BJGP Open最新文献

{"title":"How does decontextualised risk information affect clinicians understanding of risk and uncertainty in primary care diagnosis? A qualitative study of clinical vignettes.","authors":"Alex Burns, Elizabeth Shephard, Raff Calitri, Adrian Mercer, Edmund Jack, Mark Tarrant, Sarah Dean","doi":"10.3399/BJGPO.2025.0040","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0040","url":null,"abstract":"<p><strong>Background: </strong>Decontextualised risk information (DRI) is any information pertaining to diagnosis, which is introduced into a clinical consultation, or a diagnostic thought process, without being requested by the clinician. It can be risk scores, computerised warnings, or lab tests or diagnostic imaging requests ordered by other clinicians. It is an increasing, and yet under-researched phenomena in UK Primary Care.</p><p><strong>Aim: </strong>To investigate how General Practitioners (GPs) integrate DRI into their clinical decision-making and how might they communicate this to patients.</p><p><strong>Design & setting: </strong>Clinical vignettes of cases which involve DRI, designed to increase the diagnostic uncertainty of the case, were presented to UK trained GPs. \"Think-Aloud\" techniques and qualitative Interviews were used to explore clinical thinking.</p><p><strong>Method: </strong>Nine GPs were interviewed. After a warmup vignette, clinicians were shown and asked to talk through three clinical vignettes which involved DRI. Semi-structured interview questions, exploring diagnostic thinking and uncertainty, followed each vignette. Thematic Analysis was used to explore the research question.</p><p><strong>Results: </strong>DRI tends to dominate a consultation when introduced. It can produce cognitive dissonance, defensive medicine and more complex consultations. DRI explicitly presents differential diagnoses that clinicians may have considered but not discussed, compelling them to act, or justify their inaction, at several levels. Clinicians needed to recognise the complexity of clinical reasoning, and balance this against over-reliance on individual test or risk scores.</p><p><strong>Conclusion: </strong>When DRI conflicts with a clinician's judgement, it can produce cognitive dissonance leading to complex consultations and predisposes towards defensive medical practices.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144327117","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":"Declining number of home visits to older adults by GPs: an observational study using data from electronic health records in The Netherlands, 2017-2023.","authors":"Chantal J Leemrijse, Marianne J Heins, Bart J Knottnerus, Mariette Hooiveld, Judith N de Boer, Ron F Schipper, Joost W Vanhommerig","doi":"10.3399/BJGPO.2024.0255","DOIUrl":"10.3399/BJGPO.2024.0255","url":null,"abstract":"<p><strong>Background: </strong>Despite an ageing population that has higher care demands, home visits by GPs have been declining.</p><p><strong>Aim: </strong>To analyse the number of GP home visits from 2017-2023 in The Netherlands, and to investigate whether this trend differed according to age, sex, multimorbidity, and neighbourhood deprivation. In addition, to discover the most common reasons for home visits between 2017 and 2023.</p><p><strong>Design & setting: </strong>An observational study that used data derived from Nivel Primary Care Database (Nivel-PCD), which contained routinely recorded data from approximately 500 Dutch GP practices.</p><p><strong>Method: </strong>The number of home visits was calculated by age, sex, multimorbidity, and neighbourhood deprivation. Visual inspection was used to investigate the relation between the trend in number of home visits and age, sex, multimorbidity, and neighbourhood deprivation of patients.</p><p><strong>Results: </strong>A large decrease in the overall number of home visits was observed between 2017 and 2023 (-32%). The largest decrease was between 2019 and 2020 (-15%), but the downward trend continued in 2021 through 2023 (-5% per year). The most profound decline between 2023 and 2017 was found in the number of short home visits (-52%). The number of home visits for intensive GP care increased by 12% between 2017 and 2023.</p><p><strong>Conclusion: </strong>We report a continuing decline in the number of home visits by GPs, comparing 2023 with 2017. Home visits for intensive GP care, often for patients at the end of life, increased since 2017. GPs may be forced to make choices owing to the increasing workload.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755050","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":"Inequalities in cancer 2-week-wait referrals: a cross-sectional study in English general practice.","authors":"Stephanie C Wynne, Mark Ashworth","doi":"10.3399/BJGPO.2024.0052","DOIUrl":"10.3399/BJGPO.2024.0052","url":null,"abstract":"<p><strong>Background: </strong>Practices with higher 2-week-wait (2WW) referral rates demonstrate higher survival for several cancers. Yet, there is little up-to-date evidence exploring factors influencing 2WW referral rates and whether health inequalities exist, particularly after COVID-19.</p><p><strong>Aim: </strong>To establish which patient factors (for example, age, sex, ethnic group, deprivation) and practice factors (for example, remote consultations, frequency of seeing a preferred GP) independently predict 2WW referral rates.</p><p><strong>Design & setting: </strong>A cross-sectional, observational study was performed using data from English general practices for 2021-2022.</p><p><strong>Method: </strong>Multivariable linear regression was used to identify the strongest, independent predictors of 2WW referral rates for all cancers (primary outcome) and for breast, lower-gastrointestinal, lung, and skin cancers separately (secondary outcome).</p><p><strong>Results: </strong>The analysis included 6307 practices. Practices with more females, patients aged ≥75 years, and patients with a greater burden of long-term conditions were associated with higher 2WW referrals for all cancers, as were practices in Northwest England, and those with higher scores for patients feeling involved in care decisions. Conversely, practices with a higher frequency of seeing a preferred GP were predictive of fewer all-cancer 2WW referrals. Practices with a higher proportion of currently smoking patients and Asian and Black ethnicity patients also predicted fewer all-cancer 2WW-referrals, and these associations were strongest for skin cancer, and for breast cancer (except for Black ethnicity). Higher socioeconomic deprivation predicted lower 2WW referrals for lung cancer only.</p><p><strong>Conclusion: </strong>This study analyses factors influencing 2WW referral rates and highlights potential inequalities. This work identifies priority populations, including people who smoke, and Asian and Black ethnic group patients, who may benefit from interventions to increase primary care access. Shared decision making may be an underexplored resource for increasing all-cancer 2WW referral rates.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956285","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":"What's been tried: a curated catalogue of efforts to improve access to general practice.","authors":"Carol Sinnott, Evleen Price, Akbar Ansari, Rebecca Fisher, Jake Beech, Hugh Alderwick, Mary Dixon-Woods","doi":"10.3399/BJGPO.2024.0184","DOIUrl":"10.3399/BJGPO.2024.0184","url":null,"abstract":"<p><strong>Background: </strong>Although increasing numbers of appointments are being provided, public satisfaction with access to UK general practice is declining. Previous attempts to improve access have not been systematically collated.</p><p><strong>Aim: </strong>To identify interventions to improve access to general practice in the UK, to organise these interventions into thematic categories, and to identify which aspects of access are targeted.</p><p><strong>Design & setting: </strong>Narrative systematic review.</p><p><strong>Method: </strong>A three-stage search was conducted to identify interventions used to improve access to NHS general practice. Using an iterative process, we generated thematic categories to classify interventions according to how they are intended to work. We assessed which aspects of access they addressed using the seven-feature Candidacy Framework.</p><p><strong>Results: </strong>The search identified 449 relevant sources reporting on interventions to improve access to general practice over the period 1984-2023. We generated six overarching thematic categories into which we organised these interventions: appointment innovations; direct patient access to services; increasing the number and range of professionals available in general practice; offering contacts beyond core hours, core settings, and core services; supporting patient engagement; and supporting the wider structures of general practice. We assessed which features of candidacy were addressed, with 'permeability' (the ease with which people can use services) emerging as the most frequent feature.</p><p><strong>Conclusion: </strong>Multiple and diverse attempts have been made to improve access in general practice over a 40-year period. This curated, thematised catalogue offers an important resource for future efforts to improve access.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956376","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":"Low-density lipoprotein cholesterol levels and treatment intensity in secondary prevention of patients with ischaemic heart disease in the primary care setting: a real-world data registry study.","authors":"Núria Sánchez-Ruano, Anna Fibla-Matamoros, Carles Falces, Encarna Sánchez, Antoni Sisó-Almirall, Luis González-de Paz","doi":"10.3399/BJGPO.2024.0220","DOIUrl":"10.3399/BJGPO.2024.0220","url":null,"abstract":"<p><strong>Background: </strong>Monitoring low-density lipoprotein cholesterol (LDL-C) and prescribing appropriate treatment is crucial for secondary prevention in primary care.</p><p><strong>Aim: </strong>To study LDL-C levels and treatments for patients with ischaemic heart disease according to target recommendations and assess factors influencing prescribed drug intensity.</p><p><strong>Design & setting: </strong>A cross-sectional study was undertaken. We examined electronic health records of patients with ischaemic heart disease from three primary care centres in Spain.</p><p><strong>Method: </strong>LDL-C levels were assessed using the most recent registry, and LDL-C-lowering treatments were categorised by their theoretical efficacy. Factors associated with LDL-C target attainment were analysed using univariate and multivariate regression models. Prescription intensity was studied with ordinal logistic regression models.</p><p><strong>Results: </strong>We studied 1936 patients, 14.88% of whom received no LDL-C-lowering treatment. The percentages of patients who achieved LDL-C thresholds of<70 mg/dl and<55 mg/dl were 35.0% and 12.65%, respectively. The factor associated with the <55 mg/dl threshold was type 2 diabetes mellitus (odds ratio [OR] 0.55, 95% confidence interval [CI] = 0.42 to 0.73), with males showing better LDL-C levels (OR 0.34, 95% CI = 0.23 to 0.51). Males had higher-intensity prescriptions (OR 1.57, 95% CI = 1.27 to 1.94) and older patients had lower-intensity treatments (OR 0.96, 95% CI = 0.95 to 0.97).</p><p><strong>Conclusion: </strong>Increased LDL-C drug treatment improvement, monitoring, and adherence to guideline recommendations are necessary for patients with ischaemic heart disease. Sex and age are potential factors associated with inadequate lipid-lowering treatment intensity and poor LDL-C control that might worsen cardiovascular outcomes in high-risk patients, leading to avoidable inequity among patients who visit the primary health setting.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617134","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":"General practitioner characteristics and video use in out-of-hours primary care: a register-based study.","authors":"Ida Bergholdt Jul Christiansen, Mette Amalie Nebsbjerg, Claus Vestergaard, Katrine Bjørnshave Bomholt, Morten Bondo Christensen, Linda Huibers","doi":"10.3399/BJGPO.2024.0269","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0269","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) can use video when performing telephone triage in out-of-hours primary care (OOH-PC) in Denmark. Video use varies considerably among GPs; this variation could be related to GP characteristics.</p><p><strong>Aim: </strong>To investigate associations between GP characteristics and video use in OOH-PC telephone triage.</p><p><strong>Design & setting: </strong>A register-based study using data from the OOH-PC registration system from 1 January 2021 to 31 December 2021.</p><p><strong>Method: </strong>Binomial regression analysis was used to measure the associations between video contacts and triage GP characteristics, thereby calculating RRs and 95% confidence intervals (95%CI).</p><p><strong>Results: </strong>Video was used in 10.8% of telephone triage contacts to OOH-PC. Video use was significantly associated with GPs having more shifts in OOH-PC (range RR: 1.36-1.93, ref.: low number of shifts) and GPs being younger (range RR: 0.84-0.67, ref.: age<40). Central Denmark Region and Region of Southern Denmark had significant higher video user rates (range RR: 1.23-1.46) than North Denmark Region, whereas Region Zealand had significant lower rates (RR=0.57, 95% CI: 0.38-0.87). The association between video use and GP sex was modified by number of shifts in OOH-PC. Video use was positively correlated with male sex among GPs with low, medium, and high number of shifts (RR=1.18, 95% CI: 1.07-1.29) and negatively correlated with male sex among GPs with very high number of shifts (RR=0.75, 95% CI: 0.58-0.98).</p><p><strong>Conclusion: </strong>Video use was associated with the number of shifts in OOH-PC, GP sex and age, and geographical region.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276152","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":"\"We're all in the same boat… some of us just have more holes in their boat\": a qualitative interview study primary care staff views of Deep End Cymru.","authors":"Louise Thompson, Kathrin Thomas, Haroon Ahmed, Fiona Wood","doi":"10.3399/BJGPO.2025.0019","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0019","url":null,"abstract":"<p><strong>Background: </strong>Socio-economic deprivation is associated with lower life expectancy and more complex health needs. General practices may mitigate some of these health impacts by providing holistic care to their patients. The Deep End Network was established in 2009 in Scotland to support practices working in the most socio-economically deprived communities, and the concept has since spread, with Deep End Wales (Cymru) launching in 2022.</p><p><strong>Aim: </strong>To explore experiences of staff working within Deep End practices in Wales and understand their motivations for choosing to work in challenging practices along with their needs from a Deep End network.</p><p><strong>Design & setting: </strong>Qualitative study with staff from Deep End eligible practices.</p><p><strong>Method: </strong>Seventeen semi-structured interviews were undertaken. Data were analysed using thematic analysis and interpreted with reference to self-determination theory.</p><p><strong>Results: </strong>Four main themes were identified: 1. Treading Water (experiences of providing care), 2. Diving into the Deep End (motivations for working in Deep End practices), 3. Providing a Life Jacket (support from the Deep End community), 4. Swimming to Shore (the search for work-based effectiveness).</p><p><strong>Conclusion: </strong>Deep End staff reported high workload, with limited resources and time to manage complex health needs. Most participants found working in Deep End practices rewarding. However, there was concern about staff burnout, recruitment, and retention of staff. Deep End Cymru is providing hope, validation, and a place to share ideas. Barriers to success were funding and time. Participants want Deep End Cymru to advocate for them, support recruitment, improve services for patients, and support research.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276151","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":"The impact of COVID-19 lockdowns on primary care contact among vulnerable populations in England: a controlled interrupted time series study.","authors":"Scott R Walter, Chris Salisbury, Lauren J Scott, Frank de Vocht, John Macleod, Yoav Ben-Shlomo, Helen J Curtis, Aziz Sheikh, Srinivasa V Katikireddi, Amir Mehrkar, Sebastian Bacon, George Hickman, Ben Goldacre, Maria T Redaniel","doi":"10.3399/BJGPO.2025.0017","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0017","url":null,"abstract":"<p><strong>Background: </strong>UK COVID-19 lockdowns significantly affected primary care access and delivery. Little is known about whether lockdowns disproportionally impacted vulnerable groups, including people who misuse substances, domestic violence or abuse victims, those with intellectual disability, and children with safeguarding concerns.</p><p><strong>Aim: </strong>To evaluate the impact of UK COVID-19 lockdowns on primary care contact rates among vulnerable groups.</p><p><strong>Design & setting: </strong>Natural experimental design using all registered patients in the OpenSAFELY platform.</p><p><strong>Method: </strong>With approval from NHS England, we conducted controlled interrupted time-series analyses on 24million patients in England between September2019-September2021.</p><p><strong>Results: </strong>Pre-pandemic, primary care consultation rates were 110.1 per 1000 patients per week. Following the initiation of the first lockdown (23/03/2020), there was a large reduction of 29-61 contacts per 1000 patients per week among vulnerable and general population groups. For patients with alcohol misuse, aged ≥14 years with intellectual disability, and children with safeguarding concerns, this reduction was significantly more extreme than corresponding general populations (relative rate difference -23.8 [95% confidence interval -39.8,-7.7], -24.6 [-38.8,-10.5], and -15.4 [-26.9,-3.8], respectively). Following the final lockdown (29/03/2021), all groups had consulting rates exceeding pre-pandemic rates (with increases more marked in vulnerable populations), except those only including children.</p><p><strong>Conclusion: </strong>Analyses suggested a larger short-term impact of the first COVID-19 lockdown on primary care contact for some vulnerable groups, compared to the general population; differential impacts persisted through subsequent lockdowns and beyond for some vulnerable groups. There is a need to examine drivers of these differences to enable more equitable primary care access and provision.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276205","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":"Patient characteristics associated with clinically coded long COVID: an OpenSAFELY study using electronic health records.","authors":"Yinghui Wei, Elsie Mf Horne, Rochelle Knight, Genevieve Cezard, Alex J Walker, Louis Fisher, Rachel Denholm, Kurt Taylor, Venexia Walker, Stephanie Riley, Dylan M Williams, Robert Willans, Simon Davy, Sebastian Bacon, Ben Goldacre, Amir Mehrkar, Spiros Denaxas, Felix Greaves, Richard J Silverwood, Aziz Sheikh, Nish Chaturvedi, Angela M Wood, John Macleod, Claire Steves, Jonathan Sterne","doi":"10.3399/BJGPO.2024.0140","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0140","url":null,"abstract":"<p><strong>Background: </strong>Clinically coded long COVID cases in electronic health records are incomplete, despite reports of rising cases of long COVID.</p><p><strong>Aim: </strong>To determine patient characteristics associated with clinically coded long COVID.</p><p><strong>Design & setting: </strong>With the approval of NHS England, we conducted a cohort study using electronic health records within the OpenSAFELY-TPP platform in England, to study patient characteristics associated with clinically coded long COVID from 29 January 2020 to 31 March 2022.</p><p><strong>Method: </strong>We summarised the distribution of characteristics for people with clinically coded long COVID. We estimated age-sex adjusted hazard ratios and fully adjusted hazard ratios for coded long COVID. Patient characteristics included demographic factors, and health behavioural and clinical factors.</p><p><strong>Results: </strong>Among 17 986 419 adults, 36 886 (0.21%) were clinically coded with long COVID. Patient characteristics associated with coded long COVID included female sex, younger age (under 60 years), obesity, living in less deprived areas, ever smoking, greater consultation frequency, and history of diagnosed asthma, mental health conditions, pre-pandemic post-viral fatigue, or psoriasis. These associations were attenuated following two-doses of COVID-19 vaccines compared to before vaccination. Differences in the predictors of coded long COVID between the pre-vaccination and post-vaccination cohorts may reflect the different patient characteristics in these two cohorts rather than the vaccination status. Incidence of coded long COVID was higher in those with hospitalised COVID than with those non-hospitalised COVID-19.</p><p><strong>Conclusions: </strong>We identified variation in coded long COVID by patient characteristic. Results should be interpreted with caution as long COVID was likely under-recorded in electronic health records.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144276204","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":"Stakeholder perceptions of supporting patients' return-to-work in primary care: a qualitative study.","authors":"Rosie Harrison, Gwenllian Wynne Jones, Vaughan Parsons, Ira Madan, Carolyn Chew-Graham, John Pemberton, Gemma Mansell, Karen Walker-Bone, Nadine E Foster, Benjamin Saunders","doi":"10.3399/BJGPO.2024.0280","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0280","url":null,"abstract":"<p><strong>Background: </strong>Over 2.6 million people in the UK are absent from work due to ill-health, yet, for many, accessing work-orientated vocational support to facilitate return-to-work (RTW) is challenging. The majority of fit notes are issued in primary care, making this an ideal setting to provide vocational support.</p><p><strong>Aim: </strong>As part of the Work And Vocational advicE (WAVE) randomised controlled trial (RCT; registry number NCT04543097), we explored the delivery of vocational support by trained Vocational Support Workers (VSWs), from the perspectives of patients, VSWs, employers and general practitioners.</p><p><strong>Design & setting: </strong>In the WAVE RCT, patients from 10 UK general practices were randomised to the offer of usual care or usual care plus vocational support. This qualitative study explored stakeholder perspectives of the vocational support intervention.</p><p><strong>Method: </strong>Semi-structured interviews with participants in the intervention arm (<i>n</i>=10), employers, VSWs and GPs (<i>n</i>=5). Interviews were audio-recorded, transcribed and analysed using thematic analysis. Public and Patient Involvement was embedded throughout.</p><p><strong>Results: </strong>Taking a person-centred, individualised approach to vocational support enabled VSWs to identify and mitigate RTW obstacles and support participants' self-efficacy to proactively negotiate RTW. The perceived independence of the VSWs from employers and healthcare was considered important and facilitated more open discussions about capabilities and RTW planning.</p><p><strong>Conclusion: </strong>Findings indicate that individualised and independent vocational support offered to patients referred from primary care was perceived by all stakeholders to be valuable to patients absent from work due to illness and supported their RTW planning. These insights can inform future models of vocational support.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144235457","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}