The British journal of general practice : the journal of the Royal College of General Practitioners
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Randomized Controlled Trial Multicenter Study
Cluster randomised controlled trial of the effectiveness of primary care mental health workers.
Mental health issues are a core part of the work of primary care and are the second most common reason for consultations. There is some evidence that the quality of primary care mental health provision is variable. ⋯ For patients with common mental health problems, primary care mental health workers may be effective at increasing satisfaction with an episode of care.
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Multicenter Study
Clinical symptoms and 'off-label' prescribing in children with asthma.
A UK-wide database of structured asthma review consultations was used to investigate the prevalence of 'off-label' anti-asthma prescriptions in relationship to clinical symptoms of asthma control. The 1050 children (6.1%) aged 16 years or under issued with an off-label prescription reported more nighttime, daytime and activity asthma symptoms, and used more short-acting beta(2)-agonist medication than their peers. Off-label prescribing for children with asthma in UK primary care is associated with worse levels of self-reported asthma control.
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Guidance from the National Institute for Health and Clinical Excellence recommends one or two questions as a possible screening method for depression. Ultra-short (one-, two-, three- or four-item) tests have appeal due to their simple administration but their accuracy has not been established. ⋯ A one-question test identifies only three out of every 10 patients with depression in primary care, thus unacceptable if relied on alone. Ultra-short two- or three-question tests perform better, identifying eight out of 10 cases. This is at the expense of a high false-positive rate (only four out of 10 cases with a positive score are actually depressed). Ultra-short tests appear to be, at best, a method for ruling out a diagnosis and should only be used when there are sufficient resources for second-stage assessment of those who screen positive.