Commissioner) must also be notified.

Organisations will need to be prepared to conduct quick assessments of suspected data breaches to determine if they are likely to result in serious harm.
The NDB scheme will commence on 22 February 2018. It only applies to eligible data breaches that occur on, or after, that date.

For more information and a range of resources, including templates for notifying individuals and the OAIC, visit the OAIC

Medicines containing codeine can now only be accessed via a prescription

From 1 February 2018 all codeine products, including previously over-the-counter medications, will require a prescription from an authorised medical professional.

Reasons for this change are: 

  • Some people use excessive amounts of over-the-counter codeine preparations (up to 100 tablets/day) to get opioid effects and as a result sustain severe organ damage (liver, stomach and kidney). 
  • There is no evidence that the doses of codeine in these over-the-counter medications have any analgesic effects beyond placebo. Over-the-counter combinations of paracetamol and ibuprofen are far more effective. 
For more information, including suggested management of suspected opiod dependence in your patients, see the Fact Sheet For Health Professionals

The Alcohol and Drug Support Line offers a 24 hour helpline to patients who seek telephone counselling and advice in relation to alcohol and other drug issues: 
(08) 9442 5000 or 1800 198 024 (country callers).

Find Cancer Early: A Guide for General Practitioners

In Australia, over 75% of cancers first present in general practice as a result of symptoms. GPs play a key role in the early detection of cancer. GPs can experience challenges in early diagnosis as most GPs may only see between five to 10 new cases of cancer among thousands of consultations per year. Additionally, cancers in general practice often present with subtle non-specific symptoms and most symptoms of cancer can also have more common benign causes.
 
To assist GPs, Cancer Council Western Australia presents the Find Cancer Early GP Education Project with a new resource guide for GPs on colorectal, lung, prostate and breast cancer. The ‘Find Cancer Early: A Guide for General Practitioners’ resource provides evidence-based approaches to assess cancer symptoms to aid decision-making around further investigation or referral. The guide comes with a short video explaining how to use the guide in clinical practice and a WA Cancer Referral Directory. These resources are also accompanied with a Find Cancer Early Webinar Series. The series of four webinars host specialists presenting on; symptoms that best predict the four common cancers; implications for general practice when diagnosing patients with suspected cancer, and recommended referral pathways.
 
To access the resources and view the webinar recordings, visit www.cancerwa.asn.au/gp/fce.

1800 number for Health Care Home inquiries

Participating practices and patients can now contact the department on freecall 1800 290 637

This number is included in the revised patient handbook, which is being mailed to all Health Care Homes' practices and will be available online.

Practice Assist acknowledges the Traditional Owners of the country on which we work and live and recognises their continuing connection to land, waters and community.

We pay our respects to them and their cultures and to Elders both past and present.