Primary Health Care Research & Development最新文献

{"title":"Using the opinions of coronary heart disease patients in designing a health education booklet for use in general practice consultations","authors":"Claire S Leathem, M. Cupples, M. Byrne, M. Byrne, M. Corrigan, Susan M. Smith, A. Murphy","doi":"10.1017/S1463423609001224","DOIUrl":"https://doi.org/10.1017/S1463423609001224","url":null,"abstract":"Aim This study aimed to explore how the views of patients with coronary heart disease (CHD) could inform the design of an information booklet aimed at providing patients and practitioners with a resource to help influence positive health behavioural outcomes. Background Coronary heart disease has major consequences in terms of patient suffering and economic costs, with morbidity and mortality figures in the United Kingdom and the Republic of Ireland among the highest in Europe. Lifestyle behaviours such as smoking, eating an unhealthy diet and a lack of exercise are strongly associated with an increased CHD risk, and practitioners report that health education materials are used in practice to help advise and educate patients about the consequences of their lifestyle. Methods Opinions of patients with CHD were explored concerning their information needs, particularly lifestyle advice, using a qualitative approach in four general practices. This information was used to design a booklet for a pilot study aimed at promoting healthy lifestyle behaviours and medication adherence among people with CHD. Focus group discussions explored patients’ opinions about the booklet’s ‘fitness for purpose’; semi-structured interviews with practitioners examined their views on the booklet’s usefulness. Findings In initial focus groups, patients identified gaps in their information provision regarding coping with stress, available local community support and medication purpose. Previously published literature was modified to address these gaps. Patients in the pilot study were satisfied with the re-designed booklet. Practitioners reported that its use in consultations enabled change implementation and facilitated patients’ understanding of connections between lifestyle and health outcomes. Acknowledging the opinions of CHD patients in producing health information booklets emphasized a patient-centred approach and therefore supported practitioner–patient partnerships for choosing healthy lifestyle choices.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"50 1","pages":"189 - 199"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91213716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The actuarial basis for financial risk in practice-based commissioning and implications to managing budgets","authors":"Rodney P. Jones","doi":"10.1017/S1463423609990089","DOIUrl":"https://doi.org/10.1017/S1463423609990089","url":null,"abstract":"The aim of this paper is to be both educational and thought provoking. The financial risk associated with acute budgets is an issue which affects everyone in primary care, and the calculation of the size of the financial risk is explained in an easy-to-understand way. The shift in financial responsibility toward practice-based commissioning (PBC) opens the need for a deeper understanding of the actuarial basis of financial risk in healthcare purchasing. This paper first presents the statistical basis for this risk and then looks at the implications to the day to day running of practice budgets, such as what type of reports will be needed, budgets for practices in a group and the issue of overspends. Poisson, Negative Binomial and Extreme Value distributions lie behind the expression of overall financial risk. Low volume and hence, high-risk events, tend to have a high cost, and the high cost further magnifies the underlying chance risk. Particular diagnoses associated with emergency admissions have an even higher risk profile due to the influence of meteorological and environmental factors. In a capitation-funded environment, where the budget is fixed, the financial risk is higher than acceptable for populations of less then 100 000 head. A large proportion of the overall budget needs to lie within a large regional risk pool in order to allow PBC to flourish within a financially stable environment. These conclusions will also apply to health maintenance organizations in the USA.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"27 1","pages":"245 - 253"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79302069","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Childrens’ and parents’ views and experiences of attending a childhood obesity clinic: a qualitative study","authors":"S. E. Owen, D. Sharp, Julian P H Shield, K. Turner","doi":"10.1017/S1463423609990065","DOIUrl":"https://doi.org/10.1017/S1463423609990065","url":null,"abstract":"Aim To explore childrens’ and parents’ views and experiences of attending a hospital-based childhood obesity clinic, in order to inform the development of services in primary care. Background The prevalence of childhood obesity in the UK is rising. Previous literature identifies the need for long-term, regular follow-up during weight management programmes, and acknowledges the difficulties families face when making lifestyle changes. Primary care has been identified as a possible clinical setting that can meet these needs. However, there is a paucity of evidence to guide the development of such services. Method A qualitative interview study was undertaken in a hospital-based childhood obesity clinic in Bristol, England. Short in-depth interviews were held with 21 parents and 11 children attending this clinic. Interviewees were purposefully sampled to ensure interviews were held covering participants of varying age, gender and success in reducing their BMI. The interviews were audiotaped, fully transcribed and analysed thematically. Findings Families valued the multidisciplinary team approach used in the clinic in terms of the education and support it offered. They enjoyed regular follow-up, reporting that this provided ongoing support and motivation. Families whose children succeeded in BMI reduction appeared more resourceful and tended to embrace ideas for making lifestyle changes. Unsuccessful families, however, found it harder to alter their lifestyle and often met barriers to change. The authors conclude that community obesity clinics will need to provide a multidisciplinary service offering regular support and individualized exercise and dietary advice whilst attempting to address barriers to change.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"13 1","pages":"236 - 244"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80228768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Integrating genetic risk assessment for multi-factorial conditions into primary care","authors":"A. Metcalfe, Sue Wilson, D. McCahon, H. V. Sleightholme, P. Gill, T. Cole","doi":"10.1017/S1463423609001200","DOIUrl":"https://doi.org/10.1017/S1463423609001200","url":null,"abstract":"The genetic basis of many common, multi-factorial conditions is increasingly being understood but use of the knowledge created, raises major dilemmas for primary care. Identification of individuals that may be genetically predisposed to serious medical conditions provides the opportunity to offer screening or prophylactic treatment, for early detection or prevention and delay in disease onset in many complex conditions. We describe a new pilot service development to introduce genetic risk assessment for a wide range of conditions to primary care, and discuss the findings from its evaluation. The evaluation highlighted the issues about the incorporation of genetic risk assessment in primary care. The results of the evaluation along with findings from other studies, juxtaposed with the implications of developments in genetics suggest that changes are required to accommodate the integration of genetic risk assessment into primary care clinical practice. We discuss what these changes are, the benefits and drawbacks, and whether primary care can and is ready to make the changes required, further shifting the focus from disease treatment to disease prevention.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"1 1","pages":"200 - 209"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87318207","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Advancing the Expert Patient?","authors":"A. Rogers","doi":"10.1017/S1463423609001194","DOIUrl":"https://doi.org/10.1017/S1463423609001194","url":null,"abstract":"The self-management of long-term conditions undertaken by people in their own homes has been attributed with increasing importance in health care policy. Interventions based on self-skills training have been introduced as a means of promoting and increasing levels of self-care practises in the population which have been informed by psychological models and concepts of change such as in the case of the national policy of the Expert Patients Programme (EPP) self-efficacy. Evidence to date suggests modest or equivocal effectiveness and there may be a number of reasons for this. One of the reasons is a failure to give due attention to the perspectives and work that patients themselves undertake in self-management interventions. Whilst the notion of an Expert Patient conveys a sense of what a new health policy centred on long-term condition management hopes to achieve, an important corollary is understanding the conditions necessary to accommodate and embed new techniques in the routine elements of illness ‘work’ undertaken by patients living with a long-term condition. This paper explores the health policy context of self-management, including the evidence and adequacy of the organizing concepts and outcomes associated with the EPP, and suggests that a greater focus on illness work and the social and domestic contexts is required in future innovation and research in the area of long-term condition management.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"468 1","pages":"167 - 176"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87555441","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What is the role of local enhanced services in building clinical research facilities in primary care?","authors":"S. Shaw, Tracey Johns, Oksana V. Hoile, C. Gunnell","doi":"10.1017/S1463423609990077","DOIUrl":"https://doi.org/10.1017/S1463423609990077","url":null,"abstract":"The implementation of a revised government strategy for UK health research led to a reorientation of primary care research, largely focused on recruitment to, and involvement in, clinical trials. This reorientation prompted consideration of new approaches to developing clinical research facilities able to deliver this agenda. The provision of local enhanced services (LES) allow primary care organizations to provide additional services and thereby offer potential for involving primary care staff in clinical research. This paper describes the development and evaluation of one such LES scheme in the East of England, and highlights potential barriers and facilitators to progress.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"16 1","pages":"274 - 278"},"PeriodicalIF":0.0,"publicationDate":"2009-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85312853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parents’ perceptions of home injury risk and attitudes to supervision of pre-school children: a qualitative study in economically deprived communities","authors":"J. Ingram, A. Emond","doi":"10.1017/S1463423609001078","DOIUrl":"https://doi.org/10.1017/S1463423609001078","url":null,"abstract":"Aim The study sought to explore parents’ views of the injury risks to young children at home and their perceptions of supervision, targeting families living in economically deprived areas, including those living in black and minority ethnic communities. Background Unintentional injury is a leading cause of death and disability in young children; most injury occurs in and around the home, and children from more deprived families are more vulnerable. Inadequate supervision is often cited as an important risk factor in childhood injury. Methods Qualitative semi-structured interviews were carried out with 34 families (23 white, 6 black, 5 South Asian) in economically deprived communities in Bristol, UK from September 2005 to July 2006. Findings The four main interview themes were perceptions of risk, coping with kitchen hazards, attitudes to supervision, and learning strategies. No major differences were seen between different ethnic groups in perceptions expressed or methods used by parents to keep children safe. The common practice of barring children from entering the kitchen when cooking by using stair gates is discussed. Reduced use of safety equipment and a perceived risk of burns from irons in the South Asian communities are highlighted. Constant supervision and learning by experience are common strategies employed by these parents to keep their children safe in often adverse living conditions. Parents need to be aware of the link between child development and injury risk, and also of differences in injury rate as a function of the child’s individual temperament and ability.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"76 1","pages":"98 - 108"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73730992","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"V. Timonen 2008: Ageing societies: a comparative introduction . Berkshire, England: McGraw-Hill Education. 208 pp, £21.99 paperback. ISBN0335222692.","authors":"M. Partis","doi":"10.1017/S1463423609001066","DOIUrl":"https://doi.org/10.1017/S1463423609001066","url":null,"abstract":"","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"88 1","pages":"163 - 164"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85389566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Joining Up Self-Care: evaluation of a PCT-wide programme of support for self-care","authors":"A. Blenkinsopp, J. Holmes, G. Mitra, M. Pringle","doi":"10.1017/S1463423608000984","DOIUrl":"https://doi.org/10.1017/S1463423608000984","url":null,"abstract":"Background and Aim Although there is existing activity within the NHS and local communities to support self-care there has been no previous attempt at integration across a Primary Care Trust (PCT). The Joining Up Self-Care (JUSC) study aimed to implement and evaluate such a programme. Methods Three self-care support modules for members of the public, together with a training course for primary care teams, were developed with, and implemented in, one PCT. The modules related to disease prevention (community-based coronary heart disease (CHD) prevention), care of people with long-term conditions (a disease-specific self-care skills training course for asthma) and the management of minor ailments aimed at mothers of children aged 3 months to 12 years (the ‘Pharmacy First’ service plus information booklets and campaigns). Postal questionnaires were completed by participants in CHD prevention (178), management of asthma (76) and minor ailments management (92), and by controls. A general population survey (n = 540) provided a comparison group for the CHD module and assessed general awareness of local self-care support. Four focus groups were held with mothers of young children. An audit of general practitioner (GP) records was conducted for consultations for minor ailments. Structured telephone interviews were conducted with 51 local health professionals and nine members of staff from the PCT. Results Participants in the CHD module reported significantly more risk-reducing behaviours. Participants in a disease-specific Expert Patient Programme (EPP) for people with asthma rated the course positively, were subsequently more confident about discussing asthma with their doctor and had fewer concerns about their asthma medicines. Most users of the ‘Pharmacy First’ minor ailments scheme reported positive feedback and an intent to use the service again in the future. There were no significant differences in numbers of GP consultations for minor ailments between intervention and control groups. Health professionals were generally positive about encouraging self-care. Many felt they were already doing this but had insufficient time to implement it. A Local Enhanced Service (LES) was successful in engaging local general practices with self-care. Some organizational development relating to self-care occurred within the PCT but integration across different directorates was not achieved. Conclusions The JUSC programme was associated with changes in self-reported CHD risk reduction behaviours, in confidence to manage asthma and fewer concerns about medication, and with more positive attitudes towards consulting a pharmacist for minor ailments. Key principles for future PCT self-care strategies were identified. Further work is needed to embed support for self-care across the PCT as an organization.","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"3 1","pages":"83 - 97"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87521853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PHC volume 10 issue 2 Cover and Front matter","authors":"","doi":"10.1017/s1463423609001170","DOIUrl":"https://doi.org/10.1017/s1463423609001170","url":null,"abstract":"","PeriodicalId":20471,"journal":{"name":"Primary Health Care Research & Development","volume":"69 1","pages":"f1 - f4"},"PeriodicalIF":0.0,"publicationDate":"2009-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80741865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}