British Journal of General Practice最新文献

{"title":"Are good GPs holistic?","authors":"Andrew Papanikitas","doi":"10.3399/bjgp24X739749","DOIUrl":"10.3399/bjgp24X739749","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"74 748","pages":"503"},"PeriodicalIF":5.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526743/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559522","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>The Story of a Heart</i>: Two remarkable families.","authors":"Trisha Greenhalgh","doi":"10.3399/bjgp24X739857","DOIUrl":"10.3399/bjgp24X739857","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"74 748","pages":"514"},"PeriodicalIF":5.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526750/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559524","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":"Do I know you? (well enough to complete your multisource feedback … ).","authors":"Paula Wright","doi":"10.3399/bjgp24X739821","DOIUrl":"10.3399/bjgp24X739821","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"74 748","pages":"510-511"},"PeriodicalIF":5.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526755/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559530","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":"General practice should tackle healthcare inequalities but not health inequalities.","authors":"Dipesh Gopal","doi":"10.3399/bjgp24X739833","DOIUrl":"10.3399/bjgp24X739833","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"74 748","pages":"512"},"PeriodicalIF":5.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559531","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":"Collaborative discussions between GPs and pharmacists to optimise patient medication: a qualitative study within a UK primary care clinical trial.","authors":"Roxanne M Parslow, Lorna J Duncan, Barbara Caddick, Carolyn A Chew-Graham, Katrina Turner, Rupert A Payne, Cindy Man, Bruce Guthrie, Peter S Blair, Deborah McCahon","doi":"10.3399/BJGP.2024.0190","DOIUrl":"10.3399/BJGP.2024.0190","url":null,"abstract":"<p><strong>Background: </strong>There has been significant investment in pharmacists working in UK general practice to improve the effective and safe use of medicines. However, evidence of how to optimise collaboration between GPs and pharmacists in the context of polypharmacy (multiple medication) is lacking.</p><p><strong>Aim: </strong>To explore GP and pharmacist views and experiences of in-person, interprofessional collaborative discussions (IPCDs) as part of a complex intervention to optimise medication use for patients with polypharmacy in general practice.</p><p><strong>Design and setting: </strong>A mixed-method process evaluation embedded within the Improving Medicines use in People with Polypharmacy in Primary Care (IMPPP) trial conducted in Bristol and the West Midlands, between February 2021 and September 2023.</p><p><strong>Method: </strong>Audio-recordings of IPCDs between GPs and pharmacists, along with individual semi-structured interviews to explore their reflections on these discussions, were used. All recordings were transcribed verbatim and analysed thematically.</p><p><strong>Results: </strong>A total of 14 practices took part in the process evaluation from February 2022 to September 2023; 17 IPCD meetings were audio-recorded, discussing 30 patients (range 1-6 patients per meeting). In all, six GPs and 13 pharmacists were interviewed. The IPCD was highly valued by GPs and pharmacists who described benefits, including: strengthening their working relationship; gaining in confidence to manage more complex patients; and learning from each other. It was often challenging, however, to find time for the IPCDs.</p><p><strong>Conclusion: </strong>The model of IPCD used in this study provided protected time for GPs and pharmacists to work together to deliver whole-patient care, with both professions finding this beneficial. Protected time for interprofessional liaison and collaboration, and structured interventions may facilitate improved patient care.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e727-e734"},"PeriodicalIF":5.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11466292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141478035","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":"Weight management with orlistat in type 2 diabetes: an electronic health records study.","authors":"Shraboni Ghosal, Neil Heron, Kayleigh J Mason, James Bailey, Kelvin P Jordan","doi":"10.3399/BJGP.2023.0684","DOIUrl":"10.3399/BJGP.2023.0684","url":null,"abstract":"<p><strong>Background: </strong>Orlistat is recommended as an adjunct to diet and exercise for weight loss in the treatment of type 2 diabetes mellitus (T2DM).</p><p><strong>Aim: </strong>To explore associations between patient characteristics and orlistat prescribing, and to determine associations of orlistat with weight loss in T2DM and prediabetes.</p><p><strong>Design and setting: </strong>Cohort study using anonymised health records from a UK database of general practice.</p><p><strong>Method: </strong>The UK Clinical Practice Research Datalink (CPRD) Aurum database was searched to compile a cohort of patients aged ≥18 years, first diagnosed with T2DM or prediabetes in 2016 or 2017. Once the data had been collated, multivariable logistic regression models were used to determine associations with starting orlistat and stopping it early (<12 weeks of prescriptions) and orlistat's associations with weight loss in those who had not been prescribed second-line antidiabetic medications.</p><p><strong>Results: </strong>Out of 100 552 patients with incident T2DM or prediabetes, 655 (0.8%) patients with T2DM and 128 (0.7%) patients with prediabetes were prescribed orlistat. Younger people, females, those in areas of deprivation, current smokers, those coprescribed metformin, and those recorded as having hypertension were statistically significantly more likely to be prescribed orlistat; higher baseline glycated haemoglobin levels were associated with early stopping. In comparison with patients not on orlistat, those who continued using it for ≥12 weeks were more likely to lose ≥5% weight (adjusted odds ratio [AOR] 1.69, 95% confidence interval [CI] = 1.07 to 2.67) but those who stopped orlistat early were less likely to lose ≥5% weight (AOR 0.56, 95% CI = 0.29 to 1.09).</p><p><strong>Conclusion: </strong>Orlistat was significantly associated with weight loss in patients with T2DM and prediabetes when taken for at least 12 weeks; however, it was infrequently prescribed and often taken for <12 weeks. Orlistat may be a useful adjunct to lifestyle modifications for patients with T2DM and prediabetes, but barriers to continued use means it may not be effective for everyone in managing weight loss.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"758-766"},"PeriodicalIF":5.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11423350/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140857013","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":"Support for primary care prescribing for adult ADHD in England: national survey.","authors":"Anna Price, Kieran Becker, John H Ward, Obioha C Ukoumunne, Rebecca Gudka, Anita Salimi, Faraz Mughal, G J Melendez-Torres, Jane R Smith, Tamsin Newlove-Delgado","doi":"10.3399/BJGP.2023.0595","DOIUrl":"10.3399/BJGP.2023.0595","url":null,"abstract":"<p><strong>Background: </strong>Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder, for which there are effective pharmacological treatments that improve symptoms and reduce complications. Guidelines published by the National Institute for Health and Care Excellence recommend that primary care practitioners prescribe medication for adult ADHD under shared-care agreements with Adult Mental Health Services (AMHS). However, provision remains uneven, with some practitioners reporting a lack of support.</p><p><strong>Aim: </strong>This study aimed to describe elements of support, and their availability/use, in primary care prescribing for adult ADHD medication in England to improve access for this underserved population and inform service improvement.</p><p><strong>Design and setting: </strong>Cross-sectional surveys were used to elicit data from commissioners, health professionals (HPs), and people with lived experience of ADHD (LE) across England about elements supporting pharmacological treatment of ADHD in primary care.</p><p><strong>Method: </strong>Three interlinked cross-sectional surveys were used to ask every integrated care board in England (commissioners), along with convenience samples of HPs and LEs, about prescribing rates, AMHS availability, wait times, and shared-care agreement protocols/policies for the pharmacological treatment of ADHD in primary care. Descriptive analyses, percentages, and confidence intervals were used to summarise responses by stakeholder group. Variations in reported provision and practice were explored and displayed visually using mapping software.</p><p><strong>Results: </strong>Data from 782 responders (42 commissioners, 331 HPs, 409 LEs) revealed differences in reported provision by stakeholder group, including for prescribing (95% of HPs versus 64% of LEs). In all, >40% of responders reported extended AMHS wait times of ≥2 years. There was some variability by NHS region - for example, London had the lowest reported extended wait time (25%), while East of England had the highest (55%).</p><p><strong>Conclusion: </strong>Elements supporting appropriate shared-care prescribing of ADHD medication via primary care are not universally available in England. Coordinated approaches are needed to address these gaps.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e777-e783"},"PeriodicalIF":5.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11388088/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140871305","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":"Information needs for GPs on type 2 diabetes in Western countries: a systematic review.","authors":"Tue Helms Andersen, Thomas Møller Marcussen, Ole Nørgaard","doi":"10.3399/BJGP.2023.0531","DOIUrl":"10.3399/BJGP.2023.0531","url":null,"abstract":"<p><strong>Background: </strong>Most people with type 2 diabetes receive treatment in primary care by GPs who are not specialised in diabetes. Thus, it is important to uncover the most essential information needs regarding type 2 diabetes in general practice.</p><p><strong>Aim: </strong>To identify information needs related to type 2 diabetes for GPs.</p><p><strong>Design and setting: </strong>Systematic review focused on literature relating to Western countries.</p><p><strong>Method: </strong>MEDLINE, Embase, PsycInfo and CINAHL were searched from inception to January 2024. Two researchers conducted the selection process, and citation searches were performed to identify any relevant articles missed by the database search. Quality appraisal was conducted with the Mixed Methods Appraisal Tool. Meaning units were coded individually, grouped into categories, and then studies were summarised within the context of these categories using narrative synthesis. An evidence map was created to highlight research gaps.</p><p><strong>Results: </strong>Thirty-nine included studies revealed eight main categories and 36 subcategories of information needs. Categories were organised into a comprehensive hierarchical model of information needs, suggesting 'Knowledge of guidelines' and 'Reasons for referral' as general information needs alongside more specific needs on 'Medication', 'Management', 'Complications', 'Diagnosis', 'Risk factors', and 'Screening for diabetes'. The evidence map provides readers with the opportunity to explore the characteristics of the included studies in detail.</p><p><strong>Conclusion: </strong>This systematic review provides GPs, policymakers, and researchers with a hierarchical model of information and educational needs for GPs, and an evidence map showing gaps in the current literature. Information needs about clinical guidelines and reasons for referral to specialised care overlapped with needs for more specific information.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e749-e757"},"PeriodicalIF":5.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11388096/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140013731","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":"Medicines prescribed elsewhere: don't forget to record them in the GP record!","authors":"Richard Armitage","doi":"10.3399/bjgp24X739761","DOIUrl":"10.3399/bjgp24X739761","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"74 748","pages":"504"},"PeriodicalIF":5.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559533","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":"Propranolol in anxiety: poor evidence for efficacy and toxicity in overdose.","authors":"Roselle Phelan, Ash Cottrell, Siobhan Gee, Larry Rifkin","doi":"10.3399/bjgp24X739881","DOIUrl":"10.3399/bjgp24X739881","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"74 748","pages":"516-519"},"PeriodicalIF":5.3,"publicationDate":"2024-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11526748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142559535","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}