Sore Throat Management (Nurse Led)

Free Swab and Treat for ‘At Risk’ Population

1.      Introduction

The Government has allocated funding for the prevention and treatment of Group A Streptococcal (GAS) throat infections in DHBs with a high incidence of rheumatic fever with the aim to prevent the development of rheumatic fever by providing free and open access to timely sore throat management, changing the household environment to reduce the transmission of GAS throat infections, and increasing awareness of what causes rheumatic fever and how to prevent it.

Rheumatic fever is an autoimmune response to an untreated GAS throat infection. Therefore, it can be prevented by prompt diagnosis of a GAS throat infection and treatment with a full course of appropriate antibiotics. The sore throat management component aims to ensure that the High Risk Population have access to timely, free, culturally appropriate and effective treatment of GAS throat infections.

 

2.       Service Delivery/Eligibility 

Deliver a free ‘group A streptococcal throatswab and treat service to ‘at risk’ enrolled and casual and non-resident Service Users to the following populations’ at risk’:

 

Aged 4-19 yearswith 2 or more of the following:
 
°         Māori or Pacific
°         Living in a high risk/ quintile 5 community and /or
°         Any family history of rheumatic fever or rheumatic heart disease and/or
°         Present with a sore throat OR who have undeclared clinical pharyngitis (i.e., an inflamed throat and/or tonsils with or without exudate)

 

2.1.   Case Finding

In addition to providing a nurse–led free sore throat swab and treat service to Maori and Pacific children aged 4 – 19 years of age, you should look for signs of a sore throat (redness and/or pus in the throat) when Pacific children aged 4 – 12 years present for other conditions, and swab and treat as indicated. This service (swabbing and treatment) will be free to the patient.

 

2.2.    Household Contacts of an at Risk Child with a GAS + Sore Throat

Deliver a free throat swab and treat service to:

  1. Symptomatic 3- 35 year old household members of an at-risk child with a GAS+ sore throat (as above)
  2. And as per clinical variations, all household contacts, aged 3 – 35 years with:

                                                               i.      3 or more GAS + infections in the preceding 3 months, OR

                                                             ii.      a personal history of rheumatic fever OR

                                                            iii.      a family history of Rheumatic fever

3.       Treatment – Using PSO Antibiotics

 

°         offer the choice of once daily amoxicillin for 10 days, or

°         once daily erythromycin for 10 days

°         or intra-muscular (IM) single dose benzathine benzylpenicillin (Bicillin)

°         or (if there is allergy to penicillin) twice daily erythromycin.

°         Use clinically appropriate protocols and follow appropriate guidelines when delivering the service. 

You must ensure that your clinical protocols have in place the following standard practice for the management of allergy or adverse reaction:

 

4.       Follow Up

 

°         If the children/young people are not enrolled at the practice and have been seen for the sore throat service then links need to be made with the patient’s General Practice where practicable

°         Make referrals to other services as required

°         Link with existing rheumatic fever prevention services to ensure an integrated and consistent approach locally

 

Payments to Practices

 

°         $12.50 for each throat swab and treatment

°         A further fee of $12.50 if bicillin is administered

 

Non NZ Residents

Services will also be provided free of charge to non-New Zealand residents. The fee for swab and treatment will be $42.50 (inclusive of the laboratory fee)

 

6.       Claiming Procedure

The Mōhio form will guide you through the sore throat swabbing, treatment and claiming procedure.

 

References add hyperlinks

°         Heart Foundation Guidelines https://www.heartfoundation.org.nz

°         Auckland Regional Health Pathways sore throat management – Mōhio Quick links

°         NZ Primary Care Handbook 3rd Edition MOH 2012

 

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