The British journal of general practice : the journal of the Royal College of General Practitioners最新文献

{"title":"Yonder: Livestreaming clinical education, complaints, weather and mental health, and HPV and cervical cancer screening.","authors":"Alex Burrell","doi":"10.3399/bjgp26X746661","DOIUrl":"10.3399/bjgp26X746661","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 771","pages":"463"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659077/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122984","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 acceptable stimulant.","authors":"Anuj Sean Chathley","doi":"10.3399/bjgp25X742917","DOIUrl":"10.3399/bjgp25X742917","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 771","pages":"461"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149123012","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":"Continuity of care and the Buxton Index.","authors":"Euan Lawson","doi":"10.3399/bjgp26X746529","DOIUrl":"10.3399/bjgp26X746529","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 771","pages":"436"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659066/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122809","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":"Clinical empathy and relational continuity mitigate care fragmentation for patients with multiple long-term conditions: a qualitative study.","authors":"Stella Arakelyan, Bruce Guthrie, Atul Anand, Nazir Lone, Stewart W Mercer, Tricia Tooman","doi":"10.3399/BJGP.2026.0171","DOIUrl":"10.3399/BJGP.2026.0171","url":null,"abstract":"<p><strong>Background: </strong>Services for patients with multiple long-term conditions (MLTC) operate within fragmented and poorly coordinated systems but how care experiences, perceptions, and behaviours emerge and adapt in response to service changes and increasing system complexity is poorly understood.</p><p><strong>Aim: </strong>To explore how experiences and perceptions of care for patients with MLTC and their carers emerge and evolve within a complex adaptive care system to identify opportunities for better care.</p><p><strong>Design and setting: </strong>Qualitative analysis of six focus groups with 28 patients with MLTC and carers in four Scottish integrated health and social care partnerships was undertaken.</p><p><strong>Method: </strong>Data were collected between February and May 2024. Abductive analysis informed by a complex adaptive systems lens was used.</p><p><strong>Results: </strong>Care for patients with MLTC emerged through dynamic, reciprocal interactions between patients, carers, professionals, and organisational structures. Service changes introduced to manage rising demand were often perceived as misaligned with patients' complex needs, prompting patients and carers to modify their behaviours to navigate access barriers. Care experiences were unpredictable, shaped by reinforcing feedback loops in which small personal interactions had a disproportionate effect on trust and engagement. Informal care expanded to fill system gaps, with family members assuming coordination and advocacy roles. Clinical empathy and relational continuity of care acted as key stabilising influences within fragmented care systems.</p><p><strong>Conclusion: </strong>Service changes intended to improve care efficiency can inadvertently destabilise care and shift the burden onto patients with MLTC and their carers, affecting perceived care quality and relational continuity. The quality of interactions and relationships between agents shape patients' perceptions of care and future engagement.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":"e790-e797"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659071/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019553","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":"Challenges in diagnosing and supporting those with premenstrual dysphoric disorder: opportunities for GPs.","authors":"Beth Louise Woodward, Becky MacGregor, Serena Probert, Paul Faulkner, Rima Dhillon-Smith, Sarah Hillman","doi":"10.3399/BJGP.2026.0115","DOIUrl":"10.3399/BJGP.2026.0115","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 771","pages":"438-440"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659103/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122834","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":"Development of a novel GP continuity measurement for practices without personal lists: a two-practice pilot of the modified SLICC.","authors":"Kate Sidaway-Lee, Denis Pereira Gray, Jason Fearn-Smith, Alastair Buick, Serge Engamba, Nada Khan, Philip Hugh Evans","doi":"10.3399/BJGP.2025.0624","DOIUrl":"10.3399/BJGP.2025.0624","url":null,"abstract":"<p><strong>Background: </strong>It is widely recognised that continuity of GP care should be improved. This requires a continuity measure that is applicable to all practices. Previous measures have limitations.</p><p><strong>Aim: </strong>To develop an improved measure of continuity of care and compare its performance with established measures.</p><p><strong>Design and setting: </strong>Audit data were used to conduct a 1-year pilot of the measure in two suburban general practices in Devon, England.</p><p><strong>Method: </strong>The modified St Leonard's Index of Continuity of Care (mSLICC) was developed; scores were calculated monthly, and compared with those generated using the St Leonard's Index of Continuity of Care (SLICC), the 1-year Bice-Boxerman Continuity of Care (BB), and Usual Provider of Care (UPC) indices. Proportions of patients and appointments included were calculated, with patients grouped by age, sex, 3-year appointment numbers, and frailty categories.</p><p><strong>Results: </strong>In the two practices, the mSLICC included 19 840 of 29 127 (68.1%) appointments and a mean of 65.2% (standard deviation [SD] 6.4%) of patients with appointments. The UPC and BB included 21 032 (72.2%) appointments and 4096 (41.3%) of 9924 patients with appointments. In practice A, the mSLICC score was 52.0%, the SLICC score was 57.1%, the mean UPC score was 0.63 (95% confidence interval [CI] = 0.62 to 0.64), and the mean BB score was 0.41 (95% CI = 0.40 to 0.43). In practice B, the mSLICC score was 25.9%, the SLICC score was 25.3%, the mean UPC score was 0.50 (95% CI = 0.49 to 0.51), and the mean BB score was 0.23 (95% CI = 0.22 to 0.25). The mSLICC correlated with the SLICC (<i>r</i> = 0.98, <i>P</i><0.001).</p><p><strong>Conclusion: </strong>The mSLICC is a new monthly measure of continuity. It has fewer limitations than the BB and UPC, and does not require a named GP. With sufficient IT resources, the mSLICC could be used to measure continuity of care in practices that do not use personal lists.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":"e781-e789"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659075/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147611648","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":"Author's response.","authors":"Alastair D Hay","doi":"10.3399/bjgp26X746565","DOIUrl":"10.3399/bjgp26X746565","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 771","pages":"449"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659086/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122879","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":"Diagnostic models for male lower urinary tract symptom management in primary care: a prospective, multicentre, diagnostic accuracy study.","authors":"Chris Harding, Ridhi Agarwal, Janine Bates, Alison Bray, Sarah Milosevic, Emma Thomas-Jones, Michael Drinnan, Marcus Drake, Peter Michell, Bethan Pell, Haroon Ahmed, Natalie Joseph-Williams, Tom Schatzberger, Jane Davies, Kerenza Hood, Yemisi Takwoingi, Adrian Edwards","doi":"10.3399/BJGP.2025.0513","DOIUrl":"10.3399/BJGP.2025.0513","url":null,"abstract":"<p><strong>Background: </strong>Recent research has concluded that primary care assessment and management of lower urinary tract symptoms (LUTS) requires practical resources.</p><p><strong>Aim: </strong>To develop and independently validate risk-prediction models for three common urological conditions based on a combination of simple, minimally invasive index tests in men with LUTS presenting to primary care.</p><p><strong>Design and setting: </strong>A prospective, multicentre, diagnostic accuracy study with independent development and validation cohorts set in 67 general practices in England and Wales.</p><p><strong>Method: </strong>A total of 601 men presenting to primary care with LUTS, 350 in the development cohort and 251 in the validation cohort, underwent index tests - validated symptom assessment, bladder diary, physical examination, serum prostate specific antigen, uroflowmetry, and post-void residual volume estimation. Invasive urodynamic studies provided a diagnostic reference standard. Risk-prediction models for urodynamic diagnoses were developed and then validated in independent cohorts. Discriminative and calibration performance of the risk-prediction models for diagnosing bladder outlet obstruction (BOO), detrusor underactivity (DU), and detrusor overactivity (DO) using the c-index, calibration slope and plot, and sensitivity and specificity of the models was undertaken.</p><p><strong>Results: </strong>The BOO model from the development cohort demonstrated good discriminative performance (optimism-corrected c-index of 0.80). The models derived from the development cohort for DU and DO demonstrated moderate discriminative ability (optimism-corrected c-indices of 0.64 and 0.67, respectively). Similar estimates of c-index were observed for each model within the independent validation cohort (BOO, 0.82; DU, 0.63; and DO, 0.62).</p><p><strong>Conclusion: </strong>Using a combination of simple, non-invasive index tests can accurately predict common urological diagnoses in men with LUTS, potentially facilitating earlier initiation of evidence-based treatments and improved management in primary care.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":"e859-e867"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148166791","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":"What tango can help us rediscover in medicine.","authors":"Rachna Chowla","doi":"10.3399/bjgp26X746649","DOIUrl":"10.3399/bjgp26X746649","url":null,"abstract":"","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":"76 771","pages":"462"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659067/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149122977","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":"Cost savings from primary care clinic continuity among patients with chronic disease in Alberta, Canada: a retrospective population-level cross-sectional study.","authors":"Terrence McDonald, Brendan Cord Lethebe, Lee A Green","doi":"10.3399/BJGP.2026.0085","DOIUrl":"10.3399/BJGP.2026.0085","url":null,"abstract":"<p><strong>Background: </strong>Continuity of care with a primary care physician (PCP) is well known to improve patient health, result in less health service utilisation (HSU), and lower costs. Less is known about the impact of clinic continuity related to team-based care and shared practice models. Information on the cost impact of such models is needed to guide design and payment policies.</p><p><strong>Aim: </strong>To estimate savings in HSU costs for patients with chronic disease when they are moved from primary care clinics with low and moderate continuity levels to those with high levels.</p><p><strong>Design and setting: </strong>A 3-year retrospective population based cross-sectional study examined the HSU costs associated with three levels of primary care clinic continuity for approximately 70 000 matched patients from a cohort of 500 000 patients with chronic disease in Alberta, Canada. All fee-for-service PCPs were included.</p><p><strong>Method: </strong>Clinic continuity was calculated by adapting the Usual Provider of Care (UPC) Index. Costs were estimated using costing methodologies from the Canadian Institute of Health Information.</p><p><strong>Results: </strong>The association between continuity and acute care costs suggests achieving high clinic continuity (UPC 80-100%) for all 195 000 patients in less than high clinic continuity care could theoretically yield upwards of £898 million over 3 years. Estimated per-patient gains were highest among the most medically complex patients.</p><p><strong>Conclusion: </strong>Cost savings were associated with clinic continuity among patients with common chronic diseases at all levels of complexity. Significant cost savings could be realised by focusing patient care on primary care clinics that favour high levels of continuity.</p>","PeriodicalId":520790,"journal":{"name":"The British journal of general practice : the journal of the Royal College of General Practitioners","volume":" ","pages":"e798-e806"},"PeriodicalIF":5.2,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13659079/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149019105","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}