BJGP Open最新文献

Background: Type 2 diabetes mellitus (T2DM) is a major global health concern. Weight management in T2DM/prediabetes can improve quality of life (QoL) and glycaemic parameters. People with T2DM/prediabetes experience threats/barriers regarding weight management but current evidence is lacking.

Aim: The aim was to determine experiences, perceptions, facilitators and barriers related to weight management in T2DM/prediabetes.

Design & setting: Systematic review in primary care settings.

Method: A systematic search of ten databases including Medline, CINAHL Plus and Scopus, and hand searching (2015-2025), generated 5315 qualitative and mixed methods studies. We used Braun and Clarke's thematic analysis to synthesise data, and CASP tools and Hawker's quality assessment tool to assess study quality, risk of bias and strength of evidence. The Joanna Briggs Institute (JBI) standards and PRISMA guidelines were adhered to, and narrative synthesis presented findings.

Results: Thematic analysis on the article texts of 43 studies identified five overarching themes regarding success or failure of weight management in T2DM/prediabetes: (i) nutrition, diet and exercise (ii) patient/ health care professionals (HCPs) experience and knowledge (iii) perceptions and behaviours (iv) challenges, threats and barriers, and (v) roles and responsibilities. While facilitators included better support, education, motivation, diet/exercise adherence and access to care-facilitated weight management, threats or barriers included time constraints, social pressure, inequalities, language barriers and stigma, for those with T2DM/prediabetes. Clinicians/HCP are perceived to be supportive in weight management and could help overcome threats or barriers in T2DM/prediabetes.

Conclusion: Emergent evidence on weight management in T2DM/prediabetes indicates that stronger support and personalised approaches are essential. Tailoring programmes could improve weight management in T2DM/prediabetes. Future interventions should address inequalities, stigma, language barriers, and misinformation, and offer tailored advice on lifestyle, diet and exercise, and improve resources for those with T2DM/prediabetes.

Background: General Practitioner (GP) out-of-hours (OOH) co-operatives provide urgent primary care across the Republic of Ireland, but national workload trends and hospital referral patterns are poorly described.

Aim: To quantify OOH activity (2013-2022), examine for changes in OOH service utilisation over time , and describe emergency department (ED) referral rates.

Design & setting: Retrospective observational study using aggregated electronic medical record (EMR) data from eight large GP OOH co-operatives across the Republic of Ireland, 2013-2022.

Method: Annual measures included total consultations and consultation type (triage-nurse versus GP consultation; teleconsultation, treatment-centre visit, home visit). Subsets provided age mix and ED referral data. Descriptive analyses were contextualised with nationally available open data and prior literature.

Results: Across 2013-2022, participating OOH services recorded approximately 0.9 million consultations annually, with an overall 26% rise in consultations over the 10 year period. Two major inflection points were observed: introduction of free GP care for under-6s (2015) was followed by a 17% rise in consultations (2014-2016), whereas COVID-19 coincided with an 18% fall in consultation volume and fewer face-to-face visits (2020-2022). ED referral rates remained broadly stable at~13% throughout.

Conclusion: OOH GP co-operatives provide substantial, adaptive capacity- managing the vast majority of patients within primary care. This study supports the view that OOH co-operatives act as a buffer for EDs and a pressure-release valve for daytime general practice. Routinely collected EMR data can track OOH activity over time and should inform workforce and service planning.

Background: Underuse of emollients and topical corticosteroids (TCS) contributes to uncontrolled atopic eczema, but variations between countries remain unclear.

Aim: To compare the actual use of emollient and TCS use in childhood eczema in the UK and The Netherlands (NL) and examine treatment adherence in relation to guidelines.

Design & setting: A secondary analysis of data from the Rotterdam Eczema cohort study (n=367) (NL), the BATHE trial (n=482) (UK) and BEE trial (n=520) (UK).

Methods: Frequency of emollient and TCS use were compared at baseline and after 12-16 weeks of follow-up by age, sex and disease severity. Treatment adherence was defined as: 1 a) not using an emollient at all, 1b) not using an emollient when a TCS was used, 2) not using a TCS when eczema is mild or worse. Overall undertreatment was defined as category 1 and 2 combined.

Results: In total, questionnaire data from 1312 children (aged 3 months-17 years) with mostly mild (26-37%) or moderate (45-48%) eczema were analysed. Not using an emollient was significantly more prevalent in NL at baseline (14%) and follow-up (19%) than in the UK (4% and 7.6%, respectively). Not using a TCS when eczema is mild or worse differed significantly (P<0.05) between countries. The overall undertreatment rate was high and did not differ significantly between countries at baseline (UK 52.0%-NL 48.2%) and follow-up (UK 45.0%-NL 49.8%).

Conclusion: Undertreatment with emollients and TCS are common and a reminder for clinicians to explain treatment rationale and check treatment adherence. Differences in treatment practices between countries warrant further exploration.

Background: General practice nurses in England often manage long-term conditions, with more people now living with multiple conditions (MLTC). Evidence on the effectiveness and delivery of person-centred care for MLTC is limited, and the nurse's role - including necessary training - remains underexplored.

Aim: To identify and characterise general practice nurses' experiences of undertaking person-centred multiple long-term condition reviews in England.

Design & setting: Secondary analysis of qualitative data gathered from general practice staff in England.

Method: Two-part review consultations for people with three or more long-term conditions (rather than separate single-condition reviews as per usual care) in sixteen English general practices, part of a larger implementation project (PP4M). Empirical qualitative data (healthcare staff interviews and researcher fieldnotes) and theoretical approaches (chronic care model, normalisation process theory) analysed abductively.

Results: Two overarching themes identified:Healthcare professionals' understanding of MLTC reviews' purpose. Challenges and opportunities for nurses delivering MLTC reviews.Some nurses utilised reviews as data-gathering exercises, facilitating collection of nationally set, quality-driven, financial incentives linked to single-conditions. Other nurses used reviews as opportunities for meaningful discussion of complex problems, leading to action.MLTC reviews allowed nurses a new way of thinking. Some found this empowering, others found it challenging.

Conclusion: General practice nurses are central to MLTC care. They value organisational support for training in person-centred MLTC management, but it remains unclear how best to achieve necessary training. Further research is needed on skills and training required for all healthcare professionals caring for people with MLTC.

Background: Cervical screening programmes are long-established and supported by robust evidence, but participation is declining. Around a third of those eligible did not participate in England in 2023-24.

Aim: To evaluate the feasibility and acceptability of an audit and feedback intervention to improve the uptake of cervical screening in general practice.

Design & setting: Semi-structured interview study with general practice staff in three Primary Care Networks (PCNs) and regional and national policy leaders.

Method: Quarterly reports were generated for 23 general practices comparing cervical screening coverage with other local practices with similar population levels of deprivation, alongside resources and practical suggestions to improve screening uptake. Reports were emailed to practice managers requesting they be shared with teams. We conducted semi-structured interviews with practice staff and health service leaders to determine how the reports were received, understood, and used. Interviews were structured and analysed using Clinical Performance Feedback Intervention Theory (CP-FIT).

Results: Fourteen practice staff and three service leaders were interviewed. Practice teams seldom recalled seeing the feedback reports prior to interview invitations but generally viewed them positively when shown at interview. Report format, length, frequency and content were considered appropriate. Staff involved in cervical screening found the reports clear and informative, and thought that enhanced awareness and motivation could prompt positive actions.

Conclusion: Audit and feedback cannot improve cervical cancer screening uptake if targeted recipients do not receive it. More effective methods are required to engage or circumvent practice 'gatekeepers' to ensure feedback reach.

Background: We conducted research on the diagnosis and treatment of urinary tract infections in general practices in the Northern Dutch-German cross-border region. We encountered various challenges including prolonged formal ethical and legal processes, data collection, and recruitment of both general practitioners (GPs) and patients.

Aim: To provide recommendations for those in the early stages of planning and conducting research in general practices.

Design & setting: Opinion paper based on experience conducting a cross-border prospective study.

Method: We present an overview of the strategies employed to collect data and recruit participants, along with their respective advantages and disadvantages.

Results: We recruited GPs by post, email, and newsletters with varying success rates depending on the region. Overall, personal approaches fared better, leading to increased willingness to participate in the study. We used two distinct measures to collect data: students in the Netherlands and practice assistants in Germany. While utilising student assistants alleviated the constraints associated with study participation for a general practice, their limited availability disrupted the continuity of data collection phases. Instructing practice assistants to collect data independently enhanced flexibility regarding patient recruitment, but our experience revealed that this approach was more prone to errors, likely due to heavy workloads. Designating a contact person within the practice facilitated communication between the practice and the researchers, providing reminders for the ongoing study recruitment.

Conclusion: With research in general practice becoming increasingly important, it is necessary to illustrate its barriers and facilitators. Data collection strategies have to be carefully assessed and selected according to the specific needs of practices (eg, flexibility, time constraints) to mitigate disruption of regular care.

Background: There is much untapped potential for large-scale, community-based clinical trials in primary and community care; realising that potential is an important endeavour.

Aim: To understand what steps lead to readiness for clinical trial delivery in routine practice in primary and community care.

Design & setting: Scoping review of sources involving UK primary and community care settings and written in English.

Method: Three databases (Medline All, Embase and Web of Science Core Collection), grey literature and reference lists of relevant sources were searched for all types of literature available in English on the readiness of primary and community care within the UK to conduct clinical trials research. These sources underwent screening which was conducted according to relevance as judged by two independent researchers. Thematic analysis was then undertaken.

Results: Thirteen sources met the inclusion criteria. These sources covered a variety of primary and community care settings including general medical practice, general dental practice and carehomes. Themes identified for clinical trial readiness were: a supportive research culture, strong leadership, adequate infrastructure and targeted training, all underpinned by streamlined governance processes and appropriate incentives.

Conclusion: This scoping review highlights that the readiness of primary and community care as a clinical research setting is shaped by a complex interplay of organisational, cultural, and structural factors. To realise the full potential, sustained investment and policy attention is needed to embed these elements into routine practice across diverse care environments.

Background: The migration status of the 9.8 million migrants living in England is not consistently recorded in primary care electronic health records (EHRs). Codelist approaches enable creation of cohorts of individuals who have had a predefined, optional migration-related code (e.g. "refugee") added to their EHR.

Aims: We aimed to explore the use of migration-related SNOMED CT codes to inform future research using primary care data.

Design & setting: We used our OpenCodeCounts tool to explore data published by NHS England on SNOMED CT code usage in English primary care.

Method: We created migration-related codelists and described their use from 1st August 2011 to 31st July 2025. To understand code usage in the context of known information on migrants in England, we compared code usage to trends in migration-related statistics from the Home Office and the 2021 Census.

Results: There were 34.2 million uses of 1119 migration-related codes from 2011 to 2025. Migration-related coding increased over time, generally exceeding the increase observed for coding overall, with a sharp increase from 2020, particularly for country-of-birth and language. Language-related coding represented 65% of code usage and where country of birth was recorded, there was mixed agreement with the Census. Coding of immigration legal statuses was low and overwhelmingly about asylum/refugee status.

Conclusion: Utilising OpenCodeCounts, we demonstrate the feasibility of using migration-related SNOMED CT codelists within primary care EHRs and highlight some of the potential biases that cohorts created based on these codelists may have to inform future research.

Background: Early chronic obstructive pulmonary disease (COPD) diagnosis is vital, but little is known about compliance with relevant diagnostic guidelines or variation in primary care.

Aim: To quantify between-practice variations in guideline compliance and over time.

Design & setting: An observational study in English primary care.

Method: The Clinical Practice Research Datalink was used to assess the use of four pre-diagnostic investigations (spirometry, chest X-ray, full blood count [FBC], and body mass index [BMI]) by GP practices for patients with COPD recorded first in primary care, in three time periods: 2006-2007 (cohort 1), 2016-2017 (cohort 2), and March-August 2020 (cohort 3). Multilevel logistic regression models quantified the non-random variation between GP practices in spirometry around diagnosis. Funnel plots counted the proportion of outliers.

Results: Cohort totals were 31 676 (cohort 1), 37 393 (cohort 2), and 3368 (cohort 3). Overall, the mean age was 68.3 years (standard deviation 12.0), with 46.1% female. The use of pre-diagnosis spirometry improved a little in cohort 2 (74.2%) on cohort 1 (62.8%) but fell back for the COVID-19-era group (61.1%). In contrast, chest X-ray, FBC, and BMI all improved after cohort 1 and were maintained for the COVID-19 cohort; almost all patients received one of these investigations. The proportion receiving all four investigations before diagnosis jumped from 26.6% in cohort 1 to 46.7% in cohort 2 and was maintained in cohort 3 (43.0%). Modelling and funnel plots showed considerable non-random variation in spirometry use by practice, although with some improvement since cohort 1.

Conclusion: The recording of spirometry and chest X-rays warrants further and consistent improvement in the context of COPD care.

Background: Dispensing practices, which have in-house dispensaries, are paid to dispense medications directly to patients. Evidence suggests that this financial incentive influences prescribing behaviour, although the underlying mechanisms remain unclear.

Aim: To investigate the impact of dispensing status on prescription length in England.

Design & setting: Quasi-experimental, repeated-measures, cross-sectional study of English general practices.

Method: Business administration data classified practices as dispensing or non-dispensing, determined the percentage of patients eligible for dispensing, and captured prescription lengths for seven drugs with fixed dosing regimens at 3-month intervals from July 2023 to April 2024. Generalised estimating equations analysed the relationship between dispensing status and the proportion of patients eligible for dispensing with average prescription length, controlling for patient and practice characteristics.

Results: Adjusting for patient and practice characteristics, dispensing practices prescribed shorter average lengths for all drugs. Desogestrel showed the largest difference (21.9 days shorter), followed by indapamide standard release (9.85 days), indapamide modified release (9.71 days), ezetimibe (8.41 days), tamsulosin (7.18 days), alendronic acid (6.63 days), and dapagliflozin (5.85 days). An increase in the proportion of patients eligible for dispensing was associated with significantly shorter prescription lengths across all drugs. Dispensing practices more consistently prescribed medications for 28-31 days, whereas non-dispensing practices showed greater variability.

Conclusion: Dispensing practices are associated with shorter prescription lengths, increasing the number of prescriptions issued over time and the associated dispensing fee. The absence of clear guidance on prescription lengths likely contributes to this variability. Central bodies should consider providing explicit recommendations to optimise prescription durations.