BJGP Open最新文献

{"title":"Evaluation of utilisation and consequences of CRP point-of-care-testing in primary care practices: qualitative interviews with GPs from Germany.","authors":"Paul Jung, Jutta Bleidorn, Susanne Doepfmer, Christoph Heintze, Markus Krause, Lisa Kuempel, Doreen Kuschick, Lena-Sophie Lehmann, Liliana Rost, Kahina J Toutaoui, Florian Wolf","doi":"10.3399/BJGPO.2024.0076","DOIUrl":"10.3399/BJGPO.2024.0076","url":null,"abstract":"<p><strong>Background: </strong>The use and advantages of point-of-care tests (POCTs) for C-reactive protein (CRP) in general practice, especially for upper respiratory tract infections (uRTIs), have been studied extensively. However, there is limited knowledge about test indications, prerequisites, and integration of these tests into everyday practice.</p><p><strong>Aim: </strong>To investigate the attitudes and experiences of GPs in Germany regarding the use of semi-quantitative C-reactive protein point-of-care tests (CRP-POCTs). The study places special emphasis on implementation in routine care, including testing procedures, feasibility, opportunities, and barriers for specific consultation scenarios, as well as test indications and their impact on GP-patient communication.</p><p><strong>Design & setting: </strong>Qualitative interview study with 10 GPs (May 2023-August 2023) in Germany.</p><p><strong>Method: </strong>Ten German GPs who participated in an observational study on CRP-POCT use in general practices were interviewed using semi-structured interviews. Audio-recordings were transcribed and content analysis was performed.</p><p><strong>Results: </strong>Interviewed GPs stated that CRP-POCTs offer several advantages for various treatment cases. The tests improve diagnostic confidence and certainty of GPs' therapeutic decisions, and offer a broad spectrum of indications and application scenarios. Additionally, the tests have a positive impact on GP-patient communication, and their ease of use enables rapid implementation into existing workflows. On the other hand, CRP-POCTs increase the time required for test performance and patient consultation.</p><p><strong>Conclusion: </strong>Owing to the numerous benefits of semi-quantitative CRP-POCTs, interviewed GPs have a favourable attitude towards their regular integration into everyday practice. Implementation barriers include increased time and personnel expenses for testing and inadequate reimbursement by German statutory health insurance.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142308710","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":"Realities of opioid and gabapentinoid deprescribing in socioeconomically disadvantaged communities: a qualitative evaluation.","authors":"Charlotte L Parbery-Clark, Jennie Sofia Portice, Sarah Sowden","doi":"10.3399/BJGPO.2024.0160","DOIUrl":"10.3399/BJGPO.2024.0160","url":null,"abstract":"<p><strong>Background: </strong>Opioid and gabapentinoid prescribing has increased substantially in recent years despite having limited effectiveness in treating chronic primary pain. This is concerning, with the prescribing rates and adverse effects of these medications being higher in more socioeconomically disadvantaged groups. Guidance for prescribing and deprescribing these medications exists but the understanding of how deprescribing is operationalised, especially in areas of socioeconomic disadvantage, is limited.</p><p><strong>Aim: </strong>To explore primary healthcare professionals' views and experiences of designing and implementing an intervention to reduce opioid and gabapentinoid prescribing.</p><p><strong>Design & setting: </strong>A qualitative evaluation, using participant observation and semi-structured interviews with primary healthcare professionals, working in practices serving areas of substantial socioeconomic disadvantage in the North East of England.</p><p><strong>Method: </strong>Interviewees were purposively recruited with subsequent snowballing with participant observation of the peer-support meetings. Interview transcripts and notes from the participant observation were inductively coded and thematically analysed.</p><p><strong>Result: </strong>Thirteen healthcare professionals from five practices were interviewed. Person-centred care with shared decision-making was strived for, which was time-consuming owing to the complexity of the problem and patients. Where shared decision-making was not possible, owing to patient refusal or non-engagement, risk was used to determine the appropriate action. This work involved an emotional toll on staff and patients, but was at times conversely easier and more rewarding than expected. Ultimately, demedicalising pain with a culture change is required to ensure patients are not prescribed these medications for inappropriate reasons or doses.</p><p><strong>Conclusion: </strong>This study demonstrates key operational aspects to consider when undertaking opioid and gabapentinoid deprescribing in primary care, such as funding dedicated time to enable deprescribing.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The BJGP Open Top 10 Most Read Research Articles of 2024: an editorial.","authors":"Alice M Harper, Hajira Dambha-Miller","doi":"10.3399/BJGPO.2025.0047","DOIUrl":"10.3399/BJGPO.2025.0047","url":null,"abstract":"","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjusting primary-care funding by deprivation: a cross-sectional study of Lower layer Super Output Areas in England.","authors":"Ian Holdroyd, Cameron Appel, Efthalia Massou, John Ford","doi":"10.3399/BJGPO.2024.0185","DOIUrl":"10.3399/BJGPO.2024.0185","url":null,"abstract":"<p><strong>Background: </strong>Previous research has called for general practice funding to be adjusted by deprivation data. However, there is no evidence that this adjustment would better meet clinical need.</p><p><strong>Aim: </strong>To assess (1) how accurately the capitation formula (Carr-Hill), and total general practice funding predicts clinical need and (2) whether adjusting by the Index of Multiple Deprivation (IMD) score improves accuracy.</p><p><strong>Design & setting: </strong>A cross-sectional analysis of 32 844 Lower layer Super Output Areas (LSOAs) in England in 2021-2022. Sensitivity analysis used data from 2015-2019.</p><p><strong>Method: </strong>Weighted average Carr-Hill Index (CHI), total general practice funding, and five measures of clinical need were calculated for each LSOA. For both CHI and total funding, four sets of generalised linear models were calculated for each outcome measure: unadjusted; adjusted for age; adjusted for IMD; and adjusted for age and IMD. Adjusted <i>R</i> ² assessed model accuracy.</p><p><strong>Results: </strong>In unadjusted models, CHI was a better predictor than total funding of combined morbidity index (CMI) (<i>R</i> ² = 49.81%, 29.31%, respectively), combined diagnosed and undiagnosed morbidity (<i>R</i> ² = 43.52%, 21.39%) and emergency admissions (<i>R</i> ² = 32.75%, 16.95%). Total funding was a better predictor than CHI of GP appointments per patient (<i>R</i> ² = 28.5%, 22.5%, respectively) and age and sex standardised mortality rates (<i>R</i> ² = 0.42%, 0.37%). Adjusting for age and IMD improved all 10 models (<i>R</i> ² = 62.15%, 53.15%, 48.57%, 38.47%, 40.53%, 32.84%, 29.11%, 34.58%, 25.21%, 25.23%, respectively). All age and IMD adjusted models significantly outperformed age-adjusted models (<i>P</i><0.001). Sensitivity analysis confirmed findings.</p><p><strong>Conclusion: </strong>Adjusting capitation or total funding by IMD would increase funding efficiency, especially for long-term outcomes such as mortality. However, adjusting for IMD without age could have unwanted consequences.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The overlooked challenges facing out-of-hours primary care in the NHS: a missed opportunity in policy.","authors":"Alexandra L Creavin, Sam T Creavin","doi":"10.3399/BJGPO.2024.0292","DOIUrl":"10.3399/BJGPO.2024.0292","url":null,"abstract":"","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143400249","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of women on opioid substitution therapy in primary healthcare in Tshwane (South Africa): a retrospective observational study.","authors":"Daniela S Goeieman, Robert Mash, Natasha R Gloeck, Andrew Scheibe","doi":"10.3399/BJGPO.2024.0049","DOIUrl":"10.3399/BJGPO.2024.0049","url":null,"abstract":"<p><strong>Background: </strong>Women who use drugs face specific challenges compared with men such as higher rates of HIV infection, unsafe injecting practices, and intimate partner violence (IPV). However, this population's access to drug dependence treatment and gender-sensitive interventions remains limited, leading to unmet needs and increased vulnerability.</p><p><strong>Aim: </strong>To investigate the characteristics of and associations with retention in care among women on opioid substitution therapy (OST) in a community-based primary care setting.</p><p><strong>Design & setting: </strong>A descriptive observational study within the Community Orientated Substance Use Programme in Tshwane, South Africa.</p><p><strong>Method: </strong>Data from 199 women (aged <u>></u>18 years) on OST was extracted from an electronic database and paper-based files. Data were analysed descriptively, and inferential analysis looked for association of variables with retention on OST for ≥6 months.</p><p><strong>Results: </strong>The majority of participants were unemployed, with 44.3% aged 20-29 years. During the initiation and course of OST, 39.2% of women had an intimate partner of which 37.2% reported IPV, and 19.2% were pregnant. Retention on OST was significantly associated with increasing age at initiation (<i>P</i> = 0.047), knowledge of HIV status (<i>P</i> = 0.029), an increase in the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) score (<i>P</i> = 0.023), and methadone dose (<i>P</i><0.001). Factors such as race, employment status, health-system level, pregnancy, intimate partner using substances, IPV, route of administering opioids, and having tuberculosis and/or hepatitis C exposure did not show a significant relationship with retention on OST (<i>P</i>>0.05).</p><p><strong>Conclusion: </strong>This study reveals specific vulnerabilities in women receiving OST, emphasising the need for the integration of interventions to address reproductive health, violence mitigation, infectious disease, and polydrug use into care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019038","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":"Potentially inappropriate prescribing in middle-aged adults: a significant problem with a lack of action and evidence to address it.","authors":"Michael Naughton, Frank Moriarty, Patrick Redmond","doi":"10.3399/BJGPO.2023.0209","DOIUrl":"10.3399/BJGPO.2023.0209","url":null,"abstract":"","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733283","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":"Translating in-person care to telehealth: a secondary analysis of GP consultations on musculoskeletal conditions.","authors":"Yifu Li, Simon Chan, Lawrence Lu, Tim M Jackson, Hania Rahimi-Ardabili, Annie Ys Lau","doi":"10.3399/BJGPO.2024.0013","DOIUrl":"10.3399/BJGPO.2024.0013","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic led to a rapid transition to telehealth, particularly in general practice where continuous care for chronic conditions, such as musculoskeletal (MSK), is provided.</p><p><strong>Aim: </strong>To determine the appropriateness of telehealth for MSK conditions by identifying whether in-person tasks can be supported remotely via telehealth.</p><p><strong>Design & setting: </strong>This study is a secondary analysis of the Harnessing Resources from the Internet (HaRI) dataset. This dataset comprises of 281 videos of recorded GP consultations. The dataset includes 10 GPs, across eight separate clinics, and was collected during 2017 in the UK.</p><p><strong>Method: </strong>Content analysis was conducted to identify the clinical tasks, physical examinations, and physical artefacts used during the consultations. A scoring method applying two key metrics was developed to assess the translatability of clinical tasks to telehealth.</p><p><strong>Results: </strong>Across the 31 MSK consultations analysed, 12 clinical tasks, five physical examinations, and 12 physical artefacts were observed. Of clinical tasks, 17% (<i>n</i> = 2/12) were deemed to be 'easily translatable over telehealth' and 50% (<i>n</i> = 6/12) were deemed 'relatively easy to be translated over telehealth'. Only 17% (<i>n</i> = 2/12) of tasks were rated 'moderately translatable over telehealth', and 17% (<i>n</i> = 2/12) were deemed 'potentially translatable over telehealth'. No clinical tasks in this study were categorised as untranslatable to telehealth. The average telehealth translatability score was 7.1/10.</p><p><strong>Conclusion: </strong>Most clinical tasks observed during in-person GP consultations with patients with MSK conditions are translatable to telehealth. Further research is necessary to investigate the long-term efficacy and safety of telehealth utilisation for MSK conditions in primary care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082064","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: a 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 among 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 was undertaken using Microsoft Excel.</p><p><strong>Results: </strong>There were 67 responses from 68 possible ICS and health board areas, representing 99% UK coverage. Twenty-seven per cent 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 <i>n</i> = 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":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","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":"GPs' experience of difficult decisions in people with dementia who have an acute illness: a qualitative, semi-structured interview study.","authors":"Samuel Lassa, Chris Burton, Jon M Dickson","doi":"10.3399/BJGPO.2024.0074","DOIUrl":"10.3399/BJGPO.2024.0074","url":null,"abstract":"<p><strong>Background: </strong>GPs are often required to make decisions about the management of acute illness in people living with dementia. These decisions are often complex and involve multiple informants.</p><p><strong>Aim: </strong>We aimed to explore how GPs made decisions about acute illness in people with dementia using a micropolitics approach.</p><p><strong>Design & setting: </strong>Qualitative, semi-structured interviews with 13 GPs with a range of years of experience working in South Yorkshire, UK.</p><p><strong>Method: </strong>Interviews were conducted by phone. Interviews focused on GPs' accounts to reflect their own perceptions and choices as portrayed to the interviewer. The analysis used the lens of micropolitics in the analysis and interpretation of the themes, with a focus on decisions between GP, patient, family and carers, and other health and social care providers about the management of acute illness in a person with dementia.</p><p><strong>Results: </strong>The results showed that GPs act as street-level bureaucrats while carrying out their role, using discretion during decision-making in an environment characterised by uncertainties and work pressures. In addition, GPs use the 'soft power' skills of diplomacy, such as negotiation, persuasion, and engagement, in navigating difficult decision-making situations, while building relationships and partnerships with various actors in the health system.</p><p><strong>Conclusion: </strong>GPs possess and express power, and influence decision-making in people living with dementia when navigating biomedical, social, and psychological factors. This power comes in the form of soft power (street-level diplomacy) and the more formal power of street-level bureaucracy.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297461","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}