The frequency of medication errors is high in patients with polypharmacy in primary care. Development of strategies (e.g. external medication review) is required to counteract medication errors.

BackgroundUncomplicated urinary tract infections (UTI) are a frequent reason for consultation of women in primary health care. To avoid therapy failure and development of resistances, the choice of an antibiotic should be based on the knowledge of recent local resistance data but these data are scarce for the Austrian primary health care sector. Within the context of the ECO·SENS II study it was the aim to obtain appropriate and relevant local resistance data and describe the changes in the resistance pattern in comparison to the ECO·SENS study.Methods23 GPs from different parts of Austria participated in the study between July 2007 and November 2008. According to the defined inclusion- and exclusion criteria female patients with symptoms of an uncomplicated UTI were included and a midstream urine sample was collected. In case of significant bacteriuria susceptibility testing of E. coli against 14 antibiotics was performed. Descriptive statistical methods were used.ResultsIn 313 patients included in the study, a total of 147 E. coli isolates (47%) were detected and tested. The resistance rates were in %: Mecillinam (0.0), nitrofurantoin (0.7), fosfomycin trometamol (0.7), gentamycin (1.4), cefotaxime (2.7), ceftazidime (2.7), Cephadroxil (4.1) and ciprofloxacin (4.1). Higher resistance rates were found in amoxicillin/clavulanic acid (8.9), nalidixic acid (9.6), trimethoprim/sulphamethoxazole (14.4), trimethoprim (15.8), sulphamethoxazole (21.2) and ampicillin (28.8). Additionally, the comparison of these results with the results of the ECO·SENS study demonstrated an increase in resistance rates of ampicillin, amoxicillin/clavulanic acid, nalidixic acid and ciprofloxacin.ConclusionsThe resistance data for E. coli in uncomplicated UTIs in women gained by this study are the most recent data for this disease in Austria at the moment. The increased resistance rates of amoxicillin/clavulanic acid, ciprofloxacin and nalidixic acid should be respected when choosing an appropriate antibiotic for uncomplicated UTIs. The use of ampicillin, sulphamethoxazole, trimethoprim and trimethoprim/sulphametoxazole in uncomplicated UTIs in women should be questioned at all. The findings of this study should result in a regular surveillance system of resistances emerging in the ambulatory sector designed after the model of the EARS-Net.

Background Around 20-30% of all prescribed drugs are estimated to be metabolised by the cytochrome P450 (CYP) 2D6 enzyme. In a medical practice, it is usually not known whether a patient is a poor, intermediate, normal or ultra-rapid metaboliser for CYP2D6-metabolised drugs. Objective This study aims to explore the clinical relevance and the extent of hazardous prescriptions by analysing the metaboliser status of patients already taking such drugs. Methods This is a family practice-based observational study performed in a rural practice for general and family medicine in Lower Austria providing care for approximately 2100 patients annually. In 287 consecutive patients, who had taken or were taking a drug metabolised by CYP2D6 during the last 3 years, the metaboliser status was analysed. Results The genetic analysis of 287 patients resulted in 51.22% normal metabolisers, 38.68% intermediate metabolisers, 6.27% poor metabolisers and 3.83% ultra-rapid metabolisers. In 50 cases (poor metaboliser, intermediate metaboliser and ultra-rapid metaboliser, i.e. 17.42% of all tested patients taking a CYP2D6-specific drug), an altered gene function was identified, for which clinical guideline annotations, drug label annotations, or clinical annotations are available. Allele and genotype frequencies were in accordance with data from other European studies. Conclusions In 17.42% of all patients already taking a drug metabolised by CYP2D6, knowledge of the genetically defined metaboliser status would have been of immediate clinical relevance before prescribing the drug. ClinicalTrials.gov identifier NCT03859622.

Background: Almost all societies carry responsibility towards patients who require continuous medical care at home. In many health systems the general practitioner cooperates with community based services of home care and coordinates all medical and non medical activities. In Austria the general practitioner together and in cooperation with relatives of the patient and professional organisations usually takes on this task by visiting his patients.

ObjectivesChronic obstructive pulmonary disease (COPD) as a multisystemic disease has a measurable and biologically explainable impact on the auditory function detectable in the laboratory. This study tries to clarify if COPD is also a significant and clinically relevant risk factor for hearing impairment detectable in the general practice setting.DesignRetrospective matched cohort study with selection of patients diagnosed with COPD.Setting12 general practices in Lower Austria.ParticipantsConsecutive patients >35 years with a diagnosis of COPD who consulted 1 of 12 single-handed GPs in 2009 and 2010 were asked to participate. Those who agreed were individually 1:1 matched with controls according to age, sex, hypertension, diabetes, coronary heart disease and chronic heart failure.Main outcome measuresSensorineural hearing impairment as assessed by pure tone audiometry, answers of three questions concerning a self-perceived hearing problem, application of the whispered voice test and the score of the Hearing Inventory for the Elderly, Screening Version (HHIE-S).Results194 patients (97 pairs of 194 cases and controls) with a mean age of 65.5 (SD 10.2) were tested. Univariate conditional logistic regression resulted in significant differences in the mean bone conduction hearing loss and in the total score of HHIE-S, in the multiple conditional regression model, only smoking (p<0.0001) remained significant.ConclusionsThe results of this study do not support the hypothesis that there is an association between COPD and hearing impairment which, if found, would have allowed better management of patients with COPD.

Summary Objective To increase knowledge of discrete symptoms shall help to avoid misinterpretation of test results and to gain better understanding of associations between early symptoms and severe disease to provide additional criteria for targeted early interventions. Design Retrospective observational study. Setting Austrian GP practices in the year 2020, patients above 18 years were included. Participants We recruited 25 practices which included 295 participants with a positive SARS-CoV‑2 test. Main outcome measures Data collection comprised basic demographic data, risk factors and the recording of symptoms at several points in time in the course of the illness. Descriptive analyses for possible associations between demographics and symptoms were conducted by means of cross tabulation. Group differences (hospitalized yes/no) were assessed using Fisher’s exact test. The significance level was set to 0.05; due to the observational character of the study, no adjustment for multiplicity was performed. Results Only one third of patients report symptoms generally understood to be typical for COVID‑19. Most patients presented with unspecific complaints. We found symptoms indicating complicated disease, depending on when they appear. The number of symptoms may be a predictor for the need of hospital care. More than 50% of patients still experience symptoms 14 days after onset. Conclusion Unspecific symptoms are valuable indicators in the detection of early COVID‑19 disease that practitioners and the general public should be aware of also in the interpretation of low sensitivity tests. Monitoring patients using the indicators we identified may help to identify patients who are likely to profit from early intervention.

Background Early detection is essential to control COVID-19. Symptoms are often unspecific. Data collected merely from patients tested according to testing criteria might lead to missing a bulk of spreaders. Knowledge of symptom development during the disease helps to detect complications early. Few data have been collected in primary care so far. Aim To extend knowledge of early symptoms as a precondition of timely diagnosis, isolation and contact tracing. To gain understanding of associations between symptoms and complicated disease to help avoid hospitalization. Design and Settings This study was designed as a retrospective observational study in Austrian GP practices in the year 2020. Methods Patients above 18 years with a positive SARS-CoV-2 test were included. Data collection comprised basic demographic data, risk factors and the recording of symptoms at several points in time during the course of the infection. Further descriptive data analysis was carried out by using the statistical software program R. Results Symptoms clearly typical for COVID-19 are rare. Most symptoms are nonspecific, like malaise, fatigue or joint ache. We found symptoms indicating complicated disease, depending on the time of their occurrence. Anosmia we found to develop only after several days in many cases. At the end of the isolation period many patients still experience symptoms. Conclusion Low threshold contact in GP practices including testing can prevent overlooking early symptoms. Patients may benefit from early monitoring. We recommend a medical check-up at the end of the isolation period.

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