BJGP Interviews

In this episode, we talk to Julien Vos, who is a doctoral student and clinician based at the Department of General Practice at the University of Amsterdam. We’re going to discuss his paper about survivorship care for colorectal cancer and patients experiences of GP-led care in the Netherlands. 

Paper: Patients’ experiences with general practitioner-led colon cancer survivorship care; a mixed-methods evaluation at various time points

Available at: https://doi.org/10.3399/BJGP.2022.0104

Cancer survivorship care is often complex and requires a multi-dimensional approach. Patients receiving colon cancer survivorship care from either the GP or surgeon rate the received care as of high quality. Roles and responsibilities of patients and physicians need to be clear in order to help organize survivorship care. GPs can take on a more prominent role in cancer survivorship care, but other outcomes, including patients’ and physicians’ preferences, will also be important.

In this episode, we talk to Professor Jeremy Horwood, Professor of Social Science and Health at the Centre for Academic Primary Care at the University of Bristol. 

Paper: Unintended consequences of patient online access to health records: a qualitative study in UK primary care

Available at: https://doi.org/10.3399/BJGP.2021.0720

Previous studies of patient online access to their medical records have noted a range of concerns about potential unintended consequences. This study reports real-world experiences of the consequences of online access. We identified unintended consequences that impacted patient autonomy and GP documentation practices, and also increased workload through providing access while avoiding harm to patients. It is crucial that practices are adequately supported and resourced to manage the unintended consequences of online access now that it is the default position.

In this episode, we talk to Ben Cranfield, who is undertaking a PhD In the Department of Behavioural Science and Health at UCL. 

Paper: Primary care blood tests before cancer diagnosis: National Cancer Diagnosis audit data

Available at: https://doi.org/10.3399/BJGP.2022.0265

Evidence relating to the predictive value of blood tests for cancer diagnosis is growing, yet how often they are used by GPs in pre-diagnosed cancer patients is unclear. In England, two-fifths of patients subsequently diagnosed with cancer in 2018 had at least one full blood count, urea & electrolyte or liver function test. Blood test use was less likely in women, non-white and younger patients and more likely in those presenting with non-specific symptoms, with longer intervals to referral and diagnosis being associated with tested patients. This research highlights potential unmet need for interventions to reduce the risk of overuse (in populations presenting with more-specific symptoms) and underuse (in patients presenting with less-specific symptoms) of blood tests in cancer populations.

In this episode, we talk to Maha Abo-Tabik, a doctoral research student at the Global Psoriasis Atlas who is based at the University of Manchester.

Paper: Mapping opportunities for the earlier diagnosis of psoriasis in primary care settings in the UK

Available at: https://doi.org/10.3399/BJGP.2022.0137

Many people suffer needlessly from psoriasis due to missed or delayed diagnosis. Primary care professionals are most often the first point of contact for people with psoriasis. The diagnosis of psoriasis can be a challenging task for non-dermatologists. Examining electronic health records from general practices showed that the diagnosis of psoriasis may be missed or delayed. People with undiagnosed psoriasis (missed or delayed diagnosis) have an increased frequency of GP consultations from five years before their diagnosis of psoriasis is confirmed. Individuals with psoriasis are often prescribed topical corticosteroids and/or topical antifungal medications before being diagnosed with psoriasis. These medications may mask the signs of psoriasis.

In this episode, we talk to Professor Trish Greenhalgh, Professor of Primary Care Health Sciences at the University of Oxford. 

Paper: UK newspapers “on the warpath”: media analysis of remote consulting in 2021

Available at: https://doi.org/10.3399/BJGP.2022.0258

How this fits in

In 2020, the shift from in-person to remote consulting in general practice was depicted positively by the media as part of the “war” on COVID-19. In 2021, remote consulting was depicted negatively by the media, and linked in press articles to difficulties accessing primary care and compromises in patient safety.  Newspapers led campaigns which successfully put pressure on government to require a return to in-person consultations. 

In this episode, we talk to Dr Natasha Tyler and Dr Maria Panagioti who both work in the Centre for Primary Care and Health Services Research at the University of Manchester.

Paper:  Patient Safety, Self-injection and B12 deficiency: A UK Cross sectional study

https://doi.org/10.3399/BJGP.2021.0711

It is known that individuals with vitamin B12 deficiency (including pernicious anaemia) describe their primary care consultations as ‘battles’ and feel stigmatised. However, the extent of this dissatisfaction with primary care and the effect this might have on patient safety and unsafe health behaviours is unknown. This is the first study to assess the association between patient reported safety and self-medication via injection and to consider the contributory factors to patient safety that affect this patient group. Understanding any negative effects of current practice and how general practitioners and primary care clinicians can better meet the needs of this marginalised group is key, to improving safety and care.

In this episode, we talk to Dr Dan Jones, who is a GP and an Academic Clinical Lecturer at the University of Leeds.

Paper: Factors influencing symptom appraisal and help-seeking of older adults with possible cancer: a mixed methods systematic review

https://doi.org/10.3399/BJGP.2021.0655

The burden of cancer falls predominantly on older (≥65 years) adults, and prompt presentation to primary care with cancer symptoms results in better patient outcomes. The current review, which included 80 studies, found that older adults with cancer symptoms may have prolonged symptom appraisal and shorter help-seeking intervals prior to presenting to general practice. Factors such as knowledge of cancer symptoms, the influence of family and carers, fear, embarrassment, comorbidities, and patient self-management all affected the appraisal or help-seeking interval. Clinicians should be aware of patient difficulty in distinguishing potentially worrying cancer symptoms from symptoms of ageing as a result of frailty or comorbidities.

In this episode we talk to Dr Lieke Koggel who is a PhD candidate in gastroenterology at the Department of Gastroenterology and Hepatology, Radboud Institute for Health Sciences, The Netherlands.

Paper: Predictors for inappropriate proton pump inhibitor use: observational study in primary care

https://doi.org/10.3399/BJGP.2022.0178

While overuse of proton pump inhibitors (PPI) is a common issue worldwide, predictors for this remain insufficiently known. This observational study using real-world primary care data identified older age and non-selective NSAID use as most predictive for inappropriate PPI use. The study also showed that unnecessarily continued PPI therapy is common in patients using PPI therapy for dyspepsia or as ulcer prophylaxis. Future initiatives on reducing inappropriate PPI use should target these patient groups.

In this episode we talk to Dr Simon Fraser who is a GP and associate professor of public health at the School of Primary Care, Population Sciences, and Medical Education at the University of Southampton.

Paper: Change in treatment burden among people with multimorbidity: a follow-up survey

https://doi.org/10.3399/BJGP.2022.0103

The extent to which treatment burden changes over time and which groups of people are likely to experience increases or decreases in treatment burden is not known. This study identified that a third of older adults with multimorbidity experienced an increase in treatment burden category (overall 9% moving to the ‘high’ treatment burden category), and that living more than 10 minutes away from their GP – particularly for those with limited health literacy - was associated with an increase in treatment burden. Improving patient access to primary care services and enhancing health literacy may help to mitigate increases in treatment burden. Our revised single-item measure performed moderately, suggesting a brief measure of treatment burden consisting of more than one item may be required for use in practice.

In this episode we talk to Dr Sally Hull who is a GP and Honorary Reader in Primary Care Development at QMUL.

Paper: Measuring continuity of care in general practice: a comparison of two methods using routinely collected data

https://doi.org/10.3399/BJGP.2022.0043

Longitudinal continuity of care is associated with lower mortality, fewer hospital admissions, better care for chronic disease and greater patient satisfaction. In spite of these benefits few practices measure continuity and measurement is not supported by health policy. Using the UPC we report a strong correlation between patient measures of continuity and practice UPC scores. We illustrate GP continuity across a whole health economy, and demonstrate that patient age and practice size are the strongest predictors. Improving continuity will require incentivisation, and regular measurement to support change.