Identifying patients with chronic musculoskeletal pain using database searches is difficult, as chronic pain is not represented with a unique diagnostic code in electronic primary care records.

This paper describes the development and implementation of a search strategy to identify patients with chronic musculoskeletal pain in primary care databases to invite them to participate in a randomised controlled trial.

We used an exploratory, iterative approach. The first phase involved consultations with IT specialists, practice managers and doctors to gain an understanding about the processes and issues of electronic coding. In the second and third phases, we determined the most appropriate search terms and strategies. In the final phase, we tested, modified and re-tested the search strategy until the quantity and quality of the output appeared good enough to be used in general practices with different IT systems. This strategy was then implemented to recruit participants for a trial.

We identified three main search ‘domains’: prescribing, coding and attendance. We found the most useful identifier for chronic pain was the use of repeat medication. Wide variations in coding terms for chronic pain were seen between practices and individuals. Understanding ‘coding cultures’ were necessary to inform the electronic searches. In the case of chronic pain, searching on repeat medication for analgesia, low dose antidepressants and carefully selected coding terms captured most relevant patients.

Chronic obstructive pulmonary disease (COPD) may cause some psychiatric disorders such as depression and anxiety, similar to other chronic diseases. Treatment adherence may be affected by worsening of cognitive functions. We aimed to show whether the symptoms of anxiety and depression affect treatment adherence by patients.

Seventy-eight COPD patients were analysed at the first visit. The use of bronchodilator therapy was revised for standardization before they attended a second visit after six months. Hospital Anxiety and Depression Scale (HADS), Anxiety Sensitivity Index-3 (ASI-3) and SF-36 Questionnaire were carried out at that visit. ‘National Guide of Turkish Thoracic Society for Asthma’ was used for scoring method of use of the bronchodilator and evaluating treatment adherence (including maintenance therapy).

Sixty-two of 78 patients, 53 (85.5%) men and nine (14.5%) women with a mean age of 64.9 ± 9.9 joined the second visit. Thirty-three patients (53.2%) had a high-treatment adherence (HTA), whereas 29 (46.8%) had a low-treatment adherence (LTA). There were high scores of anxiety in 18 (29%) and depression in 11 (17.7%) patients. There was no statistical difference between the HTA and LTA groups in means of age, gender, educational level, presence of comorbidity, classification of COPD, high anxiety scores according to HADS and ASI-3 scores. Of the patients, 41.4% in the LTA group were still smoking, whereas it was only 12.1% in the HTA group (P = 0.009). The LTA group had higher depression scores (P = 0.004) than the HTA group. Dyspnea was found more frequent in LTA patients (P = 0.047); vitality score was also statistically low in this group (P = 0.01).

As a result, continuing smoking and the presence of depression symptoms may decrease adherence to treatment. Therefore, to increase the adherence to treatment and reduce symptoms such as dyspnea, it is important to treat any depressive symptoms that are present and to help patients cease smoking.

Our aim was to compare the return-to-work rates between individuals supported by their GP plus workplace health advisers (intervention group) and those supported by their GP alone.

Workplace sickness absence places a significant cost burden on individuals and the wider economy. Previous research shows better outcomes for individuals if they are supported while still in employment, or have been on sick leave for four weeks or less. Those helped back to work at an early stage are more likely to remain at work. A non-medicalised case-managed approach appears to have the best outcomes and can prevent or reduce the slide onto out-of-work benefits, but UK literature on its effectiveness is sparse.

The design was a feasibility-controlled trial in which participants were sickness absentees, or presentees in employment with work-related health problems. Individuals completed health status measures (SF-36; EQ-5D) and a Job Content Questionnaire at baseline and again at four-month follow-up.

In the intervention group, 29/60 participants completed both phases of the trial. GP practices referred two control patients, and, despite various attempts by the research team, GPs failed to engage with the trial. This finding is of concern, although not unique in primary care research. In earlier studies, GPs reported a lack of knowledge and confidence in dealing with workplace health issues. Despite this, we report interesting findings from the case-managed group, the majority of whom returned to work within a month. Age and length of sickness absence at recruitment were better predictors of return-to-work rates than the number of case-managed contacts. The traditional randomised controlled trial approach was unsuitable for this study. GPs showed low interest in workplace sickness absence, despite their pivotal role in the process. This study informed a larger Department for Work and Pensions study of case-managed support.

To conduct a follow-up survey ascertaining changes in usage, referral rate, beliefs and attitudes towards complementary and alternative medicine (CAM) during the last decade.

In many countries, CAM use is reported to be substantial and increasing.

A questionnaire was posted to all GPs registered with the Liverpool Primary Care Trust. Respondents were asked whether they treat, refer, endorse or discuss eight common CAM therapies and about their views on National Health Service (NHS) funding, effectiveness, CAM training needs and theoretical validity of each therapy. Comparisons were made between these results and those collected in 1999.

The response rate was low (32%) compared with the 1999 survey (52%). The main findings were similar to the most popular therapies still being acupuncture, hypnotherapy and chiropractic and the least being aromatherapy, reflexology and medical herbalism. GPs felt most comfortable with acupuncture, with greater belief in its theoretical validity, a greater desire for training and a greater support for acupuncture to receive NHS funding than for the other CAM therapies under question. Opinions about homeopathy had become less supportive. Overall, GPs were less likely to endorse CAMs than previously shown (38% versus 19%).

Work ability and work ability assessments have become important both in health care and in relation to granting sick leave. There are different interpretations of work ability among the different professionals involved, and there is no consensus on how work ability should be assessed.

The aim was to analyse how a group of experienced and specially trained physiotherapists (PTs) in primary health care (PHC) perceived their professional role in work ability assessments during 14 months.

We conducted a prospective focus group study and applied qualitative content analysis to the data.

There was a need to emphasise the PTs’ role both within PHC and also in relation to others involved. The PHC organisation was not really prepared to direct work-disabled patients to PTs before physicians. In addition, the PTs themselves needed to reorganise to better meet the requirements. The PTs underlined the advantage of their frequent and extended meetings with patients. This made it possible to assess, follow and facilitate work ability and to determine patients’ resources. The PTs believed that they could contribute to structured assessments, which was positive for themselves and also in their communication with physicians and patients. The PTs later took more initiatives in work ability questions and believed that they could be responsible for work ability assessments to a greater extent. They found it most valuable to have had the opportunity to reflect on work ability, while working in the focus groups, and also to have been the subjects for further education. This made them more prepared to handle work ability questions when compared with other colleagues.

To explore the views of non-morbidly obese people (BMI 30–40 kg/m2) with type 2 diabetes regarding: (a) the acceptability of bariatric surgery (BS) as a treatment for type 2 diabetes, and (b) willingness to participate in randomised controlled trials comparing BS versus non-surgical intervention.

Despite weight management being a key therapeutic goal in type 2 diabetes, achieving and sustaining weight loss is problematic. BS is an effective treatment for people with morbid obesity and type 2 diabetes; it is less certain whether non-morbidly obese patients (BMI 30–39.9 kg/m2) with type 2 diabetes benefit from this treatment and whether this approach would be cost-effective. Before evaluating this issue by randomised trials, it is important to understand whether BS and such research are acceptable to this population.

Non-morbidly obese people with type 2 diabetes were purposively sampled from primary care and invited to participate in semi-structured interviews. Interviews explored participants’ thoughts surrounding their diabetes and weight, the acceptability of BS and the willingness to participate in BS research. Data were analysed using Framework Analysis.

To map the availability and types of depression and anxiety groups, to examine men's experiences and perception of this support as well as the role of health professionals in accessing support.

The best ways to support men with depression and anxiety in primary care are not well understood. Group-based interventions are sometimes offered but it is unknown whether this type of support is acceptable to men.

Interviews with 17 men experiencing depression or anxiety. A further 12 interviews were conducted with staff who worked with depressed men (half of whom also experienced depression or anxiety themselves). There were detailed observations of four mental health groups and a mapping exercise of groups in a single English city (Bristol).

Some men attend groups for support with depression and anxiety. There was a strong theme of isolated men, some reluctant to discuss problems with their close family and friends but attending groups. Peer support, reduced stigma and opportunities for leadership were some of the identified benefits of groups. The different types of groups may relate to different potential member audiences. For example, unemployed men with greater mental health and support needs attended a professionally led group whereas men with milder mental health problems attended peer-led groups. Barriers to help seeking were commonly reported, many of which related to cultural norms about how men should behave. General practitioners played a key role in helping men to acknowledge their experiences of depression and anxiety, listening and providing information on the range of support options, including groups. Men with depression and anxiety do go to groups and appear to be well supported by them. Groups may potentially be low cost and offer additional advantages for some men. Health professionals could do more to identify and promote local groups.

To describe experiences among patients with chronic obstructive pulmonary disease (COPD) of the lasting usefulness one year after participating in a multidisciplinary pulmonary rehabilitation (PR) programme in a primary health care (PHC) setting.

COPD affects patients’ functioning in daily life. In a previous study, the patients participated in a programme for PR and were found to increase their functional capacity, quality of life and decrease exacerbations. The present study aims to provide a deeper understanding of the experience of participating in the programme.

The study has a descriptive, qualitative design and is part of a longitudinal study on a multidisciplinary programme for PR of patients with COPD.

Semi-structured interviews with 20 participants were performed and data analysed by qualitative content analysis.

The findings are presented in one theme that illustrates the participants’ experience of their current situation; I live life at my own pace, and three sub-themes illustrating this experience related to the participation in the programme; Awareness of limitations in my life; Regained control over my life; and No change in my life.

Irrespective of whether the patients had already found their own strategies for managing the disease or whether the programme changed their lives, they lived their lives at their own pace. However, their lives were shadowed by worry.

A multidisciplinary programme for PR in PHC could be an alternative for patients suffering from COPD, in order to facilitate for them in their daily life. It is suggested that the inclusion of patients in such groups should be based on each individual's need based on symptoms or functional capacity in everyday life, not based on spirometry values.

Acceptance and commitment therapy (ACT), a form of cognitive-behavioral therapy, may help meet a need for accessible and cost-effective treatments for chronic pain. ACT has a growing evidence base, but has not yet been tested within general practice settings.

The purpose of the present study was to examine the feasibility of conducting a full-scale randomized controlled trial of ACT in general practice.

A total of 481 potential participants with chronic pain identified from general practice in southwest England were invited into a treatment trial. Subsequently, 102 (21.2%) of those invited were screened, and 73 (71.6%) of those screened were allocated to ACT plus usual care or usual care alone. The ACT treatment included four, four-hour group-based sessions over two weeks.

Twenty-six (70.3%) of the patients allocated to ACT attended three or four sessions. Those who received ACT rated it as credible in a short survey, with Mdn rating 7.0 on a 0–10 scale, across five credibility items. During a post-treatment interview considering 12 aspects of the study from invitation to treatment termination, a median of 79.2% of participants rated the aspects ‘acceptable.’ Qualitative data from the interviews showed a mixed picture of patient experiences, revealing possible tensions between patients’ wishes to avoid discomfort and confusion, and treatment methods that explicitly ask patients to, in essence, ‘live with’ some discomfort and confusion.

These data suggest that further study of ACT, as a treatment for chronic pain, is feasible in general practice and it may be possible to further optimize the treatment experience.

To identify clinical cues indicative of depression in medical records of cases in primary care with undetected depression.

Depressive disorders are common; the lifetime risk for men and women is 27% and 45%, respectively. Despite effective treatment methods such as antidepressants and cognitive behavioural therapy, depression often remains undiscovered in primary care, with great implications both on the individual and societal level.

Clinical cues indicating depression were sought in medical records the year before an opportunistic screening for depression in primary care. In a previous study of 221 patients in the waiting room of a primary care centre during 10 randomly selected days, 45 (20%) showed signs of depression (MADRS-S ⩾ 12) and 60% of these were verified as having depressive disorders (Prime-MD). These 45 patients constitute the cases in the present study. Age- and gender-matched controls were selected among those who scored below the chosen cut-off level.

Seventeen (38%) of the 45 cases compared with eight (18%) of the 45 controls had one or more cues [odds ratio (OR) 2.81; 95% confidence interval (CI): 1.06–7.43]. Sleep disturbance showed the greatest difference between cases and controls (OR 4.53; 95% CI: 1.17–17.55). A significant relationship was found between severity of depression, frequency of cues and lower functional level. Cues were twice as common in patients with undetected depression and their functional level was lower. A two-stage procedure, screening and a structured diagnostic interview, is recommended when sleep disturbances and lowered function are present.

The UK Society for Academic Primary Care (SAPC) is re-examining the sustainability of careers in academic primary care (APC). The motivation for this is a number of significant changes within the context of APC since the last such investigation (SAPC, 2003). It is now timely to review the current situation.

As a first phase, semi-structured interviews were undertaken with 15 SAPC members from different disciplines and career stages.

Findings show that lack of clarity about APC career pathways persist, but important factors linked with sustainability were identified at individual and organisational levels. These include being proactive, developing resilience, mentorship and a positive organisational culture with a strong shared vision about why APC is important.

Sustainability is undermined by funding difficulties, lack of integration of members of different APC disciplines, leading to disparities in career progression and lack of clarity about what APC is. Phase 2 will comprise a UK-wide survey.