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GPs to boost iron in the community

Betty Clark, first patient to receive an iron infusion at Hauraki Plains Health Centre Ngatea, instead of Thames Hospital with Registered Nurse Lydia Farley.

Partnership and teamwork between community healthcare services and Waikato DHB has seen another hospital-prescribed medicine become available in the community, creating a win-win that saves patients time and reduces pressure on hospital services.

Waikato DHB pharmacy service in collaboration with the DHB’s patient blood management service, GP liaison and Primary Health Organisations (PHOs) have worked over a two year period to deliver this new service, now in its first pilot stage.

The program fits within the Map of Medicine model of care which was designed to help improve the patients’ journey through primary, secondary and tertiary care across 5 midland DHBs (Waikato, Bay of Plenty, Lakes, Tairawhiti and Taranaki).

Waikato DHB patient blood management service clinical director and anaesthetist Dr Scott Robinson stated: “The pilot is aimed at treating the elective surgical patient who presents with iron deficiency anaemia, and requires the administration of an Intravenous (IV) iron formulation. In these cases ferric carboxymaltose (Ferinject) is used.

“The ferric carboxymaltose iron formulation is administered via a 15 minute IV infusion which is much quicker to administer than previous formulations of iron.

“Several patients have now received their treatment at their GP practice and feedback has been positive.”

Ferinject was introduced to the New Zealand hospital medicine list in 2014 by PHARMAC for patients where oral iron is not tolerated, is clinically inappropriate, or a faster ‘boost’ of iron is needed for urgent surgery.

“The aim of this ‘boost’ is to allow anaemic patients to make more red blood cells which in turn reduces their chances of a complication in surgery or requiring a blood transfusion” said Dr Robinson.

Ferinject is only available to be administered in general practice to patients whose GP is registered in the pilot scheme with Waikato DHB.

Each patient is assessed by a nurse and clinician within the patient blood management service, for suitability with regards to IV iron therapy. They are then referred as a suitable candidate to their GP for treatment.

All patients are given the option of having treatment at their GP or at a Waikato DHB hospital facility.

The first stage of implementation has funding for 107 patients. These patients would otherwise receive the IV treatment at one of the regions hospitals which Waikato DHB’s pharmacy manager Jan Goddard was happy to say it will be one less trip for them.

“We’re always challenging our services to look at ways we can give patients better access to hospital prescribed healthcare. We saw an opportunity to reduce potentially a whole of day travel for the elective surgical patient with anaemia, particularly as our region has the largest rural-based patient population ranging from the south of Waikato right up to the top of the Coromandel.

“It’s really important that we can look to offer patients alternatives, where we can, and equally reduce some of the patient flow pressure our hospitals face with an increasing population.”

Other hospital-prescribed medicines Waikato has made available in the community with this partnership include a medicine to treat deep vein thrombosis that keeps patients stable until they can receive an ultrasound, a medicine that dissolves blood clots in vessels in the heart (for rural patients) and provision of IV antibiotics for administration by an infuser device in the community.

Another initiative that had positive results on reduced hospital admissions commencing in 2006/7, was a cellulitis treatment programme that allowed GP’s to diagnose and treat the common bacterial skin infection in the community. This involved the provision of kits of medicine containing IV antibiotics and oral medicines with instructions for a GP to diagnose and treat.

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