Anticholinergic medicines in an older primary care population: a cross-sectional analysis of medicines’ levels of anticholinergic activity and clinical indications

Depression is common, places a large burden on the patient, their family and community, and is often difficult to treat. Magnesium supplementation is associated with improved depressive symptoms, but because the mechanism is unknown, it is unclear whether serum magnesium levels act as a biological predictor of the treatment outcome. Therefore, we sought to describe the relationship between serum magnesium and the Patient Health Questionnaire (PHQ, a measure of depression) scores. A cross-sectional analysis of medical records from 3604 adults (mean age 62 years; 42% men) seen in primary care clinics between 2015 and 2018, with at least one completed PHQ were included. The relationship between serum magnesium and depression using univariate analyses showed a significant effect when measured by the PHQ-2 (−0.19 points/mg/dL; 95% CI −0.31, −0.07; P = 0.001) and the PHQ-9 (−0.93 points/mg/dL; 95% CI −1.81, −0.06; P = 0.037). This relationship was strengthened after adjusting for covariates (age, gender, race, time between serum magnesium and PHQ tests, and presence of diabetes and chronic kidney disease) (PHQ-2: −0.25 points/mg/dL; 95% CI −3.33, −0.09; P < 0.001 and PHQ-9: −1.09 95% CI −1.96 −0.21; P = 0.015). For adults seen in primary care, lower serum magnesium levels are associated with depressive symptoms, supporting the use of supplemental magnesium as therapy. Serum magnesium may help identify the biological mechanism of depressive symptoms and identify patients likely to respond to magnesium supplementation.

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Deprivation and primary care funding in Greater Manchester after devolution: a cross-sectional analysis

British Journal of General Practice ◽

10.3399/bjgp19x705545 ◽

2019 ◽

Vol 69 (688) ◽

pp. e794-e800

Author(s):

Jessica A Lee ◽

Rachel Meacock ◽

Evangelos Kontopantelis ◽

James Matheson ◽

Matthew Gittins

Keyword(s):

Primary Care ◽

Health Inequities ◽

Care Quality ◽

Area Deprivation ◽

Cross Sectional ◽

Practice Location ◽

Cross Sectional Analysis ◽

Health And Social Care ◽

Sectional Analysis ◽

Quality Measurements

BackgroundIn April 2016 Greater Manchester gained control of its health and social care budget, a devolution that aimed to reduce health inequities both within Greater Manchester and between Greater Manchester and the rest of the country.AimTo describe the relationship between practice location deprivation and primary care funding and care quality measurements in the first year of Greater Manchester devolution (2016/2017).Design and settingCross-sectional analysis of 472 general practices in Greater Manchester in England.MethodFinancial data for each general practice were linked to the area deprivation of the practice location, as measured by the 2015 Index of Multiple Deprivation. Practices were categorised into five quintiles relative to national deprivation. NHS Payments data and indicators of care quality were compared across social deprivation quintiles.ResultsPractices in areas of greater deprivation did not receive additional funding per registered patient. Practices in less deprived quintiles received higher National Enhanced Services payments from NHS England than practices in the most deprived quintile. A trend was observed towards funding to more deprived practices being supported by Local Enhanced Service payments from clinical commissioning groups, but these represent a small proportion of overall practice income. Practices in less deprived areas had better care quality measurements according to Quality and Outcomes Framework achievement and Care Quality Commission ratings.ConclusionFollowing devolution, primary care practices in Greater Manchester are still reliant on funding from national funding schemes, which poorly reflect its deprivation. The devolved administration’s ability to address health inequities at the primary care level seems uncertain.

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