British Journal of General Practice最新文献

{"title":"Primary care transformation in Scotland: a comparison two cross-sectional national surveys of general practitioners' views in 2018 and 2023.","authors":"Eddie Donaghy, Kieran Sweeney, Lauren Ng, Holly Haines, Alexandra Thompson, David Henderson, Harry H X Wang, Andrew Thompson, Bruce Guthrie, Stewart W Mercer","doi":"10.3399/BJGP.2024.0500","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0500","url":null,"abstract":"<p><strong>Background: </strong>The 2018 Scottish GP contract established GP Clusters and multidisciplinary team (MDT) expansion. Qualitative studies have suggested sub-optimal progress.</p><p><strong>Aim: </strong>To quantify progress since the introduction of the new contract.</p><p><strong>Design and setting: </strong>Cross-sectional postal survey of all qualified GPs in Scotland in 2023 Methods: Comparison of GPs working lives, career intentions and views on the new contract with a similar survey conducted in 2018.</p><p><strong>Results: </strong>1378/4529 (30%) GPs responded to the survey compared to 2465/4371 (56%) in 2018. Job satisfaction and negative job attributes were similar in both surveys. Both positive job attributes (p=0.011) and job pressures (p=0.004) increased but the changes were small (effect sizes < 0.15). Significantly more GPs were planning to reduce hours (p<0.001) and leave direct patient care (p=0.008) in 2023 than 2018. Quality leads views on Cluster working were unchanged, with 70-80% reporting insufficient support. Cluster knowledge and engagement was unchanged but there were small increases in knowledge of quality improvement. More than half felt that MDT expansion was insufficient to reduce their workload. Significantly more practices were trying to recruit GPs, and GPs reported worsening NHS services, higher workload, and lower practice sustainability in 2023. Only 5% of GPs in the 2023 survey thought that the new contract had improved the care of patients with complex needs.</p><p><strong>Conclusions: </strong>GPs report few improvements in working life five years after the new contract was introduced, and are responding by planning to reduce their hours or leave direct patient care.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959011","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":"General practice chlamydia testing: qualitative study of staff approaches using behavioural change theory.","authors":"Amna Asad, Beattie Robyn Hazel Sturrock, Jessica Carter, John Saunders, Jackie Cassell, Greta Rait, Lorraine McDonagh","doi":"10.3399/BJGP.2024.0498","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0498","url":null,"abstract":"<p><strong>Background: </strong>Chlamydia is the most diagnosed bacterial sexually transmitted infection in England, but opportunistic testing remains low in general practice despite high prevalence among young people. Attempts to increase testing have been met with little success; therefore, there is a need to explore why rates remain low and how this may be improved.</p><p><strong>Aim: </strong>To explore general practice staff perceptions of opportunistic chlamydia testing, including barriers, facilitators, interventions, and policies, using the Behaviour Change Wheel (BCW).</p><p><strong>Design and setting: </strong>Qualitative interviews and focus groups with general practice staff in England.</p><p><strong>Method: </strong>23 semi-structured individual interviews and seven focus groups with general practice staff were conducted. Data was analysed using inductive thematic analysis, followed by thematic categorisation onto the Behaviour Change Wheel.</p><p><strong>Results: </strong>Participants identified several barriers to chlamydia testing corresponding with BCW components, including low perceived knowledge (psychological capability), general practice context (physical opportunity), cultural norms (social opportunity), testing not prioritised (reflective motivation), and concerns about patient reactions (automatic motivation). Proposed intervention functions included education, persuasion (e.g. posters), incentivisation (e.g. financial incentives), training, and environmental restructuring (e.g. computer reminders). Potential policy categories discussed were communication (e.g. campaigns) and service provision (e.g. GP drop-in sessions at other venues).</p><p><strong>Conclusion: </strong>This study identified barriers to chlamydia testing in English general practice and potential ways to address these, contributing new insights to existing literature. This research can be utilised to design multi-component, impactful interventions to increase testing in general practice and ultimately reduce harm posed by chlamydia infections.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911218","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":"Rapid microbiological respiratory point-of-care-testing: a qualitative study with primary care clinicians.","authors":"Rebecca Clarke, Emily Brown, Alastair D Hay, Paul Mark Mitchell, Matthew J Ridd, Liang Zhu, Lucy Yardley","doi":"10.3399/BJGP.2024.0413","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0413","url":null,"abstract":"<p><strong>Background: </strong>Rapid microbiological point-of-care tests (POCTRM) present an opportunity to reduce antibiotic exposure and antimicrobial resistance. So far, there is limited understanding of how POCTRM may support clinicians in primary care in the UK and how POCTs might be integrated into practice.</p><p><strong>Aim: </strong>To investigate clinicians' views on how POCTRM could influence clinical decisions and routine practice, and perspectives on how POCTRM may impact the clinician-patient relationship.</p><p><strong>Design and setting: </strong>Qualitative study embedded in a multi-centre, individually randomised controlled efficacy trial evaluating the use of a multiplex POCTRM for suspected respiratory tract infections in primary care.</p><p><strong>Method: </strong>Individual interviews were conducted with 18 clinicians (n= 9 General Practitioners, 4 Advanced Nurse Practitioners, 1 trainee Advanced Nurse Practitioner, 1 Clinical Pharmacist, 2 Paramedics, 1 Emergency Care Practitioner). Interviews were audio-recorded, transcribed verbatim and analysed thematically informed a realist approach.</p><p><strong>Results: </strong>POCTRM can guide prescribing decisions when clinicians experience diagnostic uncertainty and support communication with patients to reinforce prescribing decisions. Consequently, the perceived value, and use of, POCTRM varied according to clinicians' confidence in making prescribing decisions and managing patient expectations and their clinical roles. The costly and time-consuming nature of POCTRM meant that integration of POCTRM into routine practice was considered unlikely at present.</p><p><strong>Conclusion: </strong>Clinicians in this study had generally favourable views towards POCTRM, but further POCTRM training, complementary strategies such as communication skills training and patient education, and clear guidance on implementation should be explored to optimise POCTRM feasibility and outcomes across different primary care settings.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911226","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":"General practitioner consultations for respiratory tract infections in children under 5 years; retrospective cohort study 2016-2023.","authors":"Kimberley A Foley, Dougal S Hargreaves, Alex Bottle, Jennifer Quint, Azeem Majeed, Sejal Saglani, Sonia Saxena","doi":"10.3399/BJGP.2024.0501","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0501","url":null,"abstract":"<p><strong>Background: </strong>Little is known about how GP consultation rates for children's respiratory tract infections (RTIs) have changed since the covid-19 pandemic restrictions lifted.</p><p><strong>Aim: </strong>To describe changes in GP consultation rates for RTIs in children <5 years from 2016-2023.</p><p><strong>Design and setting: </strong>Population-based retrospective cohort study using electronic health records.</p><p><strong>Methods: </strong>We included all children aged <5 years registered with a general practice from April 2016 to March 2023. We compared monthly GP consultation rates for RTIs from April 2021-March 2023 with corresponding months during pre-pandemic years (April 2016-February 2020).</p><p><strong>Results: </strong>There were 3 045 701 GP consultations for RTIs among 2 894 539 children. Pre-pandemic, monthly consultation rates ranged from lows in August to highs in November (from 2368 to 8682 per 100 000 children, respectively). Following the pandemic lockdowns in 2020, monthly rates in 2021/22 peaked in June and October, but the winter peak was less marked than pre-pandemic and mean monthly rates were 16.8% lower. In 2022/23 after all restrictions lifted, rates remained around 15% below pre-pandemic years, but the winter peak for children aged 3-4 exceeded prior winter peaks by 43.3% and coincided with a streptococcal group A outbreak. Across all ages, there was a sharp increase (around 60%) in tonsillitis, streptococcus A and bacterial ear infections.</p><p><strong>Conclusion: </strong>Our study shows reductions in GP consultations for RTIs for children under 5 since the lifting of covid-19 pandemic restrictions. Of concern is a sharp rise in tonsillitis, streptococcus A and bacterial ear infections that should be monitored.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":""},"PeriodicalIF":5.3,"publicationDate":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142911223","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":"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 Neal, Matthew Callister, Benjamin Cornwell, William Hamilton, Gary A Abel, Bethany Shinkins, Richard Hubbard, Matthew Barclay","doi":"10.3399/BJGP.2024.0466","DOIUrl":"https://doi.org/10.3399/BJGP.2024.0466","url":null,"abstract":"<p><strong>Background: </strong>Evidence on whether general practice rates of investigation in symptomatic patients using chest x-ray (CXR) affects outcomes is equivocal.</p><p><strong>Aim: </strong>Determine if there is an association between rates of general practice (GP) requested CXR and lung cancer outcomes.</p><p><strong>Design and setting: </strong>Retrospective observational study (England) Methods: Cancer registry data for patients diagnosed with lung cancer 2014-2018 was linked to data on GP CXRs 2013-2017. Stage at diagnosis (I/II vs III/IV) and one and five year survival (conditional on survival to one year) following diagnosis was reported by quintile of CXR rate of patients' GP with adjustment for population differences (age, smoking, prevalence of COPD and heart failure, ethnicity and deprivation) and by unadjusted category (low, medium, high).</p><p><strong>Results: </strong>192,631 patient records and CXR rates for 7,409 practices were obtained. Practices with highest quintile CXR rate had fewer cancers diagnosed at stage III/IV compared to lowest quintile (OR=0.87, 95% CI 0.83-0.92, p<0.001). The association was weaker for high unadjusted CXR category (OR=0.94, 95% CI 0.91-0.97). For the highest adjusted quintile HRs for death within one year and five years were 0.92 (0.90-0.95), p<0.001) and 0.95 (95% CI 0.91-0.99, p=0.023) respectively. For the high unadjusted CXR category the HR for one year survival was 0.98 (95% CI 0.96-0.99, p=0.004) with no association demonstrated for five year survival.</p><p><strong>Conclusions: </strong>Patients registered at GPs with higher CXR use have a favourable stage distribution and slightly better survival. This supports 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":"2024-12-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","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":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Narrative and numbers.","authors":"Ben Hoban","doi":"10.3399/bjgp25X740469","DOIUrl":"10.3399/bjgp25X740469","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 750","pages":"33"},"PeriodicalIF":5.3,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684437/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900570","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":"Forget sun, sand, and surf, who needs Australia when you've got general practice?!","authors":"Molly Dineen","doi":"10.3399/bjgp25X740421","DOIUrl":"10.3399/bjgp25X740421","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 750","pages":"11-12"},"PeriodicalIF":5.3,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684430/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900554","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":"Automation, machine learning, and AI: considerations for commissioners, providers, and recipients of health care.","authors":"Andrew Papanikitas, Siân Rees","doi":"10.3399/bjgp25X740325","DOIUrl":"10.3399/bjgp25X740325","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 750","pages":"28-29"},"PeriodicalIF":5.3,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684434/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900299","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":"Climate change and primary care: how to reduce the carbon footprint of your practice.","authors":"Michael Naughton, Thomas Round, Rupert Payne","doi":"10.3399/bjgp25X740349","DOIUrl":"10.3399/bjgp25X740349","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 750","pages":"23-25"},"PeriodicalIF":5.3,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900542","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":"GPs and assisted dying.","authors":"Euan Lawson, Andrew Papanikitas","doi":"10.3399/bjgp25X740409","DOIUrl":"10.3399/bjgp25X740409","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 750","pages":"11"},"PeriodicalIF":5.3,"publicationDate":"2024-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11684443/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142900563","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}