British Journal of General Practice最新文献

{"title":"Alpha-gal syndrome in general practice: red meat food allergy caused by UK ticks.","authors":"James Dm Douglas, Elizabeth Furrie, Simon Jones","doi":"10.3399/bjgp25X741309","DOIUrl":"10.3399/bjgp25X741309","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 753","pages":"186-188"},"PeriodicalIF":5.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961194/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733356","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":"Implementing in-vitro diagnostic point-of-care tests in community health care: how can we make this work?","authors":"Philip J Turner, Umasha Ukwatte, Ian Smith, Tim James, Paul Stephenson, Sarah Tonkin-Crine, Margaret Głogowska, Gail N Hayward","doi":"10.3399/bjgp25X741153","DOIUrl":"10.3399/bjgp25X741153","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 753","pages":"182-185"},"PeriodicalIF":5.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961181/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733365","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":"Resisting in the liminal space.","authors":"Euan Lawson","doi":"10.3399/bjgp25X741057","DOIUrl":"10.3399/bjgp25X741057","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 753","pages":"147"},"PeriodicalIF":5.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961165/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733370","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":"Discussions about physical activity in general practice: analysis of video-recorded consultations.","authors":"Adam Grice, Amy S Izon, Nada F Khan, Robbie Foy, Rebecca J Beeken, Suzanne H Richards","doi":"10.3399/BJGP.2024.0166","DOIUrl":"10.3399/BJGP.2024.0166","url":null,"abstract":"<p><strong>Background: </strong>Clinical guidance recommends promoting physical activity during general practice consultations. The frequency and content of physical activity discussions in UK general practice are poorly understood.</p><p><strong>Aim: </strong>To explore the content of physical activity discussions during routine consultations between patients and GPs.</p><p><strong>Design and setting: </strong>Secondary analysis was undertaken of video-recorded UK general practice consultations from the One in a Million study, which was conducted in the West of England.</p><p><strong>Method: </strong>In total, 294 consultation transcripts were available; these were screened to identify consultations that included or omitted physical activity advice when recommended by National Institute for Health and Care Excellence guidance. The content, quality, and depth of advice provided by GPs were scored to ascertain how meaningful the advice was.</p><p><strong>Results: </strong>Physical activity was relevant to management according to clinical guidance in 175/294 (59.5%) consultations. In 64 (36.6%) of these consultations, physical activity was discussed as part of clinical management; the depth of discussion was judged as 'meaningful' in 22 (12.6%) consultations. Although physical activity advice tended to be given most often for musculoskeletal problems, depth of advice did not appear to be related to the presenting problem. When physical activity advice was relevant and omitted, consultations prioritised another overriding presenting problem, or clinical management focused on another intervention.</p><p><strong>Conclusion: </strong>Physical activity advice, following national guidance, was potentially relevant to more than half of GP consultations; GPs delivered advice of varying depth in a third of these consultations. Future work should explore ways of delivering physical activity advice effectively, efficiently, and equitably within the constraints of general practice.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e277-e284"},"PeriodicalIF":5.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849690/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142082669","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":"Fixing our broken food health system.","authors":"Nada Khan","doi":"10.3399/bjgp25X741237","DOIUrl":"10.3399/bjgp25X741237","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 753","pages":"176-177"},"PeriodicalIF":5.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961191/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733362","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":"The familiar and strange art of diagnosis.","authors":"Andrew Papanikitas","doi":"10.3399/bjgp25X741165","DOIUrl":"10.3399/bjgp25X741165","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 753","pages":"167"},"PeriodicalIF":5.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961175/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733373","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 chest X-ray rate is associated with earlier lung cancer diagnosis and reduced all-cause mortality: a retrospective observational study.","authors":"Stephen H Bradley, Richard D Neal, Matthew Ej Callister, Benjamin Cornwell, William T Hamilton, Gary A Abel, Bethany Shinkins, Richard B Hubbard, Matthew E Barclay","doi":"10.3399/BJGP.2024.0466","DOIUrl":"10.3399/BJGP.2024.0466","url":null,"abstract":"<p><strong>Background: </strong>Evidence is equivocal on whether general practice rates of investigation in symptomatic patients using chest X-ray (CXR) affect outcomes.</p><p><strong>Aim: </strong>To determine whether there is an association between rates of CXR requested in general practice and lung cancer outcomes.</p><p><strong>Design and setting: </strong>Observational study using data on English general practices.</p><p><strong>Method: </strong>Cancer registry data for patients diagnosed with lung cancer in 2014-2018 were linked to data on general practice CXRs from 2013 until 2017. Cancer stage at diagnosis (I/II versus III/IV) and 1-year and 5-year survival rates (conditional on survival to 1 year) post-diagnosis were reported by general practice quintile of CXR rate, with adjustment for population differences (age, smoking, prevalence of chronic obstructive pulmonary disease and heart failure, ethnicity, and deprivation) and by unadjusted category (low, medium, and high).</p><p><strong>Results: </strong>In total, 192 631 patient records and CXR rates for 7409 practices were obtained. Practices in the highest quintile of CXR rate had fewer cancers diagnosed at stage III/IV compared with those in the lowest quintile (odds ratio [OR] 0.87, 95% confidence interval [CI] = 0.83 to 0.92, <i>P</i><0.001). The association was weaker for the high unadjusted CXR category (OR 0.94, 95% CI = 0.91 to 0.97). For the highest adjusted quintile, hazard ratios (HRs) for death within 1 year and 5 years were 0.92 (95% CI = 0.90 to 0.95, <i>P</i><0.001) and 0.95 (95% CI = 0.91 to 0.99, <i>P</i> = 0.023), respectively. For the high unadjusted CXR category, the HR for 1-year survival was 0.98 (95% CI = 0.96 to 0.99, <i>P</i> = 0.004), with no association demonstrated for 5-year survival.</p><p><strong>Conclusion: </strong>Patients registered at general practices with higher CXR use have a favourable stage distribution and slightly better survival. This supports the use of CXR in promoting earlier diagnosis of symptomatic lung cancer in general practice.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966530/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911214","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":"Understanding ethnic inequalities in cancer diagnostic intervals: a cohort study of patients presenting suspected cancer symptoms to GPs in England.","authors":"Tanimola Martins, Liz Down, Alfred Samuels, Deepthi Lavu, William Hamilton, Gary Abel, Richard D Neal","doi":"10.3399/BJGP.2024.0518","DOIUrl":"10.3399/BJGP.2024.0518","url":null,"abstract":"<p><strong>Background: </strong>UK Asian and Black patients experience longer cancer diagnostic intervals - the period between initial symptomatic presentation in primary care and cancer diagnosis.</p><p><strong>Aim: </strong>To determine whether the differences in diagnostic intervals are because of prolonged primary care, referral, or secondary care interval.</p><p><strong>Design and setting: </strong>A cohort study was undertaken of 70 971 patients with seven cancers (breast, lung, prostate, colorectal, oesophagogastric, myeloma, ovarian) diagnosed after symptom presentation in English primary care.</p><p><strong>Method: </strong>Data on symptom presentation and diagnosis were extracted from cancer registry-linked primary care and secondary care data. Primary interval was defined as the period between first primary care presentation and secondary care referral, referral interval as the period between referral and first secondary care appointment, and secondary care interval as the period between the first secondary care appointment and diagnosis. Accelerated failure time models were used to investigate ethnic differences across all four intervals.</p><p><strong>Results: </strong>Across all sites, the median diagnostic interval was 46 days, ranging from 13 days for breast cancer to 116 days for lung cancer. It was 14% longer for Black patients (adjusted time ratio [ATR] 1.14, 95% confidence interval [CI] = 1.05 to 1.25) and 13% longer for Asian patients (ATR 1.13, 95% CI = 1.03 to 1.23) compared with White patients. Site-specific analyses showed that, for myeloma, lung, prostate, and colorectal cancer, the secondary care interval was longer in Asian and Black patients, who also had a longer primary care interval in breast and colorectal cancer. There was little evidence of ethnic differences in referral interval.</p><p><strong>Conclusion: </strong>This study found evidence of ethnic differences in diagnostic intervals, with prolonged secondary care intervals for four common cancers and prolonged primary care intervals for two. Although these differences are relatively modest, they are unjustified and may indicate shortcomings in healthcare delivery that disproportionately affect ethnic minorities.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966531/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142848507","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":"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":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-24","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":"Relationship between the volume and type of appointments in general practice and patient experience: an observational study in England.","authors":"Patrick Burch, William Whittaker, Yiu-Shing Lau","doi":"10.3399/BJGP.2024.0276","DOIUrl":"10.3399/BJGP.2024.0276","url":null,"abstract":"<p><strong>Background: </strong>Patient satisfaction is a significant dimension of quality in general practice and has notably declined post-COVID. Understanding the dynamics between practice activities, practice characteristics, and patient experience is vital for improving care quality.</p><p><strong>Aim: </strong>To investigate the relationship between the volume, modality (telephone or face to face), and practitioner type of general practice appointments and patient experience.</p><p><strong>Design and setting: </strong>This was an observational study of general practices in England.</p><p><strong>Method: </strong>Data from the GP Patient Survey (GPPS) were merged with NHS England's practice-level appointment data, covering August 2022 to March 2023. Ordinary least squares regressions were estimated of patient satisfaction with access, general satisfaction, preference for a specific GP, and support for managing long-term conditions (dependent variables) against appointment volume, modality (telephone or face to face), and practitioner type.</p><p><strong>Results: </strong>Analysis of 5278 practices showed that a higher volume of appointments, especially face to face with GPs, was significantly (<i>P</i><0.001) associated with increased patient satisfaction. Practices having a greater proportion of same-day appointments was significantly correlated with lower patient satisfaction.</p><p><strong>Conclusion: </strong>Patient satisfaction and ability to have health needs met is associated with face-to-face access to GPs as well as the total volume of appointments available. The results suggest that patients' perceptions of access involve more than immediate availability of appointments or that patients may struggle to get appointments at practices offering more same-day appointments. Initiatives to improve access to, and satisfaction with, general practice should prioritise expanding face-to-face GP appointments.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11966529/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142513385","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}