BJGP Open最新文献

Background: Emergency presentations in General Practice (GP) are increasing, yet teams may go months without managing one. Cognitive aids such as checklists improve in-hospital emergency care, but existing tools are poorly suited to GP.

Aim: To identify common emergency presentations in GP and co-design bespoke checklists for safer management.

Design & setting: Participatory design of GP-specific emergency checklists and usability testing in real clinical settings with multidisciplinary GP teams.

Method: A multidisciplinary expert group used a mixed-methods participatory methodology to prioritise emergencies and develop checklists for a GP Quick Reference Handbook (GP-QRH). In-situ simulations in 29 GP practices informed iterative refinement of checklist content, layout and usability.

Results: The final GP-QRH comprised 15 clinical emergency checklists, one checklist for non-clinical staff, a structured handover template and emergency debrief guidance. Testing the final version in 11 GP practices was uniformly positive and emphasised the importance of simple design, clear language, prominent prompts for escalation, and team training in checklist use.

Conclusion: We have developed the first QRH for General Practice specifically tailored to primary care, co-designed with intended users. Its impact will depend on commitment to consistent use, local leadership and advocacy across GP networks. Further usability testing, evaluation of clinical impact and development of additional checklists are needed, but the GP-QRH has the potential to enhance emergency care and patient safety in UK general practice and internationally.

Background: High-risk patients with chronic conditions in Primary Care often face medication-related problems. A significant but underexplored problem is the patient's medication concern, which may also impact treatment decisions and outcomes.

Aim: This study aims to describe the characteristics of high-risk patients with chronic conditions in Madrid, Spain, who have documented medications concern and to analyze the associated factors.

Design & setting: Descriptive cross-sectional study, conducted within the IMI-H2020 European BEAMER project, including all high-risk patients with chronic conditions in the Madrid region.

Method: Patients were identified by the Adjusted Morbidity Groups stratification tool in Primary Care electronic clinical records. Variables included sociodemographic, clinical, and pharmacological, along with self-reported medication concerns. Univariate and bivariate analyses, and logistic regression models, were performed with medication concern as the dependent variable.

Results: In all, 40 776 (28.56%) reported medication concern. Patients with medication concern were older (84.64 vs 72.69 years), had more chronic conditions (7 vs 6) and medications (9.7 vs 8.7). They were more likely to live alone (8.5% vs 2.7%) and showed higher dependency. Older age OR 11.0 (95%CI:5.4-22.3; P-value<0.001), polypharmacy OR 3.2 (95%CI:3.1-3.3; P-value<0.001), living alone OR 1.5 (95%CI: 1.4-1.6; P-value<0.001), Parkinson's OR 1.3 (95%CI: 1.2-1.4; P-value<0.001); chronic pain OR 1.6 (95%CI:1.2-2.1; P-value=0.001), and cardiovascular risk factors OR 1.2 (95%CI: 1.1-1.3; P-value=0.001) were associated with medication concern.

Conclusion: Age, polypharmacy, multimorbidity, and social isolation are predictors of medication concern in high-risk chronic patients in Primary Care. Addressing psychological barriers, simplifying treatment, and strengthening social support through tailored interventions could decrease medication concerns.

Background: Patients on antipsychotic medication (APM) have an increased risk of cardiovascular disease (CVD). In general practice, however, there is a lack of solid cardiovascular risk (CVR) management for this specific group. TACTIC, a person-centred multidisciplinary cardiovascular risk programme, which aims to decrease cardiovascular risk and review APM use, was piloted in general practice.

Aim: To explore barriers and facilitators for delivering the TACTIC intervention, and assess which adjustments have to be made to evaluate its effectiveness and implementability in a future randomised controlled trial (RCT).

Design & setting: Qualitative analysis of the feasibility study in three Dutch general practices.

Method: We performed eight individual interviews with patients and two focus group interviews with 11 healthcare professionals (HCPs) involved in the study. Interviews were semi-structured and topic guides were informed by the normalisation process theory (NPT). We used the framework method for analysis of our data.

Results: The three main barriers for delivering TACTIC were as follows: the tension towards the intervention experienced by patients; the course of the multidisciplinary meeting (MDM); and the high workload experienced by GPs. The main facilitators were associated with the person-centred approach, the clear information meeting, and the ability of adjusting roles during the course of the intervention, including bringing a carer. Valuable suggestions for improvement were introducing a summary report from the psychiatrist, improving expectation management for patients, and adjusting the definition of the target group.

Conclusion: Several adjustments to the TACTIC intervention are necessary before evaluation in a larger RCT can take place. This work underlines the importance of performing a feasibility study before a trial to improve its effectiveness and efficacy.

Background: Suicide is a major public health issue. More than one third of patients will visit their GP in the month leading up to a suicide attempt, thus highlighting the key role GPs play in suicide prevention.

Aim: To explore the qualitative research on GPs' perspectives of suicide prevention in primary care.

Design & setting: A systematic scoping review of qualitative studies relating to the research question.

Method: This review is reported in accordance with Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidance. Articles at full-text review were assessed for inclusion in the study against eligibility criteria (English language, qualitative research, focus on GPs' perspectives of suicide prevention). Data were extracted using a standardised form and a thematic synthesis approach was used to describe the themes elicited from the studies.

Results: In total, 2210 abstracts were screened. Twelve studies from seven countries were included at full-text review. The following four main themes were elicited: challenges to managing suicidal behaviour; fragmented relationships with mental health services; personal attitudes of GPs regarding suicidal behaviour; and identified needs to improve suicide prevention in primary care.

Conclusion: Understanding GPs' perspectives can lead to improved training, resources, and support for primary care professionals, who are frontline providers of mental health care. This scoping review suggested there is a lack of evidence around what approaches GPs find effective in managing suicidality and how relationships can be strengthened with mental health services to deliver person-centred integrated care for those identified at risk of suicide.

Background: Transforming primary care (PC) through the development of multidisciplinary teams can represent a challenge in terms of occupational wellbeing.

Aim: To investigate associations between occupational stress, job satisfaction among GPs, and the professional composition of PC teams.

Design & setting: We conducted a secondary analysis of the data from 11 Western countries that participated in the 2019 Commonwealth Fund International Health Policy Survey of Primary Care Physicians (n = 13 200).

Method: PC practice types (n = 5) were defined in a previous study, based on their composition of healthcare professionals, which were as follows: traditional; multidisciplinary; nurse-centred; psychologist-centred; and physiotherapist-centred models. Using ordered logistic regression analysis, we assessed associations between the five practice models and two GP-reported indicators of wellbeing at work: job satisfaction and occupational stress.

Results: Working in multidisciplinary teams, when compared with traditional (GP-centred) practice, was associated with higher occupational wellbeing, both through lower occupational stress (odds ratio [OR] 0.77, 95% confidence interval [CI] = 0.68 to 0.87) and greater job satisfaction (OR 1.43, 95% CI = 1.26 to 1.62). This positive association was also observed in psychologist-centred practices for occupational stress (OR 0.81, 95% CI = 0.71 to 0.93) and for job satisfaction (OR 1.24, 95% CI = 1.09 to 1.42). Working in nurse-centred practices was associated with greater satisfaction but only in the smallest practices (OR 1.59, 95% CI = 1.14 to 2.22) with <1.4 full-time equivalent (FTE) GPs.

Conclusion: Positive associations between multidisciplinary PC teams and occupational wellbeing are important results for the future of healthcare systems in Western countries, providing interesting avenues for improvements for healthcare professionals and policymakers.

Background: General practices have been a long-standing focus of pharmaceutical promotion, but their financial relationships with pharmaceutical companies remain understudied.

Aim: To examine pharmaceutical company payments to general practices in England from 2015-2022, focusing on changing patterns of payments and what this reveals about companies' marketing.

Design & setting: Descriptive analysis of pharmaceutical company payments made to practices using data from industry's Disclosure UK database, covering 4430 recipient practices and 54 companies over an 8-year period.

Method: Annual Disclosure UK data from 2015-2022 were merged, identifying practices using a novel algorithm-based methodology, and categorising payments by type (for example, donations and grants, event sponsorship). Trends were analysed by company and payment type. The Gini coefficient measured payment concentration, and the persistence of relationships was assessed over time.

Results: Pharmaceutical payments to general practices rose from £2.5 million in 2015 to £7.5 million in 2022. While 54 companies made payments, just one company, Chiesi - marketing commonly prescribed respiratory inhalers - accounted for more than 50% of the payment value from 2017 onwards. More than 40% of practices received payments from only one company, and 74% of company-practice relationships lasted just 1 study year. A few companies dominated, with a Gini coefficient of 0.86, driven by Chiesi's payments.

Conclusion: The growing scale and concentration of payments and the dominance of one company raises concerns about bias in general practice. Future research should investigate the impact of payments on clinical decision making, but to do so, payment disclosures need enhanced transparency, particularly through including product-specific payment details.

Background: The rising prevalence of poor workplace wellbeing in healthcare practitioners has been defined as a global crisis, threatening the sustainability of healthcare systems and the quality of care. General practice staff in England are especially impacted, yet it is unclear how support for this workforce is delivered, and where accountability for this sits.

Aim: Map the provision of wellbeing strategies and interventions for the general practice workforce in England.

Design & setting: Survey and review of grey literature in contemporary England general practice.

Method: We sent Freedom of Information (FOI) requests between 28th February and 12th March 2025 to all Integrated Care Boards (ICBs) in England. We also sought existing information sources via targeted searches (eg, of professional organisation websites) and through engagement with relevant stakeholders, who also guided our methods, analysis, and dissemination.

Results: All 42 ICBs in existence at the time responded to the FOI request. Respondents' roles and responses varied widely, including the extent to which general practice staff wellbeing was seen as the responsibility of the ICB and whether/what wellbeing services were offered. We identified 139 wellbeing services available to general practice staff via the FOI and 53 via the targeted searches. Most services appeared to be reactive and aimed at the individual level.

Conclusion: This is the first study mapping workplace wellbeing services for the general practice workforce across England. Our results suggest there is an interest in staff wellbeing. More preventive approaches addressing systemic workplace wellbeing factors are now needed. Future research should evaluate the impacts of wellbeing support for the general practice workforce.

Background: General practice (family medicine) experiences more violence and abuse by patients and the public than other healthcare settings. There is limited research on such experiences amongst non-clinical staff, and no direct comparisons between staff groups in general practice.

Aims: To explore: The extent of violence and abuse from patients or the public towards general practice staff between 2020 and 2023; Staff correlates and environmental correlates for violence and abuse; Potential impacts of violence and abuse regarding staff feeling of safety and support at work.

Design and setting: An online survey of general practice staff was conducted across England between 11/7/23 and 30/11/23.

Methods: Questions covered demographics, physical violence and threats, verbal abuse, harassment, and inappropriate sexual behaviours experienced or witnessed between 2020 and 2023. It asked whether participants felt safe and supported at work.

Results: Participants (N=1,152, 44% clinical, 56% non-clinical) were aged 21-75 years (mean=47.3 years, SD=11.1). Overall, 93.7% reported violence and abuse, with 92.3% reporting verbal abuse, 47.7% reporting physical violence or threats, 60.5% reporting feeling harassed, and 23.7% reporting inappropriate sexual behaviours. Additionally, 21% of staff felt unsafe but only 57.1% felt supported at work. Non-clinical, younger or less experienced staff and those in urban and deprived areas experience more violence and abuse. Those experiencing it more frequently felt less safe and supported.

Conclusions: Violence and abuse from patients and the public towards general practice staff may be prevalent and increased since the COVID-19 pandemic. Those at greater risk require more organisational support.

Background: Previous work has highlighted that migraine is underdiagnosed and undertreated in primary care.

Aim: To characterise diagnosis and treatment patterns among patients with migraine in England.

Design & setting: A retrospective cohort study using the Clinical Practice Research Datalink Aurum linked to the 2019 Index of Multiple Deprivation dataset.

Method: The study cohort included patients presenting to general practices with migraine at age≥18 years from September 2012 to May 2023 (index event). Prescribed medications 12 months after index were compared across sociodemographic stratifications (age, sex, ethnicity, and deprivation). Medication overprescription was defined as≥10 days' (opioids/triptans) or≥15 days' (analgesics/antipyretics/NSAIDs) supply in 3 consecutive months.

Results: 1,534,807 patients with any headache/migraine were observed attending primary care in England. 876 233 (57.1%) were coded with undifferentiated/unclassified headache and 606 928 (39.5%) with a primary headache disorder. Migraine was the most coded primary headache disorder, with 476 191 adults (78.5%), constituting the final sample used for subsequent analyses. Only 36.5% of the migraine cohort were prescribed preventive medication. 17.9% of those prescribed amitriptyline, 31.3% prescribed propranolol, and 31.2% prescribed topiramate reached SIGN 155/NICE CKS recommended doses. 62.6% of the migraine cohort were prescribed an acute medication: triptan (36.6%), opioid (9.6%). 23.6% of triptan users and 44.3% of opioid users exhibited medication overprescription, consistent with the ICHD-3 medication overuse definition.

Conclusion: The majority of headache presenting to primary care remains undifferentiated/unclassified. Only one-third of patients diagnosed with migraine receive triptans or preventive medication. Acute medication overprescription is common and preventive medicines are poorly optimised.

Background: Carers are important facilitators to patients accessing care and having positive experiences. Carers often accompany patients to their consultations, providing emotional and physical support. To our knowledge, there is limited research identifying and describing the specific activities carers are involved in or the translatability of these activities to virtual care.

Aims: To 1/ identify and describe the activities carers are involved in during consultations with their general practitioner and 2/ to assess how these activities could translate to virtual care consultations.

Design & setting: This study screened 281 videos of in-person GP consultations set within 10 UK general practices, and 39 were eligible for analysis.

Method: Secondary analysis of in-person GP consultations to extract activities involving the carer. A novel evidence-based scoring system was used on each activity, determining the likelihood of whether each carer-related activity could be supported in virtual care.

Results: A total of 39 activities (7 categories) where carers were involved were identified. Out of these 39 activities, 25.6% (10/39) were categorised 'health information sharing', 23% (9/39) were categorised 'emotional or physical support', 20.5% (8/39) were categorised 'history taking', 12.8% (5/39) were categorised 'health-related at-home activities', 7.7% (3/39) were categorised 'logistics', 7.7% (3/39) were categorised 'building a relationship', and 2.6% (1/39) were categorised as 'other'. The average score of an activity being translatable to virtual care is 13/15.

Conclusion: All activities involving carers were deemed translatable/potentially translatable to virtual care. Future research should examine ways to support carers and their roles during virtual care.