BJGP Open最新文献

{"title":"Interaction patterns amongst risk factors for bladder cancer in adults with type 2 diabetes managed in primary care.","authors":"Sarah Tsz Yui Yau, Eman Yee Man Leung, Chi Tim Hung, Martin Chi-Sang Wong, Ka Chun Chong, Albert Lee, Eng Kiong Yeoh","doi":"10.3399/BJGPO.2025.0028","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0028","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have shown that patients with type 2 diabetes have a higher risk of developing bladder cancer than the general population. However, little is known about how different risk factors interact to influence the risk of bladder cancer among diabetes patients.</p><p><strong>Aim: </strong>To explore the interaction patterns among factors associated with the risk of bladder cancer incidence among patients who received diabetes management in primary care.</p><p><strong>Design & setting: </strong>A retrospective cohort study was performed using territory-wide electronic health records of Hong Kong. Patients who received diabetes care in general outpatient clinics between 2010 and 2019 without cancer history were included and followed up until December 2019.</p><p><strong>Method: </strong>The interaction patterns among factors associated with the risk of bladder cancer incidence were examined using conditional inference survival tree analysis.</p><p><strong>Results: </strong>A total of 382,770 patients were included. During a median follow-up of 6.2 years, 644 patients developed bladder cancer. Age (≤74 vs >74 years) and sex emerged as primary and secondary factors in differentiating the risk of bladder cancer sequentially. Among middle-old males (62 to 74 years) and youngest males (≤58 years), smoking (aHR for ever vs never smoker: 1.96, 95% CI 1.49-2.58) and chronic kidney disease (aHR for presence vs absence: 2.92, 95% CI 1.21-7.02) appeared as dominant risk factor for bladder cancer respectively.</p><p><strong>Conclusion: </strong>This study identified the interaction patterns among age, sex, smoking, and chronic kidney disease on the risk of bladder cancer incidence, providing potential targets for public health cancer prevention strategies in primary care for patients with type 2 diabetes.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972548","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":"Correction: GPs' drug treatment for depression by patients' educational level: registry-based study.","authors":"","doi":"10.3399/BJGPO.2025.9999","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.9999","url":null,"abstract":"","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972578","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":"Dispensing practices issue shorter prescription lengths compared to non-dispensing practices.","authors":"Ian Holdroyd, Liam Loftus, Cameron Appel, Efthalia Massou, John Ford","doi":"10.3399/BJGPO.2025.0115","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0115","url":null,"abstract":"<p><strong>Background: </strong>Dispensing practices, which have in-house dispensaries, are paid to dispense medications directly to patients. Evidence suggests that this financial incentive influences prescribing behaviour, though the underlying mechanisms remain unclear.</p><p><strong>Aim: </strong>To investigate the impact of dispensing status on prescription length in England.</p><p><strong>Design & setting: </strong>Quasi-experimental, repeated-measures, cross-sectional study of English General Practices.</p><p><strong>Method: </strong>Business administration data classified practices as dispensing or non-dispensing, determined the percentage of patients eligible for dispensing, and captured prescription lengths for seven drugs with fixed dosing regimens at three-month intervals from July 2023 to April 2024. Generalised estimating equations analysed the relationship between dispensing status and the proportion of patients eligible for dispensing with average prescription length, controlling for patient and practice characteristics.</p><p><strong>Results: </strong>Adjusting for patient and practice characteristics, dispensing practices prescribed shorter average lengths for all drugs. Desogestrel showed the largest difference (21.9 days shorter), followed by indapamide standard release (9.85 days), indapamide modified release (9.71 days), ezetimibe (8.41 days), tamsulosin (7.18 days), alendronic acid (6.63 days), and dapagliflozin (5.85 days). An increase in the proportion of patients eligible for dispensing was associated with significantly shorter prescription lengths across all drugs. Dispensing practices more consistently prescribed medications for 28-31 days, whereas non-dispensing practices showed greater variability.</p><p><strong>Conclusion: </strong>Dispensing practices are associated with shorter prescription lengths, increasing the number of prescriptions issued over time and the associated dispensing fee. The absence of clear guidance on prescription lengths likely contributes to this-central bodies should consider providing explicit recommendations to optimise prescription durations.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972569","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":"Personalising renal function monitoring and interventions in people living with heart failure: protocol for co-designing a care pathway in the RENAL-HF programme.","authors":"Suzy C Hargreaves, Christopher J Armitage, Benjamin C Brown, Dawn Dowding, Jennifer Downing, Mark Goodall, Alison Gummery, Carolyn Lees, Emma Sowden, Nefyn H Williams, Bridget Young, Munir Pirmohamed","doi":"10.3399/BJGPO.2025.0099","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0099","url":null,"abstract":"<p><strong>Background: </strong>Heart failure affects almost one million people in the UK and is increasing in prevalence. Many drugs used to treat heart failure impair renal function and can lead to hospitalisation. Adverse drug problems can be partially mitigated through regular renal monitoring and optimising of drug dose and choice to prevent deterioration of kidney function. This protocol describes part of a wider research programme: personalising <b>renal</b> function monitoring and interventions in people living with <b>h</b>eart <b>f</b>ailure (RENAL-HF).</p><p><strong>Aim: </strong>The aim of RENAL-HF is to develop improved processes in primary care to manage kidney health in people living with heart failure.</p><p><strong>Method: </strong>The protocol covers gathering views of healthcare professionals, patients and carers, to co-develop a care pathway for use in primary care. Using a mixed methods approach, the work comprises six stages: 1) understanding current practice of optimising heart failure treatment while preserving renal function, 2) co-designing a care pathway including personalised renal function monitoring, thresholds for intervention and clinical guidelines, 3) decision-making to identify elements that will support the care pathway, 4) developing training materials for primary care to enable use of the care pathway, 5) testing the useability of the prototype care pathway, and 6) a feasibility and acceptability study to inform the pre-clinical development and usability of the care pathway ahead of a cluster randomised control trial.</p><p><strong>Conclusion: </strong>All stages will elicit evidence from primary care practices, practitioners, and patients with which to assess and refine the care pathway. The evidence will inform how algorithm-guided individualised treatment can be implemented to improve outcomes of patients with heart failure.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972618","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' use of video and telephone consultation: implications for physical activity promotion for older adults. A mixed-methods study.","authors":"Christopher Thomas Callaghan, Conor Cunningham, Roger O'Sullivan","doi":"10.3399/BJGPO.2023.0256","DOIUrl":"10.3399/BJGPO.2023.0256","url":null,"abstract":"<p><p>The COVID-19 pandemic led GPs to adopt video consultation and telephone consultation (VC/TC) as part of routine practice. The potential impact on physical activity (PA) promotion and prescription for older adults, in routine practice, was unknown.</p><p><strong>Aim: </strong>To understand how VC/TC have impacted on the routine promotion of PA to older adults in GP consultations.</p><p><strong>Design & setting: </strong>A mixed-methods, cross-sectional study of GPs was conducted in the Republic of Ireland (RoI) and Northern Ireland (NI) in 2020/2021.</p><p><strong>Method: </strong>An online survey and interviews were conducted with GPs that explored awareness of PA guidelines, PA promotion during consultations to older adults (aged ≥65 years), and the impact on routine practice of moving to VC/TC during the pandemic.</p><p><strong>Results: </strong>GPs from across the island of Ireland (NI and RoI) agreed that PA promotion is part of routine practice. Analysis of interviews with GPs highlighted a need to develop practitioners' knowledge of the guidelines, and themes emerged around the use of VC/TC in routine practice. The positive themes highlighted that VC/TC enabled GPs to consult with a greater number of patients compared with face-to-face consultation (FTFC). Barriers to using VC/TC included decreased visual assessments of patients face to face (FTF).</p><p><strong>Conclusion: </strong>GPs are continuing to use VC/TC at the initial consultation stage, but the broader and longer-term implications on PA promotion with older adults are unknown.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141727908","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":"Lifestyle interventions for depression in primary care: a qualitative study.","authors":"Jolien Panjer, Manna Alma, Tryntsje Fokkema, Tom Hendriks, Daniëlle Cath, Jolien Kik, Huibert Burger, Marjolein Berger","doi":"10.3399/BJGPO.2024.0233","DOIUrl":"10.3399/BJGPO.2024.0233","url":null,"abstract":"<p><strong>Background: </strong>In individuals with depression a vicious cycle tends to occur in which depressive symptoms cause an unhealthy lifestyle, which reversibly causes an increase in depressive symptoms; both of which are associated with a decreased life expectancy. A potential way to break this cycle entails a multicomponent lifestyle intervention (MLI).</p><p><strong>Aim: </strong>To explore the barriers and facilitators for an MLI in patients with depressive symptoms from the perspective of GPs, chronic disease practice nurses (CD-PNs), mental health nurses (MHNs), lifestyle coaches (LC), and patients.</p><p><strong>Design & setting: </strong>Qualitative study using semi-structured interviews in Dutch primary care.</p><p><strong>Method: </strong>We interviewed five GPs, six MHNs, five CD-PNs, five LCs, and seven patients. Focus was on possible barriers and facilitators for an MLI. Data were analysed using thematic analysis. A focus group was used as a member check.</p><p><strong>Results: </strong>The following five themes were identified: expectations of effectiveness; motivation; stigma; logistics and organisation; and communication by professionals.</p><p><strong>Conclusion: </strong>Ideas on effectiveness were crucial and could be either a facilitator or a barrier for a depression-tailored MLI (DT-MLI). Professionals often had high expectations, based on work experience, making this a facilitator. Other facilitators were motivating participants, good logistics and good communication by professionals, thus destigmatising depression. Patients considered being motivated by the programme as a reason for participating, as they did not expect a DT-MLI would give them new information. Support from others was considered a motivator to participate.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143068392","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":"Podcasting in primary care: attitudes of Scottish GP specialty trainees and trainers towards podcast-based education in primary care.","authors":"Varun Rana, Blair Smith, Callum Leese","doi":"10.3399/BJGPO.2024.0248","DOIUrl":"10.3399/BJGPO.2024.0248","url":null,"abstract":"<p><strong>Background: </strong>Podcasts are rapidly gaining popularity within medical education, but their acceptability and effectiveness within primary care education remains understudied.</p><p><strong>Aim: </strong>To evaluate the attitudes of General Practitioner Specialty Trainees (GPSTs) and GP Trainers towards audio podcasts for primary care medical education.</p><p><strong>Design & setting: </strong>A cross-sectional questionnaire distributed to all GPSTs and GP Trainers in Scotland.</p><p><strong>Method: </strong>The survey evaluated podcast usage patterns, their perceived effectiveness, and perspectives on the benefits and challenges of podcast-based education. Quantitative data were analysed using descriptive and inferential statistics, and qualitative data underwent thematic analysis.</p><p><strong>Results: </strong>Of 1995 invited participants, 219 individuals (11.0%) responded. Medical education podcasts were used by 69.9% of respondents, with higher usage among GPSTs (73.5%) than GP Trainers (65.7%). Most respondents (89%) perceived podcasts as an effective medium for primary care education. The majority of respondents noted improvements in professional knowledge (92.8%), confidence in delivering patient care (73.5%), and clinical care provision (81.6%), as a result of podcast usage. Key benefits of podcasts included flexibility and accessibility, while the main challenge was personal time constraints. Respondents highlighted quality assurance and awareness as key areas for improving the experience of podcast-based education.</p><p><strong>Conclusion: </strong>Podcasts are accepted and perceived as an effective educational tool within primary care education. Future efforts should focus on developing high-quality, relevant podcasts, and addressing concerns around personal time constraints and quality assurance. Further research, including larger, more representative samples, is needed to assess the impact of podcasts on knowledge retention, clinician behaviour and clinical outcomes within primary care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144037645","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: a nationwide register-based cohort study.","authors":"Jonas K Olsen, Sonja Wehberg, Frans Boch Waldorff, Daniel Pilsgaard Henriksen, Jesper Lykkegaard","doi":"10.3399/BJGPO.2024.0234","DOIUrl":"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 email 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 the following three temporary latent profiles of provision of consultation services to older patients: the 'Phone heavy' profile (9%-10% of practices, 2017-2019), which provided nearly double the telephone consultations as the 'Majority' profile and was associated with the GPs being older and working single-handed; the 'High frequency' profile (12%-14% of practices, 2017-2018), which provided higher levels of face-to-face, telephone, and email consultations than the 'Majority' profile; and the 'Phone and email heavy' profile (7% of practices, 2020), which provided more email than face-to-face consultations, and more of each consultation than the 'Majority' profile. The number of profiles decreased from three in 2017 to only the 'Majority' profile in 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":2.0,"publicationDate":"2025-08-12","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":"GP referral to rapid diagnostic centres for non-specific cancer symptoms: a qualitative study.","authors":"Caroline White, Spencer Robinson, Una Macleod, Charlotte Kelly","doi":"10.3399/BJGPO.2024.0179","DOIUrl":"10.3399/BJGPO.2024.0179","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing cancer can be challenging, especially when patients present to GPs with serious, but non-specific symptoms. Rapid diagnostic centres (RDCs) have been introduced in England as diagnostic pathways for patients with non-specific symptoms where cancer is suspected, but they do not meet existing cancer pathway criteria.</p><p><strong>Aim: </strong>To investigate GP perspectives on referral to an RDC pathway for patients with non-specific symptoms and suspected cancer.</p><p><strong>Design & setting: </strong>A qualitative study using semi-structured interviews with GPs, within the catchment area of an acute NHS trust in the UK.</p><p><strong>Method: </strong>GP interviews focusing on experiences of using the RDC pathway. A thematic analysis was conducted on interview transcripts.</p><p><strong>Results: </strong>GPs reported the RDC pathway as a game changer. It offered faster referral, reduced anxiety for GPs and patients, and reduced the need for GPs to '<i>game the system</i>' when patients do not meet criteria for cancer-specific pathways. The narrative required on referral appeared to legitimise GP gut feelings and expertise. RDC results (if not cancer) gave GPs space to treat patients without concern of a missed cancer, while ensuring onward referral for those with cancer or other serious conditions. Some access barriers, especially related to travel and time, were identified especially for patients in rural areas.</p><p><strong>Conclusion: </strong>This cancer pathway fills a referral gap for GPs and patients with non-specific potential cancer symptoms. It has an important signposting function, helping identify patients requiring treatment for cancer or other serious conditions, and others whose symptoms can be treated safely within primary care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143524792","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":"Enablers and barriers to coalface primary care reform in England: a qualitative study.","authors":"Claire Jackson Am, Caroline Nicholson, Jenny Job, Jon Sussex, Stephen Morris","doi":"10.3399/BJGPO.2025.0065","DOIUrl":"https://doi.org/10.3399/BJGPO.2025.0065","url":null,"abstract":"<p><strong>Background: </strong>Since the Declaration of Alma-Ata in 1978 (1) global health policy has prioritised primary and integrated care reform to better manage chronic illness, improve health access, and prevent disease.(2) Yet internationally primary care, like the health systems it struggles to support, is currently far from strengthened; and is increasingly challenged by chronic underfunding, lack of recognition, and a diminishing and demoralised workforce.(3,4) AIM: To better understand the policy barriers responsible for the current status from the perspective of general practice in England DESIGN & SETTING: Key Informant Interviews with 12 general practice policy or practice leaders identified from publicly-available position statements, publications or innovative programs in UK primary care reform over the past decade METHOD: A qualitative deductive approach using thematic analysis to analyse informant data to understand historical barriers and explore enablers for future reform.</p><p><strong>Results: </strong>The analysis resulted in eight main themes. 1. Dynamics of power and autonomy 2. Under-investment in primary care 3. Aligning policy and implementation 4. Navigating complexity and change 5. Building trust through relationships and leadership 6. The revolving door of policy and leadership 7. Valuing the workforce: A key to morale and retention 8. Strategic communication and media engagement CONCLUSION: Better-targeted funding reform, more effective systems integration building on general practice and community service strengths, and better valuing the complex role of the primary care sector as central to a high-functioning health system, were seen as key to the future. Participants also called for more effective policy input from those skilled in the delivery of care, and the capacity for earned autonomy and flexibility to deliver care relevant to individual community need. Action to address these opportunities is pressing, as finalisation of the 10 Year Health Plan and more-immediate NHS restructure rapidly gathers momentum.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838103","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}