BJGP Open最新文献

{"title":"'Picking up the pieces': primary care practitioners' experiences of cancer care reviews. A descriptive qualitative study.","authors":"Dipesh P Gopal, Stephanie Jc Taylor, Ping Guo, Nikolaos Efstathiou","doi":"10.3399/BJGPO.2024.0064","DOIUrl":"10.3399/BJGPO.2024.0064","url":null,"abstract":"<p><strong>Background: </strong>The number of people who are living with and beyond cancer is increasing in England. Primary care delivers cancer care via structured proactive conversations which are incentivised through the Quality and Outcomes Framework (QoF): 'cancer care reviews' (CCRs). Declining workforce numbers, increasing patient demand, CCR policy changes in 2020, and the onset of the coronavirus disease 2019 (COVID-19) pandemic motivate exploration of how staff deliver CCRs.</p><p><strong>Aim: </strong>To explore primary care staff's experiences with CCRs, their view of CCRs, how they conduct CCRs, and their perception of the value of CCRs.</p><p><strong>Design & setting: </strong>Descriptive qualitative study in general practices in England.</p><p><strong>Method: </strong>Semi-structured online interviews with 15 primary care staff; data analysis using reflexive thematic analysis.</p><p><strong>Results: </strong>Four themes were identified: varied and evolving perception of cancer; the delivery and impact of CCRs; changes to CCR delivery during the COVID-19 pandemic; and ways to complement CCRs. Primary care staff felt that the way that cancer was perceived by patients, including those from ethnic minority backgrounds, impacted how CCRs were delivered. Cancer care involved acknowledging the challenge of a cancer diagnosis, helping decode jargon, and addressing unmet care needs. The pandemic resulted in remote CCR delivery for some practices. Staff suggested that community cancer teams could provide cancer care alongside existing services.</p><p><strong>Conclusion: </strong>Staff adopted the new 3- and 12-month format CCRs despite the COVID-19 pandemic. Clinical staff may benefit from better training on cancer as a long-term condition and how cancer is perceived by people from diverse ethnic backgrounds.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082063","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":"Pathways to myeloproliferative neoplasm presentation and time to diagnosis: results from a cross-sectional study.","authors":"Emma-Louise Tarburn, Lisa Iversen, Charlotte Robertson, Charlene McShane, Andrew Duncombe, Mary-Frances McMullin, Claire Harrison, Ruben Mesa, Lesley A Anderson","doi":"10.3399/BJGPO.2024.0068","DOIUrl":"10.3399/BJGPO.2024.0068","url":null,"abstract":"<p><strong>Background: </strong>Early cancer recognition is key to improving patient outcomes. Diagnosis is often delayed in patients with myeloproliferative neoplasms (MPNs), putting them at risk of thromboembolic events and other complications pre-diagnosis. A clear understanding of the barriers to presentation and diagnosis is required.</p><p><strong>Aim: </strong>To explore barriers and factors influencing delayed presentation and diagnosis of MPNs.</p><p><strong>Design & setting: </strong>A cross-sectional study of patients with MPN within the UK and the Republic of Ireland.</p><p><strong>Method: </strong>An online cross-sectional survey of patients with MPN was undertaken. Symptoms and factors influencing patient and GP delay were examined. Adjusted odds ratios (aORs) were calculated to explore the relationship between these factors and patient and GP delay.</p><p><strong>Results: </strong>Most (80.2%) of the 620 patients completing the survey reported symptomatic presentation. The most common symptoms associated with patient delay were pruritus (aOR 1.89, 95% confidence interval [CI] = 1.19 to 3.01), headaches (aOR 1.86, 95% CI = 1.13 to 2.82), and concentration difficulties (aOR 1.75, 95% CI = 1.12 to 2.76). Attributing symptoms to ageing (aOR 1.92, 95% CI = 1.19 to 3.11) and not wanting to burden the GP (2.04, 95% CI = 1.24 to 3.39) were significantly associated with patient delay. Those reporting >3 blood cancer warning signs were more likely to experience GP delay than those experiencing fewer (aOR 3.26<b>,</b> 95% CI = 1.75 to 6.29), and lack of relational continuity of GP care was significantly associated with GP delay (aOR 3.41, 95% CI = 1.65 to 7.28).</p><p><strong>Conclusion: </strong>Debunking misconceptions around ageing, encouraging timely communication with GPs, and improving relational continuity of GP care could assist in reducing diagnostic delays, prevent potentially fatal disease complications, and ultimately improve outcomes for patients with MPN.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856698","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":"Association between video consultation use and general practitioner and practice characteristics: a cross-sectional survey in Denmark.","authors":"Thim Prætorius, Eskild Klausen Fredslund, Daniel Cæsar Torp, Annelli Sandbaek","doi":"10.3399/BJGPO.2024.0228","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0228","url":null,"abstract":"<p><strong>Background: </strong>Video consultations (VC) disrupt how general practice provides care and how patients receive it. A step towards understanding the use of VC is to study the association between user-status and general practitioner and practice characteristics.</p><p><strong>Aim: </strong>To study the association between general practitioner and general practice characteristics and VC user-status (users, never users, and former users).</p><p><strong>Design & setting: </strong>An anonymous, web-based, cross-sectional survey was distributed to all 1674 Danish general practices (singlehanded, collaborative, and partnership forms) contracting with and working on a collective agreement with the public funder.</p><p><strong>Method: </strong>Multinomial logistic regression was used to correlate VC user-status and (1) general practice characteristics, and general practitioners' (2a) objective characteristics and (2b) subjective attitudes towards VC and organizational change.</p><p><strong>Results: </strong>The study sample included 416 general practitioners. Users of VC compared to never-users: partnership practices (RRR=0.22; 95% CI 0.06-0.85) and practices with six or more practice staff (RRR=0.05; 95% CI 0.01-0.28) were significantly more likely to be users. The same was found for general practitioners with a high degree of tech savviness (RRR=0.02; 95% CI 0.001-0.17) and openness to organisational change (RRR=0.26; 95% CI 0.08-0.85).</p><p><strong>Conclusion: </strong>Characteristics of general practice and general practitioners are associated with VC user-status (being a user, never user or former user). Future research should use a Difference-in-Difference study design and register data to make causality claims.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956336","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":"What's been tried: a curated catalogue of efforts to improve access to general practice.","authors":"Carol Sinnott, Evleen Price, Akbar Ansari, Rebecca Fisher, Jake Beech, Hugh Alderwick, Mary Dixon-Woods","doi":"10.3399/BJGPO.2024.0184","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0184","url":null,"abstract":"<p><strong>Background: </strong>Although increasing numbers of appointments are being provided, public satisfaction with access to UK general practice is declining. Previous attempts to improve access have not been systematically collated.</p><p><strong>Aim: </strong>We aimed to identify interventions to improve access to general practice in the UK, to organise these interventions into thematic categories, and to identify which aspects of access are targeted.</p><p><strong>Design & setting: </strong>Narrative systematic review.</p><p><strong>Method: </strong>A three-stage search was conducted to identify interventions used to improve access to NHS general practice. Using an iterative process, we generated thematic categories to classify interventions according to how they are intended to work. We assessed which aspects of access they addressed using the seven-feature Candidacy Framework.</p><p><strong>Results: </strong>The search identified 449 relevant sources reporting on interventions to improve access to general practice over the period 1984-2023. We generated six overarching thematic categories into which we organised these interventions: appointment innovations; direct patient access to services; increasing the number and range of professionals available in general practice; offering contacts beyond core hours, core settings and core services; supporting patient engagement; and supporting the wider structures of general practice. We assessed which features of Candidacy were addressed, with \"permeability\" (the ease with which people can use) services emerging as the most frequent feature.</p><p><strong>Conclusion: </strong>Multiple and diverse attempts have been made to improve access in general practice over a 40-year period. This curated, thematised catalogue offers an important resource for future efforts to improve access.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956376","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":"Core functions of primary care in Amathole district, South Africa: a descriptive study.","authors":"Robert Mash, Jenny Nash","doi":"10.3399/BJGPO.2024.0141","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0141","url":null,"abstract":"<p><strong>Background: </strong>Strengthening primary care is a priority globally and for the South African health system. The current measurement tools in South Africa do not measure the core functions of primary care: access, comprehensiveness, coordination, continuity and person-centredness. A new regional version of the Primary Care Assessment Tool (PCAT) has just been validated and can measure these core functions.</p><p><strong>Aim: </strong>To field test the regional PCAT and measure the core functions of primary care performance.</p><p><strong>Design & setting: </strong>A descriptive cross-sectional survey in Amathole District, South Africa.</p><p><strong>Method: </strong>Data were collected from 386 randomly selected patients from 40 clinics and six subdistricts. Data was collected using the REDCap mobile App and analysed in the Statistical Package for Social Sciences version 27.</p><p><strong>Results: </strong>The median primary care score was 3.3 (IQR 3.2-3.5) where a score>3 was seen as acceptable performance and>3.5 as good. Person-centredness, coordination and utilisation were all scored as good (4.0 (IQR 4.0-4.0). Comprehensiveness (3.3 (IQR 2.9-3.6) and continuity (3.2 (IQR 3.1-3.6) were scored as acceptable. Access to care was scored as poor (1.7 (IQR 1.0-2.9). There were significant differences in primary care scores between subdistricts. Those with a worse health status or chronic condition gave lower scores. The most affluent and the poorest groups also gave lower scores.</p><p><strong>Conclusion: </strong>The district needs to focus on improving access to care as well as some aspects of comprehensiveness, continuity, and coordination. The newly validated regional PCAT provided the district with novel information for performance management and improvement.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956338","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":"Inequalities in cancer two-week-wait referrals: a cross-sectional study in English general practice.","authors":"Stephanie C Wynne, Mark Ashworth","doi":"10.3399/BJGPO.2024.0052","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0052","url":null,"abstract":"<p><strong>Background: </strong>Practices with higher two-week-wait (2WW) referral-rates demonstrate higher survival for several cancers. Yet, there is little up-to-date evidence exploring factors influencing 2WW-referral-rates and whether health inequalities exist, particularly after COVID-19.</p><p><strong>Aim: </strong>To establish which patient-factors (eg, age, sex, ethnicity, deprivation) and practice-factors (eg, remote consultations, frequency of seeing a preferred-GP) independently predict 2WW-referral-rates.</p><p><strong>Design & setting: </strong>A cross-sectional, observational study was performed using data from English general practices for 2021-2022.</p><p><strong>Method: </strong>Multivariable linear regression was used to identify the strongest, independent predictors of 2WW-referral-rates for all-cancers (primary outcome) and for breast, lower-gastrointestinal, lung and skin cancers separately (secondary outcome).</p><p><strong>Results: </strong>The analysis included 6307 practices. Practices with more females, patients aged 75+and with a greater burden of long-term conditions were associated with higher 2WW-referrals for all-cancers, as were practices in Northwest England and those with higher scores for patients feeling involved in care decisions. Conversely, practices with a higher frequency of seeing a preferred-GP were predictive of fewer all-cancer 2WW-referrals. Whilst practices with a higher proportion of current smokers and Asian and Black ethnicity patients predicted fewer all-cancer 2WW-referrals, these associations were strongest for skin cancer, and for breast cancer (except for Black ethnicity). Higher socioeconomic deprivation predicted lower 2WW-referrals for lung cancer only.</p><p><strong>Conclusion: </strong>This study analyses factors influencing 2WW-referral-rates and highlights potential inequalities. This work identifies priority populations, including smokers and Asian and Black ethnicity patients, who may benefit from interventions to increase primary care access. Shared-decision-making may be an underexplored resource for increasing all-cancer 2WW-referral-rates.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956285","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":"'Stuck or unstable': partnerships between GPs and patients with complex chronic conditions. A qualitative study.","authors":"Mads Aage Toft Kristensen, Mette Bech Risør, Andreas Søndergaard Heltberg, Tora Grauers Willadsen, Ann Dorrit Guassora","doi":"10.3399/BJGPO.2024.0146","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0146","url":null,"abstract":"<p><strong>Background: </strong>In chronic care, patient-GP collaboration is essential, but might be challenging if patients have complex health problems due to multimorbidity, psychosocial predicaments and addiction problems. To understand and manage these challenges, it is important to explore how patients' and GPs' attempt to collaborate, to maintain and achieve an alliance in order to gain good quality of care.</p><p><strong>Aim: </strong>To explore how dyads of GPs and patients that GPs deem have complex health problems and difficulties following treatment perceive and manage challenges in their chronic care partnership.</p><p><strong>Design & setting: </strong>A qualitative study from Danish general practice in deprived, rural areas.</p><p><strong>Method: </strong>Semi-structured interviews with 12 dyads of GPs and patients with doctor-assessed complex chronic conditions and difficulties following treatment. The principles of Systematic Text Condensation were used in the analysis.</p><p><strong>Results: </strong>Overall, the patient-GP collaboration could be characterized as either stuck or unstable. In both types, the challenges were identified as pointless consultations, conflicts about lifestyle, resignation, concealment of information, and hopelessness. These challenges could be managed by solving conflicts, adjusting to the patient's needs, accommodating the challenges in the relationship, and offering continued emotional support even with unsolved medical problems.</p><p><strong>Conclusion: </strong>Care of patients with complex health problems may possess several challenges. In this study, patients and GPs experienced the relational dimension as crucial for collaboration. A robust therapeutic alliance, incorporating the patient's agenda, offers an essential foundation for enhancing care in individuals with complex health problems.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956291","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":"Healthcare users' evaluation of general practice - a survey among Danish men aged 45 to 70 years.","authors":"Søren Birkeland, Sören Möller","doi":"10.3399/BJGPO.2024.0153","DOIUrl":"https://doi.org/10.3399/BJGPO.2024.0153","url":null,"abstract":"<p><strong>Background: </strong>Knowledge about healthcare users' evaluation of general practice is relatively limited.</p><p><strong>Aim: </strong>We aimed to investigate evaluations in Danish men of general practice healthcare and of different aspects of general practitioners' (GPs) communication with patients.</p><p><strong>Design & setting: </strong>Secondary analyses of data from a web-based survey in 6756 Danish men aged 45-70 years (30% response rate) using municipality-level information from registries, self-reported sociodemographic data, personality characteristics, and five-point Likert scale evaluations of healthcare and communication in general practice.</p><p><strong>Results: </strong>A large majority of participants agreed (<i>n</i>=4420, 65%) or strongly agreed (<i>n</i>=1653, 24%) that their GP treatment had been \"almost perfect\", with slightly fewer (<i>n</i>=4205, 63%) responding that their GP was good at showing consideration for them. The latter item was, however, reversed, making comparisons more difficult and all differences were small. Older healthcare users evaluated healthcare higher (<i>P</i><0.01) and higher scores on the extraversion, agreeableness, and conscientiousness personality dimensions generally were associated with higher evaluation scores (<i>P</i><0.01) while the opposite tended to be true for respondents with higher neuroticism scores (<i>P</i>=0.002). When not controlling for multiplicity, participants in rural area tended to evaluate the explanation of medical procedures with lower scores (<i>P</i>=0.014) and participants with cerebrovascular disease (<i>P</i>=0.003) and those residing in higher tax income area (<i>P</i>=0.001) tended to generally evaluate GP care less positively.</p><p><strong>Conclusion: </strong>Despite an overall high evaluation of GP care, evaluations may vary, including among different groups of healthcare users.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142928420","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":"Incidence of hand and wrist disorders in primary care: a retrospective cohort study.","authors":"Patrick Krastman, Evelien It de Schepper, Patrick Je Bindels, Sita Ma Bierma-Zeinstra, Gerald Kraan, Jos Runhaar","doi":"10.3399/BJGPO.2023.0240","DOIUrl":"10.3399/BJGPO.2023.0240","url":null,"abstract":"<p><strong>Background: </strong>The incidence of different types of hand and wrist disorders in primary care is unknown since there are no specific encodings for it.</p><p><strong>Aim: </strong>To determine the overall incidence and the incidence of specific types of hand and wrist disorders in primary care.</p><p><strong>Design & setting: </strong>A retrospective cohort study was undertaken, using a healthcare registration database from Dutch general practice, which contains medical records of more than 200 000 patients, and included approximately 25% of the population of the area of Rotterdam in The Netherlands.</p><p><strong>Method: </strong>Patients aged ≥18 years with a new diagnosis of hand or wrist disorder from 1 January 2015-31 December 2019 were extracted using a search algorithm based on International Classification of Primary Care (ICPC) coding and search terms in free text.</p><p><strong>Results: </strong>The mean incidence over the study period of a hand disorder was 5.9 per 1000 persons-years and of a wrist disorder 0.3 per 1000 persons-years. The incidence of trigger finger or thumb, hand or finger fracture, tendon or ligament tendinopathy, mallet finger, and hand or finger ligament injury were 3 (95% confidence interval [CI] = 2.69 to 3.15), 1 (95% CI = 1.03 to 1.33), 1 (95% CI = 0.98 to 1.28), 0.6 (95% CI = 0.48 to 0.69), and 0.1 (95% CI = 0.06 to 0.14) per 1000 persons-years, respectively. The incidence of a wrist fracture and ligament injury were 0.2 (95% CI = 0.13 to 0.25) and 0.1 (95% CI = 0.04 to 0.12) per 1000 persons-years, respectively.</p><p><strong>Conclusion: </strong>There is a large difference between the number of patients presenting to the GP with hand and wrist complaints and the number of hand and wrist diagnoses reported in the medical files. Introducing specific ICPC codes for different types of hand and wrist disorders could (potentially) lead to a more accurate registration of a diagnosis and determination of the incidence figures.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140959914","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":"Primary care-based interventions for secondary prevention of opioid dependence in patients with chronic non-cancer pain taking pharmaceutical opioids: a systematic review.","authors":"Clare E French, David M Troy, Sarah Dawson, Michael N Dalili, Matthew Hickman, Kyla H Thomas","doi":"10.3399/BJGPO.2024.0122","DOIUrl":"10.3399/BJGPO.2024.0122","url":null,"abstract":"<p><strong>Background: </strong>Globally, almost one-third of adults with chronic non-cancer pain (CNCP) are prescribed opioids. Prevention of opioid dependence among these patients is a public health priority.</p><p><strong>Aim: </strong>To synthesise the evidence on the effectiveness of primary care-based interventions for secondary prevention of opioid dependence in patients with CNCP who are taking pharmaceutical opioids.</p><p><strong>Design & setting: </strong>Systematic review of randomised controlled trials (RCTs) and comparative non-randomised studies of interventions from high-income countries.</p><p><strong>Method: </strong>We searched five databases for studies on non-tapering secondary prevention interventions, such as tools for predicting dependence, screening tools for early recognition of dependence, monitoring of prescribing or medication, and specialist support. We examined multiple outcomes, including reduction in opioid dosage. Primary analyses were restricted to RCTs with data synthesised using an effect direction plot. Risk of bias was assessed using the Cochrane risk of bias (RoB2) tool.</p><p><strong>Results: </strong>Of 7102 identified reports, 18 studies were eligible (eight of which were RCTs). Most used multiple interventions or components. Of the seven RCTs at low risk of bias or with 'some concerns', five showed a positive intervention effect on at least one relevant outcome, four of which included a nurse care manager and/or other specialist support. The remaining two RCTs showed no positive effect of automated symptom monitoring and optimised analgesic management by a nurse care manager or a physician pain specialist team, or of a mobile opioid management app.</p><p><strong>Conclusion: </strong>We identify a clear need for further adequately powered high-quality studies. The conclusions that can be drawn on the effectiveness of interventions are limited by the sparsity and inconsistency of available data.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11687252/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141535587","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}