European Journal of General Practice最新文献

{"title":"Reducing short-acting beta-agonist overprescribing in general practice: Evaluation of a quality improvement programme in East London.","authors":"Anna De Simoni, Hajar Hajmohammadi, Paul Pfeffer, Jim Cole, Chris J Griffiths, Sally A Hull","doi":"10.1080/13814788.2026.2619229","DOIUrl":"10.1080/13814788.2026.2619229","url":null,"abstract":"<p><strong>Background: </strong>Overprescribing of short-acting beta-agonist (SABA) inhalers is a worldwide problem.</p><p><strong>Objectives: </strong>To evaluate the impact of a system-wide quality improvement programme on SABA overprescribing, and to identify the most effective strategies.</p><p><strong>Methods: </strong>All general practices within one East London borough received the intervention between October 2020 and March 2023. Practices in two neighbouring boroughs acted as comparators. Intervention practices engaged in quality improvement activities including: electronic alerts flagging patients prescribed ≥12 SABA inhalers/year; generating lists of patients overprescribed SABA to call for review; a summary guideline for clinicians; electronic patient information leaflets. All practices were offered webinar coaching. Prescribing data were collected from electronic health records, and SABA overprescription evaluated through interrupted times series analysis. Content analysis was applied to survey data and conversations with staff.</p><p><strong>Results: </strong>During the three-year study period all localities introduced programmes to reduce SABA prescribing. We observed a significant decrease in the proportion of asthma patients prescribed more than 6 SABA/year in the study practices. The COVID pandemic triggered a temporary increase in patients on asthma registers, which persisted for 6 months. When implemented by practices the electronic prescribing alerts were effective: 50% of patients who received an active response reduced to <12 SABA in the following year.</p><p><strong>Conclusions: </strong>This quality improvement programme was associated with a reduction in SABA overuse, which could also decrease hospital admissions. Practices required individual coaching to use the electronic tools effectively. Integrated prescribing alerts reduced overprescribing, and collaborative practice cultures supported faster implementation of improvement strategies.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2619229"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865841/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108461","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Population health management within the primary care context - scoping review.","authors":"Emmily Schaubroeck, Giorgio Sessa, Jan De Maeseneer, Sara Willems, Peter Decat","doi":"10.1080/13814788.2026.2633852","DOIUrl":"10.1080/13814788.2026.2633852","url":null,"abstract":"<p><strong>Background and objectives: </strong>Population health management (PHM) is increasingly promoted as a strategy to improve health outcomes, enhance healthcare quality, reduce costs, and, more recently, support clinician well-being and advance health equity - the Quintuple Aim. However, how PHM is conceptualised within the primary care context remains unclear. This scoping review explores how PHM is conceptualised within this context.</p><p><strong>Method: </strong>Five databases (PubMed, Embase, CINAHL, Web of Science and Scopus) were searched to find publications that conceptually addressed PHM and its interaction with the primary care context. Data extraction focused on definitions and related terms, the bidirectional influence between PHM and general practice, and interpretations of the components 'population' and 'management'.</p><p><strong>Results: </strong>27 publications were included. Definitions of PHM varied, with few explicitly addressing the primary care practice level. They highlighted the need to proactively address social determinants of health beyond clinical outcomes. Both top-down and bottom-up dynamics make general practices accountable for and increasingly involved in the identification of populations, risk stratification and impact assessment, with both clinical judgement and real-world primary care data. Management involves team-based and technology-supported care.</p><p><strong>Conclusion: </strong>Considering PHM within primary care highlighted the importance of general practice's accountability, its consideration of social determinants of health beyond clinical outcomes and its community alignment to enhance equity. What the potential added value of general practitioner's clinical intuition and real-world primary care data in assessing impact warrants additional exploration.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2633852"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12973839/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391287","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction.","authors":"","doi":"10.1080/13814788.2026.2620941","DOIUrl":"10.1080/13814788.2026.2620941","url":null,"abstract":"","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2620941"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12865822/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146108349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Gabapentinoids and unexplained death in general practice: Case series and feasibility study arising from a critical incident.","authors":"Augustin Gabriel, Tom Fahey","doi":"10.1080/13814788.2026.2645473","DOIUrl":"10.1080/13814788.2026.2645473","url":null,"abstract":"<p><strong>Background: </strong>Prescribing epidemiology in general practice shows gabapentinoid drugs to be independently associated with unexpected, drug-related death. There is an increasing trend of gabapentinoid deaths throughout Europe and North America.</p><p><strong>Objectives: </strong>The overall aim of this study was to assess how patient, practice and health system factors might be associated with gabapentinoid prescribing in primary care.</p><p><strong>Methods: </strong>Case series following a critical incident of an unexpected death in a patient prescribed a gabapentinoid drug in a single general practice. Unexpected and expected deaths in patients prescribed a gabapentinoid drug deaths over an 11-year period in a single general practice. We examined patient, prescriber and health system factors. Toxicology and post-mortem data were provided by the Coroner.</p><p><strong>Results: </strong>There were 36 deaths (four unexpected and 32 expected deaths) during the study period. Of the four patients who suffered an unexpected death, one of these patients' cause of death could be attributed to drug and alcohol toxicity. Over half of gabapentinoid prescribing (<i>n</i> = 19,53%) was hospital initiated, often 'off-label' (<i>n</i> = 6, 17%) and commonly co-prescribed with opiates (<i>n</i> = 15, 42%) and benzodiazepines (<i>n</i> = 11, 31%) to patients with high multi-morbidity.</p><p><strong>Conclusions: </strong>Gabapentinoids are often initiated in the outpatient setting in clinically complex patients, often for 'off label' indications, with high polypharmacy. Patient, practice and health-system related factors need to be addressed in relation to gabapentinoid associated deaths and reflected in clinical practice guidelines. There is critical value in using toxicology reports from Coroner's offices in cases of unexplained gabapentinoid death in general practice.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2645473"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13011083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505600","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"External validation of risk scores and multivariate models for the diagnosis of community-acquired pneumonia in outpatients.","authors":"Mark Ebell, Dan J Merenstein, Bruce Barrett, Theo Verheij, Paul Little","doi":"10.1080/13814788.2026.2628370","DOIUrl":"10.1080/13814788.2026.2628370","url":null,"abstract":"<p><strong>Background: </strong>While several risk scores for the diagnosis of community-acquired pneumonia (CAP) have been developed, they require prospective external validation.</p><p><strong>Objectives: </strong>To externally validate existing prediction models, risk scores, and heuristics for the diagnosis of CAP in adults.</p><p><strong>Methods: </strong>The Enhancing Antibiotic Stewardship in Primary Care (EAST-PC) study recorded signs, symptoms, demographics, and vitals in 718 adults presenting to primary or urgent care clinics with acute lower respiratory tract infection between 2019 and 2023. C-reactive protein (CRP) was available for 575. The diagnosis of CAP was based on the clinician diagnosis and/or chest radiograph. Literature was searched for previous risk scores. Using the EAST-PC population, the area under the receiver operating characteristic curve (AUROCC), calibration curves, and percentage with CAP in each risk group were calculated for each risk score.</p><p><strong>Results: </strong>We identified 11 studies describing 4 risk scores, 9 multivariate models, and 5 simple heuristics. The Genomics to Combat Resistance Against Antibiotics in Community-acquired LRTI in Europe (GRACE) risk score using the absence of a runny nose, the presence of breathlessness, crackles, diminished vesicular breathing, heart rate > 100/min, temperature >37.8 °C, and CRP > 30 mg/L was the most accurate (AUROCC 0.81). It classified 280 patients as low (0.7% CAP), 265 as moderate (5.7%) and 30 as high risk (33.3%) for CAP. The GRACE score without CRP performed similarly. Other risk scores had poor calibration or failed to accurately classify patients as low or high risk.</p><p><strong>Conclusions: </strong>The previously derived GRACE risk scores were successfully externally validated in a contemporary US outpatient population.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2628370"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12927402/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146260084","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of nurse practitioners in primary care on patients with chronic diseases in rural and underserved areas: A systematic review.","authors":"Ariane Sacchetti, Mélanie Berube, Christophe Pison, Marc-Aurèle Gagnon, Alexandre Bellier","doi":"10.1080/13814788.2026.2613495","DOIUrl":"10.1080/13814788.2026.2613495","url":null,"abstract":"<p><strong>Background: </strong>Ageing, multimorbidity, and workforce shortages increasingly limit access to primary healthcare, especially in rural and underserved areas.</p><p><strong>Objectives: </strong>To document impact of nurse practitioners (NPs) in primary care on patients with chronic diseases.</p><p><strong>Methods: </strong>Searches were conducted in Medline, EMBASE, CINAHL, and CENTRAL (March 1978-October 2023). This systematic review followed MECIR and PRISMA guidelines (PRISMA 2020 checklist: EQUATOR Network) with SWiM used as a PRISMA extension due to the lack of meta-analysis. The focus was on NPs' roles in chronic disease management and primary care in underserved or remote areas, excluding mental health, cancer, and dental care.</p><p><strong>Results: </strong>Among 3,684 citations, 25 studies were selected, including 10 RCT. NPs may improve access to primary care and chronic disease management, particularly in underserved areas. Although not all studies directly compared NPs to traditional models, they were most often assessed against General Practitioners (GPs) alone. Seven studies also evaluated collaborative NP-GP models versus GP-only care. Patient satisfaction was generally higher with NPs, possibly due to longer consultations and greater patient education. Clinical and biological outcomes were often comparable between NPs and GPs, with the best results in collaborative models, which were also associated with higher costs.</p><p><strong>Conclusion: </strong>NPs may enhance access to care, particularly for vulnerable populations. Higher patient satisfaction may be linked to longer consultations and patient education. While clinical outcomes were comparable to those of GPs, collaborative models yielded the best results, though potentially at a higher cost.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2613495"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12849805/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146068597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Dutch General Practitioners ultrasound referrals and opportunities for point-of-care ultrasound: A retrospective analysis.","authors":"Jelien Geivers, Ralph T H Leijenaar, Lola Ramakers, Jochen W L Cals, Frank M Zijta, J Martijn Nobel, Ramon P G Ottenheijm","doi":"10.1080/13814788.2025.2606572","DOIUrl":"10.1080/13814788.2025.2606572","url":null,"abstract":"<p><strong>Background: </strong>General practitioners (GPs) frequently refer patients for abdominal ultrasound. Depending on the clinical context, a 'triage ultrasound' can assess multiple potential causes of abdominal symptoms, while a 'targeted ultrasound' (point-of-care ultrasound, POCUS) focuses on specific indications (e.g. cholelithiasis).</p><p><strong>Objective: </strong>To assess whether medical questions posed by GPs in abdominal ultrasound referral letters are adequate for radiologists to perform their examination, and to identify indications for POCUS by GPs based on exclusion rates and alternative findings in radiological reports.</p><p><strong>Methods: </strong>Retrospective study analysing GP referral letters with corresponding radiology reports referred for abdominal ultrasound. Key variables: GP's medical question, indication type and the radiologist's final interpretation, following established diagnostic guidelines.</p><p><strong>Results: </strong>A total of 1,196 referral letters with corresponding reports were reviewed. Of these, 143 (12%) were excluded, primarily due to missing clinical information from the GP (102; 8.5%). The final sample comprised 1053 referral letters with reports (mean age 59.2 years; 60% female). Sixteen percent of referral letters lacked a medical question, and 33% included exclusively guideline-based indications. The most common guideline-based indications were urolithiasis (43%) and cholelithiasis (39%). For guideline-based requests, radiologists excluded the indicated condition in 75% of cases, and an alternative diagnosis was identified in fewer than 10%.</p><p><strong>Conclusion: </strong>GPs frequently provide insufficient clinically relevant information in abdominal ultrasound referral letters. Simple cases with well-defined clinical queries like cholelithiasis, urolithiasis, hydronephrosis and abdominal aortic aneurysm seem suitable for POCUS evaluation, as these are often excluded conditions for which the risk of overlooking serious diagnoses is low.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2606572"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12802515/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960980","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the diagnostic process of endometriosis in primary care: An interview study with general practitioners in Denmark using clinical vignettes.","authors":"Maria Pencheri, Karina Ejgaard Hansen, Liv Juul Nielsen, Sharon Dixon, Lisa Hinton, Anders Prior, Axel Forman, Henrik Marschall, Mikkel Seyer-Hansen, Ulrik Bak Kirk","doi":"10.1080/13814788.2026.2648318","DOIUrl":"10.1080/13814788.2026.2648318","url":null,"abstract":"<p><strong>Introduction: </strong>Endometriosis is a chronic, systemic condition affecting 5-10% of individuals assigned female at birth. Due to its non-specific symptoms, diagnosis is often delayed.</p><p><strong>Objectives: </strong>This study aims to explore diagnostic challenges and decision-making processes that general practitioners (GPs) encounter when managing patients with symptoms suggestive of endometriosis in Denmark.</p><p><strong>Methods: </strong>A qualitative research approach was employed, incorporating the co-production of three fictional clinical vignettes representing diverse endometriosis presentations. Semi-structured interviews were conducted with 27 practicing GPs (7 males and 20 females) from urban and rural areas. Participants had a mean age of 50 years (range 41-66) and clinical experience ranging from newly qualified to 27 years. Interviews involved engagement with the vignettes, and data were analysed using thematic analysis.</p><p><strong>Results: </strong>Findings reveal the challenge of the non-specific nature of symptoms, the role of cyclical symptom patterns in diagnosis, the influence of diagnostic hierarchies, patient-centred care approaches, the bio-psycho-social perspective in management, the persistent stigma surrounding gynaecological symptoms, and GPs limited trust in general gynaecologists. GPs were more likely to suspect endometriosis when symptoms followed a cyclical pattern, whereas gastrointestinal presentations were less commonly linked to the condition. While many GPs adopted a patient-centred, shared decision-making approach, some still adhered to mind-body dualism in their clinical reasoning.</p><p><strong>Conclusion: </strong>Diagnosing endometriosis in primary care is challenging due to non-specific symptoms, diagnostic hierarchies, and stigma. Encouraging GPs to routinely inquire about the cyclical nature of symptoms may serve as a valuable diagnostic tool, particularly in cases involving gastrointestinal complaints.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2648318"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13040569/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147583094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motivational factors for general practice training and career establishment: A cross-sectional study in Flanders, Belgium.","authors":"Lotta E Coenen, Madieke Maseman, Janique Lobbestael, Guy Gielis, Ann Gils, Johan Vansintejan, Inès Van Rossem","doi":"10.1080/13814788.2026.2628411","DOIUrl":"10.1080/13814788.2026.2628411","url":null,"abstract":"<p><strong>Background: </strong>In Flanders, Belgium, the 3-year specialised training in General Practice includes a specialty training rotation, for which trainees may choose their training site. After graduation, General Practitioners (GPs) decide where to establish their practice.</p><p><strong>Objective: </strong>This study explored the factors influencing GP trainees' choice of training location, reasons for settling in a specific region after graduation, and motivations for remaining in or leaving a practice.</p><p><strong>Methods: </strong>In May 2024, the Interuniversity Centre for Education of General Practitioners distributed an anonymous online survey with closed- and open-ended questions to all GP alumni graduating between 2014 and 2023. Quantitative data were analysed using linear regression; qualitative data underwent content analysis.</p><p><strong>Results: </strong>Of 772 alumni respondents (26.7% response rate), 93.4% were still practising as a GP. Most were female (70.9%), and 37.2% engaged in additional professional roles. Key influences on training location choice and practice settlement included colleague connections, proximity to home, and opportunities to work in group practices. Decisions to stay in or leave a practice were shaped by interpersonal relationships, practice organisation, and work-life balance. Working as a substitute GP was a frequent reason for changing practices, especially among recent graduates, to explore varied working environments.</p><p><strong>Conclusion: </strong>Both interpersonal and logistical factors strongly influence training practice choice and later GP practice settlement. High-quality training practices and supportive work environments are essential to promote sustainable GP careers and achieve a more balanced geographical distribution of GPs.</p>","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2628411"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12934332/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147286340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The future is now: Towards intelligent use of Generative AI in general practice.","authors":"Jako S Burgers, Angelina Müller","doi":"10.1080/13814788.2025.2602356","DOIUrl":"10.1080/13814788.2025.2602356","url":null,"abstract":"","PeriodicalId":54380,"journal":{"name":"European Journal of General Practice","volume":"32 1","pages":"2602356"},"PeriodicalIF":2.5,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12781954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145913595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}