SPANZA advisories on Tramadol
Following the FDA announcement on 20 April regarding the use of Codeine and Tramadol in children and in breastfeeding women (read here) the Society of Paediatric Anaesthesia in New Zealand and Australia (SPANZA) asked groups of experts to review the literature and produce advisory statements. The first is regarding the use of Tramadol in children and was circulated in May. The second is regarding the use of Tramadol during breastfeeding and in the neonate.
WFSA Position Statement on Anaesthesiology and Universal Health Coverage
A position statement on anaesthesiology and universal health coverage by the World Federation of Societies of Anaesthesiologists (WFSA) has been approved following a vote of member societies, including the NZSA:
‘There is an urgent need to address deficiencies in access to safe anaesthesia care. An additional 1.27 million surgical, obstetric and anaesthesia providers will be required by 2030 to achieve Universal Health Coverage. In many countries, particularly those with limited resources, anaesthesia is associated with unacceptably high mortality rates. Training and ongoing maintenance of standards are essential for increasing the number of providers and increasing the safety of anaesthesia for patients worldwide. In some countries, the anaesthesia need will be met by training anaesthesiologists. In other countries, especially those with limited resources, the need may, in part, be met by training non-anaesthesiologist providers.
Anaesthesia is complex and potentially hazardous, and optimal patient care depends on anaesthesia being provided, led or overseen by an anaesthesiologist. The WFSA recognises that effective teamwork is a vital component of patient safety. The WFSA, representing anaesthesiologists worldwide, and in official relations with the World Health Organisation, is well positioned to lead the development of standards and implementation of safe, universal anaesthesia coverage. Effective development and oversight of safe anaesthesia services will require anaesthesiologist leadership at governmental, organisational, academic, teaching and clinical levels.
The WFSA is committed to working with governments and non-governmental organisations to improve patient care and access to safe anaesthesia worldwide. Anaesthesiologist-led development of anaesthesia services is vital if we are to achieve Universal Health Coverage by 2030.
Affiliated Provider funding for anaesthesia consultations
Southern Cross has advised that anaesthetic and intensivist consultations will not be part of its Affiliated Provider (AP) only funding services for 2017. They say that while these are the only exceptions under their AP-only specialist consultation programme, they will continue their discussions with anaesthetists to investigate appropriate models of contracting with these two specialist groups. Pain specialists will be listed in Southern Cross’ Health Care Finder directory and members will be using this to identify AP-only providers that they should use to be reimbursed.
Decision to delist tramadol hydrochloride oral drops 100 mg per ml
The NZSA welcomes PHARMAC’s decision to progress the proposal to delist tramadol hydrochloride oral drops 100 mg per ml from Part II of Section H of the Pharmaceutical Schedule, and instead list a 10 mg per ml strength of tramadol hydrochloride oral solution for use in DHB hospitals. This was the subject of a consultation letter dated 4 October 2016. In summary, the effect of the decision is that:
– tramadol hydrochloride oral solution 10 mg per ml will be listed for use in DHB
hospitals from 1 January 2017.
– tramadol hydrochloride oral drops 100 mg per ml will be delisted from 30 June 2017.
Burnout rife among DHB senior doctors
Burnout is rife among senior doctors in New Zealand’s public hospitals and higher than in comparable international studies, according to the Association of Salaried Medical Specialists, with half of all senior doctors and dentists surveyed appearing to have very high levels of burnout.
Key findings of the survey include:
- Half (50.1%) of hospital specialists reported symptoms of burnout – ie, high levels of fatigue and exhaustion.
- 42.1% said this was due to their work, and they cited frustrations with management, intense and unrelenting workloads, under-staffing, and onerous on-call duties.
- 15.7% attributed their burnout to their interactions with patients.
- Three out of five female specialists (59.4%) were likely to be experiencing burnout, compared with 43.9% of male specialists.
- Burnout was even more prevalent among female doctors aged between 30 and 39, with 7 out of 10 (70.5%) experiencing burnout. More than half (51.1%) attributed this to their work.
- Some medical specialties reported higher levels of burnout than others – in particular, emergency medicine, dentistry and psychiatry.
A full report of the research findings can be read here
Sole supply of propofol
Sole Supply Contracts (Hospital Supply Status) have been awarded to two suppliers for propofol:
• AFT Pharmaceuticals’ Provive brand MCT-LCT 1% inj 10 mg per ml, 20 ml vial;
• Fresenius Kabi (NZ)’s Fresofol brand 1% MCT/LCT inj 10 mg per ml, 50 ml vial and inj 10 mg per ml, 100 ml vial.
These products will be the only brands of propofol that can be used in DHB hospitals from 1 June 2016 until 30 June 2019. The 50ml and 100ml vials of Fresofol were introduced on 1 April. All other presentations of propofol currently listed were delisted from 1 June 2016. The NZSA wrote a submission to Pharmac earlier in the year expressing strong support for continued availability of Provive and Fresofol and said consistency of supply for NZ’s leading anaesthetic drug is essential.