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, 2019POAC 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, 2019POAC 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, 2019Acute 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, 2019Management 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, 2019Changes 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, 2019New 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, 2019Hospital 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, 2019Pelvic 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, 2018Rivaroxaban 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, 2018DVT Risk Stratification
A reminder that the first action for suspected DVT is completion of Wells Score. ONLY if <2 is a d-dimer required. If score is 2 or more then proceed directly to request for ultrasound. Awaiting d-dimer delays the ultrasound request and this may not be necessary For full details, see the DVT pathway NB: If you are unable to login to Auckland HealthPathways site, please contact POAC 09 535 7218...
June 27, 2018Antibiotics in sore throat and tonsilitis
Background In patients at low risk of rheumatic fever, antibiotics should only be prescribed if the patient is severely unwell. ≥ 70% of sore throats will be viral and do not need antibiotic treatment. For risk stratification and management of sore throat see sore throat and tonsilitis Where antibiotics are required they should be administered in accordance with the Heart Foundation guideline. Consideration should be given to the use of antibiotic syrup and an antiemetic if the patient is...
June 8, 2018POAC Cellulitis Management Funding Policy
POAC aligns its funding with the best practice recommendations contained within the Auckland Regional HealthPathways. These recommendations have been agreed by primary care clinicians and hospital specialists across the metro Auckland region. This includes Infectious Diseases, Medical Specialists and the regional Antimicrobial Stewardship Group....
January 31, 2018IV antibiotics for paediatric Cellulitis
The IV antibiotics for Paediatric Cellulitis guidelines are now up on the live HealthPathways site here.Intravenous antibioticsFor cellulitis, consider intravenous antibiotics administered in the community for children aged ≥ 10 years who are stable but not responding to oral antibiotics (review full pathway for details). This is funded by POAC. Review exclusion criteria and if uncertain, seek paediatric advice.Treatment:IV ceftriaxone 50 mg/kg/dos...
November 22, 2017Hepatitis C Treatment Primary Care Reimbursement
Funding has been allocated for the provision of integrated Hepatitis C Services. The Primary Options for Acute Care (POAC) service will be the mechanism for distributing the funding to GPs across Auckland Metro who provide Hepatitis C treatment in a primary care setting. GP Reimbursement A single extended consult per patient can be claimed up to the total amount of $115.00 (including GST). There is to be no patient co-payment charged. Payment for treatment of Hepatitis C by a...
July 10, 2017Opioid Substitution Therapy Funding
From 1 May 2017 authorised GPs who provide Opioid Substitution Treatment (OST) to patients can claim a reimbursement for a fixed number of patient/GP visits per year. This service is only for patients who are identified as stable and suitable to receive this care from an authorised GP by the Community Alcohol and Drug Service (CADS)/Auckland Opioid Treatment Service (AOTS).The Auckland metro DHBs have agreed to fund :4.5 (four and one half) visits per patient/service user, per year, for those on...
May 31, 2017New Adult Dehydration Guideline
A new clinical guideline has been developed to support management of acute adult dehydration in primary care. This has been developed by a group of primary care practitioners and specialists in the field to provide guidance with respect to the management of adult dehydration. If you wish to provide any feedback on this guideline, we would love to hear from you - submit this here...
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