Literature Collection

INTRODUCTION: Comprehensiveness in primary care is defined as managing most medical needs in a population while integrating the context of patient's values, preferences, and beliefs. This study aims to synthesise validated measures for measuring comprehensiveness in primary care to facilitate its practical application. AIM: The objective of this study was to synthesise validated measures for measuring comprehensiveness in primary care, facilitating its practical application. METHODS: A narrative-style literature review was employed to conduct a hierarchical review of relevant literature. The process involved several stages: initial term filtering, separation of primary care from specialist care using medical subject heading (MeSH) terms, incorporation of non-MeSH terminology, and a manual review of titles, abstracts, and full articles. Articles were included if they discussed the measurement, assessment, or application of comprehensiveness in primary care and were relevant to primary care and methodologically sound. A multistage PubMed search of 'comprehensiveness' (MeSH) with hierarchical sub-term filtering and snowball method gleaning of additional articles from literature-described terminology was conducted. RESULTS: Thirteen studies met the inclusion criteria. Methodological strategies varied from claims-based approaches for cost and utilisation to surveys assessing the scope of clinical services and patient experience. DISCUSSION: Thoroughly measuring comprehensiveness in primary care integrates methods that evaluate the effect of physician ranges of clinical services on the cost and utilisation of health care, and the impact on patient outcomes within the context of the patient experience. Implementing these methods pragmatically can assist communities and health systems in implementing, measuring, and capturing comprehensiveness in primary care.

INTRODUCTION: The extensive and alarming use of opioids for pain management in patients with chronic pain receiving palliative care is associated with non-tolerable gastrointestinal (GI) adverse effects. Opioid-induced constipation (OIC) is the most common adverse effect impairing patient quality of life (QOL). In addition, OIC is one of the treatment limiting consequences of opioid analgesics. Management of OIC is becoming a challenge since traditional laxatives have limited efficiency. Peripherally acting mu-opioid receptor antagonists (PAMORA) have been developed for the treatment of OIC with methylnaltrexone bromide being the first approved to treat OIC in adults with advanced illness undergoing palliative care. Areas covered: The authors systematically review the clinical evidence for methylnaltrexone bromide including a review of the pharmacokinetic and pharmacodynamic data along with clinical effectiveness and cost-effectiveness. Though there is a need for further long-term clinical investigation, there is a large body of evidence for both its efficacy and safety in the treatment of OIC. Expert opinion: Methylnaltrexone has both subcutaneous injection and oral dosage forms available in the market. The lack of more evidence in specific populations such as pregnant women, pediatrics and elderly still remains. The global consumption of methylnaltrexone shows a projection of increased use since its approval worldwide in 2008.