British Journal of General Practice最新文献

{"title":"Future Health Today and patients at risk of undiagnosed cancer: a pragmatic cluster randomised trial of quality- improvement activities in general practice.","authors":"Sophie Chima, Javiera Martinez-Gutierrez, Barbara Hunter, Adrian Laughlin, Patty Chondros, Natalie Lumsden, Douglas Boyle, Craig Nelson, Paul Amores, An Tran-Duy, Jo-Anne Manski-Nankervis, Jon Emery","doi":"10.3399/BJGP.2024.0491","DOIUrl":"10.3399/BJGP.2024.0491","url":null,"abstract":"<p><strong>Background: </strong>Diagnosing cancer in general practice is complex, given the non-specific nature of many presenting symptoms and the overlap of potential diagnoses.</p><p><strong>Aim: </strong>This trial aimed to evaluate the effectiveness of Future Health Today (FHT) - a technology that provides clinical decision support, auditing, and quality-improvement monitoring - on the appropriate follow-up of patients at risk of undiagnosed cancer.</p><p><strong>Design and setting: </strong>Pragmatic, cluster randomised trial undertaken in general practices in Victoria and Tasmania, Australia.</p><p><strong>Method: </strong>Practices were randomly assigned to receive recommendations for follow-up investigations for cancer (FHT cancer module) or the active control. Algorithms were applied to the electronic medical record, and used demographic information and abnormal test results that are associated with a risk of undiagnosed cancer (that is, anaemia/iron deficiency, thrombocytosis, and raised prostate-specific antigen) to identify patients requiring further investigation and provide recommendations for care. The intervention consisted of the FHT cancer module, a case-based learning series, and ongoing practice support. Using the intention-to-treat approach, the between-arm difference in the proportion of patients with abnormal test results who were followed up according to guidelines was determined at 12 months.</p><p><strong>Results: </strong>In total, 7555 patients were identified as at risk of undiagnosed cancer. At 12 months post-randomisation, 76.0% of patients in the intervention arm had received recommended follow-up (21 practices, <i>n</i> = 2820/3709), compared with 70.0% in the control arm (19 practices, <i>n</i> = 2693/3846; estimated between-arm difference = 2.6% [95% confidence interval (CI)] = -2.8% to 7.9%; odds ratio = 1.15 [95% CI = 0.87 to 1.53]; <i>P</i> = 0.332).</p><p><strong>Conclusion: </strong>The FHT cancer module intervention did not increase the proportion of patients receiving guideline-concordant care. The proportion of patients receiving recommended follow-up was high, suggesting a possible ceiling effect for the intervention.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142683587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between cancer risk assessment tool use and GP consultation duration: an observational study.","authors":"Emily Fletcher, John L Campbell, Emma Pitchforth, Luke Mounce, Willie Hamilton, Gary Abel","doi":"10.3399/BJGP.2024.0135","DOIUrl":"10.3399/BJGP.2024.0135","url":null,"abstract":"<p><strong>Background: </strong>England is short of GPs, and GP consultation rates, consultation duration, and workload are increasing. Electronic clinical decision support tools assist decision making for screening, diagnosis, and risk management. Cancer detection is one area in which tools are designed to support GPs, with some electronic risk assessment tools (eRATs) estimating the risk of current cancer based on symptoms.</p><p><strong>Aim: </strong>To explore any association between the impact of eRATs and GP workload and workflow during consultations.</p><p><strong>Design and setting: </strong>Observational sub-study.</p><p><strong>Method: </strong>Thirteen practices in England participating in a cluster randomised controlled trial of eRATs were recruited to the study. Using mixed-effects regression models, the average duration of consulting sessions and individual consultations in which eRATs were, or were not, activated were compared.</p><p><strong>Results: </strong>There was no evidence that consulting sessions in which an eRAT was activated were, on average, longer than sessions in which an eRAT had not been activated. However, after adjusting for a range of session and consultation characteristics, individual consultations involving an eRAT were longer, on average, by 3.96 minutes (95% confidence interval = 3.45 to 4.47; <i>P</i><0.001) when compared with consultations with no eRAT.</p><p><strong>Conclusion: </strong>There was no evidence to suggest that eRATs should not be used to support GPs in early cancer diagnosis from a workload perspective. Activation of eRATs was not associated with increased workload across a consulting session, despite a small increase in time observed in individual consultations involving eRATs. Ultimately, therefore, it should be definitive findings regarding the clinical effectiveness of eRATs, not the related workload/workflow implications, that determine whether the use of eRATs should be rolled out more widely.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142717196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Symptom appraisal and help- seeking before a cancer diagnosis during pregnancy: a qualitative study.","authors":"Afrodita Marcu, Emma Ream, Karen Poole, Jo Armes, Faith Gibson, Lisa Whittaker, Jenny Harris","doi":"10.3399/BJGP.2024.0208","DOIUrl":"10.3399/BJGP.2024.0208","url":null,"abstract":"<p><strong>Background: </strong>The estimated incidence of a cancer diagnosis during or shortly after pregnancy is 1 in 1000 pregnancies in England. Pregnancy can have an impact on symptom appraisal and help-seeking for symptoms subsequently diagnosed as cancer. Little is known about the pathway to cancer diagnosis in pregnancy or delays that women can encounter.</p><p><strong>Aim: </strong>To explore symptom appraisal, help-seeking decisions, and experience of receiving a cancer diagnosis during pregnancy.</p><p><strong>Design and setting: </strong>Semi-structured interviews were conducted with women diagnosed with cancer during or shortly after pregnancy in the previous 4 years in the UK, recruited between January and May 2022 via the charity Mummy's Star.</p><p><strong>Method: </strong>This study used reflexive thematic analysis of 20 interviews. Analysis was largely inductive and the themes generated were mapped onto the intervals of the Model of Pathways to Treatment.</p><p><strong>Results: </strong>Symptoms were often interpreted through the lens of pregnancy by both participants and most of the healthcare professionals from whom they sought help. Participants who found breast lumps were likely to suspect cancer and be referred promptly for tests in secondary care. Although most participants sought timely help for their symptoms, some subsequently encountered health system delays, partly owing to both the vague nature of their symptoms and the COVID-19 pandemic.</p><p><strong>Conclusion: </strong>Health services need to better support women presenting with possible cancer symptoms during pregnancy to ensure timely diagnosis. Recommendations include prioritising symptoms over attributing them solely to pregnancy, ensuring timely referrals to rule out serious conditions, and emphasising clear communication alongside robust safety-netting practices. A full assessment is essential before dismissing symptoms as pregnancy related.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Patterns of Diagnostic Testing for Oesophagogastric Cancer-Related Symptoms in Australian General Practice.","authors":"Shaoke Lei, Brent Venning, Alison Pearce, Alex Lee, Jon Emery","doi":"10.3399/BJGP.2024.0621","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0621","url":null,"abstract":"<p><strong>Background: </strong>Oesophagogastric (OG) cancer-associated symptoms are common in primary care, but most research has focused on patients with a confirmed OG cancer diagnosis, rather than those presenting with symptoms for the first time.</p><p><strong>Aim: </strong>To examine diagnostic testing patterns for upper gastrointestinal symptoms linked to OG cancer.</p><p><strong>Design and setting: </strong>Retrospective cohort study used a linked primary care database. It included de-identified patients aged 55 and older who presented with symptoms suggestive of OG cancer between 2008 and 2022. We analysed the proportion of patients who underwent pathology, imaging, referral, endoscopy, or a test of treatment. Differences across socioeconomic groups were also examined, along with the proportion of patients diagnosed with OG cancer.</p><p><strong>Results: </strong>The study cohort consisted of 44,402 patients, of whom 126 (0.28%) were diagnosed with OG cancer within 12 months of presentation. Reflux was the most common symptom (57%), followed by nausea (11%). Patients over 75 were less likely to be investigated or referred (OR = 0.59, 95% CI: 0.56-0.62, p < 0.001). Those from less disadvantaged areas were 1.4 times more likely to be investigated (OR = 1.44, 95% CI: 1.36-1.53, p < 0.001). Patients on 'test of treatment' medications were less likely to receive further investigation (OR = 0.66, 95% CI: 0.63-0.69, p < 0.001). Multiple symptoms and visits increased the likelihood of investigation (OR = 2.77, 95% CI: 2.55-3.00, p < 0.001).</p><p><strong>Conclusion: </strong>Significant variations in diagnostic testing could contribute to disparities in OG cancer outcomes.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774916","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Selection and reporting of usual care comparators when designing primary care trials of complex health interventions: a systematic review.","authors":"Shoba Dawson, Katrina Turner, Sarah Dawson, Tom Yardley, Alyson Huntley","doi":"10.3399/BJGP.2024.0525","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0525","url":null,"abstract":"<p><strong>Background: </strong>Many primary care trials evaluating complex health interventions use a 'usual care' comparator. As 'usual care' can vary across clinical sites, countries, and over time, impacting trial design and raising ethical considerations attention should be given to its content prior to a trial starting.</p><p><strong>Aim: </strong>To understand how researchers select and describe usual care comparators when designing primary care trials of complex health interventions.</p><p><strong>Design and setting: </strong>A systematic review of primary care trial or feasibility study protocols.</p><p><strong>Method: </strong>Electronic databases were searched from 1 July 2020 to 20 June 2022.</p><p><strong>Results: </strong>A total of 83 protocols were included. A range of terms such as usual care and care as usual were used to describe usual care. The description of usual care varied significantly between protocols in terms of the level of detail provided regarding its selection and content. We categorised these descriptions according to the amount of detail they provided as: basic (72%), moderate (16%) and comprehensive (12%). Few protocols justified the content of their usual care comparator, with most simply commenting that it was based on clinical guidelines or current practice.</p><p><strong>Conclusion: </strong>Different terms are used to describe usual care and most primary care researchers provide limited details on the section and content of their usual care comparators when publishing study protocols. This has implications for transparency and replicability, and suggests researchers continue to give limited attention to the content of usual care when designing their trials.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anaemia, ethnicity and cancer incidence: a retrospective cohort study in primary care.","authors":"Liz Down, Melissa Barlow, Sarah Bailey, Luke Timothy Allan Mounce, Samuel Merriel, Jessica Watson, Ge Chen, Tanimola Martins","doi":"10.3399/BJGP.2024.0762","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0762","url":null,"abstract":"<p><p>Background Haemoglobin, Mean Corpuscular Volume (MCV), and rates of Iron Deficiency Anaemia (IDA) are used in primary care to investigate possible cancer symptoms, especially for gastro-intestinal cancers. Underlying ethnic differences in typical test results could lead to inequalities in the diagnosis of cancer in primary care. Aim To investigate the distribution of low haemoglobin, low MCV and IDA, and the rate of cancer diagnosis in patients with abnormal results, by ethnic group. Design and Setting Retrospective cohort study using routine data collected in primary care in England. Included patients had blood tests between 2010 and 2017 and were at least 40 years old with no prior cancer diagnosis. Method Multi-level logistic regression was used to investigate the relationship between blood test results and cancer risk for patients in different ethnic groups. Results Low haemoglobin, low MCV, and IDA were effective in identifying patients with increased cancer risk, particularly for gastro-intestinal cancers. MCV was found to be a stronger cancer indicator for White patients (diagnostic OR 3.84) than for Asian (OR 1.86) or Black patients (OR 1.75). Conclusion There are some small differences in cancer risk for patients with abnormal test results, when considering patient ethnic group, especially for MCV. This is likely to be a consequence of the underlying difference in typical MCV values for patients from different ethnic groups. Further investigation is required to understand the aetiology of these differences in order to disentangle any effects on outcomes for patients with cancer.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774911","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using AI to improve skin cancer detection in primary care: the vision and barriers.","authors":"Richard Armitage","doi":"10.3399/bjgp25X741177","DOIUrl":"10.3399/bjgp25X741177","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 753","pages":"168-169"},"PeriodicalIF":5.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733374","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"We should be offering GP registrars screening for specific learning differences.","authors":"Adrian Hucks","doi":"10.3399/bjgp25X741213","DOIUrl":"10.3399/bjgp25X741213","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 753","pages":"172-173"},"PeriodicalIF":5.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733375","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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":"10.3399/bjgp25X741045","DOIUrl":"10.3399/bjgp25X741045","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 753","pages":"156"},"PeriodicalIF":5.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733360","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Public health and general practice working together.","authors":"Luke N Allen, Eleanor Turner-Moss, Kathrin Thomas, Luisa Pettigrew, David Blane, Rory Honney, Richard Hobbs, Aziz Sheikh","doi":"10.3399/bjgp25X741105","DOIUrl":"10.3399/bjgp25X741105","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 753","pages":"154-155"},"PeriodicalIF":5.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733368","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}