Guidance for Health Support Service for Dioxin Exposed People: Annual Health Check This is a suggested format for the Health Support Service for Dioxin Exposed People: annual health check. The annual health check is a new comprehensive service designed to assess the health needs of individuals who may have been exposed to dioxins from the former Ivon Watkins Dow factory in Paritutu, New Plymouth, and to facilitate access to services to support wellness. History, examination, and investigations should be appropriate to each individual’s situation and health status. More information is available on the Ministry of Health’s website: www.health.govt.nz/dioxins. History Review patient questionnaire. Discuss the patient’s residential and/or occupational exposure to dioxin. Consider whether the patient has any symptoms or health conditions related to dioxin exposure (eg, review ‘Current Health’ section of patient questionnaire). Specific issues to consider include: malaise, fatigue, weight loss, night sweats, persistent fever, etc skin/soft tissue (eg, itchiness, rashes, lumps, etc) respiratory issues peripheral neuropathy or other neurological symptoms atypical pain prostatic symptoms anxiety, depression, or other mental health issues pregnancy (or future plans) and folate supplementation. Review medical history, family history, and current diseases or medication Consider whether the patient has any mental health concerns (eg, review ‘mood screening’ section of patient questionnaire). Consider the patient’s general health and lifestyle including smoking, weight/exercise, alcohol or other drug use (eg, review appropriate sections of the patient questionnaire). Explore ‘stage of change’/motivation for change. Information Provide patient with information about dioxin and its health effects and discuss any concerns about exposure or refer the patient for further information. Examination Consider completing the following examinations (where indicated): general (weight/height/BMI, blood pressure, urinalysis, blood glucose) respiratory examination and lung function (including spirometry) skin, soft tissue, lymphatic system brief neurological examination including motor, sensory function, and back and lower limb function abdominal examination prostate, breast, or gynaecological examination if indicated examination of infant of an exposed woman for dysmorphic features and a visual examination of lower back and limbs. moderate
Review screening status Review for the following screening opportunities (where indicated and update where necessary): cervical smear mammogram cardiovascular risk status diabetes annual review (‘Get Checked’) (if relevant) ultrasound to detect neural tube defects (if relevant). Management Undertake appropriate management of or referral for any conditions detected. Investigations Undertake the following investigations if indicated by standard evidence based guidelines: lipids and blood glucose serum proteins and immunoglobulin (if indication of multiple myeloma) diabetes level of control (eg, HbA1C, etc) full blood count chest X-ray (if respiratory symptoms or indications of lymphoma, Hodgkins, lung disease, etc) PSA (following an informed discussion about the advantages and limitations of PSA screening for asymptomatic men) other specific tests if clinical indications Referral Options Action referral to any of the following if indicated: Lifestyle modification smoking cessation exercise/physical activity (eg, green prescriptions) dietary advice (eg, practice nurse, dietician) alcohol/drug issues (eg, brief GP intervention or referral). Mental health counselling for mild to mental health concerns (eg, normal referral criteria apply) mental health referral for major psychiatric illness. Other specialist referral (normal referral criteria apply) Genetic advice or counselling (normal referral criteria apply) Foetal neural tube defect screening (if appropriate) Serum dioxin test. Serum dioxin testing is unlikely to contribute further to patient management. It is only appropriate when the test will assist in improving the patient’s emotional wellbeing. Full informed consent (including advantages, and disadvantages) is required. Discuss the following with the patient: limitations of the serum dioxin test testing process and interpretation of the results whether the patient has had a serum dioxin test previously (NB: a serum dioxin test should not be provided if already undertaken) review for underlying mental health issues medical reasons for not taking approximately 90 millilitres of blood.
Documentation Complete Ministry information/claim form. Provide examination/investigation report to patient (and usual GP) if requested. More information If your patient like more information, s/he can discuss this with you, or they can contact the Ministry of Health: Ministry of Health PO Box 5013 Wellington emailmoh@moh.govt.nz Telephone: 0800 288 588 Website: www.health.govt.nz/dioxins Additional information can also be found in the following guidelines. Prostate Cancer Screening in New Zealand. New Zealand Guidelines Group (April 2004). Management of Type 2 Diabetes. New Zealand Guidelines Group (December 2003). Depression: Information for Health Practitioners. New Zealand Guidelines (October 2006). Guidelines for Recognising, Assessing and Treating Alcohol and Cannabis Abuse in Primary Care. National Health Committee (July 1999). New Zealand Smoking Cessation Guidelines. Ministry of Health (August 2007).