BJGP Open最新文献

{"title":"Overprescribing of potentially harmful medication: an observational study in England's general practice.","authors":"Tasneem Khan, Bethan Copsey, Paul Carder, Stella Johnson, Mohammed Imran, Kaiwen Wang, Sarah Alderson","doi":"10.3399/BJGPO.2023.0156","DOIUrl":"10.3399/BJGPO.2023.0156","url":null,"abstract":"<p><strong>Background: </strong>Overprescribing of potentially harmful medication in UK general practice has a complex association with socioeconomic deprivation.</p><p><strong>Aim: </strong>To assess trends in general practice prescribing of five high-risk medications and their relationship with deprivation.</p><p><strong>Design & setting: </strong>An observational study was conducted using general practice data from three English regions with varied sociodemographic factors: West Yorkshire and Harrogate (WY), Black Country and West Birmingham (BC), and Surrey and East Sussex (SE).</p><p><strong>Method: </strong>Practice-level prescribing data were obtained from 2016-2021 for five drug classes: opioids, hypnotics, gabapentinoids, non-steroidal anti-inflammatory drugs (NSAIDs), and antibacterials. Prescribing trends were demonstrated using a linear model.</p><p><strong>Results: </strong>Reduction in NSAID, opioid, hypnotic and antibacterial prescriptions, and the increase in gabapentinoid prescriptions, were significant at each financial year time period. Index of Multiple Deprivation (IMD) was positively associated with all drug classes except antibacterials, which showed a positive association when incorporating the interaction term between IMD and age.When adjusting for IMD and population, region was independently associated with prescribing rate. Compared with WY, IMD had a smaller association with prescribing in BC for NSAIDs (coefficient = -0.01578, <i>P</i> = 0.004) and antibacterials (coefficient = -0.02769, <i>P</i> = 0.007), whereas IMD had a greater association with prescribing in SE for NSAIDs (coefficient = 0.02443, <i>P</i><0.001), opioids (coefficient = 0.08919, <i>P</i><0.001), hypnotics (coefficient = 0.09038, <i>P</i><0.001), gabapentinoids (coefficient = 0.1095, <i>P</i><0.001), and antibacterials (coefficient = 0.01601, <i>P</i> = 0.19).</p><p><strong>Conclusion: </strong>The association of socioeconomic deprivation with overprescribing of high-risk medication in general practice varies by region and drug type. Geographical location is associated with overprescribing, independent of socioeconomic status.</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/PMC11300984/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139521976","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":"How, when and who should ask about pregnancy intentions in primary care? A qualitative study of primary health care professionals' preferences.","authors":"Jennifer Hall, Helen Carr, Anne Connolly, Geraldine Barrett","doi":"10.3399/BJGPO.2024.0148","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0148","url":null,"abstract":"<p><strong>Background: </strong>Knowing people's pregnancy intentions would help health care professionals (HCPs) to take a holistic approach to reproductive health, and particularly to providing preconception care.</p><p><strong>Aim: </strong>To assess the feasibility of implementation of questions about pregnancy preferences in a range of primary care settings in Great Britain, including digital implementation.</p><p><strong>Design & setting: </strong>Qualitative study using online semi-structured interviews with primary care professionals across Great Britain in 2022.</p><p><strong>Method: </strong>Twelve online interviews were conducted with GPs (n=3), practice nurses (n=3), sexual and reproductive health professionals (n=4) and health visitors (n=2). Framework analysis was conducted in Nvivo, adapting a coding frame from complementary interviews with women.</p><p><strong>Results: </strong>HCPs perceived asking about pregnancy preferences as valuable in meeting patients' reproductive health needs and most suited to women's health consultations, medication and disease reviews, baby checks, or as an addition to lifestyle questions leading to health promotion advice. An introductory, non-discriminatory signposting sentence was well-liked, and the preferred question in a face-to-face clinical encounter was asking how the person would feel about a pregnancy in the next year, in line with women's preference. Guidance and training would give clinicians confidence in knowing how to ask about pregnancy preferences and advise their patients accordingly.</p><p><strong>Conclusion: </strong>Asking about pregnancy intentions is acceptable to women and HCPs and feasible in primary care, but implementation needs to be adapted to the patient and context. Digital options that enable patients to self-manage can reduce the need for HCP input and avoid medicalising a normal process.</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":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793739","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 DAWN antivirals trial: process evaluation of a COVID-19 trial in general practice.","authors":"Dajana Tare, Samuel Coenen, An De Sutter, Stefan Heytens, Dirk Devroey, Laetitia Buret, Birgitte Schoenmakers, Nicolas Delvaux, Jan Y Verbakel, Kris Bogaerts, Ann van den Bruel","doi":"10.3399/BJGPO.2023.0109","DOIUrl":"10.3399/BJGPO.2023.0109","url":null,"abstract":"<p><strong>Background: </strong>The DAWN antivirals trial was a multicentric, randomised placebo-controlled trial evaluating antiviral medication for COVID-19 in general practice. The trial was prematurely terminated because of insufficient recruitment.</p><p><strong>Aim: </strong>To explore which factors contributed to the premature termination.</p><p><strong>Design & setting: </strong>General practice in Belgium.</p><p><strong>Method: </strong>Patients were randomised to camostat or placebo (patients and physicians blinded) between June 2021 and July 2022; a third arm evaluating molnupiravir (open label) was opened in March 2022. The outcome assessor was blinded for all comparisons except for the patient reported outcomes in case of molnupiravir. The authors analysed available trial data and evaluated trial context, implementation, and mechanisms of impact based on semi-structured interviews with trial stakeholders.</p><p><strong>Results: </strong>The trial recruited 44 participants; 19 were allocated to camostat (median age 55 years), 8 to molnupiravir (median age 60 years), and 17 to placebo (median age 56 years). There were no serious adverse events in either group. Most difficulties were related to the pandemic context: disruption to routine clinical services; multiple changes to the service model for COVID-19 patients; overwhelmed clinical staff; delays of trial medication; and staff shortages in the sponsor and clinical team. In addition, regulatory approval processes were lengthy and led to additional study procedures. It was felt that the trial started too late, when vaccinations had already begun.</p><p><strong>Conclusion: </strong>The DAWN antivirals trial was stopped prematurely. Although many barriers were related to the pandemic itself, hurdles such as a small and inexperienced sponsor and clinical teams, delays in regulatory processes, and research capacity in routine settings could be overcome by established research infrastructure and standardisation of processes.</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/PMC11300998/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138177487","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":"Prevalence of anaemia, iron, and vitamin deficiencies in the health system in the Republic of Ireland: a retrospective cohort study.","authors":"Conor Cian Clancy, Leonard D Browne, Robert Gilligan, Ophelia Blake, Austin G Stack","doi":"10.3399/BJGPO.2023.0126","DOIUrl":"10.3399/BJGPO.2023.0126","url":null,"abstract":"<p><strong>Background: </strong>Anaemia is a common but treatable condition that predicts adverse clinical outcomes. However, standards of anaemia management vary considerably.</p><p><strong>Aim: </strong>To estimate the prevalence of anaemia and extent of screening for common underlying causes in the healthcare system in the Republic of Ireland.</p><p><strong>Design & setting: </strong>We conducted a retrospective cohort study of 112 181 adult patients, aged ≥18 years, who had a full blood count performed in 2013, using data from the National Kidney Disease Surveillance System.</p><p><strong>Method: </strong>The prevalence of anaemia was determined across demographic and clinical subgroups, according to World Health Organization (WHO) definitions. The proportion screened for iron, vitamin B12, and folate deficiency was determined within a 3-month follow-up period and the corresponding prevalence for each deficiency determined.</p><p><strong>Results: </strong>The overall prevalence of anaemia was 12.0% (95% confidence interval [CI] = 11.8% to 12.2%) and was higher in women than men (13.2% versus 10.5%, <i>P</i><0.001). Anaemia increased with advancing age (33.4% for those aged >75 years) and worsening kidney function (8.2%, 10.9%, 33.2%, and 63.8% for each estimated glomerular filtration rate [eGFR] categories >90, 60-89, 30-59 and <30 ml/min/1.73 m², respectively, <i>P</i><0.001). After 3-months' follow-up, the proportion screened for iron deficiency was 11.2% based on transferrin saturation and 33.7% using serum ferritin. Screening for folate and B12 deficiency was 17.6% and 19.8%, respectively. Among screened patients, the prevalence of iron deficiency, B12, and folate deficiency was 37.0%, 6.3%, and 5.8%, respectively.</p><p><strong>Conclusion: </strong>The burden of anaemia in the healthcare system is substantial especially for older patients and those with advanced kidney disease. Low screening rates for iron, B12, and folate deficiency are common and warrant quality improvement initiatives.</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/PMC11300981/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138810339","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":"Dutch GP healthcare consumption in COVID-19 heterogeneous regions: an interregional time-series approach in 2020-2021.","authors":"Maarten Homburg, Marjolein Berger, Matthijs Berends, Eline Meijer, Thijmen Kupers, Lotte Ramerman, Corinne Rijpkema, Evelien de Schepper, Tim Olde Hartman, Jean Muris, Robert Verheij, Lilian Peters","doi":"10.3399/BJGPO.2023.0121","DOIUrl":"10.3399/BJGPO.2023.0121","url":null,"abstract":"<p><strong>Background: </strong>Many countries observed a sharp decline in the use of general practice services after the outbreak of the COVID-19 pandemic. However, research has not yet considered how changes in healthcare consumption varied among regions with the same restrictive measures but different COVID-19 prevalence.</p><p><strong>Aim: </strong>To investigate how the COVID-19 pandemic affected healthcare consumption in Dutch general practice during 2020 and 2021, among regions with known heterogeneity in COVID-19 prevalence, from a pre-pandemic baseline in 2019.</p><p><strong>Design & setting: </strong>Population-based cohort study using electronic health records. The study was undertaken in Dutch general practices involved in regional research networks.</p><p><strong>Method: </strong>An interrupted time-series analysis of changes in healthcare consumption from before to during the pandemic was performed. Descriptive statistics were used on the number of potential COVID-19-related contacts, reason for contact, and type of contact.</p><p><strong>Results: </strong>The study covered 3 595 802 contacts (425 639 patients), 3 506 637 contacts (433 340 patients), and 4 105 413 contacts (434 872 patients) in 2019, 2020, and 2021, respectively. Time-series analysis revealed a significant decrease in healthcare consumption after the outbreak of the pandemic. Despite interregional heterogeneity in COVID-19 prevalence, healthcare consumption decreased comparably over time in the three regions, before rebounding to a level significantly higher than baseline in 2021. Physical consultations transitioned to phone or digital over time.</p><p><strong>Conclusion: </strong>Healthcare consumption decreased irrespective of the regional prevalence of COVID-19 from the start of the pandemic, with the Delta variant triggering a further decrease. Overall, changes in care consumption appeared to reflect contextual factors and societal restrictions rather than infection rates.</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/PMC11300972/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138832013","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":"What makes a good general practice consultation? An exploratory pilot study with people from a low socioeconomic background.","authors":"Naomi MacPherson, Binh Ta, Lauren Ball, Nilakshi Gunatillaka, Elizabeth Ann Sturgiss","doi":"10.3399/BJGPO.2023.0160","DOIUrl":"10.3399/BJGPO.2023.0160","url":null,"abstract":"<p><strong>Background: </strong>While patients from low socioeconomic (SES) backgrounds are at increased risk of developing chronic health conditions, typically managed within general practice, they report fewer positive consultation experiences with GPs than patients from higher SES groups. To our knowledge, existing research does not provide an in-depth understanding of the GP conducts that contribute to positive consultations.</p><p><strong>Aim: </strong>To identify the factors that patients from low SES backgrounds perceive as essential for creating good consultation experiences.</p><p><strong>Design & setting: </strong>This exploratory pilot study was performed in GP clinics in Melbourne, Australia.</p><p><strong>Method: </strong>We used an appreciative inquiry approach, focused on positive consultation experiences, previously shown to be helpful for researching sensitive topics. Nine patients from low SES backgrounds, who reported positive consultation experiences, undertook a semi-structured qualitative interview while watching the video recording of their GP consultation. Four different GPs were captured in the recordings. Inductive thematic coding was performed by two researchers.</p><p><strong>Results: </strong>The following four categories were developed: 1) the doctor's demeanour and how the patient was made to feel during the consultation drove their engagement; 2) an established and collaborative therapeutic relationship was of high importance to patients; 3) a doctor's therapeutic skillset was integral to patient confidence and comfort; and 4) patients appreciated verbal and non-verbal communication techniques. In each interview, the discussion about the video-recorded consultation often triggered reflections about previous consultations with the respective GP.</p><p><strong>Conclusion: </strong>For patients from low SES groups, positive consultation experiences were underpinned by perceived continuity of care with a specific GP who consistently showed good communication skills and key interpersonal characteristics. This research is a small step towards increasing our understanding of the experience of individuals from low SES backgrounds in primary care and the existing health inequities within this area.</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/PMC11300992/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708101","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":"What next for behaviour change professional development in general practice? Insights from an environmental scan and workshops.","authors":"Bryce Brickley, Jenny Advocat, Tze Lin Chai, Mitchell Bowden, Elizabeth Rieger, Lauren Ball, Raeann Ng, Nilakshi Gunatillaka, Elizabeth Ann Sturgiss","doi":"10.3399/BJGPO.2023.0187","DOIUrl":"10.3399/BJGPO.2023.0187","url":null,"abstract":"<p><strong>Background: </strong>A key role of general practice professionals (that is, GPs, and general practice nurses [GPNs]) is to support patients to change behaviours. Traditional approaches to assisting patients with, and learning about, behaviour change have modest outcomes.</p><p><strong>Aim: </strong>To explore behaviour change with GPs and GPNs and the availability of related professional development (PD) opportunities.</p><p><strong>Design & setting: </strong>Multi-methods study comprising an environmental scan survey of behaviour change tools and PD opportunities, and online workshops with Australian GPs and GPNs.</p><p><strong>Method: </strong>Survey data were analysed using qualitative content analysis, informing the design of the workshops. Workshop data included observation, note-taking, and collaborative reflection, which were analysed thematically and synthesised with survey data.</p><p><strong>Results: </strong>The survey had 18 complete responses. For the two virtual workshops, workshop 1 had 16 participants and workshop 2 had eight participants. There was diversity in awareness of existing behaviour change tools and resources. Preferences for future tools and PD opportunities related to specific aspects of its design, content, activities, and delivery. The following three themes developed from the workshop data: recognising the importance of relationships; recognising the importance of continuity; and keeping context in mind. In the absence of tools and resources, GPs and GPNs discussed behaviour change as something that occurs best through a patient-centred alliance that is continuing, respectful, grounded in trust and an understanding of their patient, and prioritises patient autonomy.</p><p><strong>Conclusion: </strong>Future general practice behaviour change PD should support clinicians to 'assist' patients and recognise the social and contextual influences on behaviour.</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/PMC11300966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139708102","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":"Severe mental illness and cardioprotective medication prescribing: a qualitative study in general practice.","authors":"Amanda Vettini, Gearóid K Brennan, Stewart W Mercer, Caroline A Jackson","doi":"10.3399/BJGPO.2023.0176","DOIUrl":"10.3399/BJGPO.2023.0176","url":null,"abstract":"<p><strong>Background: </strong>Patients with severe mental illness (SMI) die 10-20 years earlier than the general population. They have a higher risk of cardiovascular disease (CVD) yet may experience lower cardioprotective medication prescribing.</p><p><strong>Aim: </strong>To understand the challenges experienced by GPs in prescribing cardioprotective medication to patients with SMI.</p><p><strong>Design & setting: </strong>A qualitative study with 15 GPs from 11 practices in two Scottish health boards, including practices servicing highly deprived areas (Deep End).</p><p><strong>Method: </strong>Semi-structured one-to-one interviews with fully qualified GPs with clinical experience of patients with SMI. Interviews were transcribed verbatim and analysed thematically.</p><p><strong>Results: </strong>Participants aimed to routinely prescribe cardioprotective medication to relevant patients with SMI but were hampered by various challenges. These structural and contextual barriers included the following: lack of funding for chronic disease management; insufficient consultation time; workforce shortages; IT infrastructure; and navigating boundaries with mental health services. Patient-related barriers included patients' complex health and social needs, their understandable prioritisation of mental health needs or existing physical conditions, and presentation during crises. Professional barriers comprised GPs' desire to practise holistic medicine rather than treating via cardioprotective prescribing in isolation, and concerns about patients' medication concordance if patients were not prioritising this aspect of their health care at that particular time. In terms of enablers for cardioprotective prescribing, participants emphasised continuity of care as fundamental in engaging this patient group in effective cardiovascular health management. A cross-cutting theme was the current GP workforce crisis leading to 'firefighting' and diminishing capacity for primary prevention. This was particularly acute in Deep End practices, which have a high proportion of patients with complex needs and greater resource challenges.</p><p><strong>Conclusion: </strong>Although participants aspire to prescribe cardioprotective medication to patients with SMI, professional-, system- and patient-level barriers often make this challenging, particularly in deprived areas owing to patient complexity and the inverse care law.</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/PMC11300976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139736312","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":"How to address the inverse care law and increase GP recruitment in areas of socioeconomic deprivation: a qualitative study of GP trainees' views and experiences in the UK.","authors":"Matthew J Armstrong, Josephine M Wildman, Sarah Sowden","doi":"10.3399/BJGPO.2023.0201","DOIUrl":"10.3399/BJGPO.2023.0201","url":null,"abstract":"<p><strong>Background: </strong>The Deep End network in the North East and North Cumbria (NENC) was set up to tackle health inequalities in general practice. One aim is to address the inverse care law and improve recruitment of GPs, which is known to be especially challenging in areas of socioeconomic deprivation.</p><p><strong>Aim: </strong>To explore GP trainees' experiences and perceptions of working in Deep End or Deprived Area Practices (DE/DAPs) to identify how GP recruitment can be improved.</p><p><strong>Design & setting: </strong>Qualitative study recruiting 13 doctors training to be GPs from the Northumbria training programme.</p><p><strong>Method: </strong>Audio-recorded, online, semi-structured interviews and discussion groups were undertaken, transcribed verbatim, and analysed with a grounded theory approach, using a process of thematic analysis.</p><p><strong>Results: </strong>Overall, seven interviews and two discussion groups (13 participants in total) were conducted. Three themes were identified. The first theme was working in areas of socioeconomic deprivation is challenging but has many advantages. The challenges of working in DE/DAPs were not deterring factors for GP trainees wanting to work in areas of socioeconomic deprivation. The second theme was trainees are willing to work in areas of socioeconomic deprivation but clinical experience is important. Training in DE/DAPs gives trainees the confidence to work in areas of deprivation. Familiarity with a practice also makes them more likely to stay post-training. The third theme was financial incentives are not an important attracting factor but support and development opportunities are. Non-pecuniary measures, such as clinical support and protected time for continuing professional development (CPD), were found to be important.</p><p><strong>Conclusion: </strong>To improve recruitment to DE/DAPs, investments should be made to increase the opportunities to train in these environments. This can be achieved by supporting more DE/DAPs to become training practices, and providing clinical support and protected time for CPD.</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/PMC11300987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138832012","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":"New evidence on the validity of the selection methods for recruitment to general practice training: a cohort study.","authors":"Paul A Tiffin, Emma Morley, Lewis W Paton, Fiona Patterson","doi":"10.3399/BJGPO.2023.0167","DOIUrl":"10.3399/BJGPO.2023.0167","url":null,"abstract":"<p><strong>Background: </strong>Selection into UK-based GP training has used the Multi-Specialty Recruitment Assessment (MSRA) and a face-to-face selection centre (SC). The MSRA comprises of a situational judgement test and clinical problem-solving test. The SC was suspended during the COVID-19 pandemic. Evidence is needed to guide national and international selection policy.</p><p><strong>Aim: </strong>To evaluate the validity of GP training selection.</p><p><strong>Design & setting: </strong>A retrospective cohort study using data from UK-based national recruitment to GP training, from 2015-2021.</p><p><strong>Method: </strong>Data were available for 32 215 GP training applicants. The ability of scores from the specialty selection process to predict subsequent performance in the Clinical Skills Assessment (CSA) of the Membership of the Royal College of General Practitioners examination was modelled using path analysis. The effect sizes for sex, professional family background, and world region of qualification were estimated.</p><p><strong>Results: </strong>All component scores of the selection process demonstrated statistically significant independent relationships with CSA performance (<i>P</i><0.001), thus establishing their predictive validity. All were sensitive to demographic factors. The SC scores had the weakest relationship with future CSA performance. However, for candidates with MSRA scores below the lowest quartile, the relative contribution of the SC scores to predicting CSA performance was similar to that observed for MSRA components.</p><p><strong>Conclusion: </strong>The MSRA has predictive validity in this context. Re-instituting an SC for those with relatively low MSRA scores should be considered. However, the relative costs and potential advantages and disadvantages should be carefully weighed.</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/PMC11300983/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139479411","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}