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Feature
Continuity of care is linked to mortality
A systematic review links reduced mortality rates to continuity of care, and examines causative mechanisms. In this primary-care focused study, authors from the University of Leicester, Imperial College London, and McGill University in Montreal, found a statistically significant protective effect of greater care continuity in 9 of 12 studies that measured the effect of all-cause mortality. Improved clinical responsibility, physician knowledge, and patient trust were suggested as causative mechanisms. This review adds reduced mortality to the demonstrated benefits of better continuity in primary care for patients. Some patients may benefit more than others. Despite mounting evidence of its broad benefit to patients, relationship continuity in primary care is in decline — decisive action is required from policy makers and practitioners to counter this. Also online first in the BJGP is research on what patients with ongoing problems want from relational continuity of care. This study from the University of Bristol found that patients want a GP who listens to them, who takes time with them, who cares, who takes responsibility and action, and who trusts and respects them.
Highlights
Online First
Recent Features
Racism and health
Dr Carter Singh is a full time GP partner at Willowbrook Medical Practice, Nottinghamshire. An 'expert-by-lived-experience' in racial inequality, it is this passion that motivates him to challenge discrimination, inequality, and marginalisation in the NHS. The August issue of the BJGP publishes Dr Singh’s letter on Asking questions along with an Editorial on Racism and Health by Paramjit Gill and Virinder Kalra, and an Editor’s briefing on Prejudice Plus Power = Racism. Life & Times looks at BAME excess deaths and chronic stress by Sarah Evans, Conversations about race and abuse in the NHS by Tariq Hussain, COVID-19 and equity by Gemma Ashwell et al, and indigenous health in the COVID-19 torch by Tim Senior. View the full contents of the August BJGP.
Molecular point-of-care testing for flu:
integration into primary care
In managing influenza, antiviral treatment should ideally be started within 48 hours of the onset of symptoms. This is a feasibility study exploring the use of rapid molecular testing in general practice to reduce diagnostic delay. Conventional testing procedures, including sample transport to the laboratory, take considerably longer. Providing an earlier test result will help inform clinical decisions and may improve patient outcomes. Point-of-care testing might also improve information accuracy which could enhance disease surveillance and research. Read the new research by de Lusignan and colleagues from University of Oxford; Vaccine Research Department of FISABIO-Public Health in Valencia; University of Southampton; and NIHR Southampton Biomedical Research Centre.
Unsafe prescribing of methotrexate
GPs in England continue to breach national guidelines on tablet strength designed to avoid accidental methotrexate overdose, according to research on trends in prescribing of methotrexate. High doses of methotrexate increase the risk of toxicity and 21 deaths have been attributed to methotrexate from 1993 to 2017. Doctors are advised to avoid 10mg tablets and prescribe only 2.5mg tablets. Here, Brian MacKenna, Pharmacist Researcher – University of Oxford, from the Evidence-based DataLab discusses the findings. Also watch videos on Practice and OpenPrescribing at BJGP Life.
National early warning scores
Early warning scores alert clinicians to deterioration in a patient’s condition, with higher scores indicating poorer health. Originally developed for use in hospitals, new research extends the use of National Early Warning Scores (NEWS) to GPs. Scott and colleagues analysed NEWS scores collected for over 13,000 urgent GP referrals to hospital. They found that higher scores are associated with faster travel to hospital by ambulance, and with faster medical review after arriving at hospital. The authors suggest that NEWS could be used by ambulance call handlers and paramedics for triage, and patients and carers could also benefit from education about NEWS to ensure prompt transfer to hospital. Related research by Pullyblank and colleagues examines the use of NEWS scores across a number of settings both in acute trusts and the community. Scores were used by increasing numbers of GPs and, at one centre, 70% of patients had a score recorded on referral. Take up by the ambulance service and GP out of hours service were key to its success.
Altmetric Data
Altmetric tracks attention and engagement of scholarly articles. The following list shows the articles most frequently shared in social media over the past six months.
- Association between use of urgent suspected cancer referral and mortality and stage at diagnosis: a 5-year national cohort studyLast mentioned on Sun Jul 12 2020
- History lessons: the Asian Flu pandemicLast mentioned on Fri Aug 07 2020
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