General Practice Consultations Research Articles

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

Background 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). 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. Objectives To generate an in-depth understanding of VHGCs for chronic conditions in general practice, surface assumptions and sociotechnical dynamics, inform practice and extend theorisation. Methods 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. Conclusions 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.

Extravertebral low back pain: a scoping review

BackgroundLow back pain (LBP) is one of the most common reasons for consultation in general practice. Currently, LBP is categorised into specific and non-specific causes. However, extravertebral causes, such as abdominal aortic aneurysm or pancreatitis, are not being considered.MethodsA systematic literature search was performed across MEDLINE, Embase, and the Cochrane library, complemented by a handsearch. Studies conducted between 1 January 2001 and 31 December 2020, where LBP was the main symptom, were included.ResultsThe literature search identified 6040 studies, from which duplicates were removed, leaving 4105 studies for title and abstract screening. Subsequently, 265 publications were selected for inclusion, with an additional 197 publications identified through the handsearch. The majority of the studies were case reports and case series, predominantly originating from specialised care settings. A clear distinction between vertebral or rare causes of LBP was not always possible. A range of diseases were identified as potential extravertebral causes of LBP, encompassing gynaecological, urological, vascular, systemic, and gastrointestinal diseases. Notably, guidelines exhibited inconsistencies in addressing extravertebral causes.DiscussionPrior to this review, there has been no systematic investigation into extravertebral causes of LBP. Although these causes are rare, the absence of robust and reliable epidemiological data hinders a comprehensive understanding, as well as the lack of standardised protocols, which contributes to a lack of accurate description of indicative symptoms. While there are certain disease-specific characteristics, such as non-mechanical or cyclical LBP, and atypical accompanying symptoms like fever, abdominal pain, or leg swelling, that may suggest extravertebral causes, it is important to recognise that these features are not universally present in every patient.ConclusionThe differential diagnosis of extravertebral LBP is extensive with relatively low prevalence rates dependent on the clinical setting. Clinicians should maintain a high index of suspicion for extravertebral aetiologies, especially in patients presenting with atypical accompanying symptoms.

Health and lifestyle advice in community pharmacy for musculoskeletal conditions: a focused ethnography

Abstract Introduction Musculoskeletal health conditions are common, painful, and disabling, and often occur alongside other long-term conditions. Around a third of the UK population live with a musculoskeletal condition placing a huge burden on health and social care resources, accounting for 1 in 7 general practitioner consultations.[1] Primary care often focuses on using safe but less effective pharmacological approaches (e.g., paracetamol) despite evidence-based recommendations for self-management and lifestyle support being more effective, particularly in the context of pain management. However, access to such support is not always available or adequate. Community pharmacy is recognised for its important and well positioned setting for the delivery of public health promotion, supporting people to improve their health and live well through the Healthy Living Pharmacy Framework. Despite policy recommendations for an extended role in supporting people to self-manage long-term conditions and to adopt healthier behaviours, we currently do not know how community pharmacy manages and supports lifestyle advice in practice, particularly in relation to musculoskeletal health. Aim To gain an in-depth insight into community pharmacy daily practice in relation to the delivery of health and lifestyle advice, in order to examine community pharmacy’s current and future potential for supporting musculoskeletal health conditions. Methods An in-depth multi-site ethnographic approach was used across four community pharmacies differing in geographical and socioeconomic areas in England (April 2023 – October 2023). Data included 92 hours of observations within community pharmacies observing everyday practice and customer interactions, and 19 in-person semi-structured interviews (participants included counter assistants, dispensers, technicians and pharmacists). Results were analysed iteratively using analytic induction.[2] Results The provision of lifestyle advice was seen as awkward by staff members and problematic in consultations where advice was deemed unsolicited by customers, particularly in relation to sensitive topics such as weight or alcohol use. Pharmacists were generally more confident including lifestyle advice within appointments in the consultation room, and embedding behaviour change messages within an overall health check. Nevertheless, they lacked knowledge and training with regards to support and lifestyle advice specific for musculoskeletal health conditions. Observed over-the-counter interactions with customers were often complicated in terms of opportunities for staff to offer lifestyle advice, with encounters concerning pain relief medication at times resulting in tense and arduous consultations. Staff often found the experience of trying to offer lifestyle advice uncomfortable and challenging, leaving many feeling demotivated and lacking in confidence and as a result avoid introducing lifestyle advice into conversations. Conclusion Community pharmacy staff recognised the importance of the provision of lifestyle advice but experienced many barriers to its delivery. Increasing demands on community pharmacy with new services have implications with regards to capacity, time and skills development to effectively imbed lifestyle advice into everyday practice. Pharmacy staff may benefit from enhanced support and training to increase confidence and motivation in providing lifestyle advice, particularly relating to understanding musculoskeletal health and effective self-management strategies.

Associations between healthcare use and migration background in persons with dementia: A cohort study in the Netherlands

Background: Qualitative research shows barriers in access to healthcare for persons with a migration background, possibly leading to healthcare inequalities. We aimed to compare healthcare use between older community-dwelling persons with a migration background and native Dutch persons with dementia. Methods: Observational cohort study using electronic health records of NIVEL Primary Care Database (2013–2014) linked to nationwide administrative registries managed by Statistics Netherlands. We included all community-dwelling persons with dementia in the Netherlands aged 65 years and older. Negative binomial and logistic regression analyses were conducted to assess differences in healthcare use outcomes. The largest migrant groups (persons born in Surinam, Turkey and Morocco) were studied separately. Results: 138,864 persons with dementia were included in the study, whereof 3,991 persons with a migration background and 132,477 native Dutch persons. Moroccan-born persons showed 1.46 higher odds of having an unplanned hospital admission compared to native Dutch persons (95 % Confidence Interval [CI] 1.22–1.74). Persons with a migration background used less professional home care (Odds Ratio [OR] 0.55, 95 %CI 0.51–0.59), and received less home visits from their general practitioner (OR 0.50, 95 %CI 0.43–0.57) than native Dutch persons. Moroccan-born persons had more often an out-of-hours general practitioner consultation compared to native Dutch persons (Incidence Rate Ratio 1.36, 95 %CI 1.18–1.57). Conclusions: We found significant quantitative differences in healthcare use between persons with a migration background and native Dutch persons with dementia. Further research is needed to gain insight into the reasons of these differences, with consideration of specific migration background.

Effects of clinical interventions through a comprehensive medication management program: A retrospective study among outpatients in a private hospital

IntroductionThe intricate nature of certain diseases necessitates complex medication regimens, utilization including high-cost medications, and continual vigilance to avoid potential complications. To address these exigencies, numerous healthcare institutions have instituted multidisciplinary management teams, exemplified in pharmaceutical care through Comprehensive Medication Management (CMM) programs. These programs oversee diverse facets such as patient education, medication adherence promotion, clinical monitoring, dose adjustments, and scrutiny of prescribed drug therapies. Given the emphasized significance, it is relevant to possess evidence to continue endorsing these initiatives from management positions within health centers, and it is for this reason that this study aims to evaluate the clinical and economic benefits provided by a CMM program within a private hospital in Latin America, by analyzing the effects of clinical interventions. MethodsA retrospective examination was conducted involving documented pharmaceutical interventions in an outpatient setting from January 2019 to September 2022. To assess the interventions' repercussions, a retrospective analysis was undertaken. The collated data included patients' basic characteristics, a comprehensive pharmacist-generated description of interventions, potential associated complications, and avoided medical services. Multiple clinical projections, which were endorsed by internal medicine physicians, were developed to explore potential scenarios in the absence of pharmaceutical care. These projections were associated with conceivable complications, aligned with the most plausible circumstances. Subsequently, utilizing the average cost of healthcare within a private hospital in Latin America, the cumulative savings were quantified. These savings were then attributed to the intrinsic advantages offered by pharmaceutical care. ResultsThe study discloses demographic trends among patients within distinct age groups in the CMM program. Rheumatology predominated as the main referral source, and interventions centering on monitoring emerged as the pivotal drug-related concern. This encompassed a collaborative approach, involving interdisciplinary efforts toward patient education and critical parameter monitoring. Of the total 347 pharmaceutical interventions, 66.3% (N = 230) specialty office visits, 14.1% (N = 49) general practitioner consultations, 12.4% (N = 43) hospitalizations, and 7.2% (N = 25) ER visits were avoided. The economic analysis underscores cost savings ensuing from pharmaceutical interventions, amounting to a cumulative 603,792.82 USD. Extrapolating these findings to a patient cohort of 400 enrolled in the pharmaceutical care program approximates per-patient savings of 361.47 USD. ConclusionThis study reveals the significant clinical and economic benefits of CMM programs, led by multidisciplinary pharmaceutical professionals. The findings provide compelling evidence for hospital management to consider promoting such programs, drawing from the patient-centered care model in the United States applicable to Latin America.

Clinicopathological profile and its association with endoscopic findings in dyspeptic patients in a tertiary care hospital: A cross-sectional study

Background: The prevalence of dyspepsia in general practice consultations ranges from 4% to 5%, whereas it accounts for approximately 20–40% of consultations in the field of gastroenterology. Aims and Objectives: This study was carried out with the objective of estimating the percentage of Helicobacter pylori-infected people who havedyspepsia and exploring the relationship between infection and clinical manifestation. Materials and Methods: This was a hospital-based observational study conducted at a tertiary care teaching health-care facility from January 2023 to June 2023. All 50 patients with symptoms of dyspepsia were included in the study with the help of non-probability purposive sampling after their written and informed consent. A pre-designed and pre-tested structured pro forma was used to collect detailed history, clinical findings, and endoscopic findings from patients with dyspepsia. Gastritis and ulceration characteristics were observed by endoscopy, while histopathological examination (HPE) and rapid urease test (RUT) (for confirmation of H. pylori) were performed on endoscopy-obtained biopsy specimens. Results: Mean age of the patients was 46.69±15.78 with 65.4% (n=34) being males. The sample was classified into cases positive for H. pylori (13; 25%) and cases negative for H. pylori (39; 75%), according to the RUT outcome, 21.20% (n=11) had a history of smoking, 25% (n=13) had Type II DM, and 25% of patients presented with upper abdominal bloating and epigastric pain. On endoscopy, the majority of patients revealed grade III (n=22, 42.30%) gastritis and no ulceration (n=29, 55.80%), with the maximum showing a chronic non-specific lesion (n=20, 38.5%) on HPE. Comorbidities (χ2=12.56, P=0.028), endoscopic findings (χ2=10.50, P=0.032), and ulcerations (χ2=20.02, P<0.001) were the significant findings associated with H. pylori infection. Conclusion: The timely identification and expeditious management of H. pylori infection are imperative to mitigate the occurrence of severe complications.

Birth Spacing and Parents' Physical and Mental Health: An Analysis Using Individual and Sibling Fixed Effects.

An extensive literature has examined the relationship between birth spacing and subsequent health outcomes for parents, particularly for mothers. However, this research has drawn almost exclusively on observational research designs, and almost all studies have been limited to adjusting for observable factors that could confound the relationship between birth spacing and health outcomes. In this study, we use Norwegian register data to examine the relationship between birth spacing and the number of general practitioner consultations for mothers' and fathers' physical and mental health concerns immediately after childbirth (1-5 and 6-11 months after childbirth), in the medium term (5-6 years after childbearing), and in the long term (10-11 years after childbearing). To examine short-term health outcomes, we estimate individual fixed-effects models: we hold constant factors that could influence parents' birth spacing behavior and their health, comparing health outcomes after different births to the same parent. We apply sibling fixed effects in our analysis of medium- and long-term outcomes, holding constant mothers' and fathers' family backgrounds. The results from our analyses that do not apply individual or sibling fixed effects are consistent with much of the previous literature: shorter and longer birth intervals are associated with worse health outcomes than birth intervals of approximately 2-3 years. Estimates from individual fixed-effects models suggest that particularly short intervals have a modest negative effect on maternal mental health in the short term, with more ambiguous evidence that particularly short or long intervals might modestly influence short-, medium-, and long-term physical health outcomes. Overall, these results are consistent with small to negligible effects of birth spacing behavior on (non-pregnancy-related) parental health outcomes.

Burden of Disease and Treatment Patterns Amongst Patients With Vitiligo: Findings From a National, Longitudinal Retrospective Study in the United Kingdom.

This retrospective study, using UK Clinical Practice Research Datalink and Hospital Episode Statistics databases, analysed 17,239 incident patients with vitiligo. Mean incidence of vitiligo was 0.16 (2010-2021) per 1000 person-years (range: 0.10 [2010-COVID] to 0.19 [2013/2018]); prevalence increased from 0.21% (2010) to 0.38% (2021). The most common comorbidities recorded after vitiligo diagnosis were diabetes (19.4%), eczema (8.9%), thyroid disease (7.5%), and rheumatoid arthritis (6.9%). Mental health diagnoses recorded at any time were most commonly depression and/or anxiety (24.6%), depression (18.5%), anxiety (16.0%), and sleep disturbance (12.7%); recorded after vitiligo diagnosis in 6.4%, 4.4%, 5.5%, and 3.9%, respectively. Mental health comorbidities were more common among White patients (eg, depression and/or anxiety, 29.0%) than Black (18.8%), Asian (16.1%), and other ethnicities (21.4%). In adolescents, depression and/or anxiety was most commonly diagnosed after vitiligo diagnosis (7.4% vs before, 1.8%). Healthcare resources were used most frequently in the first year after vitiligo diagnosis (incident cohort), typically dermatology-related outpatient appointments (101.9/100 person-years) and general practitioner consultations (97.9/100 person-years). In the year after diagnosis, 60.8% of incident patients did not receive vitiligo-related treatments (ie, topical corticosteroids, topical calcineurin inhibitors, oral corticosteroids, phototherapy), increasing to 82.0% the next year; median (95% CI) time from diagnosis to first treatment was 34.0 (31.6-36.4) months. Antidepressants and/or anxiolytics were recorded for 16.7% of incident patients in the year after diagnosis. In 2019, 85.0% of prevalent patients did not receive vitiligo-related treatments; 16.6% had a record of antidepressant and/or anxiolytic treatments. Most patients were not on vitiligo-related treatments within a year of diagnosis, with time to first treatment >2 years, suggesting that vitiligo may be dismissed as unimportant and not treated early, in part due to limited effectiveness of available treatments. New effective treatments, early initiation, and psychological intervention and support are needed to reduce vitiligo burden on patients.

General practitioners’ experiences of providing somatic care for patients with severe mental illness: a qualitative study

BackgroundPatients dealing with severe mental illnesses (SMI) often face suboptimal clinical outcomes and higher mortality rates due to a range of factors, including undetected physical health conditions. The provision of care for individuals with SMI is frequently disjointed, as they engage with diverse healthcare providers. Despite this fragmentation, primary care, particularly general practitioners (GPs), assumes a pivotal role in the care of SMI patients. Our study aimed to delve into the first-hand experiences of GPs in delivering somatic care to SMI patients, concentrating on the challenges they encounter and the strategies they employ to navigate these difficulties.MethodsWe conducted in-depth interviews with fifteen GPs, utilizing a semi-structured interview guide, supplemented by ethnographic observations during clinical consultations in general practice. Through inductive coding, interview transcripts and observational field notes were systematically analysed using interpretative phenomenological analysis (IPA). The findings were then deliberated upon within the author group.ResultsGPs revealed that managing the chronic somatic care of SMI patients posed significant challenges. These challenges encompassed the multifaceted needs of patients, their behavior tied to symptoms, a lack of care continuity, and overarching time constraints. To tackle these challenges, the GPs had devised various strategies. However, all participants underscored the critical importance of having adequate time to properly prepare for, conduct, and follow up on consultations.ConclusionThe GPs’ interactions with SMI patients brought numerous challenges, although treating these patients were concurrently acknowledged as vital and fulfilling. The findings suggest that increased allocated time in general practice consultations for patients with SMI is important to support the somatic treatment requirements of this patient group.

From test to rest: evaluating socioeconomic differences along the COVID-19 care pathway in the Netherlands.

The COVID-19 pandemic exacerbated healthcare needs and caused excess mortality, especially among lower socioeconomic groups. This study describes the emergence of socioeconomic differences along the COVID-19 pathway of testing, healthcare use and mortality in the Netherlands. This retrospective observational Dutch population-based study combined individual-level registry data from June 2020 to December 2020 on personal socioeconomic characteristics, COVID-19 administered tests, test results, general practitioner (GP) consultations, hospital admissions, Intensive Care Unit (ICU) admissions and mortality. For each outcome measure, relative differences between income groups were estimated using log-link binomial regression models. Furthermore, regression models explained socioeconomic differences in COVID-19 mortality by differences in ICU/hospital admissions, test administration and test results. Among the Dutch population, the lowest income group had a lower test probability (RR = 0.61) and lower risk of testing positive (RR = 0.77) compared to the highest income group. However, among individuals with at least one administered COVID-19 test, the lowest income group had a higher risk of testing positive (RR = 1.40). The likelihood of hospital admissions and ICU admissions were higher for low income groups (RR = 2.11 and RR = 2.46, respectively). The lowest income group had an almost four times higher risk of dying from COVID-19 (RR = 3.85), which could partly be explained by a higher risk of hospitalization and ICU admission, rather than differences in test administration or result. Our findings indicated that socioeconomic differences became more pronounced at each step of the care pathway, culminating to a large gap in mortality. This underlines the need for enhancing social security and well-being policies and incorporation of health equity in pandemic preparedness plans.

Are children living with obesity more likely to experience musculoskeletal symptoms during childhood? A linked longitudinal cohort study using primary care records

ObjectiveTo assess whether there is a higher incidence of musculoskeletal consultations in general practice among children with obesity.DesignLongitudinalSetting285 north-east London general practitioners (GPs).Participants63 418 (50.9% boys) Reception and 55 364...

Physical health, primary care utilization and long-term quality of life in borderline personality disorder: A 10-year follow-up study in a Spanish sample

ObjectiveWe aimed to study physical health and primary care utilization in the long-term course of borderline personality disorder (BPD) and their impact on quality of life (QOL) in a Spanish clinical sample. MethodsThis study is part of a longitudinal study following a clinical cohort with BPD. A total of 41 participants were re-evaluated at 10-year follow-up, when current medical conditions, primary care utilization, and quality of life were assessed. Comparative population data were extracted from the Catalan Health Survey ESCA. Results68% of BPD patients reported physical health problems, and 32% informed of multiple medical illnesses at follow-up. Higher rates of musculoskeletal disorders and frequent use of general practitioner (GP) consultations were reported by BPD patients compared to the general population. Differences in physical health and use of primary care services between remitted and non-remitted BPD patients were not significant. BPD remission was independently associated with better long-term QOL. Comorbid somatic diseases worsened the long-term QOL of non-remitted BPD patients. ConclusionChronic somatic conditions are prevalent in people with BPD and interact negatively with persistent BPD pathology, worsening their QOL in the long-term. Health care strategies in the assistance of long-lasting BPD patients are recommended.

Knowledge about age-related eye diseases in the general population in Germany

BackgroundWith a rising prevalence of age-related eye diseases, prevention and early diagnosis of these conditions are key goals of public eye health. Disease-related knowledge in the general public supports these goals but there is little data available. Thus, we have assessed knowledge of cataract, glaucoma, age-related macular degeneration (AMD) and diabetic eye disease in the German adult general population in a cross-sectional study and identified target groups for health education interventions.MethodsKnowledge assessment content was identified based on a literature review, expert input, and a list of items was generated after a qualitative selection process. The resulting 16-item instrument (4 items per condition) was administered to 1,008 participants from a survey panel, demographically representative of the adult German population. Test properties were evaluated based on a Rasch model and multiple correspondence analysis (MCA). Binary-logistic regression analysis was performed to investigate associations with age, sex, education level, employment status, marital status, income, reported health status, visual difficulties, and recent general practitioner (GP) and ophthalmologist consultations.ResultsReplies were correct for a median of 9 out of 16 (range 2 – 16) items, which differed between conditions (p < 0.0001). Most responses were correct for cataract items (median: 3 / 4) and least were correct for AMD items (median: 2 / 4). 27%, 9%, 1% and 19% of respondents replied correctly to all cataract, glaucoma, AMD and diabetic eye disease-related items, respectively. Rasch analysis suggested an adequate targeting of items and in MCA, no evidence of multidimensionality was present. Older age, being retired, decreased general health and recent GP or ophthalmology consultations were significantly associated with more knowledge about common eye conditions (p ≤ 0.005). GP or ophthalmology consultations remained significant in a multivariable model (p ≤ 0.011).ConclusionsKnowledge gaps regarding eye health are considerable in the German general population and should therefore be addressed in educational interventions targeting the public. Special attention when designing such campaigns needs to be paid to infrequent users of the healthcare system. Knowledge of AMD seems to be poorer compared to other eye conditions.

What makes a good general practice consultation: an exploratory pilot study with people from a low socioeconomic background

BackgroundWhilst patients from low socioeconomic (SES) backgrounds are at increased risk of developing chronic health conditions, typically managed within general practice, they report less positive consultation experiences with general practitioners (GP). To our knowledge, existing research does not provide an in-depth understanding of GP conducts contribute to positive consultations.AimTo identify the factors that patients from low SES backgrounds perceive as essential for creating good consultation experiences.Design &amp; settingThis qualitative research was performed in Melbourne GP clinics.MethodWe used an appreciative inquiry approach, focused on positive consultation experiences, previously shown to be helpful for researching sensitive topics. Nine patients with low SES backgrounds who reported positive consultation experiences, undertook a semi-structured qualitative interview whilst watching the video-recording of their GP consultation. Four different GPs were captured in the recordings. Inductive thematic coding was performed by two researchers.ResultsFour categories were developed relating to: (1) the doctor’s demeanour and the patient’s feelings, (2) the therapeutic relationship, (3) the doctor’s therapeutic skill set and (4) communication techniques. In each interview, the discussion about the video-recorded consultation often triggered reflections about previous consultations with the respective GP.ConclusionFor patients from low SES groups, positive consultation experiences were underpinned by perceived continuity of care with a specific GP who consistently showed good communication skills and key interpersonal characteristics. This research is a small step towards increasing our understanding of the experience of individuals with low SES backgrounds in primary care and the existing health inequities within this.

Musculoskeletal pain in 13-year-old children: the generation R study.

Musculoskeletal (MSK) pain is a common reason for consultation in general practice and frequently reported in children and adolescents. This study examined the prevalence of MSK pain in 13-year-old children and assessed associations with physical and psychosocial factors. Data from the Generation R Study, a population-based birth cohort, was used. Prevalence and characteristics of MSK pain were assessed, using a pain mannequin, at 13 years of age (N = 3062). Demographics and data on physical activity, sedentary behaviors, previous reported MSK pain, and behavioral problems were extracted from questionnaires. The body mass index (BMI) SD-score was calculated from objectively measured weight and height. A prevalence of 23.3% was found for MSK pain in children of which 87.2% persisted for more than 3 months (ie, chronic), 45.5% experienced pain daily. More physically active children and children with a higher BMI reported MSK pain more frequently compared with non-MSK pain and no pain. The knee was the most often reported location. Children with MSK pain were more likely to have reported MSK pain at 6 years. Multivariable analyses showed significant associations for male sex (OR 0.74, 95% CI 0.56-0.98), high maternal educational (OR 0.69, 95% CI 0.49-0.96), higher BMI (OR 1.19, 95% CI 1.05-1.35), being physically active (OR 1.41, 95% CI 1.03-1.91), and behavioral problems (OR 1.85, 95% CI 1.33-2.59) with the presence of MSK pain. The chronic nature of MSK pain in combination with the relatively high prevalence of MSK pain in this study shows that MSK pain is already an important problem at a young age.

General practitioner consultations for mental health reasons prior to and following bereavement by suicide.

Prior research has shown that the majority of those bereaved by suicide express a need for mental health care services. However, there is a lack of knowledge about these individuals' use of primary health care. The objective of our study was to estimate the association between suicide bereavement and general practitioner (GP) consultations for mental health reasons. A population-wide, register-based cohort study identifying 25,580 individuals bereaved by suicide. Estimations of increases in consultation rate were modeled through individual fixed-effects linear analyses adjusted for age and time-period. Overall, 35% of those bereaved by suicide had a GP consultation for mental health reasons during the first 1-2months, and 53% after two years. In the month immediately after bereavement by suicide, there was a large increase in the consultation rate with a GP for mental health reasons. In the months that followed, the consultation rate gradually decreased. One year after bereavement, the consultation rate stabilized at a somewhat higher level than before the death. The increase in consultation rate was evident across all kinship groups, and the increase was greatest for partners and smallest for siblings. Women had more contact with the GP before the suicide and a greater increase in contact than men. Our findings suggest that many of those bereaved by suicide seek assistance from primary health care, and that some are in need of prolonged follow-up from the GP. Health governments should be aware of this and seek to strengthen the GPs knowledge of the needs and challenges associated with this patient group. Measures should also be taken to remove barriers to contact the health care system, especially for men and bereaved siblings.

Patterns of psychotropic drug prescriptions and general practice consultations among community-dwelling older people with dementia during the first two years of the COVID-19 pandemic

BackgroundThe COVID-19 pandemic and subsequent lockdown measures had serious implications for community-dwelling older people with dementia. While the short-term impacts of the pandemic on this population have been well studied, there is limited research on its long-term impacts. Quantifying the long-term impacts may provide insights into whether healthcare adaptations are needed after the acute phase of the pandemic to balance infection prevention measures with healthcare provision. This study aims to examine patterns of psychotropic drug prescriptions and general practice consultations in community-dwelling older people with dementia during the first two years of the pandemic.MethodsWe utilised routine electronic health records from three Dutch academic general practice research networks located in the North, East, and South, between 2019 and 2021. We (1) compared the weekly prescription rates of five groups of psychotropic drugs and two groups of tracer drugs, and weekly general practice consultation rates per 1000 participants, between the first two years of the pandemic and the pre-pandemic phase, (2) calculated changes in these rates during three lockdowns and two relaxation phases relative to the corresponding weeks in 2019, and (3) employed interrupted time series analyses for the prescription rates. Analyses were performed for each region separately.ResultsThe study population sizes in the North, East, and South between 2019 and 2021 were 1726 to 1916, 93 to 117, and 904 to 960, respectively. Data from the East was excluded from the statistical analyses due to the limited sample size. During the first two years of the pandemic, the prescription rates of psychotropic drugs were either lower or similar to those in the pre-pandemic phase, with differences varying from -2.6‰ to -10.2‰. In contrast, consultation rates during the pandemic were higher than in the pre-pandemic phase, increasing by around 38‰.ConclusionsThis study demonstrates a decrease in psychotropic drug prescriptions, but an increase in general practice consultations among community-dwelling older people with dementia during the first two years of the pandemic. However, reasons for the decrease in psychotropic drug prescriptions are unclear due to limited information on the presence of neuropsychiatric symptoms and the appropriateness of prescribing.

Adverse respiratory outcomes among patients with resolved asthma: matched retrospective cohort study.

Patients with asthma may have symptom remission leading to a primary care code of resolved asthma. Little is known about subsequent rates of exacerbations and respiratory tract infections (RTIs). To assess the risk of adverse respiratory outcomes for people with resolved asthma compared with those with active asthma and without asthma. This was a retrospective cohort study of patients aged >5 years, registered with a general practice in England contributing data to the Clinical Practice Research Datalink between January 2010 and December 2019. Patients with resolved asthma were matched to non-asthma controls and active asthma controls for age, sex, and practice. Negative binomial regression was used to estimate incidence rate ratios (IRRs) with 95% confidence intervals (CIs) for asthma exacerbations, RTIs, flu/pneumonia, and antibiotic prescriptions. Cohorts included 16 023 patients (8720 (54.4%) females, mean age 37 years). Compared with the active asthma cohort, the resolved cohort had fewer hospital admissions (adjusted IRR 0.29, 95% CI = 0.27 to 0.32) and general practice consultations (adjusted IRR 0.05, 95% CI = 0.04 to 0.07) for asthma exacerbations. The resolved and non-asthma cohorts had similar rates of hospital admissions for RTIs or flu/pneumonia. However, the resolved cohort had significantly greater incidence of general practice consultations for lower RTIs (adjusted IRR 2.34, 95% CI = 2.08 to 2.64) and antibiotic prescriptions (adjusted IRR 1.37, 95% CI = 1.30 to 1.44). Patients with resolved asthma had greater risk of general practice RTI and antibiotic prescription than the general population and may benefit from defined strategies for reassessing symptoms and reinitiating asthma therapy.

Video consultation in general practice during COVID-19: a register-based study in Denmark.

During the COVID-19 pandemic, general practices in Denmark rapidly introduced video consultations (VCs) to prevent viral transmission. To study the use of VCs in daytime general practice by describing the rate of VCs, and the patient characteristics associated with having VCs. Register-based study of consultations in daytime general practice in Denmark. We included all consultations in daytime general practice from 1 January 2019-30 November 2021. We calculated the rate of video use and categorised the general practices into no, low, and high use. Logistic regression was used to calculate adjusted odds ratios (aOR) for having a VC for different patient characteristics when contacting a video-using practice, stratified for low- and high-using practices. A total of 30 148 478 eligible consultations were conducted during the pandemic period. VCs were used mostly during the early stage pandemic period, declining to about 2% of all clinic consultations in the late-stage period. Patients having more VCs were young, had a long education, were employed, and lived in big cities. In low-using practices, native Danes and 'western' immigrants had higher odds of receiving a VC than 'non-western' immigrants, and patients with ≥2 comorbidities had lower odds than those without comorbidities. Patients of a younger age, with long education, or employment had higher odds of receiving a VC, while patients of an older age and patients who had retired had lower odds. This difference in the access to VCs warrants further attention.

My time, your time, our time. Older patients’ and GPs’ time sensibilities around email consultations

ABSTRACT In this study, we discuss how email consultations in general practice operate as a temporal technology, transforming working conditions and power relations between general practitioners (GPs) and patients. We draw on empirical material from Denmark in the form of a set of semi-structured interviews with 53 patients and 15 GPs, including two focus group discussions with 17 GPs. Our theoretical point of departure stems primarily from media theorist Sarah Sharma’s (2014) concept of power-chronography, which describes how power is embedded in temporal relations and everyday life and secondarily from sociologist, Judy Wajcman’s (2015) concept of multiple temporal landscapes. Patients and GPs calibrate their own time and attune their mutual time according to their expectations and ideas about the other party’s time. The patient and the GP can both be viewed as ‘time workers’ and the email consultation as a digital technology fostering the recalibration of one person’s time to that of another, requiring significant labour. The email consultation rearranges the GP-patient boundaries and thereby the power relations. Health institutions ought to consider whose time and labour is being ‘saved’ with digital systems.