Article
Medicine, General & Internal
Yu Fu, Ben Allen, Alan M. Batterham, Christopher Price, Niki Jones, Denis Martin, Nick Hex, Ewan Maule, Tracy Finch, Julia L. Newton, Cormac G. Ryan
Summary: Opioid prescribing rates are disproportionately high in the North of England, and clinician behavior and the COVID-19 pandemic have contributed to this issue. A pilot intervention using smartphone video messaging has been developed to address the problem. This study aims to evaluate the benefits, risks, and economic consequences of implementing this intervention on a larger scale.
Article
Medicine, General & Internal
Nora Jacobson, Roberta A. Johnson, Christie Schlabach, Jillian Incha, Lynn Madden, Daniel Almirall, Rose Hennessey Garza, Bri Deyo, Nicholas Schumacher, Christine Stephenson, Andrew Quanbeck
Summary: The adoption of guideline-concordant opioid-prescribing practices in primary care settings is influenced by contextual factors and prescriber characteristics at different levels, which operate through various mechanisms. A dynamic model is needed to understand the complexity of the relationships between contexts, mechanisms, and outcomes.
Review
Medicine, General & Internal
Magdalena Z. Raban, Gabriela Gonzalez, Amy D. Nguyen, Ben R. Newell, Ling Li, Karla L. Seaman, Johanna Westbrook
Summary: This systematic review explores the use of nudge interventions to reduce unnecessary antibiotic prescribing in primary care. The findings indicate that nudge interventions, particularly social norm nudges, are effective in reducing overall antibiotic prescribing. Policy-makers and managers should consider expanding the use of nudge interventions and carefully implement social norm nudges to optimize their effects.
Article
Geriatrics & Gerontology
Noll L. Campbell, Richard J. Holden, Qing Tang, Malaz A. Boustani, Evgenia Teal, Jennifer Hillstrom, Wanzhu Tu, Daniel O. Clark, Christopher M. Callahan
Summary: The multicomponent behavioral intervention did not decrease the use of high-risk anticholinergic medications in primary care older adults. Improving nudges or implementing a policy-focused component may be necessary to reduce the use of high-risk medications.
JOURNAL OF THE AMERICAN GERIATRICS SOCIETY
(2021)
Article
Medicine, General & Internal
Gemma Lewis, Louise Marston, Larisa Duffy, Nick Freemantle, Simon Gilbody, Rachael Hunter, Tony Kendrick, David Kessler, Dee Mangin, Michael King, Paul Lanham, Michael Moore, Irwin Nazareth, Nicola Wiles, Faye Bacon, Molly Bird, Sally Brabyn, Alison Burns, Caroline S. Clarke, Anna Hunt, Jodi Pervin, Glyn Lewis
Summary: Patients with depression in primary care practices who chose to discontinue antidepressant therapy had a higher risk of relapse compared to those who maintained their current therapy after 1 year.
NEW ENGLAND JOURNAL OF MEDICINE
(2021)
Article
Medicine, General & Internal
Jordan K. Schaefer, Josh Errickson, Xiaokui Gu, Tina Alexandris-Souphis, Mona A. Ali, Brian Haymart, Scott Kaatz, Eva Kline-Rogers, Jay H. Kozlowski, Gregory D. Krol, Vinay Shah, Suman L. Sood, James B. Froehlich, Geoffrey D. Barnes
Summary: This study assessed changes in aspirin use, bleeding, and thrombosis event rates among patients treated with warfarin. The results showed a decrease in aspirin use and a decrease in bleeding events after the intervention.
Article
Pharmacology & Pharmacy
Yanhong Gong, Hui Li, Heping Yang, Kun Tan, Wei Liu, Xiaotong Li, Jianxiong Wu, Guopeng Zhang, Xiaoxv Yin
Summary: The study found that the number of outpatient antibiotic prescriptions decreased annually in Shenzhen, but the use of broad-spectrum antibiotics was on the rise. The most significant changes were observed in children. Additionally, cephalosporins were commonly used, the utilization rate of recommended first-line antibiotics was not high, and the use of amoxicillin in children's prescriptions was low.
FRONTIERS IN PHARMACOLOGY
(2021)
Article
Pediatrics
Lauren Dutcher, Yun Li, Giyoung Lee, Robert Grundmeier, Keith W. W. Hamilton, Jeffrey S. S. Gerber
Summary: The reductions in antibiotic prescribing in pediatric primary care during the COVID-19 pandemic were sustained and primarily driven by decreases in respiratory tract infection encounters. The decrease in viral respiratory tract infection transmission likely played a substantial role in reducing healthcare visits and antibiotic prescriptions.
Article
Medicine, General & Internal
Sarah Hardoon, Joseph Hayes, Essi Viding, Eamon McCrory, Kate Walters, David Osborn
Summary: Contrary to current guidelines, antipsychotics are frequently and continuously prescribed to individuals with recorded personality disorder (PD) but no history of severe mental illness (SMI). An urgent review of clinical practice is necessary, including the assessment of the effectiveness of such prescribing and monitoring for adverse effects.
Article
Infectious Diseases
Xiaomin Zhong, Alexander Pate, Ya-Ting Yang, Ali Fahmi, Darren M. Ashcroft, Ben Goldacre, Brian MacKenna, Amir Mehrkar, Sebastian C. J. Bacon, Jon Massey, Louis Fisher, Peter Inglesby, Kieran Hand, Tjeerd van Staa, Victoria Palin
Summary: This study aimed to predict risks of potentially inappropriate antibiotic type and repeat prescribing and assess changes during COVID-19. The study found no evidence of changes in the level of inappropriate or repeat antibiotic prescribing after the start of COVID-19.
JOURNAL OF INFECTION
(2023)
Article
Public, Environmental & Occupational Health
Mary Lynch, Ceri R. Jones
Summary: Social prescribing interventions may lead to cost savings, particularly for frequent attenders. However, caution should be exercised in interpreting the results due to the lack of a control group.
FRONTIERS IN PUBLIC HEALTH
(2022)
Article
Engineering, Industrial
Dongming Fan, Jing Lin, Baoping Cai, Bin Liu
Summary: This study develops a two-layer MSSN and proposes a robustness definition and effect propagation models to evaluate its robustness, along with improvement strategies, including a new greedy partnership building approach. The results of the research show that this approach has a significant effect on the robustness of maintenance support service network.
RELIABILITY ENGINEERING & SYSTEM SAFETY
(2021)
Article
Immunology
Wen-Qiang He, Martyn D. Kirk, John Hall, Bette Liu
Summary: From 2013 to 2018, antimicrobial drugs were prescribed for 6.8% of acute gastroenteritis cases in general practice in Australia, with higher prescription rates for Salmonella and Campylobacter infections. There was a 2.0% decrease in prescriptions for acute gastroenteritis during this period, highlighting the need for better antimicrobial stewardship in managing infectious gastroenteritis in general practice.
EMERGING INFECTIOUS DISEASES
(2021)
Review
Infectious Diseases
Audrey Chigome, Nishana Ramdas, Phumzile Skosana, Aislinn Cook, Natalie Schellack, Stephen Campbell, Giulia Lorenzetti, Zikria Saleem, Brian Godman, Johanna C. Meyer
Summary: There are concerns regarding the prescribing of antibiotics in primary care settings in South Africa, both public and private. These concerns need to be addressed to combat rising antimicrobial resistance rates. Published studies indicate a high prescription rate of antibiotics for patients with acute respiratory infections, with varying levels of adherence to prescribing guidelines. The majority of prescribed antibiotics belong to the "Access" group rather than the "Watch" group, which is intended to limit antimicrobial resistance. Inappropriate prescribing in primary care is influenced by limited knowledge about antibiotics, antimicrobial resistance, and antimicrobial stewardship programs among prescribers and patients. Future recommendations include improving education, regularly monitoring prescribing practices, and using patient-friendly language during discussions about appropriate antibiotic use.
Article
Public, Environmental & Occupational Health
Inga Petruschke, Florian Salm, Michelle Kaufmann, Antje Freytag, Jochen Gensichen, Michael Behnke, Tobias Siegfried Kramer, Regina Hanke, Petra Gastmeier, Sandra Schneider
Summary: The study introduced a multimodal intervention by the German One-Health project RAI in the outpatient sector, targeting General Practitioners. The results showed that the intervention was widely accepted by GPs and could help in promoting rational antibiotic use in primary care settings.
ANTIMICROBIAL RESISTANCE AND INFECTION CONTROL
(2021)
Article
Psychology, Clinical
Francisco T. T. Lai, Stewart W. Mercer, Bruce Guthrie, Benjamin H. K. Yip, Gary K. K. Chung, Dan Zou, Kam-Pui Lee, Patsy Y. K. Chau, Roger Y. Chung, Eliza L. Y. Wong, Eng-Kiong Yeoh, Samuel Y. S. Wong
Summary: This study found a stronger association between depression and acute stroke incidence among male primary care patients with hypertension.
PSYCHOLOGICAL MEDICINE
(2022)
Review
Urology & Nephrology
Greg Guthrie, Bruce Guthrie, Heather Walker, Matthew T. James, Nicholas M. Selby, Marcello Tonelli, Samira Bell
Summary: This study examined the variation in defining acute kidney injury (AKI) for research using health care data and aimed to achieve consensus. The current methods for defining AKI using routinely collected data are inconsistent and poorly described. Experts could not achieve consensus for many aspects of defining AKI and describing its sequelae. The KDIGO guidelines should be extended to include a standardized definition for AKI when using routinely collected data.
AMERICAN JOURNAL OF KIDNEY DISEASES
(2022)
Editorial Material
Geriatrics & Gerontology
Adam L. Gordon, Caroline Rick, Ed Juszczak, Alan Montgomery, Rob Howard, Bruce Guthrie, Wei Shen Lim, Susan Shenkin, Paul Leighton, Philip M. Bath
Summary: The COVID-19 pandemic has had devastating effects on care home residents. However, research platforms for COVID-19 in care homes were established late compared to other care settings.
Article
Infectious Diseases
Charis A. Marwick, Anower Hossain, Rita Nogueira, Jacqueline Sneddon, Kim Kavanagh, Marion Bennie, R. Andrew Seaton, Bruce Guthrie, William Malcolm
Summary: The study evaluated the impact of general practice-level prescribing feedback on antibiotic prescribing, finding limited additional effects of the feedback in the context of decreasing antibiotic prescribing and an established national stewardship programme.
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
(2022)
Article
Economics
Anna Wilding, Luke Munford, Bruce Guthrie, Evangelos Kontopantelis, Matt Sutton
Summary: This study examines how family doctors responded to more stringent pay-for-performance targets. It finds that while doctors did not alter the number or composition of hypertension patients, they increased treatment intensity and conducted more blood pressure measurements. Additionally, they also gamed the system by exempting patients and recording patients as exactly achieving the more stringent target.
JOURNAL OF HEALTH ECONOMICS
(2022)
Review
Medicine, General & Internal
Clare MacRae, Harry William Fisken, Edward Lawrence, Thomas Connor, Jamie Pearce, Alan Marshall, Andrew Lawson, Chris Dibben, Stewart W. Mercer, Bruce Guthrie
Summary: This systematic review examines the association between multimorbidity and emergency department attendance and hospitalization rates, taking into account household and area determinants of health. The study finds evidence that factors such as household food insecurity and deprivation in living areas are associated with higher hospitalization rates and more frequent emergency department visits among individuals with multimorbidity. However, due to the limited number of studies and heterogeneity in study design, firm conclusions cannot be drawn, and further research using robust analytical methods is needed.
Article
Medicine, General & Internal
Elaine Butterly, Peter Hanlon, Anoop S. V. H. Shah, Laurie Hannigan, Emma S. McIntosh, Jim M. Lewsey, Sarah Wild, Bruce J. Guthrie, Frances A. Mair, David Kent, Sofia Dias, Nicky Welton, David McAllister
Summary: This study aimed to investigate the impact of multimorbidity on quality of life. The results showed that a higher comorbidity count was associated with lower baseline quality of life and a decline over time. However, treatment effects on quality of life were not modified by multimorbidity.
Article
Geriatrics & Gerontology
Jonathan Hauff, Marietta Rottenkolber, Patrick Oehler, Sebastian Fischer, Jochen Gensichen, Michael Drey, G. Caleb Alexander, Bruce Guthrie, Tobias Dreischulte
Summary: This study investigated the risk of falls in individuals aged 65 years and older, and found that certain drug groups were associated with an absolute increase in risk. The results showed that older individuals, especially those aged 75 years and older, who were prescribed specific medications (such as selective serotonin reuptake inhibitors, tricyclic antidepressants, antipsychotics, and three or more fall-risk-increasing drugs) had a significantly higher absolute risk of fractures.
Article
Cardiac & Cardiovascular Systems
Shona Livingstone, Daniel R. R. Morales, Jacques Fleuriot, Peter T. T. Donnan, Bruce Guthrie
Summary: This study externally validated the QRiskLifetime incident CVD risk prediction tool and found that it underpredicts 10-year CVD risk in nearly all age-groups. Treatment based on lifetime risk has considerably lower medium-term benefit compared to treatment based on 10-year risk.
BMC CARDIOVASCULAR DISORDERS
(2023)
Article
Medicine, General & Internal
Daniel R. Morales, Mark Minchin, Evangelos Kontopantelis, Martin Roland, Matt Sutton, Bruce Guthrie
Summary: This study aimed to compare the impact of the withdrawal of the Quality and Outcomes Framework (QOF) scheme in primary care in Scotland in 2016 on the recorded quality of care, compared with England where the scheme continued. The results showed a significant decrease in performance for most quality of care indicators in Scotland after the abolition of QOF.
BMJ-BRITISH MEDICAL JOURNAL
(2023)
Article
Medicine, General & Internal
Peter Hanlon, Elaine S. Butterly, Anoop S. V. M. Shah, Laurie Hannigan, Jim H. Lewsey, Frances J. Mair, David Kent, Bruce A. Guthrie, Sarah Wild, Nicky Welton, Sofia Dias, David McAllister
Summary: This study analyzed individual participant data from 120 clinical trials and found no evidence of treatment efficacy differences based on comorbidity, indicating the importance of this research for treatment recommendations.
Editorial Material
Primary Health Care
Sanghamitra Pati, Clare MacRae, David Henderson, David Weller, Bruce Guthrie, Stewart Mercer
BRITISH JOURNAL OF GENERAL PRACTICE
(2023)
Article
Medicine, General & Internal
Alexander Thompson, Ji-Hee Youn, Bruce Guthrie, Robert Hainsworth, Peter Donnan, Gabriel Rogers, Daniel Morales, Katherine Payne
Summary: This study aimed to determine the level of inconvenience associated with taking statins or bisphosphonates and to understand the factors that influence this feeling.
Review
Geriatrics & Gerontology
Stella Arakelyan, Nataysia Mikula-Noble, Leonard Ho, Nazir Lone, Atul Anand, Marcus J. Lyall, Stewart W. Mercer, Bruce Guthrie
Summary: Holistic assessment-based interventions (HABIs) are effective in older people admitted to hospital, but their effectiveness in adults with multiple long-term conditions or frailty in the community is unclear. The evidence for the effectiveness of HABIs is inconsistent across different interventions, settings, and outcomes. Comprehensive geriatric assessment (CGA) in hospital settings has the strongest evidence for reducing nursing home admissions and keeping patients alive and in their own homes.
LANCET HEALTHY LONGEVITY
(2023)
Article
Health Care Sciences & Services
Marcia McDougall, Bruce Guthrie, Arthur Doyle, Alan Timmins, Meghan Bateson, Emily Ridley, Gordon Drummond, Thenmalar Vadiveloo
Summary: This study aimed to assess the effects of implementing NICE guidelines on intravenous fluid prescribing in a general hospital setting. The study found that the use of 0.9% sodium chloride decreased by 75% and overall intravenous fluid use decreased. The incidence of acidosis decreased, and there were no adverse effects on other electrolytes. However, the incidence of stage 1 acute kidney injury increased. The study concludes that the implementation of the guidelines required significant effort and resource and recommends that prescribed volumes should still be carefully considered.