scholarly journals Influences on the use of antidepressants in primary care: All England general practice‐level analysis of demographic, practice‐level and prescriber factors

2020 ◽  
Vol 35 (5) ◽  
Author(s):  
Adrian H. Heald ◽  
Mike Stedman ◽  
Mark Davies ◽  
Sanam Farman ◽  
Rachel Upthegrove ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Practice Level ◽  
Level Analysis

scholarly journals Links between the amount of antipsychotic medication prescribed per population at general practice level, local demographic factors and medication selection

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
A. H. Heald ◽  
M. Stedman ◽  
S. Farman ◽  
C. Khine ◽  
M. Davies ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Antipsychotic Medication ◽  
Mental Illnesses ◽  
Pharmacological Intervention ◽  
Defined Daily Dose ◽  
Practice Level ◽  
Practice Population ◽  
General Practices ◽  
Antipsychotic Prescribing

Abstract Background Antipsychotic medications are the first-line pharmacological intervention for severe mental illnesses (SMI) such as schizophrenia and other psychoses, while also being used to relieve distress and treat neuropsychiatric symptoms in dementia. Our aim was to examine the factors relating to antipsychotic prescribing in general practices across England and how cost changes in recent years have impacted on antipsychotic prescribing. Methods The study examined over time the prescribing volume and prices paid for antipsychotic medication by agent in primary care. Monthly prescribing in primary care was consolidated over 5 years (2013–2018) and DDD amount from WHO/ATC for each agent was used to convert the amount to total DDD/practice. The defined Daily Dose (DDD is the assumed average maintenance dose per day for a drug used for its main indication in adults. Results We included 5750 general practices with practice population > 3000 and with > 30 people on their SMI register. In 2018/19 there were 10,360,865 prescriptions containing 136 million DDD with costs of £110 million at an average cost of £0.81/DDD issued in primary care. In 2017/18 there was a sharp increase in overall prices and they had not reduced to expected levels by the end of the 2018/19 evaluation year. There was a gradual increase in antipsychotic prescribing over 2013–2019 which was not perturbed by the increase in drug price in 2017/18. The strongest positive relation to increased prescribing of antipsychotics came from higher social disadvantage, higher population density (urban), and comorbidities e.g. chronic obstructive pulmonary disease (COPD). Higher % younger and % older populations, northerliness and non-white (Black and Minority Ethnic(BAME)) ethnicity were all independently associated with less antipsychotic prescribing. Higher DDD/general practice population was linked with higher proportion(%) injectable, higher %liquid, higher doses/prescription and higher %zuclopenthixol depot. Less DDD/population was linked with general practices using higher % risperidone and higher spending/dose of antipsychotic. Conclusions The levels of antipsychotic prescribing at general practice level are driven by social factors/comorbidities. We found a link between depot prescriptions with higher antipsychotic DDD and risperidone prescriptions with lower antipsychotic DDD. It is important that all prescribers are aware of these drivers / links.

scholarly journals Links between the amount of antipsychotic medication prescribed per population at general practice level, local demographic factors and medication selection

2020 ◽  
Author(s):  
Adrian Hugh Heald ◽  
Mike Stedman ◽  
Sanam Farman ◽  
Chaw Khine ◽  
Mark Davies ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Antipsychotic Medication ◽  
Demographic Factors ◽  
Mental Illnesses ◽  
Pharmacological Intervention ◽  
Practice Level ◽  
Practice Population ◽  
General Practices ◽  
Antipsychotic Prescribing

Abstract BACKGROUND Antipsychotic medications are the first-line pharmacological intervention for severe mental illnesses(SMI) such as schizophrenia and other psychoses, while also being used to relieve distress and treat neuropsychiatric symptoms in dementia. Since 2014 many antipsychotic agents have moved to generic provision. In 2017_18 supplies of certain generic agents were affected by substantial price increases. Our aim was to examine factors relating to antipsychotic prescribing in general practices across England and how cost changes in recent years have impacted. METHODS The study examined over time the prescribing volume/prices paid for antipsychotic medication by agent in primary care. The NHS in England/Wales publishes each month the prescribing in general practice by BNF code. This was aggregated for the year 2018_19 using Defined Daily doses (DDD). Cost of each agent year-on-year was determined. Monthly prescribing in primary care was consolidated over 5 years(2013-2018) and DDD amount from WHO/ATC for each agent was used to convert the amount to total DDD/practice. RESULTS Description We included 5,750 general practices with practice population >3000 and with >30 people on their SMI register. In 2018_19 there were 10,360,865 prescriptions containing 136 million DDD with costs of £110 million at an average cost of £0.81/DDD issued in primary care. Effect of price In 2017_18 there was a sharp increase in overall prices. There was a gradual increase in antipsychotic prescribing over 2013-2019 which was not perturbed by the drug price increase in 2017/18. Regression Demographic factors The strongest positive relation to increased prescribing of antipsychotics came from higher social disadvantage, higher population density(urban), and comorbidities e.g. chronic obstructive pulmonary disease(COPD). Higher %younger and %older populations, northerliness and non-white (Black and Minority Ethnic (BME)) ethnicity were all independently associated with less antipsychotic prescribing. Prescribing Factors Higher DDD/general practice population was linked with higher %injectable, higher %liquid, higher doses/prescription and higher %zuclopenthixol depot. Less DDD/population was linked with general practices using higher %risperidone and higher spending/dose of antipsychotic. CONCLUSIONS Levels of antipsychotic prescribing at general practice level are driven by social factors/comorbidities. We found a contrasting link between depot prescriptions with higher DDD and risperidone prescriptions with lower DDD.

scholarly journals Skill mix in primary care: the scale and distribution of skill mix in GP practice across England

2019 ◽  
Vol 69 (suppl 1) ◽  
pp. bjgp19X702869
Author(s):  
Imelda McDermott ◽  
Sharon Spooner ◽  
Jon Gibson ◽  
Matt Sutton ◽  
Mark Hann ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Descriptive Analysis ◽  
Significant Proportion ◽  
Data Set ◽  
Diverse Range ◽  
Skill Mix ◽  
Practice Level ◽  
New Ways Of Working ◽  
The Government

BackgroundDecades of under investment in primary care and inattention to suboptimal recruitment and retention of GPs and nurses have contributed to a workforce crisis. The General Practice Forward View sets out how the government is planning to achieve a strengthened model of general practice. A key element of this proposal is to expand the workforce by employing an increasingly diverse range of practitioners i.e. ‘skill mix’. The commitment to broadening skill mix in primary care is reiterated in the NHS Long Term Plan (LTP), with the announcement of a 5-year deal to boost investment in primary care. A significant proportion of this investment focuses on increasing the number of ‘new’ roles such as clinical pharmacists, physiotherapists, physician associates, and paramedics.AimThis presentation offers an early analysis of the scale and distribution of current skill mix in general practice across England. This is part of a wider study about how skill mix is affecting outcomes, costs, and experiences of healthcare in England.MethodDescriptive analysis of a longitudinal practice-level workforce data set using the practice-level workforce Minimum Data Set (wMDS).ResultsWe will present early findings about how staffing has changed and average changes within a region or a clinical commissioning group.ConclusionThese data will indicate the extent of progress towards achievement of the LTP vision of skill mix employment. Findings will inform our future analysis of the structures, contexts, and processes of these new ways of working and provide policymakers, commissioners, and practices with evidence about the wider effects of skill mix.

Dermatology in primary care: an audit of the proportion of patients who present to general practice with a dermatological problem that could be self-managed

2020 ◽  
Vol 70 (suppl 1) ◽  
pp. bjgp20X711053
Author(s):  
Luamar Dolfini ◽  
Yogesh Patel
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Acne Vulgaris ◽  
Clinical Information ◽  
Electronic Record ◽  
Self Management ◽  
Considerable Proportion ◽  
Dry Skin ◽  
Record System ◽  
Common Skin

BackgroundA considerable proportion of GPs’ workload is dermatological. It is important to investigate what common skin conditions encountered in primary care can be self-managed, in an effort to alleviate the burden on primary care.AimThe purpose of the audit was to identify the proportion of consultations that are dermatological in nature and analyse potential for self-management by patients.MethodData was collected using the patient electronic record system (EMIS) in general practice. A search was made for all consultations from the 17 April to 15 May 2019, which included all new presenting complaints that were dermatological in nature. The criteria for self-management included advising over the counter (OTC) medication or reassurance. On the other hand, a case was deemed not self-manageable if prescription only medication (POM) was prescribed or if a referral to dermatology was made.ResultsThere were a total of 2175 consultations, where 246 (11.31%) cases were dermatological. Of the 246, 80 cases (32.5%) could be self-managed. There were 46 different dermatological presenting complaints of which the 5 most common included: rash (51 cases), dermatitis (44 cases), acne vulgaris (13 cases), moles (12 cases), dry skin (11 cases). None of the acne or moles cases could be self-managed, whereas 23%, 68.2%, 72.7% of rashes, dermatitis, and dry skin cases, respectively, could be self-managed.ConclusionCertain dermatological conditions have more potential for self-management than others. Research into teledermatology as a means of addressing patient concern and providing clinical information is important in order to reduce unnecessary consultations.

The Impact of COVID-19 on Primary Care General Practice Consultations in a Teaching Hospital in Shanghai, China

2020 ◽  
Author(s):  
Zhongqing Xu ◽  
Jingchun Fan ◽  
Jingjing Ding ◽  
Xianzhen Feng ◽  
Shunyu Tao ◽  
...  
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Teaching Hospital ◽  
The Impact

scholarly journals Cross sectional study estimating prevalence of heart failure and left ventricular systolic dysfunction in community patients at risk

Heart ◽  
2001 ◽  
Vol 86 (2) ◽  
pp. 172-178 ◽  
Author(s):  
O W Nielsen ◽  
J Hilden ◽  
C T Larsen ◽  
J F Hansen
Keyword(s):  
Heart Failure ◽  
Primary Care ◽  
General Practice ◽  
Heart Disease ◽  
Left Ventricular Systolic Dysfunction ◽  
Systolic Dysfunction ◽  
Left Ventricular ◽  
Ventricular Systolic Dysfunction ◽  
Cross Sectional ◽  
General Practices

OBJECTIVETo examine a general practice population to measure the prevalence of signs and symptoms of heart failure (SSHF) and left ventricular systolic dysfunction (LVSD).DESIGNCross sectional screening study in three general practices followed by echocardiography.SETTING AND PATIENTSAll patients ⩾ 50 years in two general practices and ⩾ 40 years in one general practice were screened by case record reviews and questionnaires (n = 2158), to identify subjects with some evidence of heart disease. Among these, subjects were sought who had SSHF (n = 115). Of 357 subjects with evidence of heart disease, 252 were eligible for examination, and 126 underwent further cardiological assessment, including 43 with SSHF.MAIN OUTCOME MEASURESPrevalence of SSHF as defined by a modified Boston index, LVSD defined as an indirectly measured left ventricular ejection fraction ⩽ 0.45, and numbers of subjects needing an echocardiogram to detect one case with LVSD.RESULTSSSHF afflicted 0.5% of quadragenarians and rose to 11.7% of octogenarians. Two thirds were handled in primary care only. At ⩾ 50 years of age 6.4% had SSHF, 2.9% had LVSD, and 1.9% (95% confidence interval 1.3% to 2.5%) had both. To detect one case with LVSD in primary care, 14 patients with evidence of heart disease without SSHF and 5.5 patients with SSHF had to be examined.CONCLUSIONSSHF is extremely prevalent in the community, especially in primary care, but more than two thirds do not have LVSD. The number of subjects with some evidence of heart disease needing an echocardiogram to detect one case of LVSD is 14.

Estimating pertussis incidence in general practice using a large Australian primary care database

Vaccine ◽  
2021 ◽  
Author(s):  
Robert Neil F. Leong ◽  
James G Wood ◽  
Bette Liu ◽  
Robert Menzies ◽  
Anthony T. Newall
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Primary Care Database ◽  
Care Database
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