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International Primary Care Association

Clinical Focus Primary Care


Back pain remains one of the most common presenting complaints in primary care and often presents both diagnostic and management challenges. Accurate early diagnosis, along with appropriate early specialist intervention is key in managing these conditions, which are often lifelong and associated with significant morbidity.


Overactive Bladder (OAB) is a clinical syndrome describing the symptom complex of urgency, with or without urgency incontinence and is usually associated with frequency and nocturia. Whilst a number of women may be managed based on a clinical diagnosis alone urodynamic studies may be useful in those women with complex or refractory symptoms. In the first instance all women will benefit from a conservative approach using bladder retraining although a number will require antimuscarinic therapy. For those women with persistent symptoms following medical therapy referral to secondary care for alternative treatment modalities such as intravesical Botulinum toxin, neuromodulation or reconstructive surgery may be considered. This review, whilst giving an overview of the syndrome, will focus on a practical clinical approach to managing women with symptoms of OAB in the primary care setting.


Many GPs already treat patients with substance misuse problems and are well placed to offer screening, assessment, psychosocial interventions and prescribing to addictions patients. Emphasis in addiction treatment is shifting away from long term maintenance prescribing to recovery focussed services, recovery communities and integration of substance misusers into the world of work, education and training.

Europe and the NHS are always near the top of the media agenda, usually to report negatives. The little Englander mentality has gripped some sections of the community who are keen to leave the EU and, subsequently, still envisage UK sitting at all the top tables for decision making. In psychiatric terms this is termed “Delusional”. This is an oft state of consciousness in many of our political masters. Additionally, austerity is effecting us all but it would be worse if UK was not part of the EU and as we come out of this present blight being part of the EU will allow us access to a market of some 450 million people!

Domestic violence and abuse is a major public health and clinical problem. NICE is planning to publish guidance on domestic violence in 2014. This article defines domestic violence and abuse, examining its prevalence and health impact. It considers why and how primary care should rise to the challenge of responding to domestic violence and abuse.

Falls are a major cause of injury and death in older people, affecting more than a third of all older people each year, half of whom have recurrent falls. Falls have a major impact on primary and secondary care services and are an important cause of carer strain and admission to long term care. 50% of all care home residents have a fall each year. Multifactorial falls risk assessments should be offered to people who fall. Multifactorial interventions delivered to people who fall are effective in reducing falls rates by up to 25%.

Lower urinary tract symptoms (LUTS) are extremely common as men get older. LUTS are bladder storage and voiding symptoms, which are often caused by benign enlargement of the prostate. Initial assessment, investigation and treatment of LUTS can be provided by primary care and will be explored in this article.

Osteoporosis is an increasingly common condition, with decreased bone strength leading to increased risk of fracture. Fragility fractures lead to increased morbidity and mortality, and considerable socioeconomic costs. Identification of patients with osteoporosis can be improved with new fracture risk assessment tools, so that the effective treatments now available can be targeted at those likely to benefit.


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International Primary Care Association
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