The British journal of general practice : the journal of the Royal College of General Practitioners
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Direct oral anticoagulants (DOACs) account for an increasing proportion of prescriptions in patients with non-valvular atrial fibrillation (NVAF) in primary care. Inappropriate dosing of DOACs is a common problem, with under-dosing being a particular issue. However, conflicting results have been reported about the factors independently associated with inappropriate dosing. ⋯ The appropriateness of DOAC prescribing for NVAF can be improved, especially in older patients, and in patients with kidney failure, a higher risk of ischaemic stroke, and/or a higher risk of bleeding. GPs have a key role in increasing the proportion of appropriate DOAC prescriptions via informational, educational, and/or management strategies.
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One can assume a relatively high prevalence of urinary incontinence (UI) in people with multimorbidity. However, literature in this area is scarce. There is a need for further robust research to aid GPs to identify patients at a particular risk for UI, and to initiate the early treatment and multidisciplinary management of this condition. ⋯ In this large sample of Spanish individuals aged ≥15 years, suffering from multimorbidity was associated with a significantly higher level of UI.
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Chronic kidney disease (CKD) is commonly comorbid with hypertension, diabetes, and cardiovascular disease (CVD). However, the extent of comorbidity in CKD across a range of concordant (shared pathophysiology and/or treatment) conditions and discordant (unrelated pathophysiology and/or different or contradictory treatment) conditions is not well documented. ⋯ Chronic kidney disease is associated with extreme comorbidity across a wide range of mental and physical conditions. Routine care for people with CKD should include recognition and management of comorbidities, and clinical guidelines should support clinicians to do this.
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Personalised care planning (PCP) interventions have the potential to provide better outcomes for older people and are a key focus in primary care practice. Behaviour change techniques (BCTs) can maximise effectiveness of such interventions, but it is uncertain which BCTs are most appropriate in PCP for older adults. ⋯ Future PCP interventions to improve QoL for people aged ≥65 years may benefit from focusing on six specific BCTs. Better reporting of BCTs would enhance future design and implementation of such interventions.
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Observational Study
Primary care consultation length by deprivation and multimorbidity in England: an observational study using electronic patient records.
Longer GP consultations are recommended as one way of improving care for people with multimorbidity. In Scotland, patients who are multimorbid and living in deprived areas do not have longer consultations, although their counterparts in the least deprived areas do. This example of the inverse care law has not been examined in England. ⋯ GPs in England spend longer with patients who have more conditions, but, at all multimorbidity levels, those in deprived areas have less time per GP consultation. Further research is needed to assess the impact of consultation length on patient and system outcomes for those with multimorbidity.