bluuebunny/crossref_metadata_2025_split huggingface dataset:
Supporting people in Early Intervention in Psychosis services: the role of primary care
Authors: Chew-Graham Carolyn , Rickett Michelle , Kingstone Tom , Gupta Veenu , Shiers David , French Paul , Lennox Belinda , Crawford Mike , Penington Ed , Hedges Anna , Ward Jo 
Published: June 2024

BackgroundEarly Intervention in Psychosis (EIP) services offer treatment to people experiencing a first episode of psychosis. Service users may be referred from primary care and discharged directly back at the end of their time in an EIP service.AimTo explore the role of primary care in supporting EIP service users (SUs) and to understand how to improve collaboration between primary and specialist care.MethodQualitative study comprising semi-structured interviews with SUs, carers, healthcare professionals (HCPs), managers, and commissioners. Interviews were conducted either online or by telephone. Thematic analysis was carried out using principles of constant comparison. Patient and public involvement were key to all stages, including data analysis.ResultsIn total, 55 interviews were conducted with SUs (n= 13), carers (n= 10), and GPs, EIP HCPs, managers, and commissioners (n= 33). GPs reported difficulties in referring people into EIP services and little contact with SUs while in EIP services, even about physical health. GPs suggested they were not included in planning discharge from EIP to primary care. SUs and carers reported that transition from EIP can lead to uncertainty, distress, and exacerbation of symptoms. GPs reported only being made aware of patients on or after discharge, with no contact for 3 years. GPs described difficulty managing complex medication regimes, and barriers to re-referral to mental health services.ConclusionGPs have a key role in supporting people within EIP services, specifically monitoring and managing physical health. Inclusion of GPs in planning discharge from EIP services is vital.
‘There’s never really been an opportunity’: perspectives of those with long-term conditions on advance care planning, a qualitative interview study in primary care
Authors: Bushell Sonya , Murtagh Fliss 
Published: June 2024

BackgroundAdvance care planning (ACP), the process of discussing and documenting people’s wishes for future care, is increasingly researched within health and social care. However, it is sometimes assumed that ACP is only for those experiencing advanced cancer or those reaching the end of life. Little is known about how those living with other major conditions perceive ACP.AimTo explore attitudes towards ACP in this population.MethodIn-depth interview study in general practice. Inclusion criteria: adults living with major conditions other than cancer (diabetes, heart disease, chronic respiratory disease, and kidney disease). Interviews were conducted face-to-face, audio-recorded, and transcribed verbatim. Thematic analysis utilised a critical realist approach, underpinned by the COM-B Behaviour Change Model. NHS ethics approval (reference: 23/PR/0078).ResultsEleven participants have been recruited (recruitment ongoing): aged 61–88 years, five males, and Rockwood Frailty Scores 1–5. Emergent COM-B themes relate to capability (wellbeing, organisational skills, and understanding); opportunity (setting, time, trust, involving others, and the ‘right’ moment); and motivation (motivating factors: helping loved ones, helping professionals, fearing undesirable outcomes, desiring a peaceful death, being organised, and valuing autonomy; and demotivating factors: trusting others with decisions, uncertainty regarding the future, distrusting health care, focusing on the present, and values-based objections). ACP is understood in three ways: as proactive planning, as anticipatory planning, and as acknowledgment of ill-health and mortality. Context influences understanding and understanding influences motivation. There is openness to discussing ACP as part of proactive care.ConclusionNormalising ACP before ill-health may reduce distress. Public health campaigns and preventative healthcare consultations present opportunities for ACP signposting.
Could primary care records be used to identify women at risk of perinatal anxiety? A mixed-methods study
Authors: Fisher Tamsin , Archer Charlotte , Bailey James , Evans Jonathan , Kessler David Samuel , Kingstone Tom , Petersen Irene , Proctor Janine , Shivji Noreen , Spruce Amy , Silverwood Victoria , Smith Holly , Turner Katrina , Wu Pensee , Yu Dahai , Chew-Graham Carolyn 
Published: June 2024

BackgroundPerinatal anxiety (PNA) occurs throughout the antenatal period or up to 1 year after childbirth, with a prevalence of 21%.AimTo investigate if primary care records could be used to identify women at ‘higher risk’ of PNA.MethodMixed-methods approach using quantitative and qualitative methods. Quantitative data analysis used Clinical Practice Research Datalink and IQVIA Medical Research Data to identify risk factors for PNA. Interviews explored the lived experiences of women with PNA about predisposing factors for PNA and acceptability of being informed of risk; and perspectives of primary healthcare professionals and Voluntary, Community, and Social Enterprise practitioners about risk communication. Interviews were conducted online, digitally recorded with consent, transcribed, and anonymised prior to analysis. Data were thematically analysed. Patient and clinical advisory groups informed each stage of the research.ResultsWomen reflected on both positive and negative impacts of being identified at higher risk of PNA, a lack of understanding of how primary care records are used, and who has access to them. All interview participants suggested predisposing factors that would not be coded in primary care records. Quantitative analysis demonstrated that some predisposing factors for PNA can be identified in a woman’s primary care records. Initial analysis suggests associations between PNA and infant health and healthcare use.ConclusionWhile identification of higher risk of PNA may be acceptable, some factors that may contribute to PNA are not coded in primary care records. Identifying and managing PNA is needed to improve infant health.
Role of FeNO in predicting the responsiveness of inhaled corticosteroids in COPD: a systematic review.
Authors: Ramesh Reshma , Georgiou Andrea , Harries Timothy 
Published: June 2024

BackgroundFractional exhaled nitric oxide (FeNO) as a predictor of inhaled corticosteroid (ICS) response in asthma has been established. However, the same has not been established in chronic obstructive pulmonary disease (COPD). An optimal value of FeNO for prescribing and monitoring ICS response has not been quantified.AimTo examine the evidence for this association.MethodA systematic review was conducted of randomised controlled trials and observational studies examining the association between FeNO level and response to ICS in COPD patients. All studies examining this association were included. Five databases were searched thoroughly. Systematic screening, full-text reviews, and data extraction were carried out based on eligibility criteria.ResultsA total of 8690 studies were identified, 342 texts were screened fully, and six studies were included for the final review. One was a randomised controlled trial and the other five were non-randomised interventional trials. One study was conducted in asthma–COPD overlap (ACO patients). After ICS use, three studies found statistically significant correlations between FeNO and lung function improvement (FEV1), and three studies also found significant correlations between FeNO and COPD quality-of-life scores.ConclusionMeasurement of FeNO is non-invasive and standardised, with results available at the point of testing. Because of the small sample size and short duration of studies, exacerbation frequencies were not measured. Despite this, the review suggests that FeNO may be a potential biomarker for assessing ICS response in COPD. Further research that stratifies patients by FeNO levels and assesses the impact on acute exacerbations is needed to understand its potential value in routine clinical practice.
A retrospective, comparative analysis of A&E attendance paserns in Irish Traveller versus non-Traveller general practice patients
Authors: Welgamage Sandeepa , Speed Ewen , Turner-Moss Eleanor , Burrows Sally , Blumenfeld Tanya 
Published: June 2024

BackgroundVery little is known about Gypsy, Roma, and Traveller health, or access to and utilisation of health care. They are not coded in NHS data systems and there are multiple barriers including illiteracy, digital exclusion, and discrimination.AimTo gain rare insight into Irish Traveller patients’ emergency healthcare utilisation and outcomes.MethodA retrospective general practice review of A&E attendances was performed from January to December 2017, comparing Travellers with the rest of the practice patient population. A search was done for all A&E attendance letters and related admissions. Blind review of the diagnosis and management were assessed by two reviewers for appropriateness of attendance at A&E. The frequency and recurrence of A&E attendances, referral pathway toA&E, location of A&E, and age distribution were compared.ResultsTraveller patients attending A&E were younger. There were fewer repeat attendances in the travelling community but proportionally more in the Traveller under-20-year-old cohort. Only 38% of A&E attendances in Travellers (56% non-Travellers) were deemed appropriate (χ27.16,P= 0.007). Only 20% of Travellers (36% non-Travellers) attending A&E were admitted to hospital (χ26.33,P= 0.01). Further, 93% of A&E attendances in Irish Travellers (75% non-Travellers) did not follow initial contact with either a GP or NHS 111 (χ29.86,P<0.002). Finally, 51% of Irish Travellers (6% non-Travellers) attended A&E departments distant to their registered GP practice (χ289.5,P<0.001).ConclusionThis work throws light on health service utilisation patterns by Irish Travellers. A&E attendances may have been more suited to a non-emergency setting and there may have been missed opportunities for contact with primary care or NHS 111, which may have an impact on continuity, onward referral, and quality of care.
Opioid and dependence-forming medications co-prescription reduction and oversight: the OPIO-CHECK Quality Improvement Project (QIP) protocol and interim analysis
Authors: Zedan Yasmine , Wrigley Caroline 
Published: June 2024

BackgroundLong-term opioid prescription to manage chronic non-cancer pain (CNCP) is rapidly rising, despite the lacking evidence supporting their safety and efficacy. Co-prescribing opioids with other dependence-forming medications (DFMs) causes fatal side effects. Clinicians are advised to avoid combinations of DFMs and, where suitable, deprescribe to improve patient safety.AimTo review the number of patients registered to the Grange Medical Centre (Nuneaton, Warwickshire) who are co-prescribed an opioid and either benzodiazepine/gabapentinoid for CNCP and to reduce usage of these DFMs.MethodThe ‘Model for Improvement’ is used as a QIP framework. A database search was conducted on 5 October 2023 to identify the cohort of interest. The introduced changes included devising a resource pack outlining the up-to-date non-pharmacological pain management, support channels, and a medication review invitation sent to the identified patients. A pain management template has also been developed to be used by GPs and clinical pharmacists to support the medication review. Guided by the Plan–Do–Study–Act cycle, data will be re-measured to detect incremental changes in practice.ResultsIn total, 123 patients were receiving co-prescriptions of opioids along with either benzodiazepine/gabapentinoid for CNCP out of the enlisted 12 360 patients. The majority were in the 70–79 years age range. It was also noted that around 66% of patients were females. The QIP’s first cycle is currently being implemented.ConclusionThis QIP addresses a pressing need to reduce the usage of DFMs. The interim results will guide the change model in the Grange Medical Centre GP surgery and inform scoping of relevant clinical questions to improve patient safety.
Student and educator experiences of a student-led clinic in general practice
Authors: Leslie Katie , McConville Kevin 
Published: June 2024

BackgroundGiving students more responsibility for real patients during medical school may help prepare them for their transition to clinical practice. Student-led clinics (SLCs) may facilitate this. Within SLCs, students take the lead role in delivering patient care while being supported and supervised by qualified clinicians. A general practice SLC was established in Dundee, with four final-year medical students and one GP involved in each clinic.AimThis study aimed to explore students’ and educators’ experiences and perceptions of this SLC.MethodThis was an exploratory case study. Semi-structured interviews were conducted with 11 students and three educators, and 18 hours of observation were conducted over six clinics. Interview transcripts and fieldnotes were integrated and thematically analysed.ResultsOverall, students’ and educators’ experiences and perceptions were positive. Students thrived in their lead role in patient care, gaining a sense of empowerment and developing confidence in their abilities. Both students and educators felt comfortable with students having this level of responsibility due to the students’ stage of training and the supervision provided by educators. Teaching within the SLC involved individual discussions and group debriefs. Students felt a sense of belonging as a result of their relationships with their peers and educators. Challenges arose when the clinic ran behind schedule due to unexpected complex patients or lengthy individual discussions.ConclusionThe findings suggest that giving students responsibility for real patients is beneficial and feasible when adequate support is provided, and that it is possible for one GP to supervise multiple students successfully.
Team climate, job satsfaction and burnout: results from a national survey of staff in general practice in England
Authors: Williams Peter , Jones Bridget , Aspen Carole , Bird Thomas , Smylie Jessica , Touray Morro , Gage Heather , de Lusignan Simon 
Published: June 2024

BackgroundMeasures are needed to address recruitment and retention problems in general practice. A good team climate (relational processes of team working) can mitigate the effects of pressured work environments, but little is known about it in British general practice.AimTo assess team climate, explore practice characteristics and workforce combinations associated with favourable team climates, and analyse associations between practice team climate and job satisfaction, intention to remain in post, burnout and measures of practice performance.MethodAn online questionnaire distributed to practices (for all their staff) via Clinical Research Networks, mid 2022, comprising validated measures: 14 item Team Climate Inventory (TCI) and single items on job satisfaction and emotional exhaustion/burnout; a question on intention to remain in post; participant role, age group, gender. Anonymous completion; submission through the Oxford RCGP RSC.ResultsResponses received from 4.8% of national staff headcount,n =9835, (21.6% GP, 22.9% nurse/direct patient care, 55.5% non-clinical). Mean TCI score, 3.73 (scale 1–5 best); 78.3% were satisfied in their jobs; 26.1% reported high burnout. GPs perceived significantly better team climate, and reported lower job satisfaction, higher burnout (especially male GPs) and lower intention to quit than other groups. After adjusting for practice and workforce characteristics, team climate was better in smaller practices and associated with more job satisfaction, less burnout, increased intention to remain and improved patient-reported experiences; climate was unrelated to QOF performance.ConclusionTeam climate could be used to improve morale and patient experience. Micro teams might be beneficial in larger practices.
The influence of GPs’ personal experience on perceived competence in depression management
Authors: Madelpuech Eline , Simonis Virginie , Sawadogo Younoussa , Richelle Lou , Libert Gael , Offermans Anne-Marie 
Published: June 2024

BackgroundManaging depression in general practice is a multifaceted task, influenced by factors such as the condition’s characteristics, patient-specific variables, and the personal habits of attending physicians. A study by Dumesnil et al. in France highlighted the impact of GPs’ personal experiences with depression on their patient care approaches.AimThis study investigated how the personal experiences of Belgian GPs influence their self-perceived competence in managing patients with depression.MethodThis transversal study was conducted through questionnaires distributed in a GP training (2020–2022). Statistical analyses (Chi-square test/multivariate logistic regression) were conducted using STATA-SE 17.0.ResultsOut of 325 GPs, 30.46% of GPs had experienced depression and 16.62% had taken antidepressants. After categorisation and adjustment, the personal experience of GPs does not influence self-efficacy in diagnosing and supporting depressed patients. Higher self-efficacy scores were associated with an advanced age (60–64y/o) (aOR:7,9;IC95%), working in a multidisciplinary practice (aOR:3,4), prior training on the issue (aOR:2,1), and male gender (aOR:0,5). GPs with personal experiences of depression (aOR:2,6), advanced age (aOR:4,1) and working in multidisciplinary practices (aOR:3,4) had more appropriate responses to the proposed clinical situations than other groups.ConclusionThis study reveals that the personal experience of depression among GPs does not influence their perceived competencies, contrary to having received prior training on the issue. However, experiencing depression is associated with more appropriate responses to clinical situations. These results are consistent with existing literature regarding socio-demographic factors and practice type. In the future, it is important to consider these factors when developing continuing education programs.
Determinants of medical student’s perception of general practice
Authors: Madelpuech Eline , Richelle Lou , Vanderhofstadt Quentin 
Published: June 2024

BackgroundEnhancing the attractiveness of a career in general practice is a significant public health concern, given the current shortage in Belgium.AimThe objective of this study is to determine the factors that influence students’ decisions to pursue a career in general practice and their perceptions of it.MethodThis prospective study was conducted in May 2023. A questionnaire, based on existing literature, was distributed to final-year medical students. Quantitative data were analysed using descriptive and bivariate tests (chi2test).ResultsOut of the 142 participating students (response rate: 45%), 29.3% expressed a preference for general practice, while 70.7% opted for other specialties. These groups exhibited significant differences (p < 0.05) not only in terms of socio-demographic factors (nationality, parent’s education) but also in their perceptions ofgeneral practice. The latter group associated it with routine work (89.2%) and feelings of loneliness (58.5%), in contrast to the former (36.1% and 24.3%, respectively). Moreover, 76.6% of students reported a shift in their perception ofgeneral practiceduring their medical education.General practiceinternships (71.9%), GPs (78.2%), and interactions with patients (68.9%) had a positive influence on their perception, while instructors in hospital settings (72.9%) and peers (37%) often portrayedgeneral practiceas a less favourable career option.ConclusionPerceptions ofgeneral practiceare significantly shaped by interactions with role models from the medical sector who convey either a positive or negative image ofgeneral practice. To address the shortage issue, it is imperative to increase positive interactions with GPs within the curriculum and work towards changing the institutional culture at this level.
Crisis Rescue Foundation Vaxi Taxi/health and wellbeing pop-ups project
Authors: Raymond Sharon 
Published: June 2024

BackgroundEstablished by Crisis Rescue Foundation in 2021 to support the missing and vulnerable to access health and wellbeing help.AimAddress health and wellbeing needs of people experiencing barriers to accessing NHS and allied care by delivering pop-ups in the hearts of communities, outside GP surgery and hospital walls, in a warm, inclusive environment.MethodForty pop-ups so far across London delivering bespoke, individualised health information and signposting, joining up NHS, allied and local community services at key sites, including asylum seeker/homeless/faith/refugee/drug and alcohol support/food bank/sex worker support/youth club and education centres. A ‘Medical Glastonbury’ with background music, plus free food, toiletry goodie bags and clothes. Drug and alcohol/heart/oral/foot/sexual and mental health; support for carers; BLS; violence reduction; youth mentoring; housing; vaccination; wellbeing and more, information and signposting offered to local people by professionals, supporting and empowering people to access trusted guidance and care. Cardio and mental health check cards to record health information and guide next steps in appropriate care.ResultsAround 2000 Londoners were given health and wellbeing information. 80% of service users were from ethnic minority backgrounds. Over 99% of service users rated pop-ups highly. Over 1/3 had raised BP and nearly 2/3 had raised BMI detected and the individuals were signposted to appropriate information and care.ConclusionEffective, bespoke and personalised information, and signposting to support were well-received at the pop-ups. Professionals working with service users experiencing inequalities of allied and local voluntary organisations to enhance equity by addressing the unmet health and wellbeing needs of the missing and the vulnerable.
Barriers to identifying, diagnosing, and treating vulval lichen sclerosus in primary care: a mixed methods survey study
Authors: Clarke Louise , Simpson Rosalind , Crew Arabella , Leatherland Rheanne 
Published: June 2024

BackgroundVulval lichen sclerosus (VLS) is a skin condition which causes pain, itching, anatomical changes, and increases vulval cancer risk by up to 22 times. VLS is treatable, with use of topical steroids allowing symptom resolution and complication prevention. Diagnostic delay and misdiagnosis of VLS is common. Previous studies found that women attribute this to poor interactions with and knowledge of clinicians. Most VLS is diagnosed in primary care.AimTo investigate primary care clinicians’ views on confidence in identifying and managing vulval skin disease and VLS, barriers to diagnosis, education on vulval skin disease, and diagnostic criteria for VLS.MethodA mixed methods survey was distributed via professional events and networks. Qualitative data was analysed in NVivo using inductive thematic analysis. Spearman’s rank correlation was used to correlate participant characteristics and confidence.ResultsThere were 122 responses, the majority from GP trainees (48%) and GPs (43%). Confidence in diagnosing, identifying, and treating VLS positively correlated with female gender, time in role, and examination frequency. Themes identified include patients not knowing normal, male clinicians: deskilling and reluctance, lack of clinician knowledge, and uncertainty around diagnosis and treatment. 38% of participants never participated in teaching or learning on vulval skin disease. Almost all (98%) participants feel diagnostic criteria would be helpful.ConclusionThis study illuminates the multiple barriers to diagnosis and treatment of VLS. The results confirm that clinicians share patient concerns that knowledge is poor, highlight the importance of developing clear diagnostic criteria, and will allow us to target training to those lacking in confidence.