BJGP Interviews

In this episode, we talk to Professor Emma Wallace, who is a GP and Professor of General Practice at University College Cork about the incidence and severity of adverse drug reactions in older adults in the community. 

Title of paper: Cumulative incidence and severity of adverse drug reactions and associated patient characteristics in older community-dwelling adults attending general practice – a six year prospective cohort study

Available at: https://doi.org/10.3399/BJGP.2022.0181

No prospective studies have examined adverse drug reaction (ADR) occurrence among older adults attending general practice. ADRs were found to occur for approximately 1 in 4 older adults over a six-year period. Cardiovascular, nervous system and anti-infective drugs for systemic use were the most commonly implicated drug classes. Approximately 1 in 4 ADRs rated as moderate result in additional healthcare utilisation. Female sex, polypharmacy (5-9 drug classes) and major polypharmacy (≥10 drug classes) increased the likelihood for ADRs.

Today, we talk to Becky White, who is a Research Fellow at the Epidemiology of Cancer Healthcare and Outcomes Research Group at UCL. 

Paper: Underlying cancer risk among patients with fatigue and other vague symptoms in primary care: a population-based cohort study

Available at: https://doi.org/10.3399/BJGP.2022.0371

When patients present to GPs with new-onset fatigue and no alarm symptoms for cancer, optimal management is often unclear, as it is not known which of these patients may be at risk of having present but currently undetected cancer. We found that among fatigue presenters without alarm symptoms, the chance of underlying cancer exceeded risk referral thresholds of 3% in older men with fatigue combined with any of another 19 vague symptoms for cancer, and in older women with fatigue-weight loss, fatigue-abdominal pain, or fatigue-abdominal bloating. These findings can support diagnostic management and referral decisions for patients presenting with fatigue in the absence of alarm symptoms for cancer.

Today, we talk to Dr Claire Taylor, a GP and NIHR Clinical Lecturer at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. 

Paper: Natriuretic peptide testing and heart failure diagnosis in primary care: diagnostic accuracy study

Available at : https://doi.org/10.3399/BJGP.2022.0278

International guidelines recommend natriuretic peptide (NP) testing to prioritise referral for heart failure (HF) diagnostic assessment in primary care. European Society of Cardiology (ESC) and National Institute for Health and Care Excellence (NICE) guidelines differ significantly in their recommended NP referral threshold. Our study found at the lower ESC threshold fewer HF diagnoses were missed but more referrals from primary care would be required. Healthcare systems need to balance the risk of a missed or delayed diagnosis for individual patients with capacity in diagnostic services. An NP level below both the ESC and NICE thresholds was reliable in ruling out HF.

This episode (our 100th podcast!), we have a round table discussion with our Editor-in-Chief, Euan Lawson, alongside the editorial team of Sam Merriel, Tom Round and Nada Khan. We take a look at the top 10 most read papers on the BJGP website from 2022

In this episode, we talk to Dr Kitty Worthing, a GP registrar working for the Sheffield Teaching Hospitals Trust about work she did whilst working as an academic clinical foundation doctor and then clinical fellow at Queen Mary University. 

Title of paper: Reluctance to register: an exploration of the experiences and perceptions of general practice staff in North East London

Available at: https://doi.org/10.3399/BJGP.2022.0336

Previous research shows that people are often refused GP registration if they do not have access to documentation, highlighting a discrepancy between guidance and practice that has not been previously explored. Current third sector initiatives to improve inclusive registration have largely focused on reiterating guidance and explaining to staff why people may not have access to documentation. This study found that reluctance to register this group was common, and reluctance was generally fuelled not by lack of knowledge of the guidance, but by workplace and resourcing pressures, and moral judgements concerning who should be entitled to NHS services based on immigration status. The perceived practical and financial burdens relate to overall increases in workload and the current funding model utilised in general practice. Initiatives to improve access must acknowledge such concerns, alongside addressing the wider malign impact of the ‘hostile environment’ policies on individual staff decision making.

Today, we talk to Professor Paul Little, who is Professor of Primary Care Research within Medicine at the University of Southampton. Paul and his team conducted a study looking at the effectiveness of antibiotics for chest infections in children. 

Title of paper: Antibiotic effectiveness for children with lower respiratory infections: prospective cohort and trial

Available at: https://doi.org/10.3399/BJGP.2022.0239

Antibiotics are commonly prescribed for children with chest infections, but prescribing antibiotics fuels antibiotic resistance which is one of the major global public health threats. There is little randomised evidence, and trials commonly recruit selected populations which undermines their applicability. In a cohort of unwell children antibiotics for chest infections were not effective in significantly shortening the illness, and increased side effects. GP’s should support parents to self-manage at home and communicate clearly on when and how to seek medical help if they continue to be concerned.

In this episode, we talk to Nishadi Withanage, a doctoral student in the Department of General Practice at Monash University in Australia. 

Title of paper: Effectiveness of preconception interventions in primary care: a systematic review

Available at: https://doi.org/10.3399/BJGP.2022.0040

Preconception care (PCC) delivered in community and hospital settings are effective in improving pregnancy outcomes and health knowledge, and reducing preconception risk factors; however, the effectiveness of primary care-based PCC has been unclear. This systematic review demonstrates that primary care-based PCC including brief and intensive education, supplementary medication, and dietary modification are effective in improving health knowledge and reducing preconception risk factors among females, even when delivered by trained non-healthcare professionals. Non-healthcare professionals could help improve access to PCC in systems that are already struggling to provide care. As there is a limited number of studies reporting on pregnancy outcomes, further research is required to determine whether primary care-based PCC can improve pregnancy outcomes.

Today, we talk to Mai Stafford, who is a senior analytical manager at the Health Foundation. 

Title of paper: Continuity of care in diverse ethnic groups: a general practice record study in England

Available at: https://doi.org/10.3399/BJGP.2022.0271

Nationally representative survey data show lower continuity of care for most ethnic minority groups. To the authors’ knowledge, this is the first national study to examine ethnic inequalities in continuity of care using GP records. The study found that relational continuity of care was lower for people from Black African, Black Caribbean, any other Black background, Bangladeshi, and Pakistani ethnic groups. These ethnic inequalities are not accounted for by socioeconomic deprivation and are seen for people with and without multiple long-term conditions.

In this episode, we talk to Dr Laura Armitage, a GP and Doctoral Research Fellow at the Nuffield Department of Primary Health Care Sciences at the University of Oxford. Laura and her team conducted a study looking at a common issue in primary care: hypertension, and how to measure it in practice.

Title of paper: Diagnosing hypertension in primary care: the importance of night-time blood pressure assessment. 

Available at: https://doi.org/10.3399/BJGP.2022.0160

Since the 1990s, the phenotypic classification of 24-hour blood pressure has divided the population into ‘dippers’, ‘non-dippers’ (minimal night-time BP decrease compared to daytime BP) and ‘reverse dippers’ (night-time BP increases compared to day-time BP). There is an established body of research demonstrating that reverse dippers are at higher risk of death and that the night-day systolic blood pressure ratio is an independent predictor of all cause mortality and cardiovascular events. Presently, UK guidelines suggest clinicians should diagnose hypertension based solely on daytime BP measurements. This study reveals a marked proportion of our population are reverse dippers; together with the established clinical research that has demonstrated worse cardiovascular outcomes for such patients, this highlights the need for 24-hour ambulatory blood pressure assessments to detect and diagnose those with nocturnal hypertension, non-dipping or reverse-dipping blood pressure phenotypes.

In this episode, we talk to Dr Pauline Williams, a GP and an NRS Career Research Fellow. She’s based at the Institute of Applied Health Sciences at the University of Aberdeen.

Title of paper: Help seeking behaviour in women diagnosed with gynaecological cancer: a systematic review. 

Available at: https://doi.org/10.3399/BJGP.2022.0071

Reducing diagnostic delay, by improving patients’ help seeking behaviour, may reduce the UK’s excess gynaecological cancer mortality. This review identifies that symptom knowledge is not enough to initiate help seeking; patients must also have the time or means to attend health care and be motivated enough, by previous experience, to overcome any fear or embarrassment they may have.