BJGP Open最新文献

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: 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: 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: 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.

Background: Cardiovascular disease (CVD) is the main cause of mortality in type 2 diabetes (T2DM) and detection of CVD risk is a key part of routine care. Slow walking speed is strongly correlated with CVD events in the general population.

Aim: To see if this applies in people with Type 2 diabetes.

Design & setting: Systematic review of studies of people with Type 2 diabetes METHOD: We searched studies in which usual walking speed was recorded, and participants were followed up for subsequent fatal and non-fatal cardiovascular events. (PROSPERO CRD42024578164) PubMed Central, Web of Science, Cochrane Register of Controlled Trials and Google Scholar were searched in December 2024. Studies were screened by two independent reviewers. Studies reporting walking speed or comparable indices and CVD outcomes in T2DM were included. Study quality was assessed using the Newcastle-Ottowa Scale. Heterogeneity of study populations prevented meta-analysis.

Results: Out of 1281 studies identified, 53 full-texts were retrieved and four were included, all of good quality. These involved 132 967 individuals with diabetes from USA, UK and Japan. Mean study follow-up was 3-14 years. All four studies assessed walking speed by self-reported questionnaire and reported significant associations between reduced walking speed and increased CVD risk with risk/hazard ratios ranging from 1.18-5.88.

Conclusions: This is the first systematic review to indicate an association between reduced walking speed and increased CVD incidence in T2DM. This association is seen across diverse populations and settings. Further research in T2DM could explore whether increasing walking speed reduces CVD risk.

Background: Asthma is frequently misdiagnosed because clinic-based tests miss its natural variability.

Aim: As part of early stakeholder engagement, we examined primary-care healthcare professionals (HCP)' views on using handheld spirometer and fractional exhaled nitric oxide (FeNO) for home-based diagnostic testing.

Design & setting: This is a two-phase mixed-method study. Phase 1 involved two focus groups with primary care HCPs in North-West England. Phase 2 involved a national electronic survey distributed to primary-care HCPs across the UK.

Method: We used Nominal Group Technique in focus groups to identify key priorities for home-based asthma strategy, which informed the development of the national survey in Phase 2.

Results: Twenty-one primary care HCPs took part in focus groups. Advantages, challenges and facilitators for implementing home-based asthma diagnostics were identified. A total of 104 primary care HCPs completed all survey questions. Respondents represented a wide demographic and practices across all levels of socioeconomic deprivation. Only 3% considered home-based diagnostics strategy is unlikely to be feasible. The most frequently cited barrier was high device cost, while patient engagement and device accessibility were identified as the most important enablers. Most respondents highlighted more accurate asthma diagnosis as key potential benefits.

Conclusion: Home-based asthma diagnosis using handheld spirometry and FeNO is generally viewed favourably by primary care professionals based on survey findings, though implementation challenges are multifaceted. Success will require system-level changes in how home-based testing is delivered and supported. The subsequent phase involves evaluation of test feasibility and accuracy, followed by assessment of clinical and cost-effectiveness.

Background: People experiencing homelessness (PEH) are disproportionately affected by frailty, yet few interventions have targeted this syndrome in this population.

Aim: To assess the feasibility, and potential impact of a combined exercise and nutritional intervention for PEH living with frailty.

Design & setting: A single-arm feasibility trial in a GP clinic for PEH in Ireland.

Method: A two-month exercise and nutritional intervention tailored for PEH was offered to potential participants. Pre-frail and frail individuals attending a GP clinic for PEH in Ireland were invited to participate. The primary outcomes was feasibility, assessed using Bowen's framework. Secondary outcomes were based on potential impact and included frailty scores (Clinical Frailty Scale [CFS] and SHARE-Frailty Index [SHARE-FI]) and weight. A process evaluation explored participant experience.

Results: Of 124 eligible individuals, 108 (87.1%) enrolled, and 75 (69.4%) completed follow-up. Among those followed up, 70 (93.3%) engaged with at least one component of the intervention, with the majority finding the intervention easy to follow. CFS and SHARE-FI scores improved following the intervention in those followed-up.

Conclusions: This study supports the feasibility of a primary care-based exercise and nutritional intervention for PEH living with frailty. The intervention appeared to be safe and to improve frailty status of participants and can inform the design of a definitive trial.