This WHO website provides a host of resources about the global situation and strategies to achieve the nine-global voluntary NCD targets with the overall objective to reduce premature deaths from cancers, heart and lung diseases and diabetes by 25 per cent by 2025.
An additional resource about the impact of nursing on NCD management can be found here: www.who.int/hrh/resources/observer12/en.
[Site accessed 29 April and last updated February 2018].
www.researchreview.co.nz/nz/Clinical-Area/Internal-Medicine/Diabetes-Obesity.aspx
This focused review features key medical articles from global diabetes and obesity journals, with specific New Zealand expert commentary. Broadly, topics include insulin and metformin use, type 2 diabetes, gestational diabetes, type 1 diabetes, bariatric surgery, diabetic retinopathy, thiazolidinediones and sulphonylureas.
[Site accessed 29 April and last updated 2018].
Dr Kathy Holloway is the director of the Graduate School of Nursing, Midwifery and Health at Victoria University.
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More than a decade later, the Capital & Coast DHB diabetes clinical nurse specialist has been the lead on four internationally published research papers on hypoglycaemic episodes in children and adults with diabetes.
Current international guidelines are to give children 10g of glucose and adults 15g if they are hypoglycaemic, no matter what their size. But McTavish and his research team of doctor colleagues from CCDHB and the University of Otago did trials – firstly with children attending a diabetes camp and then later with adults with type 1 and then type 2 diabetes – to determine if the dose should vary with the patient’s weight.
“We carried out four clinical trials over 10 years to try to find whether there is a faster and more effective way to treat hypoglycaemia in children and adults with diabetes,” says McTavish.
The team’s recently published results indicate there is. The findings show larger people need more glucose – so a weight-based method is the best way of managing hypoglycaemia. The Wellington team’s research – if reviewed and adopted – could lead to guideline changes worldwide in how hypoglycaemia is managed.
So how did a clinical nurse specialist end up leading the world in this type of diabetes research?
“I joined what is now Capital & Coast DHB as a paediatric diabetes nurse in the diabetes service in 2000 – just a month before 9/11,” recalls McTavish. “Back then the international recommendation was to give those with diabetes 10 grams of glucose to anyone having a hypoglycaemic event, regardless of whether the child was three or 15 years old.
“I wondered about this, and asked ‘why do we do it this way when with every other medicine given to a child it is measured on how much that child weighs?’,” says McTavish.
McTavish dug deeper and found that the international research literature recommending the dosage amount for children was based on professional opinion and not on clinical evidence.
McTavish – who now has 25 years’ nursing in diabetes and a clinical master’s under his belt – at that point wasn’t sure about the next step. So he talked to paediatrician colleague Associate Professor Esko Wiltshire, whose own research specialty is diabetes, and Wiltshire recommended he go to the UK to do a short course being offered at Cambridge University by the International Society for Paediatric and Adolescent Diabetes (ISPAD). There McTavish learnt how to do both qualitative and quantitative research on diabetes in children.
“Once I’d got the ethics sorted, I was able to do our first research at a camp for children with diabetes in Otaki in 2007.”
Both the children and their families were surprisingly supportive of the research at this stage, says McTavish.
“We were looking at what types of glucose should be used when treating a hypo and looked at their weight. We tested the different groups of common carbohydrate treatments, including glucose tablets, jelly beans, fruit juice and mints, to see what was the most effective.”
Together with his team, McTavish presented their children’s camp research – which found that treatment with 0.3g/kg of carbohydrate (excluding jellybeans) effectively resolved hypoglycaemia in most children within 15 minutes – to an international meeting.
From there someone suggested doing the same study on adults with type 1 diabetes and McTavish said ‘yes let’s give it a go, let’s do it’.
This later led to a research paper on adults with type 1 diabetes, then children and adults on insulin pumps, then a research paper on what amount of glucose best helps someone with type 2 during a hypoglycaemic event.
The research all showed that treating someone with more glucose, if they were larger, and less, if they weighed very little, was more effective than the current guidelines. As a result, Capital & Coast and Hutt Valley DHBs switched 10 years ago to a weight-based approach for children and five years ago for adults.
The impact of treating hypos with glucose tied to the weight of the patient has been huge, says McTavish.
“If you give the right amount of glucose in the beginning, you can actually shorten the duration of the hypo. A hypo can last for more than 15 minutes for the symptoms of shakiness etc. to return to normal. But they can be resolved in 10 to 12 minutes if treated properly.
“If you don’t get the right amount of glucose into the patient, they will be having longer and more hypos over time.
“Cognitive gaps and signs of dementia are now being seen in long-term diabetes patients as a result of too many hypos,” says McTavish. “So you may as well do it right once rather than follow the international guidelines and give them several doses of glucose throughout one hypo.”
From the get-go, McTavish was drawn to diabetes nursing.
He sees one of the most important elements of what is a multi-faceted role is first and foremost minimising the shock of a diagnosis to the families affected by diabetes – particularly a child diagnosed with type 1 diabetes.
“Some of those families are injecting insulin two to five times a day. A lot of families and kids hate getting, or administering, injections. It is an ongoing process of matching their food with their insulin and activity to get it right.”
McTavish didn’t always plan on being a nurse; he did two years of pharmacy training before changing tack.
“I actually chose nursing after coming across a motorbike accident one day and finding I was totally useless at the scene. I later went to Sydney Children’s Hospital to start one of the last hospital-based nursing programmes – I didn’t think I was cut out for learning in a classroom.”
Prior to beginning the research, McTavish remembers reading just one line in an American Diabetes Association publication talking about studies in the 1990s suggesting tying glucose to weight.
“Otherwise it hadn’t been studied. Previously the adult patient would feel symptoms like feeling shaking and difficulty concentrating at a blood glucose of around 3.1 mmol/L then they would be told to have, say, 15 grams of glucose.
“The longer and more frequent the hypos, the higher the likelihood of brain damage of one form or another, or it could lead to poor diabetes control and bigger problems later on, like eye disease and renal failure.”
McTavish says diabetes burn-out for clients is a real thing. “You feel empathetic towards them; they’ve been doing injections and testing for many years and surviving with a chronic illness. It’s a tightrope managing both hypo and hyper events.
The juggle – of nursing and research – is also real, says McTavish. “I have to be conscious about having ringfenced time for research. Clinical time is clinical time and you think differently.”
“I came up with a simple algorithm for the type of research any nurse can do,” says McTavish. “You have a question you need the answer to. You just have to find the energy to answer it.
“You shouldn’t have to do it alone; you need a statistician and people who are willing to edit your work, as well as a librarian to help you do the literature search.
“It doesn’t have to be complicated. Research adds to the body of evidence we use every day in our clinical nursing practice.”
Hilary Graham-Smith, associate professional services manager for the
New Zealand Nurses Organisation, agrees. She says nurses are conducting research as part of their job sometimes without even realising they’re doing it.
“Nurses are doing research when they are trialling a new wound care product, for example. They bring huge experience and knowledge to research, so if they come up with a theory and put it to the test, the benefits can be fantastic for consumers.”
While there are not many positions where nurses focus solely on research, nurses can do research as part of their programme of study, including as part of their master’s study.
Nurses have insights into a patient’s experience that other health professionals do not, says Graham-Smith. “Patients can find it easier to talk to nurses about what is going on for them. Nurses are at patients’ bedsides in hospitals and that can give them a lot of insight into how patients are feeling and about their treatment.”
Graham-Smith says that while there are barriers to nurses being involved in research, such as a lack of time and a heavy workload, McTavish is an example of the power of nursing research. “Lindsay has a lot of passion, experience and knowledge and has put it to excellent use.”
For McTavish’s research on adults with type 2 diabetes, the average weight of patients was 90kg. Next up, Lindsay wants to look at the effects of a higher amount of glucose for some bigger people, weighing around 140kg.
“I never get tired of research – there’s always another question to be asked and answered. All the studies set the path for the next one.”
]]>A report released by the Health and Disability Commissioner Anthony Hill found the DHB and two of its nurses – a district nurse and a clinical nurse specialist in wound care – were in breach of the Code of Health and Disability Services Consumers’ Rights for their dealings with the case.
Hill was very critical of system failures at the DHB that resulted in three referrals made in three weeks being triaged in isolation with the individual doctors involved in triaging the woman’s referrals not having access to all relevant information, including recent referral history and previous referral documentation.
Hill was critical that the clinical nurse specialist failed to follow up her referral for the patient to undergo urgent vascular assessment and to escalate the woman’s care to her GP or the hospital. Mr Hill was also critical of the district nurse who most regularly saw the patient for failing to document objective measures of pain adequately and failing to refer the woman to a GP or a specialist when the woman’s condition deteriorated.
At the time of the events in March-April 2015 the patient was 80 years old and was living at home with weekly home help and the support of her daughter. She had multiple co-morbidities including type 2 diabetes, COPD, hyperlipidaemia, hypertension, spinal stenosis, and polymyalgia rheumatic.
In March 2015 she fell out bed and injured her right foot and first visited her GP in March 2015.
She was referred to Whanganui Hospital for an assessment by her GP, however an orthopaedic surgeon at the hospital was unable to read the referral.The surgeon therefore did not triage the referral and the woman went back to her GP, who referred her on to a podiatrist for an urgent assessment.
The podiatrist, who specialised in diabetes foot care, examined the patient and referred her on to the district nursing service for care and dressing of the ulcer wound. Several days later he also made a referral to the hospital surgical team saying the woman had arterial insufficiency and the patient would benefit from further investigations. The surgical consultant at the hospital triaged the referral as semi-urgent.
District nurses who visited the woman during March and April noted the wound was very painful. The nurses called in a DHB clinical nurse specialist in wound care to assess the wound and noted the patient had a ‘stinging burning pain in her right foot’. The specialist noted that the right foot was purplish in colour when elevated, there was oedema, no palpable pulse and a further doppler investigation revealed no audible sounds on the injured right foot. There was also a blackened toe and a pressure injury on her left buttock.
The nurse specialist said she came in on her day off to complete a referral to the public hospital for an urgent vascular assessment. However the consultant at the hospital was not made aware of the multiple other referrals and he triaged the third referral as “semi-urgent” and the relevant appointment was made for May.
A nurse fast-tracked this to the next month, but with continued visits failed to assess pain and escalate care.
When the patient showed for the vascular appointment at the end of May she was diagnosed with critical limb ischaemia – a severe obstruction of the arteries which reduces blood flow to hands, feet and legs and can cause ulcers or sores.
She was admitted to hospital and despite several limb salvaging procedures she required right below knee amputation in may and died following post-operative complications.
The investigation and Hill’s report into the inquiry was prompted by a complaint from the patient’s son.
Following the report’s findings it was recommended the DHB promptly provide updates of a new “clinical portal” system as well as create and implement a training system programme for district nurses on pain management.
Hill also recommended the DHB and one of its nurses provided a written apology to the patient’s family for failings identified in the report.
“The apologies are to be sent to HDC within three weeks of the date of this report, for forwarding to Mrs B’s family. RN D has already provided an apology,” Hill wrote.
Whanganui District Health Board’s director of nursing Sandy Blake said hospital staff were taking all of the recommendations listed in Anthony Hill’s report, on board.
The Health Board had fully implemented clinical portal – an IT system into which nurses wrote patient notes.
“This system allows health professionals to track the patient journey and allows all clinicians to see the same notes,” Blake said.
Nursing staff had undergone training and an auditing system would measure compliance.
Blake said the nurses whose practise was deemed to be unsatisfactory, were being managed through the DHB’s performance management process.
The investigation and Hill’s report into the inquiry was prompted by a complaint from the patient’s son.
Source: Wanganui Chronicle plus additional reporting by Nursing Review
The full HDC report can be read here.
]]>The study by Otago, Auckland and Victoria university physician, nurse and health researchers, just published in the international journal Annals of Family Medicine, follows the interactions that 32 patients had with their GPs, nurses and other health professionals in the first six months after being diagnosed with type 2 diabetes.
Professor Tony Dowell of University of Otago, Wellington, and the lead author, said the study found that despite many health professionals having high communication and technical skill levels, there were still many opportunities to communicate and consult more effectively with their patients.
The researchers videoed the first post-diagnosis consultation and all the patients’ subsequent consultations with health professionals over the six months, which ranged from just one consultation to up to 12 consultations. The time spent with all health professionals over that six months ranged from just 27 minutes for one patient to seven hours and 12 minutes for another patient* (see details below).
The average GP consultation was 22 minutes (range = 6 minutes to 56 minutes), the average nurse consultation was 41 minutes (range = 8 minutes to 95 minutes) and the average dietitian consultation was 24 minutes (range = 17 to 52 minutes).
Dowell said that strengths found by the researchers included high levels of communication skills, enthusiasm to co-ordinate services, and good allocation of time to patients.
But researchers believed optimal care for newly diagnosed patients could be improved in a number of ways, including questioning and listening to patients more in initial consultations to gain insight into what they already knew about diabetes and their personal circumstances.
Researchers found that often initial consultations were driven by biomedical explanations that patients did not relate to. Clinicians also often assumed patients knew little about diabetes, when many already had some diabetes knowledge from other family members or had had pre-diabetes symptoms.
“Patients who have just been diagnosed with diabetes or other long-term conditions bring their own expertise and experience to the situation and healthcare professionals need to listen to this. We need to rethink our usage of technical biomedical language when talking to these patients,” said Professor Dowell.
“Despite the high levels of generic communication expertise by clinicians, many patients found the style and content of health promotion and lifestyle advice did not apply to their lives.”
The researchers found patients were also concerned about the overuse of checklists, and suggested a need for more effective methods of sharing patient information.
The time spent with patients over the first six months was also found to vary considerably – which researchers said was partly due to patients’ varying complexities of needs, but they also found much of the time variation was due to repeating educational information because of a lack of co-ordination between GPs, nurses and other health professionals. The researchers said this meant time that could have been spent on motivation interviewing was often undermined by a duplication of information and advice.
“These findings suggest that time spent in consultations should be reviewed for appropriateness, and health professionals should agree on who will cover various aspects of education so that repetition is avoided unless intended,” found the study.
Dowell said that although there had been a huge amount of research into diabetes, this was the first study to directly observe the patient journey and interactions with different health professionals from the onset of diabetes.
“Our results highlight the important role that communication plays in diabetes management, and the overall commitment of primary care teams to delivering patient care.”
The study authors recommend that clinicians employ a framework for communications with diabetes patients that acknowledges the importance of the patient’s own particular situation and social needs and that time could be allocated more effectively and efficiently when patients see multiple clinicians.
“Our main aim is to improve our patients’ health, and this research shows that appropriate communication with patients is a key component,” said Dowell.
“The research makes us appreciate the importance of listening more and possibly talking less in consultations. It helps with understanding and improving healthcare one sentence at a time.”
*The patient with seven hours and 12 minutes of consultation time had their first post-diagnosis consultation with a nurse and in total had three Care Plus GP/nurse consultations, two nurse consultations, one GP consultation, two podiatrist consultations and two dietitian consultations.
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The changes have been implemented through the district health board-wide ‘Sweet As’ campaign to improve management of patients’ diabetes while they’re in hospital.
“Around 15-20 percent of inpatients – patients who stay overnight – have diabetes. That’s 120 patients with diabetes in our hospitals at any one time,” said diabetes nurse Miranda Walker.
“A key part of managing patients’ diabetes is ensuring they don’t develop hyper or hypoglycaemia – where blood glucose levels become too high or low. That can be difficult when a patient needs to fast before a surgery or a procedure.”
That’s why insulin management for fasting patients is being improved, along with clearer guidance around hyper and hypoglycaemia.
“We used to wait until a patient’s blood glucose dropped below four millimoles of glucose per litre of blood before acting. Now we act if it drops below six. We also have more consistent guidelines for treating high blood glucose – which can lead to slower recovery, infections, and longer hospital stays.
“These changes are expected to help keep patients’ blood glucose at levels that encourage wound healing – meaning they will recover faster from surgery, leave hospital sooner, and have a far better experience and outcome overall.”
]]>Pharmac today announced it had negotiated a sole supplier agreement with Pharmco to supply four fully-funded CareSens meters – two of them not currently funded. In addition, from August 1 it will stop funding the Freestyle Optimum and Accu-Check Performa meters and test strips currently used by about 3,000 people.
Dr Bryan Betty, Pharmac deputy medical director, says blood glucose meters are used every day by about 120,000 New Zealanders and most won’t have to change the meter they currently use.
Pharmac estimates that the deal will save more than $10 million over five years – similar savings to those signalled when Pharmac signed its contract with Pharmaco in 2012 that led to more than 100,000 people having to change their funded brand of blood glucose meter.
That massive transition was controversial, with many users expressing concern at the accuracy of the blood glucose readings from their new meters and anger at funding not continuing for their existing meters.
The concerns prompted Pharmac to commission a study which showed a “small increase” in both hyperglycaemia and hypoglycaemia hospitalisations during the changeover period in 2012-13 but found hospitalisations returned to baseline levels in 2014.
Dr Betty said in today’s announcement that Pharmac had made sure that the CareSens meters funded met international standards for blood glucose meters and tests strips.
“The meters were also tested by New Zealand laboratories before they were considered for funding,” he said.
As part of the deal Pharmac will also discontinue funding the CareSens II but says users of that meter may be eligible to upgrade to one of the other funded meters.
Dr Betty said that it had engaged with stakeholders throughout the funding process and drew heavily on feedback received, including people supportive that the contract meant the majority of people did not have to change meters, and that it would include a dual meter for people with Type 1 diabetes.
But the consultation feedback on the Pharmac website also showed that a number of submissions were received expressing concern about the sole provider contract. Technical concerns expressed about the CareSens meters and strips included:
Pharmac’s response was that the CareSens meters met ISO standards which allow for 15 per cent variations compared to a laboratory test – therefore variations were to be expected. It also said it would be working with health professionals to develop education material on how patients can make best use of their meter including keeping it a working temperature range. Plus the SmartLog app operating system used by CareSens had been extensively tested and Pharmaco would be providing customer support.
Submissions also asked for continued funding for the Freestyle strips, that are compatible with FreeStyle Libre meters, or at least continuing with special authority funding for some groups, particularly children. Pharmac said it was aware there may be some clinical reasons for people having difficulties changing meters and it would be consulting with health professionals over a process to allow some people to retain funded access to their existing meter and test strips.
There were also calls for continuous blood glucose monitoring systems (CGMS) to be funded, as they were in Australia. Pharmac said the sole supply agreement with Pharmac would not prevent the funding of CGMS and it was currently assessing funding applications for two different CGMS systems.
The four meters to be funded from February 1 2018 are:
TIMELINE
1 February 2018
31 July 2018
1 August 2018
An initial trial of the drug, ZGN-1061, had promising results in relation to both weight loss and glucose control in overweight or obese patients with type 2 diabetes who did not use insulin.
Dr Richard Carroll, an endocrinologist in Wellington who is helping run the study in the area, said the phase one trials saw patients lose between 10 and 12 per cent of their body weight over a matter of weeks and hoped phase two would be just as positive.
“We’re talking about 5 per cent weight loss being beneficial [for diabetes patients]. It’s a degree of weight loss that we haven’t yet seen in one medicine alone. It’s promising data,” he said.
About 250,000 New Zealanders had diabetes, he said, most with type 2, and many more had not been diagnosed or had pre-diabetes.
Today is World Diabetes Day and around the world more than 422 million people live with diabetes. In 2015 an estimated 1.6 million deaths were directly caused by diabetes with more attributed to high blood glucose.
With such a high prevalence of diabetes, and the latest figures suggesting almost a third of New Zealanders were obese with a further 35 per cent overweight, more treatment options were needed, Carroll said.
New Zealand’s “treatment armoury” was limited compared to much of the rest of the world and many drugs which helped people with diabetes actually resulted in weight gain, he said.
One of the cornerstones of diabetes management was a lifestyle change, which included weight loss, Carroll said, but losing weight and keeping it off was incredibly hard for many people.
“We’d like to see that focus in early diabetes with weight loss through lifestyle changes and complementing that with medicine,” he said.
Weight loss and glucose levels were areas medicine could not control, he said, but the new drug being trialled could change that.
The hope was that by improving people’s glucose control there would be fewer people reliant on insulin, he said.
Graham Manning, 41, was diagnosed with type 2 diabetes almost 10 years ago and did not hesitate to sign up for the trial.
“You never know,” he said. “I might get on to one that’s a winner, then I’m cured.”
The disease was not debilitating for him, Manning said, but did leave him with pain in his feet and feeling tired.
“If it’s successful and you get other people into it, then that’s why [I do it].”
The Auckland man had tried to lose weight without success before and hoped the drug would help get him on the right track.
“As you lose weight you start to feel better and that might just give me the kick I need,” he said. “With traditional methods it just takes so much time before you see the benefits.”
He also hoped it would help him keep control of the disease and prevent him from getting to the point where he was reliant on insulin.
About the study
• 140 participants needed across Australia and New Zealand.
• Eleven clinics in Christchurch, Wellington, Auckland, Hamilton, Hawkes Bay and the Bay of Plenty taking part with another 12 clinics in Australia.
• Four week screening period for potential participants and 12 weeks of treatment.
• Participants must have type 2 diabetes and not be using insulin.
• Participants must be between 18 and 65, have a BMI of 27 or over and have HbA1c levels of between 53 and 97mmol/mol.
• Go to www.diabetes2clinicaltrial.com to find the nearest clinic offering the trial and see if you are eligible.
The pair were presented with their awards at the NZNO’s annual conference dinner this week.
Snell was the country’s first nurse practitioner in diabetes and was also the first NP to gain her PhD. She lead the project to develop the National Diabetes Nursing Knowledge and Skills Framework 2009, the diabetes nurse specialist prescribing pilot project for the New Zealand Society for the Study of Diabetes (NZSSD), and was also project leader for developing NZSSD’s online e-learning diabetes resource for primary care nurses.
NZNO president Grant Brookes presented the awards and said Snell’s contribution to nursing knowledge in diabetes was “very significant” and she was a crucial lead for the Health Workforce New Zealand diabetes workforce review.
He said Pepe Sinclair had worked for many years as a mental health nurse and had been involved in national and international research on mental health, wellbeing and nursing workloads.
“She is lecturer and a passionate advocate for better health outcomes for Pacific people,” said Brookes. He said the award went to a nurse who was a mother, grandmother and great-grandmother born in Rakahanga in the Cook Islands.
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The regulation introducing RN prescribing in primary health and specialty teams came into force on September 20 last year, with the aim of improving access to medicines for vulnerable populations.
The 29 new RN prescribers authorised to prescribe from a schedule of common medicines for common and long-term conditions join 53 diabetes nurse specialists authorised to prescribe in diabetes health, making 82 RN prescribers in total.
Pam Doole, the Nursing Council’s Strategic Policy Manager, shared the updated statistics on the new second level prescribing at the Clinical Nurse Specialist Society NZ conference in Christchurch earlier this month.
There are now also 254 nurse practitioner prescribers (the top level and only autonomous nurse prescribers), and a group of nurses are currently trialling a third and more limited level of RN prescribing in community health. The first NP prescriber was authorised in 2003 and a pilot followed in 2011 of RN-designated prescribing in diabetes (applications under the diabetes regulations close in November).
Doole said to date most of the 29 RN prescribers in primary health and specialty teams have come through the alternative pathway of having first completed a clinical master’s degree. But the first graduates of the council-approved postgraduate diplomas in registered nurse prescribing were now starting to seek prescribing approval.
RN diploma prescriber
Hawke’s Bay’s Rachael Engelbrecht is one of the first RN prescribers to come through the diploma model.
The former practice nurse specialising in diabetes said she finished a postgraduate diploma in health sciences in 2015 at EIT and spent 2016 waiting for the new prescribing diploma path to be finalised and approved so she could do the EIT diploma’s prescribing practicum.
Engelbrecht began her practicum at the start of this year at the general practice where she had worked for eight years and had become the lead diabetes nurse after developing an interest in diabetes. She said she had a very supportive GP mentor and they envisaged that while her main prescribing focus would be diabetes, it would be useful for her to also have the potential to prescribe for conditions like urinary tract infections and other long-term conditions apart from diabetes.
But midway through her prescribing practicum she changed roles and took up a new post as a diabetes nurse specialist for Hawke’s Bay District Health Board’s diabetes service and completed her diploma practicum under an endocrinologist.
The new RN prescriber believed the role was more clear cut in secondary services and was still evolving in primary care where some issues, like what to charge for an RN prescriber consultation, needed to be worked through.
At the DHB she is one of seven diabetes nurse specialists, with five of them now prescribers – four through the diabetes prescribing regulations and herself through the primary health and specialty team regulations. She said a sixth was currently following the diploma pathway to prescribing.
Changes afoot to regulations controlling RN prescribing
Pam Doole told the clinical nurse specialists’ conference that developing the RN prescribers’ medicines list of commonly used medicines for common conditions had not been a simple process.
Including the Council needing to respond to concerns raised by doctors and pharmacists, which led to it removing some medicines from the final list that was approved and gazetted by the Ministry of Health under the Medicines Act 1981.
Doole said she was aware that medicines used by some nursing specialties, and some new medicines, were not covered by the list. She said the medicines list, gazetted in 2016, was unlikely to be reviewed for a couple of years and in the interim nurses could develop a case for adding additional medicines that could make a difference to their patients.
Meanwhile, work was underway on a new regulatory regime to replace the Medicines Act 1981 and regulations, which could see controls on prescribing shifted to the Health Practitioners Competence Assurance Act and authorities like the Nursing Council. Doole said she was not sure yet whether that meant control of the medicines list would also come under Council’s control, but it could be simpler to make changes in the future if it did.
BACKGROUND INFORMATION
The specific common and long-term conditions that nurses authorised to prescribe in primary health and specialty teams can prescribe for include:
Examples of primary health and specialty team settings that RN prescribers can work in include:
The requirements for registered nurses who wish to prescribe in primary health and specialty teams are:
The Healthier Lives National Science Challenge, the Ministry of Health and the Health Research Council of New Zealand (HRC) joined forces to establish the $7.9 million research funding pool to tackle long-term chronic health conditions.
Yesterday’s $2.3 million announcement follows the $5.7 million announced for diabetes research in February.
Massey University research fellow Dr Riz Firestone, who is of Samoan descent, received almost $1 million in health research funding to develop and put into practice a Pacifika community-based intervention programme to reduce prediabetes, the precursor to full-blown diabetes.
Dr Michael Epton, Director of the Canterbury Respiratory Research Group at Christchurch Hospital, has received just over $1 million for a 24-month study that will address New Zealand’s low referral and attendance rates for rehabilitation programmes for people with multiple long-term conditions (LTCs), such as diabetes, heart failure, arthritis, and chronic obstructive pulmonary disease.
Dr Firestone’s study will establish a Pasifika prediabetes youth empowerment programme involving Pacific youth (15–24 years old) from community groups in South Waikato and Auckland. It will build on Firestone’s recent HRC-funded pilot study in which a group of Pacific youth was taught how to plan and champion community-based interventions to counteract the key public health issues of obesity.
Epson says current approaches to rehabilitation for people with multiple LTCs focus too much on the biological aspects of their diseases and don’t include all the aspects of wellbeing that are important for improving health.
“Rather than developing new disease-specific interventions, we’ll work together with communities to develop and try initiatives that help people with multiple LTCs access community support, increase their sense of connectedness within their community, improve physical activity, and thus live lives they feel are fulfilling and worthwhile,” he said.
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