BJGP Open最新文献

{"title":"Outcomes for older people with screening-detected versus existing chronic kidney disease: a cohort study with data linkage.","authors":"Anna K Forbes, José M Ordóñez-Mena, Winnie Mei, Clare J Taylor, Nicholas Jones, Jennifer A Hirst, Fd Richard Hobbs","doi":"10.3399/BJGPO.2024.0123","DOIUrl":"10.3399/BJGPO.2024.0123","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is a common health problem associated with increased risk of cardiovascular disease (CVD), end-stage kidney disease (ESKD), and premature death. It is estimated that one-third of people aged ≥70 years have CKD globally, many of whom are undiagnosed, but little is known about the value of screening.</p><p><strong>Aim: </strong>To compare the risk of adverse health outcomes between people with an existing diagnosis of CKD and those identified through screening, and identify factors associated with mortality in CKD.</p><p><strong>Design & setting: </strong>Prospective cohort study of 892 primary care patients aged ≥60 years with CKD (existing and screening detected) in Oxfordshire, with data linkage to civil death registry and secondary care.</p><p><strong>Method: </strong>Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox proportional hazard models to compare the risk of all-cause mortality, hospitalisation, CVD, ESKD separately, and as a composite between CKD groups, as well as to identify factors associated with mortality.</p><p><strong>Results: </strong>After a median follow-up of 3-5 years, 49 people died, 512 were hospitalised, 78 had an incident CVD event, and none had an ESKD event. There was no difference in the composite outcome between those with existing CKD and those identified through screening (HR 0.94, 95% CI = 0.67 to 1.33). Older age (HR 1.10, 95% CI = 1.06 to 1.15), male sex (HR 2.31, 95% CI = 1.26 to 4.24), and heart failure (HR 5.18, 95% CI = 2.45 to 10.97) were associated with increased risk of death.</p><p><strong>Conclusion: </strong>Screening older people for CKD may be of value, as their risk of short-term mortality, hospitalisation, and CVD is comparable with people routinely diagnosed. Larger studies with longer follow-up in more diverse and representative populations of older adults are needed to corroborate these findings.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297463","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":"Treating the perimenopause in the UK Armed Forces: a mixed-methods review exploring the confidence of GPs.","authors":"Antony Sean Willman, Kate King","doi":"10.3399/BJGPO.2024.0088","DOIUrl":"10.3399/BJGPO.2024.0088","url":null,"abstract":"<p><strong>Background: </strong>Access to high quality perimenopause (PMP) care for UK Armed Forces (UKAF) personnel is crucial, given the increasing proportion of women aged 40-55 in the service. However, owing to the lack of exposure of GPs to the PMP in defence primary health care (DPHC), there are concerns about the confidence in PMP management, particularly in prescribing hormone replacement therapy (HRT).</p><p><strong>Aim: </strong>To assess the confidence of GPs working in DPHC in the management of the PMP.</p><p><strong>Design & setting: </strong>This study employed a mixed-methods approach and included all GPs (uniformed and civilian) working in DPHC.</p><p><strong>Method: </strong>A cross-sectional survey gathered quantitative data on demographics, views on PMP care, and self-rated confidence levels in managing the PMP among defence GPs (DGPs). Semi-structured interviews of purposefully sampled responders were thematically analysed to explore these issues further.</p><p><strong>Results: </strong>There were 164 responses from 542 DGPs (response rate 30.3%). The majority of responders expressed confidence in managing the PMP but reported lower confidence levels in prescribing HRT for younger women and initiating testosterone. Factors influencing confidence included recent PMP continuing professional development (CPD), GP sex, and exposure to PMP cases. Semi-structured interviews provided deeper insights into GP characteristics, CPD, and awareness of the PMP. Women's health hubs providing PMP care and experiential education were strongly supported.</p><p><strong>Conclusion: </strong>The study identified gaps in confidence among DGPs, particularly in certain aspects of PMP management, similar to those found in NHS GPs. CPD and case exposure were important predictors of confidence, with strong support for regional women's health hubs to optimise PMP care. Further research is warranted to explore strategies for bridging confidence gaps and improving PMP care delivery within the UKAF context.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584531","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":"Patient experiences of remote consulting with chronic fatigue syndrome/myalgic encephalomyelitis and fibromyalgia: a qualitative study.","authors":"Helen Leach, Abi Eccles, Carolyn A Chew-Graham, Helen Atherton","doi":"10.3399/BJGPO.2024.0079","DOIUrl":"10.3399/BJGPO.2024.0079","url":null,"abstract":"<p><strong>Background: </strong>Remote and digital consulting in primary care has rapidly expanded since March 2020. It is important to understand patient experiences, particularly for those living with complex long-term conditions, to identify how care can best be delivered, including within the remote space.</p><p><strong>Aim: </strong>To explore the experiences of people living with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) and fibromyalgia when consulting remotely in primary care.</p><p><strong>Design & setting: </strong>Semi-structured interviews with patients living with CFS/ME and fibromyalgia in general practice in England.</p><p><strong>Method: </strong>Semi-structured interviews were carried out with 13 participants. The interviews were transcribed and analysed thematically according to a Foucauldian theoretical framework.</p><p><strong>Results: </strong>All participants highlighted needing to feel believed by clinicians. Many reported difficulties with telephone and online consulting owing to the lack of physical communication. Positive outcomes were reported when there was a good relationship with a clinician. Continuity in care and recognising the complexity of these conditions were also considered important.</p><p><strong>Conclusion: </strong>This study allowed people living with CFS/ME and fibromyalgia to describe their experiences when consulting remotely. Participants highlighted needing to feel listened to and felt they benefited from an ongoing relationship with a clinician although this was difficult to achieve when consulting remotely. Some advantages of remote consulting were reported, particularly when symptoms were troublesome. Flexible access systems, with a range of consultation modalities or preferred clinician(s) availability, could improve healthcare encounters, particularly given the increased use of remote consulting in primary care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082062","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":"De-labelling erroneous penicillin allergy records in general practice: healthcare professionals' experiences.","authors":"Caity Roleston, Marta Santillo, Kelsey F Armitage, Catherine E Porter, Shadia Ahmed, Joanne Fielding, Marta Wanat, Christopher C Butler, Sue Pavitt, Jonathan At Sandoe, Sarah Tonkin-Crine","doi":"10.3399/BJGPO.2024.0119","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0119","url":null,"abstract":"<p><strong>Background: </strong>Penicillin allergy (PenA) prevalence is approximately 6%, but fewer than 10% of these people are expected to be truly allergic. Consequently, a significant proportion of the population are prescribed alternative antibiotics with potential increased risk of acquiring multi-drug resistant bacteria and worse health outcomes. The ALABAMA trial aimed to determine if a penicillin allergy assessment pathway (PAAP) initiated in primary care, is effective in de-labelling erroneous records, improving antibiotic prescribing and patient outcomes.</p><p><strong>Aim: </strong>To investigate healthcare professionals' experiences of the ALABAMA trial.</p><p><strong>Design & setting: </strong>Qualitative study using semi-structured interviews in general practice in England.</p><p><strong>Method: </strong>Semi-structured interviews were conducted with healthcare professionals (including general practitioners, research nurses, pharmacists) who delivered the trial. Interviews explored their views about de-labelling incorrect PenA records, their role(s) in the trial, and, where relevant, their experience of prescribing following de-labelling.</p><p><strong>Results: </strong>Healthcare professionals (<i>n</i>=18) believed many patients were incorrectly labelled PenA and were aware of the individual and public health risks this posed. However, GPs explained labels were rarely challenged in general practice because the perceived risks to patients and their professionalism were too great. The PAAP intervention, alongside the 'protocolisation' within the ALABAMA trial, was successful at mitigating these risks. Consequently, the trial was well-accepted and commended by healthcare professionals.</p><p><strong>Conclusions: </strong>GPs welcomed and accepted the PAAP as a means of correcting erroneous PenA records. There is great potential for PAAP to be supported in primary care if testing becomes more accessible.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469366","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General practice specialty decision-making: a system-level Australian qualitative study.","authors":"Faith R Yong, Priya Martin, Katharine A Wallis, Jordan Fox, Sneha Kirubakaran, Riitta L Partanen, Srinivas Kondalsamy-Chennakesavan, Matthew R McGrail","doi":"10.3399/BJGPO.2024.0218","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0218","url":null,"abstract":"<p><strong>Background: </strong>Ensuring sufficient supply of general practitioners (GPs) is critical for servicing increasing healthcare demands. Heightened by pandemic conditions, chronic shortages of GPs persist globally. Whilst many factors reinforcing general practice specialty choices are known, system-level understanding of GP career decision-making influences across medical training requires investigation.</p><p><strong>Aim: </strong>To explore specialty choice rationales through career selection narratives of recently registered Australian GPs, using a system-level perspective.</p><p><strong>Design & setting: </strong>Semi-structured interviews were selected for in-depth explorations of GP specialty choice rationale. Within Australia, medical specialty training choices are typically made after both university medical education and mandatory one-to-two year prevocational (hospital-based) training is completed.</p><p><strong>Method: </strong>Interviews were conducted online with GPs who had completed all training in the last 10 years. De-identified and verified transcripts underwent participant checking. Deductive framework analysis using career counselling constructs, and inductive thematic analysis were performed.</p><p><strong>Results: </strong>There were 25 participants. Career counselling constructs provided system-level understanding of GP specialty decision-making processes. Large gaps in GP career information were highlighted throughout medical training for many participants. Overcoming negative medical narratives about general practice was necessary for most in choosing a GP career. However, positive experiences with GP communities or work created insights into the broad flexibility of GP person-specialty fit.</p><p><strong>Conclusion: </strong>GP work experiences and personal GP connections could counteract prominent negative narratives about GP careers. However, lack of systemic and regular exposure to GPs throughout medical training is a critical barrier that should be addressed through sustained policy and professional interventions.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469387","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":"Sex differences in the prescription of anti-hypertensive medications in primary care patients.","authors":"Elisa Dal Canto, Sophie L Theunisse, Michiel L Bots, Frans Rutten, Marion Biermans, N Charlotte Onland-Moret, Wilko Spiering, Birsen Kiliç, Hester M Den Ruijter, Monika Hollander","doi":"10.3399/BJGPO.2024.0116","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0116","url":null,"abstract":"<p><strong>Background: </strong>Pharmacological prescription guidelines for hypertension lack differentiation between the sexes, despite reported sex differences in prevalence, awareness, pathophysiology and pharmacological response.</p><p><strong>Aim: </strong>We aimed to assess prescription patterns of blood pressure lowering medication among women and men in primary care.</p><p><strong>Design & setting: </strong>We analysed data collected in 2018 during routine primary care practice among those pharmacologically treated for elevated blood pressure, and free from cardiovascular comorbidities or diabetes mellitus.</p><p><strong>Method: </strong>We assessed sex differences in the number of prescribed drugs, defined daily dosage, type of antihypertensive medication, and blood pressure control. We adjusted for differences between sexes in age and other covariates.</p><p><strong>Results: </strong>This observational study included 8596 women and 5788 men. Both women and men were prescribed on average 1.8 antihypertensive agents per person. Women compared to men were prescribed a significantly lower defined daily dosage (1.8 vs 2.1, <i>P</i><0.001), received more often betablockers (35.4% vs 26.3%, <i>P</i><0.001) and diuretics (53.7% vs 50.5%, <i>P</i><0.001), while receiving fewer ACE-inhibitors (35.4% vs 46.3%, <i>P</i><0.001) and calcium channel blockers (28.5% vs 35.6%, <i>P</i><0.001). No sex differences were found for angiotensin receptor blockers (24.3 vs. 24.4%, <i>P</i>=0.842). Importantly, women had significantly better controlled hypertension than men (50.2% vs 45.5%, <i>P</i><0.001).</p><p><strong>Conclusion: </strong>In those pharmacologically treated for elevated blood pressure, differences between women and men exist in defined daily dosage, type of antihypertensive medication, and blood pressure control, with women achieving better hypertension control than men with different type of medication and lower dosage.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469391","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":"Consultation frequency patterns for older patients in Danish general practice.","authors":"Jonas Korsholm Olsen, Sonja Wehberg, Frans Boch Waldorff, Daniel Pilsgaard Henriksen, Jesper Lykkegaard","doi":"10.3399/BJGPO.2024.0234","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0234","url":null,"abstract":"<p><strong>Background: </strong>There may be distinctly different ways for general practices to serve the growing population of older patients, providing them different combinations of face-to-face-, telephone-, and e-mail consultations, home visits, and chronic care reviews.</p><p><strong>Aim: </strong>To identify latent general practice profiles of frequency and combination of consultation types for older patients and relate them to practice characteristics.</p><p><strong>Design & setting: </strong>Register-based cohort study of all Danish citizens aged≥75 years.</p><p><strong>Method: </strong>For each of the years 2017-2021, a latent profile analysis was conducted on the practices' frequencies of consultation types adjusting for patient population characteristics.</p><p><strong>Results: </strong>We identified a \"Majority\" and three temporary latent profiles of provision of consultation services to older patients: The \"Phone heavy\" profile (8-10% of practices, 2017-2019) providing nearly double the telephone consultations as the \"Majority\" profile and was associated with the general practitioners being older and working singlehanded, the \"High frequency\" profile (12-14% of practices, 2017-2018) providing higher levels of face-to-face, telephone, and e-mail consultations than the \"Majority\" profile, and the \"Phone and e-mail heavy\" profile (7% of practices, 2020) providing more e-mail than face-to-face consultations, and more of each consultation than the \"Majority\" profile. The number of profiles decreased from 3 in 2017 to only the \"Majority\" profile 2021.</p><p><strong>Conclusion: </strong>There is a trend towards a more uniform pattern of consultations for older patients in general practice. It is unknown whether high provision of certain types of consultations in general practice has downstream effects, such as decreased need for hospital- and out-of-hours services.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143469447","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":"Sex differences and trends in managing cardiovascular risk factors in primary care: a dynamic cohort study.","authors":"Geert Smits, Michiel L Bots, Monika Hollander, Sander van Doorn","doi":"10.3399/BJGPO.2024.0175","DOIUrl":"10.3399/BJGPO.2024.0175","url":null,"abstract":"<p><strong>Background: </strong>Treatment targets for cardiovascular risk management (CVRM) make no distinction between women and men.</p><p><strong>Aim: </strong>To explore sex differences in achieving treatment targets in patients who participated in a nurse-led, integrated CVRM care programme in primary care between 2013 and 2019.</p><p><strong>Design & setting: </strong>We conducted a dynamic cohort study in the Eindhoven region, which is the south-eastern part of the Netherlands.</p><p><strong>Method: </strong>We assessed outcomes of three biological risk factors (systolic blood pressure [SBP], low-density lipoprotein [LDL] cholesterol, and estimated glomerular filtration rate [eGFR]) and four lifestyle factors (smoking, physical activity, alcohol intake, and body mass index [BMI]). Points (1 = on target; 0 = not on target) were assigned for biological risk factors, lifestyle factors, and an overall score. Using the annual results, we applied multivariable regression models to study trends over time and differences in trends between women and men.</p><p><strong>Results: </strong>The number of participants increased from 24,889 to 38,067, mean age increased from 67.3 years to 71.5 years, with around 52 % women each year. The average of seven risk factors on target increased significantly from 4.6 to 4.9 in women, and from 4.7 to 5.0 in men, with no statistical difference between women and men. Differences between women and men in 2013 in the number of both biological and lifestyle factors on target did not materially change over time.</p><p><strong>Conclusion: </strong>Integrated cardiovascular management care led to improvements in cardiovascular risk factors on target, equally well in women than in men. Differences in risk factors on target between women and men in 2013 were still present in 2019.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093871","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":"Diagnostic information in GP referral letters to a memory clinic: a retrospective cohort study.","authors":"Demi Ronner, Dorien Oostra, Jurgen Claassen, Edo Richard, Marieke Perry","doi":"10.3399/BJGPO.2024.0065","DOIUrl":"10.3399/BJGPO.2024.0065","url":null,"abstract":"<p><strong>Background: </strong>Dementia diagnostics can often be performed in primary care, yet older people with memory complaints are frequently referred to memory clinics (MCs).</p><p><strong>Aim: </strong>To compare diagnostic information in GP referral letters of patients with and without an eventual dementia diagnosis.</p><p><strong>Design & setting: </strong>Retrospective cohort study in a Dutch academic MC.</p><p><strong>Method: </strong>We collected electronic health record (EHR) data of consecutive patients aged ≥65 years referred by their GP between 2016 and 2020. EHR data included patient characteristics, diagnostic information in referral letters, ancillary investigations performed at the MC, and established diagnoses. We performed χ² tests to compare groups.</p><p><strong>Results: </strong>Of 651 patients included, the average age was 78.0 years (standard deviation 6.8) and 348 (53.5%) were diagnosed with dementia. Most people with dementia were diagnosed without ancillary investigations (<i>n</i> = 235/348, 67.5%). In GP referral letters of people with dementia compared with people without dementia, a collateral history, any physical examination, a differential diagnosis including dementia, a Mini-Mental State Examination score, interference with daily functioning, and decline from previous levels of functioning were mentioned more often. Furthermore, the more diagnostic criteria mentioned in the referral letter, the more often dementia was diagnosed at the MC (no criteria: 35.4%; one criterion: 47.3%; two criteria: 53.4%; three criteria: 69.9%; and four or five criteria: 83.3%).</p><p><strong>Conclusion: </strong>GPs often correctly mention diagnostic information and dementia criteria in referral letters of people with dementia, and they are often diagnosed without ancillary investigations. This suggests that referral is often unnecessary, and GPs can be empowered to diagnose dementia themselves.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019039","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":"Action on elevated natriuretic peptide in primary care: a retrospective cohort study.","authors":"Cornelia Jc Vermeer, Monika Hollander, Anne Jm Stolk, Amy Groenewegen, Geert-Jan Geersing, Frans H Rutten, Huberta E Hart","doi":"10.3399/BJGPO.2024.0017","DOIUrl":"10.3399/BJGPO.2024.0017","url":null,"abstract":"<p><strong>Background: </strong>Natriuretic peptides (NPs) are released by increased ventricular wall stress, most often caused by heart failure (HF). NP level measurement helps select patients clinically suspected of HF who need echocardiography. Yet, the diagnostic actions following NP testing in daily primary care are poorly studied.</p><p><strong>Aim: </strong>To assess the diagnostic actions taken by GPs in patients with an elevated NP level.</p><p><strong>Design & setting: </strong>Retrospective observational study in general practices in The Netherlands.</p><p><strong>Method: </strong>In patients with an elevated NP level between July 2017 and July 2022, diagnostic actions were collected during 3 months following NP testing. We compared patients with an elevated NP level referred for echocardiography with those not referred by univariable analyses.</p><p><strong>Results: </strong>Among 902 patients, 394 (43.7%) had an elevated NP level. Median age was 75.0 (interquartile range [IQR] 18.0) years; 68.8% were female. In total, 166 (42.1%) were referred for echocardiography and 114 (28.9%) underwent additional electrocardiogram (ECG) recording. In total, <i>n</i> = 30/166 (18.1%) referred patients were labelled HF by the cardiologist within 3 months after NP testing compared with <i>n</i> = 29/228 (12.7%) not referred. Referred patients were compared with those not referred and they were found to be younger (69.7 versus 74.1 years, <i>P</i><0.001), were less often known to cardiologists (45.8% versus 62.3%, <i>P</i> = 0.002), and they had lower marginally elevated B-type natriuretic peptide (BNP) levels (35-50 pg/ml) (19.3% versus 36.6%, <i>P</i><0.001).</p><p><strong>Conclusion: </strong>Three out of five patients with an elevated NP level are not referred for echocardiography by GPs. Barriers to refer patients were older age, a marginally elevated BNP value, and already being under supervision of a cardiologist.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142134111","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}