European Journal of General Practice最新文献

Diagnostic prediction models are commonly used in general practice to support clinical decision-making. Traditionally, these models have been developed using statistical methods such as logistic regression. While these approaches have proven useful, they often produce average risk estimates that may not fully account for the complexity of individual patients. In recent years, the use of machine learning (ML), a subfield of artificial intelligence (AI), has grown in healthcare. We examine the similarities and differences between traditional statistical methods and AI/ML approaches for diagnostic prediction in general practice. Using examples from daily practice, we explore how ML techniques can add value, particularly in handling large, complex datasets such as those derived from electronic health records. We also discuss key challenges that hinder the adoption of AI/ML in general practice, including interpretability, data quality, external validation, clinical relevance, implementation and legal issues, and practical usability. We provide recommendations to overcome these challenges. The potential of AI/ML can only be realised if tools are developed collaboratively with GPs, focused on real-world clinical problems, and rigorously validated in practice settings. GP associations, GPs, patients, and primary care scientists should take an active role in the development, validation, and implementation of AI/ML-based diagnostic prediction tools for general practice.

Background: Managing bodily distress disorder (BDD) requires an interprofessional, holistic therapeutic approach, which can be challenging to implement in routine care.

Objectives: The aim was to evaluate a care pathway for patients with BDD involving general practitioners (GPs) and physiotherapists.

Methods: Participants were patients aged 18 years or older with BDD symptoms and the PHQ-15 (Patient Health Questionnaire 15-Item) score > 9. The treatment consisted of patient education by GPs about BDD and stress, sleep interventions, physical exercises and support to develop an active lifestyle (> 150 min per week of moderate-intensity physical activity), as measured with the Physical Activity Vital Sign (PAVS). Patient outcomes (PHQ-15 and PAVS) were compared at baseline and after six months. A survey assessed the perspectives of both patients and health professionals about the treatment.

Results: A total of 70 patients treated by 11 GPs and 6 physiotherapists were involved. Comparing outcomes at baseline vs. after six months (median [IQR]): PHQ-15 decreased, 14 [11, 17] vs. 8 [5, 12], p < 0.001; PAVS increased, 60 [30, 120] vs. 120 [60, 180], p < 0.001; GP confidence (scale 0-100) in treating BDD increased, 50 [38, 66] vs. 82 [66, 85], p = 0.005. Feedback from patients, GPs and physiotherapists about the intervention was positive.

Conclusion: The interprofessional care pathway for patients with BDD had a positive impact on patient outcomes, GP treatment confidence, and was well-received by both patients and health professionals. It can be adapted across primary care systems and tailored to local contexts to improve the quality of care.

Background: General practice medical records offer significant potential for secondary use in research, policy and public health. In Australia, these data remain underused due to concerns around privacy, governance and ethical use. Understanding the perspectives of GPs is essential to developing best practice recommendations for responsible data use.

Method: A three-round modified Delphi study was conducted with 22 Australian GPs with experience in research and/or data sharing. Participants rated and commented on 11 recommendations derived from community juries, with consensus defined as ≥75% agreement. Feedback summaries and thematic analysis informed subsequent rounds.

Results: Consensus was reached on 10 of 11 recommendations. The panel supported ethical approval, transparency, protection of the doctor-patient relationship and remuneration for practices contributing data. An opt-out approach to consent was endorsed under strict conditions, with clear distinctions made between vulnerable and non-vulnerable populations. The panel also supported the establishment of a governance body and researcher cybersecurity training. However, no consensus was reached on community involvement in research design, despite its growing recognition as best practice by funding bodies.

Conclusion: This study highlights the need for a nationally agreed remuneration model for general practices that contribute data, clearer ethical guidance for engaging vulnerable populations and reform of statutory frameworks to support responsible data use. The lack of consensus on community involvement is concerning, especially as initiatives such as the Australian Institute of Health and Welfare (AIHW) and Primary Health Networks (PHN) partnership advance national data standards. Bridging this gap is essential to align professional practice with public expectations and ensure inclusive, ethically robust research.

Background: Overprescribing of short-acting beta-agonist (SABA) inhalers is a worldwide problem.

Objectives: To evaluate the impact of a system-wide quality improvement programme on SABA overprescribing, and to identify the most effective strategies.

Methods: All general practices within one East London borough received the intervention between October 2020 and March 2023. Practices in two neighbouring boroughs acted as comparators. Intervention practices engaged in quality improvement activities including: electronic alerts flagging patients prescribed ≥12 SABA inhalers/year; generating lists of patients overprescribed SABA to call for review; a summary guideline for clinicians; electronic patient information leaflets. All practices were offered webinar coaching. Prescribing data were collected from electronic health records, and SABA overprescription evaluated through interrupted times series analysis. Content analysis was applied to survey data and conversations with staff.

Results: During the three-year study period all localities introduced programmes to reduce SABA prescribing. We observed a significant decrease in the proportion of asthma patients prescribed more than 6 SABA/year in the study practices. The COVID pandemic triggered a temporary increase in patients on asthma registers, which persisted for 6 months. When implemented by practices the electronic prescribing alerts were effective: 50% of patients who received an active response reduced to <12 SABA in the following year.

Conclusions: This quality improvement programme was associated with a reduction in SABA overuse, which could also decrease hospital admissions. Practices required individual coaching to use the electronic tools effectively. Integrated prescribing alerts reduced overprescribing, and collaborative practice cultures supported faster implementation of improvement strategies.

Background: General practitioners (GPs) frequently refer patients for abdominal ultrasound. Depending on the clinical context, a 'triage ultrasound' can assess multiple potential causes of abdominal symptoms, while a 'targeted ultrasound' (point-of-care ultrasound, POCUS) focuses on specific indications (e.g. cholelithiasis).

Objective: To assess whether medical questions posed by GPs in abdominal ultrasound referral letters are adequate for radiologists to perform their examination, and to identify indications for POCUS by GPs based on exclusion rates and alternative findings in radiological reports.

Methods: Retrospective study analysing GP referral letters with corresponding radiology reports referred for abdominal ultrasound. Key variables: GP's medical question, indication type and the radiologist's final interpretation, following established diagnostic guidelines.

Results: A total of 1,196 referral letters with corresponding reports were reviewed. Of these, 143 (12%) were excluded, primarily due to missing clinical information from the GP (102; 8.5%). The final sample comprised 1053 referral letters with reports (mean age 59.2 years; 60% female). Sixteen percent of referral letters lacked a medical question, and 33% included exclusively guideline-based indications. The most common guideline-based indications were urolithiasis (43%) and cholelithiasis (39%). For guideline-based requests, radiologists excluded the indicated condition in 75% of cases, and an alternative diagnosis was identified in fewer than 10%.

Conclusion: GPs frequently provide insufficient clinically relevant information in abdominal ultrasound referral letters. Simple cases with well-defined clinical queries like cholelithiasis, urolithiasis, hydronephrosis and abdominal aortic aneurysm seem suitable for POCUS evaluation, as these are often excluded conditions for which the risk of overlooking serious diagnoses is low.

Background: Ageing, multimorbidity, and workforce shortages increasingly limit access to primary healthcare, especially in rural and underserved areas.

Objectives: To document impact of nurse practitioners (NPs) in primary care on patients with chronic diseases.

Methods: Searches were conducted in Medline, EMBASE, CINAHL, and CENTRAL (March 1978-October 2023). This systematic review followed MECIR and PRISMA guidelines (PRISMA 2020 checklist: EQUATOR Network) with SWiM used as a PRISMA extension due to the lack of meta-analysis. The focus was on NPs' roles in chronic disease management and primary care in underserved or remote areas, excluding mental health, cancer, and dental care.

Results: Among 3,684 citations, 25 studies were selected, including 10 RCT. NPs may improve access to primary care and chronic disease management, particularly in underserved areas. Although not all studies directly compared NPs to traditional models, they were most often assessed against General Practitioners (GPs) alone. Seven studies also evaluated collaborative NP-GP models versus GP-only care. Patient satisfaction was generally higher with NPs, possibly due to longer consultations and greater patient education. Clinical and biological outcomes were often comparable between NPs and GPs, with the best results in collaborative models, which were also associated with higher costs.

Conclusion: NPs may enhance access to care, particularly for vulnerable populations. Higher patient satisfaction may be linked to longer consultations and patient education. While clinical outcomes were comparable to those of GPs, collaborative models yielded the best results, though potentially at a higher cost.

Background: General practitioners (GPs) frequently prescribe anti-vertigo drugs (AVDs), even though there is limited evidence for their effectiveness. Meanwhile, they rarely apply vestibular rehabilitation, a treatment for various vestibular disorders with a strong evidence base.

Objectives: This study aimed to identify barriers and facilitators to appropriate vestibular care in general practice.

Methods: We conducted a qualitative study in Dutch general practice using semi-structured interviews with GPs and patients with vestibular symptoms. We used purposive sampling to select participants. Interviews were audio-recorded, transcribed verbatim, and thematically analysed following the Template Analysis approach using MAXQDA 2022 software.

Results: We interviewed 11 GPs and 15 patients. We assessed barriers and facilitators to appropriate vestibular care for GPs (i.e. not prescribing AVDs, advising vestibular exercises) and patients (i.e. not using AVDs, doing vestibular exercises). We identified four themes: competence, mindset, relational determinants, and accessibility to care. Facilitators included adequate knowledge about vestibular disorders, GPs valuing delivering high-value care, positive experiences with physiotherapy, patients' coping skills, personal continuity, close collaboration between GP and colleagues, social support, and sufficient time and availability of providers. Barriers included diagnosis and treatment insecurity among GPs, patients doubting the GPs' competence, patients' desperation for treatment and GPs accommodating these wishes, positive experiences with AVDs, prescriptions by other providers, and insurance not covering physiotherapy.

Conclusion: Multiple barriers and facilitators shape appropriate vestibular care in general practice. Interventions should strengthen GPs' and patients' knowledge of vestibular management. Internet-based vestibular rehabilitation may address key barriers, particularly logistic and financial ones.