Background General practice in the UK is under significant pressure, resulting in a drive to increase training capacity. These additional training posts have historically been filled by international medical graduates (IMGs) who accounted for 50% of UK GP residents in 2025. There is however a significant ‘award gap’ (previously differential attainment) affecting IMGs in postgraduate GP training. Aim To identify literature addressing the factors underlying the award gap. Design & setting The scoping review followed the process outlined in the Joanna Briggs Institute (JBI) guidance. Studies eligible for inclusion were those reporting educational outcomes (concept) for IMGs (participants) undertaking UK GP training (context). Method Searches were conducted in Medline, EMBASE, SCOPUS and PsycINFO. A two-step screening process was employed to identify eligible articles. Analysis involved descriptive statistics (number and type of evidence sources) and a basic categorical qualitative analysis. Results 34 pieces of evidence were identified for inclusion; 24 of these reported findings from a variety of empirical research. Most articles focused on postgraduate examinations as the educational outcome of interest. Broad themes were individual vs systemic factors as predictors of success and the ‘deficit model’. Conclusion Previous research has focused on individual factors which predict failure, or on defending the validity of examinations. This has ‘responsibilised’ IMGs by failing to acknowledge that the responsibility for addressing the award gap lies not just with the individual, but also with the educational system. Further research should consider exploring why the award gap exists so we can tackle the underlying cause.
Background Increasing workload in primary care has prompted an increase in general practice (GP) training places. These additional places have historically been filled by international medical graduates (IMGs); in 2025 52% of UK GP residents were IMGs. However, disparities in allocation to training practice may disadvantage IMGs thereby causing problems in training progression. Aim To analyse the allocation of residents to GP training practices across the UK to determine whether this varies with socio-economic deprivation. Design & setting A quantitative analysis of data obtained from freedom of information (FOI) requests to UK bodies governing GP training. Method Main outcome is composition of residents within training practice; classified as IMG-only, UK medical graduate (UKMG) -only or mixed. Variable of interest is Index of Multiple Deprivation (IMD) quintile. Results We observed a 23% increase in number of UK GP training practices from 2020-2025. In this time, composition of residents shifted from predominantly UKMG-only to more mixed and IMG-only practices. Number of training practices serving the most deprived communities varied; 15% in England to 34% in Northern Ireland (NI). In England, Scotland and NI, IMG-only training practices were significantly more likely to be in areas of higher deprivation than UKMG-only practices. Prevalence of diabetes and COPD were higher in IMG-only compared to UKMG-only practices. Conclusion Findings highlight the substantial contribution of IMGs to the UK primary care workforce from 2020-2025; however, we must acknowledge and address disparities in the allocation of GP training placements and further investigate impact on resident progression.
Background Primary care research capacity is hindered by fragmented systems, limited protected clinician time, and poorly developed pathways for translating evidence into practice. The Translating Research Outcomes into the Primary Health Interface (TROPHI) initiative was established in outer Eastern Melbourne, Australia, to address these challenges by strengthening regional research capacity, fostering collaboration between primary care and academic sectors, and supporting research translation. TROPHI was funded by Windermere Foundation. Aim To evaluate the implementation and early impact of TROPHI, focusing on its ability to build interdisciplinary networks, enhance research capacity, and facilitate primary care research. Design & setting Our hybrid evaluation was set in outer Eastern Melbourne, Australia Method Our evaluation was informed by Cooke’s framework for research capacity development and the Consolidated Framework for Implementation Research (CFIR). We analysed study documents and conducted semi-structured interviews with 29 TROPHI staff, award recipients, partners, consumers, and funders. Results TROPHI established a regional interdisciplinary network and created accessible entry points into research for clinicians through mentorship, bursaries, fellowships, and seed funding. Participants reported increased research skills, confidence, and engagement, alongside early examples of translation into practice. Over three years, TROPHI leveraged an initial AUD$1M philanthropic investment into more than AUD$3M in competitive grants. Implementation was supported by established organisational partnerships but required substantial contributions from staff at lead organisations. Conclusion TROPHI strengthened primary care research capacity by fostering partnerships and supporting clinicians, generating regional momentum. It represents a promising model for regional capacity building. Sustained impact will require ongoing investment, broader workforce engagement, and stronger integration with systems.
BACKGROUND:Integrating palliative care into primary care is increasingly recognised as essential for people with life-limiting illness, yet the relevance of existing palliative care quality indicators (QIs) to primary care remains unclear. AIM:To identify, map, and appraise quality indicators (Qis) relevant to palliative care delivered in primary care. DESIGN & SETTING:Systematic review of studies describing QIs applicable to primary care-based palliative care. METHOD:We searched MEDLINE, Embase, Cochrane databases, and Global Index Medicus (inception to July 2024). Eligible studies described QIs relevant to both palliative care and primary care. Indicators were classified using Donabedian's framework, mapped to National Consensus Project Palliative Care domains and the WHO Primary Health Care (PHC) Measurement and Improvement Framework, and appraised using the Appraisal of Indicators through Research and Evaluation instrument. RESULTS:Twenty-two studies met inclusion criteria, yielding 381 relevant indicators. Most indicators focused on processes of care (64.8%), with fewer addressing structure (27.6%) and outcomes (7.6%). Palliative care indicators were concentrated in PHC domains related to continuity, coordination, person-centredness, and effectiveness. Psychosocial, spiritual, and cultural domains were sparsely represented. PHC structural system elements, including governance and population health approaches, were minimally captured. Methodological quality was highest for clarity of purpose, but variable for stakeholder involvement (28-94%) and low for implementation guidance (17-65%). CONCLUSION:Current palliative care QIs are predominantly focused on processes of care and may not fully reflect the breadth of primary care-based palliative care, particularly with respect to patient-centred outcomes and psychosocial, spiritual, and cultural domains. Further work is needed to develop and validate indicators that are specifically relevant to primary care practice.
BACKGROUND:Behavioural strategies are recommended to prevent recurrent urinary tract infections (rUTIs), but supporting evidence is unclear. AIM:To synthesise evidence on the effects of patient-facing behavioural interventions to prevent rUTIs in primary care and community settings. DESIGN & SETTING:Systematic review of quantitative, qualitative, and mixed-methods studies in primary care and community settings. METHOD:MEDLINE, Embase, PsycINFO, Web of Science, and CINAHL were searched in April 2025. Studies examining behavioural preventive interventions for UTI in adult women were included; pharmacological-only and non-behavioural studies were excluded. Findings were synthesised narratively, risk of bias was assessed using the Mixed Methods Appraisal Tool, and confidence in findings was informed by GRADE principles. RESULTS:Ten studies were included (2907 participants); two randomised controlled trials and eight non-randomised studies. Evidence was heterogeneous with low to very low confidence. Strongest evidence was for increased fluid intake, with one randomised controlled trial amongst women with low intake showing reduced UTI recurrence (N=140). Other behaviours were included in multi-component interventions but were mostly not evaluated independently or associated to outcomes. Barriers to prevention behaviours included practical, attitudinal or social factors. CONCLUSION:Evidence for behavioural interventions to prevent rUTIs is limited by variable study quality, poor reporting of intervention content, and lack of behavioural analysis. While some evidence supports increased fluid intake, other behaviours have limited evaluation. Primary care clinicians should continue to offer behavioural advice, while recognising uncertainty and tailoring support to individual circumstances.
BACKGROUND:Five-year cancer survival rates in the United Kingdom (UK) compare poorly with other high-income countries and a comparatively late stage of cancer diagnosis is a key driver. Primary care referrals led to 58.6% of cancer diagnoses in the UK in 2020, making general practice the ideal setting for targeted interventions focusing on improving early cancer diagnosis. ThinkCancer! is an innovative, team-based, theoretically-driven, complex behavioural and educational intervention aimed at reducing primary care cancer diagnostic delays. AIM:The aim of this phase III randomised control trial is to assess the effectiveness and cost-effectiveness of the ThinkCancer! intervention compared with usual primary care. An embedded case note review will characterise patients with the longest intervals to referral. DESIGN & SETTING:General practices will be randomised on a 1:1 ratio to either receive the ThinkCancer! Intervention, or to continue with usual care. METHOD:Data will be collected from 12 months pre-randomisation to 26 months post-randomisation. Primary outcome measures include the primary care interval (PCI), incremental cost per day reduction in PCI and budget impact of the ThinkCancer! INTERVENTION:Secondary outcome measures include referral rates, conversion and detection rates, cancer stage at diagnosis and the guideline interval. A process evaluation will assess intervention implementation. Qualitative interviews will explore patient and carer experiences of urgent suspected cancer referral, and an embedded case note review will explore factors which contribute to the longest primary care intervals for patients with different cancer types. RESULTS:The trial began in December 2022 with findings expected December 2027.
BACKGROUND:Suicide is the leading cause of death among adults aged 20-34 in England and Wales. Around 80% of those who die by suicide have consulted a GP within the previous year, making primary care a critical setting for prevention. Rates in Yorkshire and the Humber (YH) exceed the national average (12-13 deaths per 100 000 population). AIM:To explore GPs' perspectives on suicide prevention in primary care across YH. DESIGN & SETTING:Qualitative study with GPs from diverse practices in YH. METHOD:Purposive sampling ensured variation in demographics and patient populations. Semi-structured interviews were conducted until data saturation. Transcripts were analysed using Thematic Analysis. RESULTS:Fourteen interviews were completed (10 female, 4 male). Participants served varied populations, including asylum seekers and Roma patients. Four themes emerged: "Integration with mental health and third sector services" highlighted inconsistent mental health service organisation and the role of third sector support. "Challenges of assessing and managing risk" highlighted perceived barriers to responding to suicide risk within time and resource constraints. "Continuity of care" describes the importance of developing ongoing relationships to support suicide prevention in primary care and the risks and threats to achieving this. "Building on knowledge" describes the absence of systematic case review in general practice after suicide. CONCLUSION:An integrated, resourced system with equitable access to primary care mental health workers and third sector support may enhance suicide prevention. Continuity of care was valued but undermined by inflexible models prioritising same-day triage over personalised mental health primary care.
Background The Primary Care Functioning Consultation Tool (PCFCT) supports the integration of different aspects of health related functioning for patients with multimorbidity in disease management programs. Aim To assess feasibility, satisfaction, and potential effectiveness of the PCFCT on functioning, self-efficacy, illness perceptions, and disease performance indicators in daily general practice. Design & setting Pilot non-randomized controlled trial in Dutch general practices Method Patients with multimorbidity were allocated to the intervention group (consultations with the practice nurse using the consultation tool) or to the control group (regular consultations). Feasibility was assessed by recruitment, retention, and identified patients at baseline and 3 months. After 3 months, satisfaction of patients and nurses was measured. Potential treatment effects were assessed using the Primary Care Functioning Scale, Self-efficacy Questionnaire, Brief Illness Perception Questionnaire, and disease-related outcomes. Results Sixty-five patients were included (31 intervention, 34 control). Both patients and practice nurses reported high satisfaction and acceptability. Nineteen control patients (59%) and 24 intervention patients (80%) completed all questionnaires at baseline and 3 months. Between-group differences were not statistically significant, however intervention patients showed small exploratory differences towards better functioning, higher self-efficacy, and more adaptive illness perceptions. Missing data ranged from 25% to>90% across disease performance indicators, precluding reliable comparisons. Conclusion The PCFCT is feasible, acceptable, and can be embedded within existing chronic disease management, with the potential to improve patient outcomes.
BACKGROUND:Access to general practitioners has become a major concern in many high-income countries, including France. Evidence suggests that primary care organisation is related to population health outcomes. AIM:This study aimed to analyse the association between the territorial organisation of healthcare and two population health indicators: all-cause mortality and life expectancy at birth. DESIGN & SETTING:This is a cross-sectional ecological study using exhaustive French departmental data in 2021 (n=96). Data were obtained from public open-data sources. Outcomes were departmental all-cause mortality rate and life expectancy at birth. METHOD:Explanatory variables included GP density, hospital bed density, socio-economic indicators, and demographic characteristics. Adjusted multivariable linear regression models were estimated, with log-transformation of mortality rates. RESULTS:After adjustment, each additional GP per 10 000 inhabitants was associated with an approximately 1% lower mortality rate (-0.010 on the log-mortality scale; 95% CI [-0.019, -0.001]; P=0.027) and a 0.233 year higher life expectancy (95% CI [0.145, 0.322]; P<0.001). Hospital bed density was positively associated with mortality but not with life expectancy. Higher poverty rates and greater proportions of individuals aged≥65 years or living with long-term conditions were negatively associated with health outcomes. Population density showed inconsistent associations. CONCLUSION:Greater GP availability was associated with lower mortality and higher life expectancy at the departmental level in France. These findings support the hypothesis that primary care organisation may be related to population health outcomes. However, causal inference cannot be established because of the ecological cross-sectional design. MESH: mortality, life expectancy, primary health care, general practice, social determinants of health.
BACKGROUND:In 2024, one-third of GP appointments in England were conducted by telephone. What happens during these consultations is largely unknown. AIM:To test the feasibility of collecting recorded GP telephone consultations with linked data and consent for reuse. DESIGN & SETTING:Retrospective observational study in seven practices in South West England collected from April 2023 to June 2024. METHOD:Adults who had a telephone consultation at practices that routinely recorded calls were invited to consent to retrieval of the audio, a 4-month electronic health record (EHR) extract, and a post-consultation questionnaire. Practice-level consent rates were analysed with regression. RESULTS:Of 28 clinicians recruited, 19 GPs contributed retrievable, usable recordings with consent for research re-use. Of 2,053 patients invited, 123 consented (6.0%), with lower consent in more deprived practices (IMD deciles 1-2 versus 9-10: OR 0.22, 95% CI 0.09-0.54). Of 101 recordings retrieved, 96 were usable and 91 had consent for research re-use. Of these, 86 were linked to EHR data and 89 to patient questionnaires. Mean consultation duration was 7 minutes 13 seconds, and typing was audible in 63/91 (69%). Overall, 161 problems were discussed, averaging 1.77 per consultation. Most patients were happy their consultation was by telephone (96/117, 82%), although most reported usually preferring face-to-face appointments (68/115, 59%). CONCLUSION:It is feasible to assemble a reusable archive of GP telephone consultations with linked data. However, recruitment was low using retrospective remote consent. Future work should test alternative recruitment approaches and consider oversampling at practices serving deprived populations.
BACKGROUND:Given around 50% of people with heart failure have a degree of iron deficiency, guidelines recommend screening. It is uncertain to what extent this is done in primary care and whether testing is equitable. AIM:To report the proportion of people with incident heart failure who undergo a ferritin test within 12 months. DESIGN & SETTING:Retrospective primary care cohort study using Clinical Practice Research Datalink Aurum data, between 2016 and 2021. METHOD:We report the proportion of adults with an incident diagnosis of heart failure who received a ferritin test within 12 months. Multivariable logistic regression was used to examine the odds of testing based on key demographic covariates and co-morbidities. RESULTS:Among 105 749 individuals with an incident diagnosis of heart failure (mean age 71.6 years, SD 14.3), only 35 688 (33.7%) received a ferritin test within the subsequent year. Increasing age (odds ratio 1.25 per 10-year increase, 95% CI: 1.24-1.27), female sex (male sex OR 0.86, 0.84-0.89) and Asian ethnicity (OR 1.70, 1.59-1.80) were all associated with increased odds of testing as were diagnoses of coeliac disease (OR 1.86, 1.58-2.21), type 1 diabetes (OR 1.82, 1.51-2.19) and cirrhosis (OR 1.64, 1.43-1.87). There was geographic variation in testing, even in adjusted analyses. CONCLUSION:In a large primary care dataset, two thirds of people with incident heart failure did not receive a ferritin test for iron deficiency within a year of diagnosis demonstrating a gap in current practice and an opportunity for improvements in service delivery.
BACKGROUND:Depression is a leading cause of disability worldwide, with general practitioners (GPs) playing a crucial role in its identification and management. Despite this central position, GPs face challenges in diagnosing depression. Previous qualitative research has focused on clinical and interactional aspects of depression diagnosis in primary care, including uncertainty and negotiation; this study examines logistical and practical challenges in diagnosis. AIM:To explore GP perspectives of the challenges in diagnosing depression and providing initial support in primary care. DESIGN & SETTING:Qualitative study involving GPs across Scotland, the North-East of England and Northern Ireland. METHOD:Semi-structured interviews were conducted with GPs, recruited through clinical networks of the research team who were contacted via email, followed by a snowball sampling strategy. Interviews were recorded, transcribed and thematically analysed. Themes were developed to explore GPs' perspectives of the challenges in diagnosing depression. RESULTS:Ten GPs from a range of practice locations were interviewed. Three themes were developed highlighting the challenges that GPs face in diagnosing depression: (1) Complexity of presentation; (2) Constraints on access and time; (3) Continuity of care. CONCLUSION:Diagnostic challenges for depression in primary care are shaped by clinical complexity, time constraints, and continuity of care. Addressing these factors may help GPs navigate diagnostic uncertainty and provide earlier support for patients presenting with depressive symptoms.
Background Collaboration between general practice and hospitals is essential for quality and sustainability in healthcare. Current collaboration is often fragmented, potentially leading to inappropriate patient courses. Closer collaboration, such as specialist meetings between physicians may improve coordination and enhance patient outcomes. Aim Investigating general practitioners’ and hospital consultants’ experiences with the existing cross-sectoral collaboration and their expectations for participation in specialist meetings. Design & setting Qualitative study based on semi-structured individual interviews with general practitioners and hospital consultants. Method 11 informants were recruited using purposive and balanced sampling and interviews were conducted between January and October 2024. Data was analyzed using Reflexive Thematic Analysis and further interpreted through the lens of Self-Determination Theory. Results Findings revealed collaboration as fragmented with limited agreement on which collaborative methods to use and how to share new knowledge. For some, this resulted in frustration and insecurity, while others viewed the collaboration as pragmatic and largely effective. Our results revealed a strong motivation to improve collaboration through structured, relational engagement where specialist meetings were anticipated to increase familiarity with each other, creating a space for knowledge sharing leading to better collaboration and hence more qualified patient pathways. Self-Determination Theory provided deeper insight into the motivational dynamics underlying cross-sectoral collaboration. Conclusion Cross-sectoral collaboration between general practice and hospitals is currently shaped by fragmented communication and misaligned expectations. Specialist meetings are regarded as a promising way to strengthen cross-sectoral collaboration by fostering autonomy, competence, and relatedness, reducing fragmentation and supporting more coherent, patient-centered care pathways.
BACKGROUND:Statins are the UK's most prescribed medicine and are used more in deprived populations. Patient Information Leaflets (PILs) included in medication packaging may support safe, effective use, but only if they are understandable. Guidance states PILs should have a reading age of ≤13-years, and regulators require that ≥80% of patients answer comprehension questions correctly on them when 'user tested'. AIM:To provide the first independent evaluation of the readability and comprehension of UK statin PILs. DESIGN & SETTING:Study 1: Cross-sectional analysis of the reading age of 39/40 of the UK's approved statin PILs. Study 2: Cross-sectional survey with a representative sample of 517 UK adults aged 40-74. METHODS:Study 1: Reading age was assessed using four readability formulas, with additional scores calculated after adjusting for potentially familiar technical terms. Study 2: Two PILs (atorvastatin [MSN] and rosuvastatin [Ranbaxy]) were randomly selected and user tested with participants. They answered eight comprehension questions per PIL; responses were double-scored. RESULTS:Study 1: No PIL met the recommended reading age. Median reading age was 15.9 years (15.0 after adjustment). Atorvastatin PILs were least readable. Study 2: Key messages were poorly understood; for atorvastatin, 5/8 items met the≥80% criterion; for rosuvastatin, 2/8 met it. Key safety and use messages were frequently misunderstood. CONCLUSION:UK statin PILs do not meet recommended readability or comprehension standards and are likely to be difficult to understand for many users. Improving clarity and usability is essential to support equitable understanding and safe, informed long-term statin use.
BACKGROUND:Menopause is associated with a wide range of symptoms, including musculoskeletal pain, yet its contribution to musculoskeletal consultations and healthcare utilisation in primary care remains poorly quantified. The extent to which hormone replacement therapy (HRT) influences musculoskeletal-related healthcare use is uncertain. AIM:To quantify the prevalence, incidence, and healthcare burden of musculoskeletal symptoms and conditions among women experiencing the menopause transition in English primary care, and to explore the association between HRT use and musculoskeletal-related healthcare utilisation. DESIGN & SETTING:Closed cohort study with nested repeat cross-sectional analyses using English national primary care electronic health records from the Clinical Practice Research Datalink Aurum, 2015-2024. METHOD:Women aged 35-60 years with consultations for musculoskeletal symptoms/conditions and/or menopause-related symptoms or HRT prescribing will be identified. Annual prevalence and incidence rates per 10 000 registered women will be estimated. Healthcare utilisation outcomes include consultation frequency, investigations, analgesic prescribing, referrals, and sickness certification. Joinpoint regression will assess temporal trends. Poisson and negative binomial regression models, accounting for practice-level clustering, will estimate adjusted rate ratios. Analyses will be stratified by ethnicity and socio-economic status. Exploratory analyses will compare outcomes among HRT users and non-users. CONCLUSION:This study will provide national primary care estimates of menopause-related musculoskeletal burden and associated healthcare utilisation. Findings will inform clinical recognition, management strategies, and evaluation of potential inequalities in care.
BACKGROUND:Previous work has highlighted that children and adolescents with migraine are underdiagnosed and undertreated in primary care. AIM:To characterise diagnosis and treatment patterns among children and adolescents with migraine in primary care. DESIGN & SETTING:A retrospective cohort study using the Clinical Practice Research Datalink Aurum. METHOD:The study cohort included patients aged 6-17 years presenting to primary care practices with headache/migraine in England between September 2012 to May 2023 ("index" event). Prescribed medications, primary care consultation and referral rates 12 months after index were investigated. Medication overprescription was defined as per the ICHD-3 definition of medication overuse headache. RESULTS:246 744 children (6-12 years) and adolescents (13-17 years) were observed attending primary care with headache/migraine. The majority of headache was unclassified (67.6%), particularly in children compared to adolescents (77.6% v 57.9%). Primary headache disorders accounted for 31.3% of headache presentations, higher in adolescents compared to children (40.9% v 21.4%). Migraine was the most common primary headache disorder (N=67,059, 86.9%), constituting the final sample for subsequent analyses.Acute medication was prescribed to 28,478 (45.7%), and preventive medication for 17,153 (27.5%). Paediatric clinics referral rates were 14 referrals per 100-person-years. Medication overprescription was observed in 26.0% of triptan users. CONCLUSION:Most headache cases presenting to primary care in England remain unclassified, particularly in children (6-12 years). Compared to previous research, more children and adolescents were prescribed medication for migraine in primary care and fewer were referred to secondary care. Evidence of suboptimal medication use was still observed in this study.
BACKGROUND:Chest pain is a common symptom with causes ranging from harmless to potentially life-threatening. Interpreting its seriousness and deciding whether to seek care can be challenging for individuals. While research has focused on patients with confirmed cardiac diagnoses, less is known about how people experience and evaluate chest pain in general, and how they decide to seek care. AIM:To explore the considerations of people experiencing chest pain and identify the barriers and facilitators influencing their decision to seek medical care. DESIGN & SETTING:Qualitative study using semi-structured focus groups and individual interviews with adults who had experienced chest pain in primary care. METHOD:Two focus groups (n=3 each) and nine individual interviews were conducted. Interviews were guided by the Health Belief Model (HBM) and explored barriers and facilitators to care-seeking. Transcripts were analysed thematically. Data collection continued until no new themes emerged. RESULTS:All HBM components shaped help-seeking, often changing as symptoms progressed. Decisions to seek care were influenced by multiple, interacting factors. Barriers included fear of exaggerating symptoms, prior non-cardiac explanations, downplaying symptoms, and practical considerations. Facilitators included severe or persistent symptoms, prior recognition, social support, and positive relationships with healthcare providers. Expectations also influenced decisions, including seeking reassurance about serious illness or advice for non-cardiac or persistent symptoms. CONCLUSION:Decisions to seek medical care for chest pain are influenced by symptom interpretation, expectations, social support, and trust in healthcare providers. Clear communication, strong doctor-patient relationships, and accessible, reliable information may support timely and appropriate care-seeking.
BACKGROUND:PSA is not recommended for screening by The UK National Screening Committee due to risks of over-diagnosis and over-treatment. However, men in England aged 50+can request a PSA test from their GP. AIMES:To investigate the association between PSA and cancer mortality and estimate the absolute and relative risk of prostate cancer deaths. DESIGN & SETTING:Nested case-control study using the Clinical Practice Research Datalink (CPRD) GOLD database. METHOD:Cases were men who died of prostate (2003-2018) cancer aged 55-84. Age and sex-matched controls were selected from men without prostate cancer death. Odds ratios (OR) were estimated using conditional logistic regression, adjusting for age, socioeconomic deprivation, body mass index, and practice-level PSA testing rate. Ten-year absolute risk of prostate cancer mortality was calculated using weighted OR calibrated to national mortality rates. RESULTS:Among 2,919 cases and 8757 controls, men with a "screening" PSA test were 33% (OR=0.67, 95% CI: 0.56-0.80) less likely to die from prostate cancer than not tested. Men aged 65-74 with a PSA<2 ng/mL had a 0.15% 10-year mortality risk versus 0.8% in those not tested. Men in practices in the top 20% for PSA testing were 10% (95%CI: -5 to 23%) less likely to die of prostate cancer than those from the bottom 20%. CONCLUSIONS:PSA testing was associated with lower prostate cancer mortality, while higher PSA level was linked to increased risk. Higher primary care use of PSA testing was associated with improved patient outcomes. These findings support consideration of risk- stratified screening rather that a uniform approach.
BACKGROUND:Prostate-specific antigen (PSA)-based prostate cancer (PCa) screening risks overdiagnosis and overtreatment. PCa disproportionately affects Black men, those with a family history (FH) of the disease, and BRCA1/2 gene variant carriers. Risk-adapted approaches are gaining interest but are underexplored. AIM:To assess the feasibility of PSA-based Targeted Prostate Health Checks (TPHCs) for men at high PCa risk, compare invitation methods, and assess sociodemographic variations. DESIGN & SETTING:Prospective feasibility cohort study in four primary care networks (PCNs) in North East London. METHOD:Men aged 45-69 years from Black ethnic group, or with a positive PCa FH, were identified via primary care records and invited by the PCN to one of two TPHCs: (i) telephone-first (phone consultation followed by hospital-based PSA testing); or (ii) test-first (community-based PSA testing followed by phone consultation). Elevated PSA prompted multiparametric magnetic resonance imaging (mpMRI), and prostate biopsy if malignancy was suspected. RESULTS:Of 2400 invitees, 398 (16.6%) attended. Attendance was higher with the test-first than telephone-first TPHC (22.9% versus 11.2%, P<0.001). Only 51.4% of participants met eligibility criteria owing to inaccurate FH coding, although men who did not meet the eligibility criteria were offered PSA tests. Black men had lower prior PSA testing (55.7% versus 82.5%) and higher deprivation than White men. Elevated PSA occurred in 6.0% of participants (n = 22), with five PCa diagnoses (1.4%). CONCLUSION:Identification of men at high PCa risk is feasible using age and ethnicity primary care data, but FH coding is unreliable. Test-first invitations improved engagement. Disparities affecting Black men highlight the need for tailored outreach, and better coding of risk factors will facilitate risk-adapted screening.
BACKGROUND:Social determinants of health (SDOH) critically impact on population and individual health outcomes and underpin health inequalities, yet information on individual-level social risk are not collected routinely in healthcare settings. AIM:The aims of this study are to investigate the feasibility of SDOH screening in primary care, validate a proposed screening tool, explore acceptability of screening, and estimate the burden of social need in the study population. DESIGN AND SETTING:This explanatory sequential mixed-methods study is conducted in UK general practice. METHOD:In Work Package (WP) 1, we will compare methods for collecting social determinants of health (SDOH) data using a screening tool: text message, post with online option, telephone, and opportunistic collection in consultations. Linked medical records will describe characteristics of patients with social needs and estimate prevalence. We will also assess reliability and validity of the screening tool.In WP 2, patient interviews will explore screening acceptability, including barriers and facilitators. Focus groups and interviews with GP practice staff and community healthcare professionals will examine views on screening and its integration into routine workflows. Data will be analysed using Braun and Clarke's thematic analysis. CONCLUSION:Identifying those with unmet social needs will potentially: support clinicians to provide better personalised care, improving health outcomes; provide better information on local populations; allow for targeted support for those with unmet needs; help develop local services; and inform public health policies to reduce health inequalities. Results from this study will inform a randomised controlled trial in a larger programme of work.
