BJGP Open最新文献

Background: Social prescribing link workers (SPLWs) have been based in general practices in Scotland since 2016 but the views of general practitioners (GPs) on their work have not been quantified.

Aim: To quantify GPs satisfaction with the work of SPLWs and belief that they can reduce health inequalities, and to explore GP and practice factors that influence these views.

Design & setting: Secondary analysis of a cross-sectional survey of all qualified GPs' working lives in Scotland conducted in 2023/24.

Method: Descriptive analysis of how satisfied GPs are with SPLWs, and whether they believe they can reduce health inequalities, and univariate and multivariate analysis of factors that influence these views.

Results: 836/1380 (60.6%) of GPs reported having a SPLW in their practice, and of these, 567 (67.9%) were satisfied with their work, and 587 (70.4%) thought they could reduce health inequalities. In multilevel multi-regression analysis, three significant independent positive predictors of GP satisfaction with the work of SPLWs were identified; female GP gender (P=0.017), high practice deprivation (P=0.001), and a perceived reduction in GP workload (P<0.001). GPs belief that SPLWs can reduce health inequalities was predicted by high practice deprivation, and a perceived reduction in GP workload (both P<0.001).

Conclusions: GPs in Scotland who have a SPLW in their practice are largely satisfied with link workers and believe they can reduce health inequalities, especially those working in deprived areas and who perceive reductions in their own workload due to the work of the SPLW.

Background: An increasing number of adolescents and young adults who have never smoked now use e-cigarettes. GPs must screen and counsel effectively: vaping is linked to nicotine addiction, respiratory symptoms, and cardiovascular effects. Limited long-term data compounds risk and uncertainty for chronic users. Evidence to guide GP counselling of adolescent and young adult vapers remains scarce in routine clinical practice.

Aim: To investigate GPs' perspectives on tackling the vaping epidemic, their preparedness, challenges, and potential improvements at personal and national levels.

Design & setting: Qualitative study using semi-structured interviews (SSIs) with British GPs.

Method: Invitations for SSIs were sent to Primary Care Networks (PCNs) nationwide. Participants were purposively sampled to reflect the national GP demographic. Interviews were conducted across the UK in April and May 2024, reaching data saturation at n=11. Interviews were transcribed verbatim, imported to NVivo10 and thematically analysed using the Gioia Method.

Results: Four aggregate dimensions, 11 second-order themes and 29 first-order concepts emerged. Drivers for change centred on rising concern about youth vaping; current practice was marked by limited knowledge and variable counselling; barriers included lack of guidance, services and time; recommendations emphasised improved education, digital tools and stakeholder engagement.

Conclusion: Our findings highlight the urgent need for interventions to address rising e-cigarette use among adolescent and young adult never-smokers. While some GPs are motivated to improve practice, others are uncertain given the limited and mixed evidence currently. Effective solutions must extend beyond primary care to involve other healthcare professionals and key stakeholders.

Background: Personal continuity of care, ie, a continuous relationship between the patient and the general practitioner (GP), is a core principle of general practice, enhancing trust, safety, and therapeutic engagement. The alignment between personal continuity, as experienced by patients, and the use of GP services remains uncertain.

Aim: To assess how patient-reported preferences for seeing their own GP and patient-reported personal continuity were associated with their use of GPs.

Design & setting: Survey conducted among patients in waiting rooms of 80 GP practices in Western Norway in 2021.

Method: Data was collected from 2,230 patients using a questionnaire, which obtained information on their preferences, personal continuity (Nijmegen Continuity Questionnaire) and actual GP use. Poisson regression models were used to assess associations between patient preferences, continuity and GP use in today's consultation.

Results: Most patients (88.7%) found it very important/important to see their own GP for a known problem, compared to 74.9% for a new problem. Strong preferences increased the likelihood of seeing their own GP in the consultation by 30-40% compared to those who valued this as neutral or not important. Personal continuity scores in the upper quartiles were associated with longer patient-GP relationships and frequent consultations with one's own GP, and were not significantly reduced with increasing number of visits to other GPs in the practice.

Conclusion: This study indicates that patient-reported personal continuity can be high despite patients seeing other GPs, if there is also a sustained, frequent long-term relationship with one's own GP.

Background: Doctors training to become general practitioners (GPs) are increasingly working in cross cultural consultations. Cultural models have been developed as frameworks to better equip medical professionals towards more culturally appropriate health care, with potential to improve equity in healthcare systems.

Aim: To map evidence on models of cultural competence, cultural safety, cultural humility and transcultural care within GP training worldwide.

Design & setting: Scoping review using Arksey and O'Malley's framework.

Method: Searches were conducted across three databases, extending to grey literature such as curricula. Articles were extracted, reviewed and analysed according to inclusion criteria.

Results: Nineteen articles met inclusion criteria. Publications ranged from 2008-2024, with 10 articles from Australia, 5 from USA, 2 Sweden, 1 Canada and 1 the Netherlands. Three themes were generated: Unlearning, Informal Learning, and Informed Learning. The literature illustrates that there are gaps in knowledge of what the models are and how best to practise and teach them within GP education.

Conclusion: Cultural models advocate for cultural awareness, examine power imbalances, and encourage self-reflexivity and learning. Integrating cultural models into healthcare can better serve all patients, with potential to reduce health inequities. There also needs to be an adaptation to learning in traditional GP consultations with a focus on how our own biases impact the care that we provide, and a more formal learning of cultural models best delivered by GP trainers in partnership with cultural mentors.

Background: In Finland, the gathering of patient feedback using patient-reported outcome measures (PROMs), such as the Patient Enablement Instrument (PEI), is recommended to assess the quality of care. However, knowledge of how this feedback could be utilized by the individual primary care practitioner (PCP) is sparse.

Aim: To explore PCPs' experiences of the single-item Patient Enablement Instrument (PEI-Q2) as a feedback tool.

Design & setting: Qualitative study in Finnish primary healthcare.

Method: Semi-structured focus group interviews were conducted with 14 PCPs in spring 2023 in Central Finland after they had received feedback with the PEI-Q2. The data were analyzed using thematic analysis.

Results: PCPs regarded patient enablement as an important indicator of care quality in primary healthcare. The feedback provided through the PEI-Q2 was generally perceived as encouraging and motivating, prompting requests for its regular use. However, several PCPs found the feedback challenging to interpret. Feedback with the PEI-Q2 was seen as a promising tool for managerial benchmarking. Additionally, PCPs suggested that the utility of the PEI-Q2 feedback could be enhanced by incorporating supplementary contextual information, such as open-ended feedback.

Conclusion: From the PCPs' viewpoint, the PEI-Q2 appears to be a potential tool for delivering patient feedback. While it can serve as a measure for assessing quality of care, it should be complemented with other patient-reported feedback tools to enhance its overall applicability and usefulness. In addition, educational guidance on interpreting the measure's results is recommended.

Background: School bullying (SB) is a significant public health issue with profound mental and physical health consequences. In France, data are lacking regarding the prevalence and detection of SB among children seen in primary care settings.

Aim: To assess the prevalence of children aged 8-17 at risk of SB consulting general practitioners (GPs), using the PPC-17 screening tool.

Design & setting: A quantitative, descriptive, cross-sectional study in 13 general practices in France.

Method: Between January and May 2023, children consulting their GP (accompanied by a parent) completed the 17-item self-administered PPC-17 questionnaire. A positive risk screening was defined as at least one "often" response. GPs recorded the initial consultation reason. Data were analysed using univariate and bivariate statistics.

Results: Of 248 respondents, 53% were girls. 34.7% (n=86) were identified at risk of school bullying. Boys scored higher for physical violence (mean 4.3 [SD 4.2]) while girls had higher scores for psychological violence (mean 6.7 [SD 6.1]); older girls (13-17) had the highest psychological violence scores; boys 8-12 the highest physical violence scores. Common reasons for consultation included ENT infections (36%), osteoarticular pain (9.3%), and abdominal symptoms (8.1%), with psychiatric complaints ranking 17^th. Children at higher risk were younger on average (mean 11.7 vs 12.8 years, P<0.003).

Conclusion: Over one-third of children consulting GPs were at risk of SB. The PPC-17 enables effective screening during routine consultations and reveals distinct gender and age patterns. Systematic integration of SB screening in primary care could enhance early identification and support.

Background: A complete, up-to-date family history (FH) is imperative in primary care to identify those at increased risk of heritable conditions who may benefit from personalized screening and management. Complete FH is rarely documented in the electronic medical record.

Aim: To understand family physicians' experiences of an electronic medical record-integrated FH strategy.

Design & setting: A descriptive qualitative study using 1:1 interviews to assess a FH strategy.

Strategy: Emailed patient invitation to complete FH questionnaire, automatic electronic medical record upload, family physician notification and links to clinical support tools.

Setting: Randomly selected primary care teams affiliated with University of Toronto Practice-Based Research Network in Ontario, Canada.

Participants: Family physicians from 3 sites that implemented the strategy.

Method: Telephone interviews with family physicians. Thematic analysis used for identifying, analyzing and reporting patterns in the data. An iterative process was used, with modification of interview and coding guides as new themes emerged.

Results: 14/15 family physicians were interviewed. Six major themes identified: 1. FH informs hereditary risk and enables tailored patient care; 2. Routine, intentional FH collection by patients and family physicians is essential; 3. FH collection supports meaningful patient-physician discussions and quality care; 4. Point-of-care tools enhance family physician awareness and knowledge; 5. Success is supported by patient engagement and electronic medical record integration; 6. Tailored approaches are needed to improve acceptability.

Conclusion: Physicians expressed the importance of routine FH collection and its implications for clinical management. Factors contributing to the strategy's success included being patient-initiated and medical record integration.

Background: Incretin mimetics are increasingly used to manage diabetes and to support weight loss in people with obesity. However, their application in primary care settings by general practitioners (GPs) remains underexplored.

Aim: This study aimed to investigate GPs' healthcare experiences in relation to incretin mimetics such as semaglutide.

Design & setting: Qualitative study using semi-structured interviews with GPs from Hesse/Germany, recruited through purposive sampling.

Method: We conducted 15 semi-structured interviews. Data were analysed using a thematic analysis approach by Braun and Clarke.

Results: We identified six key themes: incretin mimetics as a new treatment option in the treatment of diabetes and obesity, patient expectations, the media as a key driver, challenges related to financial accessibility and supply, patients' therapy adherence, and the effects on quality of life and lifestyle changes.

Conclusion: Our findings emphasize that facilitating patient education using supportive educational materials might counter the lack of reliable information. Moreover, collecting both qualitative and quantitative data on incretin mimetic usage from the patient perspective would be valuable for a more comprehensive understanding of the use of the medication.

Background: Adherence to oral bisphosphonates for osteoporosis is poor; the challenges and complexity of follow-up reviews in general practice are implicated as a contributory cause. Clinical pharmacists in general practice are an expanding professional group within the UK NHS workforce and could provide person-centred, medicines optimisation interventions.

Aim: To explore clinician and patient perceptions towards a pharmacist-led osteoporosis review, including identifying current practice, care gaps and implementation barriers and facilitators.

Design & setting: Qualitative interview study with patients, clinical pharmacists, GPs, osteoporosis specialists and service commissioners.

Method: Semi-structured interviews were transcribed verbatim and analysed thematically, informed by a Normalisation Process Theory approach.

Results: In total, 32 participants were interviewed in 22 one-to-one interviews and 4 small group interviews. Three themes relevant to the design and implementation of a pharmacist-led osteoporosis follow-up review were identified: dissonant views about current provision and needs ; suitability and acceptability of pharmacists to deliver the review and training needs for this; and contextual issues affecting implementation.

Conclusion: Our study found that current practice with respect to following-up patients initiated on oral bisphosphonate treatment in primary care is variable. Although pharmacists were highlighted as well placed to conduct osteoporosis reviews, varying views about the need for this were highlighted along with a number of contextual barriers, including lack of financial and policy drivers in primary care, workload challenges, varying pharmacist skills and autonomy and lack of coordination across the health system.

Background: Pancreatic cancer causes non-specific symptoms, potentially leading to delays in diagnosis. Decision support tools may help primary care practitioners to triage patients for pancreatic imaging.

Aim: To investigate the sensitivity of three different tools for identifying patients who may have pancreatic cancer.

Design and setting: Observational study in Australia.

Method: We investigated the performance of the risk assessment tool (RAT) for pancreatic cancer, the QCancer^® tool, and a tool developed through a consensus process led by QIMR Berghofer (the QPaC Tool). We applied these tools to people with pancreatic cancer who were interviewed about their symptoms upon first presentation to a clinician. We designated patients as 'flagged' by each tool if they met specific criteria, and calculated the percentage flagged (ie, the sensitivity). Participants with jaundice were excluded from analyses of QCancer^®.

Results: We included 190 participants in analyses of the RAT and QPaC Tools (142 in analyses of QCancer). The sensitivity of the QPaC Tool and the RAT were 54% and 27% respectively. QCancer^® had a sensitivity of 14% percent, at a probability threshold of 1%; in the same 142 participants, QPaC and the RAT flagged 44% and 7%, respectively.

Conclusion: The QPaC Tool was the most sensitive, largely due to its inclusion of severe epigastric pain and emphasis on diabetes, but it has unknown specificity. More research is needed to determine whether any tool could reduce delays in diagnosis; in the interim, the QPaC Tool may support clinicians to consider pancreatic cancer in their differential diagnoses.