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Emergency admission Predictive RIsk Stratification Models: Assessment of Implementation Consequences (PRISMATIC 2): a protocol for a mixed-methods study. 急诊入院预测风险分层模型:实施后果评估(PRISMATIC 2):混合方法研究协议。
IF 2.5
BJGP Open Pub Date : 2025-02-25 DOI: 10.3399/BJGPO.2024.0182
Mark Kingston, Helen Snooks, Alan Watkins, Christopher Burton, Jeremy Dale, Jan Davies, Alex Dearden, Bridie Evans, Bárbara Santos Gomes, Jenna Jones, Rashmi Kumar, Alison Porter, Bernadette Sewell, Emma Wallace
{"title":"Emergency admission Predictive RIsk Stratification Models: Assessment of Implementation Consequences (PRISMATIC 2): a protocol for a mixed-methods study.","authors":"Mark Kingston, Helen Snooks, Alan Watkins, Christopher Burton, Jeremy Dale, Jan Davies, Alex Dearden, Bridie Evans, Bárbara Santos Gomes, Jenna Jones, Rashmi Kumar, Alison Porter, Bernadette Sewell, Emma Wallace","doi":"10.3399/BJGPO.2024.0182","DOIUrl":"10.3399/BJGPO.2024.0182","url":null,"abstract":"<p><strong>Background: </strong>Emergency admissions are costly, increasingly numerous, and associated with adverse patient outcomes. Policy responses have included the widespread introduction of emergency admission risk stratification (EARS) tools in primary care. These tools generate scores that predict patients' risk of emergency hospital admission and can be used to support targeted approaches to improve care and reduce admissions. However, the impact of EARS is poorly understood and there may be unintended consequences.</p><p><strong>Aim: </strong>To assess effects, mechanisms, costs, and patient and healthcare professionals' views related to the introduction of EARS tools in England.</p><p><strong>Design & setting: </strong>Quasi-experimental mixed-methods design using anonymised routine data and qualitative methods.</p><p><strong>Method: </strong>We will apply multiple interrupted time-series analysis to data, aggregated at former clinical commissioning group (CCG) level, to look at changes in emergency admission and other healthcare use following EARS introduction across England. We will investigate GP decision making at practice level using linked general practice and secondary care data to compare case-mix, demographics, indicators of condition severity, and frailty associated with emergency admissions before and after EARS introduction. We will undertake interviews (approximately 48) with GPs and healthcare staff to understand how patient care may have changed. We will conduct focus groups (<i>n</i> = 2) and interviews (approximately 16) with patients to explore how they perceive that communication of individual risk scores might affect their experiences and health-seeking behaviours.</p><p><strong>Conclusion: </strong>Findings will provide policymakers, healthcare professionals, and patients, with a better understanding of the effects, costs, and stakeholder perspectives related to the introduction of EARS tools.</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":"142297459","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}
引用次数: 0
GPs' experience of difficult decisions in people with dementia who have an acute illness: a qualitative, semi-structured interview study. 全科医生在为痴呆症和急性病患者做出艰难决定时的经验。
IF 2.5
BJGP Open Pub Date : 2025-02-25 DOI: 10.3399/BJGPO.2024.0074
Samuel Lassa, Chris Burton, Jon M Dickson
{"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":"2025-02-25","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}
引用次数: 0
Continuity within a community integrated palliative care model and the influence of remote and digital approaches to care: a qualitative interview study. 一项定性访谈研究,探讨社区综合姑息关怀模式的连续性以及远程和数字化关怀方式的影响。
IF 2.5
BJGP Open Pub Date : 2025-02-25 DOI: 10.3399/BJGPO.2024.0126
Emma Ladds, Malaika Ivey, Katrina Gadsby, Elin Preest, Ffion Samuels, Victoria Bradley
{"title":"Continuity within a community integrated palliative care model and the influence of remote and digital approaches to care: a qualitative interview study.","authors":"Emma Ladds, Malaika Ivey, Katrina Gadsby, Elin Preest, Ffion Samuels, Victoria Bradley","doi":"10.3399/BJGPO.2024.0126","DOIUrl":"10.3399/BJGPO.2024.0126","url":null,"abstract":"<p><strong>Background: </strong>Demand for palliative care is rising. Recent UK policy approaches promote integrated care models - collaborations between GPs and multidisciplinary specialists - and remote and digital practices. The extent to which different forms of continuity are supported within this evolving context is currently unclear.</p><p><strong>Aim: </strong>To explore the experience of continuity and impact of remote and digital practices within an integrated palliative care model.</p><p><strong>Design & setting: </strong>A qualitative interview study of patients and bereaved relatives recruited from a GP practice list and healthcare professionals delivering the integrated palliative care service for that population.</p><p><strong>Method: </strong>Twenty narrative and semi-structured interviews were conducted with 22 patients, relatives, and professionals between May 2022 and November 2023. They explored how care was delivered or received, focusing on coherency and the use of remote and digital practices. Data were theorised using a novel framework that considered psychodynamic, biomedical, sociotechnical, and sociopolitical domains of continuity.</p><p><strong>Results: </strong>The need for human care and connection were of primary importance and affected by intersubjective, biomedical, sociotechnical, and sociopolitical factors that influenced continuity of care. Despite the logistical ease of remote and digital practices, professionals had to work harder or around technologies to provide a 'caring' service. This was exacerbated by a lack of co-localisation, loss of longitudinal relationships, and reduction in tacit knowledge.</p><p><strong>Conclusion: </strong>Numerous complex factors and the exacerbating effects of remote and digital practices influence continuity and coherency within an integrated palliative care model.</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":"142308709","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}
引用次数: 0
Translating primary care to telehealth: analysis of in-person paediatric consultations and role of carers. 将初级保健转化为远程保健:分析儿科面对面咨询和护理人员的作用。
IF 2.5
BJGP Open Pub Date : 2025-02-25 DOI: 10.3399/BJGPO.2024.0030
Simon Chan, Tasneem Khandaker, Yifu Li, Tim M Jackson, Hania Rahimi-Ardabili, Annie Ys Lau
{"title":"Translating primary care to telehealth: analysis of in-person paediatric consultations and role of carers.","authors":"Simon Chan, Tasneem Khandaker, Yifu Li, Tim M Jackson, Hania Rahimi-Ardabili, Annie Ys Lau","doi":"10.3399/BJGPO.2024.0030","DOIUrl":"10.3399/BJGPO.2024.0030","url":null,"abstract":"<p><strong>Background: </strong>The usage of telehealth in general practice has risen substantially since the COVID-19 pandemic. Over this time frame, telehealth has provided care for all patient demographics, including the paediatric population (aged ≤18 years). However, the translatability of telehealth (that is, whether in-person tasks can be supported remotely via telehealth) rarely considers the paediatric population or their carers.</p><p><strong>Aim: </strong>To examine the degree of translatability to telehealth for in-person GP consultations on paediatric patients with consideration of the carers' roles.</p><p><strong>Design & setting: </strong>This study screened 281 videos of in-person GP consultations set within UK general practices, and 20 of them were eligible for analysis.</p><p><strong>Method: </strong>A secondary analysis of in-person GP consultations was undertaken to examine tasks, physical artefacts, examinations, and the interaction between carer, patient, and GP. A novel scoring method revolving around two key metrics, taking into consideration the carer, was designed to analyse whether the tasks performed can be supported via telehealth.</p><p><strong>Results: </strong>Analysis of 20 eligible consultations revealed 13 distinct physical examinations, 19 physical artefacts, and 17 clinical tasks. Of these 17 clinical tasks, 41% were deemed 'easily translatable to telehealth,' 29% 'moderately translatable with patient-provided equipment', 12% 'potentially translatable', and 18% 'currently untranslatable'. The average telehealth translatability score was 6.1/10, which suggests possible challenges with telehealth support. Regarding carer involvement, 90% of consultations involved collecting patient history, 70% placation of child, and 40% had physical support during examinations.</p><p><strong>Conclusion: </strong>Tasks performed during paediatric in-person GP consultations may not be easily translatable to telehealth and caution should be exercised when considering their translatability to telehealth.</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":"142565119","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}
引用次数: 0
Outcomes for older people with screening-detected versus existing chronic kidney disease: a cohort study with data linkage. 筛查出患有慢性肾脏病的老年人与患有慢性肾脏病的老年人的治疗效果:带有数据链接的队列研究。
IF 2.5
BJGP Open Pub Date : 2025-02-25 DOI: 10.3399/BJGPO.2024.0123
Anna K Forbes, José M Ordóñez-Mena, Winnie Mei, Clare J Taylor, Nicholas Jones, Jennifer A Hirst, Fd Richard Hobbs
{"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}
引用次数: 0
Treating the perimenopause in the UK Armed Forces: a mixed-methods review exploring the confidence of GPs. 英国武装部队中的围绝经期治疗:探索全科医生信心的混合方法综述。
IF 2.5
BJGP Open Pub Date : 2025-02-25 DOI: 10.3399/BJGPO.2024.0088
Antony Sean Willman, Kate King
{"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}
引用次数: 0
Patient experiences of remote consulting with chronic fatigue syndrome/myalgic encephalomyelitis and fibromyalgia: a qualitative study. 慢性疲劳综合征/肌痛性脑脊髓炎和纤维肌痛患者的远程咨询体验:一项定性研究。
IF 2.5
BJGP Open Pub Date : 2025-02-25 DOI: 10.3399/BJGPO.2024.0079
Helen Leach, Abi Eccles, Carolyn A Chew-Graham, Helen Atherton
{"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}
引用次数: 0
De-labelling erroneous penicillin allergy records in general practice: healthcare professionals' experiences. 在一般实践中去除错误青霉素过敏记录的标签:卫生保健专业人员的经验。
IF 2.5
BJGP Open Pub Date : 2025-02-20 DOI: 10.3399/BJGPO.2024.0119
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
{"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}
引用次数: 0
General practice specialty decision-making: a system-level Australian qualitative study. 全科专业决策:澳大利亚系统级定性研究。
IF 2.5
BJGP Open Pub Date : 2025-02-20 DOI: 10.3399/BJGPO.2024.0218
Faith R Yong, Priya Martin, Katharine A Wallis, Jordan Fox, Sneha Kirubakaran, Riitta L Partanen, Srinivas Kondalsamy-Chennakesavan, Matthew R McGrail
{"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}
引用次数: 0
Sex differences in the prescription of anti-hypertensive medications in primary care patients. 初级保健患者抗高血压药物处方的性别差异。
IF 2.5
BJGP Open Pub Date : 2025-02-20 DOI: 10.3399/BJGPO.2024.0116
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
{"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}
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