The edition · Family Medicine
Navigation, not leaflets, is what got people to lung cancer screening
Which screening invitations work, what patients and pharmacists say about polypharmacy reviews, why a named-GP scheme succeeded in one Finnish practice and not another, and a self-management programme for people at risk of diabetic kidney disease.
The edition in brief
A meta-analysis of 14 completed studies found that shared decision-making plus patient navigation (OR 4.34) and active outreach plus navigation (OR 2.20) increased completion of low-dose CT lung cancer screening, while education alone (OR 1.03) and shared decision-making alone (OR 1.15) did not; certainty was low. A BJGP qualitative study of 24 patients, pharmacists and GPs in Manchester found polypharmacy reviews often lack a clear purpose and that patients see their medicines as the means of sustaining daily life, while clinicians focus on harm; deeper problems were tackled only through continuity and trust. A Finnish before-and-after study found a named-GP model was genuinely adopted in one unit (88% of visits with the named GP) but stayed largely nominal in another (40%), depending on stable GP presence. A Chinese randomised trial in 134 people with type 2 diabetes at high risk of kidney disease found a 12-week self-management programme improved HbA1c, eGFR, systolic pressure and LDL cholesterol at 24 weeks, but not albuminuria. The pearl covers giving a medication review one stated purpose.
Patients see polypharmacy as what keeps life going; clinicians see it as risk
Start a polypharmacy review by asking what each medicine does for the patient's daily life, and agree a purpose for the review before changing anything.
A named-GP model worked where GPs stayed, and stayed nominal where they did not
If you introduce named-doctor lists, protect stable GP presence and appointment systems that route patients to their own doctor.
A 12-week self-management programme improved HbA1c, blood pressure and lipids in people at risk of diabetic kidney disease
Structured self-management support is worth offering to people with type 2 diabetes at high kidney risk, alongside drug treatment.
Give every medication review one stated purpose
Open each medication review by agreeing with the patient one goal, such as fewer side effects, fewer tablets or a safer fall risk.
Patient navigation more than doubled lung cancer screening uptake; information alone showed no effect
When inviting eligible patients for low-dose CT screening, pair the invitation with active outreach and a named navigator, not information alone.
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