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British Journal of General Practice
Journal Prestige (SJR): 0.906  Citation Impact (citeScore): 1 Number of Followers: 40  Subscription journalISSN (Print) 0960-1643 - ISSN (Online) 1478-5242 Published by RCGP  [1 journal]
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- Maternal mental illness and child atopy: a UK population-based, primary
care cohort study-
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Authors: Cemre Su Osam; Holly Hope, Darren M Ashcroft, Kathryn M Abel, Matthias Pierce
Pages: e924 - e931
Abstract: BackgroundThe number of children exposed to maternal mental illness is rapidly increasing and little is known about the effects of maternal mental illness on childhood atopy.AimTo investigate the association between maternal mental illness and risk of atopy among offspring.Design and settingRetrospective cohort study using a UK primary care database (674 general practices).MethodIn total, 590 778 children (born 1 January 1993 to 30 November 2017) were followed until their 18th birthday, with 359 611 linked to their hospital records. Time-varying exposure was captured for common (depression and anxiety), serious (psychosis), addiction (alcohol and substance misuse), and other (eating and personality disorder) maternal mental illness from 6 months before pregnancy. Using Cox regression models, incidence rates of atopy were calculated and compared for the exposed and unexposed children in primary (asthma, eczema, allergic rhinitis, and food allergies) and secondary (asthma and food allergies) care, adjusted for maternal (age, atopy history, smoking, and antibiotic use), child (sex, ethnicity, and birth year/season), and area covariates (deprivation and region).ResultsChildren exposed to common maternal mental illness were at highest risk of developing asthma (adjusted hazard ratio [aHR] 1.17, 95% confidence interval [CI] = 1.15 to 1.20) and allergic rhinitis (aHR 1.17, 95% CI = 1.13 to 1.21), as well as a hospital admission for asthma (aHR 1.29, 95% CI = 1.20 to 1.38). Children exposed to addiction disorders were 9% less likely to develop eczema (aHR 0.91, 95% CI = 0.85 to 0.97) and 35% less likely to develop food allergies (aHR 0.65, 95% CI = 0.45 to 0.93).ConclusionThe finding that risk of atopy varies by type of maternal mental illness prompts important aetiological questions. The link between common mental illness and childhood atopy requires GPs and policymakers to act and support vulnerable women to access preventive (for example, smoking cessation) services earlier.
PubDate: 2023-11-30T16:04:47-08:00
DOI: 10.3399/BJGP.2022.0584
Issue No: Vol. 73, No. 737 (2023)
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- Uptake and adoption of the NHS App in England: an observational study
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Authors: Sukriti KC; Salina Tewolde, Anthony A Laverty, Ceire Costelloe, Chrysanthi Papoutsi, Claire Reidy, Bernard Gudgin, Craig Shenton, Azeem Maȷeed, John Powell, Felix Greaves
Pages: e932 - e940
Abstract: BackgroundTechnological advances have led to the use of patient portals that give people digital access to their personal health information. The NHS App was launched in January 2019 as a ‘front door’ to digitally enabled health services.AimTo evaluate patterns of uptake of the NHS App, subgroup differences in registration, and the impact of COVID-19.Design and settingAn observational study using monthly NHS App user data at general-practice level in England was conducted.MethodDescriptive statistics and time-series analysis explored monthly NHS App use from January 2019–May 2021. Interrupted time-series models were used to identify changes in the level and trend of use of different functionalities, before and after the first COVID-19 lockdown. Negative binomial regression assessed differences in app registration by markers of general-practice level sociodemographic variables.ResultBetween January 2019 and May 2021, there were 8 524 882 NHS App downloads and 4 449 869 registrations, with a 4-fold increase in App downloads when the COVID Pass feature was introduced. Analyses by sociodemographic data found 25% lower registrations in the most deprived practices (P
PubDate: 2023-11-30T16:04:47-08:00
DOI: 10.3399/BJGP.2022.0150
Issue No: Vol. 73, No. 737 (2023)
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- Exploring GPs’ assessments of their patients’ cancer diagnostic
processes: a questionnaire study-
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Authors: Gitte Bruun Lauridsen; Dorte Eȷg Jarbol, Peter Thye–Ronn, Sanne Rasmussen, Kirubakaran Balasubramaniam, Jesper Lykkegaard
Pages: e941 - e948
Abstract: BackgroundMost cancer diagnostic pathways start from primary care and several factors affect the diagnostic processes.AimTo analyse the associations between patient characteristics, symptom presentation, and cancer type and the GP’s assessment of the diagnostic processes.Design and settingGeneral practices in the North, Central, and Southern regions of Denmark were invited to participate in a questionnaire survey.MethodParticipating GPs received a list of patients with incident cases of cancer in the period between 1 March 2019 and 28 February 2021 based on administrative hospital data. A questionnaire was completed for each patient, addressing symptom presentation and the GP’s assessment of the diagnostic process both overall and in four subcategories (the patient’s role, the GP’s role, the transition between primary and secondary care, and the secondary sector’s role).ResultsA total of 187 general practices informed on 8240 patients. For 5868 patients, diagnostic pathways started in general practice. Almost half (48.3%, 2837/5868) presented with specific cancer symptoms. GPs assessed 55.6% (3263) and 32.3% (1897) of the diagnostic processes as ‘very good’ and ‘predominantly good’, respectively; 11.9% (700) were ‘predominantly poor’ or ‘very poor’ for these 5868 patients. Long symptom duration of ≥2 months prior to GP contact and presenting with non-specific or a combination of non-specific and specific symptoms were associated with a poor overall assessment of the diagnostic process. Assessment in the four subcategories showed that the patient’s role was assessed less positively than the other three categories.ConclusionA longer symptom duration and presenting without cancer-specific symptoms were associated with GPs assessing the diagnostic process as poor.
PubDate: 2023-11-30T16:04:47-08:00
DOI: 10.3399/BJGP.2022.0651
Issue No: Vol. 73, No. 737 (2023)
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- Interconception care in Australian general practice: a qualitative study
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Authors: Sharon James; Cathy Watson, Elodie Bernard, Greasha K Rathnasekara, Danielle Mazza
Pages: e949 - e957
Abstract: BackgroundGPs provide care for women across the lifespan. This care currently includes preconception and postpartum phases of a woman’s life. Interconception care (ICC) addresses women’s health issues between pregnancies that then have impact on maternal and infant outcomes, such as lifestyle and biomedical risks, interpregnancy intervals, and contraception provision. However, ICC in general practice is not well established.AimTo explore GP perspectives about ICC.Design and settingQualitative interviews were undertaken with GPs between May and July 2018.MethodEighteen GPs were purposively recruited from South–Eastern Australia. Audiorecorded semi- structured interviews were transcribed verbatim and analysed thematically using the Framework Method.ResultsMost participants were unfamiliar with the concept of ICC. Delivery was mainly opportunistic, depending on the woman’s presenting need. Rather than a distinct and required intervention, participants conceptualised components of ICC as forming part of routine practice. GPs described many challenges including lack of clarity about recommended ICC content and timing, lack of engagement and perceived value from mothers, and time constraints during consultations. Facilitators included care continuity and the availability of patient education material.ConclusionFindings indicate that ICC is not a familiar concept for GPs, who feel that they have limited capacity to deliver such care. Further research to evaluate patient perspectives and potential models of care is required before ICC improvements can be developed, trialled, and evaluated. These models could include the colocation of multidisciplinary services and services in combination with well-child visits.
PubDate: 2023-11-30T16:04:47-08:00
DOI: 10.3399/BJGP.2022.0624
Issue No: Vol. 73, No. 737 (2023)
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- Early detection of chronic obstructive pulmonary disease in primary care:
a randomised controlled trial-
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Authors: Anthony Chapron; Emilie Andres, Laure Fiquet, Fabienne Pele, Emmanuel Allory, Estelle Le Pabic, Aurelie Veislinger, Lisa Le Guillou, Stephanie Guillot, Bruno Laviolle, Stephane Jouneau
Pages: e876 - e884
Abstract: BackgroundWorldwide, chronic obstructive pulmonary disease (COPD) remains largely underdiagnosed.AimTo assess whether the use of Global Initiative for Chronic Obstructive Lung Disease (GOLD) questions and COPD coordination, either alone or combined, would detect new COPD cases in primary care.Design and settingGPs in Brittany, France, systematically enrolled patients aged 40–80 years over a 4-month period in this French multicentre cluster randomised controlled study.MethodGPs were randomly allocated to one of four groups: control (standard of care), GOLD questions (adapted from symptoms and risk factors identified by GOLD), COPD coordination, and GOLD questions with COPD coordination. New cases of COPD were those confirmed by spirometry: post-bronchodilator forced expiratory volume in 1 second over forced vital capacity of
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/BJGP.2022.0565
Issue No: Vol. 73, No. 737 (2023)
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- Predicting illness progression for children with lower respiratory
infections in primary care: a prospective cohort and observational study-
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Authors: Paul Little; Taeko Becque, Alastair D Hay, Nick A Francis, Beth Stuart, Gilly O’Reilly, Natalie Thompson, Kerenza Hood, Michael Moore, Theo Verheiȷ
Pages: e885 - e893
Abstract: BackgroundAntibiotics are commonly prescribed for children with lower respiratory tract infections (LRTIs), fuelling antibiotic resistance, and there are few prognostic tools available to inform management.AimTo externally validate an existing prognostic model (STARWAVe) to identify children at low risk of illness progression, and if model performance was limited to develop a new internally validated prognostic model.Design and settingProspective cohort study with a nested trial in a primary care setting.MethodChildren aged 6 months to 12 years presenting with uncomplicated LRTI were included in the cohort. Children were randomised to receive amoxicillin 50 mg/kg per day for 7 days or placebo, or if not randomised they participated in a parallel observational study to maximise generalisability. Baseline clinical data were used to predict adverse outcome (illness progression requiring hospital assessment).ResultsA total of 758 children participated (n = 432 trial, n = 326 observational). For predicting illness progression the STARWAVe prognostic model had moderate performance (area under the receiver operating characteristic [AUROC] 0.66, 95% confidence interval [CI] = 0.50 to 0.77), but a new, internally validated model (seven items: baseline severity; respiratory rate; duration of prior illness; oxygen saturation; sputum or a rattly chest; passing urine less often; and diarrhoea) had good discrimination (bootstrapped AUROC 0.83, 95% CI = 0.74 to 0.92) and calibration. A three-item model (respiratory rate; oxygen saturation; and sputum or a rattly chest) also performed well (AUROC 0.81, 95% CI = 0.70 to 0.91), as did a score (ranging from 19 to 102) derived from coefficients of the model (AUROC 0.78, 95% CI = 0.67 to 0.88): a score of
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/BJGP.2022.0493
Issue No: Vol. 73, No. 737 (2023)
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- Patients’ and GPs’ views and expectations of home monitoring with a
pulse oximeter: a mixed-methods process evaluation of a pilot randomised
controlled trial-
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Authors: Karin Smit; Roderick P Venekamp, Geert-Jan Geersing, Frans H Rutten, Lisette Schoonhoven, Dorien LM Zwart
Pages: e894 - e902
Abstract: BackgroundResearch on how home monitoring with a pulse oximeter is executed and experienced by patients with an acute illness such as COVID-19 and their GPs is scarce.AimTo examine the process of structured home monitoring with a pulse oximeter for patients with COVID-19, their caregivers, and their GPs.Design and settingThis was a mixed-method process evaluation alongside a pilot feasibility randomised controlled trial. Patients drawn from a general practice setting, with COVID-19, and aged ≥40 years with cardiovascular comorbidities were included.MethodQuantitative trial data from 21 intervention group participants (age 63.2 years) were used, plus qualitative data from semi-structured interviews with 15 patients (age 62.9 years), eight informal caregivers, and 10 GPs.ResultsAdherence to the intervention was very high; 97.6% of protocolised peripheral oxygen saturation (SpO2) measurements in the first 14 days until admission to hospital were recorded (677/694, median daily per patient 2.7). Three identified themes from the interviews were: (a) user-friendliness of home monitoring: easy use of the pulse oximeter and patient preference of a three times daily measurement scheme; (b) patient empowerment: pulse oximeter use enhanced patient self-assurance and empowered patients and informal caregivers in disease management; and (c) added value to current clinical decision making. GPs perceived the pulse oximeter as a useful diagnostic tool and did not experience any additional workload. They felt more secure with remote monitoring with a pulse oximeter than only phone-based monitoring, but emphasised the need to keep an overall view on the patient’s condition.ConclusionStructured home monitoring by pulse oximetry supports patients and their informal caregivers in managing, and GPs in monitoring, acute COVID-19 disease. It appears suitable for use in acutely ill patients in general practice.
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/BJGP.2023.0139
Issue No: Vol. 73, No. 737 (2023)
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- Management of asthma in primary care in the changing context of the
COVID-19 pandemic: a qualitative longitudinal study with patients-
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Authors: Marta Santillo; Sarah Tonkin-Crine, Kay Wang, Christopher C Butler, Marta Wanat
Pages: e903 - e914
Abstract: BackgroundThe COVID-19 pandemic dramatically affected asthma monitoring in primary care, but exploration of patients’ views and their experiences of managing their asthma and seeking help from primary care during the pandemic has been limited.AimTo investigate patients’ experiences of asthma management in the community during the COVID-19 pandemic.Design and settingA qualitative longitudinal study using semi-structured interviews with patients from four GP practices across diverse regions including Thames Valley, Greater Manchester, Yorkshire, and North West Coast.MethodInterviews were undertaken with patients with asthma, who were usually managed in primary care. The interviews were audiorecorded, transcribed, and analysed using inductive temporal thematic analysis and a trajectory approach.ResultsForty-six interviews were conducted with 18 patients over an 8-month period that covered contrasting stages of the COVID-19 pandemic. Patients felt less vulnerable as the pandemic subsided, but the process of making sense of risk was dynamic and influenced by multiple factors. Patients relied on self-management strategies, but felt that routine asthma reviews should still have been conducted during the pandemic and highlighted that they had limited opportunities to discuss their asthma with health professionals. Patients with well-controlled symptoms felt that remote reviews were largely satisfactory, but still thought face-to-face reviews were necessary for certain aspects, such as physical examination and patient-led discussions of sensitive or broader issues associated with asthma, including mental health.ConclusionThe dynamic nature of patients’ perception of risk throughout the pandemic highlighted the need for greater clarity regarding personal risk. Having an opportunity to discuss their asthma is important to patients, even when access to face-to-face consultations in primary care is more restricted than usual.
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/BJGP.2022.0581
Issue No: Vol. 73, No. 737 (2023)
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- Spirometry services in England post-pandemic and the potential role of AI
support software: a qualitative study of challenges and opportunities-
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Authors: Gillian Doe; Stephanie JC Taylor, Marko Topalovic, Richard Russell, Rachael A Evans, Julie Maes, Karolien Van Orshovon, Anthony Sunjaya, David Scott, A Toby Prevost, Ethaar El-Emir, Jennifer Harvey, Nicholas S Hopkinson, Samantha S Kon, Suhani Patel, Ian Jarrold, Nanette Spain, William D-C Man, Ann Hutchinson
Pages: e915 - e923
Abstract: BackgroundSpirometry services to diagnose and monitor lung disease in primary care were identified as a priority in the NHS Long Term Plan, and are restarting post-COVID-19 pandemic in England; however, evidence regarding best practice is limited.AimTo explore perspectives on spirometry provision in primary care, and the potential for artificial intelligence (AI) decision support software to aid quality and interpretation.Design and settingSemi-structured interviews with stakeholders in spirometry services across England.MethodParticipants were recruited by snowball sampling. Interviews explored the pre- pandemic delivery of spirometry, restarting of services, and perceptions of the role of AI. Transcripts were analysed thematically.ResultsIn total, 28 participants (mean years’ clinical experience = 21.6 [standard deviation 9.4, range 3–40]) were interviewed between April and June 2022. Participants included clinicians (n = 25) and commissioners (n = 3); eight held regional and/or national respiratory network advisory roles. Four themes were identified: 1) historical challenges in provision of spirometry services; 2) inequity in post- pandemic spirometry provision and challenges to restarting spirometry in primary care; 3) future delivery closer to patients’ homes by appropriately trained staff; and 4) the potential for AI to have supportive roles in spirometry.ConclusionStakeholders highlighted historic challenges and the damaging effects of the pandemic contributing to inequity in provision of spirometry, which must be addressed. Overall, stakeholders were positive about the potential of AI to support clinicians in quality assessment and interpretation of spirometry. However, it was evident that validation of the software must be sufficiently robust for clinicians and healthcare commissioners to have trust in the process.
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/BJGP.2022.0608
Issue No: Vol. 73, No. 737 (2023)
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- The High Cost of Bad Air
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Authors: Nada Khan
Pages: 531 - 531
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735561
Issue No: Vol. 73, No. 737 (2023)
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- Prioritising universal access to respiratory diagnostics
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Authors: Luke Daines
Pages: 532 - 533
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735573
Issue No: Vol. 73, No. 737 (2023)
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- Improving early diagnosis of pancreatic cancer in symptomatic patients
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Authors: Amber J Johnston; Shivan Sivakumar, Yin Zhou, Garth Funston, Stephen H Bradley
Pages: 534 - 535
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735585
Issue No: Vol. 73, No. 737 (2023)
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- Radical solutions are needed to meet the challenge of medical student
placement capacity in primary care-
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Authors: Simon Thornton; Hugh Alberti, Joe Rosenthal, Joanne Protheroe
Pages: 536 - 537
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735597
Issue No: Vol. 73, No. 737 (2023)
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- A duty to expose: professionalism in a time of crisis
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Authors: Roger Neighbour
Pages: 538 - 539
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735609
Issue No: Vol. 73, No. 737 (2023)
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- Asthma management post-hospital admission should be based on robust
evidence-
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Authors: Peter J Edwards
Pages: 540 - 540
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735621
Issue No: Vol. 73, No. 737 (2023)
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- Supporting adults with autism — don’t forget comorbid ADHD
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Authors: Laurence Leaver; Sally Cubbin, Allyson Parry
Pages: 540 - 541
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735633
Issue No: Vol. 73, No. 737 (2023)
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- How does co-production differ from patient and public involvement
(PPI)'-
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Authors: Elen Williams
Pages: 541 - 541
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735645
Issue No: Vol. 73, No. 737 (2023)
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- Always winter, but never Christmas: does general practice need a magic
wardrobe, or a TARDIS'-
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Authors: Andrew Papanikitas
Pages: 551 - 551
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735681
Issue No: Vol. 73, No. 737 (2023)
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- Editor’s choice: 10 BJGP articles from 2022-2023
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Authors: Euan Lawson
Pages: 552 - 554
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735693
Issue No: Vol. 73, No. 737 (2023)
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- Ideas, Concerns, and Expectations for peace in the Middle East
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Authors: Rabia Aftab
Pages: 555 - 555
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735705
Issue No: Vol. 73, No. 737 (2023)
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- Storytime as a vehicle for reflective practice: part 2 — the
Christmas commercial-
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Authors: Andrew Papanikitas; Helen Salisbury, Emma McKenzie-Edwards, Ruth Wilson
Pages: 556 - 557
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735717
Issue No: Vol. 73, No. 737 (2023)
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- Shall we all move to Denmark'
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Authors: Nada Khan
Pages: 558 - 559
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735729
Issue No: Vol. 73, No. 737 (2023)
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- Books: The Dictionary of Obscure Sorrows
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Authors: Ben Hoban
Pages: 560 - 560
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735741
Issue No: Vol. 73, No. 737 (2023)
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- Books: Radical Help. How We Can Remake The Relationships Between Us and
Revolutionise The Welfare State-
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Authors: Emilie Couchman
Pages: 560 - 561
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735753
Issue No: Vol. 73, No. 737 (2023)
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- Books: Ultra-Processed People. Why Do We All Eat Stuff That Isn’t Food
… and Why Can’t We Stop'-
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Authors: Hana MO Elhassan
Pages: 562 - 562
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735765
Issue No: Vol. 73, No. 737 (2023)
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- Poem: I Would Like To Talk About Why Life Is So Unequal
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Authors: Kathleen Wenaden
Pages: 562 - 562
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735777
Issue No: Vol. 73, No. 737 (2023)
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- Yonder: Wait and see, identity loss, data failures, and patient
organisations-
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Authors: Ahmed Rashid
Pages: 563 - 563
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735789
Issue No: Vol. 73, No. 737 (2023)
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- Reflections on COVID Christmases
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Authors: Alex Burrell
Pages: 564 - 564
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735801
Issue No: Vol. 73, No. 737 (2023)
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- Fractional exhaled nitric oxide (FeNO): the future of asthma care'
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Authors: Kay Wang; Carol Stonham, Christine Rutherford, Ian D Pavord
Pages: 565 - 568
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735813
Issue No: Vol. 73, No. 737 (2023)
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- What has postmodernism ever done for us'
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Authors: David Misselbrook
Pages: 569 - 571
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735825
Issue No: Vol. 73, No. 737 (2023)
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- Assessment and management of endometriosis in young people in primary care
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Authors: Liz Hare; Victoria Roberts, Nicholas P Hare, Faraz Mughal
Pages: 572 - 573
PubDate: 2023-11-30T16:04:46-08:00
DOI: 10.3399/bjgp23X735837
Issue No: Vol. 73, No. 737 (2023)
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