BJGP Open

BackgroundEarlier identification and registration of people in the last year of life improves care quality and outcomes in general practice. However, there is little evidence on patients who subsequently no longer require end-of-life registration, nor on the safety or outcomes of de-registration following clinical review. AimTo determine the prevalence, safety, and prognostic validity of GP-led removal from the end-of-life register (EOL_R) using a systematic digital review process. Design and SettingObservational cohort study in eight practices in Wolverhampton, UK, using a whole-population integrated primary and secondary care dataset. MethodAll adults on the EOL_R were systematically reviewed using a digital end-of-life pathway (PRADA) incorporating robotic process analysis of recognised end-of-life care markers. GPs recorded a binary decision to retain or remove patients from the register. Mortality outcomes were compared with those retained on the EOL_R, a tightly propensity-matched cohort not on the register, and the residual general population over 15 months. ResultsOf 422 registered patients, 33 (7.8%) were removed following GP assessment. One-year survival in the removed group was statistically indistinguishable from the propensity-matched control cohort, and survival was significantly higher versus those retained on the EOL_R (60.4%, p<0.001). Removal demonstrated a negative predictive value for mortality of 90.9%. ConclusionGP-led removal from the end-of-life register can be undertaken safely and identifies a distinct group with substantially better prognosis. Digital systems that support systematic review, documentation, and follow-up should be incorporated into routine practice and reflected in national guidance and the Quality and Outcomes Framework. Statement boxesO_ST_ABSWhat is knownC_ST_ABSEarlier identification and registration of people in the last year of life improves care coordination and outcomes. However, little is known about patients who subsequently no longer require end-of-life registration, or whether removal following clinical review is associated with adverse outcomes. What this study addsIn a whole-population primary care cohort, General Practitioners removed 33 patients (7.8% of those registered) from the end-of-life register following structured clinical review. One-year survival in this group was equivalent to a tightly matched cohort not on the register, and survival was substantially higher than among patients retained on the register. A simple robotic based review process can prompt systematic reassessment, capture GP clinical judgement, and enable prospective monitoring following removal. ImplicationsEnd-of-life registration should be treated as a dynamic process requiring ongoing clinical review. Digital systems can support safe removal from registers by documenting decisions and embedding follow-up for patients whose prognosis remains uncertain. Evidence-based guidance and governance processes for a review process are needed to ensure people are not retained on registers unnecessarily. How this fits inEnd-of-life registers are intended to support proactive care for people in their last year of life, yet there is little evidence about patients who later stabilise and may no longer require registration. In eight UK practices, a systematic GP review supported by a digital end-of-life pathway identified a small but clinically important group suitable for removal, without adverse mortality outcomes. Beyond improving register accuracy, structured review creates opportunities for meaningful dialogue with patients, shared reassessment of care goals, and appropriate de-escalation of end-of-life labelling. Embedding routine, structured review with documented decisions and follow-up may also reduce unnecessary clinical workload and strengthen governance in primary care. Novelty StatementSystematic GP review of end-of-life registers, as stipulated in GMC guidance, is rarely evaluated. We propose a digitally driven, systematic and dynamic clinical-governance-led approach to register review.

Social prescribing has assumed increasing dominance in policy and practice internationally, including in the UK, where it has an increasing role in addressing social needs such as isolation, and social determinants of ill-health. Although General Practitioners are perceived as key referral sources, social workers in one locality were found to play a significant role in referral. This suggests that the social work role in this context has been under-recognised and under-explored. This study sought to explore social workers perceptions and experiences of social prescribing through an online survey conducted from January - June 2022. All UK social workers were eligible to participate, regardless of whether they had made referrals. Responses (105) were collected from all UK nations. Data was analysed using inductive thematic analysis. Four key themes were generated: contended and contested boundaries; complementary spaces; delineated spaces of simplicity and complexity; social work under threat. Participants recognised that social prescribing could provide valuable client support and could be a useful resource for social workers. However, they also expressed concerns about overlapping professional boundaries and the potential for social prescribing to encroach on social work, perceiving it as most appropriate for the delivery of support to those with low-level needs.

BackgroundThe COVID-19 pandemic significantly accelerated the adoption of telemedicine, but it also exposed gaps in effective remote clinical assessment, particularly for medically vulnerable patients in rural areas. The ORCHARD intervention aimed to address this by providing patients with a Medical Self-Assessment Box to enable self-reporting of vital signs during remote consultations. MethodsA single-centre randomised mixed-methods feasibility trial recruited medically vulnerable patients from a rural general practice in Northeast Scotland. Participants in intervention group received a home medical equipment box for use during telemedicine consultations over six months. Patients and GPs were interviewed and transcripts were analysed using Framework Analysis. ResultsTwelve (15%) of 82 eligible invited patients enrolled. Six each were allocated to intervention and control group. 50%(n=3)patients in intervention group used equipment in 45%(5 of 11)teleconsultations and rated it helpful in all 5 uses (100%). The intervention group had 18% fewer primary care contacts than controls. All remote consultations were by telephone. Framework Analysis of patient interviews identified facilitators such as ease of use, improved triage access, reassurance, and barriers related to GP non-engagement and written instructions. GP interviews identified clinical value in patient-generated readings, alongside concerns regarding workload and patient over-monitoring. ConclusionsHalf of intervention participants used the medical-equipment box during remote consultations, all finding it useful, though frequency of use varied among particpants.A randomised controlled trial to evaluate the effectiveness of the Medical Self-Assessment Box for optimising remote consulting in medically vulnerable rural patients is feasible.Prior to a definitive trial refinements are recommended to patient labelling, GP engagement, and training materials.

IntroductionAccess to specialist care in the Netherlands requires a general practitioner (GP) referral, yet referrals to secondary care keep rising. Triage has been proposed to manage this demand and may be relevant for internal medicine, which addresses diverse and increasingly complex conditions. This study aimed to identify the internal medicine healthcare needs which were redirected to the GP after triage and to explore the factors driving GP referral behaviour. MethodsThis multi-method study combined quantitative referral data with qualitative insights from GP focus groups. Data were extracted from a hospital in an urban region, including adults with non-acute complaints referred for outpatient consultation to internal medicine between August 2019 and July 2021. Referrals were triaged for appropriateness and redirected where possible. Focus groups explored GPs perspectives on referral practices. ResultsOf 5,826 referrals triaged, 998 (17%) were redirected to the GP with advice and guidance. Endocrinology accounted for 35% of redirected cases, followed by nephrology (8.6%). Focus groups revealed underlying drivers of referral behaviour, identifying four themes: medical factors; GP-related factors, including professional uncertainty and autonomy; patient-related factors; and external factors, such as contextual and regulatory influences. ConclusionThis study demonstrates that triage is a feasible strategy for managing referral volumes, particularly within domains such as endocrinology where many medical problems can be managed in primary care. However, referrals are shaped by more than clinical need, reflecting uncertainty, emotional considerations, patient expectations and systemic factors. Strengthened collaboration between primary and secondary care, alongside pre-referral consultation strategies, is essential to ensure appropriate, high-quality patient care.

Background In 2024, one-third of GP appointments in England were conducted by telephone. What happens during these consultations is largely unknown. Aim To test the feasibility of collecting recorded GP telephone consultations with linked data and consent for future research use. Design and setting Retrospective observational study in seven practices in South West England. Method Adults who had a telephone consultation at practices that routinely record calls were invited to consent to retrieval of call audio, a 4-month electronic health record (EHR) extract and a post-consultation patient questionnaire. Practice-level consent rates were analysed using regression models. Results Of 28 clinicians recruited, 19 GPs had consultations with patients whose recordings were retrievable, usable, and consented for future research. Of 2,053 invitations, 123 patients consented (6.0%). Consent was lower in more deprived practices (IMD 1-2 vs 9-10: OR=0.22, 95CI=0.09-0.54). Of 101 recordings retrieved, 96 were usable and 91 had consent for future research. 86/91 were linked to EHRs and 89/91 to post-consultation patient questionnaires. Mean consultation duration was 7 minutes 13 seconds; audible typing was heard in 69% (63/91). 161 problems were discussed (mean 1.77 per consultation). Most patients were happy their consultation was by telephone (96/117, 82%), although the majority reported usually preferring face-to-face appointments (68/115, 59%). Conclusion It is feasible to assemble a reusable archive of GP telephone consultations with linked data. However, recruitment was low using retrospective remote consent. Future work should test alternative recruitment approaches, particularly to improve patient engagement at practices serving deprived populations.

Purpose In deprescribing studies, a prescription-free gap is typically used to determine if patients discontinued their treatment. An appropriate gap depends on the typical time between prescriptions during continued use. This work aims to characterise the interval between prescriptions of chronic drugs using different methods for a cohort of older people in primary care in Ireland. Methods The empirical prescription interval was analysed for 38,154 patients for the twenty most common drug classes and the association between covariates and the interval was analysed using a multi-level model. Estimates were also compared to those obtained from the parametric waiting time distribution (pWTD) approach. Results Available covariates had consistent relationships with prescription intervals across drug classes. For example, each additional prescription issue was associated with an increase in the interval by 5.0 (NSAIDs) to 19.7 days ("Other antidepressants"). Full public health cover was associated with a -29.0 day (inhaled adrenergics) to -11.0 day (opioids) change relative to partial cover, while other/private cover had a -17.9 day (benzodiazepines and associated drugs) to -7.1 day (SSRI and SNRIs) change relative to partial cover. The pWTD also produced consistent estimates of the population interval for most drugs. Conclusions The interval varied substantially within drug classes, due to a mixture of patient, practice and unmodelled factors. Variation between practices was effectively explained, with residual variation between patients and within patients. The pWTD approach is useful for describing complex distributions of intervals, and may be more appropriate for inferring a gap than summarising truncated data.

BackgroundAcceptance of death is an important aspect of a good death and an indicator of high-quality palliative care. Limited evidence exists on the extent to which patients accept their approaching death and which socio-demographic or end-of-life care characteristics are associated with acceptance, in both cancer and non-cancer patients. MethodsWe conducted a retrospective cross-sectional survey in representative GP networks in the Netherlands and Italy (2013-2015), and Belgium and Spain (2013-2014). GPs registered all deceased adult patients in their practice, reporting health and care characteristics in the last three months of life and the level of acceptance of approaching death on a four-point scale ("1. Yes, completely" to "4. No, not at all"). Non-sudden deaths were included, totaling 2,796 patients (1,474 cancer; 1,322 non-cancer). ResultsAcceptance was recorded for 97% of patients (n=2,713), of which 17% were assessed as unknown. GPs assessed that 30% of patients had complete acceptance, with similar proportions in cancer and non-cancer patients (30% vs 29%). Multivariable logistic regression showed that older age (OR 1.03, 95%CI 1.02-1.04, p<0.01), country (OR 0.27 Belgium, OR 0.11 Italy, OR 0.10 Spain; reference: Netherlands), and palliative care by the GP until death (OR 1.39, 95%CI 1.07-1.79, p<0.01) were independently associated with complete acceptance. ConclusionSocio-demographic, contextual, and end-of-life care factors influence GP-assessed acceptance of approaching death, whereas a cancer diagnosis does not. These findings emphasize the importance of culturally sensitive, age-appropriate, and palliative care-oriented approaches to support patient acceptance at the end of life.

BackgroundInteractive dashboards can support safe prescribing but effectiveness depends on user engagement. The research team developed a prescribing safety dashboard, deployed in 27 Irish general practices. Trend graphs tracked prescribing changes (2019-2025) by practices across key metrics. This study explored how GPs engaged with the dashboard and their perceptions of using routine data for prescribing feedback. MethodsPrescribers from participating practices were invited to online interviews (May-August 2025). A think-aloud exercise involved participants verbalising their thoughts while navigating the dashboards, followed by a semi-structured interview exploring views on safe prescribing, feedback and data access. Interviews were recorded, auto-transcribed and manually reviewed for accuracy. Think-aloud data were analysed deductively using a sense-making framework, interviews analysed inductively, and findings triangulated to refine themes. ResultsNine general practitioners (GPs) from eight practices participated. Themes were organised into four categories: (1) Perceptions of open data, (2) Perceptions of feedback, (3) Dashboard engagement, and (4) High-quality prescribing. Most were in favour of open data and transparency but some feared misuse. GPs valued feedback but reported workload as a barrier. Engagement with the dashboard was mainly interpretative, focused on data meaning in the context of their practice. GPs showed a strong emotional dimension to engagement and also described intended actions in response to what they saw. Finally, high-quality prescribing was mainly viewed as avoiding harm. ConclusionsGPs valued and engaged with dashboard feedback but workload competed with time for reflection and action-highlighting the need for practical, streamlined tools and nudges to support engagement. Key messagesO_LIAudit and feedback, such as that delivered through interactive dashboards has a small but significant effect on professional behaviours such as prescribing, but user engagement influences effectiveness. C_LIO_LIIrish GPs engaged with a prescribing safety and quality dashboard in a reflective and contextual way and garnered rich insights on their prescribing. C_LIO_LIGPs valued feedback and showed a strong emotional attachment to their performance, but felt workload competed with time for reflection and action. C_LIO_LIWith advances in data infrastructure, it is possible to provide interactive prescribing feedback in real time. However, the way feedback is designed and delivered plays a crucial role in supporting engagement. Dashboards and related behavioural interventions should be co-designed with prescribers to maximise engagement. C_LI

Multimorbidity, the co-existence of two or more long-term conditions, is up to three times more prevalent among people with cancer than in the general population and is associated with poorer survival, particularly for cancers with a more favourable prognosis such as colorectal cancer. In Scotland, multimorbidity is the norm among older adults, emerges earlier in socioeconomically deprived populations, and may contribute to comparatively low cancer survival rates. Despite this, the influence of multimorbidity on the colorectal cancer pathway remains poorly understood. We conducted a Scottish data-linkage study of adults diagnosed with colorectal cancer between 2010 and 2014, linking the Scottish Cancer Registry to national prescribing, hospital admissions, death registration, and bowel screening datasets. Prescribing data were used to derive overall and system-specific comorbidity measures as a proxy for multimorbidity and active disease burden. Associations with stage at diagnosis, treatment, survival, and screening uptake were examined using logistic regression and Cox proportional hazards models adjusted for demographic and clinical covariates. Among 19,043 patients, 87% had at least one prescribing-based comorbidity, most commonly cardiovascular, nervous system, and gastrointestinal conditions. Overall comorbidity burden was not associated with stage at diagnosis, although laxative-related prescribing was associated with later-stage disease. Increasing comorbidity burden reduced the likelihood of receiving any treatment and surgery, while associations varied across system-specific comorbidities. Higher comorbidity burden was also associated with increased all-cause and colorectal cancer-specific mortality, particularly among patients with respiratory, nervous system, and haematological/nutritional conditions. Screening uptake was not associated with overall comorbidity burden but did differ by system-specific comorbidity. Prescribing-based multimorbidity was highly prevalent and strongly associated with treatment patterns and mortality among patients with colorectal cancer. System-specific multimorbidity measures provided greater discrimination than overall morbidity counts, highlighting the importance of considering distinct multimorbidity profiles when assessing cancer pathways and designing targeted interventions for optimising treatment and survival. Keywords (primary health care, general practice, multimorbidity, comorbidity, colorectal cancer, early diagnosis, cancer treatment, survival)

ObjectivesFor suspected hip fractures, prehospital protocols directing patients to an orthopaedic centre rather than the nearest emergency department (ED) could reduce time-to-surgery but may impact EMS travel burden. This study evaluates the impact of transfer protocols by quantifying transport to hospitals from long term care (LTC) facilities across Ontario. MethodsA retrospective cross-sectional analysis of all Ontario LTC facilities and hospitals was performed. Two protocols were modeled: standard transfer to the nearest ED with subsequent transfer if required, and selective transfer based on Collingwood Hip Fracture Rule prehospital screening1directly to the nearest orthopaedic services (orthoED). Median one-way travel distances were calculated from Google Maps. ResultsIn Ontario, 15.4% of LTC residents require hospital destination decisions because their nearest ED lacks orthopaedic services; for these facilities, median distances were 2.7km to the ED and 36.0km to the orthoED. Among the 52 LTC facilities where selective transfer was distance-optimal, it substantially reduced travel for patients with hip fracture (31.1km vs 49.6km; P<.01) while only modestly increasing travel for patients without hip fracture. Where standard transfer was distance-optimal, little travel difference was noted for patients with hip fracture, however false positive screened patients traveled significantly further to an orthoED. Greatest negative consequences of selective transfer lie in the 1.3% of residents living farthest (>100km) from an orthoED. ConclusionsEMS direct transportation to hospitals with orthopaedics may improve hip fracture care but can increase EMS burden due to patients identified falsely as having a hip fracture, particularly in remote communities.

ContextIn the UK, and in other countries, people living with a terminal illness are eligible for financial support to help with the costs of serious illness and to support their dignity and independence. This study investigates the take-up of benefits in the last year of life and identifies sociodemographic, clinical, and geographical factors associated with underclaiming. MethodsRetrospective cohort study using linked mortality, Census and benefits data for all people who died aged 16+ from chronic illnesses in England and Wales between 1 May 2018 and 30 April 2021. Outcome was receipt of non-means tested disability benefits in the last 12 months of life. We describe geographical variation in take up, and association with sociodemographic, clinical and geographical exposures using Poisson models. FindingsOur population included 1,049,493 eligible decedents, with an overall take-up rate of 65.9%. After adjusting for sociodemographic factors, variation in take-up by cause of death was wide: liver disease 44% (95% CI 43-45%), heart failure 52% (51-52%), cancer 62% (61-62%), dementia 75% (74-75%), and neurodegenerative diseases 90% (88-91%). Across Local Authorities, the age-and-sex-standardised take-up varied from 53% to 78%; rates were generally higher in more deprived areas, but not uniformly. ConclusionsIn England and Wales, 1 in 3 people who die from expected causes (120,000 each year) do not receive the benefits for which they are eligible. Our analysis uses novel data linkages and highlights clinical and sociodemographic groups and geographical areas that could be targeted with proactive take-up initiatives.

PurposeNeurogenic dysphagia is prevalent in neurological inpatients and associated with adverse outcomes, yet its independent economic impact after adjustment for frailty and functional status remains poorly quantified. We aimed to estimate the independent effect of dysphagia on hospital length of stay (LOS) and costs, to test whether this effect differs between geriatric and non-geriatric patients, and to quantify the probability and magnitude of cost savings from improvements in swallowing function. MethodsWe analysed 10,375 neurological inpatient cases (2021-2024) at a German university hospital. Dysphagia was defined by fiberoptic endoscopic evaluation of swallowing (FEES) or ICD-10 R13 coding (n = 1,382; 13.3%). Bayesian Gamma-log regression with informative priors from historical data and published literature was used to model LOS and total case costs (German DRG), adjusted for age, sex, Hospital Frailty Risk Score (HFRS, R13-adjusted), self-care index ("Selbstpflege-Index", SPI), stroke status, and emergency admission. A geriatric cohort was defined as age [&ge;]70 and adjusted HFRS [&ge;]5 (n = 2,053; 19.8%). Posterior predictive simulation estimated cost savings for hypothetical improvements of 1-3 points on the Functional Oral Intake Scale (FOIS). ResultsAfter comprehensive adjustment, dysphagia was independently associated with 46.5% longer LOS (posterior ratio 1.465; 95% credible interval [CrI] 1.397-1.537) and 28.2% higher total case costs (ratio 1.282; CrI 1.213-1.354). The dysphagia x geriatric interaction was small but credible and ran in opposite directions: slightly attenuated for LOS (interaction ratio 0.908, CrI 0.837-0.986) but slightly amplified for costs (1.096, CrI 1.012-1.185), consistent with complexity-driven DRG grouping in geriatric patients. The absolute economic burden remained larger in the geriatric cohort due to higher baseline costs. In the geriatric cohort, a one-point FOIS improvement yielded a 74.3% posterior probability of LOS-based savings (mean {euro}555/case); at three points, this rose to 84.2% (mean {euro}1,115/case). The direct cost model confirmed high benefit probabilities from the payers perspective (82.6% at {delta}FOIS = 3). ConclusionsNeurogenic dysphagia is an independent and substantial driver of hospital LOS and costs in neurological inpatients, even after adjustment for frailty and functional status. The proportional effect on costs is slightly larger in geriatric patients, while the LOS effect is slightly smaller, consistent with the mechanics of the G-DRG system. Bayesian simulation indicates that improvements in swallowing function carry a high probability of generating cost savings, supporting the characterisation of dysphagia as a modifiable economic target with particular relevance to geriatric neurology.

Background Lumbar fusion and decompression procedures are widely used for degenerative spine conditions but are associated with substantial health care costs and variable outcomes. Orthobiologic treatments, including platelet rich plasma (PRP) and bone marrow aspirate concentrate (BMAC), have emerged as less invasive options for select patients who meet surgical criteria. However, concerns remain that orthobiologic care may delay rather than avert surgery, potentially increasing downstream utilization and costs. Comparative evidence on real world utilization and costs is limited. Methods We conducted a retrospective, observational study using linked commercial insurance claims and a national orthobiologic treatment registry. Adults with lumbar degenerative disc disease (DDD) who met criteria for lumbar fusion or laminectomy, foraminotomy, discectomy, and facetectomy (LFDF) procedures, and who received PRP injection (with or without BMAC) or surgery between 2016 and 2023 were included. Two comparisons were evaluated: PRP versus lumbar fusion and PRP versus lumbar decompression procedures. Propensity score matching was used to balance cohorts on demographic characteristics, comorbidities, spine related diagnoses, prior health care use, and severity proxies. Outcomes included spine-related health care resource use and aggregate costs at 12 and 24 months, with exploratory analyses at 36 and 48 months. Costs were estimated using multiple approaches, including Medicare based estimates and commercial payer methods. Results After matching, 133 patients receiving PRP were compared with 2,560 patients undergoing fusion, and 198 patients receiving PRP were compared with 3,960 patients undergoing LFDF. Rates of subsequent spine surgery following PRP were low and below cell suppression thresholds through 24 months, with similar findings in exploratory longer-term analyses. Compared with surgical cohorts, patients receiving PRP had lower rates of postoperative imaging, home health services, and outpatient visits, with no consistent differences in opioid use, magnetic resonance imaging, or physical therapy. At 12 and 24 months, mean aggregate costs were significantly higher for fusion and LFDF cohorts across most costing methods. Cost differences were largest for fusion comparisons and were driven primarily by index procedure costs and higher reoperation and imaging rates in surgical cohorts. Findings were generally consistent across sensitivity and exploratory analyses. Conclusions Among select patients with degenerative spine conditions who meet surgical criteria, PRP was associated with lower health care utilization and substantially lower costs compared with lumbar fusion or LFDF, without evidence of increased progression to surgery. These findings support consideration of orthobiologic options for appropriately selected patients when surgery is not the only viable treatment option. Limitations include selection bias, absence of patient reported outcomes, and claims-based severity measures.

BackgroundPrimary care practitioners are well-positioned to support people of reproductive age in preparing for pregnancy and parenthood. Such "preconception care" is ideally delivered opportunistically during routine consultations, although limited time presents a barrier. AimTo achieve consensus on priority topics for opportunistic preconception care in general practice. Design and settingA three-step consensus study involving UK-based primary care practitioners and people of reproductive age. MethodThe consensus process involved: 1) identifying potential topics through literature and guideline reviews, workshops with people of reproductive age (n=15), and interviews with primary care practitioners who work in general practice (n=14); 2) prioritising topics using a Delphi survey (n=85 participants completing round one, n=63 completing all three rounds); and 3) agreeing on priority topics during an online consensus workshop (n=21 participants). Participants were recruited through a Public Advisory Group, charities, and professional organisations. ResultsReviews and workshops/interviews with people of reproductive age and practitioners identified 37 potential topics. The Delphi survey and consensus workshop identified 16 priority topics. These were combined into four overarching topic areas for discussion during relevant consultations: O_LIPatient knowledge of preconception health and pregnancy C_LIO_LIIdeas, concerns and expectations (e.g. pregnancy intention, prior pregnancy experiences) C_LIO_LIHealth conditions (e.g. medication use, mental/physical health, immunisation) C_LIO_LIHealth behaviours (e.g. folic acid supplement use, smoking, alcohol consumption). C_LI ConclusionThe agreed priority topic areas offer a structured foundation for delivering patient-centred, opportunistic preconception care in primary care. The findings support future co-development of practical tools and resources to enable routine implementation. How this fits inPreconception care improves pregnancy outcomes, but in UK general practice it is inconsistently delivered, partly due to limited time and guidance that offers little prioritisation for opportunistic consultations. This study identifies four overarching topic areas for preconception care, based on consensus among people of reproductive age and primary care practitioners. The resulting priority list offers clinicians a practical, flexible way to initiate patient-centred preconception care discussions within routine consultations.

Background Physically Disabled women are less likely to access cervical screening than non-disabled women, yet little research has been conducted to understand the problems that Disabled women face or potential solutions. Methods A cross-sectional online survey was conducted with 1493 UK-based participants who identified as having a physical disability, impairment, condition, or difference that makes cervical screening difficult or impossible. Participants were presented with statements about cervical screening problems and potential solutions and asked to indicate agreement using a 5-point scale. They also provided open-ended comments. Data were analysed using descriptive statistics, multinomial logistic regression and thematic analysis. Results More than half of participants reported delaying/missing (46.8%) or never attending (8.8%) screening, with most of those (71.0% and 81.4% respectively) indicating that the main reason was disability-related factors. The highest levels of agreement for problems were for concerns about pain, embarrassment, and fear of what the test might find and for potential solutions were for having a doctor or nurse who is willing to try different solutions, discusses specific needs, and understands physical disability. Never-attendance (OR = 0.022, 95% CI 0.014, 0.035) and delaying or missing appointments, (OR = 0.057, 95% CI 0.043, 0.076) negatively predicted future screening attendance. Six themes were identified from open-ended comments, supporting and extending the quantitative findings. Conclusion Disabled women face the same problems related to cervical screening as non-disabled women and additionally face disability-specific problems. Cervical sample taker training should incorporate ways to support physically Disabled women to have equitable access to screening.

Background In the United Kingdom, the National Health Service is attempting to address the ongoing challenges to heath equity in underserved children and young people (CYP) by creating Neighbourhood Multi-Disciplinary Teams (NMDTs) that combine health services, social care providers, local authorities, voluntary, community and faith and social enterprise is needed. Despite this significant shift in the delivery of care, there is a lack of suitably robust evidence of family experience to inform their development. This work contributes to this need using the experience and perspectives of families using the experience and perspectives of families using an early example of an NMDT for CYP the Sparkbrook Children's Zone in Birmingham, United Kingdom. Methods The study used data collected from two focus groups conducted with parents whose children had been treated by the Sparkbrook Children's Zone. The data were analysed using a directed content analysis to populate Sekhon's Theoretical Framework of Acceptability. Results In summary and by framework domain, we found that that individuals became aware of the SCZ through a range of sources, understanding that it was multidisciplinary if sometimes unsure of precisely the organisations involved (Intervention coherence) Parents described the benefits to access of a locally situated collocated service (Burden) the personalised relationship with providers (Cultural sensitivity0 extended conultation time, and support for the family's complex clinical needs (Perceived effectiveness) Conclusions Parents appeared to prefer the SCZ over usual primary care but more work is needed with larger sample sizes to ensure that the structure of NMDTs are understood and optimised.

Introduction: Osteoarthritis (OA) is a chronic joint disease, often leading to pain, joint stiffness and impaired function. The first metatarsophalangeal (MTP-1) joint is the most frequently affected joint in foot OA. Footwear interventions might have potential to reduce pain for people with MTP-1 joint OA. The aim of this study is to determine the effectiveness and cost-effectiveness of orthopaedic modifications to off-the-shelf footwear in addition to usual care, compared to usual care alone, for people with MTP-1 joint OA. Methods and analyses: We perform a pragmatic, non-blinded, two-armed, parallel-group, randomised controlled trial (RCT). A total of 136 people with MTP-1 joint OA and presence of foot pain are recruited. Participants are randomised to orthopaedic modifications to off-the-shelf footwear in addition to usual care or to usual care alone. The footwear modifications comprise a combination of sole-stiffening, rocker sole adjustments and custom-made insoles. During a 12-month follow-up period, participants receive monthly questionnaires. Primary outcomes include walking pain at 6-month follow-up and quality-adjusted life years and societal costs at 12-month follow-up. Secondary outcomes include walking pain at 12-month follow-up and foot health, physical activity level, patient acceptability and self-reported recovery at 6- and 12-month follow-up. Intention-to-treat and per-protocol analyses will be performed using (generalised) linear mixed models. Ethics and dissemination: The study is approved by the local Medical Ethics Committee of the Erasmus MC University Medical Center Rotterdam, The Netherlands (MEC-2024-0615). Prior to study participation, participants provide informed consent. Results will be disseminated amongst researchers through peer-reviewed scientific articles and presentations at conferences; and amongst people with MTP-1 joint OA and healthcare professionals through layman articles in newsletters, on websites and on social media. Discussion: This is the first RCT to investigate the effectiveness and cost-effectiveness of orthopaedic modifications to off-the-shelf footwear in addition to usual care, compared to usual care alone for people with MTP-1 joint OA. Study findings will support healthcare professionals in making substantiated decisions in the treatment of people with MTP-1 joint OA.

Background: With an aging population and increasing comorbidities, supporting people to remain at home for as long as possible is essential. A major challenge in home care is ensuring coordinated, interprofessional collaboration among all actors involved: patients and their close ones, health and social care professionals, and the broader health and social network. To address this challenge, a new organizational model promoting reinforced interprofessional collaboration, the "Reseau Interprofessionnel Ambulatoire de Proximite" (Local Interprofessional Outpatient Network; RIAP) has recently been developed in the canton of Geneva. The aim of this paper is to present the protocol for a research project evaluating both the effectiveness and implementation of this model. Methods: This is a type-2 hybrid effectiveness implementation study guided by the RE-AIM framework, aiming to evaluate the RIAP organizational model and its implementation, context, and outcomes. This multi-method study will examine the RIAP model under real-world conditions. Routinely collected data on patient outcomes and institutional processes will be used to compare the RIAP model with usual care. Questionnaires will assess patients' perceptions of continuity of care, professionals' perceptions of interprofessional collaboration, and stakeholders' views on the acceptability of the model. Open-ended questions will be included to explore experiences and insights in greater depth, complemented by qualitative data on barriers and facilitators to implementation. Financial indicators will also be analyzed to contextualize the model within the institutional setting. Results: The EFFI-RIAP project began in October 2025 and has a planned duration of 22 months. The project will primarily rely on the reuse of institutional routine data, complemented by questionnaires and interviews scheduled for September 2026. At the time of submission, study preparation and institutional data processing are ongoing. Discussion: This research will provide insights into the clinical, organizational, and implementation-related effects of the RIAP model compared with usual care. The natural deployment of new RIAP teams will enable investigation of the organizational model under real-world conditions. The combined evaluation of the effectiveness and implementation of RIAP will assess the model's added value, inform refinement, and identify potential barriers and facilitators relevant to implementation in other teams.

ObjectiveTo investigate the long-term (defined as [&ge;]12 months) prognosis of knee pain and knee function in adults and adolescents with patellofemoral pain (PFP). DesignSystematic review with meta-analysis and meta-regressions. Data sourcesMEDLINE, OVID, CENTRAL, Web of Science, OpenGrey, and International Patellofemoral Research Retreat abstract books. Eligibility criteria for selecting studiesProspective studies of patients clinically diagnosed with PFP, aged <40 years, with a long-term follow-up (minimum of 12 months). Primary outcomes were self-reported pain intensity (worst, during activity, and usual) and function. Meta-analyses and meta-regressions were performed where appropriate. Narrative synthesis was performed for those not included in the metanalysis. Risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool, and certainty of evidence using GRADE. ResultsA total of 42 studies (n = 3,230) were included. At 12 months, meta-analysis indicated reduction in worst pain (SMD 1.36; 95% CI 0.85-1.86), pain during activity (SMD 1.36; 95% CI 0.61-2.11), and resting pain (SMD 0.91; 95% CI: 0.75- 1.08). No significant reduction was found for usual pain. We found improvement in self-reported function (investigated using the Anterior Knee Pain Scale (AKPS) MD 14.60; 95% CI 11.60-17.61), FIQ (MD 3.33; 95% CI: 2.46- 4.20) and the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) (MD -7.73; 95% CI: -10.36 to - 5.10). Extended follow-up ([&ge;]60 months) suggested more variable improvements. Meta-regression showed no association between age and 12-month function, while older age was modestly associated with greater improvement in activity-related pain at extended follow-up. Overall, a considerable proportion of participants continued to report persistent symptoms, and heterogeneity across studies was substantial. Certainty of evidence ranged from very low to moderate across outcomes investigated. ConclusionPain and self-reported function generally improve over time, particularly within the first 12 months. However, substantial heterogeneity and persistent symptoms in a considerable proportion of patients at extended follow-up indicate that recovery is not universal and trajectories are highly variable. What is already knownO_LIPatellofemoral Pain (PFP) is a very common condition in both adolescents and adults. C_LIO_LIMultiple treatments modalities exist, including patient education and exercise therapy. C_LIO_LIPeople suffering from PFP request more knowledge on the long-term prognosis. C_LI What are the new findings?O_LIThis systematic review and meta-analysis provide the most comprehensive synthesis to date of long-term outcomes ([&ge;]12 months) in adolescents and adults with patellofemoral pain. C_LIO_LIPain and self-reported knee function generally improve at the group level over time, particularly within the first 12 months. C_LIO_LIDespite group-level improvement, a substantial proportion of individuals continue to report persistent symptoms, indicating that patellofemoral pain is often not fully self-limiting. C_LIO_LILong-term outcomes are highly heterogeneous, with different pain constructs demonstrating distinct trajectories across follow-up periods. C_LIO_LIMeta-regression identified no consistent prognostic associations, suggesting that current study-level variables explain little of the variability in long-term outcomes. C_LI How might this study affect research, practice or policy?O_LIClinicians should communicate that while improvement is common in patellofemoral pain, persistent symptoms are frequent, highlighting the need for realistic prognostic expectations and long-term management strategies. C_LIO_LIFuture research should prioritise harmonised outcome measures and long-term follow-up to better understand recovery trajectories and identify subgroups at risk of persistent symptoms. C_LI

OBJECTIVES To quantify socioeconomic inequalities in antibiotic prescribing for common infections in primary care, and assess whether these inequalities arise from differences in consultation frequency, prescribing behaviour, or variation in vaccination uptake, smoking, and body mass index. DESIGN Population based cohort study. SETTING Primary care data from Clinical Practice Research Datalink, England. PARTICIPANTS 17,195,399 children and adults estimated to have been registered with a general practice in 2019. MAIN OUTCOME MEASURES Antibiotic prescribing rates (prescriptions per person-year), consultation rates (consultations per person-year), and probability of receiving an antibiotic prescription following consultation. RESULTS Higher deprivation was associated with higher antibiotic prescribing rates for most respiratory tract indications. In children, prescribing rates were 44.8% (95% confidence interval [CI] 41.9% to 47.7%) higher for upper respiratory tract infections and 47.6% (95% CI 44.2% to 51.3%) higher for lower respiratory tract infections in the most versus least deprived twentile. In adults, prescribing rates for lower respiratory tract infections were 22.7% (95% CI 21.4% to 24.1%) higher in the most deprived twentile. Prescribing rates for other indications showed weak, U-shaped, or negative associations with deprivation. Prescribing inequalities were primarily driven by inequalities in consultation rates rather than probability of receiving antibiotics once consulted. Lower influenza vaccination uptake partly accounted for higher consultation rates for respiratory infections among more deprived children, while smoking prevalence contributed to inequalities among adults. CONCLUSIONS Socioeconomic inequalities in antibiotic prescribing vary by indication type and are largely explained by consultation frequency. Reducing inequalities may require interventions that decrease the need to consult, e.g. improving influenza vaccination coverage in children and reducing smoking among adults, rather than focussing solely on prescribing behaviour.