BJGP Open最新文献

Background: Chronic primary pain (CPP) as a diagnosis has been introduced in the recent International Classification of Diseases, 11^th Revision (ICD-11). CPP captures the experience of pain as the primary problem, without an underlying attributable cause. Dissemination of UK guidance regarding CPP represents the first time it has been recognised as a condition in its own right. Little is known about GP views concerning caring for patients with CPP, and how related guidance is viewed and applied in practice.

Aim: To explore GP perspectives in relation to caring for people with CPP, including challenges encountered and use of related guidelines in practice.

Design & setting: A UK-wide qualitative interview study in primary care.

Method: Purposive and snowball sampling were used to recruit 15 GP participants from England, Northern Ireland, Wales, and Scotland. Semi-structured interviews were undertaken and analysed using reflexive thematic analysis.

Results: The following three main themes were generated: (1) 'How to start? Problematic beginnings', which referred to difficulties regarding diagnosis; (2) 'Where to go? Mapping the management challenge'; and (3) 'How to get there? Navigating strategies and response', which explored GP awareness and acceptability of UK guidelines for chronic pain. Areas identified for potential improvement included increased access to non-pharmacological management (NPM) and secondary care services, support with deprescribing, and an expanded multidisciplinary team input.

Conclusion: CPP is complex to both diagnose and manage. Although guidelines provide a useful framework, they pose challenges when translating into day-to-day practice.

Background: Couple relationship satisfaction is related to good physical health, good mental health, and longevity. Many patients have discussed or wish to discuss their couple relationship with their GP and look for personalised care and support when discussing topics they perceive as sensitive.

Aim: To explore patient experiences of discussing couple relationship problems in GP consultations.

Design & setting: Qualitative study employing semi-structured interviews with patients from general practice in Norway.

Method: Individual interviews with 18 patients who had discussed their couple relationship with their GP. Participants were recruited through both social media and traditional media, and all interviews were digitally recorded. The purposive sample comprised 13 women and five men, representing diverse age groups, backgrounds, and relationship problems. All participants identified as heterosexual. We analysed interview data thematically using systematic text condensation.

Results: Three main themes emerged: 1) GPs in a facilitating role, not on an assembly line; 2) navigating the 'elephant in the room'; and 3) GPs as biomedically competent life witnesses. GP continuity was vital in fostering the trust required to discuss sensitive topics, such as relationship issues. Participants valued a biopsychosocial approach that incorporated knowledge of close relationships into medical consultations. They appreciated both GP support and constructive challenges that prompted them to take responsibility for relationship improvements.

Conclusion: Patients value their GPs' holistic, supportive, and direct approach in addressing couple relationship problems, although they perceive that GPs do not always have sufficient time. They welcome relevant challenges that can drive positive change.

Background: Deep vein thrombosis (DVT), a formation of blood clots within deep veins, mostly of the proximal lower limb, has an annual incidence of 1-2 per 1000. Patients who are affected by multiple chronic health conditions and who experience limited mobility are at high risk of developing DVT. Traditional DVT diagnosis involves probabilistic assessment in primary care, followed by specialised ultrasound scans (USS), mainly conducted in hospitals. The emergence of point-of-care ultrasound (POCUS), coupled with artificial intelligence (AI) applications, has the potential to expand primary care diagnostic capabilities.

Aim: To assess the accuracy and acceptability of AI-guided POCUS for DVT diagnosis when performed by non-specialists in primary care.

Design & setting: Diagnostic cross-sectional study coupled with a qualitative evaluation conducted at primary care DVT clinics.

Method: First, a diagnostic test accuracy (DTA) study will investigate the accuracy of AI-guided POCUS in 500 individuals with suspected DVT, performed by healthcare assistants (HCAs). The reference standard is the standard of care of USS conducted by sonographers. Second, after receiving both scans, participants will be invited to complete a patient satisfaction survey (PSS). Finally, semi-structured interviews with 20 participants and four HCAs, and three sonographers will explore the acceptability of AI-guided POCUS DVT diagnosis.

Conclusion: This study will rigorously evaluate the accuracy and acceptability of AI-guided POCUS DVT diagnosis conducted by non-specialists in primary care.

Background: Early in the COVID-19 pandemic, the use of video consultation (VC) expanded considerably, with GPs indicating high satisfaction with it. However, use of VC declined as lockdown measures were eased.

Aim: To explore reasons why VC use has declined in Norwegian general practice since the start of the pandemic by investigating GPs' experiences with VC and their attitudes towards it in a post-pandemic setting.

Design & setting: Qualitative study using semi-structured interviews with 13 GPs in southern Norway between May 2022 and March 2023.

Method: Data analysis was conducted by applying the six steps of Braun and Clarke's reflexive thematic analysis.

Results: Although the implementation of VCs was unplanned, most participants were able to use this modality without much problem. Several GPs initially envisioned long-term VC use. However, despite certain positives, VCs were largely sidelined in favour of face-to-face and telephone consultations, owing to their practicality and VC's limited usefulness when considering the extra effort required. Nonetheless, GPs recognised ways of using VC that might exploit its strengths, but they highlighted how its sustained use would require them to replace other consultation modalities. They also identified extrinsic factors that might lead to the increased use of VC, including improved VC technology and patient demand.

Conclusion: Although VC is now part of many GPs' consultation toolboxes, its perceived relative lack of usefulness and extra effort compared with other remote consultation modalities mean that most GPs have chosen to abandon it as a routine consultation modality.

Background: In France, 40% of people aged >16 years (20 million) report having at least one chronic disease requiring long-term treatment. Compliance with treatment at home is estimated to be 50% on average.

Aim: To study the practical management of oral treatments at home by people living with one or more chronic diseases.

Design & setting: A quantitative, descriptive, observational, cross-sectional study. Thirty GPs in France were invited by email to enrol 10 consecutive patients with chronic diseases.

Method: Standardised questionnaires were used to assess the sociodemographic profile of doctors and patients, and the management of oral medication at home.

Results: Twenty GPs collected 180 questionnaires of which 70% responders said they did not find taking their medication a problem; 43% used a pillbox; 79% said they knew 'all' their medications; and 61% reported forgetting to take their medication (versus 30% who reported never forgetting to take their medication).

Conclusion: More than half of patients are non-adherent to taking oral medication at home for their long-term conditions. Personalised reminders could reduce unintentional medication non-adherence.

Background: Asthma is the most common chronic disease in children, resulting in considerable morbidity and healthcare utilisation, especially in geographical areas with high deprivation. Parents play a pivotal role in children's asthma management.

Aim: To explore the views of parents whose children have asthma, regarding barriers and facilitators to receiving adequate asthma care.

Design & setting: A qualitative study conducted in an urban, multi-ethnic setting with high socioeconomic deprivation and paediatric asthma-related hospital admissions.

Method: The study used a pragmatic approach underpinned by a perspective of critical realism. Parents of children with asthma were recruited through purposive and convenience sampling, and data were collected through semi-structured interviews. Transcripts were analysed using thematic analysis, facilitated by NVivo12 software.

Results: Ten parents participated in nine interviews. Six themes were identified relating to the following: (1) the establishment of a new life dynamic following a diagnosis of asthma; (2) the turbulent and drawn-out process of asthma diagnosis; (3) the roles and expectations of the partnership established between parents and healthcare services; (4) the importance of schools in asthma management; (5) sources and access to relevant information; and (6) the importance of social support networks. Parents frequently felt unsupported and misunderstood, particularly during the diagnostic process.

Conclusion: Unmet parental educational and emotional needs, particularly around the time of diagnosis, were identified as a key barrier to adequate asthma management. Deeper understanding of gaps in support can instruct asthma care delivery and inform co-produced interventions, thus improving asthma outcomes in children.

Background: Cancer diagnoses often begin with consultations with GPs, but the non-specific nature of symptoms can lead to delayed diagnosis. Unexpected weight loss (UWL) is a common non-specific symptom linked to undiagnosed cancer, yet guidelines for its diagnostic assessment in general practice lack consistency.

Aim: To synthesise evidence on the association between UWL and cancer diagnosis, and to review clinical guidelines and recommendations for assessing patients with UWL.

Design & setting: Systematic search and analysis of studies conducted in primary care.

Method: Four databases were searched for peer-reviewed literature from 2012 to 2023. Two reviewers conducted all the steps. A narrative review was conducted detailing the evidence for UWL as a risk factor for undiagnosed cancer, existing clinical guidance, and recommended diagnostic approach.

Results: We included 25 studies involving 916 092 patients; 92% provided strong evidence of an association between UWL and undiagnosed cancer. The National Institute for Health Care and Excellence (NICE) Cancer Guideline in the UK was frequently cited. General suggestions encompassed regular weight monitoring, family history, risk factor evaluation, additional signs and symptoms, and a comprehensive physical examination. Commonly recommended pathology tests included C-reactive protein (CRP), complete blood count, alkaline phosphatase, and thyroid-stimulating hormone. Immunochemical faecal occult blood test, abdominal ultrasound, and chest X-ray were also prevalent. One large cohort study provided age, sex, and differential diagnosis-specific recommendations.

Conclusion: This evidence review informs recommendations for investigating patients with UWL and will contribute to a computer decision support tool implementation in primary care, enhance UWL assessment, and potentially facilitate earlier cancer diagnosis.

Background: The General Practice Community Pharmacist Consultation Service (GP CPCS) was established to allow patients with certain minor illnesses to be referred to a community pharmacy for assessment and treatment.

Aim: To explore patients' experiences of the GP CPCS.

Design & setting: An online survey in two regions of England.

Method: 25 general practices invited patients to take part in an exploratory survey. Descriptive statistics were used for the analysis.

Results: The response rate was 5.1% (72/1423). Prior to contacting their general practice, 14.1% (9/64) had tried to speak to a pharmacist. Most respondents accepted the CPCS referral (77.3%, 51/66), received a pharmacy consultation on the same day (80.0%, 40/50) and were largely satisfied with the amount of time the pharmacist spent with them (82.5%, 33/40) the consultation format (68.3%, 28/41) and the privacy provided during the consultation (80.9%, 38/47).However, most respondents (56.5%, 39/69) felt poorly informed by the general practice on why they were being advised to speak to a pharmacist and did not feel that it was appropriate that they had been advised to speak to a community pharmacist (54.2%, 39/72). Only 33.3% (16/48) felt that their consultation fully met their health needs and 27.1% (13/48) of patients described being re-referred from pharmacy back to their general practice.

Conclusion: In this exploratory study patients were largely accepting of the GP CPCS. Improvements in terms of explaining GP CPCS to patients, selecting patients appropriate for referral to the service and the appointment process may be of benefit.

Background: With most of the antibiotic prescriptions occurring in primary care, antimicrobial stewardship (AMS) interventions must be known, welcomed, and used by primary care physicians (PCPs).

Aim: The main objective of this study was to evaluate the present awareness about, use of, and perceived acceptability, appropriateness, and feasibility of a broad range of interventions.

Design & setting: A cross-sectional survey was distributed to Swiss PCPs from December 2023 to February 2024.

Method: The survey focused on eight AMS interventions: shared decision-making tools, factsheets for physicians, Swiss Federal Office of Public Health (FOPH) information material, national antibiotic guidelines website, audit and feedback, communication skills training, as well as the use of point-of-care C-reactive protein (POC-CRP) and procalcitonin (POC-PCT) to guide prescription. PCPs' perceived acceptability, appropriateness, and feasibility were assessed using five-point Likert scales. General expectations regarding AMS were evaluated via qualitative analysis of free-text answers.

Results: Out of 7456 potentially eligible primary care physicians, 355 PCPs answered at least one question (response rate 4.7%). PCPs were most aware of biomarkers to guide antibiotic prescription in RTIs, such as POC-PCT (67.6%) and POC-CRP (61.1%), the FOPH awareness campaign (57.3%) and the national guidelines website (52.7%). All interventions were rated as acceptable, appropriate, and feasible, with respective mean scores out of five of 3.89, 3.91, and 3.81.

Conclusion: Despite the high perceived acceptability, appropriateness, and feasibility of AMS interventions available for RTIs, their real-life impact may be hindered by insufficient awareness. Additional promotion of those tools could increase their uptake by physicians.