Shaping and delivering services in primary care: benzodiazepine and opiate withdrawal service

2021 ◽  
Vol 3 (11) ◽  
pp. 459-463
Author(s):  
Jeff Fernandez
Keyword(s):  
Primary Care ◽  
Case Studies ◽  
Patient Outcomes ◽  
Positive Patient ◽  
Opiate Withdrawal ◽  
Opioid Dependency ◽  
Addiction Services

This article looks at the development of the benzodiazepine and opiate withdrawal service (BOWS) based in addiction services in London. The service was created to implement a manageable and sustainable model that would treat patients with benzodiazepine and codeine-based dependencies. It was envisaged the service would effectively treat patients in GP practices in two boroughs in London. The article outlines what is possible in terms of treatment for patients with issues of opioid dependency, by examining two in-depth case studies. It also illustrates what is possible for nurses in the modern NHS and can be used as a resource to shape and deliver services with positive patient outcomes. Nurses should be seen as shaping and delivering care in the NHS. This is a role that should be promoted to a greater degree, wherever possible.

Shaping and delivering services in primary care: benzodiazepine and opiate withdrawal service

2021 ◽  
Vol 32 (10) ◽  
pp. 414-418
Author(s):  
Jeff Fernandez
Keyword(s):  
Primary Care ◽  
Case Studies ◽  
Patient Outcomes ◽  
Positive Patient ◽  
Opiate Withdrawal ◽  
Opioid Dependency ◽  
Addiction Services ◽  
Addiction Service ◽  
Improve Patient

Dependency on benzodiazepine and opiates is an increasing problem. Jeff Fernandez uses case studies to show how a nurse-led addiction service based in primary care can improve patient outcomes This article looks at the development of the benzodiazepine and opiate withdrawal service (BOWS) based in addiction services in London. The service was created to implement a manageable and sustainable model that would treat patients with benzodiazepine and codeine-based dependencies. It was envisaged the service would effectively treat patients in GP practices in two boroughs in London. The article outlines what is possible in terms of treatment for patients with issues of opioid dependency, by examining two in-depth case studies. It also illustrates what is possible for nurses in the modern NHS and can be used as a resource to shape and deliver services with positive patient outcomes. Nurses should be seen as shaping and delivering care in the NHS. This is a role that should be promoted to a greater degree, wherever possible.

Meeting demand for opioid dependency in an Inner London borough

2020 ◽  
Vol 2 (9) ◽  
pp. 512-517
Author(s):  
Jeff Fernandez
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Opiate Withdrawal ◽  
Large Role ◽  
Opioid Dependency ◽  
London Borough ◽  
Experienced Nurse

This paper is looking at the development of the Benzodiazepine and Opiate Withdrawal Service (BOWS) in the borough in Inner London to implement a model that would treat patients effectively in GP practices. It is to illustrate what can be achieved with experienced nurse prescribers in treating an emerging group of patients in primary care. Often patients are aware of their dependency on opiate medications and do want to reduce and come off their medications. This paper describes the BOWS service and its approach, illustrating what can be possible, in terms of treatment for patients in general practice. It also shows what can be designed in NHS services to address the growing issue of dependency on prescribed drugs and argues that services having experience in addictive behaviours can play a very large role in achieving this.

Flexible service provision for codeine-based dependencies in primary care

2020 ◽  
Vol 9 (3) ◽  
pp. 1-4
Author(s):  
Jeff Fernandez
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Health Services ◽  
Service Provision ◽  
Opiate Withdrawal ◽  
Positive Outcomes ◽  
Experienced Nurses ◽  
Addiction Services ◽  
Number Of Patients ◽  
Drug And Alcohol

This article examines the recognised problem of a growing number of patients showing addictive dependencies on prescribed medications, mainly codeine-based analgesia and benzodiazepines. Public Health England has encouraged health services to try and recognise this issue and address it. The development of the Benzodiazepine and Opiate Withdrawal Service from an area of addiction services for drug and alcohol provision in Camden and Islington has been one such initiative. This article includes case studies that show what is possible in terms of treatment. It also shows that experienced nurses can play a role in achieving positive outcomes for patients dependent on prescribed medication.

The Benzodiazepine and Opiate Withdrawal Service: an overview and case studies

2020 ◽  
Vol 9 (2) ◽  
pp. 1-4
Author(s):  
Jeff Fernandez
Keyword(s):  
Primary Care ◽  
General Practice ◽  
Drug Use ◽  
Case Studies ◽  
Opiate Withdrawal ◽  
The Past ◽  
Problematic Drug ◽  
Specialist Services ◽  
Long Time

Patients who have a dependency on benzodiazepines and nonbenzodiazepines have always been able to access drug services in the past in primary care. This has now been expanded to include other problematic drug use on mainly prescribed medications, such as tramadol, gabapentin and pregablin, with the development of the Benzodiazepine and Opiate Withdrawal Service across Camden and Islington. This article looks at the population in general practice in Islington who have been on codeine-based medications for a long time. It examines how treatment can be changed and made more beneficial for them with engaging in specialist services supporting GPs in primary care.

scholarly journals Trends in Antibiotic Prescribing in Out-of-Hours Primary Care in England from January 2016 to June 2020 to Understand Behaviours during the First Wave of COVID-19

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 32
Author(s):  
Nina J. Zhu ◽  
Monsey McLeod ◽  
Cliodna A. M. McNulty ◽  
Donna M. Lecky ◽  
Alison H. Holmes ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
Patient Outcomes ◽  
Broad Spectrum ◽  
Antibiotic Prescribing ◽  
Broad Spectrum Antibiotic ◽  
Out Of Hours ◽  
Broad Spectrum Antibiotics ◽  
National Quality ◽  
General Practices

We describe the trend of antibiotic prescribing in out-of-hours (OOH) general practices (GP) before and during England’s first wave of the COVID-19 pandemic. We analysed practice-level prescribing records between January 2016 to June 2020 to report the trends for the total prescribing volume, prescribing of broad-spectrum antibiotics and key agents included in the national Quality Premium. We performed a time-series analysis to detect measurable changes in the prescribing volume associated with COVID-19. Before COVID-19, the total prescribing volume and the percentage of broad-spectrum antibiotics continued to decrease in-hours (IH). The prescribing of broad-spectrum antibiotics was higher in OOH (OOH: 10.1%, IH: 8.7%), but a consistent decrease in the trimethoprim-to-nitrofurantoin ratio was observed OOH. The OOH antibiotic prescribing volume diverged from the historical trend in March 2020 and started to decrease by 5088 items per month. Broad-spectrum antibiotic prescribing started to increase in OOH and IH. In OOH, co-amoxiclav and doxycycline peaked in March to May in 2020, which was out of sync with seasonality peaks (Winter) in previous years. While this increase might be explained by the implementation of the national guideline to use co-amoxiclav and doxycycline to manage pneumonia in the community during COVID-19, further investigation is required to see whether the observed reduction in OOH antibiotic prescribing persists and how this reduction might influence antimicrobial resistance and patient outcomes.

scholarly journals An evaluation of the implementation of quality improvement (QI) in primary care dentistry: a multi-method approach

2021 ◽  
Vol 10 (2) ◽  
pp. e000839
Author(s):  
Heather Cassie ◽  
Vinay Mistry ◽  
Laura Beaton ◽  
Irene Black ◽  
Janet E Clarkson ◽  
...  
Keyword(s):  
Primary Care ◽  
Quality Improvement ◽  
Case Studies ◽  
Quality Care ◽  
Theoretical Domains Framework ◽  
Team Members ◽  
Knowledge And Skills ◽  
Scottish Government ◽  
The Impact

ObjectivesEnsuring that healthcare is patient-centred, safe and harm free is the cornerstone of the NHS. The Scottish Patient Safety Programme (SPSP) is a national initiative to support the provision of safe, high-quality care. SPSP promotes a coordinated approach to quality improvement (QI) in primary care by providing evidence-based methods, such as the Institute for Healthcare Improvement’s Breakthrough Series Collaborative methodology. These methods are relatively untested within dentistry. The aim of this study was to evaluate the impact to inform the development and implementation of improvement collaboratives as a means for QI in primary care dentistry.DesignA multimethod study underpinned by the Theoretical Domains Framework and the Kirkpatrick model. Quantitative data were collected using baseline and follow-up questionnaires, designed to explore beliefs and behaviours towards improving quality in practice. Qualitative data were gathered using interviews with dental team members and practice-based case studies.ResultsOne hundred and eleven dental team members completed the baseline questionnaire. Follow-up questionnaires were returned by 79 team members. Twelve practices, including two case studies, participated in evaluation interviews. Findings identified positive beliefs and increased knowledge and skills towards QI, as well as increased confidence about using QI methodologies in practice. Barriers included time, poor patient and team engagement, communication and leadership. Facilitators included team working, clear roles, strong leadership, training, peer support and visible benefits. Participants’ knowledge and skills were identified as an area for improvement.ConclusionsFindings demonstrate increased knowledge, skills and confidence in relation to QI methodology and highlight areas for improvement. This is an example of partnership working between the Scottish Government and NHSScotland towards a shared ambition to provide safe care to every patient. More work is required to evaluate the sustainability and transferability of improvement collaboratives as a means for QI in dentistry and wider primary care.

Patient outcomes from a student-led interprofessional clinic in primary care

2013 ◽  
Vol 27 (4) ◽  
pp. 336-338 ◽  
Author(s):  
Fiona Kent ◽  
Jennifer Keating
Keyword(s):  
Primary Care ◽  
Patient Outcomes

Patient outcomes associated with primary care behavioral health services: A systematic review

2018 ◽  
Vol 53 ◽  
pp. 1-11 ◽  
Author(s):  
Kyle Possemato ◽  
Emily M. Johnson ◽  
Gregory P. Beehler ◽  
Robyn L. Shepardson ◽  
Paul King ◽  
...  
Keyword(s):  
Systematic Review ◽  
Primary Care ◽  
Health Services ◽  
Behavioral Health ◽  
Patient Outcomes ◽  
Behavioral Health Services ◽  
Primary Care Behavioral Health
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