BJGP Open最新文献

Background: Heatwaves are becoming longer and more frequent. Despite the availability of open environmental data, little is operable and formatted for primary care use.

Aim: Create a user-friendly online mapping tool to assess the vulnerability of communities to heatwaves for use by primary care practitioners. This study questioned what knowledge needed to be deployed, who needed to participate and how the knowledge should be shared.

Design & setting: A participatory action-research project based on knowledge mobilization in France as part of the Green Data for Health Challenge.

Method: Knowledge was summarized on the factors most affecting heatwave vulnerability in a collaborative process, enabling a consensus on data variables and mobilised content for the online tool. Purposive sampling included primary care stakeholders with Regional Health Agencies (ARS), Public Health France, and data scientists.

Results and conclusion: Nineteen participants participated in ten co-construction workshops, a brainstorming carousel strategy and five weekly co-design meetings between December 2022 and June 2023. The heatwave vulnerability variable was constructed using surface temperature, social deprivation, vegetation coverage, and presence of air conditioning equipment. Identified experts mobilized data on the national composite indicator at the communal level for heatwave morbidity. There is no standard platform for sharing environmental data in France. This co-creation study offers a new approach to incorporating environmental data on heatwaves into primary care consultations. We demonstrate the importance of knowledge mobilisation in primary care to bridge the research-practice gap. Integrating primary care records with environmental data may promote broader applications for planetary health research.

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 amongst 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 used Microsoft Excel.

Results: There were 67 responses from 68 possible ICS and Health Board areas representing 99% UK coverage. 27% 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 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: Danish hospital physicians are required to mark their discharge summaries addressing whether the patient's general practitioner (GP) is recommended to follow up as well as suggest follow-up actions.

Aim: To investigate whether a new form of discharge summaries may contribute to improve the perceived patient safety following transition from hospitals to general practice.

Design & setting: This paper reports data from a questionnaire sent to a representative sample of GPs in Denmark.

Method: A questionnaire was prepared for GPs based on background material, focus group interviews and discussions with relevant professionals. It was subsequently pilot tested by fellow researchers and GPs and revised prior to the presently reported survey.

Results: Of 310 participating GPs, 197 (63%) 'totally agree' or 'partly agree' that the marked discharge summaries with a recommendation text box contribute to a better handover to general practice, and 223 (72%) 'totally agree' or 'partly agree' that they improve patient safety.

Conclusion: The majority of responding GPs believe that the marked discharge summaries with a recommendation text box enhance patient safety and facilitate the transition of care to general practice following hospital discharge.

Background: The true burden of acute lower respiratory tract diseases (aLRTD; includes acute lower respiratory tract infection, acute exacerbation of pre-existing heart failure and chronic lung disease) among adults presenting to primary care, and the proportion that are potentially vaccine preventable, is unknown.

Aims: To describe aLRTD incidence in adults presenting to primary care; estimate proportions caused by RSV, SARS-CoV-2 and pneumococcus; and investigate disease burden from patient and NHS perspectives.

Design & setting: Primary care prospective cohort study conducted in six representative General Practices (total ̴83 000 registered adults) in Bristol, UK.

Method: Adults (aged≥18 years) registered at participating General Practices and presenting to primary care (in-hours or out-of-hours) or emergency department (if not admitted) with aLRTD will be eligible and identified by real-time primary care record searches. Researchers will screen electronic GP records, including free text, contact patients to assess eligibility, and offer enrolment in a surveillance study and an enhanced diagnostic study (urine, saliva and respiratory samples; physical examination; and symptom diaries). Data will be collected for all aLRTD episodes, with patients assigned to one of three arms: surveillance, embedded diagnostic, and descriptive dataset. Outcome measures will include clinical and pathogen defined aLRTD incidence rates, symptom severity and duration, NHS contacts and costs, health-related quality of life changes, and mortality (≤30 days post identification).

Conclusion: This comprehensive surveillance study of adults presenting to primary care with aLRTD, with embedded detailed data and sample collection, will provide an accurate assessment of aLRTD burden due to vaccine preventable infections.

Background: People with asthma are recommended to have regular reviews in primary care, with assessment of symptoms, adjustment of treatment and self-management processes, and the delivery of a written action plan for emergencies.

Aim: Our study aimed to investigate the incidence and factors associated with attendance of annual reviews.

Design & setting: electronic health records for approximately 50 000 Scottish asthma patients, between 2008 and 2016.

Method: Multivariable logistic regression using linked primary care prescription data and primary care registration demographic data.

Results: There was a median of 381 days between subsequent reviews. Reviews in the index year were strongly associated with reviews in the following year (odds ratio 1.76 [1.68-1.84]). In contrast, asthma consultations (excluding reviews) in the index year were associated with a lower odds of having a review in the following year (0.48 [0.46-0.51]). Those aged 18-35 in the index year, or with missing address in the practice registration data, were the least likely age group to have an asthma review in the following year.

Conclusion: Reviewing the delivery of asthma care identifies patients who may be slipping through the gaps by receiving only reactive asthma care rather than the structured, preventative care which can be delivered through annual reviews. Understanding the risk factors for not receiving an annual review can be leveraged to create more effective review invitations, such as explaining the specific content of reviews, introducing new contact methods to improve health equity, and reviewing the algorithm used to determine who is invited.

Background: Good access to quality primary care in high-income countries can improve population health. Access to primary care is however often not equal among socioeconomic groups; our analysis sought to explore whether funding, a determinant of service supply, is equitably distributed among GP practices in Wales.

Aim: We sought to explore the relationship between funding and deprivation among GP practices in Wales, to understand the equity of current funding policies.

Design & setting: We obtained funding data for general practices in Wales between 2014 and 2022 and explored the equity of distribution using the percentage of practice patients living in the 20% most deprived small areas in Wales. We generated a linear regression model exploring the relationship between practice funding and deprivation, with an interaction term with time in years.

Results: Practice funding rose for all practices between 2014 and 2022. Practice deprivation and time in years were both associated with practice funding, with increases in practice deprivation associated with reduced funding allocations, and time being associated with a small increase in funding over the study period. Over the period of analysis of 2004-2022, for every 10% increase in patients living in the most deprived LSOAs, funding per patient decreases on average by 1%.

Conclusion: Primary cares in Wales in more deprived areas receive discernibly less funding per patient than those in less deprived areas. Given the potential and likelihood primary care can affect population health outcomes, this underinvestment may be contributing to existing health inequalities and requires urgent further analysis and action.

Background: Patients in old age often have complex care needs due to multimorbidity and polypharmacy. This qualitative study is part of a larger ongoing Swedish intervention trial Secure And Focused primary care for older pEople (SAFE), including shorter care agreements based on person-centred patient goals.

Aim: To explore, in a primary care setting, the views of older and vulnerable patients on a more systematic, proactive approach to care planning, including establishing and documenting care agreements based on person-centred goals.

Design & setting: Individual semi-structured interviews with patients (n 25) aged>75 years from 12 intervention primary health care centres.

Method: Qualitative content analysis.

Results: Three categories, with 10 sub-categories, were found: I would like to live in the present, so why plan ahead? Let me decide vs. they know best, and Care agreements usually went unnoticed. The latent theme, The ambivalence of care planning in the fourth age, was created to give a deeper meaning to the content of the categories.

Conclusion: This study emphasises that older, vulnerable persons have varying attitudes towards participation in proactive care planning. This ambivalence may originate from the individuals' desire to have their autonomy respected on the one hand and to avoid or postpone end-of-life conversations and care planning on the other hand. Patients also expressed a desire to be more actively involved in care planning. Although care agreements have the potential to increase patient involvement in proactive care planning, they often went unnoticed. The conversation itself was essential.

Background: Despite advances in glaucoma management, topical eyedrop treatment has been paramount, with prostaglandin analogues (PGAs) being first-line agents. While late presentation is linked with deprivation, there is no recent research examining associations between deprivation and prescribing within primary care.

Aim: To explore PGA prescribing in general practice over a 6-year timeline, assessing associations with deprivation.

Design & setting: Analysis of NHS Business Services Authority (NHSBSA) data for general practice prescribing in England from April 2016-March 2022.

Method: Glaucoma treatments by GP prescribers were extracted, identifying ~9.11-9.58 million prescriptions/annum. Data were linked to Index of Multiple Deprivation (IMD) quintiles of GP practices. Crude rates per 1000 population were calculated using population data from NHS Digital. Time-series analyses facilitated comparison in prescribing nationally and in deprived areas. Autoregressive Integrated Moving Average (ARIMA) modelling facilitated measurement of synchrony between time series using cross correlation.

Results: PGAs and fixed combination eyedrops accounted for approximately two-thirds of glaucoma-related prescribing. Prescriptions per month increased slightly over a 6-year timeline, but rates per 1000 population reduced in 2020-2021 during the COVID-19 pandemic. The number of PGA prescriptions dispensed in deprived areas was lower than all other quintiles. Cross-correlation analysis indicates a lag of ~12 months between average PGA prescribing nationally versus more deprived areas.

Conclusion: The rate of PGA prescribing in primary care was substantially lower in deprived versus affluent areas, with delayed uptake of PGAs in more deprived areas of ~12 months. Further research is needed to explore reasons for this discrepancy, permitting strategies to be developed to reduce unwarranted variation.

Background: People's involvement and participation in their own care are the essential basis of nursing care. This phenomenon can be characterised as an approach based on the integration of the person's values, beliefs, and preferences during nursing care. This process contributes to improve quality of care, improve satisfaction levels, and result in a better experience for people receiving care. To promote the person's participation in nursing care, it is necessary to better understand their experiences about this topic.

Aim: To synthesise the available evidence on people's experiences of their involvement and participation in nursing care in a hospital setting.

Design & setting: A systematic review that will be conducted according to the JBI methodology for systematic reviews of qualitative evidence.

Method: The study selection, critical appraisal, and data extraction will be conducted by two independent reviewers. This review will consider studies with a qualitative approach, published and unpublished, in Portuguese, English, or Spanish, with no temporal limit, which include adults, aged 18 years or older, who have experienced an admission to a hospital, that explored people's experiences of their involvement and participation in nursing care in hospital ward settings. Findings will be presented using a meta-aggregation approach and narrative format, and the final synthesised findings will be graded according to the ConQual approach.

Conclusion: It is expected that this qualitative synthesis will inform people, health professionals, and policymakers, allowing them to develop recommendations to promote the person's participation in nursing care.

Background: Role models encountered during undergraduate training play an important part in shaping future doctors. They can act as powerful attractants towards, and deterrents away from, a career in general practice. Many GP educators, who act as role models, are burnt-out and wish to leave the profession, which may limit their ability to influence students positively, with consequent detrimental impact on recruitment to the specialty.

Aim: A realist review will be undertaken, aiming to explore how, why, and for whom role modelling in undergraduate medical education can support medical students towards careers in general practice.

Design & setting: The realist review will follow Pawson's five steps, including: locating existing theories; searching for evidence; article selection; data extraction; and synthesising evidence and drawing conclusions. It will explore literature published in the English language between 2013 and 2024.

Method: An initial explanatory framework (initial programme theory; IPT) will be developed, guided by a stakeholder panel including medical undergraduates, GPs, and patient and public representatives. Searches will be developed and conducted in electronic databases and grey literature. Studies will be included if they explore the relationship between GP role modelling and undergraduate career choice, and relevant data will be extracted.

Conclusion: Findings will refine the IPT, unveiling key contexts, mechanisms, and outcomes that influence role modelling in undergraduate GP medical education and support or deter students from careers in general practice. These findings will support recommendations and interventions to facilitate positive outcomes, including improved recruitment to general practice.