British Journal of General Practice最新文献

{"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":5.2,"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":"Antidepressants and risk of postural hypotension: a self-controlled case series study in UK primary care.","authors":"Cini Bhanu, Kate Walters, Mine Orlu, Daniel Davis, Reecha Sofat, Irene Petersen","doi":"10.3399/BJGP.2024.0429","DOIUrl":"10.3399/BJGP.2024.0429","url":null,"abstract":"<p><strong>Background: </strong>Antidepressants are associated with postural hypotension (PH), but it is not typically recognised as a common adverse effect. PH is linked with serious complications in older adults, for example, falls, stroke, and cognitive decline. Randomised controlled trials (RCTs) examining antidepressants often exclude older people and do not focus on adverse effects.</p><p><strong>Aim: </strong>To examine the risk of PH associated with antidepressant use in adults aged ≥60 years in UK primary care.</p><p><strong>Design and setting: </strong>A self-controlled case series using routinely collected primary care data from the IQVIA Medical Research Database (IMRD) from 1 January 2000 to 31 December 2018.</p><p><strong>Method: </strong>Data from >41 000 adults aged ≥60 years in IMRD between 1 January 2000 to 31 December 2018 were obtained. Antidepressant prescriptions were determined using code lists based on British National Formulary classification. Risk of PH was examined during four exposure risk periods (90-days pre-prescription; day 1-28; 29-56; and ≥57) compared with periods outside these risk windows.</p><p><strong>Results: </strong>Among 41 005 people with incident PH in the study period, 8899 (22%) were prescribed a selective serotonin reuptake inhibitor (SSRI); 8313 (20%) were prescribed a tricyclic antidepressant (TCA); and 4656 (11%) were prescribed an 'other antidepressant'. The authors observed a consistent increased risk of PH in day 1-28 in <i>all</i> antidepressant exposure, which reduced thereafter. Risk of PH was highest with SSRIs (incidence rate ratio [IRR] 4.22, 95% confidence interval [CI] = 3.76 to 4.74), followed by 'other antidepressants' (IRR 2.17, 95% CI = 1.76 to 2.68), and then TCAs (IRR 2.12, 95% CI = 1.79 to 2.50). Risk of PH reduced from day ≥28 for all antidepressants.</p><p><strong>Conclusion: </strong>A statistically substantial increased risk of PH was observed with all antidepressants in the first month, particularly SSRIs. Prescribers should be aware of this risk and may consider monitoring PH when initiating antidepressants in older adults.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e484-e490"},"PeriodicalIF":5.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117504/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016761","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":"Potential interactions between direct oral anticoagulants and atorvastatin/simvastatin: a cohort and case-crossover study.","authors":"Angel Ys Wong, Charlotte Warren-Gash, Krishnan Bhaskaran, Clémence Leyrat, Amitava Banerjee, Liam Smeeth, Ian J Douglas","doi":"10.3399/BJGP.2024.0349","DOIUrl":"10.3399/BJGP.2024.0349","url":null,"abstract":"<p><strong>Background: </strong>Direct oral anticoagulants (DOACs) are commonly co-prescribed with statins. Although biologically plausible, whether there is a drug interaction between DOACs and atorvastatin/simvastatin is unclear.</p><p><strong>Aim: </strong>To investigate the association between co-prescribed DOACs and atorvastatin/simvastatin and bleeding, cardiovascular disease, and mortality.</p><p><strong>Design and setting: </strong>Cohort and case-crossover study using data from English general practices in the Clinical Practice Research Datalink Aurum from 1 January 2011 to 31 December 2019.</p><p><strong>Method: </strong>A cohort design was used to estimate hazard ratios for clinically relevant pharmacological interaction safety outcomes (intracranial bleeding, gastrointestinal bleeding, and other bleeding) comparing DOACs and atorvastatin/simvastatin with DOACs and other statins (fluvastatin, pravastatin, and rosuvastatin that are not anticipated to interact with DOACs). Effectiveness outcomes (ischaemic stroke, myocardial infarction, venous thromboembolism, cardiovascular mortality, and all-cause mortality) were also included. In addition, a case-crossover design was used to compare the odds of exposure to different drug initiation patterns in the hazard window versus the referent window within an individual.</p><p><strong>Results: </strong>Of 397 459 patients who were prescribed DOACs, 70 318 people co-prescribed atorvastatin and 38 724 co-prescribed simvastatin were selected. The cohort analysis showed no difference in risk of all outcomes comparing patients prescribed DOACs and atorvastatin/simvastatin versus those prescribed DOACs and other statins. In the case-crossover analysis, odds ratios (ORs) for other bleeding (OR 5.06, 99% confidence interval [CI] = 3.79 to 6.76) among those initiating DOACs while taking atorvastatin and the ORs for gastrointestinal bleeding (OR 6.05, 99% CI = 4.28 to 8.54) and other bleeding (OR 6.81, 99% CI = 4.74 to 9.78) among those initiating DOACs while taking simvastatin were greater than those initiating DOAC monotherapy. Similar patterns were also observed for cardiovascular mortality and all-cause mortality.</p><p><strong>Conclusion: </strong>This study shows no evidence of interaction between DOACs and atorvastatin/simvastatin. However, people starting a DOAC while taking atorvastatin/simvastatin were at high risk of bleeding and mortality, likely because of temporal clinical vulnerability.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e466-e473"},"PeriodicalIF":5.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12117505/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142752165","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":"Development and internal validation of a diagnostic prediction model for life-threatening events in callers with shortness of breath: a cross-sectional study in out-of-hours primary care.","authors":"Michelle Spek, Roderick P Venekamp, Anne Ah de Hond, Esther de Groot, Geert-Jan Geersing, Anna Sm Dobbe, Mathé Delissen, Frans H Rutten, Maarten van Smeden, Dorien L Zwart","doi":"10.3399/BJGP.2024.0538","DOIUrl":"10.3399/BJGP.2024.0538","url":null,"abstract":"<p><strong>Background: </strong>Shortness of breath often prompts calls to out-of-hours primary care and is the prime reason for home visits by GPs. However, a diagnostic prediction model in this setting is lacking.</p><p><strong>Aim: </strong>To develop and internally validate a model predicting life-threatening events for out-of-hours primary care callers with shortness of breath.</p><p><strong>Design and setting: </strong>This cross-sectional study includes data from 1952 patients with shortness of breath who called Dutch out-of-hours primary care between September 2020 and August 2021. The trial was registered with the Netherlands Trial Register, number: NL9682.</p><p><strong>Method: </strong>Four logistic regression models were developed with life-threatening events as the outcome. The first model included age and gender (model 1) and then, successively, call characteristics (calling at night and someone else calling on behalf of the patient; model 2), symptoms (cough, fever, inability to speak full sentences and wheezing; model 3), and medical history and medication use (cardiovascular and/or pulmonary; model 4) were added. The models were internally validated using optimism correction via bootstrap with 1000 repetitions. Performance measures of discrimination (c-statistic) and calibration (calibration intercept and slope) were determined.</p><p><strong>Results: </strong>Approximately 17% (329/1952) of callers with shortness of breath had a life-threatening event. Model 3 performed best. This model exhibited good discriminative ability (internal validation c-statistic of 0.76, 95% confidence interval = 0.74 to 0.79) and was well calibrated. All models had a high net benefit compared with using no model. Models 3 and 4 had a higher net benefit compared with models 1 and 2. As models 3 and 4 were similar in terms of net benefit, the model with fewer parameters (model 3) is preferred.</p><p><strong>Conclusion: </strong>A prediction model consisting of age, gender, call characteristics, and symptoms holds promise for improving telephone triage of callers to out-of-hours primary care with shortness of breath. However, as the study period coincided with the COVID-19 pandemic, temporal validation is necessary before widespread implementation.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e500-e508"},"PeriodicalIF":5.2,"publicationDate":"2025-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12070295/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143016838","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":"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":5.2,"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":"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":5.2,"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":"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":5.2,"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":"Low-dose amitriptyline for irritable bowel syndrome: a qualitative study of patients' and GPs' views and experiences.","authors":"Emma J Teasdale, Hazel A Everitt, Sarah L Alderson, Alexander C Ford, James Hanney, Matthew Chaddock, Emmajane Williamson, Heather Cook, Amanda J Farrin, Catherine Fernandez, Elspeth A Guthrie, Suzanne Hartley, Amy Herbert, Daniel Howdon, Delia Muir, Sonia Newman, Pei Loo Ow, Matthew J Ridd, Christopher M Taylor, Ruth Thornton, Alexandra Wright-Hughes, Felicity L Bishop","doi":"10.3399/BJGP.2024.0303","DOIUrl":"10.3399/BJGP.2024.0303","url":null,"abstract":"<p><strong>Background: </strong>Irritable bowel syndrome (IBS) can cause troublesome symptoms, which impact patients' quality of life and incur considerable health service resource use. Guidelines suggest low-dose amitriptyline for IBS as second-line treatment, but this is rarely prescribed in primary care.</p><p><strong>Aim: </strong>To explore patients' and GPs' views and experiences of using low-dose amitriptyline for IBS.</p><p><strong>Design and setting: </strong>Qualitative interview study with patients and GPs in England, nested within the ATLANTIS trial of low-dose amitriptyline versus placebo (ISRCTN48075063).</p><p><strong>Method: </strong>Semi-structured telephone interviews were conducted with 42 patients at 6 months post-randomisation, with 19 patients again at 12 months post-randomisation, and with 16 GPs between April 2020 and March 2022. Reflexive thematic analysis was used to analyse patient and GP data separately, then together, to identify unique and cross-cutting themes.</p><p><strong>Results: </strong>We found concerns about amitriptyline being an antidepressant, medicalising IBS, and side effects. Perceived benefits included the low and flexible dose, ease of treatment, and familiarity of amitriptyline and its potential to offer benefits beyond IBS symptom relief. These concerns and perceived benefits were expressed in the context of desire for a novel approach to IBS: GPs were keen to offer more options for IBS and patients sought a cure for their symptoms.</p><p><strong>Conclusion: </strong>Patients and GPs felt that the potential benefits of trying low-dose amitriptyline for IBS outweighed their concerns. When offering low-dose amitriptyline for IBS, GPs could address patient concerns about taking an antidepressant for IBS, highlighting the low and flexible dosage, and other potential benefits of amitriptyline such as improved sleep.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e431-e439"},"PeriodicalIF":5.2,"publicationDate":"2025-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920899/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082670","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":5.2,"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}