BJGP Open最新文献

{"title":"Exploring psychotropic medication use in Dutch primary care: trends, prevalence, and associations with polypsychopharmacy.","authors":"Julia Cybulska, Mike Van Verseveld, Arnt Fa Schellekens, Hanneke Hwa Fleuren, Henk J Schers, Kees Kramers, Gerard A Kalkman","doi":"10.3399/BJGPO.2025.0202","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0202","url":null,"abstract":"<p><strong>Background: </strong>Polypsychopharmacy has been associated with increased risks of adverse drug reactions, metabolic syndrome, and higher healthcare utilization. Although its prevalence is well-documented in secondary and tertiary care, data from primary care settings remain scarce.</p><p><strong>Aim: </strong>This study investigated trends in polypsychopharmacy, associated factors, and prescribing patterns in Dutch primary care from 2012-2021.</p><p><strong>Design & setting: </strong>We conducted a cross-sectional analysis of a primary care database containing medical records from approximately 500 000 adult patients across 100 practices.</p><p><strong>Method: </strong>Polypsychopharmacy was defined as concomitant use of two different psychotropic medication classes for≥90 days (chronic). Point prevalence was measured on July 1st of each year from 2012 to 2021. We performed a multivariate analyses (using 2021 data) to identify factors associated with polypsychopharmacy, including demographic characteristics, mental and physical comorbidities, analgesic use, and healthcare utilization.</p><p><strong>Results: </strong>The prevalence of polypsychopharmacy increased from 7.6 (95% CI: 7.3-8.0) to 12.6 (95% CI: 12.3-13.1) per 1,000 patients between 2012-2021 (annual increase: 0.49 per 1,000; 95% CI: 0.40-0.57). The most common combinations were antidepressant-antipsychotic (473 per 100,000), antidepressant-anxiolytic (387 per 100,000), and antidepressant-hypnotics/sedatives (251 per 100,000). Factors associated with polypsychopharmacy included older age, female sex, multiple psychiatric diagnoses, use of analgesics, and high healthcare utilization.</p><p><strong>Conclusion: </strong>Polypsychopharmacy in Dutch primary care increased considerably over the past decade, increasing demands on general practice. Although certain regimens may be clinically justified, the upward trend underscores the need for further research into prescribing appropriateness, strategies to optimize psychotropic use, and the role of non-pharmacological treatments in primary care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147857313","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":"Building stronger primary care with AI: from innovation to implementation.","authors":"Heidi Smith, Lucy Smith, Yousef Yousef, Hajira Dambha-Miller","doi":"10.3399/BJGPO.2025.0285","DOIUrl":"10.3399/BJGPO.2025.0285","url":null,"abstract":"","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147610192","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":"GPs' perceptions of unintelligible text or codes in discharge summaries as potential threats to patient safety: a nationwide survey.","authors":"Thorbjørn Hougaard Mikkelsen, Jesper Bo Nielsen, Maria Munch Storsveen, Jens Søndergaard","doi":"10.3399/BJGPO.2025.0079","DOIUrl":"10.3399/BJGPO.2025.0079","url":null,"abstract":"<p><strong>Background: </strong>Follow-up by the GP after the patient's discharge from hospital is important for patient safety and reduces the risk of readmission to hospital. Hence, it is important that discharge summaries provide effective discharge communication to general practice.</p><p><strong>Aim: </strong>To investigate whether GPs perceive incomprehensible text elements in discharge summaries as a potential threat to patient safety.</p><p><strong>Design & setting: </strong>Nationwide survey among a representative sample of Danish GPs.</p><p><strong>Method: </strong>A questionnaire was prepared for GPs based on background material, focus group interviews, and discussions with relevant professionals. It was subsequently pilot tested by fellow researchers and GPs and revised before the presently reported survey.</p><p><strong>Results: </strong>Of the 310 participating GPs, 201 (64.8%) 'totally agree' or 'partially agree' that discharge summaries contain incomprehensible text or codes, causing them concern about missing important information in discharge summaries. In total, 238 (76.8%) participants 'totally agree' or 'partially agree' that incomprehensible text or codes in discharge summaries are a threat to patient safety.</p><p><strong>Conclusion: </strong>The survey reveals that most GPs find discharge summaries contain incomprehensible text or codes, which raises concerns about missing critical information that may pose a threat to patient safety.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313951","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":"Professionals' views and experiences of the TrainDEEP (TRaining Assistance INitiative in DEep End Practices) pilot: transforming GP practices into training practices in disadvantaged areas in the North East of England.","authors":"Alisha Gupta, Mihirini Sirisena, Gillian Vance, Matthew Armstrong, Sarah Sowden","doi":"10.3399/BJGPO.2025.0090","DOIUrl":"10.3399/BJGPO.2025.0090","url":null,"abstract":"<p><strong>Background: </strong>The North East and North Cumbria Deep End (NENC DE) Network comprises GPs and primary care staff serving the most socioeconomically disadvantaged communities. GPs often work in practices where they have trained, yet there are fewer training practices (TPs) in the Deep End (DE), limiting recruitment opportunities. TRaining Assistance INitiative in DEep End Practices (TrainDEEP) aims to increase TP numbers, to enhance GP recruitment, and to improve healthcare access for communities with the greatest need.</p><p><strong>Aim: </strong>This study aimed to explore the views and experiences of professionals involved in the TrainDEEP intervention designed to transform DE practices into TPs to enhance GP recruitment and retention in socioeconomically disadvantaged areas.</p><p><strong>Design & setting: </strong>A qualitative longitudinal study involving professionals working in two DE practices in the North East of England, who were part of the TrainDEEP intervention.</p><p><strong>Method: </strong>Semi-structured interviews were conducted at two points during the 12-month intervention. Transcripts were coded inductively and thematically analysed.</p><p><strong>Results: </strong>A total of 17 interviews with 10 participants were conducted (September 2023 to February 2025). The following three main themes emerged: (1) becoming a TP, including resource provision and barriers; (2) training in a DE context, focusing on learning opportunities, and recruitment and retention challenges and solutions; and (3) impact on the practice, evaluating TrainDEEP's success and future sustainability..</p><p><strong>Conclusion: </strong>The TrainDEEP model was successfully implemented, receiving positive feedback. This model could be expanded across the local and national DE networks to increase TPs, boosting recruitment and enhancing healthcare provision for underserved communities.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145313993","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 work of the consultation in general practice: a comparison of affluent and deprived areas of Scotland using a novel consultation workload index.","authors":"Kieran D Sweeney, Lauren Ng, Stewart W Mercer","doi":"10.3399/BJGPO.2025.0103","DOIUrl":"10.3399/BJGPO.2025.0103","url":null,"abstract":"<p><strong>Background: </strong>The workload within GP consultations, and how this varies by deprivation, is not well known.</p><p><strong>Aim: </strong>To examine how deprivation influences GP consultation workload by developing and applying a novel consultation workload index (CWI).</p><p><strong>Design & setting: </strong>Secondary analysis of a cross-sectional postal survey of patients who had recently consulted a GP in deprived and affluent areas of Scotland.</p><p><strong>Method: </strong>The CWI was developed using patient-reported data on: (1) whether more than one problem was discussed in the consultation; (2) whether a complex problem (defined as involving both physical and psychosocial issues) was discussed; and (3) the presence of a disability or limiting long-term condition. Results were analysed by area-level deprivation and consultation modality (face-to-face versus telephone consultations).</p><p><strong>Results: </strong>Analysis included 721 patients. Correlations between the three variables of the CWI were low (rho<0.2), suggesting that each was capturing a distinct aspect of consultation workload. Using the CWI, more than half of all consultations in deprived areas had 'high' (29%) or 'very high' (25%) workload, compared with approximately one-quarter in affluent areas ('high' 20%, 'very high' 6%). This was evident across both face-to-face and telephone consultations.</p><p><strong>Conclusion: </strong>Greater patient need and complexity in deprived areas is reflected in higher GP workload in the consultation as measured by the CWI. Ways of operationalising the CWI routinely - for example, through real-time artificial intelligence (AI) analysis of consultations - should be explored. If robust, these could be used to inform the resource allocation to general practice to help address the inverse care law.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253048","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":"Planetary health in general practice: a cross-sectional survey in France.","authors":"Charlotte Goolaerts, Eloïse Retailleau, Ludovic Casanova, Gaetan Gentile, Pascal Auquier, Maeva Jego, Thomas Fierling","doi":"10.3399/BJGPO.2025.0153","DOIUrl":"10.3399/BJGPO.2025.0153","url":null,"abstract":"<p><strong>Background: </strong>In 2019, a global appeal was launched by the World Organization of Family Doctors that invited GPs to take action for planetary health. In 2023, 4 years after this call, what have French GPs done to promote planetary health?</p><p><strong>Aim: </strong>To describe GPs' opinions about this subject and pro-planetary health actions in general practice and to evaluate their knowledge of planetary health.</p><p><strong>Design & setting: </strong>An online survey of GPs, locums, and medical interns in France.</p><p><strong>Method: </strong>The survey was sent by email to French general practice networks. The responses were statistically analysed, and the demographic data were analysed via descriptive statistics.</p><p><strong>Results: </strong>The 974 participants who responded placed significant importance on ecology in their personal lives (mean = 7.81/10) and were relatively aware of the environmental impact of health care. In their professional lives, they placed less importance on ecology (mean = 5.80/10). Only 23.10% (<i>n</i> = 225) reported being trained on planetary health during their medical education. During consultations regarding both health and environmental benefits, the most frequently given advice involved direct benefits to patients' health. A lack of time (<i>n</i> = 676, 69.40%) was the first barrier to integrating planetary health into practice, and the second barrier was a lack of knowledge (<i>n</i> = 606, 62.22%).</p><p><strong>Conclusion: </strong>GPs are sensitive to environmental issues, but they are more detached from these issues in their professional lives. It is crucial to strengthen prevention efforts and integrate environmental considerations into training programmes and health policies to create the conditions necessary for this change in practice.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145472262","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":"Between-practice variation in chronic obstructive pulmonary disease diagnosis guideline compliance: an observational study.","authors":"Alex Bottle, Alex Adamson, Benedict Hayhoe, Jennifer K Quint","doi":"10.3399/BJGPO.2024.0263","DOIUrl":"10.3399/BJGPO.2024.0263","url":null,"abstract":"<p><strong>Background: </strong>Early chronic obstructive pulmonary disease (COPD) diagnosis is vital, but little is known about compliance with relevant diagnostic guidelines or variation in primary care.</p><p><strong>Aim: </strong>To quantify between-practice variations in guideline compliance and over time.</p><p><strong>Design & setting: </strong>An observational study in English primary care.</p><p><strong>Method: </strong>The Clinical Practice Research Datalink was used to assess the use of four pre-diagnostic investigations (spirometry, chest X-ray, full blood count [FBC], and body mass index [BMI]) by GP practices for patients with COPD recorded first in primary care, in three time periods: 2006-2007 (cohort 1), 2016-2017 (cohort 2), and March-August 2020 (cohort 3). Multilevel logistic regression models quantified the non-random variation between GP practices in spirometry around diagnosis. Funnel plots counted the proportion of outliers.</p><p><strong>Results: </strong>Cohort totals were 31 676 (cohort 1), 37 393 (cohort 2), and 3368 (cohort 3). Overall, the mean age was 68.3 years (standard deviation 12.0), with 46.1% female. The use of pre-diagnosis spirometry improved a little in cohort 2 (74.2%) on cohort 1 (62.8%) but fell back for the COVID-19-era group (61.1%). In contrast, chest X-ray, FBC, and BMI all improved after cohort 1 and were maintained for the COVID-19 cohort; almost all patients received one of these investigations. The proportion receiving all four investigations before diagnosis jumped from 26.6% in cohort 1 to 46.7% in cohort 2 and was maintained in cohort 3 (43.0%). Modelling and funnel plots showed considerable non-random variation in spirometry use by practice, although with some improvement since cohort 1.</p><p><strong>Conclusion: </strong>The recording of spirometry and chest X-rays warrants further and consistent improvement in the context of COPD care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972583","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 role of reflexivity in exploring exclusion in GP training: a qualitative study of GP educators.","authors":"Frances Wedgwood, Simon Bailey, Nagina Khan","doi":"10.3399/BJGPO.2025.0036","DOIUrl":"10.3399/BJGPO.2025.0036","url":null,"abstract":"<p><strong>Background: </strong>Reflexivity is an under-researched concept in primary care education and educators receive no formal training in reflexivity. Evidence from other disciplines suggests that reflexivity can promote patient safety and inclusivity, making it a potentially valuable tool in medical training.</p><p><strong>Aim: </strong>To examine the use of reflexivity in GP training and how it can be used to explore experiences of exclusion.</p><p><strong>Design & setting: </strong>A qualitative analysis of GP educators' perspectives in London and South East England.</p><p><strong>Method: </strong>Fourteen primary care educators were recruited. Focus groups and semi-structured interviews were conducted. Participants' opinions of reflexivity were explored, focusing on their own reflexivity, and that of their learners and the medical faculty. Data were transcribed verbatim and thematically analysed.</p><p><strong>Results: </strong>The following three key themes were identified: the value of reflexivity; revealing unfairness through reflexivity; and tokenistic reflection versus creative reflexivity.</p><p><strong>Conclusion: </strong>This study indicates GP educators are not familiar with the concept of reflexivity but are keen to consider how it could impact their learners. Moreover, the research demonstrated how issues of diversity, inclusion, and exclusion are brought to light through reflexive practice, and how this affects international medical graduate (IMG) learners. The participants identified a lack of organisational reflexivity as an important factor affecting inclusion and differential attainment, and it was suggested there was an 'inverse education law'. The educators called for more diverse leadership, less tokenistic reflection, and more reflexive and creative learning tools to address the findings of this study.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972567","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":"Enhancing understanding of interventions to increase relational continuity in general practice: a realist review protocol.","authors":"Serge Engamba, Jane Smith, Nada Khan, Kate Sidaway-Lee, Patrick Burch, Tom Marshall, Phil Evans, Denis Pereira Gray, Rob Anderson","doi":"10.3399/BJGPO.2025.0119","DOIUrl":"10.3399/BJGPO.2025.0119","url":null,"abstract":"<p><strong>Background: </strong>Relational continuity of care (RCC), which is characterised by an ongoing therapeutic relationship between patients and their primary care providers, is critical for ensuring high-quality care in general practice. Despite its importance, challenges, such as staffing shortages, policy shifts, and evolving patient needs, often impede its consistent delivery. With the new GP contract in England highlighting the need for primary care providers to monitor and deliver relational continuity, it is more crucial than ever to understand how best to achieve it.</p><p><strong>Aim: </strong>To explore how, why, and under what conditions interventions to improve relational continuity are successfully implemented in general practice.</p><p><strong>Design & setting: </strong>The realist review will be supported by an expert stakeholder panel and a patient advisory group to consider the diverse and dynamic settings of general practice, and generate contexts, mechanisms, and outcomes configurations exploring how interventions to enhance RCC in general practice work.</p><p><strong>Method: </strong>Through the synthesis of diverse international evidence sources, including qualitative, quantitative, and mixed-methods studies, as well as grey literature, the review will develop an understanding of the mechanisms that produce relational continuity, the contexts in which these mechanisms operate, and the outcomes they produce for the health system, practices, practitioners, and patients.</p><p><strong>Conclusion: </strong>The findings will provide data to inform future research and refine strategies and policies that support the effective delivery of relational continuity, which in turn may lead to improved patient outcomes and enhanced care experiences.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144765621","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":"Challenges in reducing the 10-item CARE Measure to a two-item version: comparison of patients' preferences with psychometric evaluation in a cross-sectional survey in Scotland.","authors":"Lauren Ng, Kieran D Sweeney, Stewart W Mercer","doi":"10.3399/BJGPO.2025.0085","DOIUrl":"10.3399/BJGPO.2025.0085","url":null,"abstract":"<p><strong>Background: </strong>The Consultation and Relational Empathy (CARE) Measure is a widely used 10-item measure to assess patients' perceptions of physician empathy. Takahashi <i>et al</i>'s (2022) recent study proposed a two-item version based on psychometric evaluation of survey responses, without considering patient preferences.</p><p><strong>Aim: </strong>To apply Takahashi <i>et al</i>'s psychometric method to UK data, and compare findings with patients' preferences on the two most important items.</p><p><strong>Design & setting: </strong>In 2022, a cross-sectional postal survey of 6291 Scottish adults was conducted.</p><p><strong>Method: </strong>Using Takahashi <i>et al</i>'s method, psychometric evaluation compared correlations between all possible two-item combinations with the original 10-item CARE Measure to identify the optimal two-item combination. Patients were also asked to select the two items they considered most important. Descriptive analysis examined the proportion of patients selecting each item, and level of agreement on the most popular two-item combination.</p><p><strong>Results: </strong>In total, 1053 (17%) of 6291 patients responded. Psychometric evaluation identified items 6 ('Showing care and compassion') and 8 ('Explaining things clearly') as the optimal two-item combination (Cronbach's alpha = 0.916, correlation = 0.953). This differed from patient preferences, with items 3 ('Really listening') and 8 receiving the highest proportion of votes (19% and 17%, respectively). Preferences also varied by age, deprivation level, and consultation complexity. The most popular two-item combination (items 3 and 8) was selected by 10% of responders, with 90% selecting other combinations.</p><p><strong>Conclusion: </strong>The psychometrically optimal two-item combination did not align with patient preferences. Given variation in patient preferences and low agreement, reducing the CARE Measure to two-items may be inadvisable.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144993542","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}