BJGP Open最新文献

{"title":"Declining number of home visits to older adults by general practitioners - an observational study using data from electronic health records in the Netherlands; 2017-2023.","authors":"Chantal J Leemrijse, Marianne J Heins, Bart J Knottnerus, Mariette Hooiveld, Judith N de Boer, Ron F Schipper, Joost W Vanhommerig","doi":"10.3399/BJGPO.2024.0255","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0255","url":null,"abstract":"<p><strong>Background: </strong>Despite an aging population that have higher care demand, home visits by general practitioners (GPs) have been declining.</p><p><strong>Aim: </strong>To analyze the number of GP home visits from 2017 to 2023 in the Netherlands, and to investigate whether this trend differed according to age, sex, multimorbidity, and neighborhood deprivation. In addition, the most common reasons for home visits between 2017 and 2023 are presented.</p><p><strong>Design & setting: </strong>Data were derived from Nivel Primary Care Database (Nivel-PCD), containing routinely recorded data from approximately 500 Dutch GP practices.</p><p><strong>Method: </strong>The number of home visits was calculated by age, sex, multimorbidity, and neighborhood deprivation. Visual inspection was used to investigate the relation between the trend in number of home visits and age, sex, multimorbidity, and neighborhood deprivation of patients.</p><p><strong>Results: </strong>A large decrease in the overall number of home visits was observed between 2017 and 2023 (-32%). The largest decrease was between 2019 and 2020, (-15%), but the downward trend continued in 2021 through 2023 (-5% per year). The most profound decline between 2023 and 2017 was found in the number of short home visits (-52%). The number of home visits for intensive GP care increased by 12% between 2017 and 2023.</p><p><strong>Conclusion: </strong>We report a continuing decline in the number of home visits by GPs, comparing 2023 to 2017. Home visits for intensive GP care, often for patients at the end of life, increased since 2017. GPs may be forced to make choices due to the increasing workload.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755050","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating ChatGPT for converting clinic letters into patient-friendly language.","authors":"Simon Cork, Keith Hopcroft","doi":"10.3399/BJGPO.2024.0300","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0300","url":null,"abstract":"<p><strong>Background: </strong>Previous research has shown that communication with patients in language they understand leads to greater comprehension of treatment and diagnoses but can be time consuming for clinicians.</p><p><strong>Aim: </strong>Here we sought to investigate the utility of ChatGPT to translate clinic letters into language patients understood, without loss of clinical information and to assess what impact this had on patients understanding of letter content.</p><p><strong>Design & setting: </strong>Single blinded quantitative study using objective and subjective analysis of language complexity.</p><p><strong>Method: </strong>Twenty-three clinic letters were provided by consultants across 8 specialties. Letters were inputted into ChatGPT with a prompt related to improve understanding for patients. Patient representatives were then asked to rate their understanding of the content of letters.</p><p><strong>Results: </strong>Translation of letters by ChatGPT resulted in no loss of clinical information, but did result in significant increase in understanding, satisfaction and decrease in the need to obtain medical help to translate the letter contents by patient representatives compared with clinician written originals.</p><p><strong>Conclusion: </strong>Overall, we conclude that ChatGPT can be used to translate clinic letters into patient friendly language without loss of clinical content, and that these letters are preferred by patients.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143755054","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":"Pathways to diagnosis of atrial fibrillation: findings from a qualitative study in primary care.","authors":"Patricia N Apenteng, Veronica Nanton, Trudie Lobban, Richard Lilford","doi":"10.3399/BJGPO.2025.0006","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0006","url":null,"abstract":"<p><strong>Background: </strong>Atrial fibrillation (AF) is underdiagnosed and approximately 10% of ischemic strokes occur in people with unrecognised AF.</p><p><strong>Aim: </strong>To explore the patient path to diagnosis of AF and identify ways to improve detection DESIGN & SETTING: Qualitative study in UK primary care METHOD: We interviewed patients with a recent diagnosis of AF (<6 months) to understand their path to diagnosis, and primary care clinicians to explore their experience of detecting AF. The data were analysed using framework analysis.</p><p><strong>Results: </strong>Thirty patients and ten primary care clinicians were interviewed. Patients with non-specific symptoms generally did not perceive the symptoms as serious, and many delayed seeing a healthcare professional. Their experiences in primary care aligned with findings from interviews with primary care clinicians, who acknowledged AF may not necessarily be the initial suspicion when a patient presents with certain non-specific symptoms. Primary care clinicians described narratives of good practice in the form of opportunistic pulse palpation, and challenges of detecting AF in primary care such as lack of access to holter tests and limited opportunities to detect AF due to remote consultations and healthcare assistants taking on more responsibilities.</p><p><strong>Conclusions: </strong>Our findings suggest that increased public awareness of AF could improve symptom appraisal and help-seeking from healthcare professionals. Recommending opportunistic pulse palpation in primary care is also indicated. Access to holter tests and other devices in primary care may help reduce delays in diagnosis.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754559","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":"Physical activity support for people with heart failure: mixed-methods study protocol.","authors":"Vincent Singh, John Percival, Olivia Skrobot, Rasha Okasheh, Rachel Johnson, Alison Huntley","doi":"10.3399/BJGPO.2025.0030","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0030","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a common condition affecting 1-2 in every hundred adults in the UK and one in six people aged over 85 years. Physical activity is important for people with HF (PWHF) as it can increase exercise capacity and is shown to improve quality of life. We know that people with heart failure often seek advice from healthcare professionals about participating in physical activity safely, but healthcare professionals are not always sure what physical activity advice is best for their patients. It is also important to understand what physical activity services are available for healthcare professionals to refer patients to, and to explore how patients are referred into these physical activity services AIM: To explore the barriers and enablers to primary and community healthcare professionals (GPs and nurses) referring people with heart failure to community physical activity services.</p><p><strong>Design & setting: </strong>Mixed-methods study conducted across GP practices in England.</p><p><strong>Method: </strong>The following approaches will be used: (i) in-depth qualitative interviews with GPs (<i>n</i>=12) and nurses (<i>n</i>=12) to understand their experiences of talking to people with heart failure about referral to physical activity services; (ii) find out what commissioned physical activity services are available to people with heart failure and how primary and community healthcare professionals can refer patients to the services; (iii) two workshops will be conducted to examine the findings with our stakeholders.</p><p><strong>Conclusion: </strong>The findings will be used to inform the development of an intervention for healthcare professionals referring to physical activity services and support the community service configuration.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754565","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":"Saline nasal irrigation for acute sinusitis (SNIFS II): a randomised controlled pilot trial with nested process evaluation.","authors":"Roderick P Venekamp, Ben Ainsworth, Tammy Thomas, Beth Stuart, Joanna Slodkowska-Barabasz, Fiona Mowbray, Christopher C Butler, Nick Francis, Samantha Richards-Hall, Anthony Harnden, Alastair D Hay, Claire Hopkins, Michael Moore, Lucy Yardley, Theo Jm Verheij, Shihua Zhu, Paul Little","doi":"10.3399/BJGPO.2024.0307","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0307","url":null,"abstract":"<p><strong>Background: </strong>Despite having marginal beneficial effects, antibiotics are routinely prescribed in adults with acute sinusitis. Alternative interventions for this common condition are urgently needed.</p><p><strong>Aim: </strong>To assess the feasibility and acceptability of saline nasal irrigation for acute sinusitis.</p><p><strong>Design & setting: </strong>Randomised controlled pilot trial with nested process evaluation in 24 English general practices between October 2019 and May 2021.</p><p><strong>Method: </strong>Participants were randomised to advice to high volume hypertonic saline nasal irrigation with a delayed antibiotic prescription or usual care. Feasibility outcomes included recruitment and follow-up rates, adherence, and acceptability of the intervention.</p><p><strong>Results: </strong>Of those invited, 81/107 (76%) consented and were randomised (42 intervention, 39 usual care). Two participants were excluded due to ineligibility. Antibiotic prescribing strategies were recorded at baseline for 79/79 (100%), with no or delayed antibiotics prescribed in 60% (24/40) of the saline group versus 38% (15/39) of the usual care group. At follow-up, 80% (63/79) of participants recorded whether they consumed antibiotics or not. Among those from the intervention group who returned a symptom diary, 96% (22/23) and 65% (15/23) reported using saline nasal irrigation during the first and second week, respectively. Semi-structured interviews with 16 participants revealed that most were positive about trial participation and viewed saline nasal irrigation as acceptable, noting it as alternative to antibiotics.</p><p><strong>Conclusion: </strong>Saline nasal irrigation is deemed acceptable for adults with acute sinusitis and a trial of such intervention is feasible. A large trial is warranted to assess the effectiveness of this intervention for this common condition.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143754694","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":"How general practitioners approach physical activity in routine care: a qualitative study of video-recorded consultations.","authors":"Neha Giri, Kimberley Norman, Elizabeth Ann Sturgiss","doi":"10.3399/BJGPO.2024.0253","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0253","url":null,"abstract":"<p><strong>Background: </strong>Physical activity engagement is critical for improving health and wellbeing across nearly all patient health concerns. General practitioners (GPs) are well positioned to have discussions about physical activity due to the frequency with which they see their patients over long periods of time. This study aimed to explore how physical activity is really discussed in real-world GP-patient consultations.</p><p><strong>Aim: </strong>To explore a) how physical activity is discussed in and b) the types of physical activity that are discussed in real-world GP-patient consultations.</p><p><strong>Design & setting: </strong>A qualitative descriptive study using real world video-recorded consultations with Melbourne-based general practitioners.</p><p><strong>Method: </strong>Secondary analysis of 43 video consultation data from four GPs held with the Digital Library repository at Monash University, Australia. Two researchers reviewed the consultations and analysed each consultation using descriptive content analysis.</p><p><strong>Results: </strong>From the total consultations (<i>n</i>=43), 41.9% (<i>n</i>=18) discussed physical activity. Five consultations included a structured GP Management Plan which prompted physical activity questions for discussion. GPs had a patient-centred approach discussed a range of different types of physical activity which was tailored to the specific health needs of each patient. These included exercise prescription, general advice, aerobic exercise, functional movement and allied healthcare referrals.</p><p><strong>Conclusion: </strong>GPs discuss PA with patients in opportunistic or systematic ways using a patient-centered approach. This study could be used as a foundation for establishing teaching resources for GPs, both in training and in professional development. Future studies could explore how PA discussions improve health outcomes over longer periods of time. This will contribute to understanding how, and if, PA is followed-up to further understand the effectiveness of these discussions.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143753737","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 BJGP Open Top 10 Most Read Research Articles of 2024: an editorial.","authors":"Alice M Harper, Hajira Dambha-Miller","doi":"10.3399/BJGPO.2025.0047","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0047","url":null,"abstract":"","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732080","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 action: developing a heatwave vulnerability tool for primary care.","authors":"Karolina Griffiths, Paul Basso-Bert, Mireille Abraham, Elise Chin, Layana Caroupaye-Caroupin, Manal Ahikki, Emilie Agrech, Camille Debrock, Rim Sabri, Grégoire Mercier, François Carbonnel","doi":"10.3399/BJGPO.2024.0089","DOIUrl":"10.3399/BJGPO.2024.0089","url":null,"abstract":"<p><strong>Background: </strong>Heatwaves are becoming longer and more frequent. Despite the availability of open environmental data, little is operable and formatted for primary care use.</p><p><strong>Aim: </strong>To create a user-friendly online mapping tool to assess the vulnerability of communities to heatwaves for use by primary care practitioners. This study questioned what knowledge needed to be deployed, who needed to participate, and how the knowledge should be shared.</p><p><strong>Design & setting: </strong>A participatory action-research project based on knowledge mobilisation (KM) in France, as part of the Green Data for Health Challenge.</p><p><strong>Method: </strong>Knowledge was summarised on the factors most affecting heatwave vulnerability in a collaborative process, enabling a consensus on data variables and mobilised content for the online tool. Purposive sampling included primary care stakeholders with Regional Health Agencies (Agence Régionale de Santé; ARS), Public Health France (Santé Publique France; SPF), and data scientists.</p><p><strong>Results: </strong>Nineteen participants took part in 10 co-construction meetings, a brainstorming carousel strategy, and five weekly co-creation meetings between December 2022 and June 2023. The heatwave vulnerability variable was constructed using surface temperature, social deprivation, vegetation coverage, and presence of air-conditioning equipment. Identified experts mobilised data on the national composite indicator at the communal level for heatwave morbidity.</p><p><strong>Conclusion: </strong>There is no standard platform for sharing environmental data in France. This co-creation study offers a new approach to incorporating environmental data on heatwaves into primary care consultations. We demonstrate the importance of KM in primary care to bridge the research-practice gap. Integrating primary care records with environmental data may promote broader applications for planetary health research.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142406998","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 overlooked challenges facing out-of-hours primary care in the NHS: a missed opportunity in policy.","authors":"Alexandra L Creavin, Sam T Creavin","doi":"10.3399/BJGPO.2024.0292","DOIUrl":"10.3399/BJGPO.2024.0292","url":null,"abstract":"","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400249","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":"Antibiotic prescribing intensity and community UTI resistance: a cross-sectional ecological study.","authors":"Lucy McDonnell, Mark Ashworth, Peter Schofield, Stevo Durbaba, Patrick Redmond","doi":"10.3399/BJGPO.2023.0248","DOIUrl":"10.3399/BJGPO.2023.0248","url":null,"abstract":"<p><strong>Background: </strong>Antibiotic overuse is associated with antimicrobial resistance (AMR). It is unclear whether community AMR is driven by overall antibiotic use or by high levels of repeated (intense) use by individual patients.</p><p><strong>Aim: </strong>To determine the association between high antibiotic prescribing intensity (all antibiotic prescriptions; any indication), and rates of urinary tract infection (UTI) resistance among patients within small communities.</p><p><strong>Design & setting: </strong>Repeated cross-sectional ecological analysis of geographical areas (population averaging 1500) from 2012-2015 using anonymised primary care data and urine cultures.</p><p><strong>Method: </strong>For each area, we compared the percentage of patients prescribed antibiotics who received≥5 prescriptions over 3 years or≥4 prescriptions over 1 year, with subsequent or same year UTI resistance rates. We also compared Average Daily Quantities (ADQ) of all antibiotics prescribed, with UTI resistance rates, per year, per area. Results were adjusted for covariates and analysed at area level using mixed effects logistic regression.</p><p><strong>Results: </strong>Of 196 513 patients prescribed antibiotics in 69 areas, 16% were prescribed intensively (≥5 prescriptions in 3 years), receiving almost 30% of prescriptions. Of 12 308 confirmed UTI specimens (80% <i>Escherichia coli</i>), 65% were resistant to at least one antibiotic (amoxicillin; cefalexin; ciprofloxacin; trimethoprim; nitrofurantoin). We found no significant association between high intensity 'any' antibiotic prescribing (same year or 2 preceding years) or overall 'any' antibiotic prescribing (same year) and UTI resistance.</p><p><strong>Conclusion: </strong>We found no relationship between concurrent high intensity 'any' antibiotic prescribing, and UTI resistance rates in small urban communities, pre-COVID-19. Individual patient use of multiple antibiotics, even at high intensity, may not be an independent risk factor for community UTI resistance.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366808","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}