JournalTOCs

British Journal of General Practice
Journal Prestige (SJR): 0.906

Citation Impact (citeScore): 1
Number of Followers: 41

Full-text available via subscription

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ISSN (Print) 0960-1643 - ISSN (Online) 1478-5242
Published by RCGP

[1 journal]

Antibiotic effectiveness for children with lower respiratory infections:
prospective cohort and trial in primary care
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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
  Abstract: BackgroundAntibiotics are commonly prescribed for children with chest infections but there is little randomised evidence and trials commonly recruit selected populations, which undermines their applicability.AimTo document the effectiveness of antibiotics for chest infections in children.Design and settingThis was a prospective cohort study with nested trial in primary care.MethodChildren aged 1–12 years presenting with uncomplicated lower respiratory tract infections were included in the cohort. Children were either randomised to receive amoxicillin 50 mg/kg per day for 7 days or placebo, or participated in a parallel observational study, where propensity scores controlled for confounding by indication. The outcomes were duration of symptoms rated moderately bad or worse (primary outcome) and illness progression requiring hospital assessment.ResultsA total of 764 children participated (438 trial, 326 observational), and children were more unwell than in previous cohorts (more sputum, fever, shortness of breath). Children had been unwell for a median of 5–6 days, and symptoms rated moderately bad or worse lasted another 6 days when no antibiotics were given.With antibiotics there was a non-significant reduction of approximately 1 day in duration of symptoms rated moderately bad or worse for the whole cohort (hazard ratio [HR] 1.16, 95% confidence interval [CI] = 0.95 to 1.41), similar to the trial alone (HR 1.13, 95% CI = 0.90 to 1.43). The effect of antibiotic treatment on secondary outcomes was also non-significant.ConclusionAntibiotics for uncomplicated chest infections, even in a sample of more unwell children, are unlikely to be clinically very effective.
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/BJGP.2022.0239
  Issue No: Vol. 73, No. 728 (2023)
Implementing antibiotic stewardship in high-prescribing English general
practices: a mixed-methods study
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  Authors: Sarah Tonkin–Crine; Monsey McLeod, Aleksandra J Borek, Anne Campbell, Philip Anyanwu, Ceire Costelloe, Michael Moore, Benedict Hayhoe, Koen B Pouwels, Laurence SJ Roope, Liz Morrell, Susan Hopkins, Christopher C Butler, Ann Sarah Walker
  Abstract: BackgroundTrials have identified antimicrobial stewardship (AMS) strategies that effectively reduce antibiotic use in primary care. However, many are not commonly used in England. The authors co-developed an implementation intervention to improve use of three AMS strategies: enhanced communication strategies, delayed prescriptions, and point-of-care C-reactive protein tests (POC-CRPTs).AimTo investigate the use of the intervention in high-prescribing practices and its effect on antibiotic prescribing.Design and settingNine high-prescribing practices had access to the intervention for 12 months from November 2019. This was primarily delivered remotely via a website with practices required to identify an ‘antibiotic champion’.MethodRoutinely collected prescribing data were compared between the intervention and the control practices. Intervention use was assessed through monitoring. Surveys and interviews were conducted with professionals to capture experiences of using the intervention.ResultsThere was no evidence that the intervention affected prescribing. Engagement with intervention materials differed substantially between practices and depended on individual champions’ preconceptions of strategies and the opportunity to conduct implementation tasks. Champions in five practices initiated changes to encourage use of at least one AMS strategy, mostly POC-CRPTs; one practice chose all three. POC-CRPTs was used more when allocated to one person.ConclusionClinicians need detailed information on exactly how to adopt AMS strategies. Remote, one-sided provision of AMS strategies is unlikely to change prescribing; initial clinician engagement and understanding needs to be monitored to avoid misunderstanding and suboptimal use.
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/BJGP.2022.0298
  Issue No: Vol. 73, No. 728 (2023)
Comparing GPs’ antibiotic prescribing decisions to a clinical prediction
rule: an online vignette study
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  Authors: Martine Nurek; Alastair D Hay, Olga Kostopoulou
  Abstract: BackgroundThe ‘STARWAVe’ clinical prediction rule (CPR) uses seven factors to guide risk assessment and antibiotic prescribing in children with cough (Short illness duration, Temperature, Age, Recession, Wheeze, Asthma, Vomiting).AimTo assess the influence of STARWAVe factors on GPs’ unaided risk assessments and prescribing decisions.Design and settingClinical vignettes administered to 188 UK GPs online.MethodGPs were randomly assigned to view 32 (out of a possible 64) vignettes online depicting children with cough. The vignettes comprised the seven STARWAVe factors, which were varied systematically. For each vignette, GPs assessed risk of deterioration in one of two ways (sliding-scale versus risk-category selection) and indicated whether they would prescribe antibiotics. Finally, GPs saw an additional vignette, suggesting that the parent was concerned. Mixed-effects regressions were used to measure the influence of STARWAVe factors, risk-elicitation method, and parental concern on GPs’ assessments and decisions.ResultsSix STARWAVe risk factors correctly increased GPs’ risk assessments (bssliding-scale≥0.66, odds ratios [ORs]category-selection≥1.75, Ps≤0.001), whereas one incorrectly reduced them (short illness duration: bsliding-scale −0.30, ORcategory-selection 0.80, P≤0.039). Conversely, one STARWAVe factor increased prescribing odds (temperature: OR 5.22, P
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/BJGP.2020.0802
  Issue No: Vol. 73, No. 728 (2023)
General practice management of COPD patients following acute
exacerbations: a qualitative study
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  Authors: Bianca Perera; Chris Barton, Christian Osadnik
  Abstract: BackgroundExacerbations are the strongest risk factor for future exacerbations for patients living with chronic obstructive pulmonary disease (COPD). The period immediately following exacerbation is a high-risk period for recurrence and hospital admission, and is a critical time to intervene. GPs are ideally positioned to deliver this care.AimTo explore perceptions of GPs regarding the care of patients following exacerbations of COPD and to identify factors affecting the provision of evidence-based care.Design and settingA descriptive qualitative study was undertaken involving semi-structured, in-depth interviews with Australian GPs who volunteered to participate following a national survey of general practice care for COPD patients following exacerbations.MethodInterviews were conducted via the Zoom video conference platform, which were audio-recorded and transcribed verbatim. QSR NVivo was used to support data management, coding, and inductive thematic analysis.ResultsEighteen GPs completed interviews. Six key themes were identified: 1) GPs’ perceptions and knowledge in the management of COPD patients following exacerbation and admission to hospital; 2) pharmacological management; 3) consultation time; 4) communication between healthcare professionals; 5) access to other health services; and 6) patient compliance.ConclusionDelivery of post-exacerbation care to COPD patients is affected by GPs, patients, and health service-related factors. The care of COPD patients may be further improved by supporting GPs to overcome identified barriers.
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/BJGP.2022.0342
  Issue No: Vol. 73, No. 728 (2023)
Post-consultation acute respiratory tract infection recovery: a latent
class-informed analysis of individual patient data
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  Authors: Hilda Hounkpatin; Beth Stuart, Shihua Zhu, Guiqing Yao, Michael Moore, Christin Loffler, Paul Little, Timothy Kenealy, David Gillespie, Nick A Francis, Jennifer Bostock, Taeko Becque, Bruce Arroll, Attila Altiner, Pablo Alonso–Coello, Alastair D Hay
  Abstract: BackgroundThere is a lack of evidence regarding post-consultation symptom trajectories for patients with respiratory tract infections (RTIs) and whether patient characteristics can be used to predict illness duration.AimTo describe symptom trajectories in patients with RTIs, and assess baseline characteristics and adverse events associated with trajectories.Design and settingThe study included data about 9103 adults and children from 12 primary care studies.MethodA latent class-informed regression analysis of individual patient data from randomised controlled trials and observational cohort studies was undertaken. Post-consultation symptom trajectory (severity and duration), re-consultation with same or worsening illness, and admission to hospital were assessed.ResultsIn total, 90% of participants recovered from all symptoms by 28 days, regardless of antibiotic prescribing strategy (none, immediate, and delayed antibiotics). For studies of RTI with cough as a dominant symptom (n = 5314), four trajectories were identified: ‘rapid (6 days)’ (90% of participants recovered within 6 days) in 52.0%; ‘intermediate (10 days)’ (28.9%); ‘slow progressive improvement (27 days)’ (12.5%); and ‘slow improvement with initial high symptom burden (27 days)’ (6.6%). For cough, being aged 16–64 years (odds ratio [OR] 2.57, 95% confidence interval [CI] = 1.72 to 3.85 compared with 10 days) compared with faster recovery (≤10 days). Re-consultations and admissions to hospital for cough were higher in those with slower recovery (ORs: 2.15, 95% CI = 1.78 to 2.60 and 7.42, 95% CI = 3.49 to 15.78, respectively).ConclusionOlder patients presenting with more severe, longer pre-consultation symptoms and chronic lung disease should be advised they are more likely to experience longer post-consultation illness durations, and that recovery rates are similar with and without antibiotics.
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/BJGP.2022.0229
  Issue No: Vol. 73, No. 728 (2023)
Nitrofurantoin failure in males with an uncomplicated urinary tract
infection: a primary care observational cohort study
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  Authors: Tamara N Platteel; Marijn T Beets, Hendrik A Teeuwissen, Thijs ten Doesschate, Janneke HHM van de Wijgert, Roderick P Venekamp, Alma C van de Pol
  Abstract: BackgroundNitrofurantoin is the first-choice antibiotic treatment for uncomplicated urinary tract infections (UTIs) in males according to the Dutch primary care UTI guideline. However, prostate involvement may be undetected and renders this treatment less suitable.AimTo compare the nitrofurantoin failure fraction with that found with use of other antibiotics in adult males diagnosed by their GP with an uncomplicated UTI, as well as GP adherence to the Dutch primary care UTI guideline.Design and settingRetrospective observational cohort study using routine healthcare data for males seeking care at GP practices participating in the Julius GP Network from 2014 to 2020.MethodMedical records were screened for signs and symptoms of complicated UTIs, antibiotic prescriptions, and referrals. Treatment failure was defined as prescription of a different antibiotic within 30 days after initiation of antibiotic therapy and/or acute hospital referral. The effects of age and comorbidities on failure were assessed using multivariable logistic regression.ResultsMost UTI episodes in males were uncomplicated (n = 6805/10 055 episodes, 68%). Nitrofurantoin was prescribed in 3788 (56%) of uncomplicated UTIs, followed by ciprofloxacin (n = 1887, 28%), amoxicillin/clavulanic acid (n = 470, 7%), and trimethoprim/sulfamethoxazole (n = 285, 4%). Antibiotic failure occurred in 25% (95% confidence interval [CI] = 23 to 26), 10% (95% CI = 9 to 12), 20% (95% CI = 16 to 24), and 14% (95% CI = 10 to 19) of episodes, respectively. The nitrofurantoin failure fraction increased with age. Comorbidities, adjusted for age, were not associated with nitrofurantoin failure.ConclusionNitrofurantoin failure was common in males with uncomplicated UTI and increased with age.
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/BJGP.2022.0354
  Issue No: Vol. 73, No. 728 (2023)
Adverse drug reactions and associated patient characteristics in older
community-dwelling adults: a 6-year prospective cohort study
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  Authors: Ann S Doherty; Fiona Boland, Frank Moriarty, Tom Fahey, Emma Wallace
  Abstract: BackgroundTo date, research on adverse drug reactions (ADRs) has focused on secondary care, and there is a paucity of studies that have prospectively examined ADRs affecting older adults in general practice.AimTo examine the cumulative incidence and severity of ADRs and associated patient characteristics in a sample of community-dwelling older adults.Design and settingProspective cohort study of older adults (aged ≥70 years, N = 592) recruited from 15 general practices in the Republic of Ireland.MethodManual review of the participant’s general practice electronic medical record, linked to the national dispensed prescription medicine database, and a detailed, self-reported patient postal questionnaire. The primary outcomes were ADR occurrence and severity over a 6-year period (2010–2016). Unadjusted and adjusted logistic regression models examined potential associations between patient characteristics and ADR occurrence.ResultsA total of 211 ADRs were recorded for 159 participants, resulting in a cumulative incidence of 26.9% over 6 years. The majority of ADRs detected were mild (89.1%), with the remainder classified as moderate (10.9%). Eight moderate ADRs, representing 34.8% of moderate ADRs and 3.8% of all ADRs, required an emergency hospital admission. ADRs were independently associated with female sex (adjusted odds ratio [OR] 1.83, 95% confidence interval [CI] = 1.17 to 2.85; P = 0.008), polypharmacy (5–9 drug classes) (adjusted OR 1.81, 95% CI = 1.17 to 2.82; P = 0.008), and major polypharmacy (≥10 drug classes) (adjusted OR = 3.33, 95% CI = 1.62 to 6.85; P = 0.001).ConclusionThis prospective cohort study of ADRs in general practice shows that over one-quarter of older adults experienced an ADR over a 6-year period. Polypharmacy is independently associated with ADR risk in general practice and older adults on ≥10 drug classes should be prioritised for regular medication review.
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/BJGP.2022.0181
  Issue No: Vol. 73, No. 728 (2023)
Precision public-health intervention for care coordination: a real-world
study
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  Authors: Andre Q Andrade; Jean-Pierre Calabretto, Nicole L Pratt, Lisa M Kalisch-Ellett, Vanessa T Le Blanc, Elizabeth E Roughead
  Abstract: BackgroundHealth emergencies disproportionally affect vulnerable populations. Digital tools can help primary care providers find, and reach, the right patients.AimTo evaluate whether digital interventions delivered directly to GPs’ clinical software were more effective at promoting primary care appointments during the COVID-19 pandemic than interventions delivered by post.Design and settingReal-world, non-randomised, interventional study involving GP practices in all Australian states.MethodIntervention material was developed to promote care coordination for vulnerable older veterans during the COVID-19 pandemic, and sent to GPs either digitally to the clinical practice software system or in the post. The intervention material included patient-specific information sent to GPs to support care coordination, and education material sent via post to veterans identified in the administrative claims database. To evaluate the impact of intervention delivery modalities on outcomes, the time to first appointment with the primary GP was measured; a Cox proportional hazards model was used, adjusting for differences and accounting for pre-intervention appointment numbers.ResultsThe intervention took place in April 2020, during the first weeks of COVID-19 social distancing restrictions in Australia. GPs received digital messaging for 51 052 veterans and postal messaging for 26 859 veterans. The digital group was associated with earlier appointments (adjusted hazard ratio 1.38 [1.34 to 1.41]).ConclusionData-driven digital solutions can promote care coordination at scale during national emergencies, opening up new perspectives for precision public-health initiatives.
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/BJGP.2022.0067
  Issue No: Vol. 73, No. 728 (2023)
Primary care transformation in Scotland: qualitative evaluation of the
views of national senior stakeholders and cluster quality leads
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  Authors: Eddie Donaghy; Huayi Huang, David Henderson, Harry HX Wang, Bruce Guthrie, Andrew Thompson, Stewart W Mercer
  Abstract: BackgroundPrimary care transformation in Scotland aims to improve population health, reduce health inequalities, and reduce GP workload. Two key strategies (formalised in April 2018 in the new Scottish GP contract [Scottish General Medical Services contract], although started in early 2016) are the expansion of the multidisciplinary team (MDT) and GP cluster working.AimTo explore progress in the implementation of the GP contract in Scotland in terms of the MDT and cluster working.Design and settingQualitative study with key national primary care stakeholders (PCSs) (n = 6) and cluster quality leads (CQLs) in clusters serving urban high deprivation areas (n = 4), urban mixed areas (n = 4), and remote and rural areas (n = 4).MethodSemi-structured interviews with thematic analysis.ResultsThere was general support for the initial aims of the new GP contract but all interviewees felt that progress on both MDT expansion and cluster working was slow, even before the pandemic. None of the CQLs (and few PCSs) felt that GP workload had reduced significantly, nor that the care of patients with complex needs had improved. Lack of time and poorly developed relationships were key barriers, as was a lack of relevant primary care data, and additional support (including guidance, administration, training, and protected time).ConclusionKey PCSs and CQLs in different areas of Scotland report limited progress in primary care transformation, only partly related to the pandemic. There is a need for better workforce planning and support if the new GP contract is to succeed in transforming primary care in Scotland.
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/BJGP.2022.0186
  Issue No: Vol. 73, No. 728 (2023)
The Extraordinary Challenge of Antimicrobial Resistance
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  Authors: Euan Lawson
  Pages: 99 - 99
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732021
  Issue No: Vol. 73, No. 728 (2023)
Antibiotic stewardship: where next'
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  Authors: Michael Moore
  Pages: 100 - 101
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732033
  Issue No: Vol. 73, No. 728 (2023)
What needs to be done to address staffing shortages in health and social
care'
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  Authors: Lara Shemtob; Kaveh Asanati, Nick Pahl, Azeem Majeed
  Pages: 102 - 103
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732045
  Issue No: Vol. 73, No. 728 (2023)
Primary care and bipolar disorder
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  Authors: Judy Shakespeare; Sharon Dixon, Steven Marwaha
  Pages: 104 - 105
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732057
  Issue No: Vol. 73, No. 728 (2023)
Determining the role of genetic risk scores in symptomatic cancer
detection
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  Authors: Sarah ER Bailey; Celia AM Butler, Evangelos Katsampouris, Larry Kessler, Samantha L Quaife, Sibel Saya, Samuel WD Merriel
  Pages: 106 - 107
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732069
  Issue No: Vol. 73, No. 728 (2023)
The global primary care crisis
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  Authors: Roger H Jones
  Pages: 108 - 108
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732081
  Issue No: Vol. 73, No. 728 (2023)
Who is your doctor'
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  Authors: Luke D Sayers
  Pages: 108 - 108
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732093
  Issue No: Vol. 73, No. 728 (2023)
Jacquet erosive dermatitis in an era of 'going green’
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  Authors: Laura Surgenor; Henrietta Acheson, Donal O’Kane
  Pages: 108 - 109
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732105
  Issue No: Vol. 73, No. 728 (2023)
Lymphadenopathy following COVID-19 vaccination: a wake-up call from case
reports
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  Authors: Michel Goldman
  Pages: 109 - 109
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732117
  Issue No: Vol. 73, No. 728 (2023)
Self-ageism among older rural people
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  Authors: Ryuichi Ohta
  Pages: 110 - 110
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732129
  Issue No: Vol. 73, No. 728 (2023)
GPs are not 'things’
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  Authors: Andrew Papanikitas
  Pages: 121 - 121
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732153
  Issue No: Vol. 73, No. 728 (2023)
Put a cap on it: safe workload levels in general practice
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  Authors: Nada Khan
  Pages: 122 - 123
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732165
  Issue No: Vol. 73, No. 728 (2023)
Manufacturing doctors is one thing; sustaining working communities is
quite another
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  Authors: David Zigmond
  Pages: 124 - 125
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732177
  Issue No: Vol. 73, No. 728 (2023)
Junior doctors leaving the NHS: what would it mean for general
practice'
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  Authors: Richard Armitage
  Pages: 126 - 127
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732189
  Issue No: Vol. 73, No. 728 (2023)
Be lucky
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  Authors: Anna Pacholczyk; Carwyn Hooper, John Spicer
  Pages: 128 - 129
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732201
  Issue No: Vol. 73, No. 728 (2023)
Rational self-interest and the inverse care law: how Rawls and Nozick
might have reflected on Julian Tudor Hart’s problem
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  Authors: Ayu Takayanagi
  Pages: 130 - 131
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732213
  Issue No: Vol. 73, No. 728 (2023)
Yonder: HFpEF, amputees, professional identity formation, and leadership
training
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  Authors: Ahmed Rashid
  Pages: 132 - 132
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732225
  Issue No: Vol. 73, No. 728 (2023)
Flag-waving and learning to dance
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  Authors: Ben Hoban
  Pages: 133 - 133
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732237
  Issue No: Vol. 73, No. 728 (2023)
The changing face of missed appointments
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  Authors: Jo Parsons; Gary Abel, Luke TA Mounce, Helen Atherton
  Pages: 134 - 135
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732249
  Issue No: Vol. 73, No. 728 (2023)
Safeguarding and children’s oral health: what to look out for in
primary care
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  Authors: Jeremy Gibson; Emily Keene
  Pages: 136 - 137
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732261
  Issue No: Vol. 73, No. 728 (2023)
Withdrawing from SSRI antidepressants: advice for primary care
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  Authors: Emilia G Palmer; Sangeetha Sornalingam, Lisa Page, Maxwell Cooper
  Pages: 138 - 140
  PubDate: 2023-02-23T16:05:26-08:00
  DOI: 10.3399/bjgp23X732273
  Issue No: Vol. 73, No. 728 (2023)