BJGP Interviews

We have a quick update from the editor, Euan Lawson, as we take a short break over the summer. Here are some links to ensure you stay in touch with us:

• BJGP Life: https://www.bjgplife.com. (And details on contributing here: https://www.bjgplife.com/contribute)
• Twitter: @BJGPjournal
• Facebook: https://www.facebook.com/BJGPjournal/
• YouTube: https://www.youtube.com/c/BJGPjournal
• RCGP members opt in for your print journal here: https://bjgplife.com/print

In this episode we talk to Dr Jan Verbakel who is a GP and professor of primary care at Leuven.

Paper: GPs’ perspectives on diagnosing childhood urinary tract infections: a qualitative study

https://doi.org/10.3399/BJGP.2021.0589

Diagnosis of childhood UTIs is challenging in the outpatient setting. GP’s perspectives for the diagnostic workup of childhood UTIs are not well understood. In this study, we found that assuming low UTI prevalence, the aspecific presentation of UTI in children and difficulties in urine collection were barriers for diagnosis of childhood UTI. Diagnostic uncertainty makes appropriate treatment challenging. Factors that might improve the diagnostic workup were: novel noninvasive collection techniques, instructional material for the parents, skill training for GPs, decision support tools, accurate and easy-to-use point-of-care tests and guidance on urine culture interpretation.

In this episode we talk to Dr Meena Rafiq who is an academic GP and clinical research fellow at University College London.

Paper: Inflammatory marker testing in primary care in the year before Hodgkin lymphoma diagnosis: a UK population-based case–control study in patients aged ≤50 years

https://doi.org/10.3399/BJGP.2021.0617

Understanding the timing of the inflammatory response in Hodgkin lymphoma may help identify opportunities for earlier diagnosis. In patients with Hodgkin lymphoma presenting to U  K general practice, greater than expected and increasing use of inflammatory marker tests in the year before diagnosis were observed; two-thirds of patients with Hodgkin lymphoma who were tested for inflammatory markers had abnormal results, with almost half of patients in this group having no other recorded red-flag feature beyond their abnormal result. These findings provide proof of concept about the presence of a ‘diagnostic window’ during which Hodgkin lymphoma diagnosis could be expedited in at least some patients. Given the challenges of timely diagnosis in patients with Hodgkin lymphoma, inflammatory marker testing could help to expedite the diagnosis in those presenting with non-specific symptoms if supported and utilised by future advances in diagnostic technology.

In this episode we talk to Dr Sean MacBride-Stewart who is Lead Pharmacist for Medicines Management Resources, Pharmacy Services, NHS Greater Glasgow and Clyde.

Paper: Feedback of actionable individual patient prescription data to improve asthma prescribing: pragmatic cluster randomised trial in 233 UK general practices

https://doi.org/10.3399/BJGP.2021.0695

Prescribing feedback to GPs is a common intervention but evidence suggests that alone it is not very effective in changing behaviour. We investigated whether newly available patient-level prescription data could be used to measure potentially inappropriate prescribing (PIP) of bronchodilators. This pragmatic study found patient-level feedback to GPs was effective at reducing the number of patients exposed to excess or unsafe prescribing of bronchodilator inhalers. This would be feasible to implement, at scale, where primary care electronic prescribing is in general use.

In this episode we talk to Dr Jessica Watson who is a GP and NIHR Academic Clinical Lecturer, Centre for Academic Primary Care at the University of Bristol.

Paper: ‘I guess I’ll wait to hear’: a qualitative study of communication of blood test results in primary care

https://doi.org/10.3399/BJGP.2022.0069

Previous studies have shown that failure to communicate or action blood tests can lead to patient harms, with delay in diagnosis being the commonest cause of malpractice claims in primary care worldwide. This study found that systems of test result communication vary between doctors and are often based on habits, unwritten heuristics, and personal preferences rather than protocols. Doctors generally expect that patients know how to access their test results, and assume that patients will proactively seek out their test results, with implications for patient safety. Practices have an ethical and medicolegal obligation to ensure they have robust systems for test communication.

In this episode we talk to Dr Anita Lim who is a Senior Research Fellow, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King’s College London.

Paper: Non-speculum clinician-taken samples for HPV testing: a cross sectional study in older women

https://doi.org/10.3399/BJGP.2021.0708

Speculum use is a significant barrier to cervical screening and can become particularly uncomfortable after the menopause. Self-sampling is an obvious solution but does not appeal to all women. Having a doctor or nurse take a sample without a speculum is another possibility but the test performance has not yet been examined. We found HPV testing on non-speculum clinician-taken samples to have comparable test performance to self-sampling, representing a promising new approach for cervical screening.

In this episode we talk to Dr Sarah Price who is a research fellow at the University of Exeter Medical School.

Paper: Intra-abdominal cancer risk with abdominal pain: a prospective cohort primary care study

https://doi.org/10.3399/BJGP.2021.0552

Abdominal pain is a non-specific symptom, which may portend serious disease, including intra-abdominal cancers. There is no unified pathway for investigation. This paper reports the 1-year cumulative incidence risk of intra-abdominal cancer with or without concurrent clinical features for men and women aged 40–59, 60–69 and ≥70 years. Results show that patient demographics and type of concurrent feature effects the cancer risk. These results will inform appropriate testing strategies and specialist referral.

In this episode we talk to Dr Yin Zhou who is a GP and Clinical Research Fellow at the Primary Care Unit, Department of Public Health and Primary Care, at the University of Cambridge.

Paper: Pre-diagnostic clinical features and blood tests in patients with colorectal cancer: a retrospective linked data study

https://doi.org/10.3399/BJGP.2021.0563

Understanding pre-diagnostic patterns of relevant clinical features and abnormal blood test results in patients with colon and rectal cancer could elucidate windows of opportunity during which more timely investigations and referrals could be performed, and earlier diagnosis of cancer could be achieved. We found that consultation rates increased in the year leading up to diagnosis for relevant clinical features such as low haemoglobin, rectal bleeding and change in bowel habits, as well as non-specific blood tests, from as early as 9-10 months before diagnosis. Our findings suggest that potential opportunities for more timely use of cancer investigations or referral exist, and could improve diagnostic pathways, expediting diagnosis and treatment for some patients with colorectal cancer.

In this episode we talk to Dr Kimberley Foley who is a Research Associate at the Department of Primary Care and Public Health, Imperial College London.

Paper: Impact of Covid-19 on primary care contacts with children and young people aged 0-24 years in England; longitudinal trends study 2015-2020

https://doi.org/10.3399/BJGP.2021.0643

The Covid-19 pandemic response led to health system reorganisation globally, but its impact on children and young people’s access to primary care is largely unknown. Children and young people’s health contacts with general practitioners (GPs) fell by 41%, equivalent to 2.8 million fewer contacts in England, during the first Covid-19 pandemic lockdown from March to June 2020 compared with the previous 5 years.

Face-to-face contacts with GPs fell by 88% with a corresponding increase in remote contacts. The greatest falls in face-to-face contacts occurred among children aged 1-14 (> 90%). Remote contacts with infants and with young people aged 15-24 years more than doubled, mitigating some of the total falls in these age groups.

GP contacts for respiratory illnesses fell 74% during lockdown compared with previous years, while contacts for common non-transmissible conditions (urinary tract infections, appendicitis, diabetes, and epilepsy) had a lesser fall at 31%.

In this episode we talk to Dr Rohini Mathur who is an associate professor of epidemiology at the London School of Hygiene and Tropical Medicine and Dr Sally Hull who is a GP and a member of the Clinical Effectiveness Group at QMUL.

Paper: Characterisation of type 2 diabetes subgroups and their association with ethnicity and clinical outcomes: a UK real-world data study using the East London Database

https://doi.org/10.3399/BJGP.2021.0508

Previous studies of predominantly White European populations have identified four type 2 diabetes subgroups. In the UK the clinical measures necessary to replicate these subgroups are only available in secondary care data, limiting their usefulness for diabetes management in primary care settings. The current study demonstrated how clinically meaningful type 2 diabetes subgroups can be pragmatically generated using real-world primary care data. Furthermore, it highlighted important differences between type 2 diabetes subgroups with respect to vascular outcomes, treatment initiation, and glycated haemoglobin control. Diabetes subgroups are a useful heuristic for assisting decision making by clinicians that, in turn, can lead to a more personalised design of diabetes care focused on more intensive management of subgroups most at risk of complications, such as those with severe hyperglycaemia at time of diagnosis.