BJGP Open最新文献

Background: The COVID-19 pandemic's long-term mental health implications are increasingly concerning, especially among patients suffering post-acute sequelae of SARS-CoV-2 infection: Long COVID (LC) patients.

Aim: This study explores the presence and distribution of anxiety, depression, and stress in LC individuals with cognitive complaints in northern Barcelona (Spain).

Design & settings: This cross-sectional study involved 155 diagnosed LC individuals from the "Aliança ProHEpiC-19 Cognitiu (APC)" project.

Method: Demographic data and health behavior variables were collected, and the Depression, Anxiety, and Stress Scale (DASS-21) was self-administered to assess mental health. Descriptive statistics, chi-squared tests, and Poisson regression models were used for data analysis.

Results: 'Severe' stress and 'Extremely Severe' anxiety were prevalent in the sample. There were significant differences in anxiety and depression based on age and job role, with older individuals and non-healthcare workers showing higher relative risks.

Conclusions: Our study highlights the significant mental health burden in LC patients, underscoring the need for targeted interventions, especially among adults over 45 years old and non-healthcare workers. Further research is needed to better understand LC's complex mental health impacts and develop effective clinical management strategies.

Background: Guideline-adherent oral anticoagulant treatment (OAC) in atrial fibrillation (AF) remains a challenge. In Denmark, most patients with AF are treated in general practice. Nevertheless, determinants of OAC prescription in primary care are poorly understood.

Aim: To investigate variation in OAC adherence between general practice clinics and identify clinic characteristics associated with a lower propensity to prescribe OAC.

Design & setting: Nationwide register-based cohort study including prevalent and incident patients with AF and CHA₂DS₂-VASc score≥2 (n=165,731) listed with Danish general practice clinics (n=1666) in 2021.

Method: The main outcome was OAC adherence assessed as proportion of days covered. We used clinic OAC propensity to evaluate variation. OAC propensity was quantified as ratios between observed and expected adherence. Expected adherence was estimated based on the composition of the clinic patient populations. Sampled reference populations were constructed to account for random variation. Linear regression models examined associations between OAC propensity and clinic characteristics.

Results: The proportion of days covered with OAC in the AF-population was 78%. OAC propensity in clinics in the 90^th percentile was 20% higher compared to clinics in the 10^th percentile, however this difference was reduced to 3% when accounting for random variation. Modest associations were observed between clinic characteristics and OAC propensity. The most significant difference was in the correlation between geographic location and OAC propensity, showing an 8% gap between top- and bottom-performing regions.

Conclusion: The study suggests persistent underutilisation of OAC in AF patients and little variation in OAC prescription patterns across general practice clinics.

Background: Integrating therapist-led sessions and Cognitive Behavioural Therapy (CBT) materials within one online platform may be effective for people with depression. A trial evaluating this mode of delivering CBT is being conducted. To maximize future trial recruitment and understand patients' views of health interventions, it is important to explore reasons for declining to participate.

Aim: To explore patients' reasons for declining to participate in a trial of integrated online CBT for depression.

Design & setting: A mixed methods study collecting data from patients via questionnaires and telephone interviews at the three UK trial sites.

Method: Individuals completed a short questionnaire about their reasons for not taking part in the trial. Telephone interviews further explored these reasons with a sub-group. Quantitative data were summarized using descriptive statistics. Qualitative interviews were analysed thematically.

Results: Of 1799 patients who responded to an invitation to participate in the trial, 40.3% declined contact. The most common reasons were not wanting: to take part in research (n=387); therapy provided online (n=284); to receive CBT (n=262). Qualitative interviews with 15 'decliners' highlighted that decisions related to perceptions of eligibility, previous experiences of CBT and uncertainty about receiving CBT online. Personal circumstances, depressive symptoms or other mental health issues were also barriers to participation.

Conclusion: Reasons given by primary care patients for not taking part in a trial of integrated online CBT suggest that, at the point of recruitment, it is important to discuss the patient's perceptions of their eligibility and whether they would accept the intervention being evaluated.

Background: Women now make up approximately half of the GP workforce. However, many are leaving the profession. This could be because they experience higher rates of burnout, stress and anxiety, suicide, and lower rates of career progression. They also take on a greater load of emotional labour. Retaining this staff group is one of five priorities for future policy and research.

Aim: This research aims to synthesise the available evidence on how general practice workplaces can best support women GPs to thrive at work.

Design & setting: We propose to undertake a realist review, which seeks to understand why an approach may work in specific contexts. This involves building an understanding of how contextual factors affect the activation of mechanisms (ie, changes in participant reasoning or behaviours) to produce their outcomes.

Method: We will locate available evidence on the topic, and, using a realist logic of analysis develop an understanding as to how, why, for whom and in what contexts women GPs thrive at work. Evidence will include: academic literature, policy documents, media items and guidelines.

Results: Findings will be co-disseminated with PPI and stakeholder members to all key groups including policymakers, employers, the public, and academic audiences by a wide variety of means.

Conclusion: This review is intended to improve understanding of how working environments affect women GPs. It is anticipated that findings will support the implementation of strategies to better support this group to thrive at work.

Background: Co-location and integration of services within a psychologically-informed environment is recommended for people experiencing homeless but there are few examples of this in the UK. Such a centre opened in Scotland in November 2021.

Aim: To evaluate progress of the new centre.

Design & setting: Mixed-methods pre-post-test design before (baseline) and two years after (follow-up).

Method: Baseline and follow-up staff surveys measured knowledge of trauma-informed care, well-being, team climate, and job satisfaction. The follow-up staff survey also evaluated staff support and service improvements. In-depth staff interviews were conducted at baseline (n=25) and follow-up and analysed thematically. A service users survey was also conducted.

Results: The staff survey showed significant improvements between baseline and follow-up in trauma-informed care, burnout, and team climate, together with improvements in support, service integration, and service user care. Service users reported high satisfaction with the new centre.Staff interviews identified a more psychologically-informed environment, better staff support, and improved opportunistic multidisciplinary working over the two years of the centre opening. However, a number of barriers were also identified relating to the building and the IT systems. Further work on the centre's vision; short- and long-term integration plans; workload, and sustainability were felt to be needed.

Conclusion: Co-location of services for people experiencing homelessness in Scotland has led to improvements in staff burn-out and team climate, and service users' satisfaction over the first two years of opening. However, barriers remain and full integration requires a clearer vision and 'road map', requiring collaborative leadership and sustainable funding.

Background: The practice choices of family medicine residents and early career family physicians shape access to primary care. A growing proportion of family physicians are women.

Aim: This study examined how gender operates in shaping family physician practice choices and subsequent practice patterns.

Design & setting: Qualitative interview data were analyzed.

Setting: Family medicine residents and early-career family physicians from three Canadian provinces (Nova Scotia, Ontario, and British Columbia) participated in interviews.

Method: Qualitative interview data was collected as part of a larger mixed methods study. Eighty-eight interviews were transcribed verbatim and coded into several node reports including one on gender. Reflexive thematic analysis was conducted to identify themes related to how gender impacts physician practice choices.

Results: Many participants described multiple intersecting pathways through which it was apparent that gender shaped their career and practice choices. Others did not identify the impact of gender in this regard. Parenthood and caregiving were commonly discussed, as were clinical interests specific to women's health, however, gendered expectations of patients and colleagues were also seen to shape choices. In this way, gender shaped choices directly, but also indirectly in response to gendered experiences and expectations.

Conclusion: Findings support the need for structural reforms including: increased availability of collaborative team based models, flexible work schedules, closure of gendered wage gaps, and integration of gender awareness training through academic and healthcare institutions. Consideration of how primary care policies differentially impact across clinician gender is key to future planning to support a changing workforce that meets patient needs.

Background: Illness severity, comorbidity, fever, age and symptom duration influence antibiotic prescribing for respiratory tract infections (RTI). Non-medical determinants, such as patient expectations, also impact prescribing.

Aim: To quantify the effect of general practitioners' (GPs') perception of a patient request for antibiotics on antibiotic prescribing for RTI and investigate effect modification by medical determinants and country.

Design & setting: Prospective audit in 18 European countries.

Method: Consultation data were registered of 4982 patients presenting with acute cough and/or sore throat. A mixed-effect logistic regression model analysed the effect of GPs' perception of a patient request for antibiotics. Two-way interaction terms assessed effect modification. Relevant clinical findings were added to subgroups of lower RTI (LRTI), throat infection, and influenza-like-illness (ILI).

Results: GPs who perceived a patient request for antibiotics were four times more likely to prescribe antibiotics (OR: 4.4, 95%CI: 3.4-5.5). This effect varied by country: lower in Spain (OR: 0.06), Ukraine (OR: 0.15), and Greece (OR: 0.22) compared to the lowest prescribing country. The effect was higher for ILI (OR: 13.86, 95%CI: 5.5-35) and throat infection (OR: 5.1, 95%CI: 3.1-8.4) than for LRTI (OR: 2.9, 95%CI: 1.9-4.3). For ILI and LRTI, GPs were more likely to prescribe antibiotics with abnormal lung auscultation and/or increased/purulent sputum and for throat infection, with tonsillar exudate and/or swollen tonsils.

Conclusion: GPs' perception of an antibiotic request and specific clinical findings influence antibiotic prescribing. Incorporating exploration of patient expectations, point-of-care testing and discussing watchful waiting into the decision-making process will benefit appropriate prescribing of antibiotics.

Background: Liver disease is an increasing cause of premature mortality. Early detection of liver disease in primary care gives opportunity to intervene and change outcomes. Engagement in liver disease care by NHS bodies responsible for primary care pathway development could drive improvements. The formation of integrated care systems (ICS) in England provides an opportunity to reassess engagement with liver disease nationally.

Aim: To update the level of engagement with community chronic liver disease management among ICSs and health authorities across the UK.

Design & setting: A cross-sectional follow-up survey to ICS and UK health boards.

Method: Questions used for a previous survey in 2020 were adapted and sent electronically to NHS bodies responsible for health care across the UK, using a freedom of information request. Quantitative analysis was undertaken using Microsoft Excel.

Results: There were 67 responses from 68 possible ICS and health board areas, representing 99% UK coverage. Twenty-seven per cent had a named individual responsible for liver disease. Monitoring of local liver disease health statistics happened in 34% of all UK areas. Comprehensive care pathways were available in n = 24/67 (36%) of areas, an increase from 26% in the 2020 survey. Areas with no liver pathways in place fell from 58% to 36% between the two surveys. Regional variations persist, with Wales and Scotland moving towards comprehensive coverage. Almost double the number of areas were making use of transient elastography within community pathways of care, up from 25% to 46%.

Conclusion: The results of this re-survey highlight improvements, but emphasise the need to build on regional success to further reduce inequality in care commissioning.

Background: Despite women comprising 52% of full-time equivalent general practitioners (GPs) in England, a significant gender pay gap persists (15% after adjustments). Further understanding of the barriers and facilitators impacting women GPs' careers is needed.

Aim: To identify and synthesise research evidence exploring barriers to and facilitators of women GPs' careers.

Design & setting: Systematic review of qualitative and quantitative studies. Studies were included of general practitioners conducted in the UK NHS general practice setting.

Method: Review methods followed Cochrane and PRISMA guidelines to systematically search MEDLINE, Embase, HMIC and Google Scholar to identify studies that explored gendered barriers and facilitators to GP careers. An inductive thematic analysis was used to synthesise the evidence.

Results: 21 articles were included in this review, with varied study designs. No relevant intervention studies were identified. There was a lack of recent research evidence; over half of the studies were conducted over 20 years ago. Most met quality criteria, though there were some problems with reporting and adjustment for potential confounders. Studies found barriers at personal, socio-cultural and system levels that inhibit women GPs' careers. While some positive changes have been documented across studies that span some thirty years, many challenges remain.

Conclusion: Despite general practice being a medical specialty where women outnumber men, barriers at personal, socio-cultural and system levels continue to inhibit women GPs' careers.

Background: GPs and primary care services have been identified as crucial to the care of people with personality disorder. Individuals living with personality disorder frequently face stigma and difficulties when accessing healthcare. Primary care staff often describe feeling demoralised, incompetent, hurt or angry after difficult interactions with patients.

Aim: To evaluate the effect of PDPOP training delivered to 10 GP practices in 2022-23.

Design & setting: PDPOP is a co-produced training course aimed at all staff within GP surgeries to help teams, including administrative, reception and clinical staff, to feel confident and skilled when interacting with patients who may have personality disorder.

Method: The New World Kirkpatrick Model was used to evaluate the training, through questionnaires pre- training, post-training, at follow-up, and semi-structured interviews.

Results: Evaluation found that practice teams were highly satisfied with PDPOP training and found it relevant, engaging and useful. Results demonstrated that staff felt more confident and skilled when interacting with patients who may have personality disorder through use of the training's core concepts. Increased confidence in managing distress, crisis and participant's own emotions, was associated with reduced impact on staff at interview. Practices also demonstrated action taken post-training to reduce dependency on primary care services.

Conclusion: By including lived-experience trainers and introducing core concepts, PDPOP has demonstrated a sustained positive impact on primary care teams. Further expansion of this type of training may help to increase the confidence of healthcare staff in delivering care to patients with personality disorder and similar complex emotional needs.