The BJGP Open Top 10 Most Read Research Articles of 2022: an editorial

Abstract

It has been a busy and successful year for BJGP Open. As editors we have received a vast array of wonderful and interesting manuscripts. These have spanned diverse subject matters and locations from gestational diabetes in Norway to workforce retention in South Africa. In this editorial, we reflect on the articles that have resonated most with our readership, as highlighted by our recent list of Top 10 Most Read Research Articles of 2022. The past few years have seen unprecedented change in how we consult in primary care. With remote consulting having moved from the default policy, at least in most European countries, in 2020 to media pariah in 2021,1 this year saw more balance with practices weighing up the potential risks and benefits of telehealth, and restructuring services to suit a ‘post-pandemic’ world. Several of our articles reflect the importance of human interaction, a foundation of our specialty, which was heavily impacted both professionally and personally by the pandemic. Verma and Kerrison rapidly reviewed patients’ and physicians’ experiences with remote consultations,2 finding that — although these can be more convenient than in-person appointments — patients and practitioners in this study acknowledged the impact of the loss of physical and visual assessment and non-verbal communication. The impersonal nature of remote consulting also meant that rapport and relationship building was challenging. Similarly, in Wanat et al’s3 qualitative exploration of perspectives on consultations for respiratory tract infections in eight European countries during the first wave of COVID-19, remote consultations were acceptable but the doctor-patient relationship was diminished. This is important when considering the ‘hidden pandemic’ of long COVID highlighted by Brennan et al4 in their scoping review of management. Alongside traditional approaches to symptom identification and treatment, and facilitation of access to specialist services where needed, human interaction was once again highlighted, with GPs demonstrating concern, empathy, and understanding being key to optimal care. How effectively this can be done remotely is unclear. What we do know is that remote consulting affects GPs’ behaviour: in Mayne et al’s5 exploration of sedentary behaviour among GPs, 80.7% of those surveyed reported an increase in sitting time compared to pre-pandemic, with 94.5% of those citing remote consulting as a reason for this. With this study showing an average of over 10 hours of sedentary time on a normal working day, the health of our workforce should be considered in future remote consulting system models. Active workstations may be a solution, though these were only available to 5.6% of those surveyed. How we use language matters whether we are consulting remotely or in person. Parry et al6 qualitatively investigated how people with osteoarthritis perceive flares: they found the term was often used to describe severe, infrequent, unpredictable episodes of pain but that this was applied inconsistently and not universally, with the term having ‘no clear fixed meaning’. The literature on whether remote consulting alters workload is still unclear. However, as GP consultation numbers rise and workforce shortages continue, clinically efficient, safe, and cost-effective care solutions are imperative. The importance of cost saving has been shown in Sampson et al’s7 article on the effects of a population-wide rollout of Sleepio, a program delivering digital cognitive behavioural therapy for insomnia. Through a reduction in primary care contacts and prescriptions for insomnia, a saving of £6.64 per patient was achieved. When scaled up, a potential saving of £20 million was suggested in the first year. Saran et al’s8 review found that tablet splitting could be safe, with the exception of sustained release tablets. The authors suggest that there is limited evidence to support