BJGP Open最新文献

{"title":"Designing a \"Deep End\" childhood immunisation intervention: a pre-implementation qualitative study.","authors":"Amber Sacre, Adam Todd, Clare Bambra, Sarah Sowden","doi":"10.3399/BJGPO.2025.0110","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0110","url":null,"abstract":"<p><strong>Background: </strong>Childhood vaccination uptake is declining in England. Efforts are required to prevent further decline and safeguard against outbreaks of vaccine-preventable diseases (VPDs). Individuals in areas of high socioeconomic disadvantage can face greater barriers to vaccination and, subsequently, be at an increased risk of lower uptake and VPDs.</p><p><strong>Aim: </strong>To conduct a pre-implementation evaluation of a proposed childhood \"catch-up\" immunisation pilot intervention targeted at North East and North Cumbria \"Deep End\" Network (NENC DE) general practices.</p><p><strong>Design & setting: </strong>The NENC DE is a network of general practices serving populations experiencing high levels of socioeconomic disadvantage. The proposed intervention would provide extra staffing capacity (one administrator and two vaccination-trained nurses) to be used discretionally by each NENC DE practice, such as offering an in-home roving vaccination service or identifying children not vaccinated to schedule.</p><p><strong>Method: </strong>Semi-structured qualitative interviews were employed, and a purposive and snowball sampling approach was adopted. Fifteen interviews were conducted in 2023, in the initial commissioning phase of the intervention. Transcripts were analysed using the framework method.</p><p><strong>Results: </strong>The proposed intervention was received with intrigue, especially the roving service, which would reduce some practical access barriers for families. Success could be measured by an increase in childhood vaccination uptake, hopefully amongst children most vulnerable. However, concerns regarding physical space and staff safety were raised.</p><p><strong>Conclusion: </strong>We encourage the NENC DE intervention providers to ensure the service remains flexible and customisable. Further research will be required to assess its impact and effectiveness when underway.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253005","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":"Delivering a primary care review for people prescribed opioids for persistent pain: facilitators and barriers facing practice pharmacists.","authors":"Charlotte Woodcock, Nicola Cornwall, Sarah A Harrisson, Julie Ashworth, Lisa Dikomitis, Toby Helliwell, Eleanor Hodgson, Roger Knaggs, Christian Mallen, Tamar Pincus, Miriam Santer, Simon White, Clare Jinks","doi":"10.3399/BJGPO.2025.0156","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0156","url":null,"abstract":"<p><strong>Background: </strong>People living with persistent non-cancer pain often are prescribed opioids long-term, despite a lack of evidence for their long-term effectiveness and safety. This study informed the design of a new practice pharmacist-led review (PROMPPT review) for people prescribed opioids for persistent pain in UK primary care.</p><p><strong>Aim: </strong>To explore the perspectives of pharmacists working in UK general practices regarding the proposed PROMPPT review and identify barriers to and facilitators of its delivery in practice, including supporting opioid deprescribing where appropriate.</p><p><strong>Design & setting: </strong>Multi-method qualitative study in primary care.</p><p><strong>Method: </strong>Pharmacists with experience of consulting in primary care participated in semi-structured interviews (<i>n</i>=13) and two focus groups (<i>n</i>=16) to explore attitudes, beliefs and experiences of a proposed PROMPPT review for people living with persistent pain. The Theoretical Domains Framework (TDF) provided a framework for data collection and thematic analysis.</p><p><strong>Results: </strong>16 facilitators and barriers for delivery of a pharmacist-led PROMPPT review were identified across 10 domains of the TDF and mapped to components of the COM-B model of capability (knowledge, skills), motivation (social or professional role and identity, beliefs about capabilities, beliefs about consequences, intentions, goals, emotions), and opportunity (environmental context and resources, social influences).</p><p><strong>Conclusion: </strong>This study provides theoretically based evidence of factors influencing pharmacists' delivery of PROMPPT reviews in relation to pharmacist capability, motivation, and opportunity. Factors included access to evidence-based patient-facing resources, receiving professional colleagues' peer support, and having a therapeutic alliance with patients. This work informed the co-design of the intervention and pharmacist training package.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145252908","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":"Use of digital technology amongst patients with multiple long-term conditions: a qualitative systematic review.","authors":"Laura Jefferson, Ana Castro Avila, Eleonora Uphoff, Ibrahim Otour, Faraz Siddiqui, Karen Bloor","doi":"10.3399/BJGPO.2025.0043","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0043","url":null,"abstract":"<p><strong>Background: </strong>The prevalence of multiple long-term conditions (MLTCs) is increasing internationally. More common in older people and those from disadvantaged communities, MLTCs can generate substantial treatment expenditure, presenting a global challenge for healthcare systems. Digital technologies offer an opportunity to support self-management in the community, reducing pressures on patients and health care systems.</p><p><strong>Aim: </strong>To appraise and synthesise qualitative literature exploring patients' experiences of using digital technology to manage MLTCs.</p><p><strong>Design & setting: </strong>Systematic review of international literature.</p><p><strong>Method: </strong>We searched Medline, CINAHL, PsycINFO and PubMed (to October 2023), with backward/forward citation searches (January 2024) for studies exploring patients' experiences of managing MLTCs using digital technologies. We used CASP for quality assessment.</p><p><strong>Results: </strong>Fourteen reports (13 studies) were included, predominantly from North America. Studies exploring patients' experiences of internet use for health information, peer-support videoconferencing, electronic personal health records, and apps or digital systems for home telemonitoring were included. Three themes explored 1) patients' lived experience, 2) key components of digital technologies, 3) benefits of digital tools. Patient experiences with digital health technologies are influenced by their health literacy, trust in providers and existing self-management practices. Patients need simple, patient-centred and user-tested digital health tools. If successful, they may empower patients, improve access and communication with healthcare professionals. Poorly designed tools risk disengagement. Healthcare professionals need training and capacity to support collaborative use.</p><p><strong>Conclusion: </strong>Digital technologies may empower patients' self-management. Patient-centred design is key to support potential benefits, ensuring not to exacerbate patient and health professional burden and inequalities.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253028","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":"Monitoring depression with the PHQ-9 in primary care: a qualitative study.","authors":"Brian Cf Ching, Rachel Dewar-Haggart, Carl R May, Geraldine Leydon, Tony Kendrick, Emilia Trapasso, Tasneem Patel, Molly Bird, Lauren Bridewell, Lien Bui, Emma Corcoran, Jane S Hahn, Riya Tiwari, Mekeda X Logan, Christopher Dowrick, Glyn Lewis, Mark Gabbay, Adam Wa Geraghty","doi":"10.3399/BJGPO.2025.0159","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0159","url":null,"abstract":"<p><strong>Background: </strong>Primary care guidelines recommend general practitioners consider using depression symptom questionnaires as patient-reported outcome measures (PROMs) to monitor depression in adults to inform treatment and evaluate management strategies. The PROMDEP randomised controlled trial assessed the use of the Patient Health Questionnaire's (PHQ-9) effectiveness and cost-effectiveness for monitoring depression. We gathered qualitative evidence on the views and experiences of participating patients and practitioners to inform interpretation of the findings.</p><p><strong>Aim: </strong>To explore the views and experiences of patients and practitioners of using the PHQ-9 in the PROMDEP trial of monitoring depression in primary care.</p><p><strong>Design & setting: </strong>Nested qualitative study and process evaluation of the trial in primary care in England and Wales.</p><p><strong>Method: </strong>Twenty-nine patients and 15 practitioners took part in semi-structured telephone or video interviews. Interview data were analysed using thematic analysis.</p><p><strong>Results: </strong>Patients and practitioners both valued the PHQ-9 and reported limitations in its use for monitoring depression. This included its role in improving understanding of depression, impact on consultation and care, and integration within current primary care processes. In the context of the PROMDEP trial, our findings highlight potential reasons for the mixed trial findings, including how resistance in its use in practice may be due to barriers that make it hard for practitioners to integrate the PHQ-9 in consultations.</p><p><strong>Conclusion: </strong>Monitoring of depression using PROMs need to be considered within the context of current primary care processes and resources. Further research is warranted to understand how the PHQ-9 can be successfully integrated into consultations.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253076","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 hidden workload study protocol: a national mixed-methods analysis of general practice workload and local demographics.","authors":"Kirsten Lee, Selma Audi, Thomas Brain, Polly Duncan, Serge Engamba, Tess Harris, Fiona Jones, Jonathan Stewart, Anas Tahir, Jessica Watson, Stephen J Woolford","doi":"10.3399/BJGPO.2025.0100","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0100","url":null,"abstract":"<p><strong>Background: </strong>General practice workload is increasing. Routinely reported NHS data describes workload in relation to numbers of appointments and clinicians delivering appointments. However, \"hidden\" aspects of general practice workload, such as administrative and supervisory tasks, are not measured.</p><p><strong>Aims: </strong>The Hidden Workload Study will examine the full range of tasks that general practice clinicians undertake daily and investigate how workload varies according to clinical role and practice demographics. Participants' lived experience of workload will also be explored through interviews.</p><p><strong>Design & setting: </strong>Utilising the Primary Care Academic CollaboraTive's membership and collaborative methodology, mixed quantitative and qualitative methods will be used. All clinicians working in English general practice, including general practitioners of all grades, resident doctors, nurses, physician associates, pharmacists and other allied healthcare professionals will be eligible, aiming for>500 participants across>75 practices.</p><p><strong>Method: </strong>Participants will collect data on a randomly allocated day in late 2024/early 2025. Using a data collection form and timers, participants will record their planned work schedule and then all tasks they complete, including all clinical, administrative, and supervisory tasks, and breaks. Practice demographic data will be collected from NHS Fingertips. For the qualitative arm, 15-20 semi-structured qualitative interviews will also be carried out. Quantitative data will be described according to clinical role and practice demographics, and interviews transcribed and reflexively analysed.</p><p><strong>Conclusion: </strong>The Hidden Workload Study will provide a comprehensive mixed methods analysis of contemporary general practice workload. Potential explanations for workload variations will be explored, informing future service provision and workforce planning.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253032","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":"https://doi.org/10.3399/BJGPO.2025.0103","url":null,"abstract":"<p><strong>Background: </strong>The workload within general practitioner (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).</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, over half of all consultations in deprived areas had 'high' (25%) or 'very high' (29%) workload, compared with around a 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 AI analysis of consultations, should be explored, and if robust, could be used to inform the resource allocation to general to help address the inverse care law.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-08","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":"The accuracy and suitability of eating disorder screening tools for binge eating disorder and bulimia nervosa in a primary care setting: a systematic review and narrative summary.","authors":"Stella Kozmér, Ruichen Yin, Joseph Evans, Alex Burns, Jane Smith","doi":"10.3399/BJGPO.2025.0149","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0149","url":null,"abstract":"<p><strong>Background: </strong>Despite available screening tools for eating disorders (EDs), the accuracy and suitability of these in identifying Binge eating disorder (BED) and Bulimia nervosa (BN) in a primary care setting are undetermined, despite BED/BN being the most common EDs.</p><p><strong>Aim: </strong>To evaluate the accuracy and suitability of ED screening tools for BED/BN in a primary care setting.</p><p><strong>Design & setting: </strong>A systematic review with narrative synthesis in a primary care setting.</p><p><strong>Method: </strong>Six databases were searched, including MEDLINE, PsycINFO, and Embase. Two independent reviewers screened studies for inclusion. Studies were included that assessed the accuracy and/or suitability of screening tools for BED/BN in primary care. Quality was assessed using the Mixed Methods Appraisal Tool. A narrative summary was created after integrating the data using a convergent segregated approach.</p><p><strong>Results: </strong>Four studies met inclusion criteria. The included studies reported on BEDS-7, EDE-Q and SCOFF screening tools. No studies reported on the accuracy of screening tools for BED and suitability for BN. BEDS-7 and EDE-Q screening tools reported variations in their suitability in primary care. The main barrier to implementation in primary care was time constraints and a lack of trust in screening. SCOFF showed high sensitivity (97.88-100%) for BN but had lower specificity (89.6-94.4%), increasing false positives.</p><p><strong>Conclusion: </strong>ED screening tools face feasibility and accuracy concerns for BED/BN in a primary care setting. Further research is needed to validate screening tools' accuracy and suitability in a primary care setting for BED and BN in the general population.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145253020","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":"Reducing pressurised metered-dose inhaler prescriptions for asthma to reduce carbon emissions: a qualitative study of healthcare professional perspectives.","authors":"Lauren Franklin, Christian Mallen, Helen Twohig","doi":"10.3399/BJGPO.2024.0208","DOIUrl":"10.3399/BJGPO.2024.0208","url":null,"abstract":"<p><strong>Background: </strong>Prescribing of pressurised metered-dose inhalers (pMDIs) is a key NHS carbon hotspot and reducing the number of these devices prescribed will help achieve NHS net zero targets.</p><p><strong>Aim: </strong>To explore primary healthcare professionals' perspectives on reducing the prescribing of pMDIs for people with asthma to reduce associated carbon emissions.</p><p><strong>Design & setting: </strong>Qualitative study of healthcare professionals (GPs, practice nurses [PNs], and clinical pharmacists [CPs]) working in general practice in England.</p><p><strong>Method: </strong>Eighteen semi-structured interviews were conducted with healthcare professionals. Participants were recruited through professional networks and using snowball sampling. Topic guides were developed to explore participant perspectives, concerns, and motivations.</p><p><strong>Results: </strong>Eight GPs, six PNs, and four CPs were interviewed. Results are presented over two topics. The first explores factors influencing inhaler device choice and discusses the following themes: patient-centred care; bias and assumptions; clinician confidence and knowledge; and status quo of asthma care. The second topic identifies facilitators and barriers for prescribing fewer pMDIs through the following themes: understanding; attitudes to change; confidence in dry powder inhalers (DPIs); attitudes to change; engagement with sustainable prescribing; and system drivers.</p><p><strong>Conclusion: </strong>Interlinking personal, consultation, and external factors influence which inhaler device is prescribed for patients with asthma. There are considerable actionable barriers to implementing carbon-conscious prescribing, many of which would improve the quality of asthma care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774545","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":"Complex mental health difficulties in primary care: a scoping review with thematic synthesis.","authors":"Kritica Dwivedi, Vyv Huddy, Phillip Oliver, Chris Burton","doi":"10.3399/BJGPO.2024.0223","DOIUrl":"10.3399/BJGPO.2024.0223","url":null,"abstract":"<p><strong>Background: </strong>Complex mental health difficulties (CMHD) is an umbrella term for long-term problems with emotions and relationships, including personality disorders (PD), persistent depression, and consequences of trauma. People with CMHD often fall between NHS services that focus on either common mental disorders (anxiety, depression) or psychosis, leaving GPs as their main source of support.</p><p><strong>Aim: </strong>To understand what is known about primary care for CMHD, from both GP and patient perspectives.</p><p><strong>Design & setting: </strong>We conducted a scoping review of GP and patient experiences of CMHD in primary care in UK, Europe, Australasia, and North America.</p><p><strong>Method: </strong>We searched MEDLINE, PsycInfo, and Embase for eligible studies between January 2002 and October 2023. Titles and full texts were screened by two reviewers. Thematic synthesis of qualitative studies and narrative synthesis of quantitative studies were undertaken.</p><p><strong>Results: </strong>We screened 2209 papers and 33 met inclusion criteria. The following three key themes were found: the challenge of recognising CMHD; the work of caring for people with CMHD; and patient priorities. GPs recognised CMHD through complexity of diagnoses, of psychosocial issues, and of healthcare use. However, they were ambivalent about diagnosis and lacked the resources to make or discuss diagnoses. Working with people with CMHD involved responsibility work, relationship work, and emotional work, under pressured conditions. Patient priorities included addressing stigma, reducing fragmentation, and receiving relationship-focused care.</p><p><strong>Conclusion: </strong>This scoping review delineates the very real challenges people with CMHD and their GPs face in providing care. It helps set an agenda for work to address gaps in provision and improve outcomes.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144052077","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":"Prescribing memantine in general practice in England: a mixed-methods study.","authors":"Mary Carter, Joanne Butterworth, Chris Fox, Louise Allan","doi":"10.3399/BJGPO.2025.0023","DOIUrl":"10.3399/BJGPO.2025.0023","url":null,"abstract":"<p><strong>Background: </strong>Acetylcholinesterase inhibitors (AChEIs) are routinely prescribed for mild-to-moderate Alzheimer's disease (AD). National guidance advises GPs to initiate memantine for patients already taking an AChEI, as it offers small benefits for moderate-to-severe AD, with good tolerability. But this is not routinely done, potentially depriving patients of a beneficial treatment.</p><p><strong>Aim: </strong>To assess prescribing for AD in general practice, to explore factors influencing prescribing, and to identify additional education needs.</p><p><strong>Design & setting: </strong>Mixed-methods study involving GPs in England.</p><p><strong>Method: </strong>An online survey and semi-structured interviews were conducted. Survey responses were analysed in StataNow (version 18.5). Interview transcriptions were coded in NVivo (version 14) by two researchers, who agreed themes. Quantitative and qualitative analyses were integrated and mapped to the Theoretical Domains Framework (TDF) and behaviour change wheel (BCW).</p><p><strong>Results: </strong>Survey responders (<i>n</i> = 104) mostly continued rather than initiated memantine. Less than half were confident in identifying AD stages and developing care plans for moderate-to-severe AD. Overall, 46% of responders were unaware of current national guidance concerning memantine. Interviews (<i>n</i> = 23) mostly concurred with survey findings. Direction from local formularies conflicts with current national guidance. Mapping to TDF and BCW identified barriers to, facilitators, and interventions for changing practice.</p><p><strong>Conclusion: </strong>Limited time, patchy support, and Quality and Outcomes Framework downgrading contribute to a perception that dementia is not prioritised in general practice. Local systems for diagnosis and treatment reinforce GPs' feelings of inadequacy. GPs assess the impact of AD on patients and families but may not map assessments to a disease stage for memantine initiation. Interventions to change practice should boost knowledge and confidence; local pathways should clearly reflect national guidance.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144102783","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}