A recent General Practice digest,
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Study Type: Observational study (pre-post with regression discontinuity design)

Key Question: Did Australia's minimum age-16 social media legislation meaningfully reduce social media use in under-16s within three months of implementation?

Key Findings:

• Over 85% of under-16s still reported using regulated platforms at follow-up, predominantly via their own accounts (54–68%)
• Daily use reduced modestly in 14–15 year olds (78% → 69%) but was stable in 12–13 year olds; regression discontinuity analysis found no statistically significant discontinuity at the age threshold (p≥0.60)
• Circumvention was common: fake accounts (15–19%) and private browsing (6–11%); age verification was mostly self-declared age or selfie upload

Clinical Relevance: As UK policymakers consider similar age-restriction legislation, this signals that minimum-age laws alone are unlikely to achieve short-term reductions in adolescent social media exposure without robust enforcement mechanisms.

Limitations: Small sample (n=408), short follow-up (~3 months), and self-reported outcomes limit conclusions about longer-term policy effects.

Study Type: Systematic review and meta-analysis

Key Question: Does direct access (DA) to physiotherapy reduce medication and imaging prescriptions compared with GP-led care for musculoskeletal disorders in primary care?

Key Findings:

• DA was associated with 43% fewer medication prescriptions vs GP-led pathways (RR 0.57, 95% CI 0.40–0.83; I² 60%; GRADE: low certainty; n=2,993 across 4 studies)
• Sensitivity analysis was consistent (RR 0.56, 95% CI 0.43–0.73; I² 45%)
• Imaging outcomes were inconclusive due to sparse data; a multi-modality analysis suggested reduced imaging but was non-significant (RR 0.48, 95% CI 0.16–1.41; very low certainty)

Clinical Relevance: With musculoskeletal conditions among the most common GP presentations in NHS primary care, DA physiotherapy may meaningfully reduce prescribing burden, supporting existing NHS First Contact Practitioner physiotherapy models.

Limitations: Only four studies contributed to the primary outcome, with low GRADE certainty, limiting confidence in effect size estimates.

Study Type: Qualitative study (focus groups)

Key Question: How does interpreter modality (virtual vs. in-person) affect the care experience for patients with non-English language preferences, from professional medical interpreters' perspectives?

Key Findings:

• Four themes emerged: relationship development; understanding and accuracy; accessibility/flexibility/flow; and care quality
• Interpreters predominantly favoured in-person interpretation for fostering human connection, ensuring accuracy, and promoting health equity
• Virtual interpretation was seen as acceptable in specific circumstances where access or flexibility were priorities (e.g., rare languages, urgent availability)

Clinical Relevance: In UK general practice, where language barriers affect significant patient populations and remote consultations are now routine, this supports careful consideration of when telephone/video interpretation is clinically appropriate versus when in-person interpreters should be prioritised.

Limitations: Findings reflect interpreter perspectives only — patient and clinician views are absent, limiting transferability of conclusions.

Study Type: Whole-of-population interrupted time-series analysis (cohort study using linked national administrative data)

Key Question: Did Australian telehealth policy changes affect uptake and timeliness of GP chronic disease management (CDM) services between 2018 and 2022?

Key Findings:

• Universal telehealth introduction (March 2020) maintained CDM service uptake; trends were stable compared to pre-pandemic
• Removing subsidised telephone CDM (July 2021) caused a significant drop: −4.0 users and −6.9 services per 1000 population/month (95% CI −6.3 to −1.7 and −10.5 to −3.3 respectively)
• Telehealth uptake peaked at 38.7% in month one (predominantly telephone at 37%), falling to 2.2–5.4%/month once telephone-only access was removed; timeliness improvements also stalled

Clinical Relevance: This supports the case for retaining telephone (not just video) as a subsidised modality for CDM reviews in UK general practice, where digital exclusion remains a significant equity concern.

Limitations: Australian Medicare data may not generalise directly to NHS commissioning structures or UK population demographics.

Study Type: Retrospective cohort study

Key Question: Does herpes zoster serve as a clinical marker for undiagnosed Type 2 diabetes in adults aged 65–84?

Key Findings:

• Cumulative 1-year incidence of new T2DM was 2.4% in the herpes zoster group vs 0.3% in matched controls
• Herpes zoster was associated with a markedly elevated risk of newly diagnosed T2DM (HR 6.52; 95% CI 4.92–8.63) after propensity score matching
• Authors propose herpes zoster may reflect underlying immune-metabolic disruption preceding T2DM diagnosis

Clinical Relevance: In UK general practice, a new herpes zoster diagnosis in older adults may warrant opportunistic HbA1c screening, potentially identifying undiagnosed T2DM earlier and enabling timely intervention.

Limitations: Retrospective US database design limits causal inference and generalisability to NHS populations; residual confounding cannot be excluded despite propensity score matching.

Study Type: Qualitative study (participatory health research with workshop intervention and mixed-method evaluation)

Key Question: How does a co-creation interprofessional collaborative practice intervention affect osteoporosis management in primary care, as experienced by nurses and physicians?

Key Findings:

• Three workshop sessions across five primary care centres (12 participants) enabled staff to co-create locally tailored osteoporosis care protocols
• Participants reported an expanded nursing role in osteoporosis management and improved interprofessional collaboration as key perceived outcomes
• Organisational, professional, and resource-related factors were identified as critical barriers or enablers to sustaining procedural change

Clinical Relevance: With osteoporosis management increasingly task-shifted in UK general practice, this supports structured interprofessional co-design as a practical model for developing nurse-led pathways within primary care teams.

Limitations: Small sample (12 participants across 5 centres in Sweden) limits transferability to NHS primary care contexts with different workforce structures and commissioning arrangements.

Study Type: Systematic review (24 studies: 17 quantitative, 7 qualitative; US literature 1961–2024)

Key Question: What are the effects of urban hospital closures on population health, healthcare access, and community stability?

Key Findings:

• Closures disproportionately affected socioeconomically deprived, racially diverse neighbourhoods, with greatest impact on uninsured, Medicaid, elderly, and minority populations
• Quantitative outcomes consistently showed increased travel distances, longer wait times, and reduced emergency and specialist access; mortality findings were mixed
• Qualitative evidence identified disrupted care continuity, significant workforce displacement, and loss of hospitals as social anchors within communities

Clinical Relevance: Although US-focused, findings are directly relevant to UK debates around district general hospital reconfiguration and NHS site consolidation, particularly regarding inequitable impacts on deprived communities already facing access barriers.

Limitations: All included studies are from the US healthcare context, limiting direct transferability to NHS or other universal-coverage systems.

Study Type: Retrospective cohort study

Key Question: Have General Internal Medicine inpatients become more complex over time, and does this explain increasing pressure on hospital resources?

Key Findings:

• GIM admissions across 21 Ontario hospitals rose 17% (103,851 to 121,103) between 2015–16 and 2021–22, but most patient complexity metrics (comorbidity burden, outcomes) did not consistently increase.
• CT and MRI use rose substantially: CT from 49% to 61% of admissions (aRR 1.45, CI 1.40–1.50); MRI from 11% to 14% (aRR 1.46, CI 1.39–1.54).
• COVID-19 period was associated with increased length of stay, in-hospital mortality, laboratory use, and costs — representing an atypical complexity spike.

Clinical Relevance: For NHS general practice, this challenges the assumption that rising hospital pressures are driven by sicker patients; escalating diagnostic imaging intensity may be a modifiable contributor to resource strain.

Limitations: Canadian single-province administrative data may not generalise to NHS hospital settings.