BJGP Open最新文献

{"title":"Enabling patient-physician continuity in Swedish primary care: the importance of a named GP. A registry-based observational study.","authors":"Lina Maria Ellegård, Anders Anell, Gustav Kjellsson","doi":"10.3399/BJGPO.2024.0118","DOIUrl":"10.3399/BJGPO.2024.0118","url":null,"abstract":"<p><strong>Background: </strong>Continuity of care is important for patients with chronic conditions. Assigning patients to a named GP may increase continuity.</p><p><strong>Aim: </strong>To examine whether patients who were registered with a named GP at the onset of their first chronic disease had higher continuity of care at subsequent visits than patients who were only registered at a practice.</p><p><strong>Design & setting: </strong>Registry-based observational study in Skåne County, Sweden. The study population included 66 063 patients registered at the same practice at least 1 year before the onset of their first chronic condition between 2009 and 2015.</p><p><strong>Method: </strong>We compared patients registered with a named GP with patients only registered at a practice over a 4-year follow-up period. The primary outcome was the usual provider of care (UPC) index for all visits and for visits related to the chronic disease. Secondary outcomes were the number of GP, nurse, and out-of-hours visits; emergency department visits; hospital admissions; and mortality. We used linear regression models, adjusted for patient characteristics (using entropy balancing weights) and for practice-level fixed effects, to compare the UPC between those registered with a named GP and those who were not.</p><p><strong>Results: </strong>Patients with a named GP at onset of their condition had a UPC that was 3-4 percentage points higher than patients who did not have a named GP, but the difference decreased and was not statistically significant after adjusting for patient and practice characteristics. Patients with a named GP made more visits, although not specifically for the chronic condition. There were no statistically significant differences for the other outcomes.</p><p><strong>Conclusion: </strong>Patient registration with a GP at diagnosis of their first chronic condition does not demonstrate higher continuity of care at subsequent GP visits and is not linked to other relevant outcomes for patients.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162609","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 prescriptions associated with a diagnosis of acute nasopharyngitis by GPs in France: a retrospective study.","authors":"Tran Tue Duong, Matta Matta, Beranger Lekens, Sylvain Diamantis","doi":"10.3399/BJGPO.2024.0006","DOIUrl":"10.3399/BJGPO.2024.0006","url":null,"abstract":"<p><strong>Background: </strong>Nasopharyngitis is a common viral infection that has led to an overuse of prescription drugs, in particular antibiotics, which are not indicated for this condition.</p><p><strong>Aim: </strong>The purpose of this study was to describe drug prescriptions for patients with a diagnosis of acute rhinopharyngitis in general practices in France.</p><p><strong>Design & setting: </strong>Retrospective study of 1 067 403 prescriptions for a diagnosis of nasopharyngitis issued by 2637 physicians to 754 476 patients living in metropolitan France.</p><p><strong>Method: </strong>The data were sourced from the prescription software, Cegedim, for the period 1 January 2018 to 31 December 2021 and analysed according to patients' and physicians' ages.</p><p><strong>Results: </strong>A total of 2 591 584 medications were prescribed by GPs, with a median of three medications per patient. A total of 171 540 courses of antibiotics were prescribed (16% prescription rates), with amoxicillin being the most frequently prescribed (102 089 prescriptions; 59.5% of antibiotic prescriptions). Amoxicillin prescription increased in extreme age groups (18.2% of visits in those aged 9 years and under, and 10.0% of visits in those aged over 80 years, while patients aged 20-29-years were prescribed amoxicillin in just 2.9% of visits), and more prescriptions are issued by older doctors (GPs older than 70 years prescribed antibiotics in 26.4% of visits versus 3.2% of visits by GPs aged under 29 years).</p><p><strong>Conclusion: </strong>Nasopharyngitis is frequently a cause of therapeutic over-prescriptions including antibiotics, with an antibiotic prescription rate of 16%. Additional research is required to enhance our understanding of factors linked to drug prescriptions.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141094434","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":"'I feel many of my reflections are forced': International medical graduates' perspectives on reflection in UK general practice training: a mixed methods qualitative study.","authors":"Laura Jayne Emery, Ben Jackson, Caroline Mitchell","doi":"10.3399/BJGPO.2023.0210","DOIUrl":"10.3399/BJGPO.2023.0210","url":null,"abstract":"<p><strong>Background: </strong>UK general practice training requires trainees to evidence clinical competencies through reflective writing entries in online portfolios. Trainees who complete their medical degree in the UK experience reflection as an undergraduate, whereas 80% of international medical graduates (IMGs) have no previous experience of reflection.</p><p><strong>Aim: </strong>To explore IMGs' perspectives on the positive and negative aspects of reflection in the context of postgraduate GP training.</p><p><strong>Design & setting: </strong>A mixed-methods qualitative study undertaken in the UK. Qualitative 'free-text' survey data obtained in 2021 were analysed. The themes were further explored by semi-structured interviews conducted in 2022-2023.</p><p><strong>Method: </strong>Participants were IMGs with experience of the UK GP training scheme. Verbatim open-question survey data underwent content analysis. Broad themes identified were used to develop the interview topic guide. A geographically dispersed, purposive sample of participants were recruited for semi-structured interviews. Interview and survey data were then analysed thematically.</p><p><strong>Results: </strong>In total, 433 participant datasets are included: 422 of 485 responses to a UK-wide survey, including open questions, and 11 interview transcripts. IMGs considered reflection to provide an effective approach for learning, an opportunity for self-assessment and professional development, and a means of developing self-awareness. Concerns were expressed about how time-consuming recording reflection is, how its mandated aspect makes it forced, and fears regarding the medico-legal consequences of reflective writing.</p><p><strong>Conclusion: </strong>Despite a lack of previous experience in reflection, most IMGs showed an understanding of the benefits of reflection in GP training. However, the challenges of reflection must be addressed, to avoid devaluing reflection for clinical learning.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162584","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 patients experience discussing couple relationship problems with GPs: an interview study.","authors":"Siri Dalsmo Berge, Mette Brekke, Eivind Meland, Thomas Mildestvedt","doi":"10.3399/BJGPO.2024.0044","DOIUrl":"10.3399/BJGPO.2024.0044","url":null,"abstract":"<p><strong>Background: </strong>Couple relationship satisfaction is related to good physical health, good mental health, and longevity. Many patients have discussed or wish to discuss their couple relationship with their GP and look for personalised care and support when discussing topics they perceive as sensitive.</p><p><strong>Aim: </strong>To explore patient experiences of discussing couple relationship problems in GP consultations.</p><p><strong>Design & setting: </strong>Qualitative study employing semi-structured interviews with patients from general practice in Norway.</p><p><strong>Method: </strong>Individual interviews with 18 patients who had discussed their couple relationship with their GP. Participants were recruited through both social media and traditional media, and all interviews were digitally recorded. The purposive sample comprised 13 women and five men, representing diverse age groups, backgrounds, and relationship problems. All participants identified as heterosexual. We analysed interview data thematically using systematic text condensation.</p><p><strong>Results: </strong>Three main themes emerged: 1) GPs in a facilitating role, not on an assembly line; 2) navigating the 'elephant in the room'; and 3) GPs as biomedically competent life witnesses. GP continuity was vital in fostering the trust required to discuss sensitive topics, such as relationship issues. Participants valued a biopsychosocial approach that incorporated knowledge of close relationships into medical consultations. They appreciated both GP support and constructive challenges that prompted them to take responsibility for relationship improvements.</p><p><strong>Conclusion: </strong>Patients value their GPs' holistic, supportive, and direct approach in addressing couple relationship problems, although they perceive that GPs do not always have sufficient time. They welcome relevant challenges that can drive positive change.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162579","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":"https://doi.org/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>Create a user-friendly online mapping tool to assess the vulnerability of communities to heatwaves for use by primary care practitioners. This study questioned <i>what</i> knowledge needed to be deployed, <i>who</i> needed to participate and <i>how</i> the knowledge should be shared.</p><p><strong>Design & setting: </strong>A participatory action-research project based on knowledge mobilization in France as part of the Green Data for Health Challenge.</p><p><strong>Method: </strong>Knowledge was summarized 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 (ARS), Public Health France, and data scientists.</p><p><strong>Results and conclusion: </strong>Nineteen participants participated in ten co-construction workshops, a brainstorming carousel strategy and five weekly co-design 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 mobilized data on the national composite indicator at the communal level for heatwave morbidity. 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 knowledge mobilisation 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":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-11","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":"Increasing engagement with liver disease management across the UK: follow-up cross-sectional survey.","authors":"Helen Jarvis, Charlotte Berry, Jonathan Worsfold, Vanessa Hebditch, Stephen Ryder","doi":"10.3399/BJGPO.2024.0142","DOIUrl":"10.3399/BJGPO.2024.0142","url":null,"abstract":"<p><strong>Background: </strong>Liver disease is an increasing cause of premature mortality. Early detection of liver disease in primary care gives opportunity to intervene and change outcomes. Engagement in liver disease care by NHS bodies responsible for primary care pathway development could drive improvements. The formation of integrated care systems (ICS) in England provides an opportunity to reassess engagement with liver disease nationally.</p><p><strong>Aim: </strong>To update the level of engagement with community chronic liver disease management amongst ICSs and health authorities across the UK.</p><p><strong>Design & setting: </strong>A cross-sectional follow up survey to ICS and UK Health Boards.</p><p><strong>Method: </strong>Questions used for a previous survey in 2020 were adapted and sent electronically to NHS bodies responsible for health care across the UK using a Freedom of Information request. Quantitative analysis used Microsoft Excel.</p><p><strong>Results: </strong>There were 67 responses from 68 possible ICS and Health Board areas representing 99% UK coverage. 27% had a named individual responsible for liver disease. Monitoring of local liver disease health statistics happened in 34% of all UK areas. Comprehensive care pathways were available in 24/67 (36%) of areas, an increase from 26% in the 2020 survey. Areas with no liver pathways in place fell from 58% to 36% between the two surveys. Regional variations persist, with Wales and Scotland moving towards comprehensive coverage. Almost double the number of areas were making use of transient elastography within community pathways of care, up from 25% to 46%.</p><p><strong>Conclusion: </strong>The results of this re-survey highlight improvements, but emphasise the need to build on regional success to further reduce inequality in care commissioning.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297462","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":"Do marked discharge summaries with recommendation text boxes enhance patient safety? A nationwide survey.","authors":"Thorbjørn H Mikkelsen, Jesper B Nielsen, Maria M Storsveen, Jens Søndergaard","doi":"10.3399/BJGPO.2024.0037","DOIUrl":"10.3399/BJGPO.2024.0037","url":null,"abstract":"<p><strong>Background: </strong>Danish hospital physicians are required to mark their discharge summaries addressing whether the patient's general practitioner (GP) is recommended to follow up as well as suggest follow-up actions.</p><p><strong>Aim: </strong>To investigate whether a new form of discharge summaries may contribute to improve the perceived patient safety following transition from hospitals to general practice.</p><p><strong>Design & setting: </strong>This paper reports data from a questionnaire sent to a representative sample of GPs in Denmark.</p><p><strong>Method: </strong>A questionnaire was prepared for GPs based on background material, focus group interviews and discussions with relevant professionals. It was subsequently pilot tested by fellow researchers and GPs and revised prior to the presently reported survey.</p><p><strong>Results: </strong>Of 310 participating GPs, 197 (63%) 'totally agree' or 'partly agree' that the marked discharge summaries with a recommendation text box contribute to a better handover to general practice, and 223 (72%) 'totally agree' or 'partly agree' that they improve patient safety.</p><p><strong>Conclusion: </strong>The majority of responding GPs believe that the marked discharge summaries with a recommendation text box enhance patient safety and facilitate the transition of care to general practice following hospital discharge.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142376141","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":"Prevalence and predictors of annual asthma reviews in Scottish primary care data.","authors":"Holly Tibble, Alexandria Ming Wai Chung","doi":"10.3399/BJGPO.2024.0062","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0062","url":null,"abstract":"<p><strong>Background: </strong>People with asthma are recommended to have regular reviews in primary care, with assessment of symptoms, adjustment of treatment and self-management processes, and the delivery of a written action plan for emergencies.</p><p><strong>Aim: </strong>Our study aimed to investigate the incidence and factors associated with attendance of annual reviews.</p><p><strong>Design & setting: </strong>electronic health records for approximately 50 000 Scottish asthma patients, between 2008 and 2016.</p><p><strong>Method: </strong>Multivariable logistic regression using linked primary care prescription data and primary care registration demographic data.</p><p><strong>Results: </strong>There was a median of 381 days between subsequent reviews. Reviews in the index year were strongly associated with reviews in the following year (odds ratio 1.76 [1.68-1.84]). In contrast, asthma consultations (excluding reviews) in the index year were associated with a <i>lower</i> odds of having a review in the following year (0.48 [0.46-0.51]). Those aged 18-35 in the index year, or with missing address in the practice registration data, were the least likely age group to have an asthma review in the following year.</p><p><strong>Conclusion: </strong>Reviewing the delivery of asthma care identifies patients who may be slipping through the gaps by receiving only <i>reactive</i> asthma care rather than the structured, preventative care which can be delivered through annual reviews. Understanding the risk factors for not receiving an annual review can be leveraged to create more effective review invitations, such as explaining the specific content of reviews, introducing new contact methods to improve health equity, and reviewing the algorithm used to determine who is invited.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366811","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":"Estimating the burden of vaccine preventable lower respiratory tract disease in primary care, UK: protocol for a prospective surveillance study (AvonCAP GP2).","authors":"Polly Duncan, Ruth Mears, Elizabeth Begier, Sanaz Rouhbakhsh Halvaei, Jo Southern, Siân Bodfel Porter, Robin Hubler, Glenda Oben, George Qian, Maria Lahuerta, Tim Davis, James Campling, Hannah Christensen, Jennifer Oliver, Begonia Morales-Aza, Kaijie Pan, Sharon Gray, Catherine Hyams, Leon Danon, Bradford D Gessner, Adam Finn, Alastair D Hay","doi":"10.3399/BJGPO.2024.0129","DOIUrl":"10.3399/BJGPO.2024.0129","url":null,"abstract":"<p><strong>Background: </strong>The true burden of acute lower respiratory tract diseases (aLRTD; includes acute lower respiratory tract infection, acute exacerbation of pre-existing heart failure and chronic lung disease) among adults presenting to primary care, and the proportion that are potentially vaccine preventable, is unknown.</p><p><strong>Aims: </strong>To describe aLRTD incidence in adults presenting to primary care; estimate proportions caused by RSV, SARS-CoV-2 and pneumococcus; and investigate disease burden from patient and NHS perspectives.</p><p><strong>Design & setting: </strong>Primary care prospective cohort study conducted in six representative General Practices (total ̴83 000 registered adults) in Bristol, UK.</p><p><strong>Method: </strong>Adults (aged≥18 years) registered at participating General Practices and presenting to primary care (in-hours or out-of-hours) or emergency department (if not admitted) with aLRTD will be eligible and identified by real-time primary care record searches. Researchers will screen electronic GP records, including free text, contact patients to assess eligibility, and offer enrolment in a surveillance study and an enhanced diagnostic study (urine, saliva and respiratory samples; physical examination; and symptom diaries). Data will be collected for all aLRTD episodes, with patients assigned to one of three arms: surveillance, embedded diagnostic, and descriptive dataset. Outcome measures will include clinical and pathogen defined aLRTD incidence rates, symptom severity and duration, NHS contacts and costs, health-related quality of life changes, and mortality (≤30 days post identification).</p><p><strong>Conclusion: </strong>This comprehensive surveillance study of adults presenting to primary care with aLRTD, with embedded detailed data and sample collection, will provide an accurate assessment of aLRTD burden due to vaccine preventable infections.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297460","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 the equity of distribution of general medical services funding allocations in Wales: a time-series analysis.","authors":"Jonny Currie, Kathrin Thomas, Anne Marie Cunningham, Kerry Bailey, Haroon Ahmed, Daniel Farewell, Sally Lewis","doi":"10.3399/BJGPO.2024.0080","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0080","url":null,"abstract":"<p><strong>Background: </strong>Good access to quality primary care in high-income countries can improve population health. Access to primary care is however often not equal among socioeconomic groups; our analysis sought to explore whether funding, a determinant of service supply, is equitably distributed among GP practices in Wales.</p><p><strong>Aim: </strong>We sought to explore the relationship between funding and deprivation among GP practices in Wales, to understand the equity of current funding policies.</p><p><strong>Design & setting: </strong>We obtained funding data for general practices in Wales between 2014 and 2022 and explored the equity of distribution using the percentage of practice patients living in the 20% most deprived small areas in Wales. We generated a linear regression model exploring the relationship between practice funding and deprivation, with an interaction term with time in years.</p><p><strong>Results: </strong>Practice funding rose for all practices between 2014 and 2022. Practice deprivation and time in years were both associated with practice funding, with increases in practice deprivation associated with reduced funding allocations, and time being associated with a small increase in funding over the study period. Over the period of analysis of 2004-2022, for every 10% increase in patients living in the most deprived LSOAs, funding per patient decreases on average by 1%.</p><p><strong>Conclusion: </strong>Primary cares in Wales in more deprived areas receive discernibly less funding per patient than those in less deprived areas. Given the potential and likelihood primary care can affect population health outcomes, this underinvestment may be contributing to existing health inequalities and requires urgent further analysis and action.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366810","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}