BJGP Open最新文献

Background: Many primary care organizations do not routinely collect sociodemographic data (SDD) such as race, gender, or income despite the importance of this data in addressing health disparities.

Aim: To understand the experiences of primary care providers and staff in collecting SDD.

Design & setting: A qualitative interview study with 33 primary care and interprofessional team members from eight Ontario Community Health Centres (CHCs).

Method: Semi-structured virtual interviews and content analysis of interview transcripts.

Results: Participants reported using both formal methods of SDD collection, and informal methods of SDD collection that were more organic, varied, and conducted over time. Participants discussed sometimes feeling uncomfortable collecting this data formally, as well as associated burden and limited resources to support collection. Client-provider rapport was noted as facilitating data collection and participants suggested more training, streamlined data collection, and better communication about purpose and use of data.

Conclusion: SDD can be collected informally or formally but there are limitations to informally collected data and barriers to the adoption of formal processes.

Background: Medical Office Assistants (MOAs), also known as receptionists and clerks, are front line workers and the most accessible member of the primary care team. Historically, their contributions to primary care have been unrecognised and undervalued. The COVID-19 pandemic put pressure on existing roles and systems in primary care: how MOAs adapted is unknown.

Aim: To explore the experiences of MOAs working in primary care during the COVID-19 pandemic from the perspectives of MOAs and family physicians (FPs) who worked with MOAs during this period.

Design & setting: A qualitative study using Constructivist Grounded Theory, conducted in Ontario, Canada METHOD: Seventeen participants were recruited through professional contacts of the research team. Individual semi-structured interviews were conducted with MOAs and FPs across the province.

Results: MOAs' many responsibilities in primary care intensified during the pandemic. MOAs leveraged their healthcare system knowledge and therapeutic relationships with patients to reduce patient distress. Unfortunately, MOAs experienced more frustration, and in some cases, abuse from patients. MOAs' ability to adapt to new systems and respond to high patient needs seemed to be positively influenced by their relationships with patients and FPs. FPs expressed concern for MOA welfare and recognised their critical role on primary care teams.

Conclusion: MOAs made significant contributions to primary care during the COVID-19 pandemic. This study suggests MOAs have greater capacity than previously recognised which has important implications for planning in an era of under-resourced healthcare.

Background: To strengthen primary health care (PHC), there is a need to measure its performance.

Aim: To measure primary care performance in one rural Ugandan district.

Design and study setting: A cross-sectional survey of Tororo District administered the Primary Care Assessment Tool (PCAT) across a sample of 51 facilities. There were four levels of health facilities (health centres II to general hospital).

Method: Random sample of 100 users was obtained from each level while including all primary care providers and managers. Data was collected in REDCap software, and analysed using Statistical Package for Social Sciences vs23.

Results: Only 35.1% of users had a strong affiliation with their PHC facility. Overall primary care score suggested that performance was acceptable to the majority of users (58.9% rating performance at least acceptable). Ongoing care was rated by users as very poor (<25% of people rating it at least acceptable). Comprehensiveness (services available) was rated poor by users (<50% finding it at least acceptable). Users rated first contact access and coordination (information systems) acceptable (51-75% finding them at least acceptable). Person-centredness and comprehensiveness (services provided) were rated good by users (>75% rating them as acceptable or more). Providers and users differed significantly in their scoring across all domains, with providers usually more positive. Performance significantly improved as the PHC level increased.

Conclusion: Primary care performance in the study district was sub-optimal. The PCAT identified primary care functions that needed improving and may be a useful tool to measure PHC performance across the region.

Background: Healthcare providers in general practice are expected to deliver mental healthcare to patients through shared decision-making (SDM). It is unclear if they perceive their SDM to be affected by challenging circumstances in mental healthcare, eg, how waiting time for therapy plays a role.

Aim: To explore how healthcare providers and patients in general practice engage in SDM, given the challenging circumstances in mental healthcare.

Design & setting: A qualitative interview study in seven Dutch general practices.

Method: Semi-structured interviews were conducted with general practitioners (GPs; N=9), practice nurses mental health (PNMHs; N=8) and patients that sought mental healthcare (N=18). The interviews were deductively and inductively thematically analyzed.

Results: The participants mainly reported on SDM regarding treatment in secondary mental healthcare. The PNMHs explained they lack an overview of available treatments and waiting times in facilities. The PNMHs therefore instruct patient to also search for options themselves. Most patients found this approach burdensome, especially those new to mental healthcare. These patients were said to often express no strong treatment preferences and rely on advice by their healthcare providers. The GPs and PNMHs explained that in such cases, they often adopt a pragmatic approach and for example refer indecisive patients to facilities with little waiting time.

Conclusion: The healthcare providers and patients in general practice experience they adapt their approach to SDM in reaction to the circumstances in mental healthcare. Further exploration of how SDM is implemented and shaped by challenging circumstances across different healthcare settings is needed.

Background: Access to high-quality perimenopause (PMP) care for UK Armed Forces (UKAF) personnel is crucial, given the increasing proportion of women aged 40-55. However, due to the lack of exposure of General Practitioners (GP) to the PMP in Defence Primary Health Care (DPHC), there are concerns about the confidence in PMP management, particularly in prescribing hormone replacement therapy (HRT).

Aim: To assess the confidence of GPs working in DPHC in the management of the PMP.

Design & setting: This study employed a mixed methods approach and included all GPs (Uniformed and Civilian) working in DPHC.

Method: A cross-sectional survey gathered quantitative data on demographics, views on perimenopause care, and self-rated confidence levels in managing the perimenopause among Defence GPs. Semi-structured interviews of purposefully sampled respondents was thematically analysed to explore this further.

Results: There were 164 responses from 542 Defence GPs (response rate 30.3%). The majority of respondents expressed confidence in managing the perimenopause but reported lower confidence levels in prescribing HRT for younger women and initiating testosterone. Factors influencing confidence included recent perimenopause continuing professional development (CPD), GP gender, and exposure to perimenopause cases. Semi-structured interviews provided deeper insights into GP characteristics, CPD, and awareness of the PMP. Women's health hubs providing PMP care and experiential education were strongly supported.

Conclusions: While the study identified gaps in confidence among Defence GPs, particularly in certain aspects of perimenopause management, similar to those found in NHS GPs. CPD and case exposure were important predictors of confidence, with strong support for regional women's health hubs to optimise PMP care. Further research is warranted to explore strategies for bridging confidence gaps and improving perimenopause care delivery within the UKAF context.

Background: The usage of telehealth in general practice (GP) has risen substantially ever since the COVID-19 pandemic. Over this timeframe, telehealth has provided care for all patient demographics, including the paediatric population (aged<18). However, the translatability of telehealth (ie, whether in-person tasks can be supported remotely via telehealth) rarely considers the paediatric population or their carers.

Aim: To examine the degree of translatability to telehealth for in-person GP consultations on paediatric patients with consideration of the carers' roles.

Design & setting: This study screened 281 videos of in-person GP consultations set within UK general practices, and 20 of them were eligible for analysis.

Method: Secondary analysis of in-person GP consultations to examine tasks, physical artefacts, examinations and the interaction between carer, patient and GP. A novel scoring method revolving around two key metrics, taking into consideration the carer, was designed to analyse whether the tasks performed can be supported via telehealth.

Results: Analysis of 20 eligible consultations revealed 13 distinct physical examinations, 19 physical artefacts and 17 clinical tasks. Of these 17 clinical tasks, 41% were deemed 'definitely or easily translatable to telehealth,' ' 29% 'somewhat translatable with patient-provided equipment,' 12% 'potentially translatable,' and 18% 'currently untranslatable.' The average telehealth translatability score was 6.1/10, which suggests possible challenges with telehealth support. Regarding carer involvement, 90% of consultations involved collecting patient history, 70% placation of child, and 40% had physical support during examinations.

Conclusion: Tasks performed during paediatric in-person GP consultations may not be easily translatable to telehealth and caution should be exercised when considering its translatability to telehealth.

Background: GPs' participation in continuous medical education (CME) is essential for patient care, GPs' wellbeing, and healthcare expenditure. However, one-quarter of Danish GPs did not use their reimbursement for CME in 2022. Knowledge of barriers for participating in CME is limited.

Aim: To analyse the barriers GPs face to participation in CME, and patterns in perceived barriers.

Design & setting: A cross-sectional questionnaire study design was used. The study population comprised all 3257 GPs in Denmark who, in May 2023, were registered as entitled to reimbursement for CME.

Method: The response rate was n = 1303/3257 (40%). Based on a question about use of CME, the responders were divided into 'frequent', 'partial', and 'seldom' users. Partial and seldom users answered questions about barriers related to CME (n = 726). The presence of barriers was quantified, and a latent class analysis (LCA) was used to stratify GPs according to their barrier patterns.

Results: The most frequent barriers were as follows: too busy (67%); fully booked courses (45%); and no substitute or locum doctor (39%). Based on the LCA, we found three distinctive patterns, clustering around the following: GPs from clinics with no tradition for CME (class 1, 17%); GPs who used time on professional work outside clinic (teaching, organisational work) (class 2, 43%); and GPs who were personally or professionally affected (class 3, 40%). Singled-handed and male GPs were slightly overrepresented among seldom users.

Conclusion: We have identified barriers for CME. We found three different profiles of GPs who perceived different patterns of barriers. Identified patterns in barriers should be considered in future CME initiatives.

Background: Owing to increasing antibiotic resistance, the worldwide efficacy of Helicobacter pylori (HP) eradication treatment has decreased.

Aim: To determine antimicrobial resistance of HP in primary care.

Design & setting: Retrospective cohort study using real-world routine healthcare data from 80 general practices in the Netherlands.

Method: Patients with International Classification of Primary Care (ICPC) codes for gastric symptoms or Anatomical Therapeutic Chemical (ATC) codes for acid inhibition in the period 2010-2020 were selected. Main outcomes were antimicrobial resistance of HP, defined as the prescription of a second eradication treatment within 12 months, and clinical remission of gastric symptoms, defined as no usage of acid inhibition 1 year following eradication therapy.

Results: We identified 138 455 patients with gastric symptoms and/or acid inhibition use (mean age 57 years [standard deviation 18.2 years], 43% male). A total of 5224 (4%) patients received an HP eradication treatment. A second treatment was prescribed to 416 (8%) of those patients. From these, 380 patients received amoxicillin-clarithromycin, 16 amoxicillin-metronidazole, and 11 clarithromycin-metronidazole as first regimen and were considered antimicrobial resistant. We observed a 0.8% increment per year of patients requiring a second eradication treatment (P = 0.003, 95% confidence interval = 0.33 to 1.22). After successful eradication, 2329/4808 (48%) patients used acid inhibition compared with 355/416 (85%) patients following treatment failure (P<0.001).

Conclusion: Antimicrobial treatment is not successful in almost one-tenth of HP infections in primary care after a first treatment containing clarithromycin and/or metronidazole. Although the treatment failure rate is not as high as reported in secondary care, the increasing trend is concerning and may require revision of the current guidelines.

Background: Smoking during pregnancy has many adverse effects for infant and mother. Despite this, many pregnant women continue smoking. Primary care is a suitable area to provide smoking cessation interventions.

Aim: To investigate available literature regarding effectiveness of smoking cessation interventions for pregnant women in primary care, the factors contributing to this effectiveness, and to provide suggestions for future research.

Design & setting: Systematic scoping literature review.

Method: The methodology followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews. Five electronic databases were searched. Inclusion criteria included original research studies and studies published in English. Data were extracted using a modified Joanna Briggs Institute (JBI) data-charting tool.

Results: The initial search yielded 878 articles. Following article screening, 12 studies were included. Five studies found a statistically significant increase in smoking cessation rates or reduction in tobacco consumed in the intervention group. The remaining studies showed no significant difference between the groups. However, 10 studies showed the control group received usual antenatal care involving smoking cessation promotion. An increase in smoking cessation rates was seen in intervention and control groups, demonstrating the effectiveness of these interventions. Interventions included education, counselling, self-help, and financial incentives. They were delivered by GPs, midwives, counsellors, and pregnancy advisers.

Conclusion: Primary care is suitable to offer smoking cessation interventions to pregnant women, as it is often the first point of care and more easily accessible than secondary care. Future research is needed to determine the most effective types of interventions.