Alex Burrell is a GP in Bristol.
Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature
Antidepressant follow-up
On initiation of a new antidepressant medication, National Institute for Health and Care Excellence guidance suggests a review within 1–2 weeks.1 How likely this is to happen depends on clinician, patient, and system factors. This Norwegian registry- based cohort study of 17 000 patients with a new depression diagnosis starting antidepressants found that 27.8% of patients were followed up within 14 days, 50.9% within 30 days, and 67.1% within 90 days of first drug dispensing.2 Patients who were older or had a lower level of education were less likely to have been followed up at each time point, and also less likely to access talking therapies. We should be cognisant of these discrepancies when treating patients with depression, though there is an interesting question to explore around where the balance of responsibility for follow-up lies between clinician and patient.
NHS app use
The NHS app was launched in 2019 as a patient portal to find health information and access NHS services, thereby aiming to improve satisfaction and self-management. As a user, it certainly works well for viewing test results and ordering repeat prescriptions. To be effective, we need to know who is engaging with the app and how: this study explored differences in use of NHS app features by patients in England from 2020–2022.3 App use generally was high, with over 24 million registrations. For the three main features analysed (appointments booked, medical records viewed, and prescriptions ordered), rates were higher in the least deprived practices, those with a higher proportion of White patients, and larger practices. Whether these differences affect access or health outcomes needs further exploration.
Sore throats in community pharmacy
Before the Pharmacy First initiative in England, pharmacies in Wales had trialled a sore throat test and treat (STTT) service using FeverPAIN/Centor +/– rapid antigen testing to identify the likelihood of group A strep and give antibiotics if indicated. This cohort study examined outcomes for patients issued antibiotics through the STTT service compared to similar patients seen in primary care.4 Antibiotics were less likely to be issued in STTT consultations, and up to 28 days after the index consultation. Re-consultation with a GP with the same issue within 28 days was higher in the STTT group (14% versus 7.4%, adjusted odds ratio 2.3, 95% confidence interval = 2.1 to 2.5), though the STTT service still remained cost- effective compared to GP consultations. The authors’ modelling estimates that for every 100 patients with sore throat symptoms, the STTT service saved at least 69 GP consultations and 12 antibiotic prescriptions.
Dementia and anticholinergics
The link between long-term use of anticholinergic drugs and cognitive decline is well established, but are all drugs in this class equally culpable? Using a nested case-control design, this UK study aimed to find out.5 Patients aged ≥55 years with a recorded code of dementia were matched with up to five controls and cumulative use of anticholinergic drugs for overactive bladder were compared. The risk of dementia significantly increased with greater cumulative use of oxybutynin, solifenacin, and tolterodine in the 3–16 years before diagnosis. There was no significant increase with other included drugs (darifenacin, fesoterodine, flavoxate, propiverine, and trospium). The three main culprits were the most frequently prescribed and are usually the firstline options for overactive bladder as well as (or because of?) being lower cost. They also have a greater ability to penetrate the blood–brain barrier, which may explain the findings. These results highlight the importance of non-drug interventions for overactive bladder, but also suggest we need to rethink our prescribing guidelines with dementia risk in mind.
References
1. National Institute for Health and Care Excellence (NICE). Depression in adults: treatment and management. NG222. London: NICE, 2022. https://www.nice.org.uk/guidance/ng222/chapter/recommendations (accessed 2 Jan 2025).
2. Hansen AB, Hetlevik Ø, Baste V, et al. Variation in general practitioners’ follow-up of depressed patients starting antidepressant medication: a register-based cohort study. Fam Pract 2024; DOI: 10.1093/fampra/cmae063.
3. Kc S, Papoutsi C, Reidy C, et al. Differences in use of a patient portal across sociodemographic groups: observational study of the NHS app in England. J Med Internet Res 2024; 26: e56320.
4. Mantzourani E, Ahmed H, Bethel J, et al. Clinical outcomes following acute sore throat assessment at community pharmacy versus general practice: a retrospective, longitudinal, data linkage study. J Antimicrob Chemother 2024; DOI: 10.1093/jac/dkae400.
5. Iyen B, Coupland C, Bell BG, et al. Risk of dementia associated with anticholinergic drugs for overactive bladder in adults aged ≥55 years: nested case-control study. BMJ Med 2024; 3(1): e000799.
Featured photo by Robina Weermeijer on Unsplash.
