The British journal of general practice : the journal of the Royal College of General Practitioners
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Background The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) has been implemented in many areas of the UK. It is unclear how ReSPECT is used in primary and community care settings. Aim To investigate how the ReSPECT process is understood and experienced in the community by clinicians, social care staff, patients, their relatives, and identify obstacles and enablers to its implementation. ⋯ Interpreting recommendations in emergencies was challenging. Conclusion The ReSPECT process has not translated as well as expected in the community setting. A revised approach is needed to address the challenges of implementation in this context.
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Background Personal continuity is an important dimension of continuity of care in general practice and is associated with many benefits including a higher quality of GP care and lower mortality rate. Over time, changes in society and healthcare have challenged the provision of personal continuity. Especially older patients experience more negative consequences from receiving discontinuous care. ⋯ To improve personal continuity, it was suggested to invest in team communication and stability (e.g., by efficient use of the EHR) and retaining availability and accessibility of the own GP (e.g., by delegating tasks). Barriers and facilitators were perceived on individual (e.g., GPs' involvement in tasks), organisation (e.g., staff shortages) and societal level (e.g., payment system). Conclusion As general practice moves towards a more team-based approach to ensure personal continuity, efforts to improve personal continuity should focus on supporting team-based provision of continuous care.
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Between 2003 and 2018, incident prescriptions of beta-blockers for anxiety increased substantially, particularly for young adults. National Institute for Health and Care Excellence guidance for anxiety does not recommend beta-blockers, probably due to a lack of evidence to support such use. Recent reports have highlighted the potential risks of beta-blockers. ⋯ Many GPs believe that beta-blockers have a role to play in the management of anxiety. Given recent increases in the prescribing of these drugs in primary care, there is a need to assess their safety and effectiveness as a treatment for people with anxiety disorders.
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Orlistat is recommended as an adjunct to diet and exercise for weight loss in the treatment of type 2 diabetes mellitus (T2DM). ⋯ Orlistat was significantly associated with weight loss in patients with T2DM and prediabetes when taken for at least 12 weeks; however, it was infrequently prescribed and often taken for <12 weeks. Orlistat may be a useful adjunct to lifestyle modifications for patients with T2DM and prediabetes, but barriers to continued use means it may not be effective for everyone in managing weight loss.
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Social prescribing connects patients to resources or activities to meet their non-medical needs. In the UK, it is often implemented in primary care. In the social prescribing pathway, patients are directed to link workers to identify suitable solutions for their needs such as art workshops or welfare benefit guidance. Social prescribing marks a notable transition from traditional medical treatments to more comprehensive strategies focusing on holistic health and wellbeing strategies. Insights from patient experiences can improve the development of social prescribing to better meet their needs. This understanding can aid in improving the delivery and outcomes of social prescribing. ⋯ Patients might experience lasting advantages from social prescribing if it aligns with their needs and expectations. Results highlighted the importance of matching social prescribing referral with patients' readiness to engage. Therefore, it is recommended that healthcare professionals evaluate patient suitability prior to beginning a social prescribing referral.