Tag Archives: Top ten

Top 10 most read BJGP research articles published in 2016

16Jan_Top10_research_2015_BJGP_smThese are the top 10 most read research articles based on full text downloads from bjgp.org in 2016.

1. Overdiagnosis of asthma in children in primary care: a retrospective analysis. 
http://bjgp.org/content/66/644/e152

Overdiagnosis of childhood asthma is common in primary care, leading to unnecessary treatment, disease burden, and impact on quality of life. However, only in a small percentage of children is a diagnosis of asthma confirmed by lung function tests.

2. Telephone triage systems in UK general practice: analysis of consultation duration during the index day in a pragmatic randomised controlled trial. 
http://bjgp.org/content/66/644/e214

Telephone triage is not associated with a reduction in overall clinician contact time during the index day. Nurse-led triage is associated with a reduction in GP contact time but with an overall increase in clinician contact time. Individual practices may wish to interpret the findings in the context of the available skill mix of clinicians.

3. Primary care clinician antibiotic prescribing decisions in consultations for children with RTIs: a qualitative interview study.
http://bjgp.org/content/66/644/e207

Prognostic uncertainty remains an important driver of health care professionals’ antibiotic prescribing. Experience and training in recognising severe respiratory tract infections (RTIs), together with more evidence to help professionals identify the children at risk of future illness deterioration, may support identification of the children most and least likely to benefit from antibiotics.

4. Continuity of care in primary care and association with survival in older people: a 17-year prospective cohort study.
http://bjgp.org/content/66/649/e531

This study demonstrates that low continuity of care in general practice is associated with a higher risk of mortality, strengthening the case for encouragement of continuity of care.

5. Nursery sickness policies and their influence on prescribing for conjunctivitis: audit and questionnaire survey.
http://bjgp.org/content/66/650/e674

Most of the childcare providers’ sickness policies contain requirements that are inconsistent with Public Health England guidance. The requirements of childcare sickness policies are likely to be resulting in unnecessary primary care consultations and thousands of prescriptions for antibiotics with little demonstrable clinical or public health benefit.

6. Unrecognised bipolar disorder among UK primary care patients prescribed antidepressants: an observational study.
http://bjgp.org/content/66/643/e71

Among people aged 16–40 years prescribed antidepressants in primary care for depression or anxiety, there is a substantial proportion with unrecognised bipolar disorder. When seeing patients with depression or anxiety disorder, particularly when they are young or not doing well, clinicians should review the life history for evidence of unrecognised bipolar disorder. Some clinicians might find the Mood Disorder Questionnaire to be a useful supplement to non-standardised questioning.

7. Identifying depression among adolescents using three key questions: a validation study in primary care.
http://bjgp.org/content/66/643/e65

Depression in teenagers can have serious consequences and the incidence seems to be increasing. Three short questions, suitable for use in general practice, are useful for identifying depression in adolescents in primary health care.

8. Barriers to effective management of type 2 diabetes in primary care: qualitative systematic review.
http://bjgp.org/content/66/643/e114

Although resources are important, many barriers to improving care are amenable to behaviour change strategies. Improvement strategies need to account for differences between clinical targets and consider tailored rather than ‘one size fits all’ approaches. Training targeting knowledge is necessary but insufficient to bring about major change; approaches to improve diabetes care need to delineate roles and responsibilities, and address clinicians’ skills and emotions around treatment intensification and facilitation of patient behaviour change.

9. Comparison of brief interventions in primary care on smoking and excessive alcohol consumption: a population survey in England.
http://bjgp.org/content/66/642/e1

Whereas approximately half of smokers in England visiting their GP in the past year report having received advice on cessation, less than 10% of those who drink excessively report having received advice on their alcohol consumption.

10. Molluscum contagiosum and associations with atopic eczema in children: a retrospective longitudinal study in primary care.
http://bjgp.org/content/66/642/e53

Consultations for molluscum contagiosum in primary care are common, especially in 1–9-year-olds, but they declined significantly during the decade under study. A primary care diagnosis of atopic eczema is associated with an increased risk of a subsequent primary care diagnosis of molluscum contagiosum.

 

Top 10 most read BJGP research articles published in 2015

16Jan_Top10_research_2015_BJGP_smThese are the top 10 most read research articles based on full text downloads from bjgp.org.

1. Child obesity cut-offs as derived from parental perceptions: cross-sectional questionnaire.
http://bjgp.org/content/65/633/e234

Parental perceptions and clinical definitions of child obesity are known to diverge; however, the extent of the discrepancy has not been documented. This study characterises parental classifications of obesity and identifies sociodemographic characteristics that predict misclassification. Also, BMI centile cut-offs for weight status are established as derived from parental perceptions.

2. Does mindfulness improve outcomes in patients with chronic pain? Systematic review and meta-analysis.
http://bjgp.org/content/65/635/e387.full

This current review looks at management of non-malignant chronic pain as a whole, includes only randomised controlled trials, and uniquely focuses on humanistic outcomes such as pain acceptance and perceived pain control. These are of particular relevance with this self-help technique, as well as clinical and economic outcomes.

3. Help seeking for cancer ‘alarm’ symptoms: a qualitative interview study of primary care patients in the UK.
http://bjgp.org/content/65/631/e96.full

The Model of Pathways to Treatment highlights the importance of understanding patient appraisal and decision-to-consult processes for improving earlier diagnosis. Little is known about how people make decisions about visiting their GP for potential cancer symptoms in everyday life, without a researcher-imposed cancer perspective. This is the first qualitative, community-based study to assess how people respond to cancer ‘alarm’ symptoms outside of the cancer context. The results not only highlighted the importance of people’s interpretations of symptoms, but also their sense that they had to limit their demands for GP advice, both to preserve their self-image and to avoid uncomfortable interactions with the GP if they were seen as time wasters. The findings highlight potential avenues to promote prompt help seeking.

4. Simplified sleep restriction for insomnia in general practice: a randomised controlled trial.
http://bjgp.org/content/65/637/e508.full

Insomnia is a common health problem seen in general practice. Cognitive behavioural therapy for insomnia (CBT-I) is effective but its use has been limited by the time and expense required for delivery. Sleep restriction, or restricting the time in bed, is one component of CBT-I. This trial found that simplified sleep restriction advice, delivered in two GP consultations, is a practical, effective intervention for chronic primary insomnia.

5. Cannabis, tobacco smoking, and lung function: a cross-sectional observational study in a general practice population.
http://bjgp.org/content/65/631/e89.full

Cannabis smoking is associated with increased respiratory symptoms, but evidence of adverse effects on lung function is sparse. This study provides the first UK data on the impact of cannabis smoking on the prevalence of respiratory symptoms and chronic obstructive pulmonary disease in a general practice population. Although many adverse effects appeared attributable to tobacco, evidence of some additional adverse effects of cannabis was found.

6. Physician associates and GPs in primary care: a comparison.
http://bjgp.org/content/65/634/e344.full

Physician associates (previously known as physician assistants) are a new professional group in UK general practice, and evidence is required on their outcomes and costs. For patients attending for same-day or urgent appointments, PAs attended a younger patient group who present with less medically acute problems and fewer long-term conditions, compared to those attended by GPs. After adjusting for case-mix, there was no difference between PA and GP consultations in the rate of investigations, referral to secondary care, prescriptions issued, or the rate of patient re-consultation for the same or a closely related problem within 14 days. Patients report high levels of satisfaction with PA and GP consultations. The average PA consultation was longer than with a GP, although costs per consultation with a PA were lower.

7. Reduction in self-monitoring of blood glucose in type 2 diabetes: an observational controlled study in east London.
http://bjgp.org/content/65/633/e256.full

In many people who have type 2 diabetes but are not treated with insulin, self-monitoring of blood glucose (SMBG) is an often unnecessary task that confers no benefit, while being at very high, and increasing, cost. This is the first study to describe a systematic and major reduction in unnecessary use of SMBG. In people on metformin or no treatment, SMBG use was reduced from 29.6% to 6.0%; in all non-insulin users the rate fell from 42.8% to 16.5%. If replicated nationally, this would avoid unnecessary testing in 340 000 people and save £21.8 million that is currently spent on diabetes prescribing.

8. Patients’ online access to their electronic health records and linked online services: a systematic review in primary care.
http://bjgp.org/content/65/632/e141

Online services have been successfully piloted by large American organisations (such as Kaiser Permanente) but this success has not been replicated in the UK. This study found that patient satisfaction improved through enabling better self-care. Clinicians had concerns about the additional burden and workload from online access but evidence found their fears were only partly realised. There is a lack of good quality research in these areas in the UK; especially research that measures impact (such as health outcomes).

9. Patient information materials in general practices and promotion of health literacy: an observational study of their effectiveness.
http://bjgp.org/content/65/632/e192.full

Patient information leaflets (PILs) provide information to patients to encourage participation in their health care. Research evidence has variously concluded that PILs do affect patient health outcomes, but that many are poorly written. This study shows that less than 25% of PILs in general practice meet recommended reading-level guidance, and that most would be too complex for 43% of the English population. Less than 10% of the PILs covered managing illness or health promotion.

10. Provision of medical student teaching in UK general practices: a cross-sectional questionnaire study.
http://bjgp.org/content/65/635/e409.full

Demand for GP care is rapidly increasing, but the supply of GPs is problematic. Currently, the number of GPs going into training is also problematic. Plans to expand GP training to 50% of medical graduates have been proposed. Teaching medical students in general practice increases the probability that they will opt for a career in general practice and so appropriate undergraduate experience will be important for workforce planning. Since the late 1960s GP teaching of medical students has increased to occupy 13% of the clinical teaching in UK medical schools. This study suggests that this growth has stopped, and may be in decline. Effective financial mechanisms may help to alleviate this, but central intervention may be required to deliver it.