BJGP Open最新文献

{"title":"General practitioners' decision making managing uncomplicated urinary tract infections in women: a qualitative study.","authors":"Peter K Kurotschka, Juliane Hemkeppler, David Gierszewski, Luca Ghirotto, Ildikó Gágyor","doi":"10.3399/BJGPO.2023.0224","DOIUrl":"10.3399/BJGPO.2023.0224","url":null,"abstract":"<p><strong>Background: </strong>To be effective, interventions aimed at increasing the appropriateness of antibiotic use in primary care should consider the perspectives of prescribing physicians.</p><p><strong>Aim: </strong>To explore the decision making of general practitioners (GPs) when managing uncomplicated urinary tract infections (uUTIs) in women.</p><p><strong>Design & setting: </strong>A qualitative study using semi-structured interviews with 22 GPs in Bavaria and Baden-Württemberg (southern Germany).</p><p><strong>Method: </strong>Verbatim transcripts were analysed through inductive qualitative content analysis.</p><p><strong>Results: </strong>We generated the following three main themes: factors facilitating the decision making; factors complicating the decision making; and consultation modalities. According to participants, following evidence-based recommendations makes the prescription decision smoother. GPs' and patients' prior experiences and beliefs guides decisions towards certain antibiotics, even if those experiences and beliefs contradict evidence-based recommendations. Patient expectations and demands also condition antibiotic prescribing, favouring it. Organisational constraints, such as time pressure, the day of the week (for example, before weekends), and a lower cost of antibiotics for patients than alternative treatments favour the decision to prescribe antibiotics. Diagnostic and prognostic uncertainty complicates decision making, as does scepticism towards evidence-based recommendations. Discordance within the patient-doctor relationship contributed to this complexity. Regarding consultation modalities, a more in-depth consultation and shared decision making were seen as helpful in this process.</p><p><strong>Conclusion: </strong>We identified different factors as intervening against or for a straightforward management decision when dealing with women with uUTIs. They reveal the complexity behind the GPs' decision making. Providing GPs with easy-to-apply guidance while removing economic constraints to allocate sufficient consultation time, and supporting shared decision making may help GPs appropriately manage uUTIs in women.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139997670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Family medicine and general practitioner supervisor wellbeing: a literature review.","authors":"Shaun Prentice, Helen Mullner, Jill Benson, Margaret Kay","doi":"10.3399/BJGPO.2023.0230","DOIUrl":"10.3399/BJGPO.2023.0230","url":null,"abstract":"<p><strong>Background: </strong>Research examining general practice supervisor wellbeing has often been conducted within the context of trainee wellbeing and educational outcomes.</p><p><strong>Aim: </strong>To consolidate the current literature regarding the wellbeing of GP supervisors through a 'supervisor-wellbeing' lens.</p><p><strong>Design & setting: </strong>Literature review of original research studies on Embase, Ovid MEDLINE, and Ovid PsycINFO from inception to December 2022.</p><p><strong>Method: </strong>The Embase, Ovid MEDLINE, and Ovid PsycINFO databases were systematically searched from inception to December 2022. Original research studies were eligible if they explored any aspect of wellbeing or burnout (that is, construct conceptualisations, risk and protective factors, implications, or interventions) among GPs involved in educating GP trainees. Reporting quality of included studies was assessed using the QualSyst tool. Results from included studies were narratively synthesised.</p><p><strong>Results: </strong>Data from 26 independent samples were reviewed. Burnout was generally conceptualised using the Leiter and Maslach model. Wellbeing was poorly defined in the literature, largely being conceptualised in personal psychological terms and, to a lesser extent, professional satisfaction. Risk and protective factors were identified and grouped as individual (for example, satisfaction with capacity to teach) and external (for example, autonomy, collegial relationships, resource availability) factors. GP supervisors' wellbeing appeared to affect their job performance and retention. This review identified only two studies evaluating interventions to support GP supervisors' wellbeing.</p><p><strong>Conclusion: </strong>The present review highlights a lack of conceptual clarity and research examining interventions for GP supervisor wellbeing. It provides guidance for future research designed to maximise the wellbeing of GP supervisors and support the wellbeing of trainees.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523520/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: Exploring the facilitators and barriers to addressing social media's impact on anxiety within primary care: a qualitative study.","authors":"","doi":"10.3399/BJGPO.2024.9998","DOIUrl":"10.3399/BJGPO.2024.9998","url":null,"abstract":"","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523513/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142146478","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AI-guided DVT diagnosis in primary care: protocol for cohort with qualitative assessment.","authors":"Kerstin Nothnagel, Alastair Hay, Jessica Watson, Jonathan Banks","doi":"10.3399/BJGPO.2024.0165","DOIUrl":"10.3399/BJGPO.2024.0165","url":null,"abstract":"<p><strong>Background: </strong>Deep vein thrombosis (DVT), a formation of blood clots within deep veins, mostly of the proximal lower limb, has an annual incidence of 1-2 per 1000. Patients who are affected by multiple chronic health conditions and who experience limited mobility are at high risk of developing DVT. Traditional DVT diagnosis involves probabilistic assessment in primary care, followed by specialised ultrasound scans (USS), mainly conducted in hospitals. The emergence of point-of-care ultrasound (POCUS), coupled with artificial intelligence (AI) applications, has the potential to expand primary care diagnostic capabilities.</p><p><strong>Aim: </strong>To assess the accuracy and acceptability of AI-guided POCUS for DVT diagnosis when performed by non-specialists in primary care.</p><p><strong>Design & setting: </strong>Diagnostic cross-sectional study coupled with a qualitative evaluation conducted at primary care DVT clinics.</p><p><strong>Method: </strong>First, a diagnostic test accuracy (DTA) study will investigate the accuracy of AI-guided POCUS in 500 individuals with suspected DVT, performed by healthcare assistants (HCAs). The reference standard is the standard of care of USS conducted by sonographers. Second, after receiving both scans, participants will be invited to complete a patient satisfaction survey (PSS). Finally, semi-structured interviews with 20 participants and four HCAs, and three sonographers will explore the acceptability of AI-guided POCUS DVT diagnosis.</p><p><strong>Conclusion: </strong>This study will rigorously evaluate the accuracy and acceptability of AI-guided POCUS DVT diagnosis conducted by non-specialists in primary care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141903165","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":"Practice visitations in primary care to improve performance of cardiovascular risk management: an observational study.","authors":"Geert Hjm Smits, Michiel L Bots, Monika Hollander, Ardine de Wit, Sander van Doorn","doi":"10.3399/BJGPO.2023.0213","DOIUrl":"10.3399/BJGPO.2023.0213","url":null,"abstract":"<p><strong>Background: </strong>Despite programmatic protocolised care and structured support, considerable variation is observed in completeness of registration and achieving targets of cardiovascular risk management (CVRM) between individual GPs in the Netherlands.</p><p><strong>Aim: </strong>To determine whether completeness of registration and achieved targets of cardiovascular risk factors improves with practice visitation.</p><p><strong>Design & setting: </strong>Observational study utilising the care group's database (2016-2019), comparing changes in registration and achieved targets in non-visited practices and visited practices.</p><p><strong>Method: </strong>We compared completeness scores of registration and scores of targets achieved before visitation and 1 year after visitation. Data were analysed on patient level and GP level. Separate analyses were performed among GPs who were ranked in the lower 25% of score distributions.</p><p><strong>Results: </strong>We observed no clinically relevant improvements in completeness of registration and targets achieved in 2017, 2018, and 2019 that could be attributed to visitations in the previous year, both on individual patient level and on aggregated level per general practice. In practices ranked in the lower 25% of the distribution, improvements over time were clinically relevant and larger than the overall changes. Yet, these findings were irrespective of the number of practice visitations.</p><p><strong>Conclusion: </strong>Practice visitations in our setting did not seem to lead to improvements in practice performance, nor in completeness of registration of risk factors or in reaching predefined target goals for cardiovascular risk factors.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523525/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140120989","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"From statistics to stories: understanding the complex landscape of missed medical appointments. A mixed-methods pilot study.","authors":"Lea Charton, Francis Gatier, Chloe Delacour, Camille Lépine","doi":"10.3399/BJGPO.2024.0007","DOIUrl":"10.3399/BJGPO.2024.0007","url":null,"abstract":"<p><strong>Background: </strong>Research suggests that in both France and the UK, between 5% and 10% of appointments with GPs are unattended. A comprehensive Irish study linked missed appointments with an increased short-term risk of mortality, prompting further investigation into the reasons behind absenteeism.</p><p><strong>Aim: </strong>To delve into the underlying causes of missed appointments, within the context of an urban health centre.</p><p><strong>Design & setting: </strong>Using a mixed-method approach, this study combines qualitative telephone interviews with quantitative analysis of medical records. The study focuses on patients who failed to attend appointments at an urban health centre in France over a 15-day period.</p><p><strong>Method: </strong>The interview guide collected data on circumstances leading to missed appointments and explored patients' social determinants of health. Additionally, quantitative data, including patients' socioeconomic backgrounds, were extracted from medical records.</p><p><strong>Results: </strong>Among 53 missed appointments (4.9% of all scheduled), 22 patients were interviewed. State health coverage (SHC) beneficiaries (68.2% of the sample) cited socioeconomic instability, including precarious work hours, social isolation, and multiple commitments, as reasons for non-attendance. For non-SHC beneficiaries, forgetting the appointment or failing to cancel it after self-resolution of the health issue was one of the main causes. Remarkably, 36.4% disclosed that they had experienced domestic violence. During the qualitative interview, patients were offered the opportunity to reschedule appointments, and a retrospective analysis by physicians found that over a quarter of the missed appointments were classified as 'capital appointments', meaning their absence could have significantly harmed the patient's health.</p><p><strong>Conclusion: </strong>The findings indicate that missed appointments can highlight social inequality, emphasising the need to align health care with patients' temporal realities. The identification of patients who have experienced violence and the use of missed appointments as triggers for follow-up calls seem to be promising strategies to enhance care and mitigate health inequalities.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523526/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866708","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of the FebriDx point-of-care test for lower respiratory tract infections in primary care: a qualitative interview study.","authors":"Jill Rutter, Christopher R Wilcox, Nour Odeh, Ingrid Muller, Tristan W Clark, Paul Little, Firoza Davies, John McGavin, Nick Francis","doi":"10.3399/BJGPO.2024.0024","DOIUrl":"10.3399/BJGPO.2024.0024","url":null,"abstract":"<p><strong>Background: </strong>FebriDx is a single-use, analyser-free, point-of-care test with markers for bacterial (C-reactive protein [CRP]) and viral (myxovirus resistance protein A [MxA]) infection, measured on a finger-prick blood sample.</p><p><strong>Aim: </strong>As part of a larger feasibility study, we explored the views of healthcare professionals (HCPs) and patients on the use of FebriDx to safely reduce antibiotic prescriptions for lower respiratory tract infections (LRTIs) in primary care.</p><p><strong>Design & setting: </strong>Remote semi-structured qualitative interviews were conducted in South England.</p><p><strong>Method: </strong>In total, 22 individuals (12 patients who underwent FebriDx testing and 10 HCPs from general practices that conducted testing) participated in interviews, which were analysed thematically.</p><p><strong>Results: </strong>Patients and HCPs expressed positive views about use of the test. They felt FebriDx was a useful tool to inform prescribing decisions and provided a visual aid to support shared decision making and appropriate antibiotic use. Most felt it would be feasible to integrate use into routine primary care consultations. Some practical difficulties with blood collection and interpreting results, which impacted on usability, were identified. Some patients' reactions to negative test results suggested the need for better communication alongside use of the test.</p><p><strong>Conclusion: </strong>FebriDx was perceived as a useful tool to guide antibiotic prescribing and support shared decision making. Initial practical problems with testing and communicating results are potential barriers to use. Training and practice on using the test and effective communication are likely to be important elements in ensuring patient understanding and satisfaction, and successful adoption.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523514/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140872460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hammering nails with a screwdriver: how GPs perceive video consultations.","authors":"Magnus Repstad Wanderås, Eirik Abildsnes, Elin Thygesen, Santiago Gil Martinez","doi":"10.3399/BJGPO.2024.0010","DOIUrl":"10.3399/BJGPO.2024.0010","url":null,"abstract":"<p><strong>Background: </strong>Early in the COVID-19 pandemic, the use of video consultation (VC) expanded considerably, with GPs indicating high satisfaction with it. However, use of VC declined as lockdown measures were eased.</p><p><strong>Aim: </strong>To explore reasons why VC use has declined in Norwegian general practice since the start of the pandemic by investigating GPs' experiences with VC and their attitudes towards it in a post-pandemic setting.</p><p><strong>Design & setting: </strong>Qualitative study using semi-structured interviews with 13 GPs in southern Norway between May 2022 and March 2023.</p><p><strong>Method: </strong>Data analysis was conducted by applying the six steps of Braun and Clarke's reflexive thematic analysis.</p><p><strong>Results: </strong>Although the implementation of VCs was unplanned, most participants were able to use this modality without much problem. Several GPs initially envisioned long-term VC use. However, despite certain positives, VCs were largely sidelined in favour of face-to-face and telephone consultations, owing to their practicality and VC's limited usefulness when considering the extra effort required. Nonetheless, GPs recognised ways of using VC that might exploit its strengths, but they highlighted how its sustained use would require them to replace other consultation modalities. They also identified extrinsic factors that might lead to the increased use of VC, including improved VC technology and patient demand.</p><p><strong>Conclusion: </strong>Although VC is now part of many GPs' consultation toolboxes, its perceived relative lack of usefulness and extra effort compared with other remote consultation modalities mean that most GPs have chosen to abandon it as a routine consultation modality.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141311846","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 access for inclusion health groups: perspectives and recommendations.","authors":"Aaminah Verity, Victoria Tzortziou Brown","doi":"10.3399/BJGPO.2024.0021","DOIUrl":"10.3399/BJGPO.2024.0021","url":null,"abstract":"<p><strong>Background: </strong>General practice has seen the widespread adoption of remote consulting and triage systems. There is a lack of evidence exploring how inclusion health populations have been impacted by this transformation.</p><p><strong>Aim: </strong>This study aimed to explore the post-pandemic GP access for inclusion health populations, through the lens of those with lived experience, and identify practical recommendations for improving access for this population.</p><p><strong>Design & setting: </strong>A mixed-methods study exploring the direct experience of people from inclusion health groups trying to access GP care in 13 practices in east London.</p><p><strong>Method: </strong>A mystery shopper exercise involving 39 in-person practice visits and 13 phone calls were undertaken. The findings were reflected on by a multidisciplinary stakeholder group, which identified recommendations for improvements.</p><p><strong>Results: </strong>Only 31% of the mystery shopper visits (<i>n</i> = 8) resulted in registration and the offer of an appointment to see a GP for an urgent problem. None of the mystery shoppers was able to book an appointment over the phone but <i>n</i> = 10/13 felt that they would be able to register and make an appointment if they followed the receptionist's instructions. Most mystery shoppers felt respected, listened to, and understood the information provided to them. Just under half of the practices (46%, <i>n</i> = 6) received positive comments on how accessible and supportive their spaces felt. Practice- and system-level recommendations were identified by the stakeholder group.</p><p><strong>Conclusion: </strong>Ongoing GP access issues persist for inclusion health populations. We identified practice- and system-level recommendations for improving access for this vulnerable population.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11523521/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140050567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Lyme disease in UK primary care: a knowledge, attitude and practice survey.","authors":"Lucy Delaney, Amanda Semper, Neil French, John Sp Tulloch","doi":"10.3399/BJGPO.2024.0092","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0092","url":null,"abstract":"<p><strong>Background: </strong>Lyme disease (LD) cases in the UK most commonly present within the primary care setting. Despite an upward trend of incidence, little is known regarding general practitioner (GP) experience with diagnosis and treatment.</p><p><strong>Aim: </strong>This study aims to describe baseline primary care clinician Knowledge, Attitude and Practice (KAP) in Scotland and England.</p><p><strong>Design & setting: </strong>Online KAP survey on Lyme disease for UK based practising GPs.</p><p><strong>Method: </strong>An online KAP questionnaire was developed for use in UK primary care. The survey was distributed through UK based research networks, professional societies and via social media.</p><p><strong>Results: </strong>191 complete responses were analysed (England <i>n</i>=130, Scotland <i>n</i>=61). The Scotland-based respondent group had more relevant consultations in the previous 3 years. Respondents from Scotland demonstrated a greater awareness that erythema migrans (EM) is pathognomonic for Lyme disease and that serological testing of this patient group is not indicated. Less common cardiac and neurological symptoms were not as well associated with Lyme disease by both respondent groups for the former and England-based respondents for the latter. Prescribing according to the National institute for Health and Care Excellence (NICE) guidance was identified in 70% of Scotland and 42% of England-based GP responses.</p><p><strong>Conclusion: </strong>Targeted resources may improve clinician confidence on exposure risk, symptom recognition, testing limitations and treatment dose and duration. Scotland-based respondents' better survey performance potentially reflects greater clinical exposure and public awareness of the disease, due to high endemicity within the nation.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523272","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}