British Journal of General Practice最新文献

{"title":"Continuity of care in general practice and secondary care: retrospective cohort study.","authors":"Thomas Beaney, Thomas Woodcock, Paul Aylin, Azeem Majeed, Jonathan Clarke","doi":"10.3399/BJGP.2024.0579","DOIUrl":"10.3399/BJGP.2024.0579","url":null,"abstract":"<p><strong>Background: </strong>Better continuity in primary and secondary care is linked to improved health outcomes, but it is unclear whether the sociodemographic determinants of continuity are the same in both settings and whether continuity measures in each setting are associated.</p><p><strong>Aim: </strong>To examine the determinants of relational continuity in general practice and fragmented outpatient specialty care in people with clusters of multiple long-term conditions (LTCs) and the association between continuity in each setting.</p><p><strong>Design & setting: </strong>A cohort of patients aged ≥18 years registered to general practices in England throughout 2019 and who had linked hospital outpatient records. Patients with ≥2 of 212 LTCs and with ≥3 general practice and ≥3 outpatient appointments were included.</p><p><strong>Method: </strong>The Continuity of Care Index (COCI) was calculated separately for visits to the same a) GP and b) outpatient specialty, and associations calculated for sociodemographic factors and number of LTCs with COCI scores. The association was also assessed between indices in each setting using univariable and multivariable fractional logit regression.</p><p><strong>Results: </strong>Of 1 135 903 patients, 56.3% (<i>n</i> = 639 489)were aged ≥60 years. Age was the strongest determinant of continuity in general practice, whereas number of LTCs was the strongest determinant in secondary care. Although statistically significant (<i>P</i><0.001), the relationship between the COCI in general practice and outpatients was clinically insignificant in both univariable and multivariable models.</p><p><strong>Conclusion: </strong>A lack of strong association between continuity of care in general practice and outpatient settings was found. This suggests that fragmented hospital care is not mitigated by increased continuity in general practice.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e533-e540"},"PeriodicalIF":5.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142820118","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":"Patterns in GP appointment systems: a cluster analysis of 3480 English practices.","authors":"James Scuffell, Stevo Durbaba","doi":"10.3399/BJGP.2024.0556","DOIUrl":"10.3399/BJGP.2024.0556","url":null,"abstract":"<p><strong>Background: </strong>In response to increasing demand for appointments, UK general practices have adopted a range of appointment systems. These systems vary widely in implementation. These changes have not yet been clearly described.</p><p><strong>Aim: </strong>To characterise patterns of primary care delivery in English general practices.</p><p><strong>Design and setting: </strong>Cross-sectional study using NHS Appointments in General Practice data from 3480 English GP practices, totalling 56 million appointments between August and October 2023.</p><p><strong>Method: </strong>Twelve measures associated with consultation modality, waiting time, clinician type, and triage use were derived. Practices with similar characteristics for those 12 variables were clustered together using an ensemble machine learning approach. Clustering was validated using December 2023 data. The characteristics of each practice grouping were described using 2021 Census and NHS workforce data.</p><p><strong>Results: </strong>Two main models of care emerged. 'Routine care' practices (<i>n</i> = 2286) tended towards face-to-face appointments, often delivered by non-GPs with longer wait times. 'Same-day care' (<i>n</i> = 1194) practices, a third of practices, were more likely to use telephone consultations, deliver care with GPs, and provide same-day appointments. Compared with 'routine care' practices, 'same-day care' practices were more likely to be in urban areas, had younger populations (mean age 40 years versus 41 years) and employed fewer patient-facing staff in extended roles (all clinical staff except doctors and nurses) (2.0 versus 2.5 full-time equivalents per 10 000 patients registered).</p><p><strong>Conclusion: </strong>This study identified two dominant models of primary care delivery in England, reflecting differing approaches to managing patient access. These differences could have an impact on continuity of care and equity of access to primary care.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e541-e548"},"PeriodicalIF":5.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569011","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":"Primary care transformation in Scotland: a comparison of two cross-sectional national surveys of GPs' views in 2018 and 2023.","authors":"Eddie Donaghy, Kieran D Sweeney, Lauren Ng, Holly Haines, Alexandra Thompson, David Henderson, Harry Hx Wang, Andrew Thompson, Bruce Guthrie, Stewart W Mercer","doi":"10.3399/BJGP.2024.0500","DOIUrl":"10.3399/BJGP.2024.0500","url":null,"abstract":"<p><strong>Background: </strong>The 2018 Scottish GP contract established GP Clusters and multidisciplinary team (MDT) expansion. Qualitative studies have suggested suboptimal progress with these initiatives.</p><p><strong>Aim: </strong>To quantify progress since the introduction of the new contract.</p><p><strong>Design & setting: </strong>A cross-sectional postal survey of all qualified GPs was undertaken in Scotland in 2023.</p><p><strong>Method: </strong>GPs working lives, career intentions, and views on the new contract were compared with a similar survey conducted in 2018.</p><p><strong>Results: </strong>In total, 1385/4529 (31%) GPs responded to the 2023 survey compared with 2465/4371 (56%) in 2018. Job satisfaction and negative job attributes were similar in both surveys. Both positive job attributes (<i>P</i> = 0.011) and job pressures (<i>P</i> = 0.004) increased but the changes were small (effect sizes <0.2). Significantly more GPs were planning to reduce hours (<i>P</i><0.001) and leave direct patient care (<i>P</i> = 0.008) in 2023 than in 2018. Quality leads' views on Cluster working were unchanged, with 70-80% reporting insufficient support. Cluster knowledge and engagement was unchanged but there were small increases in knowledge of quality improvement. More than half of the GPs reported that access to MDT staff was insufficient to reduce their workload in all staff categories except vaccinations. Significantly more practices were trying to recruit GPs (<i>P</i><0.01), and GPs reported worsening NHS services, higher workload, and lower practice sustainability in 2023 (<i>P</i><0.001). Only 5% of GPs in the 2023 survey thought that the new contract had improved the care of patients with complex needs.</p><p><strong>Conclusions: </strong>GPs report few improvements in working life 5 years after the new contract was introduced, and are responding by planning to reduce their hours or leave direct patient care.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e559-e565"},"PeriodicalIF":5.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12159868/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959011","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":"What patients want from access to UK general practice: systematic review.","authors":"Helen Atherton, Helen Leach, Rob Mortell, Joanne Parsons","doi":"10.3399/BJGP.2024.0582","DOIUrl":"10.3399/BJGP.2024.0582","url":null,"abstract":"<p><strong>Background: </strong>Access to general practice is a topical concern, with rising numbers of consultations and decreasing numbers of GPs placing strain on the service. Patient satisfaction with general practice has seen a reduction in the UK. While patient experience with general practice is well understood, there is a need to understand what patients say they want from access to general practice.</p><p><strong>Aim: </strong>To examine what patients want from access to contemporary general practice in the UK.</p><p><strong>Design and setting: </strong>This was a systematic review set in UK general practice.</p><p><strong>Method: </strong>Studies were included that reported patient wants in relation to access to general practice in the UK since 2010. All empirical study designs were included, both quantitative and qualitative. The mixed-methods appraisal tool was used to assess study quality for contextual purposes. Narrative synthesis was applied to the included studies, with results presented using tables and text.</p><p><strong>Results: </strong>In total, 33 studies were included. The review showed that patients wanted information about how to access the general practice, choice of clinician, choice of healthcare professional type, and choice of consultation mode. Patients wanted a nearby practice, with clean waiting rooms, easy appointment booking using simple systems and with short waiting times, and to be kept informed about the process.</p><p><strong>Conclusion: </strong>The factors that patients want should be taken into consideration when changing or developing approaches to access. Future evaluations of care, and research, should explicitly consider what patients want from access in general practice.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e526-e532"},"PeriodicalIF":5.2,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665420","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":"Effectiveness of low-dose amitriptyline and mirtazapine in patients with insomnia disorder and sleep maintenance problems: a randomised, double-blind, placebo-controlled trial in general practice (DREAMING).","authors":"Mette H Bakker, Jacqueline G Hugtenburg, Pierre M Bet, Jos Wr Twisk, Henriëtte E van der Horst, Pauline Slottje","doi":"10.3399/BJGP.2024.0173","DOIUrl":"10.3399/BJGP.2024.0173","url":null,"abstract":"<p><strong>Background: </strong>Low-dose amitriptyline and mirtazapine are widely prescribed off-label for insomnia disorder. However, evidence of their effectiveness from placebo-controlled studies is lacking.</p><p><strong>Aim: </strong>To assess the effectiveness of low-dose mirtazapine and amitriptyline in patients with insomnia disorder.</p><p><strong>Design and setting: </strong>Pragmatic, double-blind, randomised, placebo-controlled trial undertaken in general practices in the Amsterdam region, the Netherlands.</p><p><strong>Method: </strong>Patients (aged 18-85 years) with insomnia disorder and sleep maintenance problems for whom non-pharmacological treatment was insufficient were randomised to mirtazapine (7.5-15 mg/day), amitriptyline (10-20 mg/day), or placebo for 16 weeks (optional double-dose regimen in week 2-14). Insomnia Severity Index (ISI) scores (range 0-28) were assessed at baseline and again at 6, 12, 20, and 52 weeks. The primary outcome was an ISI total score at 6 weeks that was clinically relevant and signified either 'improvement' (>7 points lower than baseline) or 'recovery' (total score ≤10 points).</p><p><strong>Results: </strong>In total, 80 participants were included. At 6 weeks, in the intention-to-treat analyses, mirtazapine and amitriptyline each led to statistically significantly lower ISI scores when compared with placebo: mirtazapine mean difference = -6.0 points (95% confidence interval [CI] = -9.0 to -3.0), amitriptyline mean difference = -3.4 points (95% CI = -6.3 to -0.4). At 6 weeks mirtazapine resulted in statistically significantly higher improvement and recovery rates (52% and 56%, respectively) compared with placebo (both 14%), whereas amitriptyline (with rates of 40% and 36%, respectively) did not. From 12 weeks onwards no statistically significant differences in ISI scores were observed.</p><p><strong>Conclusion: </strong>Compared with placebo, low-dose mirtazapine provided a statistically significant and clinically relevant reduction of insomnia severity at 6 weeks, but not at later time points. Low-dose amitriptyline resulted in a statistically significant reduction at 6 weeks, but this was not clinically relevant. The results do not support the prescription of low-dose amitriptyline and mirtazapine for several months in patients with insomnia disorder in general practice. Based on the results, GPs may consider prescribing off-label low-dose mirtazapine for a period of about 6 weeks in case non-pharmacological treatment is insufficient.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e474-e483"},"PeriodicalIF":5.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12199994/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016852","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":"Patient and family engagement interventions in primary care patient safety: systematic review and meta-analysis of randomised controlled trials.","authors":"Yan Pang, Anna Szücs, Ignacio Ricci-Cabello, Jaheeda Gangannagaripalli, Lay Hoon Goh, Foon Leng Leong, Li Fan Zhou, Jose Maria Valderas","doi":"10.3399/BJGP.2024.0369","DOIUrl":"10.3399/BJGP.2024.0369","url":null,"abstract":"<p><strong>Background: </strong>Engaging patients and families has been promoted as a key strategy for improving patient safety of health systems. However, evidence remains scarce on the effectiveness of this approach in primary care.</p><p><strong>Aim: </strong>To assess the combined effectiveness of primary care interventions in randomised controlled trials (RCTs) promoting patient and family engagement in patient safety.</p><p><strong>Design and setting: </strong>A systematic review and meta-analysis.</p><p><strong>Method: </strong>The review followed PRISMA and Cochrane guidelines. Five electronic databases (Medline, CINAHL, Embase, Web of Science, CENTRAL) were searched from inception to 18 September 2024 with keywords in four blocks (patient and family engagement; patient safety; primary care; randomised controlled trial). Patient and family engagement levels were appraised. Where appropriate, results were combined into meta-analyses.</p><p><strong>Results: </strong>Of the 19 included records, 12 reported on completed RCTs. Only one intervention integrated patients/families into overall care safety (high engagement); six aimed at enhancing skills and tools (intermediate), and 12 informed patients/families how to engage and prompted them to do it (low). RCTs primarily targeted medication safety, with meta-analyses showing no significant effects on reducing adverse drug events (odds ratio [OR] 0.86, 95% confidence interval [CI] = 0.70 to 1.08) or improving medication appropriateness measured categorically (OR 0.92, 95% CI = 0.76 to 1.13) or continuously (mean difference 0.71, 95% CI = -0.10 to 1.52). Overall risk of bias was low and certainty of evidence very low to moderate.</p><p><strong>Conclusion: </strong>Existing randomised controlled evidence on patient and family engagement in primary care remains inconclusive and limited in scope. Future interventions should include higher levels of engagement and address more diverse patient safety outcomes relevant for primary care.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e491-e499"},"PeriodicalIF":5.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12364509/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006835","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":"Impact of an SMS intervention to support type 2 diabetes self-management: DiabeText clinical trial.","authors":"Rocío Zamanillo-Campos, María Antonia Fiol-deRoque, María Jesús Serrano-Ripoll, Joan Llobera-Canaves, Joana María Taltavull-Aparicio, Alfonso Leiva-Rus, Joana Ripoll-Amengual, Escarlata Angullo-Martínez, Isabel María Socias-Buades, Lluís Masmiquel-Comas, Jadwiga Konieczna, María Zaforteza-Dezcallar, María Asunción Boronat-Moreiro, Sofía Mira-Martínez, Elena Gervilla-García, Ignacio Ricci-Cabello","doi":"10.3399/BJGP.2024.0206","DOIUrl":"10.3399/BJGP.2024.0206","url":null,"abstract":"<p><strong>Background: </strong>Complications arising from uncontrolled type 2 diabetes mellitus (T2DM) pose a significant burden on individuals' wellbeing and healthcare resources. Digital interventions may play a key role in mitigating such complications by supporting patients to adequately self-manage their condition.</p><p><strong>Aim: </strong>To assess the impact of DiabeText, a new theory-based, patient-centred, mobile health intervention integrated with electronic health records to send tailored short text messages to support T2DM self-management.</p><p><strong>Design and setting: </strong>A pragmatic, phase-three, 12-month, two-arm randomised clinical trial involving primary care patients with T2DM in the Balearic Islands, Spain, including in urban and rural areas.</p><p><strong>Method: </strong>In total, 742 participants with suboptimal glycaemic control (glycated haemoglobin [HbA1c] level >7.5) were randomly allocated to a control (usual care) or intervention (DiabeText) group. In addition to usual care, the DiabeText group received 167 messages focused on healthy lifestyle and medication adherence. The primary outcome was HbA1c level. Secondary outcomes were: medication possession ratio; health-related quality of life (measured using the EQ-5D-5L questionnaire); diabetes self-efficacy (measured using the Diabetes Self-Efficacy Scale [DSES]); and self-reported adherence to medication, Mediterranean diet (measured using the 14-Item Mediterranean Diet Adherence Screener [MEDAS-14]), and physical activity (measured using the International Physical Activity Questionnaire [IPAQ]).</p><p><strong>Results: </strong>Over the 12-month period, no statistically significant differences in HbA1c were observed between the intervention and the control groups (β = -0.025 [95% confidence interval {CI} = -0.198 to 0.147; <i>P</i> = 0.772]). In comparison with the control group, the DiabeText group showed significant (<i>P</i><0.05) improvements in self-reported medication adherence (odds ratio = 1.4; 95% CI = 1.0 to 1.9), DSES (Cohen's <i>d</i> = 0.35), and EQ-5D-5L (Cohen's <i>d</i> = 0.18) scores, but not for the rest of the secondary outcomes.</p><p><strong>Conclusion: </strong>DiabeText successfully improved quality of life, diabetes self-management, and self-reported medication adherence in primary care patients with T2DM. Further research is needed to enhance its effects on physiological outcomes.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e457-e465"},"PeriodicalIF":5.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11755587/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142373623","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":"Variation in duration of repeat prescriptions: a primary care cohort study in England.","authors":"Brian MacKenna, Andrew D Brown, Richard Croker, Alex J Walker, Ben Goldacre, Apostolos Tsiachristas, Dave Evans, Peter Inglesby, Seb Bacon, Helen J Curtis","doi":"10.3399/BJGP.2024.0326","DOIUrl":"10.3399/BJGP.2024.0326","url":null,"abstract":"<p><strong>Background: </strong>Many patients receive repeat prescriptions for routine medications used to treat chronic conditions. Doctors typically issue repeat prescriptions with durations ranging from 28 to 84 days. There is currently no national guidance in England for the optimal prescription duration for routine medications.</p><p><strong>Aim: </strong>To evaluate current prescription durations for five common routine medications in England; explore and visualise geographical variation; and identify practice factors that are associated with shorter prescribing duration to inform policy making.</p><p><strong>Design and setting: </strong>A retrospective cohort study of NHS primary care prescribing data in England from December 2018 to November 2019.</p><p><strong>Method: </strong>The prescription duration was analysed for five common routine medications in England; ramipril, atorvastatin, simvastatin, levothyroxine, and amlodipine. Variation was assessed between regional clinical commissioning groups (CCGs), and practice factors associated with different durations were identified.</p><p><strong>Results: </strong>Of the common medications included, 28-day prescriptions accounted for 48.5% (2.5 billion) tablets/capsules issued, while 43.6% were issued for 56 days. There was very wide regional variation (7.2%-95.0%) in the proportion of 28-day prescriptions issued by CCGs. Practice dispensing status was the most likely predictor of prescription duration; dispensing practices had a higher 28-day prescribing proportion than non-dispensing practices. The proportion of patients with chronic conditions and the electronic health record system used by a practice were also associated with prescription duration.</p><p><strong>Conclusion: </strong>This analysis of OpenPrescribing data showed that repeat prescriptions of 28 days are common for patients taking routine medications for chronic conditions, particularly in dispensing practices. This provides data to inform the policy debate on current practice. Configuration of electronic health record systems offer an opportunity to implement and evaluate new policies on repeat prescription duration in England.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e448-e456"},"PeriodicalIF":5.3,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12236966/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143416312","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":"Social determinants of distress in South Asian men with long-term conditions: a qualitative study in primary care.","authors":"Hassan Awan, Nadia Corp, Tom Kingstone, Carolyn A Chew-Graham","doi":"10.3399/BJGP.2024.0386","DOIUrl":"10.3399/BJGP.2024.0386","url":null,"abstract":"<p><strong>Background: </strong>People with long-term physical conditions are more likely to experience distress, depression, or anxiety. Physical-mental comorbidity is associated with lower quality of life, poorer clinical outcomes, and increased mortality than physical conditions alone. People of South Asian origin are the largest minority group in the UK, and more likely to have long-term conditions (LTCs) such as diabetes and heart disease.</p><p><strong>Aim: </strong>To explore how men of South Asian origin with LTCs understand and experience emotional distress as well as the experiences of GPs supporting them.</p><p><strong>Design and setting: </strong>A UK qualitative study interviewing South Asian men with diabetes or coronary heart disease, and GPs working at practices with higher proportions than average in the UK of people of South Asian origin.</p><p><strong>Method: </strong>Online semi-structured interviews with South Asian men and GPs were undertaken. Data were analysed via reflexive thematic analysis. Topic guides were modified iteratively as data collection and analysis progressed. An ethnically appropriate patient advisory group of South Asian men was involved in all stages of the research.</p><p><strong>Results: </strong>Seventeen South Asian men with LTCs and 18 GPs were interviewed. Participants described contextualising distress, including LTCs influencing distress and the intersections of social determinants of distress including ethnicity, poverty, and perceptions of prejudice. Participants understood distress as different from depression with the need to negotiate multiple identities as well as integrative paradigms of health.</p><p><strong>Conclusion: </strong>This study highlights the influence of social determinants of distress in South Asian men with LTCs. It provides an insight into how primary care has the potential to address health inequalities by considering the intersection of these factors.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e397-e405"},"PeriodicalIF":5.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070298/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142633295","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":"Patient experiences with person-centred and integrated chronic care, focusing on patients with low socioeconomic status: a qualitative study.","authors":"Hester E van Bommel, Lena Ha Raaijmakers, Maria Etc van den Muijsenbergh, Tjard R Schermer, Jako S Burgers, Tessa van Loenen, Erik Wma Bischoff","doi":"10.3399/BJGP.2024.0400","DOIUrl":"10.3399/BJGP.2024.0400","url":null,"abstract":"<p><strong>Background: </strong>The effectiveness of single disease management programmes in general practice may be limited for patients with low socioeconomic status (SES), as these programmes insufficiently take into account the specific problems and needs of this population. A person-centred integrated care (PC-IC) approach focusing on individual patient's needs and concerns could address these problems.</p><p><strong>Aim: </strong>To explore experiences of patients with (multiple) chronic diseases with regard to the acceptability of a general practice-based PC-IC approach, with a focus on patients with low SES, and to establish which modifications are needed to tailor the approach to this group.</p><p><strong>Design and setting: </strong>In 2021, a feasibility study in seven general practices in the Netherlands was carried out. The healthcare professionals provided care based on a PC-IC approach for patients with diabetes, chronic respiratory diseases and/or cardiovascular disorders. Patients were followed for 6 months.</p><p><strong>Method: </strong>This was a qualitative study using focus group discussions, in-depth interviews, and semi-structured telephone interviews in a total of 46 patients with chronic diseases and multimorbidity, including 31 patients with low SES.</p><p><strong>Results: </strong>An overall positive experience of participants with the PC-IC approach was observed. Discussing their health made patients feel they were being taken more seriously and seen as a unique individual, and it provided the opportunity to discuss their life and health concerns. Recommended adaptations of the PC-IC approach for patients with low SES include creating materials that are clear and easy to understand and offering communication training for healthcare professionals.</p><p><strong>Conclusion: </strong>The PC-IC approach seems helpful for patients with chronic diseases, provided that it is tailored to their skills and abilities. Several modifications for patients with low SES were suggested.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e423-e430"},"PeriodicalIF":5.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117502/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807647","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}