BJGP Open最新文献

{"title":"Sex differences and trends in managing cardiovascular risk factors in primary care: a dynamic cohort study.","authors":"Geert Smits, Michiel L Bots, Monika Hollander, Sander van Doorn","doi":"10.3399/BJGPO.2024.0175","DOIUrl":"10.3399/BJGPO.2024.0175","url":null,"abstract":"<p><strong>Background: </strong>Treatment targets for cardiovascular risk management (CVRM) make no distinction between women and men.</p><p><strong>Aim: </strong>To explore sex differences in achieving treatment targets in patients who participated in a nurse-led, integrated CVRM care programme in primary care between 2013 and 2019.</p><p><strong>Design & setting: </strong>We conducted a dynamic cohort study in the Eindhoven region, which is the south-eastern part of the Netherlands.</p><p><strong>Method: </strong>We assessed outcomes of three biological risk factors (systolic blood pressure [SBP], low-density lipoprotein [LDL] cholesterol, and estimated glomerular filtration rate [eGFR]) and four lifestyle factors (smoking, physical activity, alcohol intake, and body mass index [BMI]). Points (1 = on target; 0 = not on target) were assigned for biological risk factors, lifestyle factors, and an overall score. Using the annual results, we applied multivariable regression models to study trends over time and differences in trends between women and men.</p><p><strong>Results: </strong>The number of participants increased from 24,889 to 38,067, mean age increased from 67.3 years to 71.5 years, with around 52 % women each year. The average of seven risk factors on target increased significantly from 4.6 to 4.9 in women, and from 4.7 to 5.0 in men, with no statistical difference between women and men. Differences between women and men in 2013 in the number of both biological and lifestyle factors on target did not materially change over time.</p><p><strong>Conclusion: </strong>Integrated cardiovascular management care led to improvements in cardiovascular risk factors on target, equally well in women than in men. Differences in risk factors on target between women and men in 2013 were still present in 2019.</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/PMC12138010/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142093871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arab community perceptions and awareness of family medicine: a systematic review.","authors":"Beesan Maraqa, Zaher Nazzal, Therese Zink","doi":"10.3399/BJGPO.2024.0104","DOIUrl":"10.3399/BJGPO.2024.0104","url":null,"abstract":"<p><strong>Background: </strong>Family medicine (FM), often known as general practice, is the foundation of sustainable and universal healthcare worldwide. As a new specialty in the Eastern Mediterranean Region (EMR), it must recruit doctors and gain public acceptability, which has traditionally favoured specialists.</p><p><strong>Aim: </strong>This research examined studies on Arab populations' attitudes towards FM to discover the barriers to creating and embracing this vital specialty.</p><p><strong>Design & setting: </strong>This review was based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and encompassed peer-reviewed articles from reputable sources such as PsycNet, Web of Science, PubMed, Embase, Scopus, and grey literature.</p><p><strong>Method: </strong>A comprehensive search was conducted across databases for peer-reviewed studies that explored Arabs' awareness, perceptions, and attitudes towards FM and physicians.</p><p><strong>Results: </strong>After a rigorous selection process, 19 studies were deemed suitable for analysis. These studies encompassed diverse participants, including medical students, physicians, patients, and the general public. The overall perception of FM was positive, but it was noted that few had direct exposure to family physicians during their medical education or in the clinical setting.</p><p><strong>Conclusion: </strong>Our review findings suggest the following five recommendations: (1) an education campaign for the general public about the role of FM; (2) increasing training capacity for family physicians; (3) early exposure to family physicians during medical school; (4) developing a process for continually improving the education and quality of family physicians; and (5) further research on the challenges to FM practice in Arab countries to understand the situation better and work toward its improvement.</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/PMC12138013/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297457","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Developing a data-enabled nudge intervention for childhood antibiotics in primary care: a qualitative study.","authors":"Oliver Van Hecke, Aleksandra Borek, Christopher Butler, Sarah Tonkin-Crine","doi":"10.3399/BJGPO.2024.0032","DOIUrl":"10.3399/BJGPO.2024.0032","url":null,"abstract":"<p><strong>Background: </strong>Preschool children (aged ≤5 years) have the highest antibiotic prescribing rate in general practice, mostly for self-limiting acute respiratory tract infections (RTIs). Research from >250 000 UK children suggests that a child's antibiotic history for RTI may be a good predictor for re-consulting a health professional for the same illness episode and increased clinical workload.</p><p><strong>Aim: </strong>To develop a data-enabled nudge intervention to optimise antibiotic prescribing for acute RTI based on a child's antibiotic history in general practice.</p><p><strong>Design & setting: </strong>Two-phase qualitative study with parents or carers of preschool children and primary care clinicians in England.</p><p><strong>Method: </strong>In phase 1, through an initial focus group with eight parents or carers and 'think-aloud' interviews with 11 clinicians, we co-designed the intervention (computer-screen prompt and personalised consultation leaflet). In phase 2, 13 clinicians used the intervention, integrated into the GP computer software, and shared their feedback through 'think-aloud' interviews. Interviews were audio-recorded, transcribed, and analysed thematically.</p><p><strong>Results: </strong>We co-created a data-driven intervention that automatically integrates a child's antibiotic history for acute RTI and personalised leaflet into the electronic medical records. We found that parents and clinicians found this intervention, in principle, acceptable and feasible to use in primary care consultations. GP participants reflected on the prompt's novelty and its usefulness of taking stock of the number of antibiotic prescriptions a child has had in the past year.</p><p><strong>Conclusion: </strong>Delivering such interventions, integrated into practice workflow, could be efficiently scaled up to promote effective antimicrobial stewardship and reduce unnecessary antibiotic use in primary care. Further research will test this intervention in a future trial.</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/PMC12138008/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Adjusting primary-care funding by deprivation: a cross-sectional study of Lower layer Super Output Areas in England.","authors":"Ian Holdroyd, Cameron Appel, Efthalia Massou, John Ford","doi":"10.3399/BJGPO.2024.0185","DOIUrl":"10.3399/BJGPO.2024.0185","url":null,"abstract":"<p><strong>Background: </strong>Previous research has called for general practice funding to be adjusted by deprivation data. However, there is no evidence that this adjustment would better meet clinical need.</p><p><strong>Aim: </strong>To assess (1) how accurately the capitation formula (Carr-Hill), and total general practice funding predicts clinical need and (2) whether adjusting by the Index of Multiple Deprivation (IMD) score improves accuracy.</p><p><strong>Design & setting: </strong>A cross-sectional analysis of 32 844 Lower layer Super Output Areas (LSOAs) in England in 2021-2022. Sensitivity analysis used data from 2015-2019.</p><p><strong>Method: </strong>Weighted average Carr-Hill Index (CHI), total general practice funding, and five measures of clinical need were calculated for each LSOA. For both CHI and total funding, four sets of generalised linear models were calculated for each outcome measure: unadjusted; adjusted for age; adjusted for IMD; and adjusted for age and IMD. Adjusted <i>R</i> ² assessed model accuracy.</p><p><strong>Results: </strong>In unadjusted models, CHI was a better predictor than total funding of combined morbidity index (CMI) (<i>R</i> ² = 49.81%, 29.31%, respectively), combined diagnosed and undiagnosed morbidity (<i>R</i> ² = 43.52%, 21.39%) and emergency admissions (<i>R</i> ² = 32.75%, 16.95%). Total funding was a better predictor than CHI of GP appointments per patient (<i>R</i> ² = 28.5%, 22.5%, respectively) and age and sex standardised mortality rates (<i>R</i> ² = 0.42%, 0.37%). Adjusting for age and IMD improved all 10 models (<i>R</i> ² = 62.15%, 53.15%, 48.57%, 38.47%, 40.53%, 32.84%, 29.11%, 34.58%, 25.21%, 25.23%, respectively). All age and IMD adjusted models significantly outperformed age-adjusted models (<i>P</i><0.001). Sensitivity analysis confirmed findings.</p><p><strong>Conclusion: </strong>Adjusting capitation or total funding by IMD would increase funding efficiency, especially for long-term outcomes such as mortality. However, adjusting for IMD without age could have unwanted consequences.</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/PMC12137997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142005494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Realities of opioid and gabapentinoid deprescribing in socioeconomically disadvantaged communities: a qualitative evaluation.","authors":"Charlotte L Parbery-Clark, Jennie Sofia Portice, Sarah Sowden","doi":"10.3399/BJGPO.2024.0160","DOIUrl":"10.3399/BJGPO.2024.0160","url":null,"abstract":"<p><strong>Background: </strong>Opioid and gabapentinoid prescribing has increased substantially in recent years despite having limited effectiveness in treating chronic primary pain. This is concerning, with the prescribing rates and adverse effects of these medications being higher in more socioeconomically disadvantaged groups. Guidance for prescribing and deprescribing these medications exists but the understanding of how deprescribing is operationalised, especially in areas of socioeconomic disadvantage, is limited.</p><p><strong>Aim: </strong>To explore primary healthcare professionals' views and experiences of designing and implementing an intervention to reduce opioid and gabapentinoid prescribing.</p><p><strong>Design & setting: </strong>A qualitative evaluation, using participant observation and semi-structured interviews with primary healthcare professionals, working in practices serving areas of substantial socioeconomic disadvantage in the North East of England.</p><p><strong>Method: </strong>Interviewees were purposively recruited with subsequent snowballing with participant observation of the peer-support meetings. Interview transcripts and notes from the participant observation were inductively coded and thematically analysed.</p><p><strong>Result: </strong>Thirteen healthcare professionals from five practices were interviewed. Person-centred care with shared decision-making was strived for, which was time-consuming owing to the complexity of the problem and patients. Where shared decision-making was not possible, owing to patient refusal or non-engagement, risk was used to determine the appropriate action. This work involved an emotional toll on staff and patients, but was at times conversely easier and more rewarding than expected. Ultimately, demedicalising pain with a culture change is required to ensure patients are not prescribed these medications for inappropriate reasons or doses.</p><p><strong>Conclusion: </strong>This study demonstrates key operational aspects to consider when undertaking opioid and gabapentinoid deprescribing in primary care, such as funding dedicated time to enable deprescribing.</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/PMC12138019/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141761468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The BJGP Open Top 10 Most Read Research Articles of 2024: an editorial.","authors":"Alice M Harper, Hajira Dambha-Miller","doi":"10.3399/BJGPO.2025.0047","DOIUrl":"10.3399/BJGPO.2025.0047","url":null,"abstract":"","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/PMC12137993/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143732080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characteristics of women on opioid substitution therapy in primary healthcare in Tshwane (South Africa): a retrospective observational study.","authors":"Daniela S Goeieman, Robert Mash, Natasha R Gloeck, Andrew Scheibe","doi":"10.3399/BJGPO.2024.0049","DOIUrl":"10.3399/BJGPO.2024.0049","url":null,"abstract":"<p><strong>Background: </strong>Women who use drugs face specific challenges compared with men such as higher rates of HIV infection, unsafe injecting practices, and intimate partner violence (IPV). However, this population's access to drug dependence treatment and gender-sensitive interventions remains limited, leading to unmet needs and increased vulnerability.</p><p><strong>Aim: </strong>To investigate the characteristics of and associations with retention in care among women on opioid substitution therapy (OST) in a community-based primary care setting.</p><p><strong>Design & setting: </strong>A descriptive observational study within the Community Orientated Substance Use Programme in Tshwane, South Africa.</p><p><strong>Method: </strong>Data from 199 women (aged <u>></u>18 years) on OST was extracted from an electronic database and paper-based files. Data were analysed descriptively, and inferential analysis looked for association of variables with retention on OST for ≥6 months.</p><p><strong>Results: </strong>The majority of participants were unemployed, with 44.3% aged 20-29 years. During the initiation and course of OST, 39.2% of women had an intimate partner of which 37.2% reported IPV, and 19.2% were pregnant. Retention on OST was significantly associated with increasing age at initiation (<i>P</i> = 0.047), knowledge of HIV status (<i>P</i> = 0.029), an increase in the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) score (<i>P</i> = 0.023), and methadone dose (<i>P</i><0.001). Factors such as race, employment status, health-system level, pregnancy, intimate partner using substances, IPV, route of administering opioids, and having tuberculosis and/or hepatitis C exposure did not show a significant relationship with retention on OST (<i>P</i>>0.05).</p><p><strong>Conclusion: </strong>This study reveals specific vulnerabilities in women receiving OST, emphasising the need for the integration of interventions to address reproductive health, violence mitigation, infectious disease, and polydrug use into 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/PMC12137995/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142019038","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Translating in-person care to telehealth: a secondary analysis of GP consultations on musculoskeletal conditions.","authors":"Yifu Li, Simon Chan, Lawrence Lu, Tim M Jackson, Hania Rahimi-Ardabili, Annie Ys Lau","doi":"10.3399/BJGPO.2024.0013","DOIUrl":"10.3399/BJGPO.2024.0013","url":null,"abstract":"<p><strong>Background: </strong>The COVID-19 pandemic led to a rapid transition to telehealth, particularly in general practice where continuous care for chronic conditions, such as musculoskeletal (MSK), is provided.</p><p><strong>Aim: </strong>To determine the appropriateness of telehealth for MSK conditions by identifying whether in-person tasks can be supported remotely via telehealth.</p><p><strong>Design & setting: </strong>This study is a secondary analysis of the Harnessing Resources from the Internet (HaRI) dataset. This dataset comprises of 281 videos of recorded GP consultations. The dataset includes 10 GPs, across eight separate clinics, and was collected during 2017 in the UK.</p><p><strong>Method: </strong>Content analysis was conducted to identify the clinical tasks, physical examinations, and physical artefacts used during the consultations. A scoring method applying two key metrics was developed to assess the translatability of clinical tasks to telehealth.</p><p><strong>Results: </strong>Across the 31 MSK consultations analysed, 12 clinical tasks, five physical examinations, and 12 physical artefacts were observed. Of clinical tasks, 17% (<i>n</i> = 2/12) were deemed to be 'easily translatable over telehealth' and 50% (<i>n</i> = 6/12) were deemed 'relatively easy to be translated over telehealth'. Only 17% (<i>n</i> = 2/12) of tasks were rated 'moderately translatable over telehealth', and 17% (<i>n</i> = 2/12) were deemed 'potentially translatable over telehealth'. No clinical tasks in this study were categorised as untranslatable to telehealth. The average telehealth translatability score was 7.1/10.</p><p><strong>Conclusion: </strong>Most clinical tasks observed during in-person GP consultations with patients with MSK conditions are translatable to telehealth. Further research is necessary to investigate the long-term efficacy and safety of telehealth utilisation for MSK conditions 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/PMC12137991/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082064","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12138023/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142297462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Potentially inappropriate prescribing in middle-aged adults: a significant problem with a lack of action and evidence to address it.","authors":"Michael Naughton, Frank Moriarty, Patrick Redmond","doi":"10.3399/BJGPO.2023.0209","DOIUrl":"10.3399/BJGPO.2023.0209","url":null,"abstract":"","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/PMC12138014/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142733283","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}