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":5.2,"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":"Access to general practice.","authors":"Nada Khan","doi":"10.3399/bjgp25X741465","DOIUrl":"10.3399/bjgp25X741465","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"220-221"},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040347/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144049372","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":"Riding the tides of change.","authors":"Sam Merriel","doi":"10.3399/bjgp25X741333","DOIUrl":"10.3399/bjgp25X741333","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"195"},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040370/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059193","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":"New directions in policy in NHS GP contracts.","authors":"Denis Pereira Gray, Kate Sidaway-Lee, Philip Evans, Nada Khan, Molly Dineen, Alexander Harding","doi":"10.3399/bjgp25X741381","DOIUrl":"10.3399/bjgp25X741381","url":null,"abstract":"","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":"75 754","pages":"203-204"},"PeriodicalIF":5.1,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12040352/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059190","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":"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":"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":5.2,"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}

{"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":5.1,"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":5.1,"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":"Group-delivered interventions for lowering blood pressure in hypertension: a systematic review and meta-analysis.","authors":"Sinéad Tj McDonagh, Charlotte Reburn, Jane R Smith, Christopher E Clark","doi":"10.3399/BJGP.2023.0585","DOIUrl":"10.3399/BJGP.2023.0585","url":null,"abstract":"<p><strong>Background: </strong>Hypertension is the leading modifiable cause of cardiovascular disease. Primary care management is predominantly individual and remains suboptimal. Interventions delivered to groups incorporate peer support and potentially offer efficient use of limited resources. Evidence for the benefits of group-delivered interventions in hypertension is unclear.</p><p><strong>Aim: </strong>To determine whether group-delivered hypertension interventions improve blood pressure (BP) outcomes compared to usual care (UC).</p><p><strong>Design and setting: </strong>Systematic review, meta-analyses, and meta-regression of randomised controlled trials in community, primary, or outpatient care settings.</p><p><strong>Method: </strong>MEDLINE, Embase, Cochrane CENTRAL, and CINAHL were searched from inception to 20 March 2024 for randomised controlled trials comparing group-delivered interventions to UC for adults with hypertension. Primary outcomes were changes in systolic and diastolic BP, achievement of study BP targets and medication adherence; quality was assessed using the Cochrane Risk of Bias 2 tool. Data were pooled according to intervention type using random effects meta-analyses; predictors of BP lowering were modelled with meta-regression.</p><p><strong>Results: </strong>Overall, 5326 citations were retrieved; 59 intervention groups (IGs) from 54 studies (13 976 participants) were included. Compared to UC, systolic BP reduced by 7.2 mmHg (95% confidence interval [CI] = 4.7 to 9.6; 23 IGs) following exercise, 4.8 mmHg (95% CI = 3.2 to 6.4; 26 IGs) following lifestyle education, and 3.6 mmHg (95% CI = 0.3 to 6.9; seven IGs) following psychotherapeutic interventions. Corresponding reductions in diastolic BP were 3.9 mmHg (95% CI = 2.6 to 5.2; 21 IGs), 2.9 mmHg (95% CI = 1.8 to 3.9; 24 IGs), and 1.2 mmHg (95% CI = -1.9 to 4.3; seven IGs). Achievement of target BP and medication adherence were infrequently reported, with equivocal findings (relative risks 1.1, 95% CI = 1.0 to 1.2, <i>P</i> = 0.02, 11 IGs and 1.0, 95% CI = 1.0 to 1.1, <i>P</i> = 0.60, seven IGs, respectively). In multivariable models, higher baseline BP and pre-existing cardiovascular morbidity were associated with greater BP reductions.</p><p><strong>Conclusion: </strong>Group-delivered interventions were effective at lowering BP for people with hypertension compared with UC; their feasibility and cost-effectiveness in primary care require further study.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e266-e276"},"PeriodicalIF":5.2,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11961176/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141908446","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":"Stroke incidence in heart failure and atrial fibrillation: a population-based retrospective cohort study.","authors":"Nicholas R Jones, Margaret Smith, Sarah Lay-Flurrie, Yaling Yang, Richard Hobbs, Clare J Taylor","doi":"10.3399/BJGP.2024.0470","DOIUrl":"10.3399/BJGP.2024.0470","url":null,"abstract":"<p><strong>Background: </strong>Heart failure (HF) is a risk factor for stroke among people with atrial fibrillation (AF). Prognosis following an HF diagnosis is often poor, but this is not accounted for in existing stroke risk scores.</p><p><strong>Aim: </strong>To examine stroke incidence in people with HF and AF compared with AF alone, considering the competing risk of death.</p><p><strong>Design and setting: </strong>A population-based retrospective cohort study in English primary care, linked to secondary care Hospital Episode Statistics data.</p><p><strong>Method: </strong>In total, 2 381 941 people aged ≥45 years were identified in the Clinical Practice Research Datalink from 2000 to 2018. HF and AF were included as time-varying covariates; 69 575 had HF and AF, 141 562 had AF alone, and 91 852 had HF alone. Hazard ratios (HRs) for first stroke are reported using the Cox model and the Fine-Gray model.</p><p><strong>Results: </strong>Over median follow-up of 6.62 years, 93 665 people (3.9%) had a first stroke and 314 042 (13.2%) died. Over half (51.3%) of those with HF, with or without AF, died. In the fully adjusted Cox model, relative stroke risk was highest among people with AF alone (HR 2.43, 95% confidence interval [CI] = 2.38 to 2.48), followed by HF and AF (HR 2.20, 95% CI = 2.14 to 2.26). The cumulative incidence function of stroke was also highest among those with AF only once accounting for the competing risk of all-cause mortality. In a Fine-Gray model, the relative risk of stroke was similar for people with AF alone (HR 2.38, 95% CI = 2.33 to 2.43), but there was significant attenuation among those with HF and AF (HR 1.48, 95% CI = 1.44 to 1.53).</p><p><strong>Conclusion: </strong>HF is an aetiological risk factor for stroke, yet its prognostic significance is reduced by the high incidence of death. Use of the CHA₂DS₂-VASc score may overestimate stroke incidence in some people with HF, particularly those with a poor prognosis.</p>","PeriodicalId":55320,"journal":{"name":"British Journal of General Practice","volume":" ","pages":"e258-e265"},"PeriodicalIF":5.2,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11920897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142959044","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}