Vol 11 - Jul 2025 Evidence for Primary Care
Evidence for Primary Care: the latest evidence from the Trip Database
A summary of some of the most important new documents for primary care that have recently been added to the Trip Database
Needles, Numbers & New Norms – Preventive Medicine Gets Personal
Can we vaccinate our way to better health? Switzerland tried—with RSV vaccines for older adults. They work well, but at a sky-high cost of over CHF 300,000 per QALY, they’re a tough sell for broad rollout.
Meanwhile, maternal RSV vaccination looks like a smarter investment—cheaper, safer, and capable of protecting newborns at a fraction of the cost. A rare win for both baby and budget.
In Australia, gestational diabetes screening has had a glow-up, with new ADIPS guidelines refining who to test, when, and how. It’s a targeted approach to a growing problem—spot issues early, manage better, and keep mother and baby safer.
And back in Croydon, paper leaflets are out—rehab videos via QR codes are in. Patients love them, find them easy to follow, and actually use them. A small innovation making a big difference.
What ties it all together?
Preventive care is getting sharper, simpler, and more patient-friendly. Whether it’s rethinking vaccine strategies, updating screening protocols, or swapping paper for video, the future of prevention is personalised, practical, and value-driven.
Less paper. More sense.
In This Edition
- Is RSV vaccination cost-effective and clinically beneficial for older adults and high-risk individuals aged 60–75?
- Is maternal RSV vaccination with RSVpreF cost-effective and beneficial for preventing RSV in infants compared to nirsevimab or no prevention?
- What are the 2025 ADIPS recommendations for screening, diagnosing, and classifying gestational diabetes?
- When and how should clinicians taper benzodiazepines when the risks outweigh the benefits?
- What are the updated 2025 ACG recommendations for preventive care in patients with inflammatory bowel disease (IBD)?
- Can sputum colour charts safely guide antibiotic self-treatment during COPD exacerbations?
- Do interventions targeting potentially inappropriate prescribing reduce medication burden or improve outcomes in older primary care patients?
- What diagnostic tools are available to support UTI diagnosis in primary care?
- How common and serious is antidepressant withdrawal syndrome, and what should prescribers and patients do to manage the risks?
- Can vaccination be used as a strategy to prevent cardiovascular disease in high-risk patients?
- Can rehabilitation education videos improve recovery and patient understanding after trauma?
- Can improved access to primary care reduce avoidable emergency department visits?
- Does temporarily stopping methotrexate for two weeks improve COVID-19 vaccine response in patients with immune-mediated inflammatory diseases?
- What is the most effective second-line treatment for children with acute severe asthma exacerbations?
Federal Office of Public Health
Is RSV vaccination cost-effective and clinically beneficial for older adults and high-risk individuals aged 60–75?
Clinical Bottom Line: RSV vaccination in older adults (≥75) and high-risk individuals aged 60–75 is clinically effective for preventing RSV-related lower respiratory tract disease for one season. However, the cost-effectiveness is poor under current pricing assumptions, with high incremental cost-effectiveness ratios (CHF 244,000–334,000 per QALY). Widespread reimbursement would significantly impact healthcare budgets, and cost-effectiveness improves only at substantially lower vaccine prices.
Summary: This analysis evaluated the clinical and economic impact of three RSV vaccines—RSVPreF3 (Arexvy), RSVpreF (Abrysvo), and mRNA-1345 (mRESVIA)—in older adults in Switzerland. Clinical trials show high vaccine efficacy (82.4%–85.7%) against lower respiratory tract disease during a single RSV season. Economic modeling over two years indicates that while vaccination yields additional healthy life years, it comes at high costs, with ICERs ranging from CHF 244,000 to CHF 334,000 per QALY. Budget impact estimates range from CHF 12.83 million to CHF 81.58 million depending on the age and risk group. Lower vaccine prices would be necessary to improve cost-effectiveness and support reimbursement decisions.
View ArticleFederal Office of Public Health
Is maternal RSV vaccination with RSVpreF cost-effective and beneficial for preventing RSV in infants compared to nirsevimab or no prevention?
Clinical Bottom Line: Maternal vaccination with RSVpreF during pregnancy is safe and effective for protecting infants against RSV infection. It is more cost-effective than no prevention, with an estimated CHF 15,497 per QALY gained, and results in long-term healthcare savings. Although nirsevimab may provide greater health benefits, RSVpreF offers a more favorable cost-benefit profile due to lower costs. Overall, RSVpreF vaccination is a cost-efficient strategy for reducing RSV-related disease in early infancy.
Summary: This report assesses the clinical and economic value of RSVpreF vaccination during pregnancy (32–36 weeks gestation) to protect infants against RSV. Clinical evidence supports good efficacy and safety for both RSVpreF and nirsevimab, although statistical significance was not demonstrated. Economic analyses show that RSVpreF is more cost-effective than no prevention, with a cost of CHF 15,497 per QALY gained. Compared to nirsevimab, RSVpreF results in cost savings of CHF 9.7 million annually but with a minor reduction in QALYs (18.2). A five-year cost impact analysis estimates total savings of CHF 14.8 million with RSVpreF. The findings support RSVpreF as a cost-efficient alternative for passive RSV protection in infants.
View ArticleAustralasian Diabetes in Pregnancy Society (ADIPS)
What are the 2025 ADIPS recommendations for screening, diagnosing, and classifying gestational diabetes?
Clinical Bottom Line: The 2025 ADIPS recommendations update the diagnostic thresholds and timing for screening gestational diabetes mellitus (GDM) and overt diabetes in pregnancy, with an emphasis on identifying high-risk women earlier and refining the interpretation of the oral glucose tolerance test (OGTT).
Summary: The Australasian Diabetes in Pregnancy Society (ADIPS) has released its 2025 consensus recommendations to address the growing prevalence of hyperglycaemia in pregnancy. The new guidance increases the diagnostic glucose thresholds for GDM and provides a clearer framework for early screening, particularly for women at increased risk. Overt diabetes in pregnancy can be diagnosed at any stage if fasting plasma glucose is 7.0 mmol/L or higher, 2-hour glucose after a 75 g OGTT is 11.1 mmol/L or higher, or HbA1c is 6.5% or above. GDM is diagnosed during a 75 g OGTT using updated thresholds: fasting glucose between 5.3 and 6.9 mmol/L, 1-hour glucose of 10.6 mmol/L or more, or 2-hour glucose between 9.0 and 11.0 mmol/L. Women with risk factors, such as a history of GDM or an early pregnancy HbA1c between 6.0 and 6.4%, should have a first-trimester HbA1c and, if appropriate, a 75 g OGTT between 10 and 14 weeks. All pregnant women without previously diagnosed diabetes should be offered a 75 g OGTT between 24 and 28 weeks gestation. These updated criteria are designed to improve detection and management of hyperglycaemia, helping to reduce associated short- and long-term risks for both mother and baby.
View ArticleJ Gen Intern Med.
When and how should clinicians taper benzodiazepines when the risks outweigh the benefits?
Clinical Bottom Line: When the harms of continued benzodiazepine (BZD) use outweigh the benefits, clinicians should implement individualized, gradual tapering plans using shared decision-making, with attention to withdrawal risk and the need for psychosocial support. Abrupt discontinuation should be avoided in physically dependent patients.
Summary: This joint clinical practice guideline, led by the American Society of Addiction Medicine in collaboration with nine professional associations, offers comprehensive, evidence-based recommendations for tapering benzodiazepines in patients where continued use poses more risk than benefit. Developed using modified GRADE methodology and clinical consensus, the guideline emphasizes a patient-centered approach. Clinicians are advised to conduct ongoing risk-benefit assessments and engage patients in shared decision-making. Tapering should be individualized, gradually adjusted according to patient response, and supported with non-pharmacologic interventions such as psychosocial therapies. Sudden discontinuation is discouraged, particularly in patients with physical dependence, due to the risk of withdrawal symptoms. The guideline supports a flexible, evidence-informed approach that prioritizes patient safety and collaboration.
View ArticleAmerican College of Gastroenterology
What are the updated 2025 ACG recommendations for preventive care in patients with inflammatory bowel disease (IBD)?
Clinical Bottom Line: Patients with IBD need coordinated preventive care that includes timely vaccinations, cancer screenings, and mental health assessments—especially when on immune-modifying therapies. Gastroenterologists should take an active role in this process.
Summary: The 2025 ACG guideline highlights key preventive measures for adults with IBD, including vaccination against influenza and pneumococcal disease, screening for skin and cervical cancers, osteoporosis, and mental health conditions. Live vaccines should be avoided during immunosuppressive therapy. The guideline underscores the gastroenterologist’s responsibility in ensuring preventive care is addressed alongside IBD management.
View ArticleNIHR
Can sputum colour charts safely guide antibiotic self-treatment during COPD exacerbations?
Clinical Bottom Line: Using a sputum colour chart to guide antibiotic use in COPD self-management was not shown to be safer or more effective than usual care. In fact, it may increase hospital admissions and antibiotic use without clear clinical benefit.
Summary: This UK-based randomised controlled trial evaluated whether a sputum colour chart could safely guide patients with COPD in deciding when to use antibiotics during acute exacerbations. Although the colour chart was acceptable to patients and staff, those using it experienced higher rates of hospitalisation and antibiotic use compared to usual care. Quality of life was slightly better in the colour chart group, but the study was underpowered due to early termination from low recruitment. Substudy results suggested that sputum colour alone is not a reliable indicator of bacterial infection. Overall, the findings do not support routine use of sputum colour charts for guiding antibiotic self-treatment in COPD.
View ArticleJAMA Netw Open.
Do interventions targeting potentially inappropriate prescribing reduce medication burden or improve outcomes in older primary care patients?
Clinical Bottom Line: Interventions aimed at reducing potentially inappropriate prescribing in older adults can modestly lower the number of medications prescribed, but they do not appear to significantly affect adverse events, hospitalizations, or mortality.
Summary: This systematic review and meta-analysis included 118 randomized trials involving over 417,000 older adults in primary care or long-term care. Interventions—such as medication reviews or deprescribing protocols—led to a small but meaningful reduction in the number of medications per patient. However, these interventions did not significantly improve clinical outcomes, including adverse drug reactions, falls, hospital visits, or mortality. While such strategies may help reduce polypharmacy, their broader clinical impact remains uncertain, highlighting the need for future research using standardized methods and outcome reporting.
View ArticleUK Health Security Agency
What diagnostic tools are available to support UTI diagnosis in primary care?
Clinical Bottom Line: Quick reference tools from the UK Health Security Agency and NHS England offer clear, age- and condition-specific guidance for diagnosing urinary tract infections (UTIs) in primary care, helping to reduce unnecessary antibiotic use and improve diagnostic accuracy.
Summary: Updated in July 2025, these practical diagnostic tools support primary care clinicians in identifying UTIs across three key patient groups: women under 65, adults over 65, and those with suspected catheter-associated UTIs. The tools use symptom-based flowcharts and emphasize appropriate urine sampling and interpretation of culture results. They aim to guide decision-making while avoiding over-diagnosis and inappropriate antibiotic prescribing, particularly in older adults where symptoms may be nonspecific.
View ArticleTherapeutics Initiative
How common and serious is antidepressant withdrawal syndrome, and what should prescribers and patients do to manage the risks?
Clinical Bottom Line: Antidepressant withdrawal can cause significant, prolonged, and sometimes severe symptoms, especially after long-term use. Prescribers must discuss withdrawal risks clearly before initiating treatment, ensure fully informed consent, and use slow, individualized tapering strategies when discontinuing. Withdrawal symptoms can mimic relapse, so distinguishing between the two is critical.
Summary: Antidepressant withdrawal can be severe and long-lasting, especially after long-term use. Symptoms may be mistaken for relapse. Prescribers should ensure informed consent, discuss withdrawal risks clearly, and use slow, individualized tapering when stopping treatment.
View ArticleEuropean Society of Cardiology
Can vaccination be used as a strategy to prevent cardiovascular disease in high-risk patients?
Clinical Bottom Line: Vaccination—especially against influenza and other respiratory viruses—reduces cardiovascular risk in high-risk groups. It should be integrated into preventive care for patients with or at risk of cardiovascular disease.
Summary: This European Society of Cardiology consensus statement supports using vaccines (e.g., influenza, COVID-19, RSV) as a preventive tool in cardiovascular care. Evidence shows reduced infection and fewer major cardiovascular events post-vaccination. Practical guidance is provided for complex cases, including immunosuppressed patients, pregnant women, and those with congenital heart disease.
View ArticleBritish Orthopaedic Association
Can rehabilitation education videos improve recovery and patient understanding after trauma?
Clinical Bottom Line: Patient education videos (PEVs) are a practical, well-received adjunct to traditional leaflets for post-trauma rehabilitation. They improve patient understanding and satisfaction, especially when accessed independently via QR codes, and may enhance recovery.
Summary: A pilot study at Croydon University Hospital found that trauma patients valued rehabilitation education videos, with all survey respondents reporting the videos as useful and easy to follow. Access via QR codes proved effective across age groups, particularly among younger patients. PEVs are a promising, environmentally friendly complement to printed materials and warrant broader use and further evaluation in clinical care.
View ArticleCentre for Health Economics
Can improved access to primary care reduce avoidable emergency department visits?
Clinical Bottom Line: Some emergency department (ED) visits—especially by younger, urban patients—could be managed in primary care. Extended GP hours only reduce avoidable attendances when practices are open at the specific time of need. Aligning GP access more closely with patient demand could help relieve ED pressure.
Summary: This study found that 9–22% of ED visits in England could be avoidable, depending on the definition used. Younger and urban patients were more likely to attend EDs unnecessarily. Extended GP hours reduced avoidable visits only when practices were open at the time of attendance. Enhancing same-day GP access and better aligning opening hours with patient needs may help reduce ED demand.
View ArticleNIHR
Does temporarily stopping methotrexate for two weeks improve COVID-19 vaccine response in patients with immune-mediated inflammatory diseases?
Clinical Bottom Line: Temporarily pausing methotrexate for two weeks after a COVID-19 booster significantly improves antibody responses in patients with immune-mediated inflammatory diseases, with no serious adverse effects. This simple strategy may enhance vaccine efficacy in this population.
Summary: The VROOM trial found that patients who paused methotrexate for two weeks after a COVID-19 booster had more than double the antibody response compared to those who continued treatment. The effect was consistent across disease types and demographics, and no serious adverse events occurred. This approach offers a practical way to improve vaccine effectiveness in immunosuppressed patients.
View ArticleArch Dis Child.
What is the most effective second-line treatment for children with acute severe asthma exacerbations?
Clinical Bottom Line: Intravenous magnesium sulphate shows the most promise among second-line treatments for severe asthma in children, improving severity scores and reducing hospitalisation and further medication needs. However, overall evidence is of low to very low certainty, and no single treatment can be clearly recommended over others.
Summary: This systematic review of nine RCTs (546 children) found that IV magnesium sulphate may be more effective than other second-line options (e.g. aminophylline, SABA, ketamine, adrenaline) for acute severe asthma, offering better symptom relief and reducing hospital admissions. Nonetheless, the evidence remains limited and of low quality, highlighting the need for further high-quality trials.
View Article
