Vol 17 - Feb 2026 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
The Continuity Conundrum (and Other Things the Evidence Is Trying to Tell Us)
If there’s one theme emerging from this month’s evidence, it’s that patients don’t just want access — they want continuity.
Two related studies tell the story. When patients can’t see their preferred GP, complaints rise. And while system changes — team-based care, virtual access, centralized lists — can improve access and attachment, they don’t automatically recreate the value of an ongoing clinician–patient relationship. The implication is simple but important: improving access to someone is not the same as access to their doctor.
The updated EuroGuiDerm acne guideline offers a different kind of reminder: use effective treatments early, limit antibiotics, and escalate appropriately. A familiar principle across primary care — do the right thing early and avoid long, low-value treatment.
And, as ever, some findings are reassuringly sobering: high-dose vitamin D doesn’t prevent falls, bronchodilators in bronchiectasis remain uncertain, and there’s still no clearly effective therapy to prevent repeat self-harm in adolescents.
The quiet message? Much of progress in primary care is incremental. But the first studies may be the most important: in a system focused on faster access, the evidence suggests patients still value something older — being known.
In This Edition
- Does reduced continuity with a preferred GP increase patient complaints in general practice?
- What approaches are effective for improving primary-care access and patient attachment to a regular clinician?
- How should acne be treated according to the EuroGuiDerm 2025 update?
- What do the Italian GRADE-based guidelines recommend for the diagnosis and treatment of overweight and obesity?
- Can artificial intelligence tools safely triage suspected skin cancer referrals to reduce dermatology appointments?
- What strategies improve medication adherence in older adults?
- Do GLP-1 receptor agonists and dual GLP-1/GIP receptor agonists increase the risk of severe acute pancreatitis?
- Can an electronic self-management program help patients taper and stop long-term benzodiazepine use?
- Are once-weekly insulins effective and safe for adults with type 2 diabetes?
- Do long-acting bronchodilators (with or without inhaled corticosteroids) reduce exacerbations in bronchiectasis?
- Does long-term vitamin D3 supplementation reduce the risk of falls in older adults?
- Does liraglutide improve metabolic and reproductive outcomes in overweight or obese women with polycystic ovary syndrome (PCOS)?
- Do GLP-1 receptor agonists improve walking ability and reduce amputation risk in people with type 2 diabetes and peripheral artery disease?
- Do therapeutic interventions reduce repeat self-harm in adolescents?
- Does physiotherapy reduce pelvic pain in women with endometriosis?
Centre for Health Economics
Does reduced continuity with a preferred GP increase patient complaints in general practice?
Clinical bottom line: Lower relational continuity in primary care is associated with higher rates of patient complaints: each 10-percentage-point increase in patients unable to see their preferred GP is linked to about 1.3 additional complaints per 10,000 patients, suggesting that maintaining GP–patient continuity may improve patient experience and reduce dissatisfaction.
Brief summary: This national observational study in England (2016–2023) linked GP Patient Survey data on relational continuity with practice-level complaint data and other practice characteristics. On average, 12% of patients reported rarely or never seeing their preferred GP, and practices recorded 13.8 new complaints per 10,000 patients annually. Reduced continuity was significantly associated with increased complaints, particularly after the COVID-19 pandemic, in practices that previously had high continuity, and in more deprived areas. The association did not appear to be explained by reduced trust or unmet clinical needs, suggesting that disruption of the ongoing GP–patient relationship itself contributes to dissatisfaction. The findings support policies and organisational models that preserve continuity (e.g., smaller teams) to improve patient
View ArticleMcMaster Health Forum
What approaches are effective for improving primary-care access and patient attachment to a regular clinician?
Clinical bottom line: Multiple system-level interventions—particularly interprofessional team-based care, centralized waiting lists/registries, virtual care and EMR-enabled efficiency, additional entry points (e.g., community or transitional clinics), and appropriately managed patient panel sizes—can improve primary-care attachment and access, although evidence on optimal models and equity impacts remains limited.
Brief Summary: This rapid evidence synthesis found that the most effective strategies for improving primary-care access and attachment include expanding interprofessional teams (e.g., nurse practitioner co-management), using virtual care and centralized EMRs to increase capacity, creating additional entry points such as community or transitional clinics, and implementing centralized waiting lists or registries. These approaches generally improve enrolment, timeliness, and patient or clinician experience. However, optimal patient panel sizes are uncertain, workforce supply interventions have limited evidence, and some approaches—particularly centralized waiting lists—may disadvantage more complex or socioeconomically vulnerable patients. Overall, coordinated system-wide changes are more effective than single interventions.
View ArticleEuroGuiDerm
How should acne be treated according to the EuroGuiDerm 2025 update?
Clinical bottom line: Use topical retinoids ± benzoyl peroxide as first-line for most acne; reserve systemic antibiotics for selected inflammatory cases, for the shortest effective duration and always with appropriate topical therapy to limit resistance; use oral isotretinoin for severe papulopustular/nodular/conglobate acne (or high scarring risk). Hormonal options (combined contraception and/or spironolactone) can be considered in females, and newer topicals (trifarotene, clascoterone) have roles within topical/combination regimens.
Brief summary: This EuroGuiDerm 2025 long guideline update (valid to June 2030) refreshes the 2016 guidance, with a focus on isotretinoin vs antibiotics (and antibiotic duration), hormonal treatments/spironolactone, and newer agents (trifarotene, clascoterone). It provides a severity/phenotype-based treatment approach, emphasizes early effective therapy to reduce scarring and psychosocial impact, and highlights antibiotic stewardship and key safety considerations (including pregnancy)
View ArticleItalian Society of Obesity
What do the Italian GRADE-based guidelines recommend for the diagnosis and treatment of overweight and obesity?
Clinical bottom line: Obesity should be managed as a chronic relapsing disease with structured lifestyle intervention for all patients, using additional anthropometric measures beyond BMI for risk assessment; pharmacotherapy (BMI ≥27 with comorbidities or ≥30) and bariatric surgery (especially BMI ≥40 or when other treatments fail) should be added according to risk and response, with a ≥10% weight loss associated with meaningful health and quality-of-life benefits.
Brief summary: These Italian National Institute of Health–endorsed GRADE guidelines address diagnosis, nutrition therapy, and medical, endoscopic, and surgical treatment across 13 clinical questions. They recommend assessing central adiposity in addition to BMI and offering structured medical nutrition therapy with behavioural support and physical activity to all patients. If lifestyle treatment alone is insufficient, anti-obesity medication is preferred for BMI ≥27 kg/m² with comorbidities or BMI 30–39.9 kg/m², while bariatric surgery is considered for selected patients or preferred for BMI ≥40 kg/m². Achieving at least 10% weight loss is linked to improved quality of life and lower depression risk.
View ArticleNIHR
Can artificial intelligence tools safely triage suspected skin cancer referrals to reduce dermatology appointments?
Clinical bottom line: AI triage tools such as DERM show high sensitivity for detecting malignant skin lesions and could substantially reduce unnecessary dermatology appointments, but some cancers may be missed and the impact on patient outcomes, costs, and clinical pathways remains uncertain, so use should be cautious and likely alongside specialist oversight.
Brief summary: This early value assessment reviewed evidence for two AI decision-support systems (DERM and Moleanalyzer Pro) used after primary care referral for suspected skin cancer. DERM demonstrated high sensitivity for malignancy (~96%) with moderate specificity, potentially allowing around half of referred patients to be discharged without dermatologist review, though a small number of cancers would be missed. Moleanalyzer Pro showed lower sensitivity but higher specificity for melanoma, with limited supporting evidence. No robust cost-effectiveness studies were identified, and both clinicians and patients expressed reluctance to rely on AI without dermatology input. Overall, the technologies show promise for triage, but their real-world clinical and economic impact is still uncertain.
View ArticleJ Am Geriatr Soc.
What strategies improve medication adherence in older adults?
Clinical bottom line: Multicomponent interventions—particularly patient education, behavioural support, and technical aids (e.g., reminders or adherence tools) delivered by healthcare professionals—can improve medication adherence in older adults, but benefits are variable and often short-term, with effectiveness influenced by baseline adherence and intervention intensity.
Brief summary: This systematic review (128 studies, including 96 RCTs) evaluated interventions to improve medication adherence in adults aged ≥60 years, most delivered in primary care. Over half included educational components, nearly half used technical supports (e.g., electronic reminders, packaging), and about one-third addressed attitudinal or behavioural factors, often delivered by pharmacists, nurses, or physicians. Most studies reported improved adherence, with some also showing better disease control (e.g., blood pressure, HbA1c), quality of life, and patient satisfaction. However, results were heterogeneous and generally limited to short-term improvements, with reduced impact when baseline adherence was already high or interventions were brief or low-intensity.
View ArticleMHRA
Do GLP-1 receptor agonists and dual GLP-1/GIP receptor agonists increase the risk of severe acute pancreatitis?
Clinical bottom line: GLP-1 receptor agonists and dual GLP-1/GIP agonists are associated with an uncommon but potentially severe risk of acute pancreatitis, including rare necrotising and fatal cases; clinicians should monitor for symptoms, stop treatment immediately if pancreatitis is suspected, and avoid restarting if confirmed.
Brief summary: This MHRA safety update strengthens class warnings for GLP-1 and GLP-1/GIP receptor agonists (including liraglutide, semaglutide, dulaglutide and tirzepatide) to highlight rare reports of severe pancreatitis. Between 2007 and October 2025, 1,296 UK Yellow Card reports of pancreatitis were received, including 24 necrotising cases and 19 fatalities, although overall use is widespread. Because early symptoms (abdominal pain, nausea, vomiting) may mimic common gastrointestinal side effects, clinicians should maintain a high index of suspicion, ask about prescribed or privately obtained GLP-1 therapies, and advise patients to seek urgent care for persistent severe abdominal pain radiating to the back. Use caution in patients with a history of pancreatitis and report suspected adverse reactions via the Yellow Card scheme.
View ArticleJAMA Netw Open.
Can an electronic self-management program help patients taper and stop long-term benzodiazepine use?
Clinical bottom line: A low-cost, self-administered electronic version of the EMPOWER program significantly increased complete benzodiazepine cessation at 6 months among long-term users, although it did not significantly improve partial dose reduction or symptoms compared with usual care.
Brief summary: In this randomized clinical trial (n=161) of long-term benzodiazepine users in US Veterans primary care, participants receiving the electronic EMPOWER intervention (EMPOWER-ED) were over five times more likely to completely stop benzodiazepines at 6 months than those receiving usual care. The intervention did not significantly increase the likelihood of ≥25% dose reduction and showed no differences in anxiety, sleep, or quality of life. These findings suggest that scalable, patient-led digital education and tapering support can help reduce long-term benzodiazepine dependence, with minimal clinician time required.
View ArticleDiabetes Obes Metab.
Are once-weekly insulins effective and safe for adults with type 2 diabetes?
Clinical bottom line: Once-weekly insulins provide modest improvements in glycaemic control (slightly lower HbA1c and more time in range) compared with daily insulin or semaglutide, without increasing hypoglycaemia risk, though small weight gain may occur.
Brief summary: This meta-analysis of 16 randomized trials (including major 2025 studies) found that once-weekly insulin reduced HbA1c slightly more than comparator therapies (mean difference −0.12%) and increased time in target glucose range, with similar fasting glucose effects. Rates of clinically significant or severe hypoglycaemia were comparable between groups. Body weight was generally similar, although a small increase was seen in some analyses. Overall, once-weekly insulin offers similar safety with modest efficacy benefits and the potential advantage of reduced injection burden, which may support adherence.
View ArticleNIHR HTA
Do long-acting bronchodilators (with or without inhaled corticosteroids) reduce exacerbations in bronchiectasis?
Clinical bottom line: This small pilot trial was underpowered and inconclusive; although exacerbation rates were numerically lower with dual or triple inhaled therapy than placebo, the study cannot determine effectiveness or cost-effectiveness, and evidence remains insufficient to support routine use for exacerbation prevention.
Brief summary: This pragmatic UK multicentre randomized trial compared dual bronchodilator therapy (LABA/LAMA), triple therapy (ICS/LABA/LAMA), and placebo over 12 months in adults with bronchiectasis and frequent exacerbations. Recruitment was severely limited by COVID-19, with only 33 participants randomized, so analyses were descriptive. Median exacerbations were numerically lower with dual therapy (1) and triple therapy (2) than placebo (3), with no safety concerns and good retention. However, the small sample size means the study cannot establish superiority, non-inferiority, or economic value, and the role of inhaled bronchodilators in bronchiectasis remains uncertain.
View ArticleJ Am Geriatr Soc.
Does long-term vitamin D3 supplementation reduce the risk of falls in older adults?
Clinical bottom line: In generally healthy, largely vitamin D–sufficient older adults, vitamin D3 supplementation (1600–3200 IU/day) for 5 years did not reduce falls or fall-related injuries, and high-dose supplementation should not be used routinely for fall prevention in this population.
Brief summary: In this double-blind randomized trial (n=2495) of community-dwelling older adults in Finland, participants received vitamin D3 (1600 IU/day or 3200 IU/day) or placebo for 5 years. Fall risk (55%) and fall-injury risk (11%) were similar across all groups, with no effect modification by age, sex, or BMI. Most participants were vitamin D sufficient at baseline (mean 25[OH]D ~75 nmol/L), and supplementation substantially increased serum levels without clinical benefit. These findings suggest that high-dose vitamin D does not prevent falls in vitamin D–replete older adults.
View ArticleDiabetes Obes Metab.
Does liraglutide improve metabolic and reproductive outcomes in overweight or obese women with polycystic ovary syndrome (PCOS)?
Clinical bottom line: In overweight or obese women with PCOS, liraglutide improves weight, insulin resistance, and menstrual regularity and is generally well tolerated, but evidence for effects on ovulation, pregnancy, and long-term outcomes is limited.
Brief summary: This systematic review and meta-analysis (7 RCTs, n=330) found that liraglutide significantly reduced BMI and insulin resistance and improved menstrual frequency compared with placebo or active comparators. It also lowered luteinizing hormone and androgen markers and modestly increased sex hormone–binding globulin. Adverse effects were mainly mild gastrointestinal symptoms. However, heterogeneity was high for menstrual outcomes, and key reproductive endpoints such as ovulation and pregnancy were poorly reported. Overall, liraglutide shows promising metabolic and some reproductive benefits, but larger, longer-term trials are needed to confirm clinical reproductive outcomes and safety.
View ArticleDiabetes Obes Metab.
Do GLP-1 receptor agonists improve walking ability and reduce amputation risk in people with type 2 diabetes and peripheral artery disease?
Clinical bottom line: GLP-1 receptor agonists may modestly improve walking distance in people with type 2 diabetes and peripheral artery disease, and observational data suggest a possible reduction in lower-limb amputation, but evidence for limb-event prevention is uncertain and requires confirmation in dedicated trials.
Brief summary: This systematic review and meta-analysis (7 studies; >107,000 participants) evaluated GLP-1 receptor agonists in adults with type 2 diabetes and peripheral artery disease. Randomized trial data showed a small but significant improvement in functional walking distance (moderate certainty), while RCT evidence did not demonstrate a clear reduction in major adverse limb events or amputations. Cohort studies suggested a lower risk of lower-extremity amputation, particularly with semaglutide and tirzepatide, but heterogeneity was high and certainty very low. Overall, GLP-1RAs show potential functional and limb benefits, but robust RCT evidence for amputation prevention is lacking.
View ArticleNIHR HTA
Do therapeutic interventions reduce repeat self-harm in adolescents?
Clinical bottom line: Across a wide range of psychological and supportive therapies, there is no clear evidence that any intervention reduces repeat self-harm in adolescents compared with usual care, although those with multiple prior episodes may benefit more, and no single treatment can currently be recommended.
Brief summary: This individual participant data meta-analysis combined data from 33 randomized trials (≈4100 participants) evaluating diverse interventions (e.g., CBT, dialectical behaviour therapy, family therapy, multisystemic therapy) for adolescents presenting with self-harm. Overall, there was no reduction in repeat self-harm at 12 months compared with usual or enhanced usual care, and no consistent benefits for most secondary outcomes. Evidence quality was limited, with few low-risk-of-bias studies and heterogeneous interventions and outcomes. Subgroup analyses suggested possible greater benefit among adolescents with multiple previous self-harm episodes, but findings were exploratory. The results highlight the need for better-designed, targeted trials rather than reliance on any single existing intervention.
View ArticlePain Med.
Does physiotherapy reduce pelvic pain in women with endometriosis?
Clinical bottom line: Physiotherapy appears to reduce endometriosis-related pelvic pain, with the greatest benefit seen from locally applied modalities (e.g., electrotherapy or laser), although the evidence base is small.
Brief summary: This systematic review and meta-analysis (7 studies) found that physiotherapy significantly reduced pelvic pain compared with non-physiotherapy care (mean difference −1.97 on pain scales). Modalities such as electrotherapy and laser showed the largest effects, and treatments applied locally were more effective than general approaches. Although results suggest physiotherapy is a useful adjunct for pain management in endometriosis, the limited number of studies means further high-quality trials are needed to confirm effectiveness and define optimal techniques.
View Article
