scholarly journals Trends and variation in antidepressant prescribing in English primary care

BJGP Open ◽  
2021 ◽  
pp. BJGPO.2021.0020
Author(s):  
Paul Bogowicz ◽  
Helen J Curtis ◽  
Alex J Walker ◽  
Philip Cowen ◽  
John Geddes ◽  
...  
Keyword(s):  
Primary Care ◽  
Regression Analysis ◽  
Mixed Methods Research ◽  
Descriptive Statistics ◽  
Marked Variation ◽  
Substantial Variation ◽  
National Guidelines ◽  
Level Data ◽  
Prescribing Behaviour ◽  
Treatment Sequencing

BackgroundAntidepressants are commonly prescribed. There are clear national guidelines in relation to treatment sequencing. The study examined trends and variation in antidepressant prescribing across English primary care.AimTo examine trends and variation in antidepressant prescribing in England, with a focus on: monoamine oxidase inhibitors (MAOIs); paroxetine; and dosulepin and trimipramine.Design & settingRetrospective longitudinal study using national and practice level data on antidepressant items prescribed per year (1998–2018) and per month (2010–2019).MethodClass- and drug-specific proportions were calculated at national and practice levels. Descriptive statistics were generated, percentile charts and maps were plotted, and conducted logistic regression analysis was conducted.ResultsAntidepressant prescriptions more than tripled between 1998 and 2018, from 377 items per 1000 population to 1266 per 1000. MAOI prescribing fell substantially, from 0.7% of all antidepressant items in 1998 to 0.1% in 2018. There was marked variation between practices in past year prescribing of paroxetine (median practice proportion [MPP] = 1.7%, interdecile range [IDR] = 0.7% to 3.3%) and dosulepin (MPP = 0.7%, IDR = 0% to 1.9%), but less for trimipramine (MPP = 0%, IDR = 0% to 0.2%).ConclusionRapid growth and substantial variation in antidepressant prescribing behaviour was found between practices. The causes could be explored using mixed-methods research. Interventions to reduce prescribing of specific antidepressants, such as dosulepin, could include review prompts, alerts at the time of prescribing, and clinician feedback through tools like OpenPrescribing.net.

Antimicrobial prescribing behaviour in dogs and cats by Belgian veterinarians

2017 ◽  
Vol 182 (11) ◽  
pp. 324-324 ◽  
Author(s):  
Alexia Van Cleven ◽  
Steven Sarrazin ◽  
Hilde de Rooster ◽  
Dominique Paepe ◽  
Sofie Van der Meeren ◽  
...  
Keyword(s):  
Primary Care ◽  
Online Survey ◽  
Treatment Guidelines ◽  
Current Treatment ◽  
Antimicrobial Treatment ◽  
Fourth Generation ◽  
National Guidelines ◽  
First Line ◽  
Clinical Scenarios ◽  
Prescribing Behaviour

The objective of this study is to survey general prescribing behaviour by Belgian companion animal veterinarians and to assess agreement of these practices with current treatment guidelines. Therefore an online survey was administered with five realistic and frequently occurring first-line cases to primary-care veterinary practitioners. For each case a predefined pattern of questions were asked about whether or not they would prescribe antimicrobials, if they would prescribe a non-antimicrobial treatment and if they would perform additional diagnostic steps. The responses were compared with recommendations in national guidelines and recent literature. The overall most prescribed antimicrobials were potentiated amoxicillin (43.0 per cent), fluoroquinolones (14.7 per cent), third-generation and fourth-generation cephalosporins (10.9 per cent) and tetracyclines (10.9 per cent). Only 48.3 per cent of the veterinarians complied with the guidelines in nearly all of the clinical scenarios (ie, prescribing antimicrobials when indicated, not prescribing antimicrobials when it is not indicated). Moreover, when prescribing highest priority critically important antimicrobials, susceptibility testing on bacterial cultures was performed in only 12.4 per cent of the prescriptions. The results showed that the prescribing behaviour of antimicrobial compounds by primary-care veterinary practitioners in dogs and cats is often not in agreement with national guidelines. Focus in improvement of this prescribing behaviour should be on performing the appropriate diagnostic steps and decreasing the use of highest priority critically important antimicrobials.

scholarly journals Online Symptoms Self-Assessment During Covid-19 Pandemic: An Analysis of a Covid-19 Portal Responses from Canada.

2021 ◽  
Author(s):  
Bonaventure Egbujie ◽  
Krizia Francisco ◽  
Mohamed Alarakhia ◽  
John P Hirdes
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Descriptive Statistics ◽  
Self Report ◽  
Assessment Data ◽  
Self Assessment ◽  
Peak Response ◽  
Level Data ◽  
Depth Analysis ◽  
Health Canada

Abstract BackgroundCovid-19 case was first identified in Canada on January 25, 2020, on a Toronto resident who had travelled to Wuhan China, and not long after, the WHO declared the viral infection a pandemic. Ontario health West created an online self-assessment portal that allowed individuals in the health region and adjourning areas to report any covid related symptoms.MethodRecord level data obtained the Ontario Health West self-assessment portal were analyzed. Descriptive statistics using charts and graphs were used to characterize the distribution of responses to the portal. In-depth analysis using correlation, lead-lag analysis, and trend comparison with actual Public Health Canada covid-19 cases for the region were also conducted.ResultsA total of 34,144 distinct responses were recorded on the portal between April 10 and July 29, 2020, with 1,250 (3.7%) responding positively to one of the emergency symptoms questions. Trend analysis showed a peak portal response in May 2020 with a smaller rise subsequently in July 2020, coinciding with actual covid-19 peak in the region. The five most reported symptoms on the portal were sore throat (17.2%), headache (12.9%), fatigue (12.3%), digestive problems (12.2%) and cough (9.1%). For four sub-regions, trend of self-report on the portal positively lagged actual public health covid-19 cases, while for one sub-region, the trend positively led the actual public health covid-19 cases for the area.ConclusionWe found correlation between online covid-19 self- assessment data and the confirmed covid-19 cases in the Southwestern region of Ontario. Trends in the covid-19 associated emergency symptoms reported on the portal also tracked confirmed covid-19 cases in the community. Peak response to the portal coincided with the peak volume of confirmed cases in Ontario during the first wave of covid-19 pandemic in Canada7, suggesting some consistency between the experiences of portal users and patterns of COVID-19 illness in the community. The portal was a useful tool at the person-level because it provided guidance to individuals about how to access appropriate health services according to the symptoms that they reported and connected them with primary care, reducing unnecessary visit to health facilities for covid-19 related care.

scholarly journals Trends and variation in prescribing of suboptimal statin treatment regimes: a cohort study in English primary care

2019 ◽  
Author(s):  
Helen J Curtis ◽  
Alex J Walker ◽  
Brian MacKenna ◽  
Richard Croker ◽  
Ben Goldacre
Keyword(s):  
Primary Care ◽  
Logistic Regression ◽  
Cohort Study ◽  
Behaviour Change ◽  
High Intensity ◽  
Mixed Effects ◽  
Substantial Variation ◽  
Practice Characteristics ◽  
National Guidance ◽  
Prescribing Behaviour

AbstractObjectivesWe set out to describe trends and variation in statin prescribing in England that breaches 2014 national guidance on “high-intensity” statins. We identify factors associated with breaching; and assess the feasibility of rapid prescribing behaviour change.Design, Setting and ParticipantsRetrospective cohort study in NHS primary care in England, including all 8,142 standard general practices from August 2010 to March 2019.Main Outcome MeasuresWe categorised statins as high or low/medium-intensity based on two different thresholds, and calculated the proportion prescribed below these thresholds across all practices. We plotted trends and geographical variation, carried out mixed effects logistic regression to identify practice characteristics associated with breaching guidance, and used indicator saturation to identify practices exhibiting sudden changes in prescribing.ResultsWe included all 8,142 practices across the study period. The proportion of statin prescriptions below the recommended 40% LDL-lowering threshold decreased gradually since 2012 from 80% to 45%; the proportion below a pragmatic 37% threshold decreased from 30% to 18%. The 2014 guidance had minimal impact on these trends. We found wide variation between practices (interdecile ranges 20% to 85% and 10% to 30% respectively in 2018). Mixed effects logistic regression did not identify practice characteristics strongly associated with breaching guidance. Indicator saturation identified several practices exhibiting sudden changes in prescribing towards greater guideline compliance.ConclusionsBreaches of English guidance on choice of statin remain common, with substantial variation between GP practices. Some practices and regions have implemented rapid change, indicating the feasibility of rapid prescribing behaviour change. We discuss the potential for a national strategic approach, using data and evidence to optimise care, including targeted education alongside audit and feedback to outliers through services such as OpenPrescribing.SummaryWhat is already known on this topicEnglish national guidance recommends the use of a high-intensity statin, capable of reducing LDL (low-density lipoprotein) cholesterol by 40% or more. Adherence at the time of guideline release was low, but has not been documented since.What this study addsAdherence is improving, but breaches of national guidance remain common, with 45% of prescriptions below the recommended strength, and there is very substantial variation between practices. Some practices have exhibited rapid positive change in prescribing, which indicates that better adherence could readily be achieved. We have produced a live data tool allowing anyone to explore any practice’s current statin prescribing behaviour.

scholarly journals Online Symptoms Self-Assessment During Covid-19 Pandemic: an Analysis of a Covid-19 Portal Responses from Canada.

2022 ◽  
Author(s):  
Bonaventure Egbujie ◽  
Krizia Francisco ◽  
Mohamed Alarakhia ◽  
John Hirdes
Keyword(s):  
Public Health ◽  
Primary Care ◽  
Descriptive Statistics ◽  
Self Report ◽  
Assessment Data ◽  
Self Assessment ◽  
Peak Response ◽  
Level Data ◽  
Depth Analysis ◽  
Health Canada

Abstract Background: Covid-19 case was first identified in Canada on January 25, 2020, on a Toronto resident who had travelled to Wuhan China, and not long after, the WHO declared the viral infection a pandemic. Ontario health West created an online self-assessment portal that allowed individuals in the health region and adjourning areas to report any covid related symptoms.Method: Record level data obtained the Ontario Health West self-assessment portal were analyzed. Descriptive statistics using charts and graphs were used to characterize the distribution of responses to the portal. In-depth analysis using correlation, lead-lag analysis, and trend comparison with actual Public Health Canada covid-19 cases for the region were also conducted.Results: A total of 34,144 distinct responses were recorded on the portal between April 10 and July 29, 2020, with 1,250 (3.7%) responding positively to one of the emergency symptoms questions. Trend analysis showed a peak portal response in May 2020 with a smaller rise subsequently in July 2020, coinciding with actual covid-19 peak in the region. The five most reported symptoms on the portal were sore throat (17.2%), headache (12.9%), fatigue (12.3%), digestive problems (12.2%) and cough (9.1%). For four sub-regions, trend of self-report on the portal positively lagged actual public health covid-19 cases, while for one sub-region, the trend positively led the actual public health covid-19 cases for the area.Conclusion: We found correlation between online covid-19 self- assessment data and the confirmed covid-19 cases in the Southwestern region of Ontario. Trends in the covid-19 associated emergency symptoms reported on the portal also tracked confirmed covid-19 cases in the community. Peak response to the portal coincided with the peak volume of confirmed cases in Ontario during the first wave of covid-19 pandemic in Canada, suggesting some consistency between the experiences of portal users and patterns of COVID-19 illness in the community. The portal was a useful tool at the person-level because it provided guidance to individuals about how to access appropriate health services according to the symptoms that they reported and connected them with primary care, reducing unnecessary visit to health facilities for covid-19 related care.

scholarly journals Inappropriate Azithromycin Use in Nine Primary-Care Clinics Before and After Implementation of Provider Guidance in the EMR

2020 ◽  
Vol 41 (S1) ◽  
pp. s292-s293
Author(s):  
Alexandria May ◽  
Allison Hester ◽  
Kristi Quairoli ◽  
Sheetal Kandiah
Keyword(s):  
Primary Care ◽  
Retrospective Chart Review ◽  
Antibiotic Prescribing ◽  
Upper Respiratory Tract ◽  
National Guidelines ◽  
Targeted Interventions ◽  
Primary Care Clinics ◽  
Before And After ◽  
Upper Respiratory ◽  
Tract Infections

Background: According to the CDC Core Elements of Outpatient Stewardship, the first step in optimizing outpatient antibiotic use the identification of high-priority conditions in which antibiotics are commonly used inappropriately. Azithromycin is a broad-spectrum antimicrobial commonly used inappropriately in clinical practice for nonspecific upper respiratory infections (URIs). In 2017, a medication use evaluation at Grady Health System (GHS) revealed that 81.4% of outpatient azithromycin prescriptions were inappropriate. In an attempt to optimize outpatient azithromycin prescribing at GHS, a tool was designed to direct the prescriber toward evidence-based therapy; it was implemented in the electronic medical record (EMR) in January 2019. Objective: We evaluated the effect of this tool on the rate of inappropriate azithromycin prescribing, with the goal of identifying where interventions to improve prescribing are most needed and to measure progress. Methods: This retrospective chart review of adult patients prescribed oral azithromycin was conducted in 9 primary care clinics at GHS between February 1, 2019, and April 30, 2019, to compare data with that already collected over a 6-month period in 2017 before implementation of the antibiotic prescribing guidance tool. The primary outcome of this study was the change in the rate of inappropriate azithromycin prescribing before and after guidance tool implementation. Appropriateness was based on GHS internal guidelines and national guidelines. Inappropriate prescriptions were classified as inappropriate indication, unnecessary prescription, excessive or insufficient treatment duration, and/or incorrect drug. Results: Of the 560 azithromycin prescriptions identified during the study period, 263 prescriptions were included in the analysis. Overall, 181 (68.8%) of azithromycin prescriptions were considered inappropriate, representing a 12.4% reduction in the primary composite outcome of inappropriate azithromycin prescriptions. Bronchitis and unspecified upper respiratory tract infections (URI) were the most common indications where azithromycin was considered inappropriate. Attending physicians prescribed more inappropriate azithromycin prescriptions (78.1%) than resident physicians (37.0%) or midlevel providers (37.0%). Also, 76% of azithromycin prescriptions from nonacademic clinics were considered inappropriate, compared with 46% from academic clinics. Conclusions: Implementation of a provider guidance tool in the EMR lead to a reduction in the percentage of inappropriate outpatient azithromycin prescriptions. Future targeted interventions and stewardship initiatives are needed to achieve the stewardship program’s goal of reducing inappropriate outpatient azithromycin prescriptions by 20% by 1 year after implementation.Funding: NoneDisclosures: None

scholarly journals 1542. Provider Uptake of Extragenital Screening for Gonorrhea and Chlamydia in Active Duty Air Force Members with Incident HIV Diagnosis

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S770-S771
Author(s):  
Christian C Lamb ◽  
Joseph Yabes ◽  
Shilpa Hakre ◽  
Jason Okulicz
Keyword(s):  
Primary Care ◽  
Hiv Infection ◽  
Air Force ◽  
Clinical Laboratory ◽  
Medical Center ◽  
Previous History ◽  
Primary Care Providers ◽  
Care Providers ◽  
National Guidelines ◽  
Hiv Diagnosis

Abstract Background The prevalence of Neisseria gonorrhea (GC) and Chlamydia trachomatis (CT) is much higher at extragenital anatomic sites among men who have sex with men (MSM) with HIV infection. National guidelines recommend that all MSM with HIV infection undergo screening for extragenital sexually transmitted infections (EG-STIs), however uptake is low in many primary care settings. We evaluated EG-STI screening by primary care providers (PCPs) for US Air Force (USAF) members with incident HIV infection. Methods All USAF members newly diagnosed with HIV infection who received initial HIV specialty care with Infectious Disease (ID) providers at Brooke Army Medical Center from 2016-2018 (n=98) were included. A retrospective chart review was conducted to evaluate STI screening performed by PCPs within 1 week of HIV diagnosis compared to screening at entry into ID care. Demographic, clinical, laboratory and behavioral risk data were collected. STI screening included GC/CT EG-STIs, urethral GC/CT, syphilis, and hepatitis B and C. Results Patients were predominantly male (97.9%) with a median age of 26 (IQR 23, 32) years at HIV diagnosis (Table 1). A previous history of STIs was reported in 53 (54.1%) patients and the majority of males self-identified as MSM (66.3%) or bisexual (22.5%). The median time from HIV diagnosis to ID evaluation was 26 days (IQR 9, 33). PCPs performed any STI screening in 61 (62.2%) patients (Table 2). EG-STI screening was conducted in 3 (3.1%) patients overall and in (3.4%) MSM/bisexuals. A total of 31 (31.6%) patients had missed STIs; the majority due to EG-STIs of the rectum (71%) and pharynx (21.9%). All EG-STIs would have been missed by urethral GC/CT screening alone. Table 1 Table 2 Conclusion EG-STI screening uptake was low among PCPs evaluating USAF members with incident HIV infection. Underutilization of EG-STI screening can result in missed infections and forward transmission of GC/CT. Barriers to low uptake need to be explored. Continued education and training of PCPs may be necessary to improve uptake of EG-STI screening. Disclosures All Authors: No reported disclosures

Relation of Fatigue with Alexithymia and Depression in Psychiatric Outpatients

2007 ◽  
Vol 105 (2) ◽  
pp. 539-545
Author(s):  
Thomas N. Wise ◽  
Michael J. Sheridan
Keyword(s):  
Primary Care ◽  
Regression Analysis ◽  
Psychosocial Stress ◽  
Multivariate Regression ◽  
Multivariate Regression Analysis ◽  
Psychiatric Outpatients ◽  
The Mean

The complaint of fatigue is common in community, primary care, and psychiatric settings. Fatigue is often associated with depression and psychosocial stress. This report investigated the role of alexithymia and depression in fatigue as reported in a sample of 151 psychiatric outpatients (75 men and 76 women) who completed all scales. The mean age of the sample was 45.5 yr. ( SD = 12.5), and mean education was 16.2 yr. ( SD = 2.4). Fatigue was inversely correlated with education (–.16) and positively correlated with depression (.44), anxiety (.30), and alexithymia (.35). However, in a multivariate regression analysis, only depression and alexithymia remained significant ( p ≤ .01).

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