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The rapidly evolving management of myriad diseases encountered in primary care makes it challenging for the family physician to provide optimal evidence-based patient care. The goal of this supplement is to help family physicians address some of these challenges by offering the insights of fellow physicians who have extensive experience with these management issues.

The Prospective Randomized Evaluation of Celecoxib Integrated Safety versus Ibuprofen or Naproxen (PRECISION) trial was intended to provide greater clarity regarding the cardiovascular safety of nonsteroidal anti-inflammatory drugs. Study limitations have important implications for primary care.

Alterations in the human microbiome are increasingly recognized as contributing to human disease. Treatments that target the gut microbiota are proving useful for patients with irritable bowel syndrome, as well as cirrhosis and hepatic encephalopathy. Early recognition of cirrhosis in primary care is essential to slow disease progression.

Although not much has changed in the management of patients with community-acquired bacterial pneumonia over the past decade, there are new developments on the horizon with the anticipated release of new treatment guidelines, as well as new antibiotics.

The provision of immunotherapy is a modality that has not been accessible for most family physicians. Four products recently became available in the United States that allow for allergen immunotherapy via the sublingual route. Offering similar efficacy as subcutaneous immunotherapy, these sublingual products have important benefits that make them useful for managing grass, pollen, and dust mite allergies in primary care.

As physicians on the front line managing the pandemic of diabetes, numerous advances allow greater opportunity to individualize care and improve patient outcomes. This includes new medication classes as add-on therapy to metformin such as the dipeptidyl peptidase-4 inhibitors and glucagon-like peptide-1 receptor agonists that act on the incretin system, and the sodium glucose cotransporter-2 inhibitors that act on the kidney. These medications--particularly the glucagon-like peptide-1 receptor agonists--are recommended as an alternative to prandial insulin for patients with type 2 diabetes mellitus with inadequate glycemic control with basal insulin. An important consideration in selecting therapy in patients with type 2 diabetes mellitus is medication safety. The results of several of the many clinical trials assessing their cardiovascular safety have recently been published with important implications for patient management.

Another option for the management of patients with diabetes mellitus has become available with the approval of the follow-on biologic insulin glargine in the United States. Meeting more stringent regulatory standards, there are important differences between follow-on biologies and generic small-molecule medications. Along with implementation of the Necessity-Concerns Framework and shared decision-making as part of effective patient-provider communication, new drugs and drug delivery systems for diabetes have become available (with more on the horizon) to address key patient barriers related to medication adherence.

I hope you find Hot Topics in Primary Care helpful as you continue to provide the highest quality of care for your patients.

Stephen A. Brunton, MD, FAAFP, Adjunct Clinical Professor, Department of Clinical Pharmacy Practice, Roseman University, Salt Lake City, UT; Executive Vice President for Education, Primary Care Education Consortium, Los Angeles, CA


Dr. Brunton discloses that he is on the advisory boards and speakers' bureaus for AstraZeneca; Boehringer Ingelheim GmbH; Eli Lilly and Company; Janssen Pharmaceuticals, Inc.; and Novo Nordisk Inc. He is on the advisory boards for Abbott Diabetes Care Inc.; Allergan; Becton, Dickinson and Company; Cempra, Inc.; Intarcia Therapeutics, Inc.; and Mylan N.V.
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Author:Brunton, Stephen A.
Publication:Journal of Family Practice
Geographic Code:1USA
Date:Apr 1, 2017
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