British Journal of General Practice最新文献

{"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":"e375-e381"},"PeriodicalIF":5.3,"publicationDate":"2025-05-02","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}

{"title":"Understanding Measurement of Postural Hypotension (UMPH): a nationwide survey of general practice in England.","authors":"Sinead McDonagh, Rosina Cross, Jane Masoli, Judit Konya, Gary Abel, James Sheppard, Bethany Jakubowski, Cini Bhanu, Jayne Fordham, Katrina Turner, Sarah E Lamb, Rupert A Payne, Richard McManus, John Campbell, Christopher Elles Clark","doi":"10.3399/BJGP.2025.0025","DOIUrl":"https://doi.org/10.3399/BJGP.2025.0025","url":null,"abstract":"<p><p>Background Postural hypotension (PH) is associated with excess mortality, falls and cognitive decline. PH is poorly recorded in routine general practice (practice) records. Few practice studies have explored measurement and diagnosis of PH. Aim To understand how PH is measured, diagnosed and managed in practice. Design and setting Online survey of practice staff in England. Method Clinical Research Networks distributed the survey to practices, seeking individual responses from any clinical staff involved in routine blood pressure (BP) measurement. Responses were analysed according to role and demographic data using descriptive statistics. Multivariable modelling of undertaking postural BP measurements was performed. Results 703 responses were received from 243 practices (mean practice-level response rate 17%). Half (362; 51%) of respondents were doctors, 196 (28%) practice nurses and 77 (11%) healthcare assistants (HCAs). Eight percent did not routinely check for PH, usually citing time constraints. For the remaining 92%, postural symptoms were the predominant reason for checking (97% respondents); only 24% cited any other guideline indication for PH testing. 77% used sit-to-stand BP measurements; only 25% measured standing BP for more than one minute. On regression modelling, other professionals tested less for PH than doctors (Odds ratios: nurses 0.323 (95% confidence interval 0.117 to 0.894), HCAs 0.102 (0.032 to 0.325), pharmacists 0.986 (0.024 to 0.412)). Conclusion Awareness of reasons, besides symptoms, and adherence to guidelines for PH testing, are low. Time is the key barrier to improved testing for PH. Clarity on pragmatic methods of measuring PH in practice would also facilitate measurement uptake.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035909","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":"Improving healthcare information for young people with ADHD: perspectives from general practice.","authors":"Anna Price, Kieran Becker, Rebecca Gudka, Jane Smith, Faraz Mughal, G J Melendez-Torres, Emma Pitchforth, Tamsin Newlove-Delgado","doi":"10.3399/BJGP.2024.0755","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0755","url":null,"abstract":"<p><strong>Background: </strong>Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder which can have poor long-term outcomes when unmanaged. Young people aged 16-25 with ADHD are often unable to access specialist healthcare as recommended by UK guidelines, due to gaps in services, poor transitional support between child and adult services, and long waiting lists. Healthcare information, which is important for condition management, may help mitigate service gaps and support thriving in people with ADHD, however little is known about provision via primary care.</p><p><strong>Aim: </strong>To investigate experiences of information provision supporting management of young people with ADHD in general practice and explore the potential of digital resources.</p><p><strong>Design and setting: </strong>This qualitative research comprised interviews with young people with ADHD, their supporters, and primary healthcare professionals from sites across England.</p><p><strong>Method: </strong>Participants were recruited from five purposively sampled general practices, varying by local area characteristics. Semi-structured interviews included questions about information provision, healthcare information needs, and digital resources. Themes were generated using reflexive thematic analysis, within a critical realist framework.</p><p><strong>Results: </strong>20 participants were recruited (11 healthcare professionals and nine people with lived experience). Four themes were generated: lack of ADHD-specific resources, supporting patients with condition management, dedicated resources for clinicians, and digital resources enhancing care.</p><p><strong>Conclusion: </strong>People with lived experience and healthcare professionals want better healthcare information about ADHD in general practice, including co-produced resources to support understanding and self-management. Digital resources represent a potentially cost-effective and accessible solution that is currently under-utilised.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144053125","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 of Diagnostic Testing for Oesophagogastric Cancer-Related Symptoms in Australian General Practice.","authors":"Shaoke Lei, Brent Venning, Alison Pearce, Alex Lee, Jon Emery","doi":"10.3399/BJGP.2024.0621","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0621","url":null,"abstract":"<p><strong>Background: </strong>Oesophagogastric (OG) cancer-associated symptoms are common in primary care, but most research has focused on patients with a confirmed OG cancer diagnosis, rather than those presenting with symptoms for the first time.</p><p><strong>Aim: </strong>To examine diagnostic testing patterns for upper gastrointestinal symptoms linked to OG cancer.</p><p><strong>Design and setting: </strong>Retrospective cohort study used a linked primary care database. It included de-identified patients aged 55 and older who presented with symptoms suggestive of OG cancer between 2008 and 2022. We analysed the proportion of patients who underwent pathology, imaging, referral, endoscopy, or a test of treatment. Differences across socioeconomic groups were also examined, along with the proportion of patients diagnosed with OG cancer.</p><p><strong>Results: </strong>The study cohort consisted of 44,402 patients, of whom 126 (0.28%) were diagnosed with OG cancer within 12 months of presentation. Reflux was the most common symptom (57%), followed by nausea (11%). Patients over 75 were less likely to be investigated or referred (OR = 0.59, 95% CI: 0.56-0.62, p < 0.001). Those from less disadvantaged areas were 1.4 times more likely to be investigated (OR = 1.44, 95% CI: 1.36-1.53, p < 0.001). Patients on 'test of treatment' medications were less likely to receive further investigation (OR = 0.66, 95% CI: 0.63-0.69, p < 0.001). Multiple symptoms and visits increased the likelihood of investigation (OR = 2.77, 95% CI: 2.55-3.00, p < 0.001).</p><p><strong>Conclusion: </strong>Significant variations in diagnostic testing could contribute to disparities in OG cancer outcomes.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774916","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":"Selection and reporting of usual care comparators when designing primary care trials of complex health interventions: a systematic review.","authors":"Shoba Dawson, Katrina Turner, Sarah Dawson, Tom Yardley, Alyson Huntley","doi":"10.3399/BJGP.2024.0525","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0525","url":null,"abstract":"<p><strong>Background: </strong>Many primary care trials evaluating complex health interventions use a 'usual care' comparator. As 'usual care' can vary across clinical sites, countries, and over time, impacting trial design and raising ethical considerations attention should be given to its content prior to a trial starting.</p><p><strong>Aim: </strong>To understand how researchers select and describe usual care comparators when designing primary care trials of complex health interventions.</p><p><strong>Design and setting: </strong>A systematic review of primary care trial or feasibility study protocols.</p><p><strong>Method: </strong>Electronic databases were searched from 1 July 2020 to 20 June 2022.</p><p><strong>Results: </strong>A total of 83 protocols were included. A range of terms such as usual care and care as usual were used to describe usual care. The description of usual care varied significantly between protocols in terms of the level of detail provided regarding its selection and content. We categorised these descriptions according to the amount of detail they provided as: basic (72%), moderate (16%) and comprehensive (12%). Few protocols justified the content of their usual care comparator, with most simply commenting that it was based on clinical guidelines or current practice.</p><p><strong>Conclusion: </strong>Different terms are used to describe usual care and most primary care researchers provide limited details on the section and content of their usual care comparators when publishing study protocols. This has implications for transparency and replicability, and suggests researchers continue to give limited attention to the content of usual care when designing their trials.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774919","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":"Anaemia, ethnicity and cancer incidence: a retrospective cohort study in primary care.","authors":"Liz Down, Melissa Barlow, Sarah Bailey, Luke Timothy Allan Mounce, Samuel Merriel, Jessica Watson, Ge Chen, Tanimola Martins","doi":"10.3399/BJGP.2024.0762","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0762","url":null,"abstract":"<p><p>Background Haemoglobin, Mean Corpuscular Volume (MCV), and rates of Iron Deficiency Anaemia (IDA) are used in primary care to investigate possible cancer symptoms, especially for gastro-intestinal cancers. Underlying ethnic differences in typical test results could lead to inequalities in the diagnosis of cancer in primary care. Aim To investigate the distribution of low haemoglobin, low MCV and IDA, and the rate of cancer diagnosis in patients with abnormal results, by ethnic group. Design and Setting Retrospective cohort study using routine data collected in primary care in England. Included patients had blood tests between 2010 and 2017 and were at least 40 years old with no prior cancer diagnosis. Method Multi-level logistic regression was used to investigate the relationship between blood test results and cancer risk for patients in different ethnic groups. Results Low haemoglobin, low MCV, and IDA were effective in identifying patients with increased cancer risk, particularly for gastro-intestinal cancers. MCV was found to be a stronger cancer indicator for White patients (diagnostic OR 3.84) than for Asian (OR 1.86) or Black patients (OR 1.75). Conclusion There are some small differences in cancer risk for patients with abnormal test results, when considering patient ethnic group, especially for MCV. This is likely to be a consequence of the underlying difference in typical MCV values for patients from different ethnic groups. Further investigation is required to understand the aetiology of these differences in order to disentangle any effects on outcomes for patients with cancer.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143774911","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":"Correction.","authors":"","doi":"10.3399/bjgp25X741045","DOIUrl":"10.3399/bjgp25X741045","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 753","pages":"156"},"PeriodicalIF":5.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961188/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733360","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":"Public health and general practice working together.","authors":"Luke N Allen, Eleanor Turner-Moss, Kathrin Thomas, Luisa Pettigrew, David Blane, Rory Honney, Richard Hobbs, Aziz Sheikh","doi":"10.3399/bjgp25X741105","DOIUrl":"10.3399/bjgp25X741105","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 753","pages":"154-155"},"PeriodicalIF":5.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961169/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733368","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":"Using AI to improve skin cancer detection in primary care: the vision and barriers.","authors":"Richard Armitage","doi":"10.3399/bjgp25X741177","DOIUrl":"10.3399/bjgp25X741177","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 753","pages":"168-169"},"PeriodicalIF":5.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961186/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733374","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":"We should be offering GP registrars screening for specific learning differences.","authors":"Adrian Hucks","doi":"10.3399/bjgp25X741213","DOIUrl":"10.3399/bjgp25X741213","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 753","pages":"172-173"},"PeriodicalIF":5.3,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961167/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143733375","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}