This paper describes an initiative in North East London that aimed to facilitate access to training for care-home staff by using a mobile skills-centre in the form of an adapted bus.

It has proved difficult to take a strategic approach to quality assurance in care homes and the first comprehensive national training strategy for the sector was not published until 2000. Staff value and benefit from training, but organizing the provision of education and training may be problematic, given resource constraints and staffing levels that make it difficult to release staff to go off-site.

Collaboration between the School of Community and Health Sciences, City University London; My Home Life, an initiative led by Help the Aged in collaboration with the National Care Forum and City University London; local care homes; local primary care trusts (PCTs); and the Centre for Excellence in Teaching and Learning at City University London and Queen Mary University of London. The project involved facilitation, training in the mobile skills-centre and evaluation through questionnaires.

The project was successful at a number of different levels: providing training to care-home staff; fostering collaborative relationships between care homes and PCTs; providing a forum to enable a wider educational discussion of care-home needs; and stimulating the planning of future education programmes for care-home staff and of the provision in care homes of student nurse placements.

To map the results of four empirical quantitative and qualitative studies to the Normalization Process Model (NPM) to explain why open access hysterosalpingography (HSG) for the initial management of infertile couples has or has not normalized in primary care.

The NPM is an applied theoretical model to help understand the factors that lead to the routine embedding of a complex intervention in everyday practice. Open access HSG has recently become available for the initial assessment of infertility in primary care.

The results of two qualitative studies (a focus group study and an in-depth interview study with patients and professionals) and two quantitative studies (a pilot survey and a pragmatic cluster-randomized controlled trial) evaluating open access HSG are interpreted by mapping the results to the NPM.

Application of the model shows that open access HSG would confer an advantage to all agencies if they could be sure that the expertise was present and supported within primary care.

Open access HSG was adopted but not normalized into everyday practice. Despite demonstration of modest workability, it has been counteracted by limited integration. Further evaluation of integration within contexts is required.

To establish the acceptability of telemetric monitoring of blood pressure to patients and clinicians.

Telemetric monitoring of blood pressure (BP) may allow clinicians and patients, in partnership, to more quickly control high BP through medication and lifestyle alterations. However, it is not clear if patients and clinicians would find such a system acceptable.

Questionnaire study followed by focus groups of patients with high BP, and clinicians involved in managing BP.

We received responses from 25 (50%) practice nurses, 76 (50%) general practitioners and 126 (62%) patients. We ran three focus groups of patients and clinicians. Participants were supportive of the technology, willing to try it, thought it would encourage adherence to medication and lifestyle and felt it would diagnose problems sooner than current methods. However, both groups thought the technology would be more useful for new patients or those whose BP was uncontrolled. They were concerned that individual high readings might provoke anxiety and thought patients would need reassurances about this. Clinicians were concerned about workload and the responsibility to act immediately when faced with a continuous stream of readings, regardless of how inconvenient this may be.

Participants, in general, welcomed this technology and thought it would aid adherence to medication and lifestyle advice, but felt it was most suitable to those with newly diagnosed or uncontrolled hypertension. Patients will need to be educated and reassured about the nature of occasional high readings and the need to consider average BP.

To gain insight into factors affecting patient and practitioner satisfaction with access to healthcare in a remote rural island community.

General practice based primary care is the focus of health service delivery in rural areas of the UK. Individuals from rural populations have reported inequalities in access to healthcare. User satisfaction with service performance is recognised as an important outcome of healthcare. Further investigation into factors underpinning patient and practitioner satisfaction with access to rural healthcare is required.

Qualitative interviews with patients and primary healthcare practitioners.

Isles of Scilly, Cornwall, UK.

A topic guide was developed following review of the literature. In-depth, semi-structured interviews with a purposive sample of 23 participants were conducted with individuals from all inhabited islands. Detailed field notes were kept, and interview content was partially transcribed and analysed thematically.

Principal themes identified were common to patient and practitioner participants. These were: concerns expressed regarding the equitable provision of services; obstacles to using health services; and the outlook of patients and professionals, including expectations, choice, patient–practitioner relationships and community cohesiveness. Emerging themes gave insight into a range of factors affecting satisfaction with access to healthcare.

Despite numerous policy initiatives aimed at reducing inequities in health service provision, problems with access and uptake of health services persist amongst individuals from remote rural populations. If implemented, recent National Health Service proposals may address some of the challenges identified by participants. Service developments need to take account of local priorities, expectations, geography and demography to achieve favourable outcomes.

Are there differences in diabetes care between rural and non-rural US adults with diabetes?

Rural Healthy People 2010 includes diabetes as a major health priority, suggesting a possible disparity between diabetes care in rural settings as compared to non-rural locales.

This cross-sectional study using population-based survey data sought to determine if there was a difference in the quality of diabetes care between rural and non-rural US adults (⩾18 years). A diabetes care index was computed from five separate dichotomous care-related variables (HbA1c checked, lipids checked, dilated eye exam, feet checked by health care provider, and diabetes education), with adequate care defined as receiving at least four of these interventions. Multivariate methods were used to detect differences in diabetes care received by individuals living in rural compared to non-rural settings.

Multivariate regression analysis revealed that US adults with diabetes living in rural communities were more likely to receive inadequate care than non-rural residents (OR = 1.205; 95% CI 1.201, 1.209). Rural residents were more likely to receive inadequate diabetes care if they were: <40 years of age, male, Caucasian, not a high school graduate, not partnered, without health insurance, inactive or without an identified health care provider. Those deferring medical care because of cost, or who did not have an annual routine physical or had fewer than two diabetes related office visits annually were also at greater risk for suboptimal care. Routine physical checkups and deferring medical care because of cost had a greater impact on diabetes care for rural adults compared to non-rural adults.

The results of this study indicated that rural residents were less likely to receive adequate diabetes care compared to their non-rural counterparts. The findings suggest that efforts to identify and to address this disparity would likely improve the outcomes for diabetic individuals living in rural communities.

The aim of this paper is to describe the experience of community pharmacists participating in a pilot of an information prescription service aimed at children and their parents, in the wider context of factors relevant to the adoption of new services in community pharmacies.

Information prescriptions (IP) are conceived to signpost patients to information and advice that will increase self-efficacy. The Department of Health for England has supported IP development with a national programme of pilots, only one of which incorporated distribution of IP through community pharmacies. The new contract for community pharmacy, implemented in 2005, formalized cognitive services, including information-giving about medicines and health, and positioned signposting as a core activity. There are, however, concerns about the impact of such services on the capacity of community pharmacy.

Qualitative semi-structured telephone interviews were conducted with key informants: seven pharmacists in four IP pilot community pharmacies in England (‘IP pharmacists’), and 22 other pharmacy and medicines information stakeholders. Two interviews were conducted with each IP pilot pharmacist (before and during the pilot), and one with all other stakeholders.

IP pharmacists, and other stakeholders, identified a number of benefits for parents of children with long-term conditions in receiving IP, and hoped that most parents would welcome the service. Many anticipated operational challenges consistent with those of other new cognitive community pharmacy services, such as medicines use review. Pharmacists completing IP for parents found it satisfying and straightforward. Recruitment of parents to the pilot, however, fell below IP pharmacists’ expectations. The lack of interest in the service from parents, who are assumed to be generally welcoming of information about their child’s condition, was both surprising and disappointing to them. IP should be integrated into a wider, integrated medicines and information strategy.

This paper reports on a recent review of the prevalence of glaucoma, and identifies factors that impact on its variable reporting.

Glaucoma is a recognized chronic degenerative health problem worldwide, in which approximately two-thirds of sufferers are undiagnosed. Therefore it is important to better quantify glaucoma prevalence to plan adequate resources for effective risk screening, diagnosis, management and prevention. Accurate prevalence data also assist in determining the nature of relationships between glaucoma and putative risks.

A comprehensive search of peer-reviewed databases was conducted to identify and critically appraise secondary evidence published between 2002 and 2007. Glaucoma definitions, prevalence, incidence and risk factor data were extracted and compared in the context of their population descriptors.

There was no standard definition of glaucoma or standard population descriptors (age, ethnicity, country) utilized by either the primary studies included in the secondary evidence or as inclusion criteria in the secondary evidence. Prevalence for glaucoma of between 1–4% was commonly reported. Despite this, the influence of age and ethnicity on glaucoma prevalence within specific populations was repeatedly highlighted. There was consistency across studies of the decreased risk of white (European) populations compared with other ethnic groups. There was an exponential increase in prevalence of glaucoma over decades of increasing age. There were limited Australian data; however, prevalence of open-angle glaucoma is comparable with international figures. There is a clear need for worldwide agreement on standard epidemiological descriptors of glaucoma, using standard population frameworks, terminology and age groups.

To describe the impact of interactions with health care professionals revealed by people’s accounts of living and dying with cancer; to explore reasons for the observed effects; and thus, to consider the implications for practice.

The importance of practitioner–patient interactions is enshrined within professional values. However, our understanding of how and why the consultation impacts on outcomes remains underdeveloped. Stories recounted by people living and dying with cancer offer important insights into illness experience, including the impact of contact with health services, framed within the context of the wider social setting in which people live their lives. From our recent study of distress in primary palliative care patients, we describe how people’s accounts revealed both therapeutic and noxious effects of such encounters, and discuss reasons for the observed effects.

A qualitative study with a purposive sample of 19 primary palliative care patients: (8 men, 11 at high risk of depression). In-depth interviews were analysed using the iterative thematic analysis described by Lieblich.

Living with cancer can be an exhausting process. Maintaining continuity of everyday life was the norm, and dependent on a dynamic process of balancing threats and supports to people’s emotional well-being. Interactions with health care professionals were therapeutic when they provided emotional, or narrative, support. Threats arose when the patient’s perception of the professional’s account of their illness experience was at odds with the person’s own sense of their core self and what was important to them. Our findings highlight the need for a framework in which clinicians may legitimately utilize different illness models to deliver a personalized, patient-centred assessment of need and care. The work provides testable hypotheses supporting development of understanding of therapeutic impact of the consultation.

To describe approaches to recruitment, key challenges and strategies to improve recruitment among research organizations in the UK.

Recruiting research participants is challenging. Less than one-third of studies recruit to target on time.

Descriptive survey with 31 participants from 22 public and private sector organizations.

We identified a range of recruitment pathways, highlighting the extensive range of activities required throughout the process. Methods reported to improve recruitment were related to project management, context and resources. There were differences in emphasis between sectors concerning prioritization of staff roles, feasibility work and marketing.

Organizations involved in primary care research adopt diverse approaches, yet cross-fertilization between groups is limited