Pharmacological Interventions in Primary Care: Hopes and Illusions

2009 ◽  
pp. 54-65 ◽  
Author(s):  
Frédéric Assal ◽  
Marian van der Meulen
Keyword(s):  
Primary Care ◽  
Pharmacological Interventions

scholarly journals Management of non-specific low back pain in primary care – A systematic overview of recommendations from international evidence-based guidelines

2020 ◽  
Vol 21 ◽  
Author(s):  
Cornelia Krenn ◽  
Karl Horvath ◽  
Klaus Jeitler ◽  
Carolin Zipp ◽  
Andrea Siebenhofer-Kroitzsch ◽  
...  
Keyword(s):  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
High Income ◽  
Current Evidence ◽  
Evidence Based ◽  
Low Back ◽  
Pharmacological Interventions ◽  
International Evidence ◽  
Evidence Based Guidelines

Abstract Aim: Systematic identification, characterization and analysis of recommendations concerning the diagnosis and treatment of non-specific low back pain (LBP) in primary care provided in international evidence-based guidelines from high-income countries. Background: LBP is one of the most common reasons for consulting a primary care physician and its prevalence is higher in high-income than in middle- or low-income countries. The majority of LBP is non-specific and treatment recommendations are not often based on high-quality and patient-oriented evidence. Methods: We systematically searched PubMed and major guideline databases from 2013 to 2020. Two independent reviewers performed literature selection and the quality assessment of included guidelines using the AGREE II tool. We extracted all relevant recommendations including the corresponding Grade of Recommendation. We grouped all included recommendations by topic and compared them to each other. Findings: This overview includes 10 current guidelines and overall 549 relevant recommendations. Recommendations covered aspects of assessment and diagnosis (15%), non-pharmacological interventions (46%), pharmacological interventions (26%), invasive treatments (8%) and multimodal pain management (5%). In total, 30% of all recommendations were strong and 57% weak or very weak. The proportion of recommendations for and against an intervention was 45% and 38%, respectively. The recommendations from the different guidelines were largely in good agreement. We identify only a small number of contradictory recommendations, mostly dealing with very specific interventions. Conclusion: In conclusion, current evidence-based guidelines published in high-income countries provide recommendations for all major aspects of the management of people with LBP in primary care. Recommendations from different guidelines were largely consistent. More than 50% of these recommendations were weak or very weak and a high proportion of recommendation advised against an intervention.

The Economics of Depression in Primary Care: Department of Health Initiatives

1995 ◽  
Vol 166 (S27) ◽  
pp. 60-62 ◽  
Author(s):  
Keith Lloyd ◽  
Rachel Jenkins
Keyword(s):  
Primary Care ◽  
Health Care ◽  
Mental Illness ◽  
Secondary Care ◽  
Mental Illnesses ◽  
Depression And Anxiety ◽  
Pharmacological Interventions ◽  
Department Of Health ◽  
Need To Evaluate ◽  
Health Initiatives

Background. Most mental illness is treated in primary and not secondary care settings, with depression and anxiety the commonest conditions encountered.Method. The paper describes on-going Department of Health initiatives to optimise the primary care of common mental illnesses such as depression.Discussion. Primary care attenders with depression are often higher consumers of general health care than non-depressed attenders. Further data will become available soon from these ongoing studies to inform the debate on the optimal use of available resources in primary care. There is a particular need to evaluate non-pharmacological interventions in primary care.

scholarly journals Multidimensional assessment for patients with multimorbidity in primary care – first practice test

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
G Gredinger ◽  
C Trischak ◽  
S Reitter-Pfoertner
Keyword(s):  
Primary Care ◽  
Geriatric Patients ◽  
Functional Tests ◽  
Pharmacological Interventions ◽  
Timed Up And Go ◽  
Practice Test ◽  
Functional Deficits ◽  
Health Care Structure ◽  
Care Structure ◽  
Paper Documentation

Abstract Background Multidimensional geriatric assessments are important for early detection of functional deficits, thus contributing to healthy ageing. According to the Austrian Health Care Structure Plan, such bio-psycho-social assessments should be implemented in primary care and build the basis for the care of patients with chronic diseases. Aim of the present study was to test the feasibility of a respective tool at Austrian general practitioners (GP). Methods Overall, 16 GP participated in our practice test and conducted the composed assessment in 185 geriatric patients (39% male, Ø82.6 years, Ø8 diagnoses, 9 medications). Data was analyzed using descriptive statistics (SPSS 26.0). Results In 181 tested patients (98%), the assessment revealed at least 1 relevant functional deficit (Ø4, max. 8). Level of care and number of functional deficits correlated (Spearman: 0.3, p < 0.01). Defi-cits were mainly found in mobility (55%: Timed Up and Go-Test >20 sec) and activities of daily liv-ing (86% IADL ≤ 15/16 points and 72% Barthel-Index ≤ 95/100 points). The average time to com-plete and document the functional tests was 34 minutes (min. 14, max. 61, n = 121). Use of the elec-tronic (vs. paper) documentation resulted in a significant lower time requirement of 9 minutes. Re-garding subsequent interventions, 11 GP suggested 121 interventions in 57/185 patients (30.8%); thereby, pharmacological interventions were preferred. Conclusions We conclude that our tool tool is practicable in primary care as the required time is manageable. Uncovering functional deficits per se did not induce adequate interventions (neither in number nor in quality); therefore, medical algorithms are needed that make precise recommendations for subse-quent diagnosis and/or treatment/care. Key messages Multidimensional assessments are manageable in primary care and reveal functional deficits. Subsequent to the assessment, algorithms are important in order to induce a benefit through inter-ventions.

scholarly journals Effective non-pharmacological interventions nurse practitioners can implement for the management of metabolic syndrome in primary care settings for adult patients

2021 ◽  
Author(s):  
◽  
Danika Koopmans
Keyword(s):  
Primary Care ◽  
Metabolic Syndrome ◽  
Nurse Practitioners ◽  
Effective Means ◽  
Adult Patients ◽  
Pharmacological Interventions ◽  
Pharmacological Management ◽  
Exercise Interventions ◽  
Primary Care Settings ◽  
Increased Risk

Metabolic syndrome consists of a combination of abdominal obesity, dyslipidemia, hypertension, and elevated glucose levels. Metabolic syndrome is prevalent in North America with upwards of 20% of adults meeting criteria for the condition. It is associated with increased risk of morbidity and mortality, particularly cardiovascular disease, stroke, and renal failure. Its prevalence and widespread consequences have major implications for overall burden of disease and cost on the health care system. First-line treatments for management of metabolic syndrome and its associated individual components require a multifaceted approach including nonpharmacological therapy. This integrative review seeks to answer the question: “What are effective non-pharmacological interventions nurse practitioners can implement for the management of metabolic syndrome in primary care settings for adult patients?” The Whittemore and Knafl (2005) method was followed to ensure a thorough process to which the findings and conclusion are described. There are few guidelines offering effective means of implementing non-pharmacological management of this disease. This review assesses the literature and identifies 13 articles which address effective non-pharmacological interventions in the management of MetS. These interventions were grouped into four categories including, dietary interventions, exercise interventions, psychological support, and a combined intervention approach. The lengths of intervention varied from 3 months to 5 years. Providers responsible for delivery of the interventions varied and were not limited to nurse practitioners. The outcomes of significance included improved anthropometric and serological measures, as well as improved participant motivation and behaviour change. For optimal outcomes of patients, the management of metabolic syndrome in a primary care setting requires a multifaceted and patient-centred approach.

scholarly journals Self-monitoring and other non-pharmacological interventions to improve the management of hypertension in primary care: a systematic review

2010 ◽  
Vol 60 (581) ◽  
pp. e476-e488 ◽  
Author(s):  
Liam G Glynn ◽  
Andrew W Murphy ◽  
Susan M Smith ◽  
Knut Schroeder ◽  
Tom Fahey
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Pharmacological Interventions ◽  
Self Monitoring

Fool’s Gold: Psychologists Using Disingenuous Reasoning to Mislead Legislatures into Granting Psychologists Prescriptive Authority

2003 ◽  
Vol 29 (4) ◽  
pp. 489-524
Author(s):  
Brent Pollitt
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Nurse Practitioners ◽  
Primary Care Physicians ◽  
American Psychological Association ◽  
The United States ◽  
Psychotropic Medications ◽  
American Psychological ◽  
Training Requirements ◽  
Prescriptive Authority

Mental illness is a serious problem in the United States. Based on “current epidemiological estimates, at least one in five people has a diagnosable mental disorder during the course of a year.” Fortunately, many of these disorders respond positively to psychotropic medications. While psychiatrists write some of the prescriptions for psychotropic medications, primary care physicians write more of them. State legislatures, seeking to expand patient access to pharmacological treatment, granted physician assistants and nurse practitioners prescriptive authority for psychotropic medications. Over the past decade other groups have gained some form of prescriptive authority. Currently, psychologists comprise the primary group seeking prescriptive authority for psychotropic medications.The American Society for the Advancement of Pharmacotherapy (“ASAP”), a division of the American Psychological Association (“APA”), spearheads the drive for psychologists to gain prescriptive authority. The American Psychological Association offers five main reasons why legislatures should grant psychologists this privilege: 1) psychologists’ education and clinical training better qualify them to diagnose and treat mental illness in comparison with primary care physicians; 2) the Department of Defense Psychopharmacology Demonstration Project (“PDP”) demonstrated non-physician psychologists can prescribe psychotropic medications safely; 3) the recommended post-doctoral training requirements adequately prepare psychologists to prescribe safely psychotropic medications; 4) this privilege will increase availability of mental healthcare services, especially in rural areas; and 5) this privilege will result in an overall reduction in medical expenses, because patients will visit only one healthcare provider instead of two–one for psychotherapy and one for medication.

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