General Practice Consultations Research Articles

Clinical outcomes following acute sore throat assessment at community pharmacy versus general practice: a retrospective, longitudinal, data linkage study.

To date, no research has compared longer-term outcomes (antibiotic provision; re-consultations; hospital admissions for quinsy; cost-effectiveness) following presentation with acute sore throat at general practice (GP) versus newer, pharmacy-led services. A retrospective, longitudinal cohort study of sore throat consultations between 1 November 2018 and 28 February 2020 either with the Wales pharmacy-led sore throat test and treat (STTT) service or with a healthcare professional at GP. Individual-level pharmacy consultation data from the national Choose Pharmacy IT application were securely uploaded to the Secure Anonymised Information Linkage Databank and linked to routinely collected, anonymized, population-scale, individual-level, anonymized health and administrative data. Of 72 736 index consultations, 6495 (8.9%) were with STTT and 66 241 (91.1%) with GP. Antibiotic provision at the index consultation was 1382 (21%) with STTT and 25 506 (39%) with GP [adjusted odds ratio (AOR), 0.30; 95% CI, 0.27 to 0.32]. Antibiotic provision within 28 days of index occurred in 1820 (28%) STTT and 26 369 (40%) GP consultations (AOR, 0.44; 95% CI, 0.41 to 0.47). GP re-consultation rate within 28 days of index date was 21% (n = 1389) with STTT compared with 7.4% (n = 4916) with GP (AOR, 3.8; 95% CI, 3.5 to 4.1). Coding limitations may lead to overestimates of GP re-consultations rates in the STTT group. Hospital admissions for quinsy were rare in both STTT (n = 20, 0.31%) and GP (n = 274, 0.41%) (AOR, 0.68; 95% CI, 0.43 to 1.1). STTT was less costly than consultation with GP. The pharmacy-led STTT service is safe, cost-effective, and contributes to antimicrobial stewardship.

Translating primary care to telehealth: analysis of in-person paediatric consultations and role of the carers.

The usage of telehealth in general practice (GP) has risen substantially ever since the COVID-19 pandemic. Over this timeframe, telehealth has provided care for all patient demographics, including the paediatric population (aged<18). However, the translatability of telehealth (ie, whether in-person tasks can be supported remotely via telehealth) rarely considers the paediatric population or their carers. To examine the degree of translatability to telehealth for in-person GP consultations on paediatric patients with consideration of the carers' roles. This study screened 281 videos of in-person GP consultations set within UK general practices, and 20 of them were eligible for analysis. Secondary analysis of in-person GP consultations to examine tasks, physical artefacts, examinations and the interaction between carer, patient and GP. A novel scoring method revolving around two key metrics, taking into consideration the carer, was designed to analyse whether the tasks performed can be supported via telehealth. Analysis of 20 eligible consultations revealed 13 distinct physical examinations, 19 physical artefacts and 17 clinical tasks. Of these 17 clinical tasks, 41% were deemed 'definitely or easily translatable to telehealth,' ' 29% 'somewhat translatable with patient-provided equipment,' 12% 'potentially translatable,' and 18% 'currently untranslatable.' The average telehealth translatability score was 6.1/10, which suggests possible challenges with telehealth support. Regarding carer involvement, 90% of consultations involved collecting patient history, 70% placation of child, and 40% had physical support during examinations. Tasks performed during paediatric in-person GP consultations may not be easily translatable to telehealth and caution should be exercised when considering its translatability to telehealth.

Inadequate health literacy and higher healthcare utilisation among older adults in Switzerland: cross-sectional evidence from a population-based study.

Population ageing in Switzerland poses significant challenges, including for the healthcare system. Inadequate health literacy can hinder individuals' ability to seek appropriate treatments and navigate the healthcare system efficiently. This study explores the associations between health literacy and the number of consultations with general practitioners and healthcare specialists in a population-based sample of adults aged 58+ in Switzerland. We used data from 1424 older adults who participated in Wave 8 (2020) of the Survey of Health, Ageing, and Retirement in Europe (SHARE). The analysis focuses on two outcomes: the reported number of consultations with (1) general practitioners or (2) healthcare specialists in the year prior to the interview. Health literacy, i.e. the ability to find, understand, assess and apply health information, is measured using the short version of the European Health Literacy Survey questionnaire (HLS-EU-Q16). The final health literacy score ranged from 0 to 16 and was categorised into three health literacy levels: inadequate (0-8), problematic (9-12) and sufficient (13-16). Bivariate analyses were conducted using Kruskal-Wallis tests. Partial associations were examined using multivariate generalised Poisson regression models controlling for key sociodemographic, regional and health-related variables. Overall, 68.5% of the respondents were classified as having sufficient health literacy, while the health literacy level of 23.5% and 7.9% of respondents was classified as problematic or inadequate, respectively. The median number of general practitioner consultations and specialist visits was 2 and 1, respectively, both with an interquartile range of 1. Lower levels of health literacy were statistically significantly associated (p = 0.0011) with a higher number of general practitioner consultations in the year prior to the interview. By contrast, we did not find any significant association between health literacy and the number of specialist consultations. This study finds that lower health literacy is associated with higher healthcare utilisation for older adults in Switzerland. The findings may suggest that general practitioners could have a significant role as advisors for individuals with low levels of health literacy, while a similar pattern is not observed for specialists. This discrepancy might be attributed, at least in part, to the role of general practitioners as intermediaries between patients and specialised care providers. Ensuring accessibility to general practitioners, particularly for individuals with low health literacy, could prove to be a beneficial strategy in addressing the healthcare requirements of this particularly vulnerable patient group. Additionally, improving health literacy in the population may provide further health benefits and lead to resource savings.

Sources and content of advice sought by parents/guardians prior to emergency department attendance.

To describe sources of advice and the recommendations given to parents/guardians prior to attending ED with their child. This was a prospective observational study of patients presenting to two EDs of a multi-centre Victorian Health service in June 2016. Data collection involved surveying all parents/guardians attending paediatric ED during a 1-week period by trained research assistants. We determined the proportion of eligible respondents who sought advice before attending ED, the source of advice, and the type of advice provided. One thousand sixty-nine patients presented to ED over the 1-week period. There were 730 responses to the survey, of which 65% (477/730) had received a total of 620 recommendations prior to ED attendance. Seventy-six per cent (362/477) had received advice from a single source, 19% (90/477) had received advice from 2 sources, and 5% (25/477) from 3 or more sources. The most common sources of advice were general practice consultations (49%), friends/family (13.5%), and NURSE-ON-CALL (11%). Fifty-four per cent (335/620) of the recommendations were to attend ED immediately and 12% (77/620) were to attend if their child was getting worse. Most parents and guardians sought advice from a single source prior to attending an ED. The most common source of advice was consultation with a general practitioner and the most common recommendation was to attend ED immediately, or if their child's condition worsened.

Health symptoms and cosmetic silicone breast implants: A retrospective cohort study

BackgroundThere has been a growing concern about a possible causal relationship between silicone breast implants (SBIs) and health symptoms, often referred to as Breast Implant Illness. This study assessed the association between SBIs for cosmetic augmentation and health symptoms. MethodsRetrospective cohort study using data linkage with the Dutch Breast Implant Registry and Nivel Primary Care Database. A total of 688 women with cosmetic SBIs were age-matched with 1301 women without SBIs. The occurrence of thirteen health symptoms presented in general practice was assessed one year before implantation until three years after implantation. Comparisons were made regarding the number of symptoms and general practice consultations, both before and after implantation, and between the two groups. ResultsWomen with SBIs were more likely to experience three or more distinct health symptoms and a combination of multiple symptoms with multiple consultations during follow-up than women without SBIs (adjusted OR 1.44, 95% CI 1.06 to 1.96; adjusted OR 1.44, 95% CI 1.04 to 2.00, respectively). Women with SBIs also had a more than twice greater likelihood of these outcomes in the second year after implantation compared to one year before implantation (OR 2.13, 95% CI 1.27 to 3.57; OR 2.13, 95% CI 1.22 to 3.72, respectively). ConclusionsWomen with cosmetic SBIs had increased odds of health symptoms after implantation compared to before and to women without SBIs. These results suggest an association between health symptoms and cosmetic SBIs that needs further research to explore whether there is causality or residual confounding.

Determining the role of remote consultations in general surgical practice in Scotland: a qualitative questionnaire-based study

INTRODUCTION Telemedicine consultations became widespread during the COVID-19 pandemic to deliver healthcare while minimising viral transmission. Research around establishing the role of remote appointments in general surgery outpatient clinics after the pandemic has not been undertaken. The aim of this study was to investigate views on remote consultations to determine this. METHODS Patients attending the adult general surgical outpatient clinic at Aberdeen Royal Infirmary between August 2021 and January 2022 as well as general surgeons from three neighbouring hospitals were invited to complete an anonymous questionnaire on the acceptability of remote and face-to-face (F2F) appointments in pre and postoperative scenarios. Differences in patients’ preferences between demographic groups, and between patients’ and surgeons’ views were analysed. RESULTS A total of 51 patients and 26 surgeons responded. Patients’ views differed depending on demographic parameters and the scenario. Patients and surgeons had similar views on preoperative consultations. Given the choice of telephone, video or F2F appointments, the F2F option was overall most popular. Patients and surgeons differed in their views on remote consultations following surgery and acute admissions. In some scenarios, young patients, those who lived in remote regions and those in employment/education preferred remote appointments. CONCLUSIONS While telemedicine is feasible and acceptable in general surgery clinics, there are differences in preferences between surgeons and patients. Patients’ preferences varied depending on their background, home circumstances and clinical context. Service provision should ensure that when remote consultations are available, patient preference is prioritised rather than surgeon ease.

The impact of the COVID-19 pandemic on antibiotic prescription rates in out-of-hours primary care – a register-based study in Denmark

Background Antibiotic prescription rates can be affected by pandemic measures such as lockdowns, social distancing, and remote consultations in general practice. Therefore, such emergency states may negatively affect antimicrobial stewardship, specifically in out-of-hours (OOH) primary care. As contact patterns changed in the COVID-19 pandemic, it would be relevant to explore the impact on antimicrobial stewardship. Aim To study the impact of the pandemic on antibiotic prescription rates in OOH primary care, overall and per age group. Methods This cross-sectional register-based study used routine data from OOH primary care in the Central Denmark Region. We included all patient contacts in two equivalent time periods: pre-pandemic and pandemic period. The main outcome measure was defined as the number of antibiotic prescriptions per contact (antibiotic prescription rate). Results The overall antibiotic prescription rate decreased during the first year of the pandemic compared to the pre-pandemic period (RR = 0.97, 95%CI: 0.96–0.98). Likewise, the rate decreased for clinic consultations (RR = 0.63, 95%CI: 0.62–0.64). However, an increase was seen for telephone consultations (RR = 1.73, 95%CI: 1.70–1.76). The decline in clinic consultations was largest for consultations involving children aged 0–10 years (RR = 0.53, 95%CI: 0.51–0.56). Conclusion Antibiotic prescription rates in Danish OOH primary care decreased during the first year of the COVID-19 pandemic, especially for young children. Prescription rates decreased in clinic consultations, whereas the rates increased in telephone consultations. Further research should explore if antibiotic prescription rates have returned to pre-pandemic levels, and if the introduction of video consultations has affected antibiotic prescription patterns in OOH primary care.

Care trajectories for musculoskeletal disorders following a new episode of low back pain

Abstract This study explored diverse care trajectories (CTs) for low back pain (LBP) and other musculoskeletal disorders (MSDs), over a 5-year period following a first episode of LBP. Based on Quebec's administrative health data from 2007 to 2011, this longitudinal cohort study involved 12,608 adults seeking health care for LBP. Using a new multidimensional state sequence analysis, we identified 6 distinct types of CTs. The most prevalent types 1, 2, and 3 (comprising 79.2%, 18.0%, and 21.7% of the cohort, respectively) exhibit rapid recovery and similar patterns of healthcare use over 5 years but differing in initial diagnoses: nonspecific LBP in type 1, trauma-related LBP in type 2 (mostly younger men and highest initial emergency consultation), and specific LBP in type 3. Types 4 to 6, representing smaller groups, show high healthcare utilization with comparable mixed LBP diagnoses at entry but distinctive subsequent care use patterns. Patients in types 4 and 6 (mainly older age groups and women) sought care for other MSDs from general practitioners or specialists, while middle-aged patients in type 5 experienced persistent nonspecific LBP with frequent general practitioner consultations over 5 years. The CTs typology revealed several key areas for improvement in nonpharmacological interventions, including the need to address possible inappropriate medical imaging and invasive interventions for older women with MSDs and the lack of ambulatory care access for younger patients with trauma-related LBP. Finally, results clearly highlighted poor access to rehabilitation physicians and rehabilitation services for all patients suffering from LBP and MSDs.

Reducing strain on primary healthcare systems through innovative models of care: the impact of direct access physiotherapy for musculoskeletal conditions—an interrupted time series analysis

ObjectivesTo evaluate the longitudinal impact of introducing a national, direct access physiotherapy model of care on the rates of primary and secondary care consultations for musculoskeletal (MSK) conditions.DesignInterrupted time series...

The Use of Online Consultation Systems or Remote Consulting in England Characterized Through the Primary Care Health Records of 53 Million People in the OpenSAFELY Platform: Retrospective Cohort Study.

The National Health Service (NHS) Long Term Plan, published in 2019, committed to ensuring that every patient in England has the right to digital-first primary care by 2023-2024. The COVID-19 pandemic and infection prevention and control measures accelerated work by the NHS to enable and stimulate the use of online consultation (OC) systems across all practices for improved access to primary care. We aimed to explore general practice coding activity associated with the use of OC systems in terms of trends, COVID-19 effect, variation, and quality. With the approval of NHS England, the OpenSAFELY platform was used to query and analyze the in situ electronic health records of suppliers The Phoenix Partnership (TPP) and Egton Medical Information Systems, covering >53 million patients in >6400 practices, mainly in 2019-2020. Systematized Medical Nomenclature for Medicine-Clinical Terminology (SNOMED-CT) codes relevant to OC systems and written OCs were identified including eConsultation. Events were described by volumes and population rates, practice coverage, and trends before and after the COVID-19 pandemic. Variation was characterized among practices, by sociodemographics, and by clinical history of long-term conditions. Overall, 3,550,762 relevant coding events were found in practices using TPP, with the code eConsultation detected in 84.56% (2157/2551) of practices. Activity related to digital forms of interaction increased rapidly from March 2020, the onset of the pandemic; namely, in the second half of 2020, >9 monthly eConsultation coding events per 1000 registered population were registered compared to <1 a year prior. However, we found large variations among regions and practices: December 2020 saw the median practice have 0.9 coded instances per 1000 population compared to at least 36 for the highest decile of practices. On sociodemographics, the TPP cohort with OC instances, when compared (univariate analysis) to the cohort with general practitioner consultations, was more predominantly female (661,235/1,087,919, 60.78% vs 9,172,833/17,166,765, 53.43%), aged 18 to 40 years (349,162/1,080,589, 32.31% vs 4,295,711/17,000,942, 25.27%), White (730,389/1,087,919, 67.14% vs 10,887,858/17,166,765, 63.42%), and less deprived (167,889/1,068,887, 15.71% vs 3,376,403/16,867,074, 20.02%). Looking at the eConsultation code through multivariate analysis, it was more commonly recorded among patients with a history of asthma (adjusted odds ratio [aOR] 1.131, 95% CI 1.124-1.137), depression (aOR 1.144, 95% CI 1.138-1.151), or atrial fibrillation (aOR 1.119, 95% CI 1.099-1.139) when compared to other patients with general practitioner consultations, adjusted for long-term conditions, age, and gender. We successfully queried general practice coding activity relevant to the use of OC systems, showing increased adoption and key areas of variation during the pandemic at both sociodemographic and clinical levels. The work can be expanded to support monitoring of coding quality and underlying activity. This study suggests that large-scale impact evaluation studies can be implemented within the OpenSAFELY platform, namely looking at patient outcomes.

Evaluating video and hybrid group consultations in general practice: mixed-methods, participatory study protocol (TOGETHER 2).

General practice is facing an unprecedented challenge in managing the consequences of the pandemic. In the midst of a policy drive to balance remote and in-person service provision, substantial workload pressures remain, together with increasing prevalence of long-term conditions, and declining staff numbers and morale. To address these challenges, some practices in the UK have been delivering video and hybrid group consultations (VHGCs) providing clinical care to multiple patients at the same time. Despite positive initial findings and enthusiasm, there are still gaps in our understanding of the influence VHGCs have on patient experience, healthcare utilisation, quality, safety, equity and affordability. To generate an in-depth understanding of VHGCs for chronic conditions in general practice, surface assumptions and sociotechnical dynamics, inform practice and extend theorisation. Mixed-methods, multi-site research study using co-design and participatory methods, from qualitative, quantitative and cost-related perspectives. WP1 includes a national, cross-sectional survey on VHGC provision across the UK. In WP2 we will engage patients and general practice staff in co-design workshops to develop VHGC models with emphasis on digital inclusion and equity. In WP3 we will carry out a mixed-methods process evaluation in up to 10 GP practices across England (5 sites already running VHGCs and 5 comparison sites). Qualitative methods will include interviews, focus groups and ethnographic observation to examine the experiences of patients, carers, clinical and non-clinical NHS staff, commissioners and policy-makers. Quantitative methods will examine the impact of VHGCs on healthcare utilisation in primary and secondary care, patient satisfaction, engagement and activation. We will also assess value for money of group and individual care models from a health economics perspective. We aim to develop transferable learning on sociotechnical change in healthcare delivery, using VHGCs as an exemplar of technology-supported innovation. Findings will also inform the design of a future study.

What physical examinations are observed during an in-person GP consultation? Automatic extraction using a text-based approach

ObjectivesTeleconsultation is anticipated to have a long-term role in primary care. However, conducting virtual physical examinations is a well-known limitation. To anticipate unmet needs general practitioners (GPs) and patients may experience during teleconsultation, this study aims to automatically identify physical examinations typically conducted during in-person GP consultation. Material and MethodsThis study utilizes 281 GP in-person consultations (de-identified transcripts & video recordings) within UK general practices, where 169 eligible ones were included in this study. We propose an automated text-based approach using regular expressions on keywords in GP-patient consultation dialogue (e.g., “roll up your sleeves”) to identify physical examinations (e.g. blood pressure measurement). This approach involves the construction of conceptual diagrams to visually inspect the relationship between keywords and physical examinations, syntax analysis to identify patterns between keywords and generate regular expressions, and the use of these regular expressions in consultation transcripts to detect potential instances of physical examinations, where matching video frames were subsequently retrieved. The performance of our automated text-based approach is compared to manual classification by 2 independent researchers using 5-fold cross-validation (precision, recall, and F1-score). ResultsAmong the 169 eligible GP in-person consultations, 133 (79%) required a physical examination, while the other 33 visits were for psychological reasons. Out of these 133 consultations, a total of 283 physical examinations were observed, with 21 instances conducted behind a curtain. We identified 42 distinct types of physical examinations from these 283 instances, grouped into 10 physical examination categories based on body areas and physical artefacts. The most frequent category of physical examinations is Vital Signs 26.80% (76/283). Overall, blood pressure measurement (also belonging to the Vital Signs category) is the most frequent physical examination at 59.2% (45/76). The comparison between manual classification and the regular expression model demonstrates an average precision of 88.3%, recall of 78.9%, and an F1-score of 83.3% from 5-fold cross-validation, providing significant insights into the frequency and types of physical examinations conducted during in-person GP consultations. ConclusionBy using regular expressions in consultation dialogues between GPs and patients, we can automatically identify physical examinations in GP consultations with a precision of 88.3%. Findings from this study, i.e. physical examinations during in-person GP consultations, provide insights into areas where GPs and patients may need support during teleconsultation.

Communication during telemedicine consultations in general practice: perspectives from general practitioners and their patients

BackgroundTelemedicine allows delivery of healthcare to occur between parties that are not in the same location. As telemedicine users are not co-present, effective communication methods are crucial to the delivery and reception of information. The aim of this study was to explore perspectives of general practitioners (GPs) and patients on the interactional components of telemedicine consultations.MethodsSemi-structured qualitative interviews were held with telemedicine users; 15 GPs and nine patients self-selected from a larger telemedicine study. Participants were asked about their preparation for telemedicine consultations, conducting telemedicine consultations and post-consultation activities. Deidentified transcripts from the interviews were analysed thematically.ResultsGPs and patients discussed factors they used to decide whether a consultation would be best conducted by telemedicine or in-person; the condition to be discussed, the existing doctor-patient relationship and whether physical examination was required. Participants also described how they prepared for their telemedicine consultations, gathering relevant documents, and reading previous notes. Participants described strategies they employed to optimise the telemedicine interaction; improving conversational flow and building rapport, as well as difficulties they experienced when trying to provide and receive care via telemedicine.ConclusionsPatient factors including health literacy and familiarity with technology affect the transfer of information shared during telemedicine consultations and consideration of these factors when choosing patients for telemedicine is required. Many GPs and patients have innate communication skills to effectively deliver and receive care through telemedicine. However, they may not be aware of these subconscious techniques to use to optimise telemedicine consultations. Communication training could be delivered to increase conversational flow, build rapport, and establish safety netting.

P187 CO-DESIGNING AN INTERVENTION FOR CARDIOVASCULAR DISEASE RISK ASSESSMENT AND MANAGEMENT AFTER HYPERTENSIVE DISORDERS OF PREGNANCY

Background and objective: Women with a history of hypertensive disorders of pregnancy (HDP) are at two-to-fourfold increased risk of developing cardiovascular disease (CVD) within 10 years post-pregnancy. Despite clinical practice guidelines recommending general practitioners (GPs) for ongoing CVD preventative care, no intervention strategies exist within primary care aimed at improving risk assessment or management for women after HDP. This study aimed to co-design an intervention to enhance the implementation of CVD risk assessment and management following HDP for primary care settings in Australia. Methods: Researchers used the Integrated Knowledge Translation (IKT) framework and conducted five co-design meetings with the investigative team and end-users. Meetings were informed by the Behaviour Change Wheel (BCW) framework for intervention development and incorporated research findings from a systematic review and meta-analysis, surveys, and an online discussion. Data from activities and audio recordings following each meeting were analysed iteratively to inform ongoing intervention development. Results: The 18 end-users included women with lived HDP experience (n=8), obstetricians (n=2), midwives (n=5), and GPs (n=3). The target priorities were to improve communication between hospital staff and GPs following HDP occurrence and increase knowledge of GPs and women regarding CVD prevention post-HDP. Part 1 of the intervention is delivered within the hospital setting via physical resources to address communication gaps between hospital and primary care providers for women after post-HDP. Part 2 is delivered via an update to existing GP education platforms and resources for use within GP consultations to provide education for women and GPs on CVD prevention post-HDP. Conclusions: The IKT and BCW frameworks played a crucial role in development of a tailored intervention aimed at bridging gaps in current primary care practice and enhancing implementation of CVD risk assessment and management for women following HDP. This an important step in addressing CVD risk in women of childbearing age.

71 - Weight management discussion in real-world general practice consultations: A qualitative analysis in Australian primary care

71 - Weight management discussion in real-world general practice consultations: A qualitative analysis in Australian primary care

1593P Factors associated with multiple general practitioner consultations before cancer diagnosis in adolescents and young adults: A cohort study in Australia

1593P Factors associated with multiple general practitioner consultations before cancer diagnosis in adolescents and young adults: A cohort study in Australia

Factors associated with patients’ experience of accessibility to general practice: results from a national survey in Norway

BackgroundThis study aimed to explore the influence of patient-, general practitioners (GP)-, and GP practice-level predictor variables on patient-experienced accessibility to GPs and GP practices. Additionally, we aimed to enhance our understanding of patient-experienced accessibility by analysing the free-text comments from patients who reported lowest accessibility scores to GPs and GP practices.MethodsWe performed a secondary analysis of data from a 2021-2022 national Norwegian survey on patient experiences with their GP and GP practice. We identified seven accessibility-related items including experience and acceptance of regular waiting time and for urgent appointments, time spent with the GP, waiting time in the wating-room, and getting in touch with the GP practice by telephone. A composite accessibility score was computed. Predictor variables consisted of patient’s self-reported characteristics, as well as background data about the GP and GP practice from National GP registry. The analysis included multiple linear regression of the composite accessibility score and seven accessibility items. Finally, a qualitative analysis was conducted of free-text survey comments among patients that had a score of 0 (unfavourable) on all the seven accessibility items.ResultsThe key factor for patient-experienced accessibility to general practice was seeing their own GP, showing a statistically significant positive correlation (p<0.001) across all seven accessibility items and the composite accessibility score in regression analyses. Other associations with positive experience included better self-reported health, and at the GP-level, a specialization in general medicine. Conversely, a negative experience was associated with longer time since the last GP consultation, female patients, and a higher number of GPs at the practice. Qualitative data confirmed accessibility challenges, detailing quantitative scores and highlighted that low accessibility scores were related to difficulties in seeing one’s own GP.ConclusionsThis study highlights the importance of continuity between patient and their GP in improving patients’ experiences of accessibility to general practice. Several GP and GP practice-level factors were related to patient-reported accessibility. These results can be used to inform initiatives aimed at improving accessibility to general practice.

Translating in-person care to telehealth: analysis of GP consultations on musculoskeletal conditions.

The COVID-19 pandemic led to a rapid transition to telehealth particularly in general practice (GP) where continuous care for chronic conditions such as musculoskeletal (MSK) is provided. To determine the appropriateness of telehealth for MSK by identifying whether in-person tasks can be supported remotely via telehealth. This study is a secondary analysis of the HaRI dataset. This dataset comprises of 281 videos of recorded GP consultations. The data set includes 10 general practitioners, across 8 separate clinics and was collected during 2017 in the United Kingdom. Content analysis was conducted to identify the clinical tasks, physical examinations and physical artefacts used during the consultations. A scoring method applying two key metrics was developed to assess the translatability of clinical tasks to telehealth. Across the 31 MSK consultations analysed, 12 clinical tasks, five physical examinations and 12 physical artefacts were observed. Of clinical tasks, 17% (2/12) were deemed to be 'easily translatable over telehealth' and 50% (5/12) were deemed 'relatively easy to be translated over telehealth'. Only 17% (2/12) of tasks were rated 'moderately translatable over telehealth', and 17% (2/12) were deemed 'potentially translatable over telehealth'. No clinical tasks in this study were categorised as untranslatable to telehealth. The average telehealth translatability score was 7.1/10. Most clinical tasks observed during in-person GP consultations with MSK patients are translatable to telehealth. Further research is necessary to investigate the long-term efficacy and safety of telehealth utilisation for MSK in primary care.

Discussions about physical activity in general practice: analysis of video-recorded consultations.

Background Clinical guidance recommends promotion of physical activity during general practice consultations. The frequency and content of physical activity discussions in UK general practice are poorly understood. Aim To explore the content of physical activity discussions during routine consultations between patients and general practitioners (GPs). Design and setting Secondary analysis of video-recorded UK general practice consultations from the One in a Million study. Methods We screened 294 consultation transcripts, identifying consultations that included or omitted physical activity advice when recommended by National Institute for Health and Care Excellence (NICE) guidance. We coded the content, quality and depth of advice provided by GPs. Results Physical activity was relevant to management according to clinical guidance in 175/294 (59.5%) consultations. In 64/175 (36.6%) of these consultations physical activity was discussed as part of clinical management and the depth of discussion was judged as 'meaningful' in 22 (12.6%). Whilst physical activity advice tended to be given most often for musculoskeletal problems, depth of advice did not appear to be related to the presenting problem. When physical activity advice was relevant and omitted, consultations prioritised another overriding presenting problem, or clinical management focussed on another intervention. Conclusion Physical activity advice, following national guidance, was potentially relevant to over half of GP consultations; GPs were able to deliver advice of varying depth in a third of these consultations. Future work should explore ways of delivering physical activity advice effectively, efficiently and equitably within the constraints of general practice. Keywords Physical activity; general practice; video recording.

Annual incidence of general practice consultations related, according to the general practitioner, to bed bugs and description of cases, 2019-2020, France.

Bed bug infestations have been increasing worldwide since the 2000s. Their consequences for health range from skin reactions to major psychological distress. However, epidemiological data is still lacking. This study estimated the incidence of general practice consultations related to bed bugs in France and evaluated factors associated with repercussions on everyday life. We conducted a prospective observational study from March 2019 to April 2020 among 217 GPs in France. Annual and monthly GP consultations related to bed bugs were estimated from the reported cases. Descriptive analyses were performed, and factors associated with repercussions on everyday life were assessed using a logistic regression model. The annual incidence rate of GP consultations related to bed bugs was estimated at 109 per 100,000 inhabitants [95%CI: 92-126]. Bed bug-related consultations occurred in all regions, peaking in the summer. Moderate-to-severe repercussions on everyday life were reported by 39% of the patients. The associated factors with this level of repercussions were: having seen bed bugs (OR = 4.02 [95%CI: 1.6-10.73]), having lesions from scratching (OR = 5.25 [1.65-19.92]), having lesions on the head and the neck (OR = 3.97 [1.52-10.95]) and reporting psychological distress (OR = 6.79 [2.47-20.42]). This study provides new knowledge on GP consultations related to bed bugs in France. These data will help tailor public health programs to the population's needs, including information and training for primary healthcare professionals.