British Journal of General Practice

BackgroundGP practices in Scotland are changing with the emergence of megapractices. We aimed to update analyses of GP practice sizes in Scotland, and to begin the development of a typology of GP practices. MethodsFour methods were employed: 1. Analyses of routinely published data on GP practice sizes and listed GPs to identify and quantify megapractices; 2. Qualitative interviews; 3. Creation of commercial profiles; 4. Derivation of a GP practice typology. ResultsMost Scottish practices have ...

BackgroundCommunication issues across the primary-secondary care interface are considered one of the most important challenges in improving patient safety in primary care in the UK. Teleconferencing offers a potential means of improving communication during referrals but is largely unevaluated. AimTo explore teleconferencing as an alternative to written Advice and Guidance (A&G) referrals for neurology cases, by assessing its impact on GP-specialist communication and relationships, and explorin...

ObjectiveTo assess contemporary UK population-level trends in second-line glucose-lowering therapy initiation and explore treatment outcome trends across age and frailty groups in people with type 2 diabetes (T2D). MethodsWe studied 117,064 adults with T2D who initiated major second-line glucose-lowering drug classes after metformin between 2019-2024 in population-representative UK data (Clinical Practice Research Datalink). Outcomes were assessed in three groups: age [≤]70 years (n=84,589 [...

AbstractRising urgent care use, avoidable hospital deaths, and missed end-of-life (EOL) registration reflect poor care at this critical phase of life. These are known to be avoidable by earlier identification and EOL registration for effective care planning. Current identification tools are generally non-digital. PRADA, a digital system, uses prediction methodologies for early identification of individuals, escalated to clinicians in active decision support, to promote clinical assessment, the c...

Background.Only one in five people with hypertension have their blood pressure (BP) controlled (<140/90 mmHg). Patient education improves BP control, yet there is limited guidance to adapt to individuals evolving needs across the hypertension management journey. This study aimed to identify key behavioural barriers and enablers to patient education throughout the hypertension management journey, which were synthesised into patient personas to support translation and practical application. Metho...

BackgroundDementia affects over 57 million people worldwide. UK and international policy position personalised, conversation-based care planning as central to post-diagnostic support. However, delivery in primary care is inconsistent, and many practitioners lack dementia-specific communication training. Existing evidence focuses on single roles or settings, leaving a gap in understanding how communication operates across the primary care workforce. AimsTo identify what helps and hinders effecti...

BackgroundDuring the COVID-19 pandemic, Ontario implemented a self-triage tool that assessed risk and directed users to care. Screening for entry to workplaces and schools was provincially mandated, allowing for adaptation to specific needs, often implemented with digital symptom checkers. Thus, self-assessment tools that looked similar, may have varied in purpose, and possibly in assessment criteria. ObjectiveThis study asks: what can we learn from family medicine providers experiences with, a...

QuestionDo advanced practice physiotherapists succeed in conducting shared decision-making (SDM)? DesignA prospective cross-sectional observational study of patients with musculoskeletal pain and their perceptions of SDM measured using the CollaboRATE instrument. Written feedback was collected after consultation to gain understanding of patients experiences of their consultations. ParticipantsChronic pain patients (n = 5123) diagnosed with either upper limb (n = 1230, 24%), lower limb ((n = 30...

BackgroundChronic kidney disease (CKD) affects approximately 10% of adults in England. <1% progress to end stage-kidney disease (ESKD), significantly impacting health-related quality of life with high healthcare costs. CKD is associated with cardiovascular disease risk. New therapies to improve outcomes highlight the need for effective risk stratification. AimTo explore primary care teams views and experiences of CKD risk stratification. Design and SettingQualitative interview and focus group ...

Artificial intelligence (AI) is dramatically changing the healthcare landscape by providing patients, clinicians, administrators, and public health professionals with tools aiming to improve efficiency, outcomes, and experience in health. As elsewhere, New York State (NYS) experiences high demand for - and high investment in - transformation in healthcare with AI tools, though little is known about clinicians use and interest in adopting AI tools in their work. A large share of the nations futur...

Smoking Cessation Efforts for Patients with Asthma and COPD IntroductionSmoking cessation can alter the natural history of both COPD and asthma by reducing the frequency and severity of exacerbations and slowing disease progression. Accordingly, the Global Initiative for Asthma and the Global Initiative for Chronic Obstructive Lung Disease recommend that clinicians address smoking cessation at every visit using counseling and pharmacotherapy. MethodsThe Mount Sinai Health System includes seven...

BackgroundRecurrent sore throat affects a small minority of adults but can cause substantial morbidity. Evidence to guide tonsillectomy eligibility in adults is limited, and current criteria are extrapolated from paediatric populations. We aimed to describe the epidemiology, management, and prognosis of adult sore throat in UK primary care. MethodsUsing CPRD Aurum (2010-2020 adults with a first coded episode of sore throat or tonsillitis were identified and matched to controls. Episode frequenc...

BackgroundApproximately 1 in 5 Canadians experience a mental health illness in any given year. While most individuals can be successfully treated within a primary care setting, a subset of individuals present with a severity and complexity requiring specialist care. Unfortunately, a shortage of psychiatrists (especially in rural regions) can result in wait times of months to years. MethodsWe designed the Alberta Network for Community Health Outreach and Rural Mental Health. ANCHOR-MH is a 12-we...

ObjectivesArtificial intelligence (AI)-enabled digital stethoscopes combine phonocardiography and electrocardiography to support detection of cardiac rhythm and structural abnormalities. This study evaluated the feasibility and exploratory diagnostic performance of AI-guided cardiac auscultation during routine general practice consultations and home visits. MethodsIn this prospective feasibility study, 50 consecutive patients aged [&ge;]65 years underwent AI-assisted auscultation using the Eko ...

ObjectiveMore people than ever before are living with cancer. Patient education is a core component of cancer care, and patients are increasingly using large language models (LLMs), such as ChatGPT, for advice. The objectives of this study were to evaluate the ability of ChatGPT to explain specialist cancer care records (multidisciplinary team (MDT) meeting reports) to patients and to understand key stakeholders views and opinions about the technology. MethodsSix simulated MDT meeting reports w...

ObjectiveTo explore how younger and older adults in the UK experience, manage, and seek treatment for long COVID-related cognitive impairments, and to identify their treatment preferences and expectations. DesignQualitative study using Charmazs (2014) constructivist grounded theory methodology. SettingOnline, semi-structured interviews conducted with UK adults reporting long COVID-related cognitive symptoms, recruited via patient support groups and research panels. ParticipantsTwenty-one adul...

ObjectivesThe cancer diagnostic process may be more complicated for patients with a learning disability ("intellectual disability" outside of the UK) than for other patients. We aimed to investigate whether patients with a learning disability were more likely to experience disadvantage in cancer diagnostic pathways and outcomes. DesignA retrospective cohort study using routinely collected linked data across primary and secondary care, and cancer registration. Setting1470 general practices in E...

BackgroundHypertension guidelines recommend the use of automated BP devices over manual devices to reduce observer bias, such as terminal digit preference. We aimed to evaluate systematic differences in BP readings and the association with incident stroke according to type of measurement. MethodsUsing de-identified electronic health record data from Optum Labs Data Warehouse from primary care visits in 2024, we classified providers BP measurement method using proportion of odd terminal digit pr...

An understated disruption to health services brought about by the Covid-19 pandemic was the increase in deaths occurring outside a hospital. Since quality of end-of-life care is typically monitored through place of death and hospital activity, a new approach focused on care in community settings is needed. In this study, we aimed to test whether patient-centric measures of quality at the end of life can be derived from primary care electronic records. With the approval of NHS England, analysis ...

BackgroundPlatelet count and C-reactive protein (CRP) are blood tests commonly used in primary care as part of diagnostic work up for symptomatic patients. Abnormal results of these tests can indicate an undetected cancer; however, it is not known whether the association between an abnormal test result and cancer risk varies by patient ethnicity. MethodsThis cohort study used routinely collected primary and secondary health care records in England with linkage to national cancer registry data. ...