Alex Burrell is a GP in Bristol and Associate Editor at BJGP Open.
Yonder: a diverse selection of primary care relevant research stories from beyond the mainstream biomedical literature
Access and quality of life
Access to primary care is, as ever, a major issue. However, one aspect that isn’t often explored is the impact of employer policies on seeking health care during working hours. This study from the University of Manchester used data from the General Practice Patient Survey to explore the relationship between health-related quality of life and whether or not people are allowed time off to attend healthcare appointments.1 Those with no constrained access to health care had significantly higher health-related quality of life scores, and were more likely to be male, aged >44 years, and of white ethnicity. This effect was heightened in patients with a longterm condition. Areas of socioeconomic deprivation contained higher proportions of individuals with constrained access. Should the onus be on the healthcare system to provide extended access to accommodate work schedules, or should healthcare access form part of an employer’s responsibility for their employee’s health?
Vaccine hesitancy
Vaccine uptake in the UK continues to fall for childhood immunisations, with no vaccines currently meeting the 95% coverage target.2 Uptake of COVID-19 boosters has also been falling among eligible patients. This survey study aimed to explore vaccine hesitancy in England, looking at both people who refused COVID-19 vaccinations and those who received them despite being hesitant, or ‘hesitant adopters’.3 In the population sampled, gender (male compared to female or non-binary), ethnicity (mixed, Asian or Black compared to white ethnicities), level of education (college or undergraduate compared to postgraduate), those more prone to belief in conspiracy theories, and those aligned with right-wing authoritarianism were more likely to be hesitant towards the vaccine. Concerns over the efficacy or safety of the vaccine as well as a belief that one’s own immune system was sufficient to combat infection were also associated with vaccine refusal. These findings should be considered in future public health campaigns, though selection and reporting biases are issues in this survey of predominantly university students.
SABAs and acute cardiovascular events
Short-acting beta agonists (SABAs) have been under the spotlight in recent years, with SABA overuse an important predictor of a number of adverse outcomes. This database study takes a slightly different approach, the association between SABA use and acute cardiovascular events (ACE), excluding patients with >1 course of oral steroids to avoid the confounding relationship between frequent steroid use and cardiovascular mortality.4 A higher number of SABA prescriptions in a 3-month period was associated with a significantly increased incidence of ACE. This relationship was stronger when patients with any oral steroid prescription were excluded. This could either reflect direct actions of SABA on the cardiovascular system, or poorly controlled airways disease with potentially unreported exacerbations being independently associated with increased cardiovascular risk.
Air quality
The World Health Organization estimates that 2.4 billion people are subject to dangerous levels of pollution daily, with the combined effects of ambient and household air pollution being associated with 7 million premature deaths each year. This database study in the US aimed to study the impact of air quality on 5-year all-cause mortality.5 When adjusted for the confounders of age, gender, ethnicity, region, and year of entry into study, there was significant association between poor air quality and a higher hazard of mortality. This association was heightened for older adults and Black/African American patients. This clearly has public health implications, but the authors also argue there is a need for individual clinicians to use real-time air quality maps to ‘routinely assess the air quality in their patients’ environments.’
References
1. Wilding A, Moss C, Munford L, Sutton M. Impact of constrained access to primary care on health-related quality of life. Value Health 2025; DOI: https://doi.org/10.1016/j.jval.2025.07.013.
2. NHS England. Childhood vaccination coverage statistics, England, 2023–24. 2024. https://digital.nhs.uk/data-andinformation/publications/statistical/nhsimmunisation-statistics/england-2023-24 (accessed 1 Sep 2025).
3. Annandale G, Kola-Palmer S, Duke É. The complex landscape of vaccine hesitancy and hesitant adopters: quantitative predictors and thematic insights into COVID-19 vaccine attitudes. Hum Vaccin Immunother 2025; 21(1): 2511350.
4. Pfeffer PE, Heatley H, Hubbard R, et al. Association of frequent short-acting beta agonist inhaler prescriptions with acute cardiovascular events. Pragmat Obs Res 2025; 16: 147–154.
5. Periyakoil D, Chu I, Prata N, Diener-West M. The impact of air quality on patient mortality: a national study. IJERPH 2025; 22(7): 1123.
Featured photo by Mathurin NAPOLY / matnapo on Unsplash.
