BJGP Open最新文献

{"title":"Continuity of care and mortality in patients with type 2 diabetes: a cohort study.","authors":"Eero H Mellanen, Timo Kauppila, Hannu Kautiainen, Mika T Lehto, Ossi Rahkonen, Kaisu H Pitkälä, Merja K Laine","doi":"10.3399/BJGPO.2024.0144","DOIUrl":"10.3399/BJGPO.2024.0144","url":null,"abstract":"<p><strong>Background: </strong>How GP continuity of care (GP-CoC) affects mortality in patients with type 2 diabetes (T2D) is unclear.</p><p><strong>Aim: </strong>To examine the effect of having no continuity of care (CoC) and GP-CoC on mortality in primary health care (PHC) patients with T2D.</p><p><strong>Design & setting: </strong>A cohort study in patients aged ≥60 years with T2D, which was conducted within the public PHC of the city of Vantaa, Finland.</p><p><strong>Method: </strong>The inclusion period was between 2002 and 2011 and follow-up period between 2011 and 2018. Six groups were formed (no appointments, one appointment and Modified, Modified Continuity Index [MMCI] quartiles). Mortality was measured with standardised mortality ratio (SMR) and adjusted hazard ratio (aHR). GP-CoC was measured with MMCI. Comorbidity status was determined with Charlson Comorbidity Index (CCI).</p><p><strong>Results: </strong>In total, 11 020 patients were included. Mean follow-up time was 7.3 years. SMRs for the six groups (no appointments, one appointment, MMCI quartiles) were 2.46 (95% confidence interval [CI] = 2.24 to 2.71), 3.55 (95% CI = 3.05 to 4.14), 1.15 (95% CI = 1.06 to 1.25), 0.97 (95% CI = 0.89 to 1.06), 0.92 (95% CI = 0.84 to 1.01) and 1.21 (95% CI = 1.11 to 1.31), respectively. With continuous MMCI, mortality formed a U-curve. The inflection point was at a MMCI value of 0.65 with corresponding SMR of 0.86. Age and CCI aHR for death between men and women was 1.45 (95% CI = 1.35 to 1.58).</p><p><strong>Conclusion: </strong>Patients with no CoC had the highest mortality. In patients having care over time, the effect of GP-CoC on mortality was minor and mortality increased with high GP-CoC.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093870","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":"Prevalence and severity of anxiety, stress, and depression in long COVID among adults in Barcelona.","authors":"Brenda Biaani León-Gómez, Meritxell Carmona-Cervelló, Rosalia Dacosta-Aguayo, Noemí Lamonja-Vicente, Jofre Bielsa-Pascual, Victor M López-Lifante, Valeria Zamora-Putin, Gemma Molist, Pilar Montero-Alia, Alba Pachón-Camacho, Eduard Moreno-Gabriel, Rosa García-Sierra, Adrià Bermudo-Gallaguet, Carla Chacón, Anna Costa-Garrido, Jose A Muñoz-Moreno, Lourdes Mateu, Maria Mataró, Julia G Prado, Eva Martínez-Cáceres, Marta Massanella, Concepción Violán, Pere Torán-Monserrat","doi":"10.3399/BJGPO.2024.0098","DOIUrl":"10.3399/BJGPO.2024.0098","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic's long-term mental health implications are increasingly concerning, especially among patients suffering post-acute sequelae of SARS-CoV-2 infection: Long COVID (LC) patients.</p><p><strong>Aim: </strong>This study explores the presence and distribution of anxiety, depression, and stress in LC individuals with cognitive complaints in northern Barcelona (Spain).</p><p><strong>Design & settings: </strong>This cross-sectional study involved 155 diagnosed LC individuals from the \"Aliança ProHEpiC-19 Cognitiu (APC)\" project.</p><p><strong>Method: </strong>Demographic data and health behavior variables were collected, and the Depression, Anxiety, and Stress Scale (DASS-21) was self-administered to assess mental health. Descriptive statistics, chi-squared tests, and Poisson regression models were used for data analysis.</p><p><strong>Results: </strong>'Severe' stress and 'Extremely Severe' anxiety were prevalent in the sample. There were significant differences in anxiety and depression based on age and job role, with older individuals and non-healthcare workers showing higher relative risks.</p><p><strong>Conclusions: </strong>Our study highlights the significant mental health burden in LC patients, underscoring the need for targeted interventions, especially among adults over 45 years old and non-healthcare workers. Further research is needed to better understand LC's complex mental health impacts and develop effective clinical management strategies.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030019","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"General practice-related variation in oral anticoagulant treatment of atrial fibrillation: a nationwide cohort study.","authors":"Ina Grønkjær Laugesen, Claus Høstrup Vestergaard, Amanda Paust, Flemming Bro, Erik Lerkevang Grove, Anders Prior","doi":"10.3399/BJGPO.2024.0197","DOIUrl":"10.3399/BJGPO.2024.0197","url":null,"abstract":"<p><strong>Background: </strong>Guideline-adherent oral anticoagulant treatment (OAC) in atrial fibrillation (AF) remains a challenge. In Denmark, most patients with AF are treated in general practice. Nevertheless, determinants of OAC prescription in primary care are poorly understood.</p><p><strong>Aim: </strong>To investigate variation in OAC adherence between general practice clinics and identify clinic characteristics associated with a lower propensity to prescribe OAC.</p><p><strong>Design & setting: </strong>Nationwide register-based cohort study including prevalent and incident patients with AF and CHA₂DS₂-VASc score≥2 (<i>n</i>=165,731) listed with Danish general practice clinics (<i>n</i>=1666) in 2021.</p><p><strong>Method: </strong>The main outcome was OAC adherence assessed as proportion of days covered. We used clinic OAC propensity to evaluate variation. OAC propensity was quantified as ratios between observed and expected adherence. Expected adherence was estimated based on the composition of the clinic patient populations. Sampled reference populations were constructed to account for random variation. Linear regression models examined associations between OAC propensity and clinic characteristics.</p><p><strong>Results: </strong>The proportion of days covered with OAC in the AF-population was 78%. OAC propensity in clinics in the 90^th percentile was 20% higher compared to clinics in the 10^th percentile, however this difference was reduced to 3% when accounting for random variation. Modest associations were observed between clinic characteristics and OAC propensity. The most significant difference was in the correlation between geographic location and OAC propensity, showing an 8% gap between top- and bottom-performing regions.</p><p><strong>Conclusion: </strong>The study suggests persistent underutilisation of OAC in AF patients and little variation in OAC prescription patterns across general practice clinics.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629602","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":"Patients' reasons for declining a primary care trial online therapy: a mixed methods study.","authors":"Fiona Fox, Debbie Tallon, Roz Shafran, Paul Lanham, Christopher Williams, Berry Jude, Nicola Wiles, David Kessler, Katrina Turner","doi":"10.3399/BJGPO.2024.0272","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0272","url":null,"abstract":"<p><strong>Background: </strong>Integrating therapist-led sessions and Cognitive Behavioural Therapy (CBT) materials within one online platform may be effective for people with depression. A trial evaluating this mode of delivering CBT is being conducted. To maximize future trial recruitment and understand patients' views of health interventions, it is important to explore reasons for declining to participate.</p><p><strong>Aim: </strong>To explore patients' reasons for declining to participate in a trial of integrated online CBT for depression.</p><p><strong>Design & setting: </strong>A mixed methods study collecting data from patients via questionnaires and telephone interviews at the three UK trial sites.</p><p><strong>Method: </strong>Individuals completed a short questionnaire about their reasons for not taking part in the trial. Telephone interviews further explored these reasons with a sub-group. Quantitative data were summarized using descriptive statistics. Qualitative interviews were analysed thematically.</p><p><strong>Results: </strong>Of 1799 patients who responded to an invitation to participate in the trial, 40.3% declined contact. The most common reasons were not wanting: to take part in research (<i>n</i>=387); therapy provided online (<i>n</i>=284); to receive CBT (<i>n</i>=262). Qualitative interviews with 15 'decliners' highlighted that decisions related to perceptions of eligibility, previous experiences of CBT and uncertainty about receiving CBT online. Personal circumstances, depressive symptoms or other mental health issues were also barriers to participation.</p><p><strong>Conclusion: </strong>Reasons given by primary care patients for not taking part in a trial of integrated online CBT suggest that, at the point of recruitment, it is important to discuss the patient's perceptions of their eligibility and whether they would accept the intervention being evaluated.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030017","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":"Investigating the conditions in which women GPs thrive: a realist review protocol.","authors":"Ruth Abrams, Laura Jefferson, Su Golder, Lilith Whiley, Sophie Park, Vickie Williams, Ruth Riley","doi":"10.3399/BJGPO.2024.0275","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0275","url":null,"abstract":"<p><strong>Background: </strong>Women now make up approximately half of the GP workforce. However, many are leaving the profession. This could be because they experience higher rates of burnout, stress and anxiety, suicide, and lower rates of career progression. They also take on a greater load of emotional labour. Retaining this staff group is one of five priorities for future policy and research.</p><p><strong>Aim: </strong>This research aims to synthesise the available evidence on how general practice workplaces can best support women GPs to thrive at work.</p><p><strong>Design & setting: </strong>We propose to undertake a realist review, which seeks to understand why an approach may work in specific contexts. This involves building an understanding of how contextual factors affect the activation of mechanisms (ie, changes in participant reasoning or behaviours) to produce their outcomes.</p><p><strong>Method: </strong>We will locate available evidence on the topic, and, using a realist logic of analysis develop an understanding as to how, why, for whom and in what contexts women GPs thrive at work. Evidence will include: academic literature, policy documents, media items and guidelines.</p><p><strong>Results: </strong>Findings will be co-disseminated with PPI and stakeholder members to all key groups including policymakers, employers, the public, and academic audiences by a wide variety of means.</p><p><strong>Conclusion: </strong>This review is intended to improve understanding of how working environments affect women GPs. It is anticipated that findings will support the implementation of strategies to better support this group to thrive at work.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143030016","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":"Staff and service user perspectives of a co-located homelessness centre in Scotland: a mixed-methods evaluation.","authors":"Lauren Ng, Eddie Donaghy, John Conway, Stewart W Mercer","doi":"10.3399/BJGPO.2024.0198","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0198","url":null,"abstract":"<p><strong>Background: </strong>Co-location and integration of services within a psychologically-informed environment is recommended for people experiencing homeless but there are few examples of this in the UK. Such a centre opened in Scotland in November 2021.</p><p><strong>Aim: </strong>To evaluate progress of the new centre.</p><p><strong>Design & setting: </strong>Mixed-methods pre-post-test design before (baseline) and two years after (follow-up).</p><p><strong>Method: </strong>Baseline and follow-up staff surveys measured knowledge of trauma-informed care, well-being, team climate, and job satisfaction. The follow-up staff survey also evaluated staff support and service improvements. In-depth staff interviews were conducted at baseline (<i>n</i>=25) and follow-up and analysed thematically. A service users survey was also conducted.</p><p><strong>Results: </strong>The staff survey showed significant improvements between baseline and follow-up in trauma-informed care, burnout, and team climate, together with improvements in support, service integration, and service user care. Service users reported high satisfaction with the new centre.Staff interviews identified a more psychologically-informed environment, better staff support, and improved opportunistic multidisciplinary working over the two years of the centre opening. However, a number of barriers were also identified relating to the building and the IT systems. Further work on the centre's vision; short- and long-term integration plans; workload, and sustainability were felt to be needed.</p><p><strong>Conclusion: </strong>Co-location of services for people experiencing homelessness in Scotland has led to improvements in staff burn-out and team climate, and service users' satisfaction over the first two years of opening. However, barriers remain and full integration requires a clearer vision and 'road map', requiring collaborative leadership and sustainable funding.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143024984","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":"How gender shapes practice choices among family medicine residents and early career family physicians: a Canadian qualitative study.","authors":"Anneka Sheppard, Amanda Gormley, Lauren Mills, Madeleine McKay, Fiona Bergin, Roetka Gradstein, Catherine Moravac, Ian Scott, Ruth Lavergne","doi":"10.3399/BJGPO.2024.0158","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0158","url":null,"abstract":"<p><strong>Background: </strong>The practice choices of family medicine residents and early career family physicians shape access to primary care. A growing proportion of family physicians are women.</p><p><strong>Aim: </strong>This study examined how gender operates in shaping family physician practice choices and subsequent practice patterns.</p><p><strong>Design & setting: </strong>Qualitative interview data were analyzed.</p><p><strong>Setting: </strong>Family medicine residents and early-career family physicians from three Canadian provinces (Nova Scotia, Ontario, and British Columbia) participated in interviews.</p><p><strong>Method: </strong>Qualitative interview data was collected as part of a larger mixed methods study. Eighty-eight interviews were transcribed verbatim and coded into several node reports including one on gender. Reflexive thematic analysis was conducted to identify themes related to how gender impacts physician practice choices.</p><p><strong>Results: </strong>Many participants described multiple intersecting pathways through which it was apparent that gender shaped their career and practice choices. Others did not identify the impact of gender in this regard. Parenthood and caregiving were commonly discussed, as were clinical interests specific to women's health, however, gendered expectations of patients and colleagues were also seen to shape choices. In this way, gender shaped choices directly, but also indirectly in response to gendered experiences and expectations.</p><p><strong>Conclusion: </strong>Findings support the need for structural reforms including: increased availability of collaborative team based models, flexible work schedules, closure of gendered wage gaps, and integration of gender awareness training through academic and healthcare institutions. Consideration of how primary care policies differentially impact across clinician gender is key to future planning to support a changing workforce that meets patient needs.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013422","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 effect of a general practitioner's perception of a patient request for antibiotics on antibiotic prescribing for respiratory tract infections: secondary analysis of a point prevalence audit survey in 18 European countries.","authors":"Julie Domen, Rune Aabenhus, Anca Balan, Emily Bongard, Femke Böhmer, Valerija Bralic Lang, Pascale Bruno, Slawomir Chlabicz, Annelies Colliers, Ana Garcia-Sangenis, Hrachuhi Ghazaryan, Anna Kowalczyk, Siri Jensen, Christos Lionis, Tycho M van der Linde, Lile Malania, Jozsef Pauer, Angela Tomacinschii, Akke Vellinga, Ihor Zastavnyy, Herman Goossens, Christopher C Butler, Alike W van der Velden, Samuel Coenen","doi":"10.3399/BJGPO.2024.0166","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0166","url":null,"abstract":"<p><strong>Background: </strong>Illness severity, comorbidity, fever, age and symptom duration influence antibiotic prescribing for respiratory tract infections (RTI). Non-medical determinants, such as patient expectations, also impact prescribing.</p><p><strong>Aim: </strong>To quantify the effect of general practitioners' (GPs') perception of a patient request for antibiotics on antibiotic prescribing for RTI and investigate effect modification by medical determinants and country.</p><p><strong>Design & setting: </strong>Prospective audit in 18 European countries.</p><p><strong>Method: </strong>Consultation data were registered of 4982 patients presenting with acute cough and/or sore throat. A mixed-effect logistic regression model analysed the effect of GPs' perception of a patient request for antibiotics. Two-way interaction terms assessed effect modification. Relevant clinical findings were added to subgroups of lower RTI (LRTI), throat infection, and influenza-like-illness (ILI).</p><p><strong>Results: </strong>GPs who perceived a patient request for antibiotics were four times more likely to prescribe antibiotics (OR: 4.4, 95%CI: 3.4-5.5). This effect varied by country: lower in Spain (OR: 0.06), Ukraine (OR: 0.15), and Greece (OR: 0.22) compared to the lowest prescribing country. The effect was higher for ILI (OR: 13.86, 95%CI: 5.5-35) and throat infection (OR: 5.1, 95%CI: 3.1-8.4) than for LRTI (OR: 2.9, 95%CI: 1.9-4.3). For ILI and LRTI, GPs were more likely to prescribe antibiotics with abnormal lung auscultation and/or increased/purulent sputum and for throat infection, with tonsillar exudate and/or swollen tonsils.</p><p><strong>Conclusion: </strong>GPs' perception of an antibiotic request and specific clinical findings influence antibiotic prescribing. Incorporating exploration of patient expectations, point-of-care testing and discussing watchful waiting into the decision-making process will benefit appropriate prescribing of antibiotics.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013425","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":"2025-01-17","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":"Barriers to and facilitators of women general practitioners' careers: a systematic review.","authors":"Laura Jefferson, Elin Webster, Su Golder, Katie Barnett, Nicola Greenwood, Veronica Dale, Karen Bloor","doi":"10.3399/BJGPO.2024.0282","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0282","url":null,"abstract":"<p><strong>Background: </strong>Despite women comprising 52% of full-time equivalent general practitioners (GPs) in England, a significant gender pay gap persists (15% after adjustments). Further understanding of the barriers and facilitators impacting women GPs' careers is needed.</p><p><strong>Aim: </strong>To identify and synthesise research evidence exploring barriers to and facilitators of women GPs' careers.</p><p><strong>Design & setting: </strong>Systematic review of qualitative and quantitative studies. Studies were included of general practitioners conducted in the UK NHS general practice setting.</p><p><strong>Method: </strong>Review methods followed Cochrane and PRISMA guidelines to systematically search MEDLINE, Embase, HMIC and Google Scholar to identify studies that explored gendered barriers and facilitators to GP careers. An inductive thematic analysis was used to synthesise the evidence.</p><p><strong>Results: </strong>21 articles were included in this review, with varied study designs. No relevant intervention studies were identified. There was a lack of recent research evidence; over half of the studies were conducted over 20 years ago. Most met quality criteria, though there were some problems with reporting and adjustment for potential confounders. Studies found barriers at personal, socio-cultural and system levels that inhibit women GPs' careers. While some positive changes have been documented across studies that span some thirty years, many challenges remain.</p><p><strong>Conclusion: </strong>Despite general practice being a medical specialty where women outnumber men, barriers at personal, socio-cultural and system levels continue to inhibit women GPs' careers.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013403","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}