British Journal of General Practice最新文献

{"title":"What do patients want from access to UK general practice?","authors":"Helen Atherton, Helen Leach, Rob Mortell, Joanne Parsons","doi":"10.3399/BJGP.2024.0582","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0582","url":null,"abstract":"<p><strong>Background: </strong>Access to general practice is a topical concern, with rising numbers of consultations and decreasing numbers of general practitioners placing strain on the service. Patient satisfaction with general practice has seen a reduction in the UK. We sought to summarise the existing evidence about what patients want in relation to accessing general practice, to determine what is important to patients.</p><p><strong>Aim: </strong>To examine what patients want from access to contemporary general practice in the UK.</p><p><strong>Design and setting: </strong>Systematic review set in UK general practice.</p><p><strong>Method: </strong>We included studies that reported patient wants in relation to access to general practice in the UK since 2010. All empirical study designs were included, both quantitative and qualitative. The mixed methods appraisal tool was used to assess study quality for contextual purposes. Narrative synthesis was applied to the included studies, with results presented using tables and text.</p><p><strong>Results: </strong>We included 33 studies. The review showed that patients wanted information about how to access the general practice, choice of clinician, choice of healthcare professional type and choice of consultation mode. Patients wanted a nearby practice, with clean waiting rooms, easy appointment booking using simple systems and with short waiting times and to be kept informed about the process.</p><p><strong>Conclusion: </strong>The factors that patients want should be taken into consideration when changing or developing approaches to access. Future evaluations of care, and research, should explicitly consider what patients want from access in general practice.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143665420","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"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":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-11","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":"Supporting patients to use online services in general practice: focused ethnographic case study.","authors":"Jennifer Newbould, Carol Bryce, Stephanie Stockwell, Bethan Treadgold, John Campbell, Christine Marriott, Emma Pitchforth, Laura Sheard, Rachel Winder, Helen Atherton","doi":"10.3399/BJGP.2024.0137","DOIUrl":"10.3399/BJGP.2024.0137","url":null,"abstract":"<p><strong>Background: </strong>In England online services in general practice encompass a range of provision from ordering repeat medication to having a consultation. Some groups of individuals may find accessing and/or using such services difficult and may require 'digital facilitation', that is the range of processes, procedures, and personnel which seeks to support NHS patients in their uptake and use of online services.</p><p><strong>Aim: </strong>To gain insight, from the perspective of general practice staff and patients/carers, into how and why digital facilitation might lead to benefits, and the key processes involved in supporting patients to use online services.</p><p><strong>Design and setting: </strong>Eight general practices across England with varied geographical and sociodemographic characteristics were included in the study.</p><p><strong>Method: </strong>This was a focused ethnographic case study of observations and interviews (<i>N</i> = 69).</p><p><strong>Results: </strong>Typically, digital facilitation was delivered in an <i>ad hoc</i> fashion to individual patients. Online services were delivered via multiple systems each working differently and creating a need for support so that patients could access them. Younger practice staff were expected to deliver support on account of their age, despite there being no evidence of age-related training and experience. It was understood by practice staff that patients with challenging personal circumstances may require specific support to access online services.</p><p><strong>Conclusion: </strong>At present patient use of online services is supported by digital facilitation that is primarily delivered by reception staff. Supporting patients to use online services requires review of how many services are provided and what for, and consideration for the time and effort needed to support patients to use them.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920896/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142689779","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":"Artificial Intelligence for early detection of lung cancer in General Practitioners' clinical notes.","authors":"Martijn C Schut, Torec T Luik, Iacopo Vagliano, Miguel A Rios Gaona, Charles W Helsper, Kristel M van Asselt, Niek de Wit, Ameen Abu-Hanna, Henk van Weert","doi":"10.3399/BJGP.2023.0489","DOIUrl":"https://doi.org/10.3399/BJGP.2023.0489","url":null,"abstract":"<p><strong>Background: </strong>The journey of more than 80% of patients diagnosed with lung cancer starts in general practice. About 75% of patients are diagnosed in an advanced stage (3 or 4), leading to more than 80% mortality within one year at present. The long-term data in general practitioners' records might contain hidden information that could be used for earlier case-finding of patients with cancer.</p><p><strong>Aim: </strong>To develop new prediction tools that improve the risk assessment for cancer.</p><p><strong>Design and setting: </strong> Text analysis of electronic patient data using natural language processing and machine learning in general practice files of four networks in the Netherlands.</p><p><strong>Method: </strong>Files of 525,526 patients were analysed, of whom 2386 were diagnosed with lung cancer. Diagnoses were validated in the Dutch Cancer registration, and structured and free text data were used to predict diagnosis of lung cancer five months before diagnosis (four months before referral).</p><p><strong>Results: </strong>Our algorithm could facilitate earlier detection of lung cancer using routine general practice data. We established discrimination, calibration, sensitivity, and specificity under various cut-off points of the prediction five months before diagnosis. Internal validation demonstrated an area under the curve of 0.90 (CI 95%: 0.90-0.93), and 0.84 (CI: 0.83-0.85) during external validation. The desired sensitivity determines the number of patients to be referred to detect one patient with lung cancer.</p><p><strong>Conclusion: </strong> AI-based support enables earlier detection of lung cancer in general practice using readily available text in the patient files of general practitioners, but needs additional prospective clinical evaluation.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569006","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":"Patterns in GP Appointment Systems: a cluster analysis of 3480 English practices.","authors":"James Scuffell, Stevo Durbaba, Mark Ashworth","doi":"10.3399/BJGP.2024.0556","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0556","url":null,"abstract":"<p><p>Background In response to increasing demand for appointments, UK general practices have adopted a range of appointment systems. These systems vary widely in implementation. These changes have not yet been clearly described. Aim Characterise patterns of primary care delivery in English general practices. Design and Setting Cross-sectional study using NHS Appointments in General Practice data from 3480 English GP practices, totalling 56 million appointments between August and October 2023. Method We derived 12 measures associated with consultation modality, waiting time, clinician type and triage use. Practices with similar characteristics of those 12 variables were clustered together using an ensemble machine learning approach. Clustering was validated using December 2023 data. The characteristics of each practice grouping were described using 2021 Census and NHS workforce data. Results Two main models of care emerged. 'Routine care' practices (n=2286) tended towards face-to-face appointments, often delivered by non-GPs with longer wait times. 'Same day care' (n=1194) practices, a third of practices, were more likely to use telephone consultations, deliver care with GPs, and provide same day appointments. Compared to 'Routine care' practices, 'Same day care' practices were more likely to be in urban areas, had younger populations (mean age 40 vs 41 years) and employed fewer patient-facing staff (2.0 vs 2.5 full time equivalents per 10,000 patients registered). Conclusion This study identified two dominant models of primary care delivery in England, reflecting differing approaches to managing patient access. These differences could have an impact on continuity of care and equity of access to primary care.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Qualitative assessment of physicians' appraisal of parental concerns.","authors":"Laura Cuypers, Cato Dessers, Birgitte Schoenmakers, Jaan Toelen","doi":"10.3399/BJGP.2024.0554","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0554","url":null,"abstract":"<p><strong>Background: </strong>In clinical encounters with children and their parents, physicians rely on both analytical and non-analytical factors to assess the clinical problem. Research on clinical gut feeling has recognized this as a significant diagnostic factor, yet little is known about how physicians evaluate parental concerns.</p><p><strong>Aim: </strong>To investigate which parent- and physician-related factors influence a physician's assessment of parental concerns.</p><p><strong>Design and setting: </strong>Qualitative semi-structured focus group interviews were conducted with 15 general practitioners and 15 paediatricians in Belgium between May and August 2022.</p><p><strong>Method: </strong>Nine semi-structured focus group interviews were independently coded and analyzed thematically using the constant comparative analysis method.</p><p><strong>Results: </strong>The factors that physicians use to assess parental concerns can be categorized into four groups: parent-related, physician-related, context-related, and child-related factors. Within each category, there are multiple determinants, with the most influential being: having multiple children as a parent, the physician's work experience, and disease severity.</p><p><strong>Conclusion: </strong>This study confirms some determining factors that have already been described in the literature, but it also identifies new determinants (e.g., having multiple children as a parent and physician fatigue). Quantitative research could assess the extent to which the identified factors are involved in the assessment of gut feeling.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569018","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":"Physical Activity Program among Cancer Survivors in General Practice: Evaluating Patient Outcomes.","authors":"Famke Huizinga, Nico-Derk Lodewijk Westerink, Annemiek M E Walenkamp, Annette J Berendsen, Mathieu H G de Greef, Michiel de Boer, Geertruida de Bock, Marjolein Berger, Daan Brandenbarg","doi":"10.3399/BJGP.2024.0558","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0558","url":null,"abstract":"<p><p>Background Physical activity (PA) benefits cancer survivors' health, yet no PA programs are incorporated in general practice. Aim Evaluate cancer survivors' outcomes of a PA program in general practice. Design and Setting Single-arm PA intervention implementation study among cancer survivors in 15 Dutch general practices. Method Patients aged ≥18 years and ≥6 months post-cancer treatment were eligible. The nine-month intervention comprised counselling sessions with a primary care practitioner (PCP, aimed at increasing daily PA. Reach, Effectiveness, and Implementation of the RE-AIM framework were evaluated among participants. Primary health outcomes included self-reported symptoms of fatigue, depression, and anxiety; secondary outcomes included step count, caloric expenditure, weight, physical function, and self-reported quality of life, and PA. Outcomes were assessed at T0-T3 (0,3,6, and 9 months) or at PCPs' sessions S1-S6 (0,3,6weeks,3,6,9months). Non-participants completed a single baseline questionnaire. We used (non-)parametric independent tests and linear mixed models for analyses. Results Of 564 invited patients, 149 (26%) participated. Participants had less formal education, higher unemployment, less PA, and more fatigue and psychological symptoms than non-participants. All primary and most secondary health outcomes improved over time, with clinically relevant changes in step count and physical function. 11% dropped out before, and 26% during the program. Counselling session adherence and PA goal achievement were 98% and 73%, respectively. Conclusion The program reached long-term cancer survivors with poorer health status, and showed positive health changes particularly on PA and physical function. Such PA programs may benefit health of a rising number of cancer survivors visiting primary care.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569014","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":"Patients' perceptions on reasons for self-referring to the emergency department shortly before cancer diagnosis: a qualitative study.","authors":"Xavier Bosch, Elisabet Montori-Palacin, Pedro Moreno, Ana-Maria Guio, Alfonso López-Soto","doi":"10.3399/BJGP.2024.0355","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0355","url":null,"abstract":"<p><strong>Background: </strong>Some cancer patients are diagnosed following self-referral to the emergency department (ED), even after consulting primary care (PC). However, the rationale and factors involved in this decision are largely unknown.</p><p><strong>Aim: </strong>To explore patients' perceptions on reasons for emergency self-referral shortly before cancer diagnosis.</p><p><strong>Design and setting: </strong>Qualitative interview study at a high-volume public institution in Barcelona.</p><p><strong>Method: </strong>Semi-structured interviews with two patient groups: patients who self-referred as emergencies and never consulted PC (nonconsulters) and patients who self-referred despite consulting PC (consulters). Data were analysed by two independent coders-an emergency and a PC physician-using a codebook approach to thematic analysis.</p><p><strong>Results: </strong>Fifteen nonconsulters and 17 consulters were interviewed. Nonconsulters were more likely to belong to disadvantaged and ethnic communities. There was little variation between patient groups in their experiences and perceptions regarding pain intensity and related distress and ED's advantages in terms of accessibility and convenience. Cancer fear, uncertainty about symptoms, and frustration in accessing PC due to language barriers were unique among nonconsulters, leading to help-seeking delays. Patients' perception of the ED as a facility providing high-quality care and able to meet all medical needs emerged as a distinct theme among consulters.</p><p><strong>Conclusion: </strong>Healthcare organisations and public health services bear the responsibility to promote patient education and improve communication regarding the specific roles and purposes of PC and the ED. Increasing awareness and developing community-based programs that target cancer fear and fatalism may encourage early presentation to PC, especially among underrepresented and ethnic minority groups.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143569009","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":"Exploring rural Scottish GPs' migration decisions: a secondary qualitative analysis considering burnout.","authors":"Helen Ann Latham, Andrew S Maclaren, Johannes H De Kock, Louise Locock, Peter Murchie, Zoë Skea","doi":"10.3399/BJGP.2024.0494","DOIUrl":"10.3399/BJGP.2024.0494","url":null,"abstract":"<p><strong>Background: </strong>The challenges of recruiting and retaining rural GPs are well described. UK data suggest high levels of burnout, characterised by detachment, exhaustion, and cynicism, plays a role in GP turnover. The contrast is engagement with work. There is limited evidence examining the relationship between work engagement and recruitment and retention in rural areas.</p><p><strong>Aim: </strong>To qualitatively investigate GPs decisions to move or stay in rural areas through exploring areas that can promote work engagement.</p><p><strong>Design and setting: </strong>This was a secondary analysis of qualitative data with Scottish GPs.</p><p><strong>Method: </strong>A secondary analysis of 44 semi-structured interviews with GPs from across Scotland was undertaken. Data were analysed thematically and the Areas of Worklife Scale was used to structure data.</p><p><strong>Results: </strong>Factors associated with burnout were identified and experienced as barriers to moving or staying rurally. Fear of dealing with pre-hospital emergency cases, clinical isolation, and rural training were concerns. Personal factors such as lack of partner employment played a key role in migration decisions. Factors associated with engagement were identified and experienced as facilitators for moving or staying rurally. Professional networks reduced professional isolation and rural GPs valued increased autonomy and time. Many felt being a rural GP was more aligned with their professional values and highly valued the rural lifestyle for themselves and their families.</p><p><strong>Conclusion: </strong>Our data suggest that factors associated with engagement and burnout can contribute to rural GPs' migration decisions. We highlight four areas that could promote desirable work environments by mitigating burnout and promoting engagement at work.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e187-e194"},"PeriodicalIF":5.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11849693/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959005","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":"Meaningful community engagement: a Deep End perspective.","authors":"Nic Dickson, Leanne McBride, Colette Mason, Fraser Devine, Marianne McCallum","doi":"10.3399/bjgp25X740913","DOIUrl":"10.3399/bjgp25X740913","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 752","pages":"126-127"},"PeriodicalIF":5.3,"publicationDate":"2025-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11892766/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143525378","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}