GP Practices Research Articles

HOME BLOOD PRESSURE TELEMONITORING IN THE NETHERLANDS: A PILOT STUDY IN GENERAL PRACTICES

Objective: Home Blood Pressure Telemonitoring (HBPT) has been proposed to improve blood pressure (BP) control, and efficient care delivery in patients with hypertension. Its adoption in GP practices however remains low. In this pilot study we evaluated barriers and facilitators for successful implementation, patient satisfaction, clinical effectiveness, and efficiency for a HBPT project in Dutch GP practices by means of the Quadruple Aim Model. Design and method: GP practices included patients with hypertension that were part of their regular cardiovascular disease program. The hospital would initially support the HBPT program followed by a period in which the GP practices were primarily responsible for the telemonitoring (figure 1, procedures A and B). We conducted semi-structured interviews at 3- and 6-months (figure 2) to identify barriers and facilitators for successful implementation. Patient satisfaction was measured with Telehealth Usability (TUQ) - and MHealth App Usability (MAUQ) Questionnaires. A Systolic Blood Pressure Intervention Trial (SPRINT) -protocol BP measurement was performed after the pilot project to assess clinical effectiveness. Efficiency data were collected on the number of registered consultations during the 6-month project. Results: Three GP practices included 19 patients. Barriers for implementation (table 1) were a lack of a reimbursement structure, lack of information technology system integration and increased experienced workload when using HBPT. Facilitators (table 1) included the positive effects on BP control, increased sense of safety for patient and care provider, and increased disease-insight. Median satisfaction scores for TUQ and MAUQ questionnaires (scale 1-7) were 6 (IQR 5-6) and 6 (IQR 5-7). At baseline, 16% of the patients had a BP <140/90 mmHg. Based on the performed SPRINT measurements, 68% had a well-controlled BP (<140/90 mmHg) after 6 months. Average BP improved from 151/89 mmHg to 132/81 mmHg (p=0.0004). On average, one monthly contact moment related to hypertension between patient and GP practice was registered. Conclusions: We found positive results following the introduction of HBPT in GP practices on clinical outcomes and patients’ satisfaction, however for large-scale implementation improvements with regards to organizational efficiency and a clear reimbursement structure are needed.

Evaluating palliative care case conferences in primary care for patients with advanced non-malignant chronic conditions: a cluster-randomised controlled trial (KOPAL).

Patients with congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD) and dementia are underrepresented in specialist palliative home care (SPHC). However, the complexity of their conditions requires collaboration between general practitioners (GPs) and SPHC teams and timely integration into SPHC to effectively meet their needs. To facilitate joint palliative care planning and the timely transfer of patients with advanced chronic non-malignant conditions to SPHC. A two-arm, unblinded, cluster-randomised controlled trial. 49 GP practices in northern Germany were randomised using web-based block randomisation. We included patients with advanced CHF, COPD and/or dementia. The KOPAL intervention consisted of a SPHC nurse-patient consultation followed by an interprofessional telephone case conference between SPHC team and GP. The primary outcome was the number of hospital admissions 48weeks after baseline. Secondary analyses examined the effects on health-related quality of life and self-rated health status, as measured by the EuroQol 5D scale. A total of 172 patients were included in the analyses. 80.4% of GP practices had worked with SHPC before, most of them exclusively for cancer patients. At baseline, patients reported a mean EQ-VAS of 48.4, a mean quality of life index (EQ-5D-5L) of 0.63 and an average of 0.80 hospital admissions in the previous year. The intervention did not significantly reduce hospital admissions (incidence rate ratio = 0.79, 95%CI: [0.49, 1.26], P= 0.31) or the number of days spent in hospital (incidence rate ratio = 0.65, 95%CI: [0.28, 1.49], P= 0.29). There was also no significant effect on quality of life (∆ = -0.02, 95%CI: [-0.09, 0.05], P= 0.53) or self-rated health (∆ = -2.48, 95%CI: [-9.95, 4.99], P= 0.51). The study did not show the hypothesised effect on hospitalisations and health-related quality of life. Future research should focus on refining this approach, with particular emphasis on optimising the timing of case conferences and implementing discussed changes to treatment plans, to improve collaboration between GPs and SPHC teams.

WHITE-COAT EFFECT AND MASKED HYPERTENSION IN HIGH-NORMAL OFFICE BLOOD PRESSURE: RESULTS OF THE HUNGARIAN ABPM REGISTRY

Objective: White-coat hypertension refers to the untreated condition in which BP is elevated in the office but is normal when measured by ambulatory blood pressure monitoring (ABPM), home blood pressure monitoring (HBPM) or both. However, white-coat effect can be present in high-normal blood pressure (BP) category as well. The aims of this study were to evaluate the presence of white-coat effect and masked hypertension in high-normal office BP (OBP) and also to explore the prevalence of untreated very high CV risk (CVD) patients with high-normal OBP. Design and method: Data of the Hungarian ABPM Registry were used in our analysis. Results: From 14 817 uploaded ABPM curves with clinical data 1 255 subjects were categorized as having high-normal OBP. 999 (79.6%) were on antihypertensive treatment. Based on the ABPM recordings apparent high-normal BP was found in 35.9% (n=450), white-coat effect was present in 28.5% (n=358) and masked hypertension was diagnosed in 35.6% (n=447). Similar results were found in treated and untreated subjects as well. Independent predictors of white-coat effect were age (OR: 1.014 (95%CI:1.006-1.023), p=0.001), male sex (OR: 0.565 (0.432-0.739), p<0.001), and obesity (OR: 1.994 (1.480-2.687), p<0.001). Independent predictors of masked hypertension were age (OR: 1.014 (95%CI:1.005-1.023), p=0.003), heart rate (OR: 1.028 (1.011-1.044), p=0.01) and obesity (OR:1.679 (1.262-2.234), p<0.001). 142 subjects had very high CV risk with high-normal OBP and only 7 of them were untreated. With ABPM only one of them had apparent high-normal BP. Conclusions: In high-normal OBP ABPM is a useful tool to diagnose white-coat effect and masked hypertension. Untreated high-normal OBP with very high CV risk is a very rare condition in the general practitioner practice when ABPM is also recommended to evaluate the true blood pressure phenotype before therapeutic decisions.

The CARE (CArdiovasculaR prEvention) Score - an instrument for recording the quality of care of cardiovascular risk patients in the GP practice

There is potential for improvement in the care of cardiovascular diseases in Switzerland, particularly when it comes to achieving target values defined in guidelines. Adherence scores such as the SGED score for diabetic care established in Switzerland can help to reduce the evidence-performance gap. The CARE score presented here is an adherence score that validly reflects the quality of care for patients with a cardiovascular risk using process and outcome indicators.

Opportunistic atrial fibrillation screening in primary care in Ireland: results of a pilot screening programme

BackgroundAtrial fibrillation (AF), a common, frequently asymptomatic cardiac arrhythmia, is a major risk factor for stroke. Identification of AF enables effective preventive treatment to be offered, potentially reducing stroke risk...

Delayed antibiotic prescribing in primary care in Cornwall

Delayed antibiotic prescribing in primary care can be a useful strategy to help manage patient expectations and reduce antibiotic consumption. This project surveyed GP practices in Cornwall and Isles of Scilly Integrated Care System to identify current approaches to the use of delayed antibiotic prescriptions, as well as the incentives and barriers to implementation.

Review of lidocaine plaster prescribing and monitoring in primary care

Abstract Introduction Lidocaine medicated plasters (LMPs) are accepted by the Scottish Medicines Consortium (SMC) for restricted use in post-herpetic neuralgia where first-line therapies are ineffective or intolerable.[1] Subsequently, LMPs are restricted for use in post-herpetic neuralgia within a large NHS board with Ralvo as formulary brand due to cost-effectiveness. Despite this, the spend on LMPs is increasing with the cost per 1000 list size above the national average.[2] Aim To review and improve LMP prescribing and monitoring in a general practice. Methods An audit within a GP practice was undertaken by conducting an EMIS search to extract all patients prescribed LMPs within the previous 6 months from December 2022. A baseline audit was completed to determine compliance against the criteria (standards set as 100%), shown in Table 1. Data were analysed using Microsoft Excel. In the interest of improving audit results, a pharmacist then conducted telephone reviews with a view to stopping LMP if appropriate, reducing prescription quantities and/or switching to Ralvo. Post review, criteria were re-audited to determine the impact. Following this, an education session was conducted. Results The results against the standards are shown in Table 1. The LMP reviews resulted in: therapy stopped (n=2; 8%), therapy reduced (n=7; 26%), therapy continued (n=11; 40%), and therapy removed from repeat (n=7; 26%). Reductions were achieved by reducing the number of patches, cutting patches or increasing the patch-free interval. Some patients continued therapy despite off-license indication due to a significant reduction in pain score and benefit in physical function. Following the audit and review of LMP, an informal general practitioner education session was conducted to promote adherence to formulary and SMC recommendations, aiming to prevent LMP initiation for off-license indications. Impact was not studied. Conclusion There is a lack of compliance with SMC and formulary recommendations with all patients in this study being prescribed LMPs for off-licensed indications. Pharmacy involvement in regular reviews could ensure patients are prescribed the most cost-effective brand and ongoing treatment appropriateness assessed, particularly for off-license indications. The study was implemented in one general practice; therefore, there is scope for extrapolation across the National Health Service board with aims to reduce LMP prescription costs and medication burden. Further work is also required to achieve a change in prescribing habits.

Introducing a new national tool to monitor the carbon footprint of inhalers

Abstract Introduction The Welsh Government launched its National Health Service (NHS) Wales decarbonisation strategic delivery plan in March 2021.[1] The plan includes a number of actions related to the carbon footprint of inhalers. The National Prescribing Support Unit was requested to provide data for the carbon footprint of inhalers, and develop an analysis tool to measure progress in reducing the carbon footprint and movement towards the all Wales target of 20,000 carbon dioxide (CO2) tonnes per annum. Aim To introduce a new tool for monitoring the carbon footprint of inhalers used in Wales. Methods The data requirements for the tool were determined using a nominal group technique. A literature search was conducted to identify any available sources of inhaler carbon footprint values that would be used to inform the required analyses. A collaborative approach with specialist groups was adopted to develop and pilot the dashboard. Results The nominal group technique identified the essential minimal dataset required. These were data relating to quantity, cost, and carbon footprint of the inhalers prescribed. Data for quantity and cost of inhalers used were already available to the unit. A literature search revealed a reliable source of inhaler carbon footprint values for developing the initial dashboard, and any updating required as additional inhalers are presented within the dataset.[2] Through the collaborative approach with specialist groups, a dashboard was developed and piloted with selected individuals within Wales. Feedback was then attained and actioned upon where appropriate, before the dashboard was made readily available to all NHS Wales employees. Conclusion The new monitoring tool went live in January 2022 and provides data on inhaler quantity, spend and carbon footprint at an all Wales, Health Board, cluster and GP practice level. This enables reporting at a national and organisational level, as well as lower down to specific geographies. Ongoing work involves the addition of new inhalers, refreshing with the most recent data, and updating the background carbon footprint values held within the tool. These are instigated on an issuing of changes in the supporting reference data values.[2] The availability of a tool to report on the carbon footprint of inhalers used within Wales provides a consistent data source to support the strategic delivery plan targets. A strength of this work has been to deliver a meaningful tool in support of this aim. Whilst a limitation is that we do not know the exact impact of the tool in making the change happen, we are aware that the tool is used on a regular basis by stakeholders.

Hospital initiation of opioids and long-term prescribing among older adults in primary care - a cohort study

Abstract Introduction The upwards trend in opioid prescribing poses concern for older adults given risks associated with prolonged opioid use.[1] With patients 65 years or older being predominantly prescribed stronger opioids, minimising duration of therapy is important to reduce falls, fracture and hospitalisation risk.[2] Studies assessing the associations between initial prescription attributes and duration of opioid use have yet to be conducted in an Irish setting. Aim This study aims to assess long-term opioid prescribing in opioid-naive patients initiated on opioid therapy in hospital, and patient and discharge prescription factors associated with long-term opioid prescribing. Methods This retrospective cohort study included approximately 40,000 patients aged ≥65 years from 44 GP practices during 2012-2018 in Ireland. Using GP record and hospital discharge data, individuals initiating an opioid at hospital discharge who were opioid naive (no opioid prescription in the previous 365 days) were identified. The primary analysis excluded cancer-related hospitalisations based on ICD-10 classification. Among non-cancer-related hospitalisations, Cox regression analysis assessed associations between patient and discharge prescription factors (opioid drug, duration, tapering instructions, as needed use specified) with the duration of opioid continuation post-discharge. Results Overall, 975 non-cancer-related opioid-naive patients were initiated on opioids at discharge (48.4% male, mean age 77.9 years). Of the 975 patients, 141 (14.5%) were prescribed 2 opioids and 10 (1.0%) were prescribed 3 opioids. Forty-one percent (n=403) continued opioid therapy following discharge, and 8.2% (n=80) were continually prescribed for >365 days. Of those who discontinued therapy within 365 days, the mean time to discontinuation was 106 days. Initial prescription factors including morphine (HR 0.43, 95%CI 0.23-0.80); duration ≥14 days (HR 0.58, 95%CI 0.39-0.86); and no duration stated (HR 0.46, 95%CI 0.32-0.66) (Figure 1) had statistically significant associations with long-term opioid therapy among those with non-cancer hospitalisations, adjusting for other factors. Conclusion Opioid type and initial prescription characteristics such as duration were associated with longer duration of use. Although limited by lack of information on the specific indication for opioid use, this study is the first in the Irish setting to evaluate the prescribing factors which may be modified to reduce their contribution to prolonged opioid therapy post-discharge.

The relationship between prescription rates of oral corticosteroids for respiratory diseases and deprivation in England

Respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD), are common in England with the worst respiratory outcomes observed in the most deprived areas. There is limited published research to establish whether the rate of oral corticosteroid (OCS) prescribing for asthma and COPD is linked to levels of deprivation. This study carried out a multivariable regression analysis of publicly available data and found that deprivation is associated with a statistically significant increase in the proportion of patients receiving an OCS prescription for asthma or COPD at a GP practice level (p < 0.001). The model estimated that the proportion of prescriptions is 1.88% (95% CI 1.83% to 1.92%) and 2.84% (95% CI 2.70% to 2.98%) for the least deprived GP practice and the most deprived GP practice, respectively. This study lays the groundwork for future research using individual patient level data to consider the impact of variation in OCS prescribing rates.

Ethnic inequities in 6-8 week baby check coverage in England 2006- 2021: a cohort study using the Clinical Practice Research Datalink.

Inequities in the coverage of 6-8-week maternal checks, health visitor reviews, and infant vaccinations have been reported in England. Ethnic inequities in 6-8-week baby checks have not been studied nationally. To examine the effect of maternal ethnicity on 6-8 week baby check coverage in England 2006-2021. This cohort study used electronic health records from primary care in England. Baby check coverage was calculated in 16 ethnic groups, by year and region. Risk ratios were estimated using modified Poisson regression. Coverage and timing of baby checks in relation to maternal checks and infant vaccinations by ethnic group were calculated. Ethnic inequities in 6-8 week baby check coverage in England varied by year and region. Coverage increased 2006-2007 to 2015-2016, then stabilised to 80-90% for most groups. Coverage was lowest for Bangladeshi and Pakistani groups 2006-2007 to 2011-2012. In the West Midlands, coverage was lowest at approximately 60% for four groups: Bangladeshi, Caribbean, African, and Any other Black, African or Caribbean background. In the North West, coverage was lowest for Bangladeshi (65.3%) and Pakistani (69.2%) groups. These patterns remained after adjusting for other factors and persisted over time. Coverage was highest in those whose mothers received a maternal check and those who received at least one dose of 8-week infant vaccinations. Coordinated action at the level of integrated commissioning boards, primary care networks, and GP practices is required to better understand the reasons behind these inequities and redress the persistent disparities in 6-8 week baby check coverage.

A movement for movement: an exploratory study of primary healthcare professionals' perspectives on implementing the Royal College of General Practitioners' active practice charter initiative.

Regular physical activity (PA) results in extensive physical, psychological, and social benefits. Despite primary care being a key point of influence for PA behaviours in the UK, research indicates poor application of PA interventions in this context. To address this, the Royal College of General Practitioners' (RCGP) developed and implemented the Active Practice Charter (APC). The aim of the study was to evaluate the perceived impact and acceptability of the APC initiative from the perspective of primary healthcare professionals (PHPs). An online exploratory cross-sectional survey was designed to assess the perceived impact, experiences, and challenges of the APC initiative, from the perspective of PHPs. The survey was distributed by the RCGP via email to 184 registered APC practices across the UK. Responses were reviewed from staff (n = 33) from 21 APC practices. Initiatives used by APC practices included: educational programmes, partnerships with PA providers, referral systems, and infrastructure investment. Perceived benefits included: increased awareness about PA, staff cohesion, and improved well-being. However, staff felt the APC had limited effect due to implementation barriers, including: a lack of engagement, time, resources, and funding. This is the first evaluation of any nationwide UK-based initiative engaging GP practices in promoting PA. Acknowledging the limitations in response rate, although support exists for the RCGP APC, the evaluation highlights challenges to its implementation. Nonetheless, the wide reach of the RCGP, combined with the cited staff and patient benefits, demonstrates the significant potential of the APC initiative. Given the need to address physical inactivity nationally, further development the APC offers a possible solution, with further research required to overcome the challenges to implementation.

Frequency of office blood pressure measurements and the seasonal variability of blood pressure: results of the Hungarian Hypertension Registry

Purpose Hypertension is a major public health problem, thus, its timely and appropriate diagnosis and management are crucial for reducing cardiovascular morbidity and mortality. The aim of the new Hungarian Hypertension Registry is to evaluate the blood pressure measurement practices of general practitioners (GPs), internists and cardiologists in outpatient clinics, as well as to assess the seasonal variability of blood pressure. Materials and methods Omron M3 IT devices were used during four-month periods between October 2018 and April 2023 in GP practices and in hypertension clinics. The blood pressure data were then transmitted online from the monitors’ cuffs to a central database using the Medistance system of Omron. Results Family physicians (n = 2491), and internists/cardiologists (n = 477) participated in the study. A total of 4804 821 blood pressure measurements were taken during 10 four-month evaluation periods. In the ten periods, the daily average number of measurements was between 3.0 and 5.6. Following ESH diagnostic criteria, the proportion of subjects in optimal, normal and high-normal blood pressure categories were 14, 13.4 and 16.7%, respectively. Altogether 56% of the measurements belonged to stage 1, stage 2 or stage 3 hypertension categories (31.6, 17.1 and 7.4%, respectively). On average, a difference of 5/2 mmHg was observed between winter and summer data in systolic and diastolic blood pressures, respectively. The average systolic blood pressure values were higher in GP practices with more than 2000 patients than in the ones with less than 1500 patients (141.86 mmHg versus 140.02 mmHg, p < 0.05). Conclusion In conclusion, the low daily average number of blood pressure measurements indicates a limited blood pressure screening awareness/capacity in the case of Hungarian family physicians. In GP practices with more patients, blood pressure is usually less well-controlled. These results suggest that the further promotion of home blood pressure monitoring is necessary.

Home blood pressure telemonitoring in the Netherlands: a pilot study in GP practices

BackgroundHome Blood Pressure Telemonitoring (HBPT) has been proposed to improve drug adherence, blood pressure control, and efficient care delivery in patients with hypertension. Its adoption in GP practices however remains low. In this pilot study we evaluated barriers and facilitators for successful implementation, patient satisfaction, clinical effectiveness, and efficiency for a HBPT project in Dutch GP practices by means of the Quadruple Aim Model.MethodsGP practices included patients with hypertension that were part of their regular cardiovascular disease program. We conducted semi-structured interviews at 3- and 6-months to identify barriers and facilitators for successful implementation. Patient satisfaction was measured with Telehealth Usability (TUQ)—and Mhealth App Usability (MAUQ) Questionnaires. A SPRINT-protocol blood pressure measurement was performed after the pilot project to assess clinical effectiveness. Efficiency data were collected on the number of registered consultations and practice measurements performed during the 6-month project.ResultsThree GP practices included 19 patients. Barriers for implementation were a lack of a reimbursement structure, lack of information technology (IT) system integration and increased experienced workload when using HBPT. Facilitators included the positive effects on blood pressure control, increased sense of safety for patient and care provider, and increased disease-insight. Median satisfaction scores for TUQ and MAUQ questionnaires (scale 1–7) were 6 (IQR 5–6) and 6 (IQR 5–7). At baseline, 16% of the patients had a blood pressure < 140/90 mmHg. Based on the performed SPRINT measurements, 68% had a well-controlled blood pressure (< 140/90 mmHg) after 6 months. Average blood pressure improved from 151/89 mmHg to 132/81 mmHg (p = < 0.05). On average, one monthly contact moment related to hypertension between patient and GP practice was registered.ConclusionsWe found positive results following the introduction of HBPT in GP practices on clinical outcomes and patients’ satisfaction, however for large-scale implementation improvements with regards to organizational efficiency and a clear reimbursement structure are needed.

InspeCKD - Analysis of the use of diagnostics in patients at high risk for chronic kidney disease in German general practitioner (GP) practices

Despite the high prevalence of chronic kidney disease (CKD) in Germany, only a small proportion of patients are currently diagnosed with CKD. Patients with hypertension, diabetes mellitus, and/or cardiovascular disease have a significantly increased risk of developing CKD and rapid disease progression and should therefore be screened and monitored in accordance with the guidelines. The aim of this retrospective, cross-sectional study was to gain insights into appropriate diagnosis of patients at risk for CKD in German general practitioner practices. For the analysis of the use of CKD-relevant diagnostics, electronic patient records from German general practitioner practices were analyzed. Adults with hypertension and/or diabetes mellitus and/or cardiovascular disease with a documented observation period of at least one year were included in the study. Data from a total of 448,837 patients from 1244 general practitioner practices were analyzed. 75.8% of patients had hypertension, 35.1% had cardiovascular disease, and 32.4% had diabetes mellitus. During a mean observation period of 1.7 years, serum creatinine was assessed at least once in 45.5% of patients. A urine dipstick test for albuminuria was performed in 7.9% of patients and in 0.4% of patients, urine albumin-to-creatine ratio (UACR) was measured. Laboratory diagnostics were initiated a little more frequently in high-risk patients compared to the overall cohort. The study highlights that despite known risk factors, guideline compliant CKD screening is rarely performed in German general practitioner practices, which implicates the need to increase the awareness of early diagnosis of CKD in patients at risk.

Participatory development of an mHealth intervention delivered in general practice to increase physical activity and reduce sedentary behaviour of patients with prediabetes and type 2 diabetes (ENERGISED)

BackgroundThe escalating global prevalence of type 2 diabetes and prediabetes presents a major public health challenge. Physical activity plays a critical role in managing (pre)diabetes; however, adherence to physical activity recommendations remains low. The ENERGISED trial was designed to address these challenges by integrating mHealth tools into the routine practice of general practitioners, aiming for a significant, scalable impact in (pre)diabetes patient care through increased physical activity and reduced sedentary behaviour.MethodsThe mHealth intervention for the ENERGISED trial was developed according to the mHealth development and evaluation framework, which includes the active participation of (pre)diabetes patients. This iterative process encompasses four sequential phases: (a) conceptualisation to identify key aspects of the intervention; (b) formative research including two focus groups with (pre)diabetes patients (n = 14) to tailor the intervention to the needs and preferences of the target population; (c) pre-testing using think-aloud patient interviews (n = 7) to optimise the intervention components; and (d) piloting (n = 10) to refine the intervention to its final form.ResultsThe final intervention comprises six types of text messages, each embodying different behaviour change techniques. Some of the messages, such as those providing interim reviews of the patients’ weekly step goal or feedback on their weekly performance, are delivered at fixed times of the week. Others are triggered just in time by specific physical behaviour events as detected by the Fitbit activity tracker: for example, prompts to increase walking pace are triggered after 5 min of continuous walking; and prompts to interrupt sitting following 30 min of uninterrupted sitting. For patients without a smartphone or reliable internet connection, the intervention is adapted to ensure inclusivity. Patients receive on average three to six messages per week for 12 months. During the first six months, the text messaging is supplemented with monthly phone counselling to enable personalisation of the intervention, assistance with technical issues, and enhancement of adherence.ConclusionsThe participatory development of the ENERGISED mHealth intervention, incorporating just-in-time prompts, has the potential to significantly enhance the capacity of general practitioners for personalised behavioural counselling on physical activity in (pre)diabetes patients, with implications for broader applications in primary care.

Патология билиарного тракта: от МКБ-10 к МКБ-11

Pathology of the biliary tract is widespread among the adult population of many countries around the world. This is due to the high incidence of risk factors in these populations. In addition to the commonality of risk factors and progression, another characteristic feature of the entire group of biliary diseases of both organic and functional nature is the presence of similar clinical manifestations. The main manifestation of biliary tract pathology is biliary pain. This article reflects modern data on the most common variants of biliary tract pathology in the practice of general practitioners and gastroenterologists in the light of the transition from ICD X to ICD XI, and presents a step-by-step diagnostic algorithm and approaches to the management of patients with biliary pain, including an example own clinical case.

Cancer survivors' experiences of a physical activity program in primary care: a qualitative study.

This study aimed to gain insight into the experiences of, and reasons for, cancer survivors participating in a primary care PA program. We interviewed 17 patients from 11 Dutch GP practices. Patients were selected by purposive sampling based on their general practice, gender, educational level, motivation for PA, and change in PA. Interviews were audio recorded, transcribed verbatim, and pseudonymized for inductive thematic analysis. Three domains were identified with five themes: institutional domain: GP practice; program-specific domain: content sessions and PA, and activity tracker and goal setting; individual domain: experienced benefits, and personalized care needs. Participants valued the PA program because it was offered close to home, without additional costs, and by a trusted practice nurse familiar with the patients' medical background. Activity tracker use and goal setting motivated many participants but also led to demotivation and feelings of failure in others. Reported benefits included behavior change and favorable health outcomes. Many patients expressed the need to personalize psychological support and the program's timing. Access to a PA program in a primary care setting is valued for its accessibility and experienced health benefits, but also seems to meet an unmet need for support in picking up life during cancer recovery. Primary care is important for continued care of cancer survivors. An accessible PA program in this setting may fulfil a need for not only lifestyle support but also continuing life after cancer treatment.

Dietary guidance from GPs - what do patients report?

Diet can have a major impact on health. In this study, we surveyed the extent to which the subject of diet was raised by patients in general practice and which patients desired such discussions. We conducted a questionnaire-based cross-sectional study of patients ≥18 years of age at GP practices in Western Norway in 2022. The questionnaire consisted of nine questions about dietary knowledge, the desire to receive dietary guidance and lose weight, and medication use. Logistic regression was used to identify groups more likely to report a desire to receive guidance on how diet affects health. A total of 2105 of the 2531 (83%) invited patients ≥18 years of age completed the questionnaire, and 2075 of these were included in the analysis. One in three had raised the subject of diet with their GP. A total of 96% reported having the knowledge they needed about diet, 56% wanted advice or guidance on how diet affects health, 62% wanted to lose weight and 40% reported being confused by diet/dietary advice. Younger patients, men, patients with lower levels of education, patients who wanted to lose weight and patients taking medication for chronic conditions more frequently wanted advice/guidance on how diet affects health. Over half of the patients in the GP practices wanted advice/guidance on how diet affects health. Knowing who is more likely to want guidance can be useful for prioritising which consultations are appropriate for providing guidance on diet and health impacts.

Adolescent bariatric surgery—a survey of referring practitioners

BackgroundRecent guidelines, supported by large, well-designed studies, suggest that bariatric surgery is a safe and effective treatment for adolescents living with severe obesity to improve health and psychosocial functioning. The aim of this study was to assess the opinions and referral practices of general practitioners (GPs) and paediatricians in Ireland.MethodsA cross-sectional survey was circulated online to practising paediatricians and GPs. The survey consisted of a short introduction about childhood obesity and 12 questions on adolescent bariatric surgery and obesity medications.ResultsThere were 45 unique responses to the survey from 22 GPs (48%), 8 paediatricians (17%), and 15 others. Most GPs (72%) would not consider referring an adolescent for bariatric surgery. Paediatricians were significantly more likely to refer (72% vs. 28%, p = 0.034). A minimum BMI of 40 kg/m2 was the most common response, which GPs (45%) and paediatricians (37.5%) suggested should be a pre-requisite for surgery. There was strong support for family psychological assessment and a reported deficit in the community support needed to manage obesity. GPs were more likely than paediatricians to respond that anti-obesity medications should be made available to adolescents, specifically liraglutide (45% vs. 25%), semaglutide (45% vs. 37.5%), and orlistat (22% vs. 0%).DiscussionThere is a reluctance among GPs to refer adolescents with severe obesity for consideration of bariatric surgery. Concerns regarding the different obesity treatments held by medical professionals should be addressed through education and engagement and should be fundamental to the development of child and adolescent obesity services.