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Updated algorithm for COVID-19 assessment and management in the community

The COVID-19 assessment and management algorithm (HERE) has been updated. The new algorithm now aligns with national rates for COVID-19 swabbing and comes into effect from midnight, Friday 18 September.  Please note that from this time there will no longer be different payments for ‘Out of Hours’ swabbing and face-to-face visits that do not result in a swab. These will now be paid at the rate of $60 per patient, rather than $80 per patient. These rates will be in place until further not...

September 18, 2020

Cellulitis HealthPathway-important updated advice for atypical location sites (e.g. hands, face, over a joint)

A recent review of POAC cellulitis cases has identified many cases where IV antibiotics have been administered for cellulitis at locations other than on limbs A sample of these cases has been reviewed with the regional Infectious Diseases specialists and the following changes have been made to the best practice recommendations within the Cellulitis HealthPathway: -when cellulitis location is atypical (hand, face ,head and neck, over a joint) specialist discussion is advised for all but mild case...

September 18, 2020

Increase in hospital admissions for AKI secondary to Cephazolin use

A review of multiple recent cellulitis cases has shown an increase in hospital admissions for Acute Kidney Injury (AKI) secondary to cephazolin use. In these cases, cephazolin doses have not been considered for reduction in patients with known or possible renal impairment, and Probenecid has been given. These cases have been reviewed by the POAC regional governance group Please note the following information: IF IV cephazolin is indicated i.e.: -Patient >/= 15 years -No improvement or worseni...

August 12, 2020

Temporary Covid19 funding change from 12th Aug 2020

COVID-19 swabbing: Urgent call to action Published by Auckland, Counties Manukau and Waitematā DHBs on 12/08/2020 9:14:31 PM. Auckland urgent care and general practices are asked to create and provide maximum capacity for Covid-19 testing. High priority to be swabbed: all contacts of current community cases (SURV-TM2 on lab form and e-Notification) all HIS- symptomatic and asymptomatic all symptomatic non-HIS Asymptomatic non-HIS are lowest priority but may be swabbed (SURV-TM2 required on la...

August 12, 2020

New OST Claiming Process

As of 1st July a new process will be introduced for referring and claiming for OST services. No action will be required by the GP practice.  All new OST referrals and quarterly invoicing will now be automatically processed by the POAC team using the CADs register of active patients. A reminder that no co-payment should be charged to the patient. Any queries should be directed to POAC accounts@poac.co.nz See all details HERE...

July 1, 2020

CELLULITIS IN PATIENTS WITH DIABETIC FOOT DISEASE

Over the last 12 months POAC claims have been made in seven cases where IV antibiotics were administered to patients with active diabetic foot ulceration who have then required hospital admission.  Five of these admissions resulted in amputation. POAC aligns its funding with the best practice, regionally agreed Auckland Regional HealthPathways. The Cellulitis in Adults pathway recommends against primary care administration of IV antibiotics in cellulitis associated with active ulceration in...

June 22, 2020

TSANZ statement on nebuliser use during Covid-19

Novel coronavirus disease 2019 (COVID-19) is an infectious disease caused by a newly discovered severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Since its identification in December 2019, COVID-19 has spread internationally and was declared a Public Health Emergency of International Concern by the World Health Organization (WHO) on 30 January 2020.It is recognised that some respiratory therapies such as nebulisation, high flow oxygen, non-invasive ventilation, and the use of cough a...

April 10, 2020

INR monitoring during Covid-19

Outpatient INR monitoring for patients receiving warfarin during COVID-19 pandemic. The need for regular INR testing among patients receiving warfarin to achieve safe anticoagulation is difficult during this time of “social distancing” to minimise the risk of spreading the virus. Hospitals, general practitioner practices and pathology services are minimising patients visits greatly. The following should be considered during this time to minimise patient contact: 1. Review if a direct oral a...

March 31, 2020

COVID-19 TESTING CENTRE LOCATIONS

Counties Medical , 106 Great South Rd, Takanini (09) 299 7670ETHC Airport Oaks, 149a Kirkbride Rd, Mangere (09) 275 1202Whitecross St Lukes, 52 St Lukes Rd, Mt Albert (09) 815 3111Henderson Specialist Centre, 31 Lincoln Rd, Henderson Shorecare Northcross, 948 East Coast Rd, Northcross (corner Oteha Valley Rd) Phone: 021 256 6321 (MUST CALL AHEAD)...

March 23, 2020

COVID-19 FUNDING

The e-Notification via Care Connect should be used to submit all Covid-19 notifications to Auckland Regional Public Health Service.     Reimbursement for activity is based on the patient paying no co-payment and is to be applied regardless of Residency status - see here: The e-referral will automatically generate a payment to the referring provider.  Do not submit a POAC referral. Retrospective submissions: For prior activity, please use the e-No...

March 23, 2020

CXR UNDER POAC FOR LOWER RESPIRATORY TRACT INFECTION

In light of the current COVID – 19 pandemic POAC would like to take the opportunity to reinforce the POAC funding policy for CXR in Community Acquired Pneumonia (CAP). In accordance with the Auckland Regional HealthPathway for Community Acquired Pneumonia in Adults Chest X ray is not usually needed in CAP unless it will change management. Acute CXR under POAC is not indicated unless it has the potential to avoid same-day hospital presentation or change immediate management. In most cases of ...

March 19, 2020

Rivaroxaban now an option pre-ultrasound for delayed DVT scans

The ultrasound DVT pathway has been updated to include a stat dose of 15mg oral Rivaroxaban where there is a delay >6 hours to ultrasound. This is an alternative to administering Clexane. Ensure to check contraindications and cautions - see link here for the Ultrasound DVT information The on-call Haematologist should be called for Friday delays where >1 dose may be required over the weekend. In addition to this change, note: Always calculate the Wells score FIRST unless special case (...

March 4, 2020

Top tips for adult dehydration management

POAC only funds dehydration cases for moderate dehydration with vomiting and must include a trial antiemetic and oral fluids for all patients presenting with moderate dehydration in primary care. After 60mins, reassess and if insufficient response then give IV fluids + antiemetic. Excludes patients with diabetes and children <15yrs. For migraine presentations, IV fluids are only funded if assessed as moderate dehydration and unable to tolerate oral fluids. Full adult dehydration guideline see...

February 18, 2020

New Toothache Auckland Regional HealthPathway

This new pathway provides guidance on the likely causes of toothache by type of pain and options for pain relief.  In addition it discusses the limited role of oral antibiotics, which antibiotics to use, and that intravenous antibiotics are not indicated for dental abscess. The pathway also suggests possible sources of assistance if cost is a barrier to accessing dental care. Please circulate and discuss at upcoming clinical meetings as POAC will not fund IV antibiotics for any dental relat...

February 12, 2020

Top tips for adult cellulitis management

A trial oral Fluclox 1g QID unless : symptomatic PVD, symptomatic venous insufficiency or BMI >40 for all patients presenting with cellulitis in primary care Discuss all cases for consideration of IVs without a trial of oral antibiotics with the Infectious Diseases team unless the criteria above are met-POAC funding requires specialist approval IV antibiotics pre or post incision and drainage are not funded through POAC-discuss with surgical team at hospital if required Great article on IV an...

January 22, 2020

POAC Funded ECG for chest pain

An internal review of chest pain cases has demonstrated that many claims for ECGs performed to investigate a possible  diagnosis  of  Acute Coronary Syndrome do not align with the Acute Chest Pain HealthPathway A normal ECG alone cannot rule out Acute Coronary Syndrome (ACS). Unless admitting to hospital based on ECG review, troponin must be sent to the laboratory and reviewed as soon as practical for the ECG funding criteria to be met in cases where possible ACS is being investig...

December 10, 2019

POAC funding of X-ray

An internal review of radiology cases claimed under POAC has highlighted many X-ray requests that do not align with the plain X-Ray HealthPathway  POAC funded X-ray should be reserved for same day imaging where results will inform immediate management and/or determine requirement for acute hospital admission.  To support claims, clinical notes submitted to POAC must include documentation of same—day review  of the X-ray result and the subsequent plan for patient care. &...

November 12, 2019

POAC funding awaiting ambulance transfer

Historically it has not been part of POAC’s remit to fund unavoidable admission i.e. admissions where, from the initial community assessment, it is clear that hospital evaluation is required.   In the current environment, delays in ambulance services continue to increase. This is particularly concerning with winter pressures and places additional resource issues on primary care facilities.   ...

August 31, 2019

Acute Pelvic Pain in Young Women

This pathway assists GPs with navigating through the causes of pelvic pain in young women to decide a provisional diagnosis and thereby refer to the correct service, or appropriately investigate and follow-up in the community. Please note there are limited indications for POAC-funded acute pelvic ultrasound –see (POAC pelvic policy); for publicly funded USS use access to diagnostics or DHB e-Referral if outside POAC criteria.View the full pathway for acute pelvic pain in women here...

May 28, 2019

Management of cellulitis accompanying an abscess

In January 2019 new pathways were published for Skin and Soft Tissue Abscess in Adults, Mastitis and Breast Abscess and Bartholin’s Cyst or Abscess. Communications were sent via Medinz and the POAC blog – click here to sign up Following review by the regional Antimicrobial Stewardship group please be reminded that any cellulitis surrounding an abscess should be managed in line with the cellulitis pathway (adults or children’s).  IV antibiotics are not funded by POAC for abscess m...

April 12, 2019

Changes to Hepatitis C Treatment

The Chronic Hepatitis C pathway has been updated for the newly funded direct acting antiviral (DAA) medication, Maviret™. Maviret™ is the recommended treatment in primary care for a majority of patients with Hepatitis C who do not have cirrhosis: Cure rate of 99% in primary care use.Only eight weeks of tablets once a day.Much simpler treatment to prescribe than previous funded medications.Very few drug interactions.Side effects usually minor and transient.Requires no on-treatment blo...

February 1, 2019

New Abscess Management Pathways

Auckland Regional HealthPathways has developed three new pathways for abscess management: Skin and soft tissue abscess in adultsBartholin's cyst or abscess Mastitis and breast abscess These best practice regionally agreed pathways have been developed with both primary and secondary clinicians and signed off through the regional Clinical Pathways Operational Group.  Please note the following main points: SKIN OR SOFT TISSUE ABSCESS Management of a skin or soft tissue  abscess is ...

January 31, 2019

Hospital Referral to Urgent Care/GP Clinic

When a patient attends Urgent Care with a hospital discharge summary stating for further POAC funded treatment, this includes the following principles: The Urgent Care clinic generates the POAC referral/case number when the patient attendsThe initial consult and all treatment for this episode of care should be invoiced to POACACC surcharges are funded by POAC, where relevantHyperemesis includes all presentations for duration of the pregnancyThere should be no cost to the patientAny queries pleas...

January 15, 2019

Pelvic Ultrasound Funding

Suspected retained products of conception beyond Section 88 funded scan time period. Persistent, heavy PV bleeding lasting more than 2 weeks following miscarriage or termination of pregnancy, or more than 6 weeks post-delivery, to rule out retained products of conception. For persistent but lighter bleeding a scan should be requested under Access to Diagnostics or via e-referral to radiology. Note that women within 2 weeks of miscarriage or termination of pregnancy, or within 6 weeks of delivery...

November 7, 2018

Rivaroxaban funding

In line with the Auckland Regional HealthPathway, when there is a delay in obtaining community ultrasound for DVT, Enoxaparin continues to be the medication to be administered and funded through POAC. The issue of using rivaroxaban instead of enoxaparin for anticoagulation coverage whist awaiting ultrasound for DVT was considered when the pathways were updated upon the PHARMAC funding of rivaroxaban. However, rivaroxaban use for this indication would be off licence and is not recommended by the ...

September 17, 2018 Posts 1-25 of 43 | Page next
 

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