British Journal of General Practice最新文献

Background: UK Asian and Black patients experience longer cancer diagnostic intervals - the period between initial symptomatic presentation in primary care and cancer diagnosis.

Aim: To determine whether the differences in diagnostic intervals are because of prolonged primary care, referral, or secondary care interval.

Design and setting: A cohort study was undertaken of 70 971 patients with seven cancers (breast, lung, prostate, colorectal, oesophagogastric, myeloma, ovarian) diagnosed after symptom presentation in English primary care.

Method: Data on symptom presentation and diagnosis were extracted from cancer registry-linked primary care and secondary care data. Primary interval was defined as the period between first primary care presentation and secondary care referral, referral interval as the period between referral and first secondary care appointment, and secondary care interval as the period between the first secondary care appointment and diagnosis. Accelerated failure time models were used to investigate ethnic differences across all four intervals.

Results: Across all sites, the median diagnostic interval was 46 days, ranging from 13 days for breast cancer to 116 days for lung cancer. It was 14% longer for Black patients (adjusted time ratio [ATR] 1.14, 95% confidence interval [CI] = 1.05 to 1.25) and 13% longer for Asian patients (ATR 1.13, 95% CI = 1.03 to 1.23) compared with White patients. Site-specific analyses showed that, for myeloma, lung, prostate, and colorectal cancer, the secondary care interval was longer in Asian and Black patients, who also had a longer primary care interval in breast and colorectal cancer. There was little evidence of ethnic differences in referral interval.

Conclusion: This study found evidence of ethnic differences in diagnostic intervals, with prolonged secondary care intervals for four common cancers and prolonged primary care intervals for two. Although these differences are relatively modest, they are unjustified and may indicate shortcomings in healthcare delivery that disproportionately affect ethnic minorities.

Background: The estimated incidence of a cancer diagnosis during or shortly after pregnancy is 1 in 1000 pregnancies in England. Pregnancy can have an impact on symptom appraisal and help-seeking for symptoms subsequently diagnosed as cancer. Little is known about the pathway to cancer diagnosis in pregnancy or delays that women can encounter.

Aim: To explore symptom appraisal, help-seeking decisions, and experience of receiving a cancer diagnosis during pregnancy.

Design and setting: Semi-structured interviews were conducted with women diagnosed with cancer during or shortly after pregnancy in the previous 4 years in the UK, recruited between January and May 2022 via the charity Mummy's Star.

Method: This study used reflexive thematic analysis of 20 interviews. Analysis was largely inductive and the themes generated were mapped onto the intervals of the Model of Pathways to Treatment.

Results: Symptoms were often interpreted through the lens of pregnancy by both participants and most of the healthcare professionals from whom they sought help. Participants who found breast lumps were likely to suspect cancer and be referred promptly for tests in secondary care. Although most participants sought timely help for their symptoms, some subsequently encountered health system delays, partly owing to both the vague nature of their symptoms and the COVID-19 pandemic.

Conclusion: Health services need to better support women presenting with possible cancer symptoms during pregnancy to ensure timely diagnosis. Recommendations include prioritising symptoms over attributing them solely to pregnancy, ensuring timely referrals to rule out serious conditions, and emphasising clear communication alongside robust safety-netting practices. A full assessment is essential before dismissing symptoms as pregnancy related.

Background: Physical activity (PA) benefits cancer survivors' health, yet no PA programmes are incorporated in Dutch general practice.

Aim: To evaluate cancer survivors' outcomes following a PA programme in general practice.

Design and setting: A single-arm PA intervention implementation study among cancer survivors in 15 Dutch general practices.

Method: Patients aged ≥18 years who completed primary cancer treatment ≥6 months prior were eligible. The 9-month intervention comprised counselling sessions with a primary care practitioner (PCP) aimed at increasing daily PA. Reach, Effectiveness, and Implementation of the RE-AIM framework were evaluated among participants. Primary health outcomes included self-reported symptoms of fatigue, depression, and anxiety; secondary outcomes included step count, caloric expenditure, weight, physical function, self-reported quality of life, and PA. Outcomes were assessed at time (T)₀-T₃ (0, 3, 6, and 9 months) or at PCPs' sessions S1-S6 (0, 3, 6 weeks, and 3, 6, 9 months). Non-participants completed a single baseline questionnaire. The study used (non-)parametric independent tests and linear mixed models for analyses.

Results: Of 564 invited patients, 149 (26%) participated. Participants had less formal education, higher unemployment, less PA, and more fatigue and psychological symptoms than non-participants. All primary and most secondary health outcomes improved over time, with clinically relevant changes in step count and physical function. In total, 11% (n = 16/149) dropped out before and 26% (n = 35/133) during the programme. Counselling session adherence and PA goal achievement were 98% (n = 647/661) and 73% (n = 81/111), respectively.

Conclusion: The programme reached long-term cancer survivors with poorer health status, and showed positive health changes particularly on PA and physical function. Such PA programmes may benefit the health of a rising number of cancer survivors visiting primary care.

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: To investigate the relationship between the volume, modality (telephone or face to face), and practitioner type of general practice appointments and patient experience.

Design and setting: This was an observational study of general practices in England.

Method: Data from the GP Patient Survey (GPPS) were merged with NHS England's practice-level appointment data, covering August 2022 to March 2023. Ordinary least squares regressions were estimated 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 5278 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.