BJGP Open最新文献

{"title":"Findings from the development of a novel course of both group and individual Alexander Technique lessons for neck, hip, and knee pain: a mixed-methods study.","authors":"Joseph Little, Adam Geraghty, Carolyn Nicholls, Paul Little","doi":"10.3399/BJGPO.2024.0295","DOIUrl":"10.3399/BJGPO.2024.0295","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal pain, often affecting multiple sites - including neck, hip, and knee - is common, with limited treatment options. Novel treatments are needed to support self-management, preferably addressing multiple pain sites.</p><p><strong>Aim: </strong>To develop and explore the acceptability of a short, mixed course of individual (one-to-one) and group lessons in the Alexander Technique (AT), which addresses dysfunctional use of the musculoskeletal system.</p><p><strong>Design & setting: </strong>A single-centre, mixed-methods study of patients with chronic or recurrent neck, hip, or knee pain from four general practices.</p><p><strong>Method: </strong>Preliminary development of a course of 10 AT lessons (six group, four individual) took place with a group of AT teachers. Semi-structured interviews of participants were undertaken, which were analysed using inductive thematic analysis. Descriptive pre-post analysis of quantitative scales were used to assess improvement (Numerical pain scale [NRS]; modified Roland-Morris Disability Questionnaire (RMDQ); enablement (modified Patient Enablement Instrument used in the ATEAM trial); and global improvement (Health Transition scale).</p><p><strong>Results: </strong>Twenty-three participants were included; 18 were interviewed. Commonly, participants found the mixture of group and individual lessons helpful, including helping multiple pain sites, and the mix of different problems enhanced learning. There was moderate improvement in standard quantitative measures over 12 weeks (NRS from 5.15 to 3.85; modified RMDQ 8.26 to 5.7) but with more substantial improvement in enablement and global improvement. Those who perceived underlying structural damage to the knee reported little benefit.</p><p><strong>Conclusion: </strong>People with chronic or recurrent neck, hip, or knee pain found a course of mixed group and individual lessons in AT helpful in managing their pain, but not those with severe knee problems. Whether standard quantitative measures provide the best measures of effectiveness requires exploration.</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":"144064837","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":"Quality indicators for lifestyle or behavioural management for the primary prevention of cardiovascular disease in primary care: a systematic review.","authors":"Kiran Bam, Beilei Lin, Muideen T Olaiya, Dominique A Cadilhac, Julie Redfern, Mark R Nelson, Lauren M Sanders, Nadine E Andrew, Vijaya Sundararajan, Lisa Murphy, Monique F Kilkenny","doi":"10.3399/BJGPO.2025.0018","DOIUrl":"10.3399/BJGPO.2025.0018","url":null,"abstract":"<p><strong>Background: </strong>Monitoring lifestyle or behavioural risk factors using quality indicators is critical for the primary prevention of cardiovascular disease (CVD).</p><p><strong>Aim: </strong>To summarise indicators for monitoring lifestyle risk factors for the primary prevention of CVD.</p><p><strong>Design & setting: </strong>A systematic review of quality indicators in primary care.</p><p><strong>Method: </strong>Four research databases (Ovid MEDLINE, Ovid Embase, CINAHL Plus, and Scopus) and grey literature were searched to identify articles (indicator sets) used to monitor lifestyle risk factors. Articles were assessed for methodological quality using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. Articles with strong methodological quality, scoring ≥50% in each domain (that is, relevance, stakeholder involvement, scientific evidence, and usage) were included. Indicators were categorised into assessment of lifestyle risk factors or advice on healthy lifestyle.</p><p><strong>Results: </strong>We identified 39/282 (14%) articles including indicators to monitor lifestyle risk factors from a full-text review. Of these, 19 (49%) articles with strong methodological quality, comprising 90 unique indicators, were included. Most of the indicators were on assessing smoking status (21%), body weight (18%), advice on smoking cessation (13%), immunisation (9%), and advice on physical activity (8%). Assessment of alcohol consumption (3%) and healthy eating (2%) were the least reported. When comparing assessment versus advice indicators, we found gaps in monitoring smoking status (41% assessment versus 27% advice) and body weight (35% versus 14%). Notably, there were more indicators for advice on (16%) than assessment of (4%) healthy eating.</p><p><strong>Conclusion: </strong>We identified several indicators for the monitoring of lifestyle risk factors. However, there is a need to ensure an appropriate mix of indicators on assessment versus advice.</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":"144022753","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":"Composition of general practices in western countries and associations with their perceived ability to manage patients with chronic conditions.","authors":"Adeline Cachou de Camaret, Pascal Wild, Nicolas Senn, Christine Cohidon","doi":"10.3399/BJGPO.2024.0200","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0200","url":null,"abstract":"<p><strong>Background: </strong>Primary care teams (PCTs) are recognized to improve the quality of care. However, few studies have examined which PCT composition best meets patients' primary care (PC) needs.</p><p><strong>Aim: </strong>The present study aimed to describe the composition of PCTs in eleven Western countries and investigate potential associations with general practitioners' (GPs) opinions about their practice's ability to manage patients with chronic conditions and communicate with caregivers.</p><p><strong>Design & setting: </strong>We conducted a secondary analysis of the data from 11 Western countries that participated in the 2019 Commonwealth Fund International Health Policy Survey of Primary Care Physicians (<i>N</i>=13,200).</p><p><strong>Method: </strong>We used a hierarchical clustering algorithm to characterise different types of PCT according to the composition of the health care professionals (HCPs) making them up, in addition to GPs. We subsequently assessed associations between practice types and two GP-reported indicators: their practice's coordination with social services (SS) and other community providers (CPs) and ability to manage patients with chronic conditions.</p><p><strong>Results: </strong>We characterised five types of PCT (Traditional, Multidisciplinary, Nurse-centred, Psychologist-centred and Physiotherapist-centred). The <i>Traditional</i> type represented 51.6% of all PCTs; they were mainly composed of moderate percentages of all the HCPs: The <i>Multidisciplinary</i> (11.9%) were composed of high percentages of the different HCPs. After controlling for country, the <i>Multidisciplinariy</i> type reported better coordination with SS and CPs than did <i>Traditional</i> ones (OR 0.39, 95%CI [0.29-0.53]).</p><p><strong>Conclusion: </strong><i>Multidisciplinary</i> PCTs reported better outcomes than <i>Traditional</i> ones regarding their coordination with SS and CPs and perceived ability to manage patients with chronic conditions. These results should encourage governmental efforts to promote PC that uses multidisciplinary PCTs.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145226072","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":"Cost-effectiveness and equity impact of complex primary care interventions for disadvantaged populations.","authors":"Chloe Thomas, Ben Jackson, Caroline Mitchell, Josephine Reynolds, Daniel Hind","doi":"10.3399/BJGPO.2025.0167","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0167","url":null,"abstract":"<p><strong>Background: </strong>Reducing health inequity is essential. The FAIRSTEPS study developed and prioritised 28 vignettes describing complex primary care interventions targeted to disadvantaged groups, through Delphi consensus ranking by primary care practitioners for feasibility and perceived usefulness.</p><p><strong>Aim: </strong>To build on FAIRSTEPS by quantifying potential impacts of prioritised vignettes on cost-effectiveness and health equity.</p><p><strong>Design & setting: </strong>Simplified distributional cost-effectiveness analysis (DCEA) in England.</p><p><strong>Method: </strong>Pragmatic literature searches were carried out around each vignette, to identify 1) available economic evidence and 2) information about size and distribution of populations targeted. Economic evidence was quality assessed using adapted National Institute of Health and Care Excellence appraisal checklists. Extracted cost and quality-adjusted life-year data and population data, were combined with published distributions of health opportunity costs and baseline lifetime health, to estimate net health benefits and equity measures for each vignette.</p><p><strong>Results: </strong>Suitable cost-effectiveness evidence was identified for 17 of 28 vignettes, with variable study quality and applicability. 14 vignettes were both cost-effective and equity-generating, with the most beneficial on both dimensions relating to community champions for health promotion; integrated care for rough sleepers, sex workers and drug users; and weight-loss programmes targeted at low-income people.</p><p><strong>Conclusions: </strong>Simplified DCEA using published data can be used to provide additional evidence to help prioritise complex primary care interventions aimed at disadvantaged populations, although is hindered by low quality economic data and limited study comparability. Further research estimating baseline health and health opportunity cost distributions across disadvantaged groups would improve accuracy of health equity assessments.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207833","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":"Strengthening integration of pathways into general practice in Australia: a virtual workshop study with stakeholders.","authors":"Faith Yong, Priya Martin, Sneha Kirubakaran, Katharine Ann Wallis, Riitta Partanen, Jordan Fox, Srinivas Kondalsamy Chennakesavan, Matthew McGrail","doi":"10.3399/BJGPO.2025.0074","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0074","url":null,"abstract":"<p><strong>Background: </strong>There remains an urgent need for more medical graduates choosing general practice to address expanding general practitioner (GP) workforce shortages. Priority interventions remain unclear but strengthened integration of medical training pathways into general practice may help.</p><p><strong>Aim: </strong>To explore stakeholder views on ways to strengthen integration of pathways into general practice across the medical education and training pipeline.</p><p><strong>Design & setting: </strong>Participatory research virtual workshop. Participants were purposively sampled to include representation across the Australian medical education and GP training sector.</p><p><strong>Method: </strong>Using a nominal group technique, participants were prompted to generate suggestions in activities that build upon known factors, and to discuss proposed new and modified solutions to the GP shortage. Content analysis and synthesis supported iterative review of the categorisation framework until team consensus was reached.</p><p><strong>Results: </strong>17 participants (four workshops) made 145 suggestions, which were refined to 67 proposed interventions. There were three overarching categories: 1) improved equity in pay and status for GP trainees and specialists; 2) increased systemic exposure to general practice and generalism; and 3) clearer pathway options to general practice and generalism.</p><p><strong>Conclusion: </strong>General practice pathways could be strengthened by increased exposure to general practice working conditions and generalism philosophies, along with clearer transitions between different training stages. However, increased equity of resources and the status of general practice within medical specialties were also very important macro factors, beyond education and training alone. Thus, GP pathway interventions require reconfiguration supporting integration into the medical training system to actively value GP healthcare contributions.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207999","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":"Ethnicity and clinical empathy in primary care consultations: a web-based experiment.","authors":"Qingyan He, Rui Du, Saniya Belgi, Greg J Neil, Hazel Everitt, Felicity L Bishop","doi":"10.3399/BJGPO.2025.0084","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0084","url":null,"abstract":"<p><strong>Background: </strong>Clinical empathy may enhance patient satisfaction and health outcomes. The interaction between ethnicity and clinical empathy is under-explored.</p><p><strong>Aim: </strong>To compare how people from different ethnicities perceive GPs' communication of clinical empathy.</p><p><strong>Design & setting: </strong>A 2 (consultation style) x4 (participant ethnicity) web-based experiment using film vignettes.</p><p><strong>Method: </strong>274 UK Black British, White Caucasian, East Asian, and South Asian adults (50% female; Mean age 39.7), recruited from an online participant pool were randomly assigned to watch one of two films showing enacted GP consultations for osteoarthritis - enhanced consultation (high empathy) or standard consultation (limited empathy). Participants' perceptions of clinical empathy were assessed quantitatively and qualitatively.</p><p><strong>Results: </strong>Across the whole sample and within all four ethnicities, enhanced consultations were rated as more empathic than standard consultations; there were no significant effects of participant ethnicity on ratings of empathy. Bayesian analysis confirmed an effect of consultation style and indicated there were no differences between ethnicities in ratings of clinical empathy. Qualitative comments talked about the doctor: (not) showing interest in the patient; responding with(out) respect; conveying warmth, empathy, and hope; and (not) clearly explaining management options or clinical decisions. Participants of all four ethnicities commented on similar aspects of the enhanced and standard consultations.</p><p><strong>Conclusions: </strong>In this well-controlled experiment, the empathic communication skills modelled in the enhanced consultation were interpreted similarly positively by UK adults of Black British, Caucasian, East Asian, and South Asian ethnicities. Core elements of clinical empathy appear relevant and similarly valued across these ethnic groups.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207953","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":"English general practice in a period of change: A mixed methods study of staff and patient perspectives.","authors":"Heather Gage, Alice Herron, Bridget Jones, Simon Bailey, Amanda Bates, Rebecca Cassidy, Catherine Marchand, Emily McKean, Karen Spilsbury, Suzanne H Richards, John Campbell, Rupa Chilvers, Peter Williams, Phelim Brady, Mark Joy, Simon de Lusignan, Stephen Peckham","doi":"10.3399/BJGPO.2025.0069","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0069","url":null,"abstract":"<p><strong>Background: </strong>The covid-19 pandemic prompted widespread use of remote (telephone and online) communication in general practice in England which exacerbated long-term pressures from staffing shortages. The public perceived problems with access.</p><p><strong>Aim: </strong>To explore patient and staff perspectives on changing processes in general practice.</p><p><strong>Design & setting: </strong>Mixed methods (patient survey, staff focus groups) in a sample of 22 general practices in England, varied by size, region, deprivation, demography, 2022.</p><p><strong>Method: </strong>An online survey was delivered by sms text to adult patients at 21 practices. Data from answers to an open question about patients' experiences were analysed using summative content and thematic analysis. Virtual focus groups conducted with four categories of staff (general practitioners, nurses, receptionists & administrators, practice managers) covered team working, roles, patient interactions, adapting to change and workload. Data were transcribed and analysed using framework and thematic methods. Themes common to patients and staff were identified.</p><p><strong>Results: </strong>Overall median survey response was 10.9%, IQR 9.7%, 14.6%; 14 401 patient respondents provided 10 348 comments, 51.2% were positive. Patient and staff perspectives overlapped in two areas: contact and communication encapsulating differing views around access, and the roles of receptionists. Patients reported barriers to getting timely appointments with their chosen professional whilst staff were seeking ways to manage the volume of communications. Use of non-clinical staff to triage appointment requests was unpopular with patients and receptionists felt clinically unqualified.</p><p><strong>Conclusions: </strong>Effective methods are needed to improve patient communication with practices and access. Receptionists require recognition and training for their pivotal role.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207962","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 practitioners' perspectives on patients presenting with endometriosis symptoms - an interview study.","authors":"Sólja Petersen, Ulrik Bak Kirk, Maria Pencheri, Sharon Dixon, Rebecca Mawson, Birgitte Nørgaard, Michael Marcussen","doi":"10.3399/BJGPO.2025.0086","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0086","url":null,"abstract":"<p><strong>Background: </strong>Endometriosis affects about one in ten women, yet diagnosis often takes eight to twelve years after onset of symptoms. In the Faroe Islands, GPs play a key role in recognizing symptoms, managing care and coordinating referrals to specialists. Therefore, GPs' perspectives on how challenges arise or how they could be improved are crucial to developing effective interventions for change.</p><p><strong>Aim: </strong>To investigate how GPs in the Faroe Islands experience encounters with patients presenting with endometriosis symptoms.</p><p><strong>Design & setting: </strong>Qualitative interview study with six GPs from various practice across the Faroe Islands.</p><p><strong>Method: </strong>This study conducted semi-structured individual interviews and analysed participants' responses using systematic text condensation inspired by Malterud's thematic analysis to explore GPs' perspectives on their interactions with patients presenting with endometriosis symptoms.</p><p><strong>Results: </strong>Within the constraints of the Faroese healthcare system, many GPs reported difficulties collaborating with gynaecologists on treatment protocols. Limited referral pathways often led to challenges, particularly when referrals were declined or when patients were returned to general practice without clear diagnosis or management plan. GPs expressed frustration with the limited treatment options available in primary care and a sense of being professionally constrained. They emphasized the need for specialist involvement and highlighted the importance of building long-term relationships with patients offering holistic care, managing expectations early, and maintaining continuity of care.</p><p><strong>Conclusion: </strong>This study highlights the difficulties when GPs managing and referring patients with suspected endometriosis. Enhancing collaboration with specialists and improving referral protocols are crucial for optimising patients' care and outcomes.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207958","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":"Co-locating frailty intervention activities and general practice: experiences and perceptions of participants and delivery partners.","authors":"Alexandra Thompson, Luke Robertshaw, Barbara Hanratty, Michael Ali, Jennifer Liddle","doi":"10.3399/BJGPO.2025.0007","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0007","url":null,"abstract":"<p><strong>Background: </strong>Physical activity interventions targeting frailty improve health in later life. Integrating these with Primary Care services may enhance perceptions and outcomes of delivery. Every Move Matters (EMM) is an 8-week group-based frailty intervention aimed at improving physical ability, social connection, and well-being. Recruitment is embedded within primary care pathways. EMM is delivered by external partners within or near General Practice venues.</p><p><strong>Aim: </strong>To explore the experiences and perceptions of participants, intervention providers, and primary care staff involved in delivering the EMM frailty intervention, with a focus on the impact of its co-location within or near general practice settings.</p><p><strong>Design & setting: </strong>A rapid inductive qualitative evaluation of the EMM intervention co-located with primary care services.</p><p><strong>Method: </strong>Semi-structured interviews were conducted with nine EMM attendees, six primary care staff and three staff members from the activity provider organisation. Transcripts were analysed thematically.</p><p><strong>Results: </strong>Three themes were developed: straightforward implementation and adaptation; effectiveness; and buoyant atmosphere. EMM's location within primary care reassured attendees and fostered enthusiasm and support from primary care staff, promoting recruitment and feelings of pride. A dedicated embedded postholder with access to patient records could enhance recruitment.</p><p><strong>Conclusion: </strong>Implementing co-located interventions in collaboration with primary care is possible and has benefits for intervention attendees, delivery staff and primary care practitioners. The potential to embed other interventions within primary care settings could be explored. Closer collaboration with primary care may promote access to data for evaluation of the longer-term benefits and sustainability of a range of interventions.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207781","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":"Understanding and improving compound pressures in general practice: a realist review protocol.","authors":"Emily Owen-Boukra, Ruth Abrams, Tanya Cohen, Claire Goodman, Cecily Henry, Laura Ingle, Kamal Mahtani, Margaret Ogden, Nia Wyn Roberts, Rupesh Shah, James Thomas, Geoff Wong, Sophie Park","doi":"10.3399/BJGPO.2025.0073","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0073","url":null,"abstract":"<p><strong>Background: </strong>Compound Pressures (CP) significantly impact the role of General Practice (GP) in supporting human health. These pressures include climate change, pandemics, and financial crises. CP can be predictable, pre-determined, or unpredictable in nature and scope. Strategies to address the demands arising from CP range from short-term initiatives to buffering existing GP systems to ensure flexible and agile resources. Interventions designed to prevent, identify, and manage CP may result in both intended and unintended outcomes.</p><p><strong>Aim: </strong>To conduct a realist appreciative inquiry, realist review, and three embedded studies within a review (SWAR) about CP affecting GP and the delivery of effective, equitable patient care.</p><p><strong>Design & setting: </strong>Realist appreciative inquiry, realist review, and three SWARS.</p><p><strong>Method: </strong>We will conduct a realist appreciative inquiry facilitating patient and stakeholder input into the review scope, focus, and initial programme theory development. This approach emphasises the identification of assets, successes, hopes, and aspirations to enable positive change. Based on these insights, we will conduct a realist review of empirical and grey literature. This project includes three elements of methodological innovation (SWARs). First, evaluation of how appreciative inquiry can inform initial programme theory development. Two further SWARs will examine how artificial intelligence might a) support the identification of relevant resources at title and abstract, and full-text stages, and b) support data extraction and analysis in future realist reviews.</p><p><strong>Conclusion: </strong>Our research aims to understand the effects of CP on GP, supporting preparation and solutions that can inform future policies, interventions, and support systems.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145207960","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}