British Journal of General Practice最新文献

Background: Relapse contributes to the clinical and societal burden associated with depression. It is not well understood how relapse risk and prevention are managed and discussed between patients and GPs in primary care.

Aim: To understand the extent to which relapse risk and prevention are discussed and managed in general practice.

Design and setting: A qualitative study undertaken in general practice in the UK.

Method: Participants were recruited through general practices. Data were generated using semi-structured interviews and analysed using thematic analysis. Patient and public involvement informed all aspects of the study.

Results: Twenty-three people with lived experience of depression and 22 GPs were interviewed. The following three themes are presented in this paper: perceived determinants of depression course (participants viewed environmental, social, and personal factors as being most important); relapse risk and prevention (relapse was considered important but not consistently or routinely discussed in general practice consultations); and relationships and communication (participants discussed the key role of the GP-patient relationship). Conceptually, relapse was perceived as having limited meaning and usefulness in primary care, owing to the implication of an episodic, discrete course not recognised by many patients and an over-reliance on biomedical diagnosis. Longer-term follow-up and monitoring of depression could be improved in primary care.

Conclusion: We provide an evidence-informed framework to improve practice systems and GP consultations to enhance longer-term care and support for people with depression. Going forwards, acute depression management could be optimised to include discussions of relapse risk and prevention. Brief, scalable relapse prevention interventions are needed for use in primary care.

Background: Online records access, including test results, was rolled out as part of changes to the GP contract in England in 2023. Blood test result communication is important for patient-centred care, patient safety, and primary care workload. Evidence is needed to ensure that test results are communicated safely and efficiently to patients in primary care.

Aim: To summarise existing evidence for blood test result communication between primary care providers and their patients and carers.

Design and setting: A mixed-methods systematic review was undertaken.

Method: MEDLINE, Embase, PsycInfo (Ovid), CINAHL (EBSCOhost), and the Cochrane Library were searched from January 2013-September 2023. Qualitative or quantitative studies that provided information on the communication of blood test results by primary care staff to adult patients and carers were eligible for inclusion.

Results: There were 71 included studies, including 10 experimental studies and no randomised controlled trials. Study quality was mostly poor and risk of bias was high, partly owing to a lack of reported information. The studies found that patients want more information about their blood test results, particularly in terms of 'what next', and prefer results to be provided quickly. Electronic methods, such as online access or text messages, were generally well accepted but not by everyone, and not for all results. Clinicians' opinions were mixed as to whether online direct release of test results to patients was beneficial or could cause problems, such as increased patient anxiety and increased workload.

Conclusion: A range of evidence has been identified on patient and clinician preferences, and barriers and facilitators to test communication, which is particularly important in the current NHS context of a move towards patient online access.

Background: International medical graduates (IMGs) comprise more than half of GP registrars but are more likely to fail postgraduate assessments than UK graduates.

Aim: To assess whether there is an association between the language of the primary medical qualification (PMQ) and Membership of the Royal College of General Practitioners (MRCGP) results, and whether performance in previous prequalification assessments is correlated.

Design and setting: Retrospective observational study in the UK.

Method: The World Directory of Medical Schools and the UK Medical Education databases were used to obtain data for all candidates who sat the MRCGP exams between October 2013 and July 2021 (n = 28 020). Candidates were split into three cohorts: cohort 1 comprised UK graduates; cohort 2 comprised IMGs with English as the language of the PMQ, who trained in countries with English (cohort 2a) or non-English (cohort 2b) as a first language; and cohort 3 included IMGs with non-English as the language of the PMQ. Logistic and linear regression analyses were used to compare the odds of exam passing and the scores relative to pass. Associations with past Multi-Specialty Recruitment Assessment (MSRA) scores, International English Language Testing System (IELTS) scores, and Professional and Linguistic Assessments Board (PLAB) scores were examined.

Results: IMGs who trained in countries with non-English as a first language had statistically significantly lower odds of passing the exams and lower exam scores across all exam components. There were statistically significant positive correlations between MRCGP exam scores and MSRA, IELTS, and PLAB scores.

Conclusion: English being the language of the PMQ and undertaking medical training in a country with English as the native language seemed to result in statistically significantly better chances of passing the exams and better exam scores. Performance in prequalification assessments can help to identify those IMG registrars who may benefit from tailored support.