The British journal of general practice : the journal of the Royal College of General Practitioners
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Despite respiratory tract infections usually being viral and self-limiting, most primary care consultations still result in an antibiotic prescription. The National Institute for Health and Clinical Excellence (NICE) introduced the 'delayed prescribing' (DP) strategy. It remains unknown how useful UK clinicians find this approach. ⋯ DP was not considered to be a helpful strategy for managing patients with self-limiting respiratory tract infections within primary care and the findings do not support the centrality of DP in NICE guidelines as a primary means of reducing antibiotic prescribing. Future training and guidelines should encourage alternative ways of communicating empathy, addressing patient beliefs, and encouraging self-management.
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Review Meta Analysis
Acute infective conjunctivitis in primary care: who needs antibiotics? An individual patient data meta-analysis.
Acute infective conjunctivitis is a common problem in primary care, traditionally managed with topical antibiotics. A number of clinical trials have questioned the benefit of topical antibiotics for patients with acute infective conjunctivitis. ⋯ Acute conjunctivitis seen in primary care can be thought of as a self-limiting condition, with most patients getting better regardless of antibiotic therapy. Patients with purulent discharge or a mild severity of red eye may have a small benefit from antibiotics. Prescribing practices need to be updated, taking into account these results.
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Antidepressant prescribing is increasing worldwide, prompting policy interventions and targets to halt the rise. ⋯ The large rise in antidepressant volumes is caused by a complex mixture of more patients being prescribed SSRI and 'other' antidepressants, the use of higher doses, and longer durations of treatment, with the balance changing overtime. Tricyclic prescribing is now largely low dose, and probably for conditions other than depression. Interventions to improve the quality of antidepressant prescribing need to be more subtle than blanket targets to reduce the total volume of antidepressants prescribed.
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Antibiotics are widely believed to be overused and misused. Approximately 80% of all prescriptions for antibiotics are written by GPs. There are many external factors that influence a GP's decision to prescribe, including patient pressure. Access to primary care services operates on a two-tier system in the Republic of Ireland: General Medical Service (GMS) card holders have free access to GPs and medications; and non-card holders (private patients) must pay a non-subsidised fee to visit their GP. ⋯ These results demonstrate that a GP's decision to provide a prescription for antibiotics may be influenced by whether or not the patient pays for their consultation at the GP interface. Private patients are more likely than GMS card holders to receive a prescription for antibiotics.