BJGP Open

Objective: To identify patient, clinician, therapist and service priorities for a health-literacy intervention combining patient education with patient-reported outcome measure (PROM) feedback in routine hand surgery and hand therapy. Methods: A qualitative co-design study was undertaken across public and private hand-care contexts in New South Wales, Australia. Twelve stakeholders participated: five consumers, three hand surgeons, one hand therapist and three administrative/managerial staff. Individual interviews plus a clinician group discussion were conducted. Data were collected in March 2026, audio-recorded, transcribed verbatim and de-identified. General inductive thematic analysis was undertaken in NVivo by one researcher, with final themes reviewed by co-investigators. Results: Four themes guided intervention design: (1) providing information is not enough, it must be understood, retained and reinforced; (2) patients need a practical roadmap of diagnosis, treatment, recovery and rehabilitation; (3) education should be multimodal, reusable and adaptable to individual needs; and (4) PROMs should improve the clinical conversation rather than become another burden. Participants supported brief, accessible PROMs and visual feedback over time, but views differed on comparison with other patients because benchmarking could either reassure or create anxiety and unrealistic expectations. Conclusion: Health-literate hand care requires more than readable leaflets. It requires repeated, practical and adaptable communication across the care pathway, with PROM feedback embedded in patient-clinician conversations. Practice implications: Hand services should pair standardized core education with flexible delivery and use brief PROMs as conversation tools. Longitudinal displays may support monitoring and shared decisions, while group comparisons should be optional and carefully explained.

Background: The 10 Year Health Plan for England indicates governmental intention to shift care from hospital to community. Disease Modifying Treatments (DMTs) and biomarker tests for dementia will likely be introduced, with potentially significant impacts on community care, particularly general practice. Aim: To explore dementia diagnosis, post diagnostic support and expectations around future care in primary care settings. Design and Setting: Codesigned survey with general practitioners (GPs), policy researchers, carers and people with lived experience. One GP per practice invited from five English Integrated Care Boards (ICBs). Methods: Inductive content analysis for qualitative responses and non-weighted means calculated for quantitative answers. Findings contextualised using national data. Results: Between September and December 2025, 80/1094 (7.3%) eligible practices participated (80 GPs). Most, (79/80, 98.8%) used cognitive assessments and 100% (80/80) blood tests to support dementia diagnosis, with 27/70 (39.7%) able to order brain scans directly. GPs primarily conducted annual physical, mental or care plan reviews for people with known dementia. Respondents considered it unlikely (47/80, 58.8%) they would formally diagnose dementia or assess (50/80, 62.3%) for DMT eligibility in the next five years. GPs considered it somewhat/most likely (54/80, 67.5%) they could offer blood biomarker tests and continue established DMT prescribing or monitoring (61/80, 76.3%). Resource, capacity and training needs were perceived barriers. Conclusion: GPs are the first point of contact for accessing a dementia diagnosis in England. Accommodating novel diagnostic tools and treatments requires a reimagining of the relationship between primary, secondary and social care to address GP reported constraints.

Background Effective communication during consultations is facilitated by clinical empathy and realistic optimism, and can enhance patient satisfaction with care, alleviate symptoms, and improve quality of life. However, primary care systems are under significant strain and changing rapidly, which may affect practitioners' ability to communicate empathically and convey realistic optimism, with implications for the patient-practitioner relationship and patient outcomes. Understanding patients' perspectives of healthcare communication in the current clinical context is therefore important. We aimed to explore patients' experiences and perceptions of communication in UK primary care consultations, focussing on the communication of clinical empathy and realistic optimism. Methods A qualitative interview study was conducted as part of a multi-centre cluster-randomised trial of EMPathicO, a brief e-learning package for Primary Care Practitioners (PCPs) on communicating clinical empathy and realistic optimism. Participants were not aware whether their general practice had access to EMPathicO or not. Interviews were conducted within 7-14 days of participants' consultations, explored their views and experiences of clinical empathy and realistic optimism, and were transcribed verbatim. Interviews were analysed using Ritchie and Spencer's Framework Method. Results We conducted semi-structured audio-recorded qualitative telephone interviews with 71 participants from 29 primary care practices taking part in the EMPathicO trial. Following comprehensive mapping of data to the framework derived following initial analysis, four themes were agreed. Overall, most participants described positive empathic consultations with their PCPs, however, participants' experiences were shaped by wider systemic and contextual factors. They described a stretched and inefficient primary care system impacting empathy and optimism; the impact of PCP 'preparedness' as a marker for empathy; how consultation modality (i.e. in-person or telephone) shaped perceptions of empathy, and how PCPs sharing next steps in participants' treatment and management could foster realistic optimism. Conclusions While clinical empathy and realistic optimism may be experienced by patients during consultations with practitioners, the wider contextual challenges of accessing and navigating primary care systems can threaten overall perceptions of feeling cared for. Future primary care policy and workforce training must consider these system pressures to preserve effective communication in consultations and positive patient-practitioner encounters.

Aims To develop a 'core' dataset of diabetes related variables to support reproducible research using UK routinely collected health data. Methods A workshop was conducted bringing together diabetes healthcare professionals, researchers, and patient and public representatives to discuss and prioritise variables for inclusion in the Diabetes Core Dataset. Core variables were those considered to be highest priority for diabetes research and available at high quality in NHS data routinely used for research (primary care [GP] and Hospital Episode Statistics [HES] data). Candidate variables for inclusion in the Diabetes Core Dataset were from a review of existing core datasets and expert opinion. Participants scored variables anonymously based on priority for diabetes research. Results 25 variables from existing diabetes core datasets and 87 other candidate variables were considered for inclusion in the Diabetes Core Dataset. All 25 of those from existing diabetes core datasets and 5 of the 87 candidate variables met the core requirements for inclusion. In addition, 7 variables were identified as high priority but not included in the core dataset as they are not currently available in GP/HES data; these were labelled as 'future high priority' variables for diabetes research. Conclusions A new diabetes core dataset for UK EHR research has been developed using a consensus-based process. The core dataset is openly available and can be flexibly applied in UK EHR (https://healthdatagateway.org/en/tool/426), including in new NHS Research Secure Data Environment platforms, to enhance reproducible research to improve the clinical care of people with diabetes and associated conditions.

Objective: To determine outcomes by referral route (any Advice and Guidance [A&G] versus elective referrals only) for patients with inflammatory bowel disease (IBD), Parkinson's disease, and systemic lupus erythematosus (SLE). Design: Population-based retrospective cohort study. Setting: Linked Clinical Practice Research Datalink (CPRD) Aurum primary care records, 2015-2022. Participants: Patients with incident diagnosis of IBD, Parkinson's disease, or SLE. Main Outcome Measures: Time from the earliest recorded A&G or elective referral to diagnosis, first recorded definitive treatment and first attended outpatient appointment. Secondary outcomes included counts of primary care consultations, prescriptions, referrals, and outpatient appointments. Propensity score weighted flexible parametric survival analyses accounted for differences between exposure groups. Results: Among 71,145 eligible patients, A&G was recorded for 1,137 (3.0%) with IBD, 971 (3.4%) with Parkinson's, and 243 (4.9%) patients with SLE. Compared with elective referral only, A&G was associated with slower time to diagnosis for IBD (adjusted median difference 15.9 weeks; hazard ratio 0.58, 95% confidence interval 0.52 to 0.66), Parkinson's disease (11.4 weeks; 0.57, 0.51 to 0.64), and SLE (6.3 weeks; 0.82, 0.73 to 0.91). However, A&G was not associated with a longer time to treatment or first attended outpatient appointment. An increase in primary care consultations following A&G was observed in patients later diagnosed with IBD and SLE. Conclusion: A&G was associated with a longer diagnostic interval than elective referral only. These findings do not establish that A&G caused diagnostic delay. A&G might be used at an earlier stage of more complex diagnostic pathways.

Background: Palliative care is suboptimal in pulmonary fibrosis. Symptom burden is high despite evidence-based interventions, guidelines, and information resources. The application of existing knowledge and methods to optimally manage palliative and end of life care for people with pulmonary fibrosis in the UK has not been realised. Aim: To establish patient views and understanding of how palliative care services and approaches can better meet the needs of people with pulmonary fibrosis. To identify the current barriers and facilitators to receiving palliative care services. Design: Qualitative exploration of patient views via semi-structured interviews and focus groups. Content analysis was conducted. Setting/Participants: The study was conducted from March to August 2024 within an Interstitial Lung Disease Specialist Centre, based in an NHS acute Trust. Results: Two focus groups and four interviews were conducted, involving nine patients. Four overarching themes were identified as to how palliative care can better meet the needs of this group: (1) establishing mechanisms for identifying and addressing palliative care needs; (2) open channels of communication with healthcare professionals; (3) the importance of a palliative care approach within respiratory, community and specialist services; and (4) support for unpaid/family carers. Conclusions: Patients highlighted the importance of person-centred principles and services that adapted to their needs (such as real-time telephone support), rather than services that imposed their own requirements on the patients. Understanding how existing palliative care provision can meet this standard could help improve the palliative and end of life care for people with pulmonary fibrosis.

Background: This study focused on adults with complex care needs due to problems on multiple life domains and consequent high acute care use. The Hotspotters Project was undertaken to assess the effects of proactive integrated care on health outcomes and healthcare costs in this group. We evaluated the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of the Hotspotters Project in order to identify factors that influenced implementation and outcomes. Method: This mixed method study followed the RE-AIM-framework, using validated questionnaires, routine care data and semi-structured interviews. Qualitative data from patients and care providers offered insight in the quantitative outcomes. Quantitative data were analyzed descriptively (SPSS), and interview transcripts were analyzed using inductive thematic content analysis (Atlas.ti). Results: As acute care use was lower than expected, few patients were eligible (153/1403) and subsequent low enrollment (n=30) limited conclusions regarding effectiveness. Nevertheless, the intervention improved collaboration with social work, and the structured intake was valued for the overview of patients complex needs. Many practices adopted the intervention into regular care, despite the complex inclusion process. Care providers proposed revising the target population and recruitment to better reflect the Dutch context. Conclusion: Although cost-effectiveness could not be assessed, this study nonetheless provides insights that can help future interventions and trials to better match patients needs, adapt to local context and reduce patients study burden. Adapting the definition of patients with complex needs to a local context can strengthen the rationale for implementation and enhance patient motivation.

Background. Guidelines recommend surgery for moderate and severe cervical spondylotic myelopathy (CSM) but support either surgery or nonoperative care for mild disease. How patients weigh the adverse events associated with each pathway is not well characterized. Methods. We conducted a three-arm randomized vignette experiment among United States adults aged 40 years and older recruited through an online research panel. All participants read an identical description of mild CSM and were randomized to one of three scenarios: surgery that improved symptoms, surgery that halted progression without improvement, or nonoperative management with symptom progression. Participants in the surgical scenarios rated 12 possible complications and those in the nonoperative scenario rated 8 progression outcomes. For each item, participants rated how strongly it would influence their decision (0-10) and whether they would still choose the same treatment. Items for which participants would no longer choose the same treatment were termed dominant decision factors. Results. Of 276 respondents, 263 (95.2%) were analyzed. Dominant factor rates ranged from 13.5% to 87.8% across complications. Complications described as persisting at one year produced substantially higher rates than the same complications described as resolving by three months. Adverse events more frequently constituted dominant factors when surgery was framed as offering less benefit, although differences between scenarios were not statistically significant. In the nonoperative scenario, worsening bladder control (56.6%) and neck pain interfering with sleep (53.0%) were the strongest influences, exceeding needing a cane to walk (32.1%). Conclusions. Treatment decisions for mild CSM are driven primarily by the expected permanence of adverse events and their anticipated impact on daily quality of life, rather than by conventional neurological metrics or surgical benefit framing.

IntroductionCurrent evidence suggests that patient health passports may improve care for patients with chronic illnesses. This systematic review aimed to evaluate the impact of patient health passports on health outcomes in adults with diabetes. MethodsA systematic review was conducted in February 2025 following PRISMA 2020 guidelines, using Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, Web of Science, and Scopus. The review included studies of adult diabetic patients using paper or digital patient health passport as part of their care in comparison with the standard of care. Data were analysed using meta-analysis and a thematic analysis where appropriate; otherwise, the data are presented narratively. Quality appraisal was undertaken using the Cochrane Collaboration tool for assessing risk of bias and Evidence-based librarianship checklist. The certainty of the evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation. ResultsEleven studies (n=14,350) were included. Seven studies were randomised controlled trials, two were retrospective in nature, one was a qualitative and one was a pre-post study. Overall, the studies are limited in design, resulting in high or unclear risk of bias across multiple domains. Results of the meta-analysis of five studies showed a statistically significant mean difference reduction in HbA1c and total cholesterol in favour of the intervention group; however, the certainty of the evidence is low or very low. The narrative analysis of the data revealed little to no improvement in body mass index, blood pressure, blood glucose, and cholesterol levels. Patients opinions and perceptions revealed some benefits in usability, perceived value, and in enhancing collaboration. ConclusionThis review provides evidence suggesting that patient health passports may improve patient care and can inform the design of future high-quality studies. However, the low certainty of the evidence highlights the need for high-quality studies with larger sample sizes. Key PointsO_LIPatient health passports show promise in enhancing diabetes management, however current evidence is limited by high risk of bias; future high-quality studies are required to confirm efficacy. C_LIO_LINurses are pivotal in this process as they play a central role in diabetes education, self-management support and continuity of care. C_LIO_LIPatient health passports could be considered as a structured tool to facilitate ongoing monitoring, reinforce adherence, enhance communication between patient and nurses/multidisciplinary team. C_LI

Background: Chronic obstructive pulmonary disease (COPD) is a progressive condition with high symptom burden. Advanced COPD management should relieve symptoms, optimise daily functioning and reduce carer burden, yet there is limited enactment of policy-advocated person-centred approaches to care and support. The Living with Breathlessness Study sought to establish evidence-based recommendations to inform a new paradigm to improve care and support in advanced COPD. Methods: Comprehensive multiple-perspective longitudinal evidence was collected on care, support, functioning and needs in advanced COPD from a population-based cohort of over 500 patients, their unpaid/family carers and health care professionals through semi-structured interviews and validated outcome measures over an 18-month period. Quantitative data analysed using standard descriptive statistics, numerical and univariate analyses, and qualitative data using a Framework approach. Recommendations were then generated through three linked strategies: (1) an expert multidisciplinary group, (2) a stakeholder workshop and (3) a stakeholder survey. Results: Six inter-related recommendations emerged, linked by the concept of proactive person-centred care, supported by action points to enable delivery. Recommendations in brief: (1) stop focusing on the challenge of prognostication as a barrier to meeting need, (2) change targets to incentivise person-centred care, (3) enable identification of patient support needs, (4) identify and support carers, (5) identify and respond to psychological morbidity, (6) change societal understandings of COPD, breathlessness, palliative care and informal carers. The recommendations garnered significant support from stakeholders, with caution regarding ease of implementation. Conclusions: Enactment of the resulting six evidence-based recommendations, through their action points, could inform a new paradigm to improve care and support in advanced COPD recognising the slow relentless progression of non-malignant disease, and its effect on patients and their carers. They hold potential for other patients and unpaid/family carers who are living in between conventional disease management and end-of-life care, and for those HCPs striving to support them.

Mobile clinical-support applications can facilitate access to evidence-based information at the point of care, but evidence on their usability and perceived usefulness among newly graduated physicians working in health facilities with limited capacity is scarce. We assessed physicians experiences with BMJ Best Practice using a convergent mixed-methods study. All 81 eligible physicians assigned to rural facilities were invited; 32 enrolled and received application access and training. After three months, participants completed an online survey, and 23 reported using the application. Ten physicians reporting the highest consultation frequency were purposively selected for semi-structured interviews. Survey findings showed a predominantly favorable perception of usability: for most items, 70%-90% of participants agreed or strongly agreed with the statements assessed. Among users, 14 of 23 (60.9%) used the mobile application and 9 (39.1%) used the web version. Interviews indicated that participants valued rapid searches, organized and evidence-based information, and support for diagnostic reasoning, referral decisions, learning, and clinical confidence. Barriers included limited connectivity, difficulties searching in Spanish, automatic updates, challenges locating or using some calculators, and treatment information that was sometimes insufficiently specific. Most importantly, participants could not always implement recommendations because suggested medicines, diagnostic tests, or other resources were unavailable in their facilities. Mobile clinical-support applications may complement decision-making and learning among early-career physicians in rural primary care. However, their practical value depends not only on usability and evidence quality, but also on adaptation to users language, workflow, connectivity, and local service capacity.

Objective Women carry disproportionate shares of caregiving and other life demands that may compound the work of diabetes self-management. We sought to examine gender differences in overall and digital treatment burden and their key contributors. Research Design and Methods Cross-sectional analysis of two cohorts of adults with type 1 or type 2 diabetes attending outpatient endocrinology visits who completed the Treatment Burden Questionnaire Plus Digital (TBQ+D) (n=472). Multivariable regression estimated gender differences in overall and digital treatment burden, ability to live a normal life, and sustainability of current self-care effort, adjusting for age, diabetes type, insulin intensity, HbA1c, and cohort. Item-level analyses identified contributors to observed differences. Results Compared to men, women reported higher median overall treatment burden (33 vs 20, adjusted mean difference 10.6 points, 95% CI 5.1-16.3; p<.0001) and digital treatment burden (13 vs 7, adjusted mean difference 3.5 points, 95% CI 1.1-6.1; p=.009). They also had higher odds of not living a normal life (OR 1.77, 95% CI 1.18-2.67; p=.006) and difficulty sustaining current self-care efforts indefinitely (OR 2.01, 95% CI 1.10-3.66; p=.023). Digital burden differences were concentrated in annoyance, precautions, and time and effort required to use digital medicine tools, whereas contributors to differences in overall burden varied, with relationships, self-monitoring, and injections contributing most. Conclusions After adjusting for treatment intensity and other factors, women living with diabetes were twice as likely to be overwhelmed by diabetes care than men. Their greater vulnerability to treatment burden demands healthcare service redesign and individualization of plans of care that minimally disrupt patients' and caregivers' lives.

Background: Public and clinical attention to postural orthostatic tachycardia syndrome (POTS) has increased, particularly since the COVID-19 pandemic. We quantified changes in United Kingdom Google search interest and examined whether searches increasingly used diagnostic and self-assessment language. Methods: We extracted monthly Google Trends relative search volume (RSV; 0-100) for the Health-category search term 'Pots syndrome' in the United Kingdom from January 2004 through July 2026. Five extraction attempts were made; two returned complete, identical monthly series and were retained. Prespecified eras were summarised and an exploratory interrupted time-series model at March 2020 used ordinary least squares with Newey-West heteroskedasticity and autocorrelation consistent standard errors (12 lags). Comparator searches included conventional orthostatic diagnoses, POTS diagnostic terms, associated conditions and YouTube searches. Results: The primary series comprised 271 complete months. Mean RSV increased from 18.6 during 2015-2019 to 64.8 during 2022-2023 (3.49-fold) and remained 50.6 during January 2024-July 2026 (2.73-fold above baseline). Search interest peaked in October 2022 (RSV 100); July 2026 RSV was 57. The interrupted time-series model estimated an immediate March 2020 level increase of 21.8 points (95% CI 2.8-40.7; p=0.024), while the slope change was not statistically supported (0.069 points/month, 95% CI 0.299 to 0.438; p=0.713). Searches for 'POTS symptoms', 'POTS test' and 'POTS heart rate' increased more steeply than the general term, although low baseline volumes made fold changes unstable. Conclusions: UK Google search interest in POTS rose before 2020, increased sharply after the pandemic began, and remained substantially above its prepandemic baseline. The results demonstrate a sustained change in public attention, not disease incidence or social-media causation. The growth of symptom- and testing-oriented searches is compatible with increased diagnostic self-investigation and warrants linkage to referral, diagnosis and social-media exposure data.

Background Falls are a major safety concern in healthcare. In palliative care, patients are particularly vulnerable due to complex symptom burdens and rapid physical decline. However, standard falls risk assessment tools, primarily designed for acute clinical environments, rely on static risk scores and lack efficacy in hospice settings. The Falls Early Warning Score (FEWS) is a observational tool developed to address the specific contributing factors and complex needs of palliative patients. Aims To explore and understand staff views regarding the implementation, utility, and benefits of the FEWS tool to identify people at risk of falling in a specialist palliative care inpatient unit. Methods A mixed-methods study was conducted at a UK hospice. Healthcare professionals with clinical experience using the FEWS chart completed an electronic questionnaire assessing their confidence, practice, and perceived barriers. Questionnaire outcomes informed subsequent face-to-face, semi-structured interviews. Qualitative data were evaluated using reflexive thematic analysis. Results Eleven staff completed the questionnaire, and five participated in interviews. Three major themes were identified: (1) Education, highlighting staff preferences for 1:1 training and the necessity of dedicated user guides; (2) Location and format of the FEWS tool, contrasting the data collection benefits of electronic formats against the bedside accessibility of paper charts; and (3) Recognised benefits of the FEWS tool, including its ability to prompt safe staffing levels, highlight variable patient presentation, and mitigate the emotional and physical impact of falls. Conclusions It is feasible and highly acceptable to integrate bespoke falls risk assessment tools into palliative care. By addressing the unique complexities of hospice patients, customised tools like FEWS can empower staff and support dynamic clinical decision-making. Further research is required to evaluate their clinical efficacy in reducing falls.

Background: GPs are often the first clinicians to assess acute chest pain in gatekeeper healthcare systems, but usually with limited diagnostic support. They must distinguish conditions that can be managed safely in primary care from those requiring immediate hospital evaluation, particularly acute coronary syndrome (ACS), while avoiding unnecessary over-referral to already pressured emergency departments. We evaluated HEART-GP, a novel GP-led strategy combining structured clinical assessment, fingerstick point-of-care high-sensitivity troponin I testing, and ECG when available. Methods: We performed a prospective, multicentre, paired diagnostic accuracy study in four Dutch out-of-hours primary care centres implementing the HEART-GP strategy. Patients with acute non-traumatic chest pain and possible ACS according to the treating GP were enrolled from March 2023 to August 2025. Before troponin results were available, GPs recorded intended management, allowing paired comparison with unaided clinical judgement. The HEART-GP strategy recommended urgent referral for high clinical suspicion, troponin of >=4 ng/L, or ischaemic ECG. The primary outcome was adjudicated 6-week major adverse cardiovascular events (MACE). The study was registered as ISRCTN11954040. Findings: Of 1104 patients who underwent HEART-GP, 917 were included. MACE occurred in 62 (6.8%) and myocardial infarction in 52 (5.7%). HEART-GP classified 478 (52.1%) as low risk. For MACE, sensitivity was 95.2% (95% CI 86.5-99.0) and negative predictive value was 99.4% (98.1-99.8); three MACE occurred in the low-risk group, with no cardiac deaths. For myocardial infarction, sensitivity was 98.1% (89.7-100) and negative predictive value was 99.8% (98.6-100). Compared with unaided GP judgement, HEART-GP improved sensitivity for MACE (95.2% vs 67.7%; p<0.001) and myocardial infarction (98.1% vs 67.3%; p<0.001), and reduced urgent referrals (439 [47.9%] vs 483 [52.7%]; p=0.042). Interpretation: HEART-GP showed high rule-out safety and may support GP diagnostic certainty and efficient referrals in patients with possible ACS. Implementation requires training, governance, safety-netting, and local pathways.

Background: Early cancer detection is aided by timely GP referrals. However, GP practices face pressures, particularly in deprived areas, which may be associated with diagnostic inequalities. Aim: To examine whether within-practice changes in access, workforce, and population income deprivation were associated with diagnostic care indicators. Design and setting: Retrospective longitudinal study of 6,194 practices between 2015-2019 and 2022-2023. Method: Panel fixed-effects regression examined USC referral rates, USC PPV, USC sensitivity, and emergency presentation rates. Predictors were patient-reported access, GP workforce, and practice population income deprivation. Results: Per one SD increase within practices, (i) USC referral rates were lower with better appointment-making experience (-1.4%) and older average GP age (-3.5%), and higher with female GP share (+1.3%); GP FTE showed a small positive association (+0.7% to +0.8%). (ii) USC PPV increased with older average GP age (+2.2%). (iii) USC sensitivity was lower with older average GP age (-1.1%); emergency presentations showed limited association with access or workforce factors. Practices had higher emergency presentation rates when serving the most deprived rather than least deprived populations (+13.7%). There was little evidence that deprivation modified access and workforce associations. Average GP age was an exception: USC referral associations weakened from Q2 to Q5, USC PPV peaked at Q3, and USC sensitivity was significant only in the most deprived quintile. Conclusion: Practice-level access and workforce factors were associated mainly with USC referral activity. Persistent deprivation gaps in emergency presentation suggest monitoring USC referrals alongside PPV, sensitivity, and emergency presentations.

Background: Social prescribing has expanded rapidly in England and internationally. However, the collection of consistent data to monitor and evaluate its reach and impact remains to be challenging. Methods: This study used routine data from the Clinical Practice Research Datalink (CPRD) Aurum in England. UpSet plots were used to describe intersections among different social prescribing codes, and between social prescribing and other non-clinical interventions. After identifying potential problematic intersections, we fitted multilevel regression models to examine variation between general practices and to understand factors associated with potentially problematic coding. Findings: Between 2019 and 2025, approximately 3.8 million consultations involving social prescribing codes were recorded in CPRD Aurum. Social prescribing codes were most often recorded individually (38.1%), but intersections existed both among different social prescribing codes, and between social prescribing and related non-clinical support. Many intersections reflect plausible stages and scenarios within the social prescribing pathway. However, some coding patterns appeared ambiguous or potentially inconsistent, particularly those related to social prescribing being offered and referrals being made. Results from the multilevel regression models suggested that 28.4-34.6% of variation in these codes was attributable to differences between practices, and problematic coding varied by region and year of recording. Interpretation: Our findings highlight opportunities to improve the quality and consistency of social prescribing coding in primary care, thereby strengthening service monitoring and evaluation both in England and internationally. They also provide important insights for researchers using CPRD data to investigate social prescribing.

Gaps remain in the evidence base for postoperative management following forefoot surgery. A recent randomized controlled trial (ClinicalTrials.gov NCT04927234) demonstrated improved outcomes with intermittent one Hertz (Hz) neuromuscular electrical stimulation (NMES) of the common peroneal nerve. This sub-analysis evaluates its effect in patients undergoing forefoot surgery. Forty-two patients undergoing forefoot procedures were included; 26 received NMES plus standard of care (SOC) and 16 received SOC alone. Wound healing was assessed at 14 days. Edema was measured using the figure-of-eight (FO8) method. Patient-reported outcomes were assessed using the Manchester-Oxford Foot Questionnaire (MOXFQ). At 14 days, complete wound healing occurred in 77% of patients receiving NMES plus SOC compared with 40% in the SOC group (p<0.05). Edema reduction was significantly greater in the NMES group, with a 74% relative reduction compared with SOC (p=0.02). Intermittent one Hz NMES of the common peroneal nerve was associated with improved wound healing and reduced postoperative edema following forefoot surgery.

Background Chronic postsurgical pain (CPSP) affects between 7-23% and 13-44% of patients after hip and knee arthroplasty, respectively. Standardised methods of pain assessment provide superior evaluation of pain, including the Oxford Joint Score Pain Subscale (OJS-PS). We aim to estimate the proportion of patients with a phenotype consistent with CPSP through a k-medoids clustering technique and identify a threshold on the OJS-PS to highlight such patients at a population level. Methods In this cross-sectional study Patient Reported Outcomes Measures data 6-months after hip and knee arthroplasty from 2017 to 2025 were examined. An adapted k-medoid clustering technique utilising subsampling, batch assignment and probabilistic consensus allocated clusters. A receiver operator characteristic analysis identified a threshold on the OJS-PS noting the lowest scoring cluster. Our categorisation was compared to self-reported severe or moderate pain; sensitivity, specificity and accuracy of this categorisation were calculated. Results We analysed 109,542 hip and 113,799 knee arthroplasty patients; three clusters were used in each analysis. After hip arthroplasty: 14.4% of patients were assigned to the cluster with the lowest median OJS-PS of 11 [IQR 8 - 13]. A threshold of 15.5 classified patients as severe or moderate pain with 60.6% sensitivity, 91.0% specificity and 85.7% accuracy. Similarly, after knee arthroplasty, 25.3% were assigned to the cluster with the lowest median OJS-PS of 14 [IQR 11 - 16]. A threshold of 18.5 on the OJS-PS had an 85.4% sensitivity, 88.4% specificity and 87.8% accuracy for classifying patients with self-reported severe or moderate pain. Conclusions This robust and scalable clustering technique on ordinal clinical data estimates the proportion of patients reporting a phenotype consistent with CPSP. On a population level the thresholds identified on the OJS-PS could aid screening for potential CPSP patients 6 months after hip and knee arthroplasties.

Objectives Genetic testing is increasingly used in the diagnosis and management of respiratory conditions, including pulmonary fibrosis (PF). The perspectives of people with PF and healthcare professionals (HCP) on the use of genetic testing remain largely unexplored. Methods A qualitative study was undertaken. People living with PF, their caregivers, and HCP were invited to undertake a semi-structured interview. Interviews were conducted via videoconference or telephone, audio-recorded, and transcribed verbatim. Data were analysed by two researchers using inductive thematic analysis. Results Thirty-eight participants; 15 people living with PF, 1 caregiver, and 22 HCPs were interviewed. Analysis revealed three key themes. Genetic testing in PF was valued by all groups; people with PF wanted testing now, whilst respiratory physicians were cautious, citing their uncertainty regarding clinical value. All groups desired more information and support; people with PF desired a better understanding of terminology, whilst genetic counsellors wanted to better understand PF. No single model for returning genetic results in PF was identified, however resources, multidisciplinary care, and timely return of results was considered important. Conclusion Genetic testing is valued by people with PF and their HCP, but uncertainties remain regarding whether it should be offered and how results should be best communicated.