scholarly journals The relationship between primary care antibiotic prescribing and bacterial resistance in adults in the community: a controlled observational study using individual patient data

2005 ◽  
Vol 56 (1) ◽  
pp. 146-153 ◽  
Author(s):  
Alastair D. Hay ◽  
Michael Thomas ◽  
Alan Montgomery ◽  
Mark Wetherell ◽  
Andrew Lovering ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Bacterial Resistance ◽  
Individual Patient Data ◽  
Patient Data ◽  
Antibiotic Prescribing ◽  
The Relationship

scholarly journals The contribution of depressive ‘disorder characteristics’ to determinations of prognosis for adults with depression: an individual patient data meta-analysis

2021 ◽  
pp. 1-14
Author(s):  
Joshua E. J. Buckman ◽  
Rob Saunders ◽  
Zachary D. Cohen ◽  
Phoebe Barnett ◽  
Katherine Clarke ◽  
...  
Keyword(s):  
Primary Care ◽  
Depressive Symptoms ◽  
Depressive Symptom ◽  
Panic Disorder ◽  
Symptom Severity ◽  
Individual Patient Data ◽  
Antidepressant Treatment ◽  
Patient Data ◽  
History Of ◽  
Depressive Symptom Severity

Abstract Background This study aimed to investigate general factors associated with prognosis regardless of the type of treatment received, for adults with depression in primary care. Methods We searched Medline, Embase, PsycINFO and Cochrane Central (inception to 12/01/2020) for RCTs that included the most commonly used comprehensive measure of depressive and anxiety disorder symptoms and diagnoses, in primary care depression RCTs (the Revised Clinical Interview Schedule: CIS-R). Two-stage random-effects meta-analyses were conducted. Results Twelve (n = 6024) of thirteen eligible studies (n = 6175) provided individual patient data. There was a 31% (95%CI: 25 to 37) difference in depressive symptoms at 3–4 months per standard deviation increase in baseline depressive symptoms. Four additional factors: the duration of anxiety; duration of depression; comorbid panic disorder; and a history of antidepressant treatment were also independently associated with poorer prognosis. There was evidence that the difference in prognosis when these factors were combined could be of clinical importance. Adding these variables improved the amount of variance explained in 3–4 month depressive symptoms from 16% using depressive symptom severity alone to 27%. Risk of bias (assessed with QUIPS) was low in all studies and quality (assessed with GRADE) was high. Sensitivity analyses did not alter our conclusions. Conclusions When adults seek treatment for depression clinicians should routinely assess for the duration of anxiety, duration of depression, comorbid panic disorder, and a history of antidepressant treatment alongside depressive symptom severity. This could provide clinicians and patients with useful and desired information to elucidate prognosis and aid the clinical management of depression.

scholarly journals Association between doctor-patient familiarity and patient-centred care during general practitioner's consultations: a direct observational study in Chinese primary care practice

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Chenwen Zhong ◽  
Mengping Zhou ◽  
Zhuojun Luo ◽  
Cuiying Liang ◽  
Lina Li ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Health Knowledge ◽  
Care Practice ◽  
Patient Centred Care ◽  
Time Length ◽  
Significant Difference ◽  
Information Treatment ◽  
Observation Code ◽  
The Relationship

Abstract Background Patient-centred care is a core attribute of primary care. Not much is known about the relationship between patient-centred care and doctor-patient familiarity. This study aimed to explore the association between general practitioner (GP) perceived doctor-patient familiarity and the provision of patient-centred care during GP consultations. Methods This is a direct observational study conducted in eight community health centres in China. Level of familiarity was rated by GPs using a dichotomized variable (Yes/No). The provision of patient-centred care during GP consultations was measured by coding audiotapes using a modified Davis Observation Code (DOC) interactional instrument. Eight individual codes in the modified DOC were selected for measuring the provision of patient-centred care, including ‘family information’, ‘treatment effects’, ‘nutrition guidance’, ‘exercise guidance’, ‘health knowledge’, ‘patient question’, ‘chatting’, and ‘counseling’. Multivariate analyses of covariance were adopted to evaluate the association between GP perceived doctor-patient familiarity and patient-centred care. Results A total of 445 audiotaped consultations were collected, with 243 in the familiar group and 202 in the unfamiliar group. No significant difference was detected in overall patient-centred care between the two groups. For components of patient-centred care, the number of intervals (1.36 vs 0.88, p = 0.026) and time length (7.26 vs. 4.40 s, p = 0.030) that GPs spent in ‘health knowledge’, as well as time length (13.0 vs. 8.34 s, p = 0.019) spent in ‘patient question’ were significantly higher in unfamiliar group. The percentage of ‘chatting’ (11.9% vs. 7.34%, p = 0.012) was significantly higher in the familiar group. Conclusions This study suggested that GP perceived doctor-patient familiarity may not be associated with GPs’ provision of patient-centred care during consultations in the context of China. Not unexpectedly, patients would show more health knowledge and ask more questions when GPs were not familiar with them. Further research is needed to confirm and expand on these findings.

scholarly journals Delayed antibiotic prescribing for respiratory tract infections: protocol of an individual patient data meta-analysis

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e026925 ◽  
Author(s):  
Beth Stuart ◽  
Hilda Hounkpatin ◽  
Taeko Becque ◽  
Guiqing Yao ◽  
Shihua Zhu ◽  
...  
Keyword(s):  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Characteristics ◽  
Patient Data ◽  
Published Data ◽  
Controlled Trials ◽  
Antibiotic Prescribing ◽  
Cochrane Central Register ◽  
Life Years ◽  
Tract Infections

IntroductionDelayed prescribing can be a useful strategy to reduce antibiotic prescribing, but it is not clear for whom delayed prescribing might be effective. This protocol outlines an individual patient data (IPD) meta-analysis of randomised controlled trials (RCTs) and observational cohort studies to explore the overall effect of delayed prescribing and identify key patient characteristics that are associated with efficacy of delayed prescribing.Methods and analysisA systematic search of the databases Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Ovid Embase, EBSCO CINAHL Plus and Web of Science was conducted to identify relevant studies from inception to October 2017. Outcomes of interest include duration of illness, severity of illness, complication, reconsultation and patient satisfaction. Study authors of eligible papers will be contacted and invited to contribute raw IPD data. IPD data will be checked against published data, harmonised and aggregated to create one large IPD database. Multilevel regression will be performed to explore interaction effects between treatment allocation and patient characteristics. The economic evaluation will be conducted based on IPD from the combined trial and observational studies to estimate the differences in costs and effectiveness for delayed prescribing compared with normal practice. A decision model will be developed to assess potential savings and cost-effectiveness in terms of reduced antibiotic usage of delayed prescribing and quality-adjusted life years.Ethics and disseminationEthical approval was obtained from the University of Southampton Faculty of Medicine Research Ethics Committee (Reference number: 30068). Findings of this study will be published in peer-reviewed academic journals as well as General Practice trade journals and will be presented at national and international conferences. The results will have important public health implications, shaping the way in which antibiotics are prescribed in the future and to whom delayed prescriptions are issued.PROSPERO registration numberCRD42018079400.

scholarly journals Acute infective conjunctivitis in primary care: who needs antibiotics? An individual patient data meta-analysis

2011 ◽  
Vol 61 (590) ◽  
pp. e542-e548 ◽  
Author(s):  
Joanna Jefferis ◽  
Rafael Perera ◽  
Hazel Everitt ◽  
Henk van Weert ◽  
Remco Rietveld ◽  
...  
Keyword(s):  
Primary Care ◽  
Individual Patient Data ◽  
Meta Analysis ◽  
Patient Data

scholarly journals Effect of antibiotic prescribing in primary care on antimicrobial resistance: a literature review 2020

2020 ◽  
Vol 7 (2) ◽  
pp. 783
Author(s):  
Bandar A. Alharbi ◽  
Abrar A. Assiri ◽  
Khulud A. Asiri ◽  
Dalia A. Albagli ◽  
Abrar A. Alanazi ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Studies ◽  
Bacterial Resistance ◽  
Urinary Infection ◽  
Experimental Studies ◽  
Antibiotic Prescribing ◽  
Randomised Trials ◽  
Symptomatic Infection ◽  
Primary Care Data ◽  
Mesh Terms

Our aim is to review the literature and, where appropriate, investigating subsequent antibiotic resistance in individuals prescribed antibiotics in primary care. Data sources are observational and experimental studies identified through Medline, Embase, and Cochrane searches. Review methods Electronic searches using MeSH terms and text words identified 4373 papers. Results The review included 24 studies, 22 involved patients with symptomatic infection and two involved healthy volunteers, 19 were observational studies (of which two were prospective) and five were randomised trials. The observations concluded that individuals prescribed an antibiotic in primary care for a respiratory or urinary infection develop bacterial resistance to that antibiotic.

scholarly journals Association between Physicians’ Perception of Shared Decision Making with Antibiotic Prescribing Behavior in Primary Care in Hubei, China: A Cross-Sectional Study

Antibiotics ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 876
Author(s):  
Dan Wang ◽  
Chenxi Liu ◽  
Xuemei Wang ◽  
Xinping Zhang
Keyword(s):  
Primary Care ◽  
Cross Sectional Study ◽  
Antibiotic Prescribing ◽  
Sectional Study ◽  
Positive Perception ◽  
Cross Sectional ◽  
Prescribing Behavior ◽  
Physician Patient ◽  
The Relationship ◽  
Over 40 Years

Shared decision-making (SDM) has been advocated as one effective strategy for improving physician–patient relationships and optimizing clinical outcomes. Our study aimed to measure physicians’ perception of SDM and establish the relationship between physicians’ perception of SDM and prescribing behavior in patients with upper respiratory tract infections. One cross-sectional study was conducted in Hubei Province from December 2019 to January 2020. The SDM questionnaire and prescription data of 2018 from electronic health records data were matched for each physician in this study. Multilevel modeling was applied to explore the relationship between physicians’ perception of SDM and antibiotic prescribing in primary care. Analyses were statistically controlled for demographic characteristics of the physicians and patients. Physicians’ positive perception of SDM had small but statistically significant effects on lower prescribing of antibiotics in the patient group aged over 40 years (odds ratio (OR) < 1; p < 0.05). Moreover, female physicians (OR = 0.71; p = 0.007) with higher educational levels (bachelor’s degree and above; OR = 0.71; p = 0.024) were significantly associated with the prescribing of less antibiotics (p < 0.05). A more positive perception of SDM was demonstrated as one significant predictor of less prescribing of antibiotics in the patient group over 40 years. There may be a promising focus of implementing SDM strategies targeting physician–patient communication in primary care.

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