In this episode, we talk to Juan Carlos Bazo-Alvarez, a Senior Research Fellow within the Department of Primary Care and Population Health at University College London. 

Title of paper: Risk of Parkinson’s disease in people with New Onset Anxiety over 50 years - Incidence and Associated Features

Available at: https://doi.org/10.3399/BJGP.2023.0423

Presence of anxiety is known to be increased in the prodrome of Parkinson’s disease (PD). This study investigated the risk of developing PD in people with anxiety compared with those without anxiety, accounting for a number of confounding variables. The results suggest that there is a strong association between anxiety and later diagnosis of PD in patients aged ≥50 years who present with a new diagnosis of anxiety. This provides evidence for anxiety as a prodromal presentation of PD.

In this episode, we talk to Dr Meena Rafiq, Academic GP and Clinical Research Fellow within the Institute of Epidemiology and Health at University of Melbourne. 

Title of paper: Clinical activity in general practice before sarcoma diagnosis: an Australian cohort study

Available at: https://doi.org/10.3399/BJGP.2023.0610

Sarcoma is challenging to diagnose with delays associated with poor patient outcomes and experiences. This study has shown that patients with sarcoma often have multiple GP visits and imaging requests in the year before their diagnosis. Clinical activity in general practice increases from 6 months before sarcoma diagnosis, primarily in the form of imaging requests, indicating that opportunities for a timelier diagnosis may exist in some patients. Primary care interventions to increase awareness of sarcoma symptoms and streamline diagnostic pathways, including promoting and clarifying guidelines to optimise the use of appropriate imaging and direct specialist centre referrals, could improve earlier diagnosis and patient outcomes.

In this episode, we talk to Dr Abi Eccles, Assistant Professor within Warwick Applied Health at Warwick Medical School. 

Title of paper: The GP’s role in supporting women with anal incontinence after childbirth injury

Available at: https://doi.org/10.3399/BJGP.2023.0356

Anal incontinence after childbirth injury has profound impacts on women’s lives and many find they cannot access healthcare and support. GPs can play a crucial role, but we know that very few women speak to their GPs about their symptoms. In combining GPs’ and women’s views, we show how anal incontinence after childbirth injury is often missed in a primary care setting. Drawing on these findings, we highlight the key ways GPs can provide support for such women

Click here for the RCGP course on anal incontinence after childbirth.

In this episode, we talk to Dr Ed Tyrell, a GP and Clinical Assistant Professor within the Faculty of Medicine and Health Sciences at the University of Nottingham. 

Title of paper: Primary care consultation patterns before suicide: a nationally representative case–control study

Available at: https://doi.org/10.3399/BJGP.2023.0509

Although increased primary care utilisation in the preceding year has been linked with death by suicide, longer-term consulting patterns and primary care-recorded reasons for consulting have not been previously examined. This large, nationally representative sample from England showed rates of consulting among patients who died by suicide continuously rose in the 5 years before suicide, especially in the last 3 months. Suicide risk was significantly increased among those who consulted more than once every month in the final year, irrespective of any sociodemographic characteristics and irrespective of the presence (or absence) of known psychiatric comorbidities. Common reasons why patients who died by suicide consulted before their death included medication review, depression, and pain.

In this episode, we talk to Carina Benthin, a psychologist and PhD student based at Helmut-Schmidt University. 

Title of paper: What helps and what hinders antidepressant discontinuation? Qualitative analysis of patients’ experiences and expectations

Available at: https://doi.org/10.3399/BJGP.2023.0020

Long-term antidepressant use is increasing, including among those patients who may consider discontinuation. In this study, patients with remitted major depressive disorder and long-term antidepressant use reported negative expectations about discontinuation. These expectations were partly shaped by their previous negative experiences, which persisted despite a wish to stop antidepressants, and hindered discontinuation. The findings of this study highlight patients’ need for information about treatment discontinuation, and professional support and structure throughout discontinuation, while taking into account their individual expectations and previous experiences.

In this episode, we talk to Dr Adam Geraghty, Associate Professor of Psychology and Behavioural Medicine within the School of Primary Care, Population Sciences and Medical Education at the University of Southampton. 

Title of paper: Distinguishing emotional distress from mental disorder: A qualitative exploration of the Four-Dimensional Symptom Questionnaire (4DSQ)

Available at: https://doi.org/10.3399/BJGP.2023.0574

A range of different approaches have been suggested to support primary care clinicians in the identification and management of mental health problems, from brief depression questionnaires, to approaches focusing on shared understanding within consultations. The Four-Dimensional Symptom Questionnaire (4DSQ) is a questionnaire developed in primary care that can support this process by distinguishing general distress from depressive or anxiety disorder. In this study we show that people recruited from primary care and community settings find completing a multidimensional questionnaire acceptable and find the splitting of general (potentially severe) distress from depression and anxiety helpful. Use of the 4DSQ may support collaborative diagnostic conversations as part of primary care consultations.

In this episode, we’re going to recognise some exceptional researchers here in the UK. We talk to Dr Ben Bowers and Dr Steve Bradley, this year’s winners of the Royal College of GPs and Society for Academic Primary Care early career researcher award. 

For more information about the award, see below two interviews with Ben and Steve on the RCGP website:

Dr Ben Bowers: https://www.rcgp.org.uk/Blog/SAPC-OECR-Awards-2024-Ben-Bowers

Dr Steve Bradley: https://www.rcgp.org.uk/Blog/SAPC-OECR-Awards-2024-Stephen-Bradley

Congratulations to Ben and Steve!

In this episode, we talk to Dr Erin Oldenhof, Research Coordinator and a benzodiazepine withdrawal counsellor at Reconnexion, a non-profit organisation that offers teratmenta nd support for insomnia, depression and anxiety. We’re also joined by Dr Petra Staiger, Associate Professor within the School of Psychology at Deakin University in Melbourne. 

Title of paper: “Let’s talk about sleep health”: Patient perspectives on willingness to engage in psychological interventions for insomnia

Available at: https://doi.org/10.3399/BJGP.2023.0310

Psychological interventions for insomnia are recommended as the first-line treatment but remain underutilised in primary care settings relative to pharmacological treatments. Coupled with known harms regarding prolonged use of benzodiazepine receptor agonists (BZRAs) to manage insomnia, the need for increased uptake of psychological interventions is critical. This study explored the influence of key factors that motivate individuals’ intention to engage with psychological interventions, revealing the importance of active involvement of GPs in this process from the initial consultation through to supporting treatment adherence long-term. By understanding the consumer perspective in conjunction with the unique clinical expertise of GPs, we have offered guidance on how to enhance patient-practitioner collaboration across the entire treatment process and increase GP confidence to facilitate increased engagement with evidence-based psychological treatment modalities.

In this episode, we talk to Dr Erica di Martino, a Research Fellow based within the School of Medicine at the University of Leeds.

Title of paper: Understanding General Practitioners’ referral decisions for younger patients with symptoms of cancer: a qualitative interview study

Available at: https://doi.org/10.3399/BJGP.2023.0304

Some cancers are becoming more common in younger people, yet clinical guidelines often recommend urgent referral for suspected cancer only if patients are above a certain age. Findings from this study show that, whilst most GPs interpret age criteria in cancer guidelines flexibly, some perceive and apply them as firm directives. In addition, system constraints may create unwarranted rigidity and act as barriers to prompt investigation. More in-built and explicit flexibility in the referral system is required to facilitate timely diagnosis of younger patients perceived as at higher risk by their GP.

In this episode, we talk to Becky Gudka, a Graduate Research Assistant based at the University of Exeter, about a study she’s published here in the BJGP titled, ‘Primary care provision for young people with ADHD: A multi-perspective qualitative study’. We’re also joined by her study co-author, Dr Anna Price, a Senior Research Fellow also at the University of Exeter who is the study principle investigator and senior author who led this research. 

Title of paper: Primary care provision for young people with ADHD: A multi-perspective qualitative study

Available at: https://doi.org/10.3399/BJGP.2023.0626

Attention deficit hyperactivity disorder (ADHD) is a highly prevalent neurodevelopmental disorder, with negative consequences for individuals and their communities. Research indicates a current “failure of healthcare” for people with ADHD in England, but previous recommendations to improve support for ADHD in primary care lack feasible and practical recommendations for health professionals. This study highlights individual-, practice- and system-level barriers to accessing support for ADHD via primary care and provides suggestions for how to overcome these barriers from the perspectives of multiple stakeholders. Health professionals and people with lived experience provided data which points to the standardisation of ADHD provision, providing additional information and support for clinicians, and better utilisation of reasonable adjustments for patients with ADHD in general practice.