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Feature
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.
Highlights
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Recent Features
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.
BJGP Webinar on Health Inequalities
It is 50 years since the ‘Inverse Care Law’ was introduced by Dr Julian Tudor Hart. In recognition of the totemic article, the BJGP hosted a free 1.5-hour webinar on health inequalities, with a video introduction from Prof. Sir Michael Marmot. The webinar focused on recent research and analysis from leading primary care researchers, in the form of short presentations. Visit BJGP Webinars for upcoming events and join the Twitter discussion at: #BJGPwebinar.
Jump to various sections in the video by following the links: 00:00 BJGP Editor, Dr Euan Lawson, opens the webinar. 01:07 Webinar chaired by Dr Carey Lunan, GP, Chair of the Deep End Project, and former Chair of RCGP Scotland; Dr Lunan introduces Prof. Sir Michael Marmot. 03:59 Prof. Sir Michael Marmot speaks on 50 years of the Inverse Care Law. 16:42 Prof. Simon de Lusignan, Professor of Primary Care and Clinical Informatics, University of Oxford: Excess mortality in the first COVID-19 wave. 29:54 Dr Sarah Hillman, GP and Clinical Lecturer in Primary Care, University of Warwick: Socioeconomic status and HRT. 43:55 Prof Paramjit Gill, Professor of Primary Care, University of Warwick; Trustee, South Asian Health Foundation: BME minorities and COVID-19. 01:02:22 Q&A Panel Attendees’ questions. 01:26:11 Close and final comments by Chair: sum up of '3 things we can take back to our practice'.
Group consultations in UK general practice
New research by Dr Laura Swaithes and colleagues at Keele University suggests group consultations provide an enjoyable interaction between general practice staff and patients. Seeking interviews with general practice staff from a range of disciplines, the research revealed that group consultations may enhance multidisciplinary working, provide the opportunity for more patient-centred care, and reduce workload. With GPs and nurses reporting high levels of stress and burnout, primary care needs to adapt and deliver new models of care to ease workload pressures. Could group consultations be the future?
