BJGP Open最新文献

Background: Hidradenitis suppurativa (HS) is a painful, chronic, inflammatory skin condition affecting the skin folds. It is frequently misdiagnosed, leading to delays in care and the progression of the disease to permanent scarring.

Aim: To understand the level of knowledge and confidence of healthcare professionals (HCPs) in primary care managing patients with HS. To establish their ability to recognise the early signs of HS, awareness of associated comorbidities, and recognition of treatment options available in primary care.

Design & setting: A survey was distributed to HCPs working in primary care in the UK.

Method: The survey was disseminated via weekly GP bulletins distributed by local integrated care boards, the Primary Care Dermatology Society (PCDS) mailing lists, and at professional events.

Results: Of 183 responders, most (93%) did not have a specialist role in dermatology or a postgraduate qualification in dermatology (69%), 36 (20%) were not doctors, and there was a good geographical spread over the UK. Of the responders, 74% felt confident diagnosing HS, but only 39% were confident in managing the pain associated with the disease. Perceived confidence did not correlate with understanding the importance of early referral to secondary care where multiple skin sites were affected.

Conclusion: Further education in diagnosing and managing HS in primary care is needed. Future research could focus on developing a tool to support the diagnosis of HS in primary care and a clear, primary care-focused management guideline for identified patients.

Background: The year 2022 saw the largest number of human immunodeficiency virus (HIV) cases diagnosed in the Republic of Ireland on record, with a 122% increase on 2021 and a 68% increase compared with the pre-pandemic year of 2019. Late-stage diagnoses and difficulties accessing testing are more common outside of Dublin.

Aim: To assess practices and attitudes to testing in general practice in the West of Ireland.

Design & setting: This cross-sectional mixed-methods study was carried out through University Hospital Galway, which provides all HIV care for the West and North-West of Ireland.

Method: A postal survey was sent to GPs. The survey was based on a study in 2013.

Results: There was a 21.4% response rate (n = 136) to the survey, which found 79.4% reported a registered patient living with HIV. Sexual history and patient request were the most common indications for testing and 19.1% used guidelines for testing. More responders had patients living with HIV in 2023 than in 2013 (79.4% versus 59.2%). In 2013, urban GPs were significantly more likely to have sent a test compared with their rural colleagues (P = 0.005). This difference was not observed in 2023. Qualitative themes identified included low perceived impact of HIV on daily practice. A key theme was a desire for national guidelines.

Conclusion: GPs report a positive attitude to HIV testing but have concerns regarding undertesting. Urban and rural GPs reported different testing practices but this may be lessening over time. Guideline usage was low. We believe this study highlights areas to improve testing in this region.

Background: Acetylcholinesterase inhibitors (AChEIs) are routinely prescribed for mild-to-moderate Alzheimer's disease (AD). National guidance advises GPs to initiate memantine for patients already taking an AChEI, as it offers small benefits for moderate-to-severe AD, with good tolerability. But this is not routinely done, potentially depriving patients of a beneficial treatment.

Aim: To assess prescribing for AD in general practice, to explore factors influencing prescribing, and to identify additional education needs.

Design & setting: Mixed-methods study involving GPs in England.

Method: An online survey and semi-structured interviews were conducted. Survey responses were analysed in StataNow (version 18.5). Interview transcriptions were coded in NVivo (version 14) by two researchers, who agreed themes. Quantitative and qualitative analyses were integrated and mapped to the Theoretical Domains Framework (TDF) and behaviour change wheel (BCW).

Results: Survey responders (n = 104) mostly continued rather than initiated memantine. Less than half were confident in identifying AD stages and developing care plans for moderate-to-severe AD. Overall, 46% of responders were unaware of current national guidance concerning memantine. Interviews (n = 23) mostly concurred with survey findings. Direction from local formularies conflicts with current national guidance. Mapping to TDF and BCW identified barriers to, facilitators, and interventions for changing practice.

Conclusion: Limited time, patchy support, and Quality and Outcomes Framework downgrading contribute to a perception that dementia is not prioritised in general practice. Local systems for diagnosis and treatment reinforce GPs' feelings of inadequacy. GPs assess the impact of AD on patients and families but may not map assessments to a disease stage for memantine initiation. Interventions to change practice should boost knowledge and confidence; local pathways should clearly reflect national guidance.

Background: Podcasts are rapidly gaining popularity within medical education, but their acceptability and effectiveness within primary care education remains understudied.

Aim: To evaluate the attitudes of general practice specialty trainees (GPSTs) and GP trainers towards audio podcasts for primary care medical education.

Design & setting: A cross-sectional questionnaire distributed to all GPSTs and GP trainers in Scotland.

Method: The survey evaluated podcast usage patterns, their perceived effectiveness, and perspectives on the benefits and challenges of podcast-based education. Quantitative data were analysed using descriptive and inferential statistics, and qualitative data underwent thematic analysis.

Results: Of 1995 invited participants, 219 individuals (11.0%) responded. Medical education podcasts were used by 69.9% of responders, with higher usage among GPSTs (73.5%) than GP trainers (65.7%). Most responders (89.0%) perceived podcasts as an effective medium for primary care education. The majority of responders noted improvements in professional knowledge (92.8%), confidence in delivering patient care (73.5%), and clinical care provision (81.6%), as a result of podcast usage. Key benefits of podcasts included flexibility and accessibility, while the main challenge was personal time constraints. Responders highlighted quality assurance and awareness as key areas for improving the experience of podcast-based education.

Conclusion: Podcasts are accepted and perceived as an effective educational tool within primary care education. Future efforts should focus on developing high-quality, relevant podcasts, and addressing concerns around personal time constraints and quality assurance. Further research, including larger, more representative samples, is needed to assess the impact of podcasts on knowledge retention, clinician behaviour, and clinical outcomes within primary care.

Background: UK COVID-19 lockdowns significantly affected primary care access and delivery. Little is known about whether lockdowns disproportionally impacted vulnerable groups, including people who misuse substances, people who have experienced domestic violence or abuse, those with intellectual disability, and children with safeguarding concerns.

Aim: To evaluate the impact of UK COVID-19 lockdowns on primary care contact rates among vulnerable groups.

Design & setting: Natural experimental design using all registered patients in the OpenSAFELY platform.

Method: With approval from NHS England, we conducted controlled interrupted time-series analyses on records from 24 million patients in England between September 2019 and September 2021.

Results: Pre-pandemic, primary care contact rates were 110.1 per 1000 patients per week. Following the initiation of the first lockdown (23 March 2020), there was a large reduction of 29-61 contacts per 1000 patients per week among vulnerable and general population groups. For patients with alcohol misuse, those aged ≥14 years with intellectual disability, and children with safeguarding concerns, this reduction was significantly more extreme than corresponding general populations (relative rate difference -23.8 [95% confidence interval {CI} = -39.8 to -7.7, P = 0.003], -24.6 [95% CI = -38.8 to -10.5, P<0.001], and -15.4 [95% CI = -26.9 to -3.8, P = 0.009], respectively). Following the final lockdown (29 March 2021), all groups had contact rates exceeding pre-pandemic rates (with increases more marked in vulnerable populations), except those only including children.

Conclusion: Our results suggested a larger short-term impact of the first COVID-19 lockdown on primary care contact for some vulnerable groups, compared with the general population, and differential impacts persisted through subsequent lockdowns and beyond for some vulnerable groups. There is a need to examine drivers of these differences to enable more equitable primary care access and provision.

Background: Socioeconomic deprivation is associated with lower life expectancy and more complex health needs. General practices may mitigate some of these health impacts by providing holistic care to their patients. The Deep End network was established in 2009 in Scotland to support practices working in the most socioeconomically deprived communities, and the concept has since spread, with Deep End Wales (Cymru) launching in 2022.

Aim: To explore experiences of staff working within Deep End practices in Wales and understand their motivations for choosing to work in challenging practices along with their needs from a Deep End network.

Design & setting: Qualitative study with staff from Deep End eligible practices in Wales.

Method: Seventeen semi-structured interviews were undertaken. Data were analysed using thematic analysis and interpreted with reference to self-determination theory.

Results: The following four main themes were identified: (1) Treading water (experiences of providing care in Deep End practices); (2) Diving into the Deep End (motivations for working in a Deep End practice); (3) Providing a life jacket (support from the Deep End Cymru community); and (4) Swimming to shore (the search for work-based effectiveness).

Conclusion: Deep End staff reported high workload, with limited resources and time to manage complex health needs. Most participants found working in Deep End practices rewarding. However, there were concerns about staff burnout, recruitment, and retention of staff. Deep End Cymru is providing hope, validation, and a place to share ideas. Barriers to success were funding and time. Participants want Deep End Cymru to advocate for them, support recruitment, improve services for patients, and support research.

Background: Artificial intelligence (AI) is increasingly recognised as a transformative tool in health care. However, despite these prospects, the adoption of AI in primary care remains limited in Germany owing to various concerns.

Aim: To investigate current AI use, perceived barriers, and training needs among GPs. It also aims to compare attitudes of current users and non-users of AI technologies.

Design & setting: This was a cross-sectional study of practising GPs in the Free State of Saxony, Germany; participants received an invitation to participate in an online survey between November 2024 and January 2025.

Method: In total, 1620 GPs received an invitation and two additional reminders to complete the survey via REDCap.

Results: A total of 154 GPs completed the questionnaire, of whom n = 70 currently use AI in practice, predominantly for therapy (n = 51, 72.9%) and speech recognition or transcription (n = 47, 67.1%). The biggest barrier to AI implementation was a lack of knowledge about suitable AI-based applications and of how AI works. Compared with AI users, non-users expressed greater legal concerns, more concerns about patient acceptance, and less familiarity with suitable AI applications; they also perceived AI as less relevant to their daily work. To reduce barriers, participants emphasised a favourable cost-benefit ratio of AI applications and facilitating seamless integration into practice software. The majority of responders (n = 83 out of 149, 55.7%) expressed a need for further training on using AI. GPs emphasised the importance of maintaining the interpersonal relationship in health care.

Conclusion: Our study underscores the need for targeted training programmes that address GPs' specific needs and concerns.

Background: Health care contributes substantially to climate change. GPs want to implement sustainable health care but are hesitant, worried that this may jeopardise their doctor-patient relationship. However, whether this concern is valid should be urgently assessed.

Aim: To explore patients' perspectives on sustainable health care in general practice.

Design & setting: In 2022 and 2023, we performed an online study with Dutch adults using experimental vignettes and a questionnaire.

Method: The vignettes described GP appointments for three health complaints with randomly allocated treatment advice, varying in sustainability and explanation, but with comparable health outcomes. The questionnaire assessed participants' perspectives on sustainable health care in general practice. We analysed the vignettes using mixed-design analysis of variance (ANOVA) and the questionnaire using descriptive statistics and correlations.

Results: In total, 801 participants completed the vignettes, and 397 the questionnaire. We found no difference on satisfaction with a doctor's visit (P values >0.24) when comparing a sustainable and a less-sustainable treatment option. The effect of explicitly mentioning sustainability differed per health complaint (dyspnoea: no difference; knee pain: mean difference [MD] = 0.31, P = 0.002; erythema: MD = -0.23, P = 0.003). In the questionnaire, participants reported positive expectations, and trust in the GP and treatment when delivering sustainable health care, but were more neutral about the GP's role.

Conclusion: We found no indication that sustainable treatment advice leads to lower satisfaction with GP care. The effect of explicitly mentioning sustainability was minimal and differed per health complaint. When directly asked, participants were mainly positive about sustainable health care. These results could encourage GPs to introduce sustainable treatment advice, without worrying about negatively influencing patient satisfaction.

Background: Osteoporosis is a chronic disease characterised by decreased bone mineral density (BMD) and increased fracture risk. Osteoporosis disproportionately affects residential care home populations.

Aim: To develop recommendations aimed at improving osteoporosis management in UK care homes.

Design & setting: Modified Delphi study of UK geriatric and osteoporosis care.

Method: A steering group of six UK experts in geriatric medicine and osteoporosis care convened to discuss challenges in osteoporosis management within care homes. Forty-five consensus statements were developed and tested in a survey distributed to their peers (targeting 150 responses). Responders rated their agreement on a four-point Likert scale. Consensus was defined a priori as ≥75% strong agreement or very strong agreement as ≥90%. The group reconvened to analyse the results and generate recommendations.

Results: In total, 101 survey responses were received from clinicians and care home managers representing all UK regions; 39.6% of responders had >20 years' experience in their role. Consensus was achieved for most (42/45 [93.3%]) statements and very high agreement achieved for two-thirds (66.7%). Therefore, the survey window was not extended to meet the response target. Nine recommendations to improve osteoporosis and bone health care across the UK primary care network were developed. These emphasise the need for coordinated referrals, treatment plans, and bone health education across primary and secondary care, including care homes. A potential care pathway was generated incorporating these recommendations.

Conclusion: Our study highlights gaps in osteoporosis care in UK care homes, including communication issues. A proactive approach to bone health is encouraged to improve patient outcomes and help alleviate the burden osteoporosis presents.

Background: Monitoring lifestyle or behavioural risk factors using quality indicators is critical for the primary prevention of cardiovascular disease (CVD).

Aim: To summarise indicators for monitoring lifestyle risk factors for the primary prevention of CVD.

Design & setting: A systematic review of quality indicators in primary care.

Method: Four research databases (Ovid MEDLINE, Ovid Embase, CINAHL Plus, and Scopus) and grey literature were searched to identify articles (indicator sets) used to monitor lifestyle risk factors. Articles were assessed for methodological quality using the Appraisal of Indicators through Research and Evaluation (AIRE) instrument. Articles with strong methodological quality, scoring ≥50% in each domain (that is, relevance, stakeholder involvement, scientific evidence, and usage) were included. Indicators were categorised into assessment of lifestyle risk factors or advice on healthy lifestyle.

Results: We identified 39/282 (14%) articles including indicators to monitor lifestyle risk factors from a full-text review. Of these, 19 (49%) articles with strong methodological quality, comprising 90 unique indicators, were included. Most of the indicators were on assessing smoking status (21%), body weight (18%), advice on smoking cessation (13%), immunisation (9%), and advice on physical activity (8%). Assessment of alcohol consumption (3%) and healthy eating (2%) were the least reported. When comparing assessment versus advice indicators, we found gaps in monitoring smoking status (41% assessment versus 27% advice) and body weight (35% versus 14%). Notably, there were more indicators for advice on (16%) than assessment of (4%) healthy eating.

Conclusion: We identified several indicators for the monitoring of lifestyle risk factors. However, there is a need to ensure an appropriate mix of indicators on assessment versus advice.