Advising patients with hepatitis C in primary care

Infection with hepatitis C virus can cause a slowly progressive disease of the liver. By the end of 2003, there had been around 60,000 reported laboratory diagnoses of this infection in the UK. In addition, around five times as many people are thought to have been infected but are unaware of this. While those diagnosed with hepatitis C infection should be offered referral to a specialist for investigation and treatment, many will also need information and reassurance from healthcare professionals working in primary care. Also, the new national strategy to improve prevention, diagnosis and treatment of hepatitis C infection will increase the number of people who are tested for the virus and, therefore, require counselling about their test results. Here we provide practical advice to help healthcare professionals in their discussions with patients.     

Anticoagulant treatment of patients in Swedish primary health care

OBJECTIVE: Assessing the quality of anticoagulant (AC) treatment in primary health care with regard to safety. DESIGN: Surveys of patients on AC treatment during 1999. SETTING: Community health centres (CHCs) in the northeastern region of Stockholm County. SUBJECTS: Nine hundred and fifty-seven patients, from 16 CHCs. MAIN OUTCOME MEASURES: Rate of bleeding and thromboembolic events during AC treatment and rate of values within the recommended treatment interval. The reporting of prothrombin-time (PT) results changed during the year from PT values to international normalised ratio (INR). RESULTS: A total of 48 bleeding events in 44 patients were noted, i.e. 6.8 per 100 patient-years. Of these, ten were major bleedings, 1.4 per 100 patient-years, including three fatal bleedings, 0.4 per 100 patient-years. Six thrombo-embolic events were noted during treatment, i.e. 0.8 per 100 patient-years. Bleeding events were more common at INR values greater than 2.80 than at values of 2.80, [relative risk (RR) 3.30, 95% confidence interval 1.90-5.71]. Of all the noted PT values, 65% were within the recommended intervals (the most common being PT 15-25%) and of all noted INR values 60% (the most common being INR 2.1-3.0). No differences in the rate of bleeding or the number of thrombo-embolic events between the periods of PT and INR results were found. CONCLUSIONS: The rate of complications was low and AC treatment in primary health care seems to be as safe as in hospital clinics.     

Polypharmacy in older patients at primary care units in Brazil

International Journal of Clinical Pharmacy - Background Despite extensive studies of polypharmacy in older patients, no consensus regarding the definition of this practice exists in the...     

Predictors of uncontrolled hyperlipidaemia in high-risk ambulatory patients in primary care

ABSTRACT

Objective: To determine (a) the proportion of patients at high risk of cardiovascular events who achieve low-density lipoprotein cholesterol (LDL-C) goals as recommended by the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP III) guidelines, and (b) the predictors of poor LDL-C control.

Methods: Two open-label, prospective, non-randomised, observational studies (study 1 with n?=?19 194 patients, predominantly with coronary artery disease (CHD); study 2 with n?=?19 484 patients, predominantly with diabetes mellitus (DM)). Patients received, usually after statin pretreatment, ezetimibe 10?mg plus simvastatin as fixed-dose combinations over 3?months. Bivariate and multivariate regression analysis was performed to identify factors associated with poor LDL-C control.

Results: At study end, 38?%?(up from 4.7?%?at baseline) of CHD and 35?%?(up from 3.3?%?at baseline) of diabetic patients achieved the target LDL value?<?100?mg/dl (2.6?mmol/l) after treatment with a fixed-dose ezetimibe–simvastatin combination. In both studies, concomitant atherosclerotic disease was associated with good control. Conversely, factors associated with poor control were, among others, high baseline LDL-C values, pretreatment with certain statins, and (in the DM study) high HbA_1c, and high body mass index.

Conclusion: Under real world, general practice conditions, a substantial proportion of high-risk patients with CHD and/or DM met LDL-C target levels on dual cholesterol inhibition with ezetimibe/simvastatin. A limited number of easily recognisable factors allow physicians to identify high risk patients whose LDL-C is likely to be difficult to control. Early identification of this patient group may have profound clinical benefits in general practice by enabling specific early interventions such as counselling on physical activity, dietary support and/or follow up visits to the GP.     

Prevalence of COPD among symptomatic patients in a primary care setting

Abstract

Objective:

Spirometry is recognized as the gold standard assessment for the diagnosis of COPD. However, spirometry continues to be underused, perpetuating the underdiagnosis of COPD. The aim of this study was to evaluate the prevalence of COPD in a primary care setting in patients with a smoking history and self-reported chronic bronchitis symptoms.     

Gout in primary care

Gout affects around 1% of people in the UK, most aged over 45 years. The condition, which is five times more common in men than women, usually presents as a painful inflammatory monoarthritis, which can be diagnosed clinically and successfully treated with a high dose of an NSAID. Problems arise when the features are atypical or when high doses of an NSAID are inappropriate. Also; there is no robust evidence to guide when to start prophylactic therapy or what advice to give on lifestyle changes. Here we review current practice and offer advice on managing patients with this increasingly common condition, concentrating on approaches to be taken by the non-specialist.     

Deprescribing clonazepam in primary care older patients: a feasibility study

International Journal of Clinical Pharmacy - Background Inappropriate use of clonazepam by older adults is associated with cognitive impairment, delirium, and falls. Strategies to optimize its use...     

Medication errors when transferring elderly patients between primary health care and hospital care

Objective: The aims were to evaluate the frequency and nature of errors in medication when patients are transferred between primary and secondary care.Method: Elderly primary health care patients (> 65years) living in nursing homes or in their own homes with care provided by the community nursing system, had been admitted to one of two hospitals in southern Sweden, one university hospital and one local hospital. A total of 69 patient-transfers were included. Of these, 34 patients were admitted to hospital whereas 35 were discharged from hospital.Main outcome measure: Percentage medication errors of all medications i.e. any error in the process of prescribing, dispensing, or administering a drug, and whether these had adverse consequences or not.Results: There were 142 medication errors out of 758 transfers of medications. The patients in this study used on an average more than 10 drugs before, during and after hospital stay. On an average, there were two medication errors each time a patient was transferred between primary and secondary care. When patients were discharged from the hospital, the usage of a specific medication dispensing system constituted a significant risk for medication errors. The most common error when patients were transferred to the hospital was inadvertent withdrawal of drugs. When patients left the hospital the most common error was that drugs were erroneously added.Conclusion: Medication errors are common when elderly patients are transferred between primary and secondary care. Improvement in documentation and transferring data about elderly patients medications could reduce these errors. The specific medication dispensing system that has been used in order to increase safety in medication dispensing does not seem to be a good instrument to reduce the number of errors in transferring data about medication.