To describe the context, mechanisms and outputs of a regional primary care partnership for research facilitation over a three-year period, and evaluate factors which were likely to be worth replicating in the new UK Clinical Research Network (UKCRN) structures.

The revision of NHS research and development structures into the UKCRN has presented organizational challenges to pre-existing partnerships. This raises questions of whether pre-existing arrangements had already delivered effective research facilitation in NHS settings, and makes evaluation of successful practice a crucial part of organizational learning for the current management of research delivery in the UK.

A mixed methods case study in one R&D consortium (Norfolk and Waveney, England). Using a model of realistic evaluation, we analysed context, mechanisms, working practices, and outcomes for research delivery in the primary care context – covering key priorities of research governance and ethics, hosting and recruiting to studies, and training and support approaches.

From January 2005 to December 2007, 35 general practices opted into a host practice research network, each hosting an average of 10 studies over that period, with 278 projects being active overall. By the last year, an extension of network activity to all practices in Norfolk, Great Yarmouth and Waveney had led to 96% of all practices delivering at least one study, and a turnaround, from application to commencement of approved studies, of 28 days for 74% of studies. This level of activity can act as a baseline for future UKPCRN activities, and the factors associated with it may be helpful for others seeking to provide an effective networking structure. The larger structures of the new UKCRN regional networks will be able to draw on extensive good practice in some areas, and should be sure to preserve these, as they may already be fulfilling the important goals for which UKCRN was created.

This longitudinal study was designed to address four research questions and the hypothesis; that adults living in a rural community receiving primary health care and emergency services from a team that included an on-site nurse practitioner (NP) and paramedics and an off-site family physician would, over time, demonstrate evidence of improved psychosocial adjustment and less expenditure of health care resources.

In Canada, there is a growing awareness and commitment to addressing the challenges of providing primary health care services in rural areas. A literature review supported the role of NPs in primary health care and a potential role for paramedics. No studies were found that evaluated the combination of NPs, paramedics and physicians as providers of primary health care.

Structured questionnaires, individual and group interviews with patients, health and social service care providers and administrators and community members were used to describe and evaluate the impact of the model of care over the three years of the study.

The innovative model of care resulted in decreased cost, increased access, a high level of acceptance and satisfaction and effective collaboration among care providers. Organizational structures to support the innovative model of primary health care were identified.

To identify and describe the meaning of support and its impact on the life-situation of people diagnosed with Type 2 diabetes mellitus in relation to gender, age and duration of disease.

Social support can buffer the level and effects of stress. Diabetes requires self-care that is demanding and may cause stress. No previous investigations focusing on the perceptions of people with diabetes, concerning the content, need and desire they might have for social support, have been found.

A purposive sample of 40 Swedish adults, 24 men and 16 women, diagnosed with Type 2 diabetes was included. Mixed methods were employed and qualitative data were collected by semi-structured interviews and quantitative data collected using the Norbeck Social Support Questionnaire (NSSQ).

Participants described the meaning of support as mainly concerning informative and emotional support in managing diabetes. Women, independent of the duration of diabetes, experienced support as limited or non-existent when treated outside hospital/specialized care. Some men reported being given informative support and sufficient material support from health care professionals on diagnosis. Respondents considered the need for support individual, differing with regard to gender and age. Men were assumed to need more support and women were considered to have better networks. Younger people were perceived to need more support to learn to live with diabetes. NSSQ measurement showed people with diabetes scoring low figures on total emotional support, total aid and total function. Men scored higher on emotional support, aid and network than women.

Diabetes demands knowledge about managing the disease and self-care, which is why informative and emotional support is important to gain control over the situation. Informants had perceived lack of support, particularly during the process of diagnosis of diabetes, in their contact with physicians and with primary health care.

Ongoing structured patient education, for those with type 2 diabetes, is a core requirement within diabetes health policy. Although type 2 education programmes are becoming established in the UK, a recent review reveals mixed results with little evidence to suggest whether or how such programmes might be directed, to achieve maximal benefit. Black and ethnic minority peoples, and poor and socially disadvantaged groups are especially vulnerable to the effects of the disease. What are the attitudes of these hard-to-reach groups towards diabetes learning?

Eight semi-structured interviews were carried out on participants from different cultural backgrounds. All were from the same primary-care setting, who had type 2 diabetes for more than 12 months. Potential participants were asked to opt in to the research process by invitation letter and in-house poster advertisement. Purposive sampling was undertaken on those who opted in. When recruitment proved difficult, targeted personal approaches were undertaken opportunistically, to increase the opt-in rate, and allow further purposive sampling. During analysis, themes and categories emerged inductively from participants’ dialogue, with no ‘a priori’ categories or themes. The themes were then linked into a map, which ultimately described the whole. The sample size was too small to be representative of the practice population and as such findings were not generalisable to a wider setting.

Diabetes education was highly valued, it was needed so that people felt well and alive; it had to be a respectful experience involving listening and being listened to. It was necessary for the learning to be personal, the desire coming from within. Previous learning related to employment had involved being shown the ropes and was viewed positively. Past diabetes learning had taken place in family settings, in informal meetings and within consultations with health professionals. These were generally preferred to formal classes. The quality of the learning experience was very important to participants. Stress and depression were barriers to learning and diminished capacity to change. The hard to reach are aptly named when trying to recruit for interview studies.

To define the predictive value of clinical diagnosis of chronic obstructive pulmonary disease (COPD) or suspected COPD in primary care patients with spirometric criteria for diagnosis.

The diagnosis of COPD is usually made clinically but often not confirmed by diagnostic testing. Recent initiatives have called for universal spirometry testing in primary care to diagnose and monitor such patients the implications of this policy on diagnostic accuracy are not as yet known.

Retrospective comparative analysis of 677 consecutive primary care referrals to a district general hospital lung function laboratory for spirometry, March 1998 to December 2006.

Five hundred and three of 677 patients referred for open access spirometry had a primary care clinical diagnosis or suspected diagnosis of COPD. When compared with NICE spirometric criteria for diagnosis of COPD, 141 patients (28%) had normal spirometry, 46 (9%) had reversible airflow obstruction and 14 (3%) a restrictive pattern of spirometry. The positive predictive value of a primary care clinical diagnosis of COPD was 0.62 for patients referred for assessment of severity and 0.56 for those referred for diagnostic testing. Clinical suspicion of COPD in this sample was not confirmed by spirometry in a high proportion of referred patients. The introduction of the widespread use of spirometry for confirmation of primary care clinician made COPD diagnosis have important implications for both individual patients and primary care service planning.

Colorectal cancer is the third most common cancer in the UK. Referral guidance can help general practitioners (GPs) identify predictive symptoms of colorectal cancer at an earlier stage in primary care. The objectives of this study were to test the feasibility of a paper-based assessment tool incorporating the CAPER score, a clinical prediction rule for patients presenting to primary care with lower gastrointestinal (GI) symptoms. Three different recruitment methods and GP compliance with completing the CAPER score were assessed.

Patients aged 45 years and above consulting for bowel-related symptoms were recruited in 25 general practices in five regions in the UK. Two recruitment methods were carried out by practice receptionists and one by the GP (GP-prompted). The assessment tool prompted GPs to calculate a score using CAPER; a score of 35 points or over indicated a study referral. Three audits assessed recruitment success, compliance with the assessment tool and clinical outcomes.

In total, 122 patients were recruited into the trial. Although overall recruitment was low, GP-prompted recruitment was more successful than the other two methods. Most GPs completed a clinical examination (92.6%) as directed by the assessment tool; however, only 64% of GPs completed a rectal examination. GPs did not comply well with carrying out haemoglobin (48%) and faecal occult blood (FOB) tests (38%). Only 55% of the final CAPER scores were calculated correctly by GPs. Four patients were diagnosed with colorectal cancer; all met the referral criteria for the CAPER score; however, only three met the NICE referral criteria.

Overall, recruitment into the study was lower than expected. GP-prompted recruitment was the most effective. Assessment tool compliance was low, which indicates that in future trials a more user-friendly design should be developed.

To explore the acceptability amongst general practitioners (GPs) of an early intervention to prevent long-term sickness absence from work and to identify the appropriate broad characteristics of such a service.

The effect of long-term sickness absence from work on individuals and society has been the subject of recent policy debate. In the United Kingdom, a number of return-to-work interventions have been piloted and plans to reform the incapacity benefit system are underway. Since GPs play a key role in the sickness certification process, their views on the appropriateness of an early return-to-work intervention were sought to help inform the development of a primary care-based model.

A panel of nine GPs from eight practices in a mixed rural/urban area of the South West of England participated in a modified RAND/UCLA appropriateness method (RAM) study. Panellists completed two rounds of an online survey in which they were asked to read a summary of relevant research evidence and then rate the level of appropriateness of providing a return-to-work intervention in a series of clinical scenarios.

There was general support for a return-to-work intervention. Panellists considered the intervention would be more appropriate for patients with mild-moderate rather than severe symptoms and for those with longer symptom duration. There was support for early intervention after approximately seven weeks of absence from work, but not before four weeks of absence. The return-to-work intervention was considered most appropriate for patients with repeat or recurrent patterns of sickness absence, rather than those on their first sickness absence period, and for those not already receiving specialist health input for their condition. Panellists considered that a multidisciplinary team providing a combination of biopsychosocial and vocational support would be the most appropriate model, with the service possibly being located outside of a general practice setting.