Primary care's quieter prescribing decisions

The edition in brief

Four primary-care-oriented items for the family physician. An American Family Physician review of cognitive behaviour therapy sets out where it is first-line — insomnia, anxiety, depression, obsessive-compulsive disorder, PTSD, somatic symptom and several others — and where it is a useful adjunct, from chronic pain to irritable bowel syndrome, with telehealth and brief primary-care-delivered versions now supported; a reminder to reach for it, not only medication. An audit of 256 adults on antibiotic prophylaxis for recurrent UTI across 18 UK practices found prophylaxis ran a median 2.2 years, only 58% were reviewed within six months, and although a quarter grew resistant organisms, therapy was modified in fewer than a quarter of those — a stewardship gap in a common prescription. A randomised trial of 151 women with risky drinking in Brazilian primary care found a nurse-delivered telephone brief intervention lowered AUDIT scores over the first six months, with benefit attenuating thereafter while the control group's drinking rose, supporting brief intervention but also booster contact. A clinic pearl: close every undifferentiated consultation with explicit safety-netting — what to watch for, when and where to seek help, and the expected course. Finally, an AFP review of stopping buprenorphine for opioid use disorder underlines that the drug more than halves overdose and all-cause mortality, that discontinuation should be voluntary and shared, and that longer maintenance beyond 12 months and slow tapers of 2 mg per month or less with naloxone cover carry the lowest overdose risk — with sustained dose reduction, not full cessation, a reasonable goal for some.