British Journal of General Practice最新文献

{"title":"Making decisions about antidepressant use during pregnancy: a qualitative interview study of a sample of women in the UK.","authors":"Heather James, Sophie Smith, Dheeraj Rai, Iryna Culpin, Katrina Turner","doi":"10.3399/BJGP.2024.0068","DOIUrl":"10.3399/BJGP.2024.0068","url":null,"abstract":"<p><strong>Background: </strong>An increasing number of pregnant women now take antidepressants. Many pregnant women experience decisional conflict when deciding whether to take antidepressants, but little is known about the attitudes and experiences that influence these decisions.</p><p><strong>Aim: </strong>To explore the attitudes and experiences influencing women's decisions about antenatal antidepressant use.</p><p><strong>Design and setting: </strong>A qualitative study using in-depth interviews with a sample of UK women who experienced antenatal depression or took antidepressants antenatally within the preceding 3 years.</p><p><strong>Method: </strong>Recruitment adverts were placed by a perinatal mental health charity and on parenting forums and social media platforms, resulting in a convenience sample. Interview data were coded and analysed with thematic analysis using QSR NVivo.</p><p><strong>Results: </strong>Twenty-two women were interviewed; one-half had taken antidepressants during pregnancy. Most women had concerns about adverse effects and viewed antidepressants as adjunctive to non-pharmacological treatments, which were reported as difficult to access. Some women reported that professional advice was insufficiently detailed. Women described the need to cope with their symptoms, their baby, and existing responsibilities, and related their decisions to their perceived ability to cope. This perception was influenced by physical and emotional challenges relating to pregnancy. Women's decisions were influenced by their previous experiences and by the perceived societal expectations placed on pregnant women.</p><p><strong>Conclusion: </strong>Decision making is a complex and dynamic process, personal to each woman's circumstances. Perceived ability to cope is an important factor in decision making. Detailed information should be offered to women for support with decision making in relation to antenatal medication use.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e440-e447"},"PeriodicalIF":5.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966528/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395486","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":"Practitioner perspectives on symptomatic faecal immunochemical testing in the UK: a qualitative interview study.","authors":"Christina Dobson, Adam Biran, Colin Rees, Willie Hamilton, Christian von Wagner, John Whelpton, Linda Sharp","doi":"10.3399/BJGP.2024.0358","DOIUrl":"10.3399/BJGP.2024.0358","url":null,"abstract":"<p><strong>Background: </strong>Faecal immunochemical testing (FIT) is now core to the management of patients presenting in primary care with symptoms of possible colorectal cancer. Patients with a positive FIT (≥10 μg haemoglobin [Hb]/g faeces) qualify for an urgent suspected cancer referral. FIT-negative patients are typically managed in primary care or referred through routine pathways.</p><p><strong>Aim: </strong>To examine practitioners' experiences of delivering symptomatic FIT, identifying perceived benefits, disbenefits, and implementation issues, to inform potential future service improvements.</p><p><strong>Design and setting: </strong>A qualitative interview study with primary and secondary care health professionals involved in delivering symptomatic FIT pathways from across the UK.</p><p><strong>Method: </strong>Thirty semi-structured interviews were conducted with professionals from a range of specialties. An iterative topic guide informed interviews while allowing freedom to explore novel lines of enquiry. Pseudo-anonymised transcripts were coded, and themes were identified and developed.</p><p><strong>Results: </strong>Symptomatic FIT was seen to be beneficial for increasing confidence in clinical decision making and enriching the pool of patients being definitively investigated for colorectal neoplasia. There were varying views on the impact of symptomatic FIT on workload with the burden of additional workload generally seen to impact primary care. Concerns about current practice included overuse of FIT, burden of investigations in patients with false-positive results, and diagnostic delays for both cancer and benign disease. Uncertainties existed around management of patients with rectal bleeding, appropriate strategies for safety netting, and the value of repeat FIT.</p><p><strong>Conclusion: </strong>Symptomatic FIT is largely seen as beneficial; however, health professionals would welcome further evidence and guidance around optimal application.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e390-e396"},"PeriodicalIF":5.3,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070297/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143043416","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 Characteristics and Degrees of Discontinuity of care in General practice.","authors":"Ditte Elschner Rimestad, Peder Ahnfeldt-Mollerup, Troels Kristensen","doi":"10.3399/BJGP.2024.0570","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0570","url":null,"abstract":"<p><strong>Background: </strong>Continuity of care (COC) is crucial for effective healthcare, but patients often experience discontinuity of care. Understanding these patterns and associated patient characteristics can guide interventions to improve COC.</p><p><strong>Aim: </strong>This study investigates longitudinal provider Discontinuity of Care (DCOC) and identifies disparities in patient characteristics across DCOC levels in Danish general practice.</p><p><strong>Design and setting: </strong>We utilized cohort data from all Danish general practice patients aged 12 and older, alive from 2007 to 2018.</p><p><strong>Methods: </strong>Logistic regression was employed to estimate DCOC at levels: 0 vs 1-2, 0 vs 3-4, 0 vs 5-6, 0 vs 7-8, and 0 vs 9+ shifts. Five regression models were used to analyze the odds of DCOC levels relative to demographic, regional, municipal, socioeconomic, and morbidity factors.</p><p><strong>Results: </strong>The majority of males were likely to have lower DCOC levels, while subgroups of males had odds for the highest DCOC levels. Young adults had a higher likelihood of moderate to high DCOC compared to those aged 12-24, while older adults showed a lower probability. Higher DCOC was linked to residents of the Region of Zealand, the Capital Region, and municipality status. Unemployed individuals, other ethnicities, single status, and those in lower income quartiles had increased probability of DCOC. Patients with lower or moderate to high morbidity also faced higher likelihood of DCOC than patients with no chronic diseases.</p><p><strong>Conclusion: </strong>This study revealed disparities in DCOC among patients with lower socioeconomic status, higher morbidity, and varying odds based on education, municipality type, age, and gender.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144082246","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":"Addressing the Inverse Care Law in Scottish general practice: systematic scoping review.","authors":"James Bogie, Meike van Dijk, Cara Bezzina, Carey Lunan, David Henderson, Stewart W Mercer, David Nicholas Blane","doi":"10.3399/BJGP.2024.0622","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0622","url":null,"abstract":"<p><p>Background Recent evidence demonstrates persistence of the inverse care law (ICL) in general practice in England. Although the ICL was well-described in Scotland 20 years ago, progress in interventions since then is unclear. Aim To review national and local interventions which aimed to specifically address the ICL in Scottish general practice since 2000. Design & Setting Systematic scoping review, Scotland. Method We searched EMBASE, Web of Science, MEDLINE, CINAHL, Cochrane and BASE from 2000 to February 2024. We also performed a systematic grey literature search of government, NHS and third sector websites. All papers were double screened for inclusion. We included quantitative and qualitative studies and assessed quality using the Joanna Briggs Institute tools. Results Out of 13089 results, 67 papers reporting on 20 interventions were included. Interventions to improve general practice in deprived areas were categorised as: 1) enhancing patients' financial or social support, 2) targeting specific health conditions, 3) targeting specific groups and 4) enhancing generalist healthcare. Six interventions accounted for 49% of all included papers. Only two interventions have been rolled out nationally - Community Link Workers and Welfare Advice and Health Partnerships - with both facing uncertain long-term funding. Conclusion There remains a major implementation gap between Scottish Government's policy ambitions to address health inequalities and sustainable delivery on the ground. To address the inverse care law, greater overall investment in general practice is needed, together with additional resources for more deprived areas according to local population need (a \"proportionate universalism\" approach).</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059063","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":"Personal GP-continuity improves healthcare outcomes in primary care populations - A systematic review.","authors":"Sven Göran Engström, Malin André, Eva Arvidsson, Carl Johan Östgren, Margareta Troein, Lars Borgquist","doi":"10.3399/BJGP.2024.0568","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0568","url":null,"abstract":"<p><p>Background Personal continuity is a hallmark for GPs but there is insufficient evidence to support its benefits in ordinary primary-care populations. Aim To investigate the effects of GP- personal continuity on the healthcare outcomes of primary-care populations. Design and Setting Systematic review of quantitative studies investigating associations between personal continuity of care and outcomes such as mortality and healthcare utilisation. Methods Embase, PubMed, Scopus, and Web of Science were searched for studies published between January 1, 2000 and October 31, 2023. Due to study heterogeneity the synthesis was conducted narratively; study results were summarised, and expressed as having higher (compared to lower) continuity of care. Certainty of each summarised result was assessed using the GRADE framework. Results Out of 5 792 unique references 18 studies were included in the final analyses. The outcomes were grouped into three categories of summarised outcomes. Higher (when compared to lower) personal continuity with a GP/FP probably prevents premature mortality (moderate certainty: 4 studies, 5 638 305 participants), probably reduces the risk of hospitalisation (moderate certainty: 11 studies, 13 642 684 participants) and probably lowers risk of emergency-department visits (moderate certainty: 7 studies, 3 885 487 participants). Conclusion Higher, compared to lower, continuity in the relationship between GP and patients in primary care populations is associated with reduced mortality, hospitalisation, and emergency-department visits. Relatively small improvements in personal continuity, that may be achieved in most practices, significantly reduce healthcare consumption, and thus influence the access to care, which have implications for healthcare policy.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059034","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":"Evidence-based tests to monitor adults with type 2 diabetes mellitus in primary care: rapid reviews and consensus process.","authors":"Martha Maria Christine Elwenspoek, Rachel O'Donnell, Joni Jackson, Sarah Dawson, Katie Charlwood, Alastair D Hay, Jessica Watson, Penny Whiting","doi":"10.3399/BJGP.2024.0744","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0744","url":null,"abstract":"<p><p>Background When monitoring long-term conditions both over- and undertesting risk patient harm and increased healthcare costs. Aim To evaluate the evidence base for type 2 diabetes mellitus (T2DM) monitoring tests and develop methods for creating evidence-based testing strategies. Design and setting Rapid reviews, consensus process. Primary care. Method We identified tests that are recommended or used commonly to monitor T2DM. We created filtering questions to examine the rationale of each test, which were answered by stepwise rapid reviews of evidence cited by guidelines, systematic reviews, and individual studies. A consensus group of patient representatives and clinicians voted whether tests should be included or excluded based on the evidence or whether further evidence was needed. Results Of 15 tests, only HbA1c, to monitor disease progression and treatment response, and eGFR, to detect chronic kidney disease, have a strong evidence base. Based on available evidence and consensus group feedback, routinely testing for fructosamine to monitor disease progression; thyroid function, vitamin B12, ferritin, folate, clotting, bone profile, C-reactive protein, erythrocyte sedimentation rate, and B-type natriuretic peptide; and liver function for adverse treatment effects of metformin was deemed unnecessary. We found insufficient evidence for vitamin B12 to screen for adverse treatment effects, and lipids and haemoglobin for secondary conditions. Conclusion We found that the evidence-base for most T2DM monitoring tests is weak or absent. Clinicians should avoid non-evidence based tests unless there are additional clinical indications for testing. Standardised evidence-based testing panels for T2DM and other long-term conditions could reduce unnecessary testing.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144006834","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":"Evolution of the general practice receptionist role and online services: qualitative study.","authors":"Stephanie Stockwell, Helen Atherton, Carol Bryce, John Campbell, Christine Marriott, Emma Pitchforth, Bethan Mair Treadgold, Rachel Winder, Jennifer Newbould","doi":"10.3399/BJGP.2024.0677","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0677","url":null,"abstract":"<p><p>Background General practice receptionists are perceived as the 'gatekeepers' to primary care services and are central to managing patient demand and facilitating patient care. This role is evolving and becoming increasingly complex in a digital world. Aim To consider the growing role of patient facing online services and the impact these have on the role of the general practice receptionist. Design and setting A focused ethnographic case study in eight general practices across England and 19 stakeholder interviews. Method Focused ethnographic case study and stakeholder interviews were conducted between September 2021 and July 2022. Results The receptionist role looks different across practices, but is now more varied and less repetitive than it has been historically. The volume of patients and number of channels by which patients contact the practice means that receptionists are dealing with increasingly complex demand management and navigation to appropriate services. This now includes online services, which has created a new element to the receptionist role - digital facilitation. The role is also largely navigated by the receptionists without any formal training and staff are mostly expected to learn on the job from other receptionists, leading to inconsistent practices. Conclusion The digitalisation of healthcare services impacts the workflow and consistency in task completion of general practice receptionist staff and has potential implications regarding job satisfaction and retention. In addition, the knowledge and skills required to fulfil this role are evolving and therefore may have recruitment and training implications.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027037","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":"Is NICE failing to prioritise environmentally sustainable health care?","authors":"Emma Radcliffe, Sophie von Heimendahl","doi":"10.3399/bjgp25X741453","DOIUrl":"https://doi.org/10.3399/bjgp25X741453","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"219"},"PeriodicalIF":5.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040349/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144063306","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":"Globus: a practical guide for general practice.","authors":"Alex Watson, Rakesh Chopra, Anand Muddaiah","doi":"10.3399/bjgp25X741573","DOIUrl":"https://doi.org/10.3399/bjgp25X741573","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"237-238"},"PeriodicalIF":5.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040374/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043317","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":"Books: <i>GPs, Politics and Medical Professional Protest in Britain, 1880-1948</i>: A history of GPs' concerns about workload, funding, and threats to independence.","authors":"Richard Vautrey","doi":"10.3399/bjgp25X741513","DOIUrl":"https://doi.org/10.3399/bjgp25X741513","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"226-227"},"PeriodicalIF":5.3,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040356/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059218","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}