JournalTOCs

British Journal of General Practice
Journal Prestige (SJR): 0.906

Citation Impact (citeScore): 1
Number of Followers: 40

Full-text available via subscription

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ISSN (Print) 0960-1643 - ISSN (Online) 1478-5242
Published by RCGP

[1 journal]

Variation in duration of repeat prescriptions: a primary care cohort study
in England
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  Authors: Brian MacKenna; Andrew D Brown, Richard Croker, Alex J Walker, Ben Goldacre, Apostolos Tsiachristas, Dave Evans, Peter Inglesby, Seb Bacon, Helen J Curtis
  Pages: e448 - e456
  Abstract: BackgroundMany patients receive repeat prescriptions for routine medications used to treat chronic conditions. Doctors typically issue repeat prescriptions with durations ranging from 28 to 84 days. There is currently no national guidance in England for the optimal prescription duration for routine medications.AimTo evaluate current prescription durations for five common routine medications in England; explore and visualise geographical variation; and identify practice factors that are associated with shorter prescribing duration to inform policy making.Design and settingA retrospective cohort study of NHS primary care prescribing data in England from December 2018 to November 2019.MethodThe prescription duration was analysed for five common routine medications in England; ramipril, atorvastatin, simvastatin, levothyroxine, and amlodipine. Variation was assessed between regional clinical commissioning groups (CCGs), and practice factors associated with different durations were identified.ResultsOf the common medications included, 28-day prescriptions accounted for 48.5% (2.5 billion) tablets/capsules issued, while 43.6% were issued for 56 days. There was very wide regional variation (7.2%–95.0%) in the proportion of 28-day prescriptions issued by CCGs. Practice dispensing status was the most likely predictor of prescription duration; dispensing practices had a higher 28-day prescribing proportion than non-dispensing practices. The proportion of patients with chronic conditions and the electronic health record system used by a practice were also associated with prescription duration.ConclusionThis analysis of OpenPrescribing data showed that repeat prescriptions of 28 days are common for patients taking routine medications for chronic conditions, particularly in dispensing practices. This provides data to inform the policy debate on current practice. Configuration of electronic health record systems offer an opportunity to implement and evaluate new policies on repeat prescription duration in England.
  PubDate: 2025-06-26T16:05:27-07:00
  DOI: 10.3399/BJGP.2024.0326
  Issue No: Vol. 75, No. 756 (2025)
Impact of an SMS intervention to support type 2 diabetes self-management:
DiabeText clinical trial
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  Authors: Rocio Zamanillo–Campos; Maria Antonia Fiol–deRoque, Maria Jesus Serrano–Ripoll, Joan Llobera–Canaves, Joana Maria Taltavull–Aparicio, Alfonso Leiva–Rus, Joana Ripoll–Amengual, Escarlata Angullo–Martinez, Isabel Maria Socias–Buades, Lluis Masmiquel–Comas, Jadwiga Konieczna, Maria Zaforteza–Dezcallar, Maria Asuncion Boronat–Moreiro, Sofia Mira–Martinez, Elena Gervilla–Garcia, Ignacio Ricci–Cabello
  Pages: e457 - e465
  Abstract: BackgroundComplications arising from uncontrolled type 2 diabetes mellitus (T2DM) pose a significant burden on individuals’ wellbeing and healthcare resources. Digital interventions may play a key role in mitigating such complications by supporting patients to adequately self-manage their condition.AimTo assess the impact of DiabeText, a new theory-based, patient-centred, mobile health intervention integrated with electronic health records to send tailored short text messages to support T2DM self-management.Design and settingA pragmatic, phase-three, 12-month, two-arm randomised clinical trial involving primary care patients with T2DM in the Balearic Islands, Spain, including in urban and rural areas.MethodIn total, 742 participants with suboptimal glycaemic control (glycated haemoglobin [HbA1c] level>7.5) were randomly allocated to a control (usual care) or intervention (DiabeText) group. In addition to usual care, the DiabeText group received 167 messages focused on healthy lifestyle and medication adherence. The primary outcome was HbA1c level. Secondary outcomes were: medication possession ratio; health-related quality of life (measured using the EQ-5D-5L questionnaire); diabetes self-efficacy (measured using the Diabetes Self-Efficacy Scale [DSES]); and self-reported adherence to medication, Mediterranean diet (measured using the 14-Item Mediterranean Diet Adherence Screener [MEDAS-14]), and physical activity (measured using the International Physical Activity Questionnaire [IPAQ]).ResultsOver the 12-month period, no statistically significant differences in HbA1c were observed between the intervention and the control groups (β = −0.025 [95% confidence interval {CI} = −0.198 to 0.147; P = 0.772]). In comparison with the control group, the DiabeText group showed significant (P
  PubDate: 2025-06-26T16:05:27-07:00
  DOI: 10.3399/BJGP.2024.0206
  Issue No: Vol. 75, No. 756 (2025)
Potential interactions between direct oral anticoagulants and
atorvastatin/simvastatin: a cohort and case-crossover study
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  Authors: Angel YS Wong; Charlotte Warren–Gash, Krishnan Bhaskaran, Clemence Leyrat, Amitava Banerȷee, Liam Smeeth, Ian J Douglas
  Pages: e466 - e473
  Abstract: BackgroundDirect oral anticoagulants (DOACs) are commonly co-prescribed with statins. Although biologically plausible, whether there is a drug interaction between DOACs and atorvastatin/simvastatin is unclear.AimTo investigate the association between co-prescribed DOACs and atorvastatin/simvastatin and bleeding, cardiovascular disease, and mortality.Design and settingCohort and case-crossover study using data from English general practices in the Clinical Practice Research Datalink Aurum from 1 January 2011 to 31 December 2019.MethodA cohort design was used to estimate hazard ratios for clinically relevant pharmacological interaction safety outcomes (intracranial bleeding, gastrointestinal bleeding, and other bleeding) comparing DOACs and atorvastatin/simvastatin with DOACs and other statins (fluvastatin, pravastatin, and rosuvastatin that are not anticipated to interact with DOACs). Effectiveness outcomes (ischaemic stroke, myocardial infarction, venous thromboembolism, cardiovascular mortality, and all-cause mortality) were also included. In addition, a case-crossover design was used to compare the odds of exposure to different drug initiation patterns in the hazard window versus the referent window within an individual.ResultsOf 397 459 patients who were prescribed DOACs, 70 318 people co-prescribed atorvastatin and 38 724 co-prescribed simvastatin were selected. The cohort analysis showed no difference in risk of all outcomes comparing patients prescribed DOACs and atorvastatin/simvastatin versus those prescribed DOACs and other statins. In the case-crossover analysis, odds ratios (ORs) for other bleeding (OR 5.06, 99% confidence interval [CI] = 3.79 to 6.76) among those initiating DOACs while taking atorvastatin and the ORs for gastrointestinal bleeding (OR 6.05, 99% CI = 4.28 to 8.54) and other bleeding (OR 6.81, 99% CI = 4.74 to 9.78) among those initiating DOACs while taking simvastatin were greater than those initiating DOAC monotherapy. Similar patterns were also observed for cardiovascular mortality and all-cause mortality.ConclusionThis study shows no evidence of interaction between DOACs and atorvastatin/simvastatin. However, people starting a DOAC while taking atorvastatin/simvastatin were at high risk of bleeding and mortality, likely because of temporal clinical vulnerability.
  PubDate: 2025-06-26T16:05:27-07:00
  DOI: 10.3399/BJGP.2024.0349
  Issue No: Vol. 75, No. 756 (2025)
Effectiveness of low-dose amitriptyline and mirtazapine in patients with
insomnia disorder and sleep maintenance problems: a randomised,
double-blind, placebo-controlled trial in general practice (DREAMING)
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  Authors: Mette H Bakker; Jacqueline G Hugtenburg, Pierre M Bet, Jos WR Twisk, Henriette E van der Horst, Pauline Slottȷe
  Pages: e474 - e483
  Abstract: BackgroundLow-dose amitriptyline and mirtazapine are widely prescribed off-label for insomnia disorder. However, evidence of their effectiveness from placebo-controlled studies is lacking.AimTo assess the effectiveness of low-dose mirtazapine and amitriptyline in patients with insomnia disorder.Design and settingPragmatic, double-blind, randomised, placebo-controlled trial undertaken in general practices in the Amsterdam region, the Netherlands.MethodPatients (aged 18–85 years) with insomnia disorder and sleep maintenance problems for whom non-pharmacological treatment was insufficient were randomised to mirtazapine (7.5–15 mg/day), amitriptyline (10–20 mg/day), or placebo for 16 weeks (optional double-dose regimen in week 2–14). Insomnia Severity Index (ISI) scores (range 0–28) were assessed at baseline and again at 6, 12, 20, and 52 weeks. The primary outcome was an ISI total score at 6 weeks that was clinically relevant and signified either ‘improvement’ (>7 points lower than baseline) or ‘recovery’ (total score ≤10 points).ResultsIn total, 80 participants were included. At 6 weeks, in the intention-to-treat analyses, mirtazapine and amitriptyline each led to statistically significantly lower ISI scores when compared with placebo: mirtazapine mean difference = −6.0 points (95% confidence interval [CI] = −9.0 to −3.0), amitriptyline mean difference = −3.4 points (95% CI = −6.3 to −0.4). At 6 weeks mirtazapine resulted in statistically significantly higher improvement and recovery rates (52% and 56%, respectively) compared with placebo (both 14%), whereas amitriptyline (with rates of 40% and 36%, respectively) did not. From 12 weeks onwards no statistically significant differences in ISI scores were observed.ConclusionCompared with placebo, low-dose mirtazapine provided a statistically significant and clinically relevant reduction of insomnia severity at 6 weeks, but not at later time points. Low-dose amitriptyline resulted in a statistically significant reduction at 6 weeks, but this was not clinically relevant. The results do not support the prescription of low-dose amitriptyline and mirtazapine for several months in patients with insomnia disorder in general practice. Based on the results, GPs may consider prescribing off-label low-dose mirtazapine for a period of about 6 weeks in case non-pharmacological treatment is insufficient.
  PubDate: 2025-06-26T16:05:27-07:00
  DOI: 10.3399/BJGP.2024.0173
  Issue No: Vol. 75, No. 756 (2025)
Antidepressants and risk of postural hypotension: a self-controlled case
series study in UK primary care
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  Authors: Cini Bhanu; Kate Walters, Mine Orlu, Daniel Davis, Reecha Sofat, Irene Petersen
  Pages: e484 - e490
  Abstract: BackgroundAntidepressants are associated with postural hypotension (PH), but it is not typically recognised as a common adverse effect. PH is linked with serious complications in older adults, for example, falls, stroke, and cognitive decline. Randomised controlled trials (RCTs) examining antidepressants often exclude older people and do not focus on adverse effects.AimTo examine the risk of PH associated with antidepressant use in adults aged ≥60 years in UK primary care.Design and settingA self-controlled case series using routinely collected primary care data from the IQVIA Medical Research Database (IMRD) from 1 January 2000 to 31 December 2018.MethodData from>41 000 adults aged ≥60 years in IMRD between 1 January 2000 to 31 December 2018 were obtained. Antidepressant prescriptions were determined using code lists based on British National Formulary classification. Risk of PH was examined during four exposure risk periods (90-days pre-prescription; day 1–28; 29–56; and ≥57) compared with periods outside these risk windows.ResultsAmong 41 005 people with incident PH in the study period, 8899 (22%) were prescribed a selective serotonin reuptake inhibitor (SSRI); 8313 (20%) were prescribed a tricyclic antidepressant (TCA); and 4656 (11%) were prescribed an ‘other antidepressant’. The authors observed a consistent increased risk of PH in day 1–28 in all antidepressant exposure, which reduced thereafter. Risk of PH was highest with SSRIs (incidence rate ratio [IRR] 4.22, 95% confidence interval [CI] = 3.76 to 4.74), followed by ‘other antidepressants’ (IRR 2.17, 95% CI = 1.76 to 2.68), and then TCAs (IRR 2.12, 95% CI = 1.79 to 2.50). Risk of PH reduced from day ≥28 for all antidepressants.ConclusionA statistically substantial increased risk of PH was observed with all antidepressants in the first month, particularly SSRIs. Prescribers should be aware of this risk and may consider monitoring PH when initiating antidepressants in older adults.
  PubDate: 2025-06-26T16:05:27-07:00
  DOI: 10.3399/BJGP.2024.0429
  Issue No: Vol. 75, No. 756 (2025)
Patient and family engagement interventions in primary care patient
safety: systematic review and meta-analysis of randomised controlled
trials
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  Authors: Yan Pang; Anna Szucs, Ignacio Ricci–Cabello, Jaheeda Gangannagaripalli, Lay Hoon Goh, Foon Leng Leong, Li Fan Zhou, Jose Maria Valderas
  Pages: e491 - e499
  Abstract: BackgroundEngaging patients and families has been promoted as a key strategy for improving patient safety of health systems. However, evidence remains scarce on the effectiveness of this approach in primary care.AimTo assess the combined effectiveness of primary care interventions in randomised controlled trials (RCTs) promoting patient and family engagement in patient safety.Design and settingA systematic review and meta-analysis.MethodThe review followed PRISMA and Cochrane guidelines. Five electronic databases (Medline, CINAHL, Embase, Web of Science, CENTRAL) were searched from inception to 18 September 2024 with keywords in four blocks (patient and family engagement; patient safety; primary care; randomised controlled trial). Patient and family engagement levels were appraised. Where appropriate, results were combined into meta-analyses.ResultsOf the 19 included records, 12 reported on completed RCTs. Only one intervention integrated patients/families into overall care safety (high engagement); six aimed at enhancing skills and tools (intermediate), and 12 informed patients/families how to engage and prompted them to do it (low). RCTs primarily targeted medication safety, with meta-analyses showing no significant effects on reducing adverse drug events (odds ratio [OR] 0.86, 95% confidence interval [CI] = 0.70 to 1.08) or improving medication appropriateness measured categorically (OR 0.92, 95% CI = 0.76 to 1.13) or continuously (mean difference 0.71, 95% CI = −0.10 to 1.52). Overall risk of bias was low and certainty of evidence very low to moderate.ConclusionExisting randomised controlled evidence on patient and family engagement in primary care remains inconclusive and limited in scope. Future interventions should include higher levels of engagement and address more diverse patient safety outcomes relevant for primary care.
  PubDate: 2025-06-26T16:05:27-07:00
  DOI: 10.3399/BJGP.2024.0369
  Issue No: Vol. 75, No. 756 (2025)
Development and internal validation of a diagnostic prediction model for
life-threatening events in callers with shortness of breath: a
cross-sectional study in out-of-hours primary care
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  Authors: Michelle Spek; Roderick P Venekamp, Anne AH de Hond, Esther de Groot, Geert–Jan Geersing, Anna SM Dobbe, Mathe Delissen, Frans H Rutten, Maarten van Smeden, Dorien L Zwart
  Pages: e500 - e508
  Abstract: BackgroundShortness of breath often prompts calls to out-of-hours primary care and is the prime reason for home visits by GPs. However, a diagnostic prediction model in this setting is lacking.AimTo develop and internally validate a model predicting life-threatening events for out-of-hours primary care callers with shortness of breath.Design and settingThis cross-sectional study includes data from 1952 patients with shortness of breath who called Dutch out-of-hours primary care between September 2020 and August 2021. The trial was registered with the Netherlands Trial Register, number: NL9682.MethodFour logistic regression models were developed with life-threatening events as the outcome. The first model included age and gender (model 1) and then, successively, call characteristics (calling at night and someone else calling on behalf of the patient; model 2), symptoms (cough, fever, inability to speak full sentences and wheezing; model 3), and medical history and medication use (cardiovascular and/or pulmonary; model 4) were added. The models were internally validated using optimism correction via bootstrap with 1000 repetitions. Performance measures of discrimination (c-statistic) and calibration (calibration intercept and slope) were determined.ResultsApproximately 17% (329/1952) of callers with shortness of breath had a life-threatening event. Model 3 performed best. This model exhibited good discriminative ability (internal validation c-statistic of 0.76, 95% confidence interval = 0.74 to 0.79) and was well calibrated. All models had a high net benefit compared with using no model. Models 3 and 4 had a higher net benefit compared with models 1 and 2. As models 3 and 4 were similar in terms of net benefit, the model with fewer parameters (model 3) is preferred.ConclusionA prediction model consisting of age, gender, call characteristics, and symptoms holds promise for improving telephone triage of callers to out-of-hours primary care with shortness of breath. However, as the study period coincided with the COVID-19 pandemic, temporal validation is necessary before widespread implementation.
  PubDate: 2025-06-26T16:05:27-07:00
  DOI: 10.3399/BJGP.2024.0538
  Issue No: Vol. 75, No. 756 (2025)
Prescribing in good faith
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  Authors: Euan Lawson
  Pages: 291 - 291
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742677
  Issue No: Vol. 75, No. 756 (2025)
When, why, and how to stop HRT: women and clinicians need more evidence
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  Authors: Sarah Hillman; Sarah Bunnewell, Jeremy Dale, Jane Daniels, Martha Hickey, Laura L Jones, Richard McManus, Katie Morris, Beck Taylor
  Pages: 292 - 294
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/BJGP.2025.0300
  Issue No: Vol. 75, No. 756 (2025)
An international primary care workforce: addressing the ethics beyond the
red list
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  Authors: Laura Emery; Vincent Faseyosan, Sophie Park
  Pages: 295 - 296
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/BJGP.2025.0243
  Issue No: Vol. 75, No. 756 (2025)
Violence against women and girls: how can general practice respond'
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  Authors: Gene Feder; Helen Cramer, Lucy Potter, Jessica Roy, Eszter Szilassy
  Pages: 297 - 299
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/BJGP.2025.0244
  Issue No: Vol. 75, No. 756 (2025)
GP unemployment and academics
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  Authors: Max Cooper
  Pages: 300 - 300
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742689
  Issue No: Vol. 75, No. 756 (2025)
The 2.1% dilemma: reassessing video consultation in Simulated Consultation
Assessment examinations
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  Authors: Chris Jacobs
  Pages: 300 - 300
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742701
  Issue No: Vol. 75, No. 756 (2025)
Attention deficit hyperactivity disorder, misinformation, and the need for
verified voices
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  Authors: Katharine R Russell
  Pages: 300 - 301
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742725
  Issue No: Vol. 75, No. 756 (2025)
How changes by GPs have affected community nurses
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  Authors: Crispin AH Fisher
  Pages: 301 - 301
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742713
  Issue No: Vol. 75, No. 756 (2025)
Measuring continuity in a small rural GP practice using the Usual Provider
of Care Index
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  Authors: Philip Sparks; Sarah Simpson
  Pages: 301 - 301
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742737
  Issue No: Vol. 75, No. 756 (2025)
An educated mind is a requirement for good general practice
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  Authors: Andrew Papanikitas
  Pages: 310 - 310
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742749
  Issue No: Vol. 75, No. 756 (2025)
Yonder
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  Authors: Alex Burrell
  Pages: 311 - 311
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742761
  Issue No: Vol. 75, No. 756 (2025)
The day of small things
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  Authors: Chris Ellis
  Pages: 312 - 313
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742773
  Issue No: Vol. 75, No. 756 (2025)
Clerical error, clinical risk, and the automation of primary care
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  Authors: Saud Jukaku; Amrit Lamba
  Pages: 314 - 315
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742785
  Issue No: Vol. 75, No. 756 (2025)
The psychosomatic self
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  Authors: Ben Hoban
  Pages: 316 - 317
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742797
  Issue No: Vol. 75, No. 756 (2025)
The Music and Mental Health Project: uniting primary health care globally
through music
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  Authors: Alfredo de Oliveira Neto; Arnab Bishnu Chowdhury, Christopher Dowrick
  Pages: 318 - 319
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742809
  Issue No: Vol. 75, No. 756 (2025)
Netflix’s Adolescence: an unsettling reminder of the toxic effect
of social media on children
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  Authors: Paul McNamara; Nicholas Dunn
  Pages: 320 - 321
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742821
  Issue No: Vol. 75, No. 756 (2025)
Explaining AuDHD: Recognise It, Embrace It and Thrive With It
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  Authors: Emilie Couchman
  Pages: 322 - 323
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742833
  Issue No: Vol. 75, No. 756 (2025)
Medicine, Patients and the Law
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  Authors: Andrew Papanikitas
  Pages: 323 - 323
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742845
  Issue No: Vol. 75, No. 756 (2025)
A Medical Love Story, Season One
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  Authors: Saul Miller
  Pages: 324 - 324
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/bjgp25X742857
  Issue No: Vol. 75, No. 756 (2025)
Medicines and society: systemic change needed to address overprescribing
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  Authors: Caroline McCarthy
  Pages: 325 - 329
  PubDate: 2025-06-26T16:05:26-07:00
  DOI: 10.3399/BJGP.2025.0050
  Issue No: Vol. 75, No. 756 (2025)
Building capacity in the academic general practice research workforce
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  Authors: Clare J Taylor; Anthony J Avery, Faraz Mughal, Michael Kidd, Sanjiv Ahluwalia, Luke Daines, Louise Dubras, Joanne Harris, Richard J McManus, Scott Wilkes, FD Richard Hobbs, Aziz Sheikh
  Pages: 330 - 333
  PubDate: 2025-06-26T16:05:27-07:00
  DOI: 10.3399/BJGP.2025.0089
  Issue No: Vol. 75, No. 756 (2025)
Long-term nitrofurantoin use: risks and alternatives in general practice
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  Authors: Nada F Khan; Hannah Warren, Tomazo J Kallis
  Pages: 334 - 335
  PubDate: 2025-06-26T16:05:27-07:00
  DOI: 10.3399/BJGP.2025.0320
  Issue No: Vol. 75, No. 756 (2025)

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