BJGP Open最新文献

{"title":"Patterns and indications for quetiapine prescribing in Dutch primary care.","authors":"Busra R Cinar, Suzanne A Ligthart, Hugo Ajm de Wit, Arnt Schellekens, Hanneke Hwa Fleuren, Cornelis Kramers, Albert Batalla, Gerard A Kalkman","doi":"10.3399/BJGPO.2024.0219","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0219","url":null,"abstract":"<p><strong>Background: </strong>Quetiapine, an antipsychotic, is registered for schizophrenia, bipolar disorder, and as an add-on therapy for major depressive disorder. Its anxiolytic and sedative effects make it attractive for off-label uses like insomnia, despite cardiovascular and metabolic side effects. The global increase in quetiapine use over the past decade warrants an examination of its prescribing patterns, especially off-label.</p><p><strong>Aim: </strong>This study investigates quetiapine prescribing trends in Dutch primary care, with a focus on off-label use.</p><p><strong>Design & setting: </strong>A retrospective database study using national and regional prescribing data from the Netherlands.</p><p><strong>Method: </strong>National prescribing trends from 2003-2022 were analysed using data from the Drug Information Project database, focusing on the top 10 antipsychotics. Regional data from the Radboudumc Technology Centre Health Database provided detailed quetiapine prescribing patterns from 2012-2021, categorized by daily dose. Indications for quetiapine prescriptions between 2020-2022 were derived from the detailed RTC patient records, including free-text portions, with specific attention for use in sleep problems.</p><p><strong>Results: </strong>Antipsychotic use increased from 1510 to 2061 per 100 000 between 2003-2022, largely due to a 13-fold increase in quetiapine (66 to 870 per 100000). Detailed regional data revealed a 3.3-fold increase in quetiapine use from 2012-2021, particularly at doses<100 mg/day. Among new quetiapine users in 2020-2022 from a subset of practices, 76.6% were for off-label indications, and sleep problems were the primary reason for starting quetiapine in 46.9% of cases.</p><p><strong>Conclusion: </strong>Off-label quetiapine prescribing, particulary for sleep problems, is rising in the Netherlands, despite guideline warnings. Further research on the drivers and long-term effects of this practice is needed.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617203","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":"A mixed methods study of the experience of GP educational supervisors.","authors":"Derek Elliott, Annabel Shepherd, Karena Anne Hanley, Nitin Gambhir","doi":"10.3399/BJGPO.2024.0106","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0106","url":null,"abstract":"<p><strong>Background: </strong>Quality supervision in the clinical learning environment is known to improve future quality of patient care by graduates of that training. Supports required by supervisors are not well documented.</p><p><strong>Aim: </strong>To conduct a needs assessment of educational supervisors (ESs) on the GP training programme.</p><p><strong>Design & setting: </strong>This is a mixed methods study conducted among the trainer population in the West of Scotland Region.</p><p><strong>Method: </strong>The instrument development mixed methods model was used to design a questionnaire for a whole population survey. This collected quantitative and qualitative data which were analysed in a way which triangulated and expanded the data.</p><p><strong>Results: </strong>116 educational supervisors (37%) responded, and cited time pressures, trainee variation, and professional assessment demands as the biggest challenges to providing quality supervision. Less than half of respondents felt they had sufficient time for clinical supervision in the working day. Trainees with additional needs require extra support, a third of ESs do not have sufficient time for pastoral care of their trainee, and the professional assessment burden may have a detrimental effect on the apprenticeship model of GP training. Suggestions for better support are made.</p><p><strong>Conclusion: </strong>With increasing demands on time, an increased trainer workload and an increase in the number of trainees with more variable needs, the willingness of GPs to become ESs may be reaching a tipping point. This research identifies areas for targeting support, but also recommends review of some of the structures of GP training in order to retain quality GP supervision in GP training.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617185","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":"Exploring considerations for becoming a GP practice owner: a qualitative study.","authors":"Hinda Stegeman, Manna A Alma, Hanneke Pm Vervoort, Vivian van Vliet, Nynke D Scherpbier, Danielle Jansen, Marjolein Berger","doi":"10.3399/BJGPO.2024.0213","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0213","url":null,"abstract":"<p><strong>Background: </strong>General practice owners are responsible for access to care 24 hours a day, but they can struggle to find associates or successors. Fewer practice owners means that the core value, continuity of care (COC), is at risk. However, little is known about the career considerations of young GPs and barriers and facilitators to become practice owners.</p><p><strong>Aim: </strong>To explore the considerations of GPs for becoming a practice owner.</p><p><strong>Design & setting: </strong>A qualitative study of GP trainees, freelance/salaried GPs, practice owners, and ex-practice owners in the north of the Netherlands.</p><p><strong>Method: </strong>Ninety GPs were purposively recruited for focus groups and interviews, which were audio/video recorded, transcribed verbatim, and analysed thematically.</p><p><strong>Results: </strong>Becoming a practice owner results from a complex interplay between professional, personal, external, and process-related factors, often over an extended period. Participants indicated that COC, autonomy, and personal development had predominantly positive impacts on decisions about practice ownership. Factors that negatively affected considerations included work-life balance, ultimate responsibility, negative role models, unappealing practices, (un)preparedness, and issues with the process. Of note, non-practice owners felt that practice ownership could not be discussed.</p><p><strong>Conclusion: </strong>Modifications to perceived behavioural control and subjective norms are needed, together with an open dialog among GPs about practice ownership and alternative models. Our findings offer a foundation for further prospective quantitative research into efforts designed to address the shortage of practice owners in the Netherlands and other countries. This could uncover universal and country-specific themes.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617200","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 strange adolescent world that complicates general practitioner prevention: a qualitative study.","authors":"Elodie Million, Manon Herbreteau, Gérard Bourrel, Bruno Falissard, François Carbonnel, Béatrice Lognos, Agnès Oude-Engberink","doi":"10.3399/BJGPO.2024.0290","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0290","url":null,"abstract":"<p><strong>Background: </strong>Prevention is important in the international primary care system. In adolescents, several prevention areas need to be addressed: sexual health, mental health, substance use and addiction, physical activity, screen use, and social relationships... However, consultations with adolescents are complex, which puts health professionals in a difficult position. While there are professional recommendations in many countries, they focus on a single theme.</p><p><strong>Aim: </strong>To understand the preventive approaches taken by general practitioners (GPs) in consultation with adolescents.</p><p><strong>Design & setting: </strong>This preliminary qualitative study used semi-structured interviews with French GPs. Participants were recruited following direct requests and sampled using the snowball sampling method.</p><p><strong>Method: </strong>Analysis was conducted using grounded theory for the identification of conceptualizing categories.</p><p><strong>Results: </strong>Twelve interviews led to the emergence of four conceptualizing categories: 1) the characteristics of adolescents make the preventive approach complex and generate a fear of failure for GPs; 2) the world of adolescents is foreign to GPs, which hinders empathetic relationships and has a negative impact on prevention; 3) as individuals, GPs approached adolescent prevention during consultations based on their own experiences (parenthood, their own adolescence, professional practices) and interpersonal skills; and 4) GPs propose an optimized prevention approach for adolescents.</p><p><strong>Conclusion: </strong>GPs are opportunistic in terms of adolescent prevention: any occasion for consultation should be the object of a preventive action, whatever the initial motive. GPs require tools and consultations dedicated to prevention to optimize their approaches sometimes difficult. Further research about adolescents' experiences should be manage to complete GPs practical proposals.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617292","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":"LDL cholesterol levels and treatment intensity in secondary prevention of patients with ischemic 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":"https://doi.org/10.3399/BJGPO.2024.0220","url":null,"abstract":"<p><strong>Background: </strong>Monitoring LDL cholesterol (LDL-C) and prescribing appropriate treatment is crucial for secondary prevention in primary care.</p><p><strong>Aim: </strong>We studied LDL-C levels and treatments for ischemic heart disease patients according to target recommendations and assessed factors influencing prescribed drug intensity.</p><p><strong>Design & setting: </strong>We examined electronic health records of patients with ischemic heart disease from three primary care centers.</p><p><strong>Method: </strong>LDL-C levels were assessed using the most recent registry, and LDL-C-lowering treatments were categorized by their theoretical efficacy. Factors associated with LDL-C target attainment were analyzed using univariate and multivariate regression models. Prescription intensity was studied with ordinal logistic regression models.</p><p><strong>Results: </strong>We studied 1,936 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 12.6%, respectively. The factor associated with the<55 mg/dL threshold was type 2 diabetes mellitus (OR: 0.55, 95% CI: 0.42; 0.73), with men showing better LDL-C levels (OR: 0.34, 95% CI: 0.23; 0.51). Men had higher-intensity prescriptions (OR: 1.57, 95% CI: 1.27; 1.94), and older patients had lower-intensity treatments (OR: 0.96, 95% CI: 0.95; 0.97).</p><p><strong>Conclusion: </strong>Increased LDL-C drug treatment improvement, monitoring, and adherence to guideline recommendations are necessary for patients with ischemic heart disease. Sex and age are potential factors associated with inadequate lipid-lowering treatment intensity and poor LDL-C control, 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":"2025-03-12","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":"Characteristics of patients with frequent contact with general practice.","authors":"Jesper B Nielsen, Helene S Andersen","doi":"10.3399/BJGPO.2024.0195","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0195","url":null,"abstract":"<p><strong>Background: </strong>Frequent attenders (more than 11 annual contacts) use more resources than most other patients in general practice.</p><p><strong>Aim: </strong>We aim to study what characterises frequent attenders related to age, gender, mode of contact (face-to-face, email, phone), and patient contact (GP or GP staff).</p><p><strong>Design & setting: </strong>We use patient data from 11 Danish GP clinics and 38.874 patients covering a 12-month period.</p><p><strong>Method: </strong>Bivariate as well as regression analyses of patient data were used.</p><p><strong>Results: </strong>Frequent attenders exist in all age groups, but with different frequencies. In the age group 55-64 years 25% of patients were frequent attenders, this increased to 33% in the next age decade from age 65-74 years and reached 48% among those above age 74 years. Frequent attenders have a different user pattern related to physical visits, phone consultations, or email consultations than other patients. In their contact to the GP clinic, the frequent attender is relatively more often in contact with the practice staff than a GP compared to other patients.</p><p><strong>Conclusion: </strong>Within our Danish patient population,22% had more than 11 annual contacts to their GP clinic. These frequent attenders are in general terms characterized by being women, above 65 years of age, having 20 annual contacts to the GP clinic, and having plus 10 diagnoses. For the entire patient population, the GP handles 40% of the patient contacts (60% by other staff members), and this percentage is lowest among frequent attenders. E-mail contact is more frequent among frequent attenders than other patients.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617190","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 paramedics working in primary care teams on other professionals and patient experiences: a qualitative study.","authors":"Georgette Eaton, Stephanie Tierney, Geoff Wong, Veronika Williams, Julia Williams, Kamal R Mahtani","doi":"10.3399/BJGPO.2024.0152","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0152","url":null,"abstract":"<p><strong>Background: </strong>Paramedics are among the professional groups identified in recent policy initiatives aimed at addressing the unsustainable workload and workforce crises in primary care. Their support aims to enhance patient access to care and alleviate the burden of workload pressures.</p><p><strong>Aim: </strong>To explore the impact of paramedics working in primary care on primary care teams and the experiences of patients who have a clinical consultation with a paramedic in primary care.</p><p><strong>Design & setting: </strong>Focused observations and interviews involving fifteen geographically dispersed sites across the United Kingdom.</p><p><strong>Method: </strong>Data were collected between May 2022 and January 2023, incorporating 60 semi-structured interviews and 60 hours of observations of paramedics. Transcripts were thematically analysed.</p><p><strong>Results: </strong>Patients, GPs and other staff in primary care perceive that the paramedic role enhances healthcare availability in primary care by increasing workforce capacity. This is especially prevalent when paramedics work in a clinical capacity that complements the GP role. However, successful integration into the primary care team relies on paramedics having significant clinical experience and receiving clinical supervision from GPs. Patients are trusting of the paramedic role when they have positive clinical consultations.</p><p><strong>Conclusion: </strong>Paramedics have potential to improve access to the primary care workforce. However, attention to supportive transition processes (such as clinical supervision) are required for the paramedic to successfully be integrated into the primary care team.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143617288","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":"Chronic pain - prevalence, demographic inequalities and healthcare utilisation: a primary care database analysis.","authors":"Siddesh Shetty, James Scuffell, Dianne Aitken, Mark Ashworth","doi":"10.3399/BJGPO.2024.0147","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0147","url":null,"abstract":"<p><strong>Background: </strong>Chronic pain (CP) is an ill-defined condition, often under-recorded in primary care records.</p><p><strong>Aim: </strong>To determine prevalence, evidence of health inequalities, primary care consultation rates and healthcare utilisation costs of CP.</p><p><strong>Design & setting: </strong>Cross-sectional, retrospective study using anonymised primary care data from all GP practices in one inner-city London area.</p><p><strong>Method: </strong>CP was defined on the basis of analgesic medication codes and novel inclusion of diagnostic codes for conditions known to be strongly associated with CP. CP prevalence and consultation rates were determined; comparisons were made with 31 other Long-Term Condition (LTCs). Consultation cost estimates were based on health care professional type and consultation mode.</p><p><strong>Results: </strong>358 889 adult patients were registered in sample practices, with continuous (12-month) health care records available for 327 800 (91.3%). CP prevalence was 18.6%; the second most prevalent LTC after anxiety at 21.4%. CP mean annual consultation rates were 15.3/patient, the highest LTC consultation rate. CP incurred the highest primary care consultation costs of any of the included LTCs. Age was the strongest predictor of CP, particularly in those aged≥60 years (Adjusted Odds Ratio (AOR): 9.32; 95% Confidence Interval: 8.83 to 9.84; compared to 18-39-year-olds). Much smaller AORs were found for ethnicity, social deprivation, gender and non-UK country of birth.</p><p><strong>Conclusion: </strong>CP represents the most demanding LTC, in terms of consultation rates and costs, managed in primary care. Yet there is considerable uncertainty about optimal management and alternatives to long term, high volume primary care consultation rates.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524791","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":"GP referral to rapid diagnostic centres for non-specific cancer symptoms: a qualitative study.","authors":"Caroline White, Spencer Robinson, Una Macleod, Charlotte Kelly","doi":"10.3399/BJGPO.2024.0179","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0179","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing cancer can be challenging, especially when patients present to General Practitioners (GPs) with serious, but nonspecific symptoms. Rapid Diagnostic Centres (RDCs) have been introduced in England as diagnostic pathways for patients with non-specific symptoms where cancer is suspected, but they do not meet existing cancer pathway criteria.</p><p><strong>Aim: </strong>To investigate GP perspectives on referral to an RDC pathway for patients with non-specific symptoms and suspected cancer.</p><p><strong>Design & setting: </strong>Semi-structured interviews with GPs within the catchment area of an acute NHS Trust METHOD: GP interviews focusing on experiences of using the RDC pathway. A thematic analysis was conducted on interview transcripts.</p><p><strong>Results: </strong>GPs reported the RDC pathway as a game changer. It offered faster referral, reduced anxiety for GPs and patients, and reduced the need for GPs to 'game the system' when patients do not meet criteria for cancer-specific pathways. The narrative required on referral appeared to legitimise GP gut feelings and expertise. RDC results (if not cancer) gave GPs space to treat patients without concern of a missed cancer, while ensuring onward referral for those with cancer or other serious conditions. Some access barriers, especially related to travel and time, were identified especially for patients in rural areas.</p><p><strong>Conclusion: </strong>This cancer pathway fills a referral gap for GPs and patients with non-specific potential cancer symptoms. It has an important signposting function, helping identify patients requiring treatment for cancer/other serious conditions, and others whose symptoms can be treated safely within primary care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524792","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":"De-labelling erroneous penicillin allergy records in general practice: healthcare professionals' experiences.","authors":"Caity Roleston, Marta Santillo, Kelsey F Armitage, Catherine E Porter, Shadia Ahmed, Joanne Fielding, Marta Wanat, Christopher C Butler, Sue Pavitt, Jonathan At Sandoe, Sarah Tonkin-Crine","doi":"10.3399/BJGPO.2024.0119","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0119","url":null,"abstract":"<p><strong>Background: </strong>Penicillin allergy (PenA) prevalence is approximately 6%, but fewer than 10% of these people are expected to be truly allergic. Consequently, a significant proportion of the population are prescribed alternative antibiotics with potential increased risk of acquiring multi-drug resistant bacteria and worse health outcomes. The ALABAMA trial aimed to determine if a penicillin allergy assessment pathway (PAAP) initiated in primary care, is effective in de-labelling erroneous records, improving antibiotic prescribing and patient outcomes.</p><p><strong>Aim: </strong>To investigate healthcare professionals' experiences of the ALABAMA trial.</p><p><strong>Design & setting: </strong>Qualitative study using semi-structured interviews in general practice in England.</p><p><strong>Method: </strong>Semi-structured interviews were conducted with healthcare professionals (including general practitioners, research nurses, pharmacists) who delivered the trial. Interviews explored their views about de-labelling incorrect PenA records, their role(s) in the trial, and, where relevant, their experience of prescribing following de-labelling.</p><p><strong>Results: </strong>Healthcare professionals (<i>n</i>=18) believed many patients were incorrectly labelled PenA and were aware of the individual and public health risks this posed. However, GPs explained labels were rarely challenged in general practice because the perceived risks to patients and their professionalism were too great. The PAAP intervention, alongside the 'protocolisation' within the ALABAMA trial, was successful at mitigating these risks. Consequently, the trial was well-accepted and commended by healthcare professionals.</p><p><strong>Conclusions: </strong>GPs welcomed and accepted the PAAP as a means of correcting erroneous PenA records. There is great potential for PAAP to be supported in primary care if testing becomes more accessible.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469366","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}