BJGP Interviews The British Journal of General Practice

In this episode, we talk to Dr Faraz Mughal, who is a practising NHS General Practitioner and NIHR Doctoral Fellow at the School of Medicine at Keele University.
Title of paper: Recent GP consultation before death by suicide in middle-aged males: a national consecutive case series study
Available at: https://doi.org/10.3399/BJGP.2022.0589
Preventing suicide in middle-aged males is a global priority. This national case series study found that 43% of middle-aged males who died by suicide had a final GP consultation in the preceding 3 months, and of these males, over half presented with a mental health problem. Males who had recent GP contact before suicide were more likely to have self-harmed in the 3 months before compared with males who had no recent GP contact. Males who had a current physical illness, recent history of self-harm, attended for a mental health problem, and experienced recent work-related problems were more likely to consult with their GP shortly before dying by suicide. GPs and primary care clinicians should be alert to these clinical factors that may be proximal to suicide, and in turn, offer personalised holistic care.

In this episode, we talk to Dr James Sheppard, who is an Associate Professor at the Nuffield Department of Primary Care Health Sciences at the University of Oxford. 
Title of paper: Predicting the risk of acute kidney injury: Derivation and validation of STRATIFY-AKI
Available at: https://doi.org/10.3399/BJGP.2022.0389
Acute kidney injury (AKI) is one of the more serious adverse events associated with antihypertensive treatment, reducing an individual’s health-related quality of life and increasing the risk of admission to hospital. Clinical guidelines recommend that when prescribing antihypertensives GPs should take into account the likelihood of both the benefits and harms from treatment, but few data exist in regard to the risk of AKI. A clinical prediction model was developed and externally validated for the risk of AKI up to 10 years in the future in patients eligible for antihypertensive medication, incorporating commonly recorded patient characteristics, comorbidities, and prescribed medications. The model showed good discrimination and good calibration for probabilities up to 20%, enabling GPs to accurately identify patients at higher risk of AKI. This could be useful to reassure the majority of patients starting or continuing treatment that their risk of AKI is very low.

In this episode, we talk to Gillian Doe and Rachael Evans, both based at the University of Leicester.
Title of paper: Diagnostic delays for breathlessness in primary care: a qualitative study to investigate current care and inform future pathways
Available at: https://doi.org/10.3399/BJGP.2022.0475
Delays to diagnosis for patients presenting with chronic breathlessness are well described. This study set out to investigate current care for patients awaiting a diagnosis to inform future diagnostic pathways. The data highlight the challenges of symptom recognition, timely investigations, making a positive diagnosis, and difficult consultations. To achieve earlier diagnosis and better outcomes for patients with breathlessness, clinicians need to Ask, Act, and Advise: Ask to understand and validate symptoms, Act to initiate timely investigations, and Advise a positive diagnosis while offering breathlessness relief strategies.

In this episode, we talk to Jennifer MacLellan and Sultana Bi about the paper they have recently published here in the BJGP.
Title of paper: Primary care practitioners’ experiences of peri/menopause help-seeking among ethnic minority women
Available at: https://doi.org/10.3399/BJGP.2022.0569
Ethnic minority women may have different experiences of the peri/menopause from their white peers. Ethnic minority women may face language, inhibition and health literacy barriers to primary care. There is a need for increased awareness and trustworthy information resources to help ethnic minority women prepare for the menopause and advocate for their health. Resources, training and quality interpreter support are needed to help clinicians recognise ethnic minority women’s experiences and offer support, improving quality of life and potentially reducing future disease risk.

In this episode, we talk to Dr Gail Davidge and Dr Brian McMillan, who are both based at the Centre for Primary Care and Health Services Research at the University of Manchester.
Title of paper: Putting principles into practice: A qualitative exploration of the views and experiences of primary care staff regarding patients having online access to their electronic health record
Available at: https://doi.org/10.3399/BJGP.2022.0436
Previous research has noted primary care staff concerns about patients having online access to their health record, relating to issues such as: workload, safeguarding, patient confusion or distress, and health inequities. This study provides additional insights in the aftermath of the Covid-19 pandemic and in the light of NHS England’s plans to enable full prospective records access for patients by default. Findings highlight that most primary care staff agree with patient records access in principle, and can see its potential benefits, but remain concerned about the impact on patient centred care, safeguarding, and how to navigate this change. This study underlines the need for additional training and support for primary care staff to adapt their practice so they can address the needs of patients and protect patient safety and well-being whilst maintaining the clinical integrity of health records.

In this episode, we talk to Professor Jon Emery, who is the Herman Chair of Primary Care Cancer Research at the University of Melbourne. 
Title of paper: The CRISP Trial: RCT of a decision support tool for risk-stratified colorectal cancer screening
Available at: https://doi.org/10.3399/BJGP.2022.0480
Using risk models that account for family history, lifestyle and medical history could tailor CRC screening and determine starting age and screening test. This could be more cost-effective than population screening. In this RCT, we showed that using the CRISP risk tool in general practice can increase risk-appropriate CRC screening in those due screening. Its effect is more uncertain in patients who are up-to-date with screening. The CRISP intervention could be used in people in their fifth decade to ensure people start CRC screening at the optimal age with the most cost-effective screening test.