British Medical Journal

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BACKGROUND: Substantial increases in UK consulting rates, mean consultation duration and clinical workload were observed between 2007 and 2014. No analysis of more recent trends in clinical workload has been published to date. This study updates and builds on previous research, identifying underlying changes in population morbidity levels affecting demand for primary health care. AIM: To describe the changes in clinical workload in UK primary care since 2005. DESIGN AND SETTING: Retrospective cohort study...

BACKGROUND: System problems, known as operational failures, can greatly affect the work of GPs, with negative consequences for patient and professional experience, efficiency, and effectiveness. Many operational failures are tractable to improvement, but which ones should be prioritised is less clear. AIM: To build consensus among GPs and patients on the operational failures that should be prioritised to improve NHS general practice. DESIGN AND SETTING: Two modified Delphi exercises were conducted online among NHS GPs and patients in several regions across England...

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder with effective pharmacological treatments that improve symptoms and reduce complications. NICE guidelines recommend primary care practitioners prescribe medication for adult ADHD under shared care agreements with adult mental health services (AMHS). However, provision remains uneven, with some practitioners reporting a lack of support. AIM: This study aimed to describe supportive elements (prescribing, shared care, AMHS availability) of primary care prescribing for adult ADHD medication in England, to inform service improvement and improve access for this underserved population...

AIMS: Orlistat is recommended as an adjunct to diet and exercise for weight loss in type 2 diabetes mellitus (T2DM). The aims were to explore (i) associations between patient characteristics and orlistat prescribing and to determine (ii) associations of orlistat with weight loss in T2DM/prediabetes. METHODS: This cohort study used anonymised records of T2DM/prediabetes (2016-2017) patients ≥18 years, from the UK Clinical Practice Research Datalink (CPRD) database...

OBJECTIVE: To train and test a super learner strategy for risk prediction of kidney failure and mortality in people with incident moderate to severe chronic kidney disease (stage G3b to G4). DESIGN: Multinational, longitudinal, population based, cohort study. SETTINGS: Linked population health data from Canada (training and temporal testing), and Denmark and Scotland (geographical testing). PARTICIPANTS: People with newly recorded chronic kidney disease at stage G3b-G4, estimated glomerular filtration rate (eGFR) 15-44 mL/min/1...