BJGP Open最新文献

{"title":"Impact of vertical integration on patients' use of hospital services in England: an analysis of activity data.","authors":"Catherine Saunders, Charlotte Davies, Manbinder Sidhu, Jon Sussex","doi":"10.3399/BJGPO.2023.0231","DOIUrl":"10.3399/BJGPO.2023.0231","url":null,"abstract":"<p><strong>Background: </strong>Debate surrounding the organisation and sustainability of primary care in England highlights the desirability of a more integrated approach to patient care across all settings. One such approach is 'vertical integration', where a provider of specialist care, such as a hospital, also runs general practices.</p><p><strong>Aim: </strong>To quantify the impact of vertical integration on hospital use in England.</p><p><strong>Design & setting: </strong>Analysis of activity data for NHS hospitals in England between April 2013 and February 2020.</p><p><strong>Method: </strong>Analysis of NHS England data on hospital activity, which looked at the following seven outcome measures: accident and emergency (A&E) department attendances; outpatient attendances; total inpatient admissions; inpatient admissions for ambulatory care sensitive conditions; emergency admissions; emergency readmissions; and length of stay. Rates of hospital use by patients of vertically integrated practices and controls were compared, before and after the former were vertically integrated.</p><p><strong>Results: </strong>In the 2 years after a GP practice changes, for the population registered at that practice, compared with controls, vertical integration is associated with modest reductions in rates of A&E attendances (2% reduction [incidence rate ratio {IRR} 0.98, 95% confidence interval {CI} = 0.96 to 0.99, <i>P</i><0.0001]), outpatient attendances (1% reduction [IRR 0.99, 95% CI = 0.99 to 1.00, <i>P</i> = 0.0061]), emergency inpatient admissions (3% reduction [IRR 0.97, 95% CI = 0.95 to 0.99, <i>P</i> = 0.0062]), and emergency readmissions within 30 days (5% reduction [IRR 0.95, 95% CI = 0.91 to 1.00, <i>P</i> = 0.039]), with no impact on length of stay, overall inpatient admissions, or inpatient admissions for ambulatory care sensitive conditions.</p><p><strong>Conclusion: </strong>Vertical integration is associated with modest reductions in use of some hospital services and no change in others.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404711","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":"GP perceptions of informal peer support in primary care: a qualitative study.","authors":"Aminah Hussan, Maya Satheeskaran, Hajin Dho, Avishek Basu, Yunis Fazaldin, Samir Tariq, Maria Farkas","doi":"10.3399/BJGPO.2023.0151","DOIUrl":"10.3399/BJGPO.2023.0151","url":null,"abstract":"<p><strong>Background: </strong>Burnout is on the rise among GPs in the UK. One approach to mitigating burnout in GPs is through informal peer support (IPS). This refers to GPs informally supporting each other on an informational (advice) and emotional (venting and reflection) basis.</p><p><strong>Aim: </strong>To explore GPs' perceptions of how IPS manifests in the primary care setting and what factors influence effective GP engagement with IPS.</p><p><strong>Design & setting: </strong>A qualitative study utilising semi-structured interviews to develop an in-depth understanding of GPs' perceptions of IPS, based on their experiences in practices across England.</p><p><strong>Method: </strong>Fifteen GPs were purposively sampled to include the views of locum, salaried, and trainee GPs and GP partners. Semi-structured interviews were conducted, recorded, and transcribed verbatim. Transcripts were analysed using inductive thematic analysis.</p><p><strong>Results: </strong>Four types of IPS were identified relating to emotional support, professional advice, sharing of workload, and mentorship, which reflect existing literature. The frequency and efficacy of IPS was found to be influenced by several factors categorised into individual traits, practice culture, and occupation.</p><p><strong>Conclusion: </strong>The results highlight where efforts should be directed to improve GP engagement with IPS. Specifically, GP leaders have an important role in shaping practice culture and fostering an environment for IPS to occur. Practices may also benefit from introducing professional development measures targeted at training GPs to better support each other based on their individual traits.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139479407","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":"Selective serotonin reuptake inhibitors (SSRIs) in women of reproductive age: a systematic review of local formularies.","authors":"Elizabeth Lovegrove, Alice Maidwell-Smith, Beth Stuart, Miriam Santer","doi":"10.3399/BJGPO.2023.0255","DOIUrl":"10.3399/BJGPO.2023.0255","url":null,"abstract":"<p><strong>Background: </strong>Depression is the second most common chronic condition affecting women of reproductive age; 23.4% of women enter pregnancy with depression and use of selective serotonin reuptake inhibitors (SSRIs) in pregnancy is often necessary for maternal wellbeing. However, SSRI use during pregnancy can cause congenital malformations, postpartum haemorrhage (PPH), and persistent pulmonary hypertension of the newborn (PPHN). In UK primary care, prescribing formularies are one medium by which prescribers are provided with local medicines advice.</p><p><strong>Aim: </strong>To review all local prescribing formularies with respect to prescribing SSRIs in women of reproductive age, during pregnancy, and during breastfeeding.</p><p><strong>Design & setting: </strong>A systematic review of prescribing formularies in England and Wales.</p><p><strong>Method: </strong>A systematic keyword search of all clinical commissioning group and Integrated Care Board websites in England and Local Health Board websites in Wales was undertaken between December 2021-22 to identify prescribing formularies. Data were extracted on prescribing guidance for SSRIs.</p><p><strong>Results: </strong>Seventy-four prescribing formularies were reviewed. Of these, 14.9% (<i>n</i> = 11/74) provided links to the Medicines and Healthcare products Regulatory Agency guidance on congenital abnormalities associated with SSRIs, 28.4% (<i>n</i> = 21/74) provided links to guidance on PPH risk, and 1.4% (<i>n</i> = 1/74) provided links to guidance on PPHN. Specific local guidance was given on SSRI prescribing for women of reproductive age, during pregnancy, and during breastfeeding in 12.2% (<i>n</i> = 9/74), 23.0% (<i>n</i> = 17/74), and 21.6% (<i>n</i> = 16/74) of formularies, respectively.</p><p><strong>Conclusion: </strong>Our results suggest that prescribers may be poorly informed by local formularies about the risks of SSRI use around pregnancy. This could place babies at increased risk of unintentional SSRI exposure.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300978/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139563645","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":"Acute cystitis in men- a nationwide study from primary care: antibiotic prescriptions, risk factors, and complications.","authors":"Håkon Sætre, Marius Skow, Ingvild Vik, Sigurd Høye, Louise Emilsson","doi":"10.3399/BJGPO.2023.0207","DOIUrl":"10.3399/BJGPO.2023.0207","url":null,"abstract":"<p><strong>Background: </strong>Research on acute cystitis in men is scarce and treatment guidelines differ between countries. Improved antibiotic stewardship is needed.</p><p><strong>Aim: </strong>To analyse antibiotic prescriptions and outcomes of Norwegian men diagnosed with cystitis in primary care.</p><p><strong>Design & setting: </strong>A nationwide retrospective study was undertaken in primary care in Norway.</p><p><strong>Method: </strong>We identified all episodes of acute cystitis in men diagnosed in Norwegian primary care during 2012-2019. Choice of antibiotic (from the Norwegian Prescription Database), treatment failure, re-prescription, and complications were stratified by age, calendar year, and risk factors. We used logistic regression to explore predefined risk factors (diabetes, prostate cancer, benign prostate hyperplasia [BPH], urinary retention, and any cancer) with complications (pyelonephritis, prostatitis, and hospitalisation) and re-prescriptions. Linear regression was used to explore time trends.</p><p><strong>Results: </strong>In total, 108 994 individuals contributed 148 635 episodes. Narrow-spectrum antibiotics were first-choice treatment in 71.0% of the episodes (52.5% of all prescriptions were pivmecillinam). More than 75% of the episodes with narrow-spectrum versus 82.2% of broad-spectrum treatment did not lead to any re-prescription or complication. Complications occurred in 1.8% of all episodes (0.5% prostatitis, 0.7% pyelonephritis, and 0.7% hospitalisation). BPH was associated with increased risk of complications and re-prescription. Diabetes was associated with a lower risk of re-prescriptions. Prostate cancer and urinary retention were associated with a lower risk of both complications and re-prescriptions.</p><p><strong>Conclusion: </strong>Our results support narrow-spectrum antibiotics as first-line treatment. Risk factor analyses warrants further investigation.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300979/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404709","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":"Gender inequalities across ethnicities in primary care cancer referrals: a scoping review protocol.","authors":"Deepthi Lavu, Adnan Khan, Judit Konya, Tanimola Martins, Sarah Price, Richard Neal","doi":"10.3399/BJGPO.2023.0211","DOIUrl":"10.3399/BJGPO.2023.0211","url":null,"abstract":"<p><strong>Background: </strong>Early cancer diagnosis is associated with improved mortality and morbidity; however, studies indicate that women and individuals from ethnic minorities experience longer times to diagnosis and worse prognosis compared with their counterparts for various cancers. In countries with a gatekeeper healthcare system, such as the UK, most suspected cancer referrals are initiated in primary care.</p><p><strong>Aim: </strong>To understand the extent of evidence available on the relationship between primary care cancer referral pathways and cancer outcomes in relation to gender across different ethnic groups. This will identify research gaps and enable development of strategies to ease potential inequalities in cancer diagnosis.</p><p><strong>Design & setting: </strong>A scoping review of articles written in English, based on the Joanna Briggs Institute methodology. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) will be used.</p><p><strong>Method: </strong>Electronic databases and private collections of the team members will be searched for studies. Two independent reviewers will carry out the study selection and data extraction. Based on Population (or participants), Concept, and Context (PCC) framework, this review will consider studies after year 2000, which explored the relationship between gender, across various ethnic groups, and cancer outcomes, following primary care cancer referral in countries with gatekeeper healthcare systems (UK, New Zealand, Sweden, Australia, Canada, Denmark, Republic of Ireland, and Norway). Results will be presented as a narrative analysis.</p><p><strong>Conclusion: </strong>The results are expected to provide an overview of the discrepancies in primary care cancer referrals based on gender across ethnic groups, which will be crucial to define an appropriate range of strategies to ease any inequalities in primary healthcare cancer diagnosis.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300982/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708100","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":"An evaluation of the social deprivation practice grant in Irish general practice.","authors":"Muireann O Shea, Bridget Kiely, Patrick O'Donnell, Susan M Smith","doi":"10.3399/BJGPO.2023.0195","DOIUrl":"10.3399/BJGPO.2023.0195","url":null,"abstract":"<p><strong>Background: </strong>The inverse care law states that availability of good medical care varies inversely with the need for it in the population served. In 2019, the main medical union and the Department of Health in the Republic of Ireland (RoI), agreed on funding a social deprivation practice grant for general practices in urban deprived areas.</p><p><strong>Aim: </strong>To examine the implementation and impact of the social deprivation practice grant in participating general practices.</p><p><strong>Design & setting: </strong>A mixed-methods study with sequential design based in Irish general practice.</p><p><strong>Method: </strong>Data were collected using a questionnaire and online semi-structured interviews with GPs and practice staff. Data were analysed separately, and the findings compared to examine the extent to which they converged or diverged.</p><p><strong>Results: </strong>There were 25 survey responses and nine interviews. All practices reported the grant was beneficial and most practices utilised the grant to fund additional doctor hours (17/25). Both surveys and interviews indicated that a small amount of additional funding allowed additional clinical need in areas of deprivation to be addressed, but there were some barriers identified in accessing the grant and implementing planned expenditure.</p><p><strong>Conclusion: </strong>Delivery of health care in areas of socioeconomic deprivation presents significant challenges. While there were some problems with implementation, the introduction of a small, targeted grant for general practices in areas of social deprivation allowed those practices to enhance their services, with tailored initiatives seeking to meet the needs of their patient populations.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300971/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139940962","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":"Peripheral artery disease recognition, diagnosis, and management in general practice in the Republic of Ireland and England: an online survey.","authors":"Judit Konya, Sinead Tj McDonagh, Peter Hayes, Sebastian Debus, Victor Aboyans, Christopher E Clark","doi":"10.3399/BJGPO.2023.0150","DOIUrl":"10.3399/BJGPO.2023.0150","url":null,"abstract":"<p><strong>Background: </strong>Peripheral artery disease (PAD) is common and associated with future cardiovascular events. PAD is underdiagnosed, which limits opportunities to address secondary prevention of cardiovascular disease. It is unknown how closely guidelines for detection of PAD are followed in primary care.</p><p><strong>Aim: </strong>To survey GPs' attitudes to diagnosis and follow-up of patients with PAD.</p><p><strong>Design & setting: </strong>Online survey of GPs in England and the Republic of Ireland (RoI).</p><p><strong>Method: </strong>GPs' approaches to management of PAD were assessed using likelihood ratings (scales of 0-10) and discrete questions. Findings were summarised as proportions, or median and interquartile ranges (IQR).</p><p><strong>Results: </strong>In total, 111 responses were analysed; 68 (61%) from England and 43 (39%) from the RoI. Considering a hypothetical patient at risk of PAD, likelihood of GPs enquiring about PAD symptoms (leg pains: 3/10 or erectile dysfunction: 2/10) was low. GPs in the RoI compared with GPs in England more often examined the heart (10/10 versus 7/10) or carotid vessels (5/10 versus 1/10). Lower limb pulses were palpated in response to symptoms or signs of PAD. In England 25% of practitioners, and in the RoI 55% of practitioners, reported that they do not measure ankle-brachial index (ABI).</p><p><strong>Conclusion: </strong>Currently, detection of PAD is generally triggered by 'classical' leg claudication symptoms, while known vascular risk factors appear to elicit little consideration. ABI measurement is not performed by many practitioners, suggesting that a proportion of vascular referrals must be based on history and examination findings alone. Opportunities to recognise PAD are missed.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300980/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140029194","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":"The commercial determinants of health in Ireland: fueling an industrial epidemic at home and abroad.","authors":"Mélissa Mialon, James Larkin, Clare Patton, Mimi Tatlow-Golden, Kathryn Reilly, Paula Leonard, Malvina Walsh, Norah Campbell","doi":"10.3399/BJGPO.2024.0029","DOIUrl":"10.3399/BJGPO.2024.0029","url":null,"abstract":"","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300973/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870109","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":"Barriers, enablers, benefits, and drawbacks to point-of-care testing: a survey of the general practice out-of-hours service in Scotland.","authors":"Sarah Ee Mills, Sm Babar Akbar, Virginia Hernandez-Santiago","doi":"10.3399/BJGPO.2023.0094","DOIUrl":"10.3399/BJGPO.2023.0094","url":null,"abstract":"<p><strong>Background: </strong>The general practice out-of-hours (GPOOH) service is under pressure to treat more patients in less time, while reducing referrals and minimising diagnostic errors. Point-of-care (POC) testing involves rapid clinical tests that can be used to generate results during the consultation, and has the potential to facilitate managing these competing demands safely.</p><p><strong>Aim: </strong>To describe current availability of POC tests in GPOOH in Scotland, and identify barriers, enablers, benefits, and drawbacks to its use.</p><p><strong>Design & setting: </strong>Cross-sectional mixed-methods study, which surveyed opinions of clinicians working in the GPOOH service in NHS Scotland.</p><p><strong>Method: </strong>An electronic questionnaire was developed, designed, piloted, and distributed to clinicians, which had closed questions and areas for free text.</p><p><strong>Results: </strong>In total, 142 responses were received. Urine dipstick testing (99.2%), pregnancy tests (98.5%), oxygen saturation (97.7%), and blood glucose testing (93.9%), were the only POC tests commonly available in GPOOH in NHS Scotland. There was strongest support for the provision of POC tests, particularly C-reactive protein (CRP; 79.4%), strep A (76.0%), and D-dimer (75.2%). Responders felt that POC tests would improve confidence (92.3%) and safety (89.8%) surrounding clinical decision making, improve patient satisfaction (80.6%), and reduce hospital and secondary care referrals (77.5%). Barriers to POC test use were availability of the test kits and machines (94.5%), training requirements on how to use the machine (71.1%) and interpret results (56.3%), and time to do the test (62.0%).</p><p><strong>Conclusion: </strong>Few POC tests are in regular use in GPOOH in Scotland. GPOOH clinicians are supportive of using POC testing. They identified a number of benefits to its use, with very few drawbacks. Increased provision of POC testing in GPOOH in NHS Scotland should be considered urgently.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300988/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138810025","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":"GPs' views on emergency care treatment plans: an online survey.","authors":"Martin Underwood, Angela Noufaily, Hazel Blanchard, Jeremy Dale, Jenny Harlock, Paramjit Gill, Frances Griffiths, Rachel Spencer, Anne-Marie Slowther","doi":"10.3399/BJGPO.2023.0192","DOIUrl":"10.3399/BJGPO.2023.0192","url":null,"abstract":"<p><strong>Background: </strong>A holistic approach to emergency care treatment planning is needed to ensure that patients' preferences are considered should their clinical condition deteriorate. To address this, emergency care and treatment plans (ECTPs) have been introduced. Little is known about their use in general practice.</p><p><strong>Aim: </strong>To find out GPs' experiences of, and views on, using ECTPs.</p><p><strong>Design & setting: </strong>Online survey of GPs practising in England.</p><p><strong>Method: </strong>A total of 841 GPs were surveyed using the monthly online survey provided by medeConnect, a market research company.</p><p><strong>Results: </strong>Forty-one per cent of responders' practices used Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) plans for ECTP, 8% used other ECTPs, and 51% used Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) forms. GPs were the predominant professional group completing ECTPs in the community. There was broad support for a wider range of community-based health and social care professionals being able to complete ECTPs. There was no system for reviewing ECTPs in 20% of responders' practices. When compared with using a DNACPR form, GPs using a ReSPECT form for ECTP were more comfortable having conversations about emergency care treatment with patients (odds ratio [OR] = 1.72, 95% confidence interval [CI] = 1.1 to 2.69) and family members (OR =1.85, 95% CI = 1.19 to 2.87).</p><p><strong>Conclusion: </strong>The potential benefits and challenges of widening the pool of health and social care professionals initiating and/or completing the ECTP process needs consideration. ReSPECT plans appear to make GPs more comfortable with ECTP discussions, supporting their implementation. Practice-based systems for reviewing ECTP decisions should be strengthened.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139404710","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}