BJGP OpenPub Date : 2025-04-24Print Date: 2025-04-01DOI: 10.3399/BJGPO.2024.0163
Anne Heaven, Marilyn Foster, Robbie Foy, Rebecca Hawkins, Claire Hulme, Sara Humphrey, Jane Smith, Andrew Paul Clegg
{"title":"Personalised care planning for older people with frailty: a review of factors influencing implementation.","authors":"Anne Heaven, Marilyn Foster, Robbie Foy, Rebecca Hawkins, Claire Hulme, Sara Humphrey, Jane Smith, Andrew Paul Clegg","doi":"10.3399/BJGPO.2024.0163","DOIUrl":"10.3399/BJGPO.2024.0163","url":null,"abstract":"<p><strong>Background: </strong>Frailty increases vulnerability to major health changes because of seemingly small health problems. It affects around 10% of people aged >65 years. Older adults with frailty frequently have multiple long-term conditions, personal challenges, and social problems. Personalised care planning (PCP) based on 'goal setting' and 'action planning' is a promising way to address the needs of older adults living with frailty.</p><p><strong>Aim: </strong>To identify and explore factors that influence the implementation of PCP-style interventions for older adults.</p><p><strong>Design & setting: </strong>We conducted a scoping review and identified a small number of interventions that explicitly employed goal setting and action planning.</p><p><strong>Method: </strong>We used a range of sources to identify relevant material. We included all interventions inclusive of patients aged ≥65 years and reported in English. We excluded end-of-life care interventions, group education, and/or those that did not involve one-to-one engagement. We explored all related articles that described, examined, or discussed implementation. We constructed a thematic framework in NVivo (version 11). Findings were narratively synthesised.</p><p><strong>Results: </strong>We identified 18 potentially relevant PCP-style interventions and 13 of these met the inclusion criteria. Within these, were seven main categories of potentially modifiable influences relevant to older adults with frailty related to the following: primary care engagement; delivery staff characteristics; training; patient engagement; collaborative working; organisation and management; and systems.</p><p><strong>Conclusion: </strong>Many modifiable factors can influence the implementation of PCP. We identified several influences that have informed the development and implementation of a novel intervention PeRsOnaliSed care Planning for oldER people with frailty (PROSPER).</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138007/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928425","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}
BJGP OpenPub Date : 2025-04-24Print Date: 2025-04-01DOI: 10.3399/BJGPO.2024.0045
Line T Jakobsen, Anne Søjbjerg, Stinne E Rasmussen, Kaj S Christensen
{"title":"Identifying impaired mental health in patients with type 2 diabetes: a cross-sectional study in general practice.","authors":"Line T Jakobsen, Anne Søjbjerg, Stinne E Rasmussen, Kaj S Christensen","doi":"10.3399/BJGPO.2024.0045","DOIUrl":"10.3399/BJGPO.2024.0045","url":null,"abstract":"<p><strong>Background: </strong>Type two diabetes (T2D) is linked to impaired mental health. International guidelines emphasise the importance of including psychological aspects in diabetes care. Yet, no systematic approach has been implemented to assess mental health in patients with T2D in general practice.</p><p><strong>Aim: </strong>To evaluate the mental health of patients with T2D in general practice, and to investigate the effectiveness of asking patients about their wellbeing by using a single-item question compared with the five-item World Health Organization-Five Wellbeing Index (WHO-5).</p><p><strong>Design & setting: </strong>A cross-sectional study was undertaken, which included 230 patients with T2D in Danish general practice, from 1 May 2023-31 January 2024.</p><p><strong>Method: </strong>Eligible patients were recruited at the annual chronic care consultation. They answered a single-item question on wellbeing and four validated measures of general wellbeing (WHO-5), depression (Patient Health Questionnaire-9; PHQ-9), anxiety (Generalised Anxiety Disorder-7; GAD-7), and diabetes distress (Problem Areas in Diabetes-5; PAID-5).</p><p><strong>Results: </strong>Overall, 32% of patients expressed symptoms of impaired mental health. Notably, the WHO-5 identified 53% of these patients, whereas only 12% of patients were identified through the single-item question. Importantly, among the patients exhibiting symptoms of impaired mental health, those identified by the WHO-5 displayed statistically significantly lower mental health scores across all measures (except PAID-5) compared with those not identified by the WHO-5.</p><p><strong>Conclusion: </strong>A significant proportion of patients with T2D in general practice are affected by mental health issues. Our findings indicate that a single-item question may not sufficiently detect these issues, highlighting the importance of incorporating tools, such as the WHO-5, to offer a more comprehensive approach in diabetes care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138021/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005495","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}
BJGP OpenPub Date : 2025-04-24Print Date: 2025-04-01DOI: 10.3399/BJGPO.2024.0084
Robert Mash, Kefilath Bello, Innocent K Besigye, Anna Galle
{"title":"Adapting the Primary Care Assessment Tool for sub-Saharan Africa: a validation study.","authors":"Robert Mash, Kefilath Bello, Innocent K Besigye, Anna Galle","doi":"10.3399/BJGPO.2024.0084","DOIUrl":"10.3399/BJGPO.2024.0084","url":null,"abstract":"<p><strong>Background: </strong>The World Health Organization's (WHO) measurement framework for primary health care includes the core functions of primary care: first-contact access, comprehensiveness, coordination, continuity, and person-centredness. The Primary Care Assessment Tool (PCAT), originally developed in the USA, was adapted for use by four African countries, and can measure the core functions of primary care.</p><p><strong>Aim: </strong>To face and content validate a PCAT for sub-Saharan Africa that measures the core functions of primary care.</p><p><strong>Design & setting: </strong>Nineteen countries within the Primary Care and Family Medicine (PRIMAFAMED) network for sub-Saharan Africa participated in a validation study.</p><p><strong>Method: </strong>Two stages included a PRIMAFAMED workshop to assess face validity and a Delphi study to reach consensus on content validity among an expert panel as well as key stakeholders.</p><p><strong>Results: </strong>Thirteen countries participated in the workshop and suggested rephrasing 39 items, deleting six and adding four new items. Nineteen countries participated in the Delphi study and all 20 panel members reached consensus (>70%) on including the items as written. Seven experts and stakeholders reviewed the PCAT and suggested rephrasing 23 items, deleting one and adding one. The final PCAT for sub-Saharan Africa (SSA-PCAT) consists of 85 items that measure affiliation with the primary care facility, first-contact access and utilisation, comprehensiveness, continuity, coordination, and person-centredness, as well as health, demographic and socioeconomic status.</p><p><strong>Conclusion: </strong>The SSA-PCAT will now be piloted in Benin, Uganda, and South Africa. Further psychometric evaluation will be possible followed by more widespread use by researchers, district managers, and policymakers in the region.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138020/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019037","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}
BJGP OpenPub Date : 2025-04-24Print Date: 2025-04-01DOI: 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":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12137999/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082062","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}
BJGP OpenPub Date : 2025-04-24Print Date: 2025-04-01DOI: 10.3399/BJGPO.2024.0167
Lisa Kastbom, Anna Olaison, Annette Sverker, Anna Segernäs
{"title":"Vulnerable older people's views on proactive care planning: a qualitative interview study in primary care.","authors":"Lisa Kastbom, Anna Olaison, Annette Sverker, Anna Segernäs","doi":"10.3399/BJGPO.2024.0167","DOIUrl":"10.3399/BJGPO.2024.0167","url":null,"abstract":"<p><strong>Background: </strong>Patients in old age often have complex care needs owing to multimorbidity and polypharmacy. This qualitative study is part of a larger ongoing Swedish intervention trial Secure And Focused primary care for older pEople (SAFE), including shorter care agreements based on person-centred patient goals.</p><p><strong>Aim: </strong>To explore, in a primary care setting, the views of older and vulnerable patients on a more systematic, proactive approach to care planning, including establishing and documenting care agreements based on person-centred goals.</p><p><strong>Design & setting: </strong>Individual semi-structured interviews with patients (<i>n</i> = 25) aged >75 years from 12 intervention primary healthcare centres in two counties in Sweden.</p><p><strong>Method: </strong>Interviews were conducted between June and October 2023. They were digitally recorded and transcribed verbatim. Latent qualitative content analysis was used.</p><p><strong>Results: </strong>The following three categories, with 10 sub-categories, were found: I would like to live in the present, so why plan ahead? Let me decide versus they know best; and Care agreements usually went unnoticed. The latent theme - The ambivalence of care planning in the fourth age - was created to give a deeper meaning to the content of the categories.</p><p><strong>Conclusion: </strong>This study emphasises that older, vulnerable persons have varying attitudes towards participation in proactive care planning. This ambivalence may originate from the individual's desire to have their autonomy respected and express future care preferences on the one hand, and to avoid or postpone end-of-life conversations and care planning on the other hand. Patients also expressed a desire to be more actively involved in care planning. Although care agreements have the potential to increase patient involvement in proactive care planning, they often went unnoticed. The conversation itself was essential.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138017/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142366812","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}
BJGP OpenPub Date : 2025-04-24Print Date: 2025-04-01DOI: 10.3399/BJGPO.2024.0144
Eero H Mellanen, Timo Kauppila, Hannu Kautiainen, Mika T Lehto, Ossi Rahkonen, Kaisu H Pitkälä, Merja K Laine
{"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":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138002/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093870","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}
BJGP OpenPub Date : 2025-04-24Print Date: 2025-04-01DOI: 10.3399/BJGPO.2024.0092
Lucy Delaney, Amanda Semper, Neil French, John Sp Tulloch
{"title":"Lyme disease in UK primary care: a knowledge, attitude, and practice survey.","authors":"Lucy Delaney, Amanda Semper, Neil French, John Sp Tulloch","doi":"10.3399/BJGPO.2024.0092","DOIUrl":"10.3399/BJGPO.2024.0092","url":null,"abstract":"<p><strong>Background: </strong>Lyme disease (LD) cases in the UK most commonly present within the primary care setting. Despite an upward trend of incidence, little is known regarding GP experience with diagnosis and treatment.</p><p><strong>Aim: </strong>This study aims to describe baseline primary care clinician Knowledge, Attitude and Practice (KAP) in Scotland and England.</p><p><strong>Design & setting: </strong>Online KAP survey on LD for UK-based practising GPs.</p><p><strong>Method: </strong>An online KAP questionnaire was developed for use in UK primary care. The survey was distributed through UK-based research networks, professional societies, and via social media.</p><p><strong>Results: </strong>A total of 191 complete responses were analysed (England <i>n</i> = 130, Scotland <i>n</i> = 61). The Scotland-based responder group had more relevant consultations in the previous 3 years. Responders from Scotland demonstrated a greater awareness that erythema migrans (EM) is pathognomonic for LD and that serological testing of this patient group is not indicated. Less common cardiac and neurological symptoms were not as well associated with LD by both responder groups for the former and England-based responders for the latter. Prescribing according to the National institute for Health and Care Excellence (NICE) guidance was identified in 70% of Scotland and 42% of England-based GP responses.</p><p><strong>Conclusion: </strong>Targeted resources may improve clinician confidence on exposure risk, symptom recognition, testing limitations and treatment dose and duration. Scotland-based responders' better survey performance potentially reflects greater clinical exposure and public awareness of the disease, due to high endemicity within the nation.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138015/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142523272","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}
BJGP OpenPub Date : 2025-04-22DOI: 10.3399/BJGPO.2024.0166
Julie Domen, Rune Aabenhus, Anca Balan, Emily Bongard, Femke Böhmer, Valerija Bralić Lang, Pascale Bruno, Slawomir Chlabicz, Annelies Colliers, Ana García-Sangenís, 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
{"title":"The effect of a GP'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 Bralić Lang, Pascale Bruno, Slawomir Chlabicz, Annelies Colliers, Ana García-Sangenís, 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":"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 a GP's 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 of general practices 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' perceptions 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>A GP's perception of a request for antibiotics meant they were four times more likely to prescribe antibiotics (odds ratio [OR] 4.4, 95% confidence interval [CI] = 3.4 to 5.5). This effect varied by country: lower in Spain (OR 0.06), Ukraine (OR 0.15), and Greece (OR 0.22) compared with the lowest prescribing country. The effect was higher for ILI (OR 13.86, 95% CI = 5.5 to 35) and throat infection (OR 5.1, 95% CI = 3.1 to 8.4) than for LRTI (OR 2.9, 95% CI = 1.9 to 4.3). For ILI and LRTI, GPs were more likely to prescribe antibiotics with abnormal lung auscultation and/or increased or purulent sputum and for throat infection, with tonsillar exudate and/or swollen tonsils.</p><p><strong>Conclusion: </strong>GPs' perceptions 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":"2025-04-22","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}
BJGP OpenPub Date : 2025-04-22DOI: 10.3399/BJGPO.2024.0111
Désanne Noordam, Monique Heijmans, Janneke Noordman, Tim Olde Hartman, Sandra van Dulmen
{"title":"Mental health care and pragmatic shared decision making in general practice: an interview study.","authors":"Désanne Noordam, Monique Heijmans, Janneke Noordman, Tim Olde Hartman, Sandra van Dulmen","doi":"10.3399/BJGPO.2024.0111","DOIUrl":"10.3399/BJGPO.2024.0111","url":null,"abstract":"<p><strong>Background: </strong>Healthcare providers in general practice are expected to deliver mental health care to patients through shared decision making (SDM). It is unclear whether they perceive their SDM to be affected by challenging circumstances in mental healthcare; for example, how waiting time for therapy plays a role.</p><p><strong>Aim: </strong>To explore how healthcare providers and patients in general practice engage in SDM, given the challenging circumstances in mental health care.</p><p><strong>Design & setting: </strong>A qualitative interview study in seven Dutch general practices.</p><p><strong>Method: </strong>Semi-structured interviews were conducted with GPs (<i>n</i> = 9), practice nurses mental health (PNMHs; <i>n</i> = 8), and patients who sought mental health care (<i>n</i> = 18). The interviews were deductively and inductively thematically analysed.</p><p><strong>Results: </strong>The participants mainly reported on SDM regarding treatment in secondary mental health care. The PNMHs explained they lack an overview of available treatments and waiting times in facilities. The PNMHs therefore instruct patients to also search for options themselves. Most patients found this approach burdensome, especially those new to mental health care. These patients were said to often express no strong treatment preferences and rely on advice by their healthcare providers. The GPs and PNMHs explained that in such cases, they often adopt a pragmatic approach and, for example, refer indecisive patients to facilities with little waiting times.</p><p><strong>Conclusion: </strong>The healthcare providers and patients in general practice report that they adapt their approach to SDM in reaction to the circumstances in mental health care. Further exploration of how SDM is implemented and shaped by challenging circumstances across different healthcare settings is needed.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584431","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}
BJGP OpenPub Date : 2025-04-22DOI: 10.3399/BJGPO.2024.0264
Julie Carson, Anna Frain, Heidi Emery, Edward Tyrrell, Daniel Crowfoot, Gurvinder Sahota, Emma Wilson, Jaspal Taggar
{"title":"Attainment of medical student learning outcomes following general practice speciality trainee supervision: a pilot study.","authors":"Julie Carson, Anna Frain, Heidi Emery, Edward Tyrrell, Daniel Crowfoot, Gurvinder Sahota, Emma Wilson, Jaspal Taggar","doi":"10.3399/BJGPO.2024.0264","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0264","url":null,"abstract":"<p><strong>Background: </strong>Innovative training approaches are needed to address the lack of capacity in primary care for undergraduate medical student clinical placements. Near-Peer Teaching (NPT) by General Practice Speciality Trainees (GPSTs) is one possible solution.</p><p><strong>Aim: </strong>Compare the attainment of intended learning outcomes (ILOs) for students taught by GPSTs and qualified General Practitioners (GPs).</p><p><strong>Design & setting: </strong>Quantitative pilot study of medical students undertaking clinical training in GP at Nottingham University.</p><p><strong>Method: </strong>Year 3 GPSTs were trained to supervise first-year graduate entry medical students undertaking 6 half-day GP visits (2022-2023). Using Likert-scale post-training questionnaires, self-reported attainment of ILOs was compared for supervision provided to students by GPSTs and GPs. Secondary outcomes included student, GPST and GP views about NPT.</p><p><strong>Results: </strong>Of 112 medical students, 7 were supervised by GPSTs and 105 by GPs. 101 students responded [7 (100%) from GPST supervision; 94 (90%) from GP supervision]. There was no significant difference between groups in attainment of 7 ILOs with significantly greater attainment for students supervised by GPSTs for receiving feedback [<i>P</i>=0.018] and self-reflection [<i>P</i>=0.015]. GPSTs reported improved organisation, communication, feedback skills, and desire for future student supervision. Medical students and GPs reported enthusiasm for future NPT by GPSTs.</p><p><strong>Conclusion: </strong>Attainment of ILOs during undergraduate GP placements was at least equivalent when students were supervised by GPSTs compared with GPs. GPSTs are an important group for building supervisory capacity for undergraduate education and this study adds confidence in enabling GPST supervision of undergraduates.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040402","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}