BJGP Open最新文献

{"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":2.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421278/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584431","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 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":2.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143013425","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":"Primary care performance in a Ugandan rural district: a cross-sectional descriptive study.","authors":"Innocent Kabahena Besigye, Robert James Mash","doi":"10.3399/BJGPO.2024.0105","DOIUrl":"10.3399/BJGPO.2024.0105","url":null,"abstract":"<p><strong>Background: </strong>To strengthen primary health care (PHC), there is a need to measure its performance. Global recommendations emphasise patient involvement in the improvement of services.</p><p><strong>Aim: </strong>To measure primary care performance in one rural Ugandan district.</p><p><strong>Design & setting: </strong>A cross-sectional survey of Tororo District where the Ugandan Primary Care Assessment Tool (UG-PCAT) was administered across a sample of 51 facilities. There were four levels of health facilities (health centre [HC] II, HC III, HC IV, and general hospital).</p><p><strong>Method: </strong>A sample of 488 users was obtained from each of the four levels while including all primary care providers and managers at the health facilities. Data were collected in REDCap software, and analysed using Statistical Package for Social Sciences (version 23).</p><p><strong>Results: </strong>Only 35.1% of users had a strong affiliation with their PHC facility. Overall, the primary care score suggested that performance was acceptable to the majority of users (58.9% rating performance at least acceptable). Ongoing care was rated by users as very poor (<25% of people rating it at least acceptable). Comprehensiveness (services available) was rated poor by users (<u><</u>50% finding it at least acceptable). Users rated first-contact access and coordination (information systems) acceptable (51-75% finding them at least acceptable). Person-centredness and comprehensiveness (services provided) were rated good by users (>75% rating them as acceptable or more). Providers and users differed significantly (<i>P</i> value <0.05) in their scoring across all domains, with providers usually more positive. Performance significantly improved as the PHC level increased (<i>P</i> value <0.05).</p><p><strong>Conclusion: </strong>Primary care performance in the study district was suboptimal. The UG-PCAT identified primary care functions that needed improving and may be a useful tool to measure PHC performance across the region.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421270/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142591837","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":"How GPs communicate the urgent suspected cancer referral pathway to patients: a qualitative study of GP-patient consultations.","authors":"Jessica Russell, Laura Boswell, Athena Ip, Jenny Harris, Hardeep Singh, Ashley Nd Meyer, Traber D Giardina, Afsana Bhuiya, Katriina L Whitaker, Georgia B Black","doi":"10.3399/BJGPO.2024.0115","DOIUrl":"10.3399/BJGPO.2024.0115","url":null,"abstract":"<p><strong>Background: </strong>The UK National Institute for Health and Care (NICE) recommends that GPs inform patients referred onto the urgent suspected cancer (USC) pathway about what to expect from the service. However, there is a lack of evidence on patient experience and information needs at the point of referral. It is a challenge for GPs to communicate the reasons for referral and provide reassurance.</p><p><strong>Aim: </strong>To examine how GPs communicate a potential cancer diagnosis and USC referral in practice.</p><p><strong>Design & setting: </strong>This is a secondary analysis of a dataset of 23 audio-recorded GP-patient consultations, selected from a larger dataset of 200 consultations collected in Surrey and London, UK in 2017-2018. The consultations were selected based on inclusion criteria related to cancer discussions.</p><p><strong>Method: </strong>This is a qualitative analysis of video-recordings of face-to-face patient consultations.</p><p><strong>Results: </strong>We found that most GPs informed patients that they might have cancer and engaged in reassurance using personalised risk statements. Some GPs avoided all mention of cancer, using symptom-led language instead. GPs focused on communicating practical rather than support-based information. Although most GPs informed patients that they would be seen by a specialist within 2 weeks, few discussed patients' support needs during the referral period.</p><p><strong>Conclusion: </strong>Clear communication about cancer in primary care is promoted in UK policy, and has an important role driving patient investigations attendance. The study highlights the need for further research on communication practices around cancer referral to improve patient understanding and experience. Our recommendations for enhanced communication may improve patient outcomes by optimising routes to diagnosis via primary care.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421275/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682498","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":"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 (OAC) treatment 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 treatment adherence between general practice clinics and to identify clinic characteristics associated with a lower propensity to prescribe OAC treatment.</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 treatment adherence assessed as proportion of days covered (PDC). 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 PDC with OAC treatment in the AF population was 78%. OAC propensity in clinics in the 90^th percentile was 20% higher compared with 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 treatment in patients with AF and little variation in OAC prescription patterns across general practice clinics.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421259/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142629602","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":"'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":"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 because of 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, who 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>This was a qualitative study from Danish general practice in deprived, rural areas.</p><p><strong>Method: </strong>Semi-structured interviews were conducted 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 characterised 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 present 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":2.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421286/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142956291","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":"General practice characteristics associated with pay-for-performance in the UK: a systematic review.","authors":"Rhatica Srai, David Cromwell, Nicholas Mays, Luisa M Pettigrew","doi":"10.3399/BJGPO.2024.0174","DOIUrl":"10.3399/BJGPO.2024.0174","url":null,"abstract":"<p><strong>Background: </strong>The Quality and Outcomes Framework (QOF), a pay-for-performance programme, has been the most widespread quality initiative in NHS general practice since 2004. It has contributed between 25% and 8% of practices' income during this time, but concerns about its effect on equity have been raised.</p><p><strong>Aim: </strong>To understand which practice characteristics are associated with QOF performance.</p><p><strong>Design and setting: </strong>A systematic review was conducted, focusing on NHS general practice in the UK.</p><p><strong>Method: </strong>MEDLINE, Embase, CINAHL+, Web of Science, and grey literature were searched for studies examining the association between general practice characteristics and QOF performance.</p><p><strong>Results: </strong>Twenty-two studies, published between 2006 and 2022, exploring the relationship between six population and 15 organisational characteristics and QOF measures were found. Most studies were cross-sectional, of English general practices, and used data from the early years of QOF. A negative association was frequently found between overall QOF performance and socioeconomic deprivation; increasing proportion of registered patients aged >65 years; increasing list size; increasing mean GP age; and Alternative Provider Medical Services contracts. Group practices (versus single-handed), more full-time equivalent (FTE) GPs, and being a training practice were frequently associated with better overall QOF performance. The associations of most other characteristics with performance were inconsistent.</p><p><strong>Conclusion: </strong>Associations with characteristics both within and outside practices' control were identified. Pay-for-performance instruments may systematically disadvantage practices serving those at greatest risk of ill-health such as older and more deprived populations. Given the cross-sectional design of many studies and focus on the early years of QOF, more up-to-date evidence is needed to understand if and why these relationships persist.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421283/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682286","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":"Perception of antimicrobial stewardship interventions in Swiss primary care: a mixed-methods survey.","authors":"Simeon Schaad, Jelena Dunaiceva, Arnaud Peytremann, Sophie Gendolla, Lauren Clack, Catherine Plüss-Suard, Anne Niquille, Anna Nicolet, Joachim Marti, Noémie Boillat-Blanco, Aline Wolfensberger, Yolanda Mueller","doi":"10.3399/BJGPO.2024.0110","DOIUrl":"10.3399/BJGPO.2024.0110","url":null,"abstract":"<p><strong>Background: </strong>With most antibiotic prescriptions occurring in primary care, antimicrobial stewardship (AMS) interventions must be known, welcomed, and used by primary care physicians (PCPs).</p><p><strong>Aim: </strong>The main objective of this study was to evaluate the present awareness about, use of, and perceived acceptability, appropriateness, and feasibility of a broad range of interventions.</p><p><strong>Design & setting: </strong>A cross-sectional survey was distributed to Swiss PCPs from December 2023 to February 2024.</p><p><strong>Method: </strong>The survey focused on eight AMS interventions: shared decision-making tools, factsheets for physicians, Swiss Federal Office of Public Health (FOPH) information material, national antibiotic guidelines website, audit and feedback, communication skills training, as well as the use of point-of-care C-reactive protein (POC-CRP) and procalcitonin (POC-PCT) to guide prescription. PCPs' perceived acceptability, appropriateness, and feasibility were assessed using 5-point Likert scales. General expectations regarding AMS were evaluated via qualitative analysis of free-text answers.</p><p><strong>Results: </strong>Out of 7456 potentially eligible primary care physicians, 355 PCPs answered at least one question (response rate 4.7%). PCPs were most aware of biomarkers to guide antibiotic prescription in respiratory tract infections (RTIs), such as POC-PCT (67.6%) and POC-CRP (61.1%); the FOPH awareness campaign (57.3%); and the national guidelines website (52.7%). All interventions were rated as acceptable, appropriate, and feasible, with respective mean scores out of five of 3.89, 3.91, and 3.81.</p><p><strong>Conclusion: </strong>Despite the high perceived acceptability, appropriateness, and feasibility of AMS interventions available for RTIs, their real-life impact may be hindered by insufficient awareness. Additional promotion of those tools could increase their uptake by physicians.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421261/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142802560","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":"General Practice Community Pharmacist Consultation Service: an exploratory patient survey.","authors":"Julia Gauly, Catherine Grimley, Jeremy Dale, Paramjit Gill, Helen Atherton","doi":"10.3399/BJGPO.2024.0204","DOIUrl":"10.3399/BJGPO.2024.0204","url":null,"abstract":"<p><strong>Background: </strong>The General Practice Community Pharmacist Consultation Service (GPCPCS) was established to allow patients with certain minor illnesses to be referred to a community pharmacy for assessment and treatment.</p><p><strong>Aim: </strong>To explore patients' experiences of the GPCPCS.</p><p><strong>Design & setting: </strong>An online survey in two regions of England.</p><p><strong>Method: </strong>Twenty-five general practices invited patients to take part in an exploratory survey. Descriptive statistics were used for the analysis.</p><p><strong>Results: </strong>The response rate was 5.1% (72/1423). Prior to contacting their general practice, 14.1% (9/64) of patients had tried to speak to a pharmacist. Most responders accepted the GPCPCS referral (77.3%, 51/66); received a pharmacy consultation on the same day (80.0%, 40/50); and were largely satisfied with the amount of time the pharmacist spent with them (82.5%, 33/40), the consultation format (68.3%, 28/41), and the privacy provided during the consultation (80.9%, 38/47). However, most responders (56.5%, 39/69) felt poorly informed by the general practice on why they were being advised to speak to a pharmacist and did not feel that it was appropriate that they had been advised to speak to a community pharmacist (54.2%, 39/72). Only 33.3% (16/48) felt that their consultation fully met their health needs and 27.1% (13/48) of patients described being re-referred from pharmacy back to their general practice.</p><p><strong>Conclusion: </strong>In this exploratory study patients were largely accepting of the GPCPCS. Improvements in terms of explaining GPCPCS to patients, selecting patients appropriate for referral to the service, and the appointment process may be of benefit.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421265/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142839826","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":"Treatment patterns and burden of uncomplicated urinary tract infection in England: a retrospective cohort study.","authors":"Mark H Wilcox, Dave Heaton, Aruni Mulgirigama, Ashish V Joshi, Viktor Chirikov, Daniel C Gibbons, David Webb, Xiaocong L Marston, Myriam Na Alexander, Fanny S Mitrani-Gold","doi":"10.3399/BJGPO.2024.0214","DOIUrl":"10.3399/BJGPO.2024.0214","url":null,"abstract":"<p><strong>Background: </strong>Uncomplicated urinary tract infections (uUTIs) are common bacterial infections.</p><p><strong>Aim: </strong>To evaluate the burden of uUTI in England for 1) potential determinants of disease progression; 2) extent and impact of antimicrobial prescribing non-concordant with treatment guidelines; and 3) healthcare burden and economic costs.</p><p><strong>Design & setting: </strong>Retrospective cohort study utilising patient data (January 2017-February 2020) from the Clinical Practice Research Datalink (CPRD) linked to English Hospital Episode Statistics.</p><p><strong>Method: </strong>Female patients aged ≥12 years with a new uUTI between 2018 and 2019, ≥14 months' continuous CPRD enrolment (≥12 months baseline, ≥2 months follow-up), and ≥1 oral antibiotic prescription ±5 days of uUTI diagnosis were included. Baseline characteristics were described in patients with or without disease progression (hospitalisation for acute pyelonephritis, bacteraemia, or sepsis). Treatment non-concordance with current English guidelines was assessed. Burden (all-cause and urinary tract infection-related healthcare resource use [HCRU] and costs) was evaluated in a 1:1 age and comorbidity-matched uUTI-free cohort.</p><p><strong>Results: </strong>Of 120 519 patients, 207 (0.2%) had disease progression requiring hospitalisation (during index uUTI episode); determinants included older age, index uUTI home consultation, prior hospitalisation, and medications prescribed for comorbid conditions in the prior 12 months (<i>British National Formulary</i> classes: cardiovascular system, eye, and other drugs and preparations). Non-concordant treatment was observed in 43.5% of patients. All-cause HCRU burden and costs were significantly higher in patients with uUTI versus age and comorbidity-matched controls (<i>P</i><0.001) at 28 days (£160.06 versus £37.63) and in the 12-month follow-up (£1206.77 versus £460.97).</p><p><strong>Conclusion: </strong>All-cause HCRU burden and costs were significantly higher in patients with uUTI versus matched controls (<i>P</i><0.001). Hospitalisation for acute pyelonephritis, bacteraemia, or sepsis following uUTI was uncommon.</p>","PeriodicalId":36541,"journal":{"name":"BJGP Open","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12421281/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142819530","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}