British Journal of General Practice最新文献

Background: COVID-19 pandemic restrictions may have influenced behaviours related to weight.

Aim: To describe patterns of weight change among adults living in England with type 2 diabetes (T2D) and/or hypertension during the pandemic.

Design and setting: An observational cohort study using the routinely collected health data of approximately 40% of adults living in England, accessed through the OpenSAFELY service inside TPP.

Method: Clinical and sociodemographic characteristics associated with rapid weight gain (>0.5 kg/m²/year) were investigated using multivariable logistic regression.

Results: Data were extracted on adults with T2D (n = 1 231 455, 43.9% female, and 76.0% White British) or hypertension (n = 3 558 405, 49.7% female, and 84.3% White British). Adults with T2D lost weight overall (median δ = -0.1 kg/m²/year [interquartile range {IQR} -0.7-0.4]). However, rapid weight gain was common (20.7%) and associated with the following: sex (male versus female: adjusted odds ratio [aOR] 0.78 [95% confidence interval {CI} = 0.77 to 0.79]); age (older age reduced odds, for example, aged 60-69 years versus 18-29 years: aOR 0.66 [95% CI = 0.61 to 0.71]); deprivation (least deprived Index of Multiple Deprivation [IMD] quintile versus most deprived IMD quintile: aOR 0.87 [95% CI = 0.85 to 0.89]); White ethnicity (Black versus White: aOR 0.95 [95% CI = 0.92 to 0.98]); mental health conditions (for example, depression: aOR 1.13 [95% CI = 1.12 to 1.15]); and diabetes treatment (non-insulin treatment versus no pharmacological treatment: aOR 0.68 [95% CI = 0.67 to 0.69]). Adults with hypertension maintained stable weight overall (median δ = 0.0 kg/m²/year [IQR -0.6-0.5]); however, rapid weight gain was common (24.7%) and associated with similar characteristics as in T2D.

Conclusion: Among adults living in England with T2D and/or hypertension, rapid pandemic weight gain was more common among females, younger adults, those living in more deprived areas, and those with mental health conditions.

Background: Clinical coding allows for structured and standardised recording of patients' electronic healthcare records. How clinical and non-clinical staff in general practice approach clinical coding is poorly understood.

Aim: To explore primary care staff's experiences and views on clinical coding.

Design and setting: Qualitative, semi-structured interview study among primary care staff across Wales.

Method: All general practices within Wales were invited to participate via NHS health boards. Semi-structured questions guided interviews, conducted between February 2023 and June 2023. Audio-recorded data were transcribed and analysed using reflexive thematic analysis.

Results: A total of 19 participants were interviewed and six themes were identified: coding challenges, motivation to code, making coding easier, daily task of coding, what and when to code, and coding through COVID.

Conclusion: This study demonstrates the complexity of clinical coding in primary care. Clinical and non-clinical staff spoke of systems that lacked intuitiveness, and the challenges of multimorbidity and time pressures when coding in clinical situations. These challenges are likely to be exacerbated in socioeconomically deprived areas, leading to underreporting of disease in these areas. Challenges of clinical coding may lead to implications for data quality, particularly the validity of research findings generated from studies reliant on clinical coding from primary care. There are also consequences for patient care. Participants cared about coding quality and wanted a better way of using coding. There is a need to explore technological and non-technological solutions, such as artificial intelligence, training, and education to unburden people using clinical coding in primary care.

Background: Barriers to accessing and using primary care services among minoritised ethnic communities have been extensively evidenced in the UK. However, the impact of the rapid digitalisation of these services on these communities remains under-researched.

Aim: To explore the impact of digitalisation on access to and use of primary care services among minoritised ethnic communities.

Design and setting: Underpinned by a critical realist intersectional approach, and employing qualitative research methods, this study explores minoritised ethnic individuals' experiences of digital primary care in the UK.

Method: In total, 100 minoritised ethnic adults who identify as Black African, Black Caribbean, Bangladeshi, Indian, Pakistani, Chinese, and of mixed or multiple ethnic heritage in four sites in the UK were purposively recruited and interviewed. Interviews were thematically analysed to increase understanding of how individuals' ethnicity intersects with other characteristics (for example, language, age, gender, socioeconomic status) to identify constraints and enablements to accessing health care.

Results: Minoritised ethnic individuals' access to digital primary care is impeded by factors such as digital precarity (for example, inadequate devices, internet connectivity, and digital literacy skills), a lack of language support, and staff shortcomings in responding to ethnically diverse populations. Intergenerational support and bespoke offerings by general practices in some areas enable some individuals to overcome some of the constraints.

Conclusion: The rapid digitalisation of primary care services is replicating and potentially exacerbating barriers to using these services among minoritised ethnic communities, a finding that merits urgent attention by practitioners and policymakers.

Background: Self-harm is a growing problem in young people. GPs are usually the first point of healthcare contact for young people aged 16-25 years, after self-harm. GPs can experience barriers to supporting young people and behaviour change theory can help to understand these, and the influences on, GP behaviour.

Aim: To explore the capabilities, opportunities, and motivations (COM-B model of behaviour) of GPs, and their perceived training needs, to help young people aged 16-25 years avoid future self-harm.

Design and setting: This was a qualitative study of GPs in England.

Method: Semi-structured interviews were conducted with NHS GPs who were purposively sampled. Interviews occurred in 2021. Data were analysed using reflexive thematic analysis and mapped onto the COM-B model domains. The study's patient and public involvement group supported data analysis.

Results: Fifteen interviews were completed. Four themes were generated. GPs described mixed capabilities, with many feeling they had the physical and psychological skills to support young people to avoid future self-harm, but some felt doing so was emotionally tiring. GPs identified opportunities to better support young people, such as use of electronic consultation tools, but cited lack of time as a concern. GPs reported motivation to help young people, but this can be influenced by their workload. Unmet training needs around communication, knowledge, and optimising safety were identified.

Conclusion: GPs are supported by their practice teams to support young people after self-harm, but a lack of time hinders opportunities to do so. Future effective GP-led interventions may improve GP motivation to support young people after self-harm.

Background: Living in socioeconomically deprived areas is associated with shorter lives and worse health. GPs working in these areas face additional challenges compared with those in more affluent locations.

Aim: To establish GPs' motivation for working in these areas, to discover the challenges that GPs face, and to gain insights from GPs on potential improvements and changes.

Design and setting: An interpretative phenomenological analysis was undertaken of GPs' lived experiences of working in the most socioeconomically deprived practices in Northern Ireland (NI), which is the most deprived country within the UK.

Method: Interviews were carried out with nine GPs to find out the challenges facing them, why they work in a Deep End area, and what suggestions, ideas, and solutions they have to improve patient care and GP experience at NI's Deep End.

Results: The challenges related to wider health service failures including the increased demand on GPs and feelings of powerlessness. Patient population challenges included 'missingness', late or crisis presentations, alongside the clinical difficulties of a highly 'medicalised' patient population, as well as the high prevalence of mental health problems. However, GPs choose to work in Deep End areas because the environments were seen as clinically stimulating and rewarding, as well as giving them feelings of belonging and fulfilling a duty to 'their' area. Improvements focused on providing more flexible access, increased mental health provision, and future training and recruitment, particularly around widening participation in medical school.

Conclusion: Improving the environmental conditions, empowering individuals, and investing in communities are essential factors to achieving health. The current model of providing reactionary acute care is leading to GPs experiencing powerlessness and feelings of helplessness at the Deep End.

Background Patient satisfaction is a significant dimension of quality in general practice and has notably declined post-COVID. Understanding the dynamics between practice activities, practice characteristics and patient experience is vital for improving care quality. Aim This study investigates the relationship between the volume, modality (telephone or face-to-face) and practitioner type of general practice appointments and patient experience. Design and Setting An observational study of general practices in England. Method Data from the General Practice Patient Survey (GPPS) were merged with NHS Digital's practice level appointment data, covering August 2022 to March 2023. We estimate ordinary least squares regressions of patient satisfaction with access, general satisfaction, preference for a specific GP, and support for managing long-term conditions (dependent variables) against appointment volume, modality (telephone or face-to-face), and practitioner type. Results Analysis of 5,278 practices showed that a higher volume of appointments, especially face-to-face with GPs, was significantly (p<0.001) associated with increased patient satisfaction. Practices having a greater proportion of same-day appointments was significantly correlated with lower patient satisfaction. Conclusion Patient satisfaction and ability to have health needs met is associated with face-to-face access to GPs as well as the total volume of appointments available. The results suggest that patients' perceptions of access involve more than immediate availability of appointments or that patients may struggle to get appointments at practices offering more same day appointments. Initiatives to improve access to and satisfaction with general practice should prioritise expanding face-to-face GP appointments.

Background: In 2019, the Additional Roles Reimbursement Scheme (ARRS) was introduced in England as a crucial component of the government's manifesto pledge to enhance access to general practice. The primary objective was to recruit 26,000 extra personnel through new roles into general practice.

Aim: This study aimed to analyse the effects of ARRS staff on prescription rates and patient satisfaction.

Design and setting: The study was a retrospective panel data analysis combining data from the General Workforce Minimum Dataset and National Health Service (NHS) Digital datasets about primary care practices and their activity from 2018 until 2022. The study included data from more than 6000 general practices.

Methods: A linear regression analysis was conducted to determine the association between ARRS staff and prescription rates and patient satisfaction, controlling for patient and practice characteristics.

Results: The results showed that ARSS roles tend to be more frequent in larger general practices, with fewer full-time general practitioners per patient, and with more overseas trained general practitioners. The use of ARRS staff was significantly associated with lower prescription rates (β=-0.52, p<0.000) and higher patient satisfaction (β=3.2, p<0.000), after controlling for patient and practice characteristics.

Conclusion: This study suggests that ARRS has the potential to have a positive role in primary care, notably through reduced prescription rates and improved patient satisfaction. Further research is needed to explore the long-term effects of ARRS on primary care, including patient outcomes and health care costs, and the potential barriers to its implementation.