British Journal of General Practice最新文献

Background: Routine primary care data may be a valuable resource for preconception health research and to inform the provision of preconception care.

Aim: To review how primary care data could provide information on the prevalence of preconception indicators and examine associations with maternal and offspring health outcomes.

Design and setting: Systematic review of observational studies using UK routine primary care data.

Method: Literature searches were conducted in March 2023 using five databases to identify observational studies that used national primary care data from individuals aged 15-49 years. Preconception indicators were defined as medical, behavioural, and social factors that may impact future pregnancies; health outcomes included those that may occur during and after pregnancy.

Results: From 5259 screened records, 42 articles were included. The prevalence of 37 preconception indicator measures was described for female patients, ranging from 0.01% for sickle cell disease to >20% for each of advanced maternal age, previous caesarean section (among those with a recorded pregnancy), overweight, obesity, smoking, depression, and anxiety (irrespective of pregnancy). Few studies reported indicators for male patients (n = 3) or associations with outcomes (n = 5). Most studies had a low risk of bias, but missing data may limit generalisability of the findings.

Conclusion: The findings demonstrated that routinely collected UK primary care data could be used to identify patients' preconception care needs. Linking primary care data with health outcomes collected in other datasets is underutilised, but could help to quantify how optimising preconception health and care could reduce adverse outcomes for mothers and children.

Background: Providing safety-netting advice (SNA) in out-of-hours (OOH) primary care is a recognised standard of safe care, but it is not known how frequently this occurs in practice.

Aim: Assess the frequency and type of SNA documented in OOH primary care and explore factors associated with its presence.

Design and setting: This was a retrospective cohort study using the Birmingham Out-of-hours general practice Research Database.

Method: A stratified sample of 30 adult consultation records per month from July 2013 to February 2020 were assessed using a safety-netting coding tool. Associations were tested using linear and logistic regression.

Results: The overall frequency of SNA per consultation was 78.0% (1472/1886), increasing from 75.7% (224/296) in 2014 to 81.5% (220/270) in 2019. The proportion of specific SNA and the average number of symptoms patients were told to look out for increased with time. The most common symptom to look out for was if the patients' condition worsened followed by if their symptoms persisted, but only one in five consultations included a timeframe to reconsult for persistent symptoms. SNA was more frequently documented in face-to-face treatment-centre encounters compared with telephone consultations (odds ratio [OR] 1.77, 95% confidence interval [CI] = 1.09 to 2.85, P = 0.02), for possible infections (OR 1.53, 95% CI = 1.13 to 2.07, P = 0.006), and less frequently for mental (versus physical) health consultations (OR 0.33, 95% CI = 0.17 to 0.66, P = 0.002) and where follow-up was planned (OR 0.34, 95% CI = 0.25 to 0.46, P<0.001).

Conclusion: The frequency of SNA documented in OOH primary care was higher than previously reported during in-hours care. Over time, the frequency of SNA and proportion that contained specific advice increased, however, this study highlights potential consultations where SNA could be improved, such as mental health and telephone consultations.

Background: The Recommended Summary Plan for Emergency Care and Treatment (ReSPECT) has been implemented in many areas of the UK. It is unclear how ReSPECT is used in primary and community care settings.

Aim: To investigate how the ReSPECT process is understood and experienced in the community by clinicians, social care staff, patients, their relatives, and identify obstacles and enablers to its implementation.

Design and setting: A qualitative interview and focus-group study across 13 general practices in three areas of England, between January and December 2022.

Method: We interviewed GPs, specialist nurses, patients and relatives, and senior care home staff. Focus groups were conducted with community nurses, paramedics, and home care workers. Questions focused on understanding experiences of, and engagement with, ReSPECT. We analysed data using thematic analysis and a coding framework drawn from normalisation process theory.

Results: Participants included n = 21 GPs, n = 5 specialist nurses, n = 9 patients, n = 7 relatives, n = 31 care home staff, n = 9 community nurses, n = 7 home care workers, and n = 2 paramedics. Participants supported ReSPECT, regarding it as a tool to facilitate person-centred care. GPs faced challenges in timing the introduction of ReSPECT and ensuring sufficient time to complete plans with patients. ReSPECT conversations worked best when there was a trusting relationship between the clinician and the patient (and their family). Anticipating future illness trajectories was difficult, yet plans were rarely reviewed. Interpreting recommendations in emergencies was challenging.

Conclusion: The ReSPECT process has not translated as well as expected in the community setting. A revised approach is needed to address the challenges of implementation in this context.