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Feature
CKD: inappropriate prescribing
Potentially inappropriate prescribing in primary care is common in chronic kidney disease and existing prescribing recommendations are often non-specific and relatively unhelpful to clinicians. In this video, Dr Clare MacRae explains that: BNF renal impairment warnings are heterogeneous in terminology; almost 4% of patients were prescribed a drug with a clear ‘contraindicated’ warning; and ‘potentially high risk’ drugs were prescribed in almost 1/4 of patients. High risk prescribing in CKD contributes to adverse drug reactions, unintended harmful events attributed to the use of medicines, and drug-related acute kidney injury (AKI). People with CKD have poorest health outcomes after drug-related AKI, specifically being most likely to have additional loss of kidney function, require dialysis, and die. Adjustment of medications according to kidney function, and avoiding medications that increase the risk of kidney damage, can slow progression of kidney disease and reduce rates of illness.
Highlights
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Recent Features
Webinar: Cancer and primary care
26 May, 7pm–8.30pm
Free to register
Join us for the second BJGP Webinar, 26 May, on the topic of Cancer and primary care. The webinar will be introduced by Prof. Fiona Walter, from Queen Mary University of London & University of Cambridge. There will be presentations, a panel discussion, and time for your questions.
SPEAKERS & RESEARCH
Prof. Fiona Walter: Introduction on the impact of active research
Dr Stephen Bradley: Estimating lung cancer risk from chest X-ray
Dr Garth Funston: CA125 test for ovarian cancer
Dr Claire Friedemann Smith: GPs’ use of gut feelings when assessing cancer risk
Join us by registering at: BJGP Webinar on Cancer
Discontinuing long-term antidepressant use
Discontinuation of long-term antidepressants is more than a simple deprescribing decision. New research shows a repeat prescription should not be considered as ‘just a script’ consultation. Deprescribing begins with considering a patient's social and relational context, and is a journey involving careful preparation, tailored care and regular review. This study suggests GPs need clinical time to do the complex contextual and relational decision-making around diagnosis, prescribing and discontinuing antidepressants. A request for a repeat prescription should always come with a review of whether this medication is still required. Deprescribing is an important consideration, particularly as long-term antidepressant use is on the rise, most antidepressant prescribing takes place in general practice, and about one-third of long-term users have no clear reason for continued use. Listen to the podcast with Associate Prof. Riitta Partanen.
GPs’ gut feelings for assessing cancer risk
The use of gut feelings has often been described in primary care, and bodies like NICE are beginning to recognise clinicians' judgement in their guidance. This study shows how, rather than being used in isolation, gut feelings prompt evidence gathering and discussion with colleagues that can benefit patients with symptoms that don't easily fit with clinical guidelines. GPs use their gut feelings to prompt building a case for accessing further investigations, by re-examining the reasons why the patient came to them, how their presentation fits with clinical guidance, and seeking second opinions from their colleagues. Experience was seen as important to the development of reliable gut feelings, but so too was empathy and the GPs' relationships with their patients which allowed them to notice the subtle changes that could make them think: 'Something is not right here and I need to find out what it is'. Read the new qualitative research and the associated quantitative article.
