L. Smith, J. Carmichael, G. Cook, B. Shinkins, R. Neal
Smith et al describe the issues with the current diagnostic process for myeloma in general practice, explore the potential impact of the COVID-19 pandemic, and identify alternative strategies that may improve the early diagnosis. Around half of myeloma patients have three or more pre-referral consultations and around one-third are diagnosed through emergency presentation. Improving the timeliness of myeloma diagnosis is vital to improving patient outcomes, but is difficult to achieve because of complex, non-specific, and varied presentations. Improving GP education on the salient features of multiple myeloma presentation and the investigations required for diagnosis, alongside ensuring adequate safety netting for patients with persistent, unexplained symptoms, should be urgent priorities. Changes to general practice consultations following the COVID-19 pandemic have made myeloma diagnosis more difficult, and, over the longer term, research is required to develop intelligent and technological strategies that support physician decision making and reduce diagnostic delay.
{"title":"Diagnosing myeloma in general practice: how might earlier diagnosis be achieved?","authors":"L. Smith, J. Carmichael, G. Cook, B. Shinkins, R. Neal","doi":"10.3399/bjgp22X720737","DOIUrl":"https://doi.org/10.3399/bjgp22X720737","url":null,"abstract":"Smith et al describe the issues with the current diagnostic process for myeloma in general practice, explore the potential impact of the COVID-19 pandemic, and identify alternative strategies that may improve the early diagnosis. Around half of myeloma patients have three or more pre-referral consultations and around one-third are diagnosed through emergency presentation. Improving the timeliness of myeloma diagnosis is vital to improving patient outcomes, but is difficult to achieve because of complex, non-specific, and varied presentations. Improving GP education on the salient features of multiple myeloma presentation and the investigations required for diagnosis, alongside ensuring adequate safety netting for patients with persistent, unexplained symptoms, should be urgent priorities. Changes to general practice consultations following the COVID-19 pandemic have made myeloma diagnosis more difficult, and, over the longer term, research is required to develop intelligent and technological strategies that support physician decision making and reduce diagnostic delay.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"23 1","pages":"462 - 463"},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84996506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
M. Theodoreson, Richard Darnton, I. Rowe, R. Parker
IN PRIMARY CARE GPs are no strangers to non-alcoholic fatty liver disease (NAFLD) and are commonly faced with non-specific liver function tests (LFTs) or an incidental finding of steatosis on ultrasound scan (USS). Interpreting these results and conveying their significance to the patient can be a challenge, with huge variation in practice. NAFLD is a spectrum of liver abnormalities from simple fat deposition (steatosis) to inflammation (non-alcoholic steatohepatitis, NASH). Steatohepatitis causes persistent hepatocellular inflammation leading to fibrosis that can, in some individuals, progress to cirrhosis. The disease burden of NAFLD is rising, now the most common liver disease globally, affecting up to 46% of all adults.1 Importantly, only 0.5% of patients are expected to progress to cirrhosis, which carries a risk of liver failure.2 Patients with NAFLD are at greater risk of all-cause mortality and, for most patients, the risk of non-hepatic ill health greatly outweighs the risk of liver-related morbidity.1–3 NAFLD is overwhelmingly associated with modifiable lifestyle factors, with obesity and metabolic syndrome the key drivers.1 This review describes how and when to make a diagnosis of NAFLD, the use of fibrosis markers to identify patients at risk of significant disease, and appropriate follow-up.
{"title":"Non-alcoholic fatty liver disease: leading the fight in primary care","authors":"M. Theodoreson, Richard Darnton, I. Rowe, R. Parker","doi":"10.3399/bjgp22x720917","DOIUrl":"https://doi.org/10.3399/bjgp22x720917","url":null,"abstract":"IN PRIMARY CARE GPs are no strangers to non-alcoholic fatty liver disease (NAFLD) and are commonly faced with non-specific liver function tests (LFTs) or an incidental finding of steatosis on ultrasound scan (USS). Interpreting these results and conveying their significance to the patient can be a challenge, with huge variation in practice. NAFLD is a spectrum of liver abnormalities from simple fat deposition (steatosis) to inflammation (non-alcoholic steatohepatitis, NASH). Steatohepatitis causes persistent hepatocellular inflammation leading to fibrosis that can, in some individuals, progress to cirrhosis. The disease burden of NAFLD is rising, now the most common liver disease globally, affecting up to 46% of all adults.1 Importantly, only 0.5% of patients are expected to progress to cirrhosis, which carries a risk of liver failure.2 Patients with NAFLD are at greater risk of all-cause mortality and, for most patients, the risk of non-hepatic ill health greatly outweighs the risk of liver-related morbidity.1–3 NAFLD is overwhelmingly associated with modifiable lifestyle factors, with obesity and metabolic syndrome the key drivers.1 This review describes how and when to make a diagnosis of NAFLD, the use of fibrosis markers to identify patients at risk of significant disease, and appropriate follow-up.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"85 1","pages":"499 - 501"},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76803068","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
often represents a major upheaval, with potential for physical, psychological, social, and economic consequences. Hospital admissions are also associated with an increased risk of adverse consequences to both physical and emotional wellbeing. Indeed, the broader negative impacts of the ‘allostatic stress’ of an admission may even outstrip those of physical illness in depleting reserves — a risk that persists beyond discharge.1 In patients with frailty, even a short so-termed ‘ambulatory’ admission is associated with increased mortality and subsequent use of health resources.2 While a hospital admission is rarely relished, there is evidence across international health systems that the COVID19 pandemic has heightened peoples’ desire to stay out of hospital, with an increasing trend of patients delaying or avoiding seeking urgent care altogether for fear of being admitted.3 While specific worries about hospitalacquired infection are undoubtedly a component, it appears that people may be more broadly re-evaluating the pros and cons of unscheduled hospital care as part of their re-framed priorities in the postpandemic era. These new sets of priorities, combined with a renewed urgency (driven by unprecedented demand) to explore alternative models of unscheduled care that don’t require inpatient stays, mean we may need to look again at how we conceptualise the avoidable admission. A major challenge of research in this area is the lack of a single, consistently applied definition of an avoidable admission.4 Academics and clinicians alike have long sought a concise and utilitarian way to define exactly who these patients might be, and in which circumstances alternative care is practical and appropriate. One approach is to define this cohort according to a disease or illness for which there exists a viable care pathway that does not require an inpatient stay. Ambulatory care sensitive conditions (ACSCs) are one such classification, defining conditions where effective person-centred community care may prevent the need for hospital admission.5 Along with others, we have previously utilised a nuanced version of this definition — primary care sensitive conditions (PCSCs) — in which the list of conditions is extended to include ‘situations’ that may not themselves be diagnoses or illnesses, but which may be amenable to timely and holistic primary care input to avoid an admission (for example, social care crises).6 Similarly, the term urgent care sensitive conditions (UCSCs) has been used in the literature to describe when same-day urgent care may prevent further resource use,7 although the definition of urgent care is not itself universally agreed. Basing the study of avoidable admissions on ASCSs alone, however, results in an incomplete understanding of the phenomenon. Recent analysis identified a complex relationship between ACSCs, admissions, and ‘preventable’ emergency care.8 The potential ability of primary care to decrease the number of admissions due to
{"title":"Towards new definitions of avoidable hospital admissions","authors":"M. Booker, S. Purdy","doi":"10.3399/bjgp22x720725","DOIUrl":"https://doi.org/10.3399/bjgp22x720725","url":null,"abstract":"often represents a major upheaval, with potential for physical, psychological, social, and economic consequences. Hospital admissions are also associated with an increased risk of adverse consequences to both physical and emotional wellbeing. Indeed, the broader negative impacts of the ‘allostatic stress’ of an admission may even outstrip those of physical illness in depleting reserves — a risk that persists beyond discharge.1 In patients with frailty, even a short so-termed ‘ambulatory’ admission is associated with increased mortality and subsequent use of health resources.2 While a hospital admission is rarely relished, there is evidence across international health systems that the COVID19 pandemic has heightened peoples’ desire to stay out of hospital, with an increasing trend of patients delaying or avoiding seeking urgent care altogether for fear of being admitted.3 While specific worries about hospitalacquired infection are undoubtedly a component, it appears that people may be more broadly re-evaluating the pros and cons of unscheduled hospital care as part of their re-framed priorities in the postpandemic era. These new sets of priorities, combined with a renewed urgency (driven by unprecedented demand) to explore alternative models of unscheduled care that don’t require inpatient stays, mean we may need to look again at how we conceptualise the avoidable admission. A major challenge of research in this area is the lack of a single, consistently applied definition of an avoidable admission.4 Academics and clinicians alike have long sought a concise and utilitarian way to define exactly who these patients might be, and in which circumstances alternative care is practical and appropriate. One approach is to define this cohort according to a disease or illness for which there exists a viable care pathway that does not require an inpatient stay. Ambulatory care sensitive conditions (ACSCs) are one such classification, defining conditions where effective person-centred community care may prevent the need for hospital admission.5 Along with others, we have previously utilised a nuanced version of this definition — primary care sensitive conditions (PCSCs) — in which the list of conditions is extended to include ‘situations’ that may not themselves be diagnoses or illnesses, but which may be amenable to timely and holistic primary care input to avoid an admission (for example, social care crises).6 Similarly, the term urgent care sensitive conditions (UCSCs) has been used in the literature to describe when same-day urgent care may prevent further resource use,7 although the definition of urgent care is not itself universally agreed. Basing the study of avoidable admissions on ASCSs alone, however, results in an incomplete understanding of the phenomenon. Recent analysis identified a complex relationship between ACSCs, admissions, and ‘preventable’ emergency care.8 The potential ability of primary care to decrease the number of admissions due to ","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"37 1","pages":"464 - 465"},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84839840","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
K. Balasubramaniam, S. Rasmussen, P. Haastrup, L. M. S. Sætre, J. Søndergaard, D. Jarbøl
symptoms ranging from barely noticeable sensations to disturbing discomforts. The causes vary from normal physiological processes and self-limiting benign conditions to life-threatening diseases. Symptom experiences do not occur as stand-alone events but are influenced by an interchange of biological, psychological, and cultural factors, leading to various ways of interpreting and managing symptoms.1 Consequently, many symptoms are managed privately without consulting the healthcare system;2 however, some symptoms should lead to further investigation as they are alarming from a healthcare perspective and timely investigation is warranted.3,4 GPs play an important role in helping patients interpret symptoms;5 however, the healthcare-seeking process is not simple, and numerous factors, including previous experiences, social relations, and support, may contribute in deciding whether or not to seek health care.6 To elucidate how symptoms are interpreted and managed in the general population, we initiated the Danish Symptom Cohort (DaSC), a nationwide webbased survey. In 2012, we invited 100 000 randomly selected individuals aged >20 years to complete a questionnaire covering 44 predefined symptoms comprising both cancer symptoms as well as common symptoms, for example, back pain, urinary incontinence, and tiredness. If responders confirmed a symptom experience, followup questions were asked concerning onset, influence on daily activities, concerns about the symptom, whether the responder had consulted the GP regarding the symptom, and considerations about contacting the GP with the symptom in question. Responders were also asked about smoking status, alcohol intake, and physical activity. For the invitees, socioeconomic status (education, income, cohabitation status, ethnicity, and labour market affiliation) were then collected from national registers7–11 and linked to survey data. In this editorial we summarise the findings from the DaSC studies, highlighting the lessons learned but also pointing to what needs to be further explored in the 10-year follow-up questionnaire, DaSC II, which was distributed in May 2022. The 34 current publications deriving from the DaSC are available online,12 with details of the results and contextualisation of findings within the existing literature.
{"title":"Dealing with symptoms in the general population: lessons learned from the Danish Symptom Cohort","authors":"K. Balasubramaniam, S. Rasmussen, P. Haastrup, L. M. S. Sætre, J. Søndergaard, D. Jarbøl","doi":"10.3399/bjgp22x720713","DOIUrl":"https://doi.org/10.3399/bjgp22x720713","url":null,"abstract":"symptoms ranging from barely noticeable sensations to disturbing discomforts. The causes vary from normal physiological processes and self-limiting benign conditions to life-threatening diseases. Symptom experiences do not occur as stand-alone events but are influenced by an interchange of biological, psychological, and cultural factors, leading to various ways of interpreting and managing symptoms.1 Consequently, many symptoms are managed privately without consulting the healthcare system;2 however, some symptoms should lead to further investigation as they are alarming from a healthcare perspective and timely investigation is warranted.3,4 GPs play an important role in helping patients interpret symptoms;5 however, the healthcare-seeking process is not simple, and numerous factors, including previous experiences, social relations, and support, may contribute in deciding whether or not to seek health care.6 To elucidate how symptoms are interpreted and managed in the general population, we initiated the Danish Symptom Cohort (DaSC), a nationwide webbased survey. In 2012, we invited 100 000 randomly selected individuals aged >20 years to complete a questionnaire covering 44 predefined symptoms comprising both cancer symptoms as well as common symptoms, for example, back pain, urinary incontinence, and tiredness. If responders confirmed a symptom experience, followup questions were asked concerning onset, influence on daily activities, concerns about the symptom, whether the responder had consulted the GP regarding the symptom, and considerations about contacting the GP with the symptom in question. Responders were also asked about smoking status, alcohol intake, and physical activity. For the invitees, socioeconomic status (education, income, cohabitation status, ethnicity, and labour market affiliation) were then collected from national registers7–11 and linked to survey data. In this editorial we summarise the findings from the DaSC studies, highlighting the lessons learned but also pointing to what needs to be further explored in the 10-year follow-up questionnaire, DaSC II, which was distributed in May 2022. The 34 current publications deriving from the DaSC are available online,12 with details of the results and contextualisation of findings within the existing literature.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"12 1","pages":"460 - 461"},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78005122","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
D. McKechnie, Neelam A. Parmar, Sarah Armstrong, Lucy Pratt, L. Pope, H. Alberti, Sophie Park
{"title":"General practice and the Medical Licensing Assessment","authors":"D. McKechnie, Neelam A. Parmar, Sarah Armstrong, Lucy Pratt, L. Pope, H. Alberti, Sophie Park","doi":"10.3399/bjgp22x720905","DOIUrl":"https://doi.org/10.3399/bjgp22x720905","url":null,"abstract":"","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"62 1","pages":"497 - 498"},"PeriodicalIF":0.0,"publicationDate":"2022-09-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85055612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Actively tackling inactivity","authors":"Steve Haake, Simon Tobin","doi":"10.3399/bjgp22x720497","DOIUrl":"https://doi.org/10.3399/bjgp22x720497","url":null,"abstract":"","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"69 1","pages":"414 - 415"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80226389","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Video consultations: a potential gamechanger in clinical education","authors":"Richard Darnton, Richard Thomson, J. McKimm","doi":"10.3399/bjgp22x720509","DOIUrl":"https://doi.org/10.3399/bjgp22x720509","url":null,"abstract":"","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"441 1","pages":"416 - 417"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82916419","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Balakumar Anandasivam, Michael Tam, K. McGeechan, K. Price, Katrina Mclean, M. Tracy, J. Hall, Andrew Knight, K. Vuong
Background Preventive guidelines for melanoma recommend that patients at high risk of melanoma receive targeted screening; however, this requires careful selection of those at high risk. To the authors’ knowledge, there has been no previous research into how all physicians approach the selection and management of high-risk individuals. Melanoma risk-prediction models are available to assist in the identification of high-risk patients but are not routinely used clinically. Aim To examine how GPs assessed and managed melanoma risk, and the opportunities for using melanoma risk-prediction models in primary care. Design and setting Semi-structured telephone interviews were conducted with 20 Australian GPs. Method GPs who had completed a cross-sectional online questionnaire study on melanoma risk were purposively sampled and recruited. Semi-structured telephone interviews were conducted with Australian GPs between 9 July and 10 September 2019. Interviews were audiorecorded, professionally transcribed, and analysed using grounded theory. Results Melanoma risk assessment and its management can be understood as a linear workflow consisting of five clinical process domains with patient selection as the entry point. There was variation between GPs on the identification of melanoma risk factors, melanoma risk estimation, management, and patient education because of intuitive and analytical processes guiding risk assessment, and the influence of patient factors. GPs were largely receptive towards melanoma risk-prediction models, sharing facilitators for and barriers to their potential implementation. Conclusion Further primary care interventions sensitive to existing workflow arrangements may be required to standardise melanoma risk-assessment and management processes.
{"title":"Melanoma risk assessment and management: a qualitative study among Australian GPs","authors":"Balakumar Anandasivam, Michael Tam, K. McGeechan, K. Price, Katrina Mclean, M. Tracy, J. Hall, Andrew Knight, K. Vuong","doi":"10.3399/BJGP.2021.0668","DOIUrl":"https://doi.org/10.3399/BJGP.2021.0668","url":null,"abstract":"Background Preventive guidelines for melanoma recommend that patients at high risk of melanoma receive targeted screening; however, this requires careful selection of those at high risk. To the authors’ knowledge, there has been no previous research into how all physicians approach the selection and management of high-risk individuals. Melanoma risk-prediction models are available to assist in the identification of high-risk patients but are not routinely used clinically. Aim To examine how GPs assessed and managed melanoma risk, and the opportunities for using melanoma risk-prediction models in primary care. Design and setting Semi-structured telephone interviews were conducted with 20 Australian GPs. Method GPs who had completed a cross-sectional online questionnaire study on melanoma risk were purposively sampled and recruited. Semi-structured telephone interviews were conducted with Australian GPs between 9 July and 10 September 2019. Interviews were audiorecorded, professionally transcribed, and analysed using grounded theory. Results Melanoma risk assessment and its management can be understood as a linear workflow consisting of five clinical process domains with patient selection as the entry point. There was variation between GPs on the identification of melanoma risk factors, melanoma risk estimation, management, and patient education because of intuitive and analytical processes guiding risk assessment, and the influence of patient factors. GPs were largely receptive towards melanoma risk-prediction models, sharing facilitators for and barriers to their potential implementation. Conclusion Further primary care interventions sensitive to existing workflow arrangements may be required to standardise melanoma risk-assessment and management processes.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"63 1","pages":"e737 - e746"},"PeriodicalIF":0.0,"publicationDate":"2022-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82185476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background Group consultations have been gaining ground as a novel approach to service delivery. When in-person care was restricted owing to COVID-19, general practice staff began delivering group consultations remotely over video. Aim To examine how multiple interacting influences underpinned implementation and delivery of video group consultations (VGCs). Design and setting Qualitative study in general practice in England. Method a) 32 semi-structured interviews with patients, clinical, and non-clinical staff (from eight GP surgeries in total), NHS policymakers and programme managers, and other stakeholders; b) observation in relevant training and operational meetings; and c) three co-design workshops (21 participants). Thematic analysis was informed by the Planning and Evaluating Remote Consulting Services (PERCS) framework. Results In the first year of the pandemic, VGCs focused on supporting those with long-term conditions or other shared health and social needs. Most patients welcomed clinical and peer input, and the opportunity to access their practice remotely during lockdown. However, not everyone agreed to engage in group-based care or was able to access IT equipment. At practice level, significant work was needed to deliver VGCs, such as setting up the digital infrastructure, gaining team buy-in, developing new patient-facing online facilitation roles, managing background operational processes, protecting online confidentiality, and ensuring professional indemnity cover. Training provided nationally was seen as instrumental in capacity building for VGC implementation. Conclusion Small scale VGC implementation addressed unmet need during the pandemic. However, embedding VGCs in routine care requires rethinking of operational, infrastructural, and clinical processes. Additional research on costs and benefits at service and patient level is needed.
{"title":"Implementing video group consultations in general practice during COVID-19: a qualitative study","authors":"C. Papoutsi, S. Shaw, T. Greenhalgh","doi":"10.3399/BJGP.2021.0673","DOIUrl":"https://doi.org/10.3399/BJGP.2021.0673","url":null,"abstract":"Background Group consultations have been gaining ground as a novel approach to service delivery. When in-person care was restricted owing to COVID-19, general practice staff began delivering group consultations remotely over video. Aim To examine how multiple interacting influences underpinned implementation and delivery of video group consultations (VGCs). Design and setting Qualitative study in general practice in England. Method a) 32 semi-structured interviews with patients, clinical, and non-clinical staff (from eight GP surgeries in total), NHS policymakers and programme managers, and other stakeholders; b) observation in relevant training and operational meetings; and c) three co-design workshops (21 participants). Thematic analysis was informed by the Planning and Evaluating Remote Consulting Services (PERCS) framework. Results In the first year of the pandemic, VGCs focused on supporting those with long-term conditions or other shared health and social needs. Most patients welcomed clinical and peer input, and the opportunity to access their practice remotely during lockdown. However, not everyone agreed to engage in group-based care or was able to access IT equipment. At practice level, significant work was needed to deliver VGCs, such as setting up the digital infrastructure, gaining team buy-in, developing new patient-facing online facilitation roles, managing background operational processes, protecting online confidentiality, and ensuring professional indemnity cover. Training provided nationally was seen as instrumental in capacity building for VGC implementation. Conclusion Small scale VGC implementation addressed unmet need during the pandemic. However, embedding VGCs in routine care requires rethinking of operational, infrastructural, and clinical processes. Additional research on costs and benefits at service and patient level is needed.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"244 1","pages":"e483 - e491"},"PeriodicalIF":0.0,"publicationDate":"2022-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80561602","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kimberley A Foley, E. Maile, A. Bottle, F. Neale, R. Viner, S. Kenny, A. Majeed, D. Hargreaves, S. Saxena
Background The NHS response to COVID-19 altered provision and access to primary care. Aim To examine the impact of COVID-19 on GP contacts with children and young people (CYP) in England. Design and setting A longitudinal trends analysis was undertaken using electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum database. Method All CYP aged <25 years registered with a GP in the CPRD Aurum database were included. The number of total, remote, and face-to-face contacts during the first UK lockdown (March to June 2020) were compared with the mean contacts for comparable weeks from 2015 to 2019. Results In total, 47 607 765 GP contacts with 4 307 120 CYP were included. GP contacts fell 41% during the first lockdown compared with previous years. Children aged 1–14 years had greater falls in total contacts (≥50%) compared with infants and those aged 15–24 years. Face-to-face contacts fell by 88%, with the greatest falls occurring among children aged 1–14 years (>90%). Remote contacts more than doubled, increasing most in infants (over 2.5-fold). Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote contacts, mitigating the total fall (31%). Conclusion During the COVID-19 pandemic, CYP’s contact with GPs fell, particularly for face-to-face assessments. This may be explained by a lower incidence of respiratory illnesses because of fewer social contacts and changing health-seeking behaviour. The large shift to remote contacts mitigated total falls in contacts for some age groups and for common non-transmissible conditions.
{"title":"Impact of COVID-19 on primary care contacts with children and young people in England: longitudinal trends study 2015–2020","authors":"Kimberley A Foley, E. Maile, A. Bottle, F. Neale, R. Viner, S. Kenny, A. Majeed, D. Hargreaves, S. Saxena","doi":"10.3399/BJGP.2021.0643","DOIUrl":"https://doi.org/10.3399/BJGP.2021.0643","url":null,"abstract":"Background The NHS response to COVID-19 altered provision and access to primary care. Aim To examine the impact of COVID-19 on GP contacts with children and young people (CYP) in England. Design and setting A longitudinal trends analysis was undertaken using electronic health records from the Clinical Practice Research Datalink (CPRD) Aurum database. Method All CYP aged <25 years registered with a GP in the CPRD Aurum database were included. The number of total, remote, and face-to-face contacts during the first UK lockdown (March to June 2020) were compared with the mean contacts for comparable weeks from 2015 to 2019. Results In total, 47 607 765 GP contacts with 4 307 120 CYP were included. GP contacts fell 41% during the first lockdown compared with previous years. Children aged 1–14 years had greater falls in total contacts (≥50%) compared with infants and those aged 15–24 years. Face-to-face contacts fell by 88%, with the greatest falls occurring among children aged 1–14 years (>90%). Remote contacts more than doubled, increasing most in infants (over 2.5-fold). Total contacts for respiratory illnesses fell by 74% whereas contacts for common non-transmissible conditions shifted largely to remote contacts, mitigating the total fall (31%). Conclusion During the COVID-19 pandemic, CYP’s contact with GPs fell, particularly for face-to-face assessments. This may be explained by a lower incidence of respiratory illnesses because of fewer social contacts and changing health-seeking behaviour. The large shift to remote contacts mitigated total falls in contacts for some age groups and for common non-transmissible conditions.","PeriodicalId":22333,"journal":{"name":"The British Journal of General Practice","volume":"42 2 1","pages":"e464 - e471"},"PeriodicalIF":0.0,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78204312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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