The British Journal of General Practice最新文献

{"title":"How parents and children evaluate emollients for childhood eczema: a qualitative study.","authors":"Eileen Sutton, Alison Rg Shaw, Matthew J Ridd, Miriam Santer, Amanda Roberts, Helen Baxter, Hywel C Williams, Jonathan Banks","doi":"10.3399/BJGP.2021.0630","DOIUrl":"10.3399/BJGP.2021.0630","url":null,"abstract":"<p><strong>Background: </strong>Eczema affects one in five children in the UK. Regular application of emollients is routinely recommended for children with eczema. There are four main emollient types, but no clear evidence of which is best. The current 'trial and error' approach to find suitable emollients can be frustrating for parents, children, and clinicians.</p><p><strong>Aim: </strong>To identify how parents and children experience and evaluate emollients.</p><p><strong>Design and setting: </strong>Qualitative interview study, nested within a primary care trial of emollients (Best Emollients for Eczema [BEE] trial).</p><p><strong>Method: </strong>Semi-structured interviews with children with eczema and their parents were conducted. Participants were purposively sampled on emollient type (lotion, cream, gel, or ointment), age, and eczema severity.</p><p><strong>Results: </strong>Forty-four parents were interviewed, with children participating in 24 of those interviews. There was no clear preference for any one emollient type. The strongest theme was the variation of experience in each of the four types. Participants focused on thickness and absorbency, both positively and negatively, to frame their evaluations. Effectiveness and acceptability were both considered when evaluating an emollient but effectiveness was the primary driver for continued use. For some, participating in the trial had changed their knowledge and behaviour of emollients, resulting in use that was more regular and for a longer duration.</p><p><strong>Conclusion: </strong>There is no one emollient that is suitable for everyone, and parents/children prioritise different aspects of emollients. Future research could evaluate decision aids and/or tester pots of different types, which could enable clinicians and parents/children to work collaboratively to identify the best emollient for them.</p>","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9172216/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88757336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementing video group consultations in general practice during COVID-19: a qualitative study","authors":"C. Papoutsi, S. Shaw, T. Greenhalgh","doi":"10.3399/BJGP.2021.0673","DOIUrl":"https://doi.org/10.3399/BJGP.2021.0673","url":null,"abstract":"Background Group consultations have been gaining ground as a novel approach to service delivery. When in-person care was restricted owing to COVID-19, general practice staff began delivering group consultations remotely over video. Aim To examine how multiple interacting influences underpinned implementation and delivery of video group consultations (VGCs). Design and setting Qualitative study in general practice in England. Method a) 32 semi-structured interviews with patients, clinical, and non-clinical staff (from eight GP surgeries in total), NHS policymakers and programme managers, and other stakeholders; b) observation in relevant training and operational meetings; and c) three co-design workshops (21 participants). Thematic analysis was informed by the Planning and Evaluating Remote Consulting Services (PERCS) framework. Results In the first year of the pandemic, VGCs focused on supporting those with long-term conditions or other shared health and social needs. Most patients welcomed clinical and peer input, and the opportunity to access their practice remotely during lockdown. However, not everyone agreed to engage in group-based care or was able to access IT equipment. At practice level, significant work was needed to deliver VGCs, such as setting up the digital infrastructure, gaining team buy-in, developing new patient-facing online facilitation roles, managing background operational processes, protecting online confidentiality, and ensuring professional indemnity cover. Training provided nationally was seen as instrumental in capacity building for VGC implementation. Conclusion Small scale VGC implementation addressed unmet need during the pandemic. However, embedding VGCs in routine care requires rethinking of operational, infrastructural, and clinical processes. Additional research on costs and benefits at service and patient level is needed.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80561602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevention in practice: why is it neglected and what can we do?","authors":"Paul Aveyard, Susan Jebb","doi":"10.3399/bjgp22X719429","DOIUrl":"10.3399/bjgp22X719429","url":null,"abstract":"","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9090446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74229478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 on primary care contacts with children and young people in England: longitudinal trends study 2015–2020","authors":"Kimberley A Foley, E. Maile, A. Bottle, F. Neale, R. Viner, S. Kenny, A. Majeed, D. Hargreaves, S. Saxena","doi":"10.3399/BJGP.2021.0643","DOIUrl":"https://doi.org/10.3399/BJGP.2021.0643","url":null,"abstract":"Background The NHS response to COVID-19 altered provision and access to primary care. Aim To examine the impact of COVID-19 on GP contacts with children and young people (CYP) in England. Design and setting A longitudinal trends analysis was undertaken using electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum database. Method All CYP aged <25 years registered with a GP in the CPRD Aurum database were included. The number of total, remote, and face-to-face contacts during the first UK lockdown (March to June 2020) were compared with the mean contacts for comparable weeks from 2015 to 2019. Results In total, 47 607 765 GP contacts with 4 307 120 CYP were included. GP contacts fell 41% during the first lockdown compared with previous years. Children aged 1–14 years had greater falls in total contacts (≥50%) compared with infants and those aged 15–24 years. Face-to-face contacts fell by 88%, with the greatest falls occurring among children aged 1–14 years (>90%). Remote contacts more than doubled, increasing most in infants (over 2.5-fold). Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote contacts, mitigating the total fall (31%). Conclusion During the COVID-19 pandemic, CYP’s contact with GPs fell, particularly for face-to-face assessments. This may be explained by a lower incidence of respiratory illnesses because of fewer social contacts and changing health-seeking behaviour. The large shift to remote contacts mitigated total falls in contacts for some age groups and for common non-transmissible conditions.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78204312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can early cancer detection be improved in deprived areas by involving community pharmacists?","authors":"J. Konya, Richard Neal, C. Clark, D. Bearman, J. Campbell","doi":"10.3399/bjgp22X718865","DOIUrl":"https://doi.org/10.3399/bjgp22X718865","url":null,"abstract":"The key to the success of cancer treatments and better clinical outcomes is early detection. The incidence and mortality from cancer is higher in patients with lower socioeconomic status compared to that for more affluent patients.1 General practice is crucial for the early diagnosis of cancer. The COVID-19 pandemic highlighted pre-existing GP workforce and access inequalities, which are expected to get worse.2 The 2020 General Practice Patient Survey suggests that patients from deprived areas have more difficulties accessing general practice than patients from affluent areas.3 Secondary care treatment waiting times have also become longer compared to pre-pandemic levels, and have increased significantly in deprived populations.4","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83593839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lifestyle advice for hypertension or diabetes: trend analysis from 2002 to 2017 in England.","authors":"John A Henry, Susan A Jebb, Paul Aveyard, Cesar Garriga, Julia Hippisley-Cox, Carmen Piernas","doi":"10.3399/BJGP.2021.0493","DOIUrl":"10.3399/BJGP.2021.0493","url":null,"abstract":"<p><strong>Background: </strong>Guidelines recommend that GPs give patients lifestyle advice to manage hypertension and diabetes. Increasing evidence shows that this is an effective and practical treatment for these conditions, but it is unclear whether GPs offer this support.</p><p><strong>Aim: </strong>To investigate trends in the percentage of patients with hypertension/diabetes receiving lifestyle advice versus medication.</p><p><strong>Design and setting: </strong>This was a trend analysis of self-reported data from the annual Health Survey for England (HSE) (2003-2017) and GP-recorded data from the QResearch database (2002-2016).</p><p><strong>Method: </strong>The percentage of patients with hypertension or diabetes who received lifestyle advice or medication was calculated in each year. Associations between likelihood of receiving lifestyle advice and characteristics were assessed using multivariable logistic regression.</p><p><strong>Results: </strong>The percentage of patients receiving lifestyle advice was consistently lower than those receiving medication in both self-reported and medical records. There was consistent evidence of increasing trends in the percentage of patients with hypertension receiving lifestyle advice (HSE 13.8% to 20.1%; <i>P_trend</i> <0.001; QResearch 11.0% to 22.7%; <i>P_trend</i> <0.001). For diabetes, there was a non-significant decline in self-reported receipt of lifestyle advice (45.0% to 27.9%; <i>P_trend</i> = 0.111) and a significant increase in medically recorded delivery of this advice (20.7% to 40.5%; <i>P_trend</i> <0.001). Patients with hypertension who were overweight or obese were more likely to receive lifestyle advice than those of a healthy weight, whereas the opposite was true for diabetes.</p><p><strong>Conclusion: </strong>Only a minority of patients with diabetes or hypertension report receiving lifestyle advice or have this recorded in their medical records. Interventions beyond guidelines are needed to increase the delivery of behavioural interventions to treat these conditions.</p>","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8936182/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78583374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-diagnostic clinical features and blood tests in patients with colorectal cancer: a retrospective linked-data study","authors":"Marie Moullet, G. Funston, L. Mounce, G. Abel, N. D. de Wit, F. Walter, Yin Zhou","doi":"10.3399/BJGP.2021.0563","DOIUrl":"https://doi.org/10.3399/BJGP.2021.0563","url":null,"abstract":"Background The majority of colorectal cancer is diagnosed in patients following symptomatic presentation in the UK. Aim To identify windows of opportunity for timely investigations or referrals in patients presenting with colon and rectal cancer-relevant symptoms or abnormal blood tests. Design and setting A retrospective cohort study was undertaken using linked primary care and cancer registry data for patients with colorectal cancer diagnosed in England between 2012 and 2015. Method Monthly consultation rates for relevant clinical features (change in bowel habit, rectal bleeding, abdominal pain, abdominal mass, constitutional symptoms, and other bowel symptoms) and abnormal blood test results (low haemoglobin, high platelets, and high inflammatory markers) up to 24 months pre-diagnosis were calculated. Poisson regression adjusted for age, sex, and relevant comorbidities was used to estimate the most likely month when consultation rates increased above baseline. Results In total, 5033 patients with colon cancer and 2516 with rectal cancer were included. Consultations for all examined clinical features and abnormal blood tests increased in the year pre-diagnosis. Rectal bleeding was the earliest clinical feature to increase from the baseline rate: at 10 months (95% confidence interval [CI] = 8.3 to 11.7) pre-diagnosis for colon cancer and at 8 months (95% CI = 6.1 to 9.9) pre-diagnosis for rectal cancer. Low haemoglobin, high platelets, and high inflammatory markers increased from as early as 9 months pre-diagnosis. Conclusion This study found evidence for an early increase in rates of consultation for relevant clinical features and abnormal blood tests in patients with colorectal cancer, suggesting that earlier instigation of cancer-specific investigations or referrals may be warranted in some patients who were symptomatic.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76261930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accuracy of the NICE traffic light system in children presenting to general practice: a retrospective cohort study","authors":"Amy Clark, R. Cannings‐John, Megan Blyth, Alastair D Hay, Christopher C. Butler, K. Hughes","doi":"10.3399/BJGP.2021.0633","DOIUrl":"https://doi.org/10.3399/BJGP.2021.0633","url":null,"abstract":"Background The National Institute for Health and Care Excellence (NICE) traffic light system was created to facilitate the assessment of unwell children in primary care. To the authors’ knowledge, no studies have validated this tool in UK general practice. Aim To evaluate the accuracy of this system for detecting serious illness in children presenting to general practice. Design and setting A retrospective diagnostic accuracy study was undertaken, using a cohort of acutely unwell children aged <5 years presenting to general practice in England and Wales. Method The traffic light categories of 6703 children were linked with hospital data to identify admissions and diagnoses. The sensitivity and specificity of these categories were calculated against the reference standard: a hospital-diagnosed serious illness within 7 days of GP consultation, measured using International Classification of Diseases, 10th Revision codes. Results In total, 2116 (31.6%) children were categorised as ‘red’; 4204 (62.7%) as ‘amber’; and 383 (5.7%) as ‘green’. There were 139 (2.1%) children who were admitted to hospital within 7 days of consultation, of whom 17 (12.2%; 0.3% overall) had a serious illness. The sensitivity of the red category (versus amber and green) was 58.8% (95% confidence interval [CI] = 32.9 to 81.6) and the specificity 68.5% (95% CI = 67.4 to 69.6). The sensitivity and specificity of red and amber combined (versus green) was 100% (95% CI = 80.5 to 100) and 5.7% (95% CI = 5.2 to 6.3), respectively. Conclusion The NICE traffic light system did not accurately detect children admitted with a serious illness, nor those not seriously ill who could have been managed at home. This system is not suitable for use as a clinical tool in general practice. Further research is required to update or replace the system.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82423057","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a primary care-initiated hepatitis C treatment pathway in Scotland: a qualitative study.","authors":"David Whiteley, Elizabeth M Speakman, Lawrie Elliott, Helen Jarvis, Katherine Davidson, Michael Quinn, Paul Flowers","doi":"10.3399/BJGP.2022.0044","DOIUrl":"10.3399/BJGP.2022.0044","url":null,"abstract":"<p><strong>Background: </strong>The ease of contemporary hepatitis C virus (HCV) therapy has prompted a global drive towards simplified and decentralised treatment pathways. In some countries, primary care has become an integral component of community-based HCV treatment provision. In the UK, however, the role of primary care providers remains largely focused on testing and diagnosis alone.</p><p><strong>Aim: </strong>To develop a primary care-initiated HCV treatment pathway for people who use drugs, and recommend theory-informed interventions to help embed that pathway into practice.</p><p><strong>Design and setting: </strong>A qualitative study informed by behaviour change theory. Semi-structured interviews were undertaken with key stakeholders (<i>n</i> = 38) primarily from two large conurbations in Scotland.</p><p><strong>Method: </strong>Analysis was three-stage. First, a broad pathway structure was outlined and then sequential pathway steps were specified; second, thematic data were aligned to pathway steps, and significant barriers and enablers were identified; and, third, the Theoretical Domains Framework and Behaviour Change Wheel were employed to systematically develop ideas to enhance pathway implementation, which stakeholders then appraised.</p><p><strong>Results: </strong>The proposed pathway structure spans broad, overarching challenges to primary care-initiated HCV treatment. The theory-informed recommendations align with influences on different behaviours at key pathway steps, and focus on relationship building, routinisation, education, combating stigmas, publicising the pathway, and treatment protocol development.</p><p><strong>Conclusion: </strong>This study provides the first practicable pathway for primary care-initiated HCV treatment in Scotland, and provides recommendations for wider implementation in the UK. It positions primary care providers as an integral part of community-based HCV treatment, providing workable solutions to ingrained barriers to care.</p>","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9423057/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90372207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Remote primary care during the COVID-19 pandemic for people experiencing homelessness: a qualitative study","authors":"K. Howells, Mat Amp, Martin Burrows, Jo-Ann Brown, R. Brennan, Joanne Dickinson, Shaun Jackson, Wan-Ley Yeung, D. Ashcroft, S. Campbell, T. Blakeman, C. Sanders","doi":"10.3399/BJGP.2021.0596","DOIUrl":"https://doi.org/10.3399/BJGP.2021.0596","url":null,"abstract":"Background The COVID-19 pandemic has caused unprecedented disruption and change to the organisation of primary care, including for people experiencing homelessness who may not have access to a phone. Little is known about whether the recent changes required to deliver services to people experiencing homelessness will help to address or compound inequality in accessing care. Aim To explore the experience and impact of organisational and technology changes in response to COVID-19 on access to health care for people experiencing homelessness. Design and setting An action-led and participatory research methodology was employed in three case study sites made up of primary care services delivering care for people experiencing homelessness. Method Individual semi-structured interviews were conducted with 21 people experiencing homelessness and 22 clinicians and support workers. Interviews were analysed using a framework approach. Results The move to remote telephone consultations highlighted the difficulties experienced by participants in accessing health care. These barriers included problems at the practice level associated with remote triage as participants did not always have access to a phone or the means to pay for a phone call. This fostered increased reliance on support workers and clinicians working in the community to provide or facilitate a primary care appointment. Conclusion The findings have emphasised the importance of addressing practical and technology barriers as well as supporting communication and choice for mode of consultation. The authors argue that consultations should not be remote ‘by default’ and instead take into consideration both the clinical and social factors underpinning health.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2022-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77714718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}