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 ascertain the prevalence of urinary incontinence and lower urinary tract symptoms, impact on quality of life and help-seeking behaviour.

Urinary incontinence is common and will affect more individuals as the population ages. Estimates of the prevalence of urinary incontinence vary hugely. Additional information is required to inform resource allocation.

Population-based cross-sectional postal evaluation of all female patients over 21 years registered at a single medical practice in the United Kingdom.

A total of 40% of respondents suffered urinary incontinence, which caused significant problems in 8.5%. Stress urinary incontinence was the most common type of incontinence while 10% had symptoms of voiding dysfunction. A total of 17% of women had sought professional help. Patients perceived that urinary incontinence was part of the natural ageing process and that there was a low expectation of successful treatment.

The aim of the study was to determine whether positive psychological interventions (PPIs) in a primary health care setting would improve physical and mental health over time.

Most treatments for depression focus on reducing symptoms rather than on creating positive states of mental health. Empirical studies to verify the efficacy of PPIs in primary health care are needed.

In a six-week pilot program, we invited patients in a primary health care setting with symptoms of depression to participate in groups designed to increase levels of happiness. The program involved interventions such as engaging in good deeds, writing gratitude letters, and introducing empirical research. Patients completed the SF12v2® at the beginning and end of the program and at three- and six-month follow-up. Measures included physical functioning, bodily pain, mental health, social functioning, and vitality. Patients also participated in focus groups to discuss their experiences.

Of the 124 patients who enrolled in this pilot study, 75 completed the six-week program, and 35 participated in two follow-up assessments. Among the participants who remained for all follow-up assessments, scores improved from baseline to 6-month follow-up for health, vitality, mental health, and the effects of mental and physical health on daily activities. This subset of patients reported greater energy and more daily accomplishments, along with reductions in functional limitations. Improvements in mental and physical health and functioning were shown over a six-month period. The study provides a basis for the further investigation of PPIs in creating improvements for patients with depression in primary health care.

The aim was to explore adults’ experiences of their family members’ use of interpreters in health-care encounters.

Language barriers are a major hindrance for migrants to receive appropriate healthcare. In a foreign country, family members often need support in care of migrant patients. No previous studies focusing on adult family members’ experiences of the use of interpreters in healthcare have been found.

A purposive sample of 10 adult family members with experiences of the use of interpreters in health-care encounters. Data were collected between May and September 2009 by focus-group interviews and analysed with qualitative analysis according to a method described for focus groups.

Three categories emerged from the analysis: (1) Experiences of the use of professional interpreters, (2) Experiences of being used as an interpreter and (3) Experiences of what needs to be improved when using interpreters. The main findings showed no agreement in family members’ experiences; interpretation should be individually and situationally adapted. However, when family members acted as interpreters, their role was to give both practical and emotional support, and this led to both positive and negative emotions. Use of simple language, better collaboration in the health-care organization and developing the interpreters’ professional attitude could improve the use of professional interpreters. The type of interpreter, mode of interpretation and patient's preferences should be considered in the interpretation situation. In order to achieve high-quality healthcare, health-care professionals need to organize a good interpretation situation case-by-case, choose the appropriate interpreters with the patient in focus and cooperate with members of the patient's social network.

The aim of the present study was to describe the development of Families First, a new mentalization-based group intervention model for supporting early parenthood. The general aim of the intervention was to support well-functioning models of parenting and prevent transmission of negative parenting models over generations, and thus promote child development and overall family health.

In the Finnish society, great concern has aroused during the last decade regarding the well-being and mental health of children and adolescents. Increased number of divorces, poverty, substance abuse, and mental health problems among parents enhance the risk for child neglect and abuse. New effective, preventive, and health-promoting intervention tools are greatly needed to support families with young children. At present, the Families First intervention is being implemented in primary social and healthcare units all over Finland.

This article will provide a theoretical understanding of the importance of parental mentalization for the development of the parent–child relationship and the development of the child as well as proposed mechanisms of actions in order to enhance mentalizing capacity. The cultural context will be described. The article will also provide a description of the scientific evaluation protocol of the intervention model. Finally, possible limitations and challenges of the intervention model are discussed.

The purpose of this study is to assess the effectiveness of diabetes self-management education (DSME) in a rural agricultural town.

In this prospective, education-intervention trial, 85 adults with type 2 diabetes mellitus from villages randomly assigned to DSME and 70 from villages assigned to standard care participated. The DSME group underwent a curriculum delivered by peer educators; those in the standard group received usual advice. Outcome measures were anthropometric, biochemical, health behaviors, and medication use data taken at baseline then after three and six months.

DSME group had a lower median A1C after three and six months. After six months, there was a 0.5% median A1C reduction in DSME group and a 0.25% increase in the standard group. There were more participants in DSME group with A1C ⩽7.0% after three and six months. By the third month, there were more participants in DSME group performing foot examination.

DSME in this rural agricultural town improved glycemic control and promoted foot examination.

To explore how irritable bowel syndrome (IBS) impacts on patients’ lives in order to explain the reported reduction in quality of life (QOL).

IBS affects 10–20% of the population and over half of the people with the condition consult in primary care, with many consultations ending unsatisfactorily. IBS is known to have a detrimental effect on the QOL, though the mechanisms through which this is affected are poorly understood. A greater understanding of the patient experience of IBS would facilitate better healthcare provision.

Eighteen semi-structured, in-depth interviews were undertaken in the West Midlands, United Kingdom from August 2006 to March 2008. Interviews were carried out until data saturation was achieved. All interviewees had previously taken part in one of the two recent primary care-based IBS studies and were long-term sufferers of IBS. Participants were purposively sampled to capture a range of experiences and included both genders, a range of ages, symptom severity scores and IBS sub-types.

In contrast to the previously reported ‘worried well’ label, participants reported integration of the disease into their lives to the extent that it became a part of their identity. Even so, IBS did at times prevent their participation in everyday activities. Strategies used by participants to manage symptoms were an integral part of daily living and events which threatened routine coping strategies caused stress and exacerbated symptoms. Both adaptive and maladaptive coping strategies were identified. These were in part patient created, but for many incorporated advice or medication provided by their doctor. The findings not only confirm the extensive impact of IBS on daily living but also expose the additional impacts of IBS on emotional well-being and self-identity. The reduced QOL reported in previous studies may be an underestimate of the impact of IBS on patients’ lives as patients integrate coping mechanisms completely into daily living.

To conduct a process-based evaluation of the inception and early implementation of a social prescribing initiative (Healthy Connections Stewartry) in two UK General Practices.

Prescribing a range of social, cultural, arts and educational activities to clients in primary care (known as ‘social prescribing’ or ‘community linking schemes’) as a means of addressing long-term physical health conditions and promoting mental health and well-being is becoming increasingly prominent and popular. However, concerns exist over a lack of evidence of effectiveness and formalised insights into how such initiatives may be optimally implemented.

Within a case study design and using 1–1 semi-structured interviews, three related data sets were developed over a 12-month period from 30 purposively sampled informants: the project steering group; the wider primary care team; and various community groups. Data analysis drew on various theoretical resources, particularly those pertaining to nurturing sufficient capacity for the organisational ‘normalisation’ of this practice and understanding the dynamic flows and linkages between potential clients, ‘prescribing’ primary care staff and the available community resources.

The inception and implementation of the initiative had been broadly successful and that more generally, there were grounds to suggest that these practices were becoming ‘normalised’ into the day-to-day cultures and routines of the primary care organisations. A series of procedural features are considered significant in achieving such ends. Some specific barriers to change are identified and ultimately in the context of potential ‘transferability’, a wider reflection is undertaken of the potential for such innovative practice to become established in less advantageous organisational circumstances. Fundamental difficulties are recognised and thus the need for formally implemented ‘change’ processes. Furthermore, for social prescribing to become a pervasive feature of health-care provision, the need for necessary capacity and resources is stressed.

Depression, isolation, low self-esteem, and lack of hope are just a few of the characteristics evident in adolescents involved in bullying. The aims of this study are as follows: to examine the association between involvement in school bullying and depressive symptoms and suicide ideation among victims, bully victims, and those uninvolved; to investigate the effects of vulnerability factors on depression and suicide ideation among subjects aged 17 involved in school bullying.

A self-reported school-based survey was completed by 290 secondary school students aged 17 years, attending the third grade, coming from 15 different classes of secondary schools in the Tuzla (coming from each municipality in the Tuzla Canton), 2007. Using peer nominations, three groups were established: victims, bully victims, and uninvolved participants as control group subjects. Data were obtained using a self-rated questionnaire on bullying, Beck inventory to identify depression and suicide ideations, and state-trait anxiety scales to assess anxiety state/trait among examinees. Data analysis was performed using SPSS version 12.0.

There was an increased prevalence of depression (29.0% versus 8.8%) and suicidal ideation (16.1% versus 3.5%) in adolescents who have been victims in relationships to respondents who were uninvolved subjects. There was an increased prevalence of depression (17.5% versus 8.8%) and suicidal ideation (15.8.1% versus 3.5%) in adolescents who have been bully victims in relationships to respondents who were uninvolved subjects too. Adolescents who are victims and those who are bully victims are more likely to have suicide ideation compared to uninvolved subjects. Discontent with financial situation is a vulnerability factor associated with elevated levels of depression in victims.

In evaluations of students involved in bullying behavior, it is important to assess depression and suicide ideation.

To present an overview of effective interventions for quality improvement in primary care at the practice level utilising existing systematic reviews.

Quality improvement in primary care involves a range of approaches from the system-level to patient-level improvement. One key setting in which quality improvement needs to occur is at the level of the basic unit of primary care – the individual general practice. Therefore, there is a need for practitioners to have access to an overview of the effectiveness of quality improvement interventions available in this setting.

Design: A tertiary evidence synthesis was conducted (a review of systematic reviews). A systematic approach was used to identify and summarise published literature relevant to understanding primary-care quality improvement at the practice level. Quality assessment was via the Critical Appraisal Skills Programme tool for systematic reviews, with data extraction identifying evidence of effect for the examined interventions. Scope: Included reviews had to be relevant to quality improvement at the practice level and relevant to the UK primary-care context. Reviews were excluded if describing system-level interventions. Outcome measures: A range of measures across care structure, process and outcomes were defined and interpreted across the quality improvement interventions.

Audit and feedback, computerised advice, point-of-care reminders, practice facilitation, educational outreach and processes for patient review and follow-up all demonstrated evidence of a quality improvement effect. Evidence of an improvement effect was higher where baseline performance was low and was particularly demonstrated across process measures and measures related to prescribing. Evidence was not sufficient to suggest that multifaceted approaches were more effective than single interventions.

Evidence exists for a range of quality improvement interventions at the primary-care practice level. More research is required to determine the use and impact of quality improvement interventions using theoretical frameworks and cost-effectiveness analysis.

The aim of this study was to explore the realities of everyday nursing practice associated with the implementation of a guideline for the assessment and management of cardiovascular risk.

The use of clinical practice guidelines is pivotal to improving health outcomes. However, the implementation of guidelines into practice is complex, unpredictable and, in spite of much investigation, remains resistant to explanation of what works and why. Exploration of the nature of guideline implementation has the potential to illuminate the complexities of guideline implementation by focussing on the nature of practice. Nurses are well placed at the front line of primary health care to contribute to an understanding of how guideline implementation plays out in their everyday practice.

Qualitative description was used, involving focus groups and interviews with 32 participants (20 nurses, four doctors, five managers and three funder/planners), to explore the use of a guideline in everyday primary health-care practice. Thematic analysis of data was managed through an inductive process of familiarisation, coding, categorising and generation of themes.

Four themes were generated from the data portraying the realities of guideline implementation for primary health-care nurses: self-managing patient, everyday nursing practice, developing new relationships in the health team and impact on health-care delivery. The findings reveal that, even with the best of intentions to implement the guideline, health professionals were frustrated and at a loss as to how to achieve that in practice. Consequently, cardiovascular risk assessment and management was uneven and fragmented. Primary health-care practice environments vary so much that solutions to the difficulties of implementing evidence into practice requires context-specific solution-finding through collaborative teamwork. Furthermore, the attention of guideline developers, health-care policymakers, funders and researchers requires direct focus on the ‘how’ and the ‘what’ of evidence implementation.

Primary care providers and researchers wishing to estimate study recruitment rates need estimates of illness frequency in primary care. Previous studies of children’s symptoms have found that presentations are most common for the symptoms: cough, fever, earache, rash, diarrhoea and vomiting. Since 2000, primary care provision in the United Kingdom has changed with the introduction of Walk-in-Centres (WICs) and new Out of Hours (OoHs) providers.

To describe the type and frequency of parent-reported presenting symptoms at a range of primary care sites between 2005 and 2007.

Parent-reported presenting symptoms, recorded in their own words, were extracted from data collected from all children aged six months to six years during recruitment to a randomised controlled trial. Presenting symptoms were coded and presented as frequency per 100 ‘consulting sessions’ by type of primary care site.

Results were evaluated from 2491 episodes of illness at 35 sites. When grouped by primary care site, respiratory symptoms were the most common at OoHs centres, the WIC and general practitioner (GP) surgeries. Trauma symptoms were common in the Emergency Department, but unexpectedly, diarrhoea and vomiting were more common in the Emergency Department and skin presenting symptoms more common at the WIC than at GP sites.

We report the relative frequency of acute symptoms by type of primary care provider. These data may be useful to those planning recruitment to primary care paediatric studies and policy makers for planning primary care service provision.

This qualitative study investigates how the Electronic Patient-Reported Outcome (ePRO) mobile application and portal system, designed to capture patient-reported measures to support self-management, affected primary care provider workflows.

The Canadian health system is facing an ageing population that is living with chronic disease. Disruptive innovations like mobile health technologies can help to support health system transformation needed to better meet the multifaceted needs of the complex care patient. However, there are challenges with implementing these technologies in primary care settings, in particular the effect on primary care provider workflows.

Over a six-week period interdisciplinary primary care providers (n=6) and their complex care patients (n=12), used the ePRO mobile application and portal to collaboratively goal-set, manage care plans, and support self-management using patient-reported measures. Secondary thematic analysis of focus groups, training sessions, and issue tracker reports captured user experiences at a Toronto area Family Health Team from October 2014 to January 2015.

Key issues raised by providers included: liability concerns associated with remote monitoring, increased documentation activities due to a lack of interoperability between the app and the electronic patient record, increased provider anxiety with regard to the potential for the app to disrupt and infringe upon appointment time, and increased demands for patient engagement. Primary care providers reported the app helped to focus care plans and to begin a collaborative conversation on goal-setting. However, throughout our investigation we found a high level of provider resistance evidenced by consistent attempts to shift the app towards fitting with existing workflows rather than adapting much of their behaviour. As health systems seek innovative and disruptive models to better serve this complex patient population, provider change resistance will need to be addressed. New models and technologies cannot be disruptive in an environment that is resisting change.

Patients living in rural areas often need to travel long distances for access to specialist care. To increase access to specialist care, video consultation between patients in primary healthcare and specialist care has been used. In order for this new method to be developed and used to the fullest, it is important to understand healthcare personnel’s experiences with this intervention.

The aim of this study was to describe healthcare personnel’s experiences using video consultation in their work in primary healthcare.

A mixed methods design was used, and the data were analysed using qualitative and quantitative analysis methods. Interviews were conducted with eight general practitioners and one district nurse, all of whom had conducted a video consultation with a patient and a specialist physician or a cardiac specialist nurse. After each video consultation, the participants completed a consultation report/questionnaire.

Healthcare personnel considered video consultation to provide quicker access to specialist care for the patient, and greater security when the video consultation encounter was conducted at their own primary healthcare centre. They considered video consultation an opportunity to provide education and for the patients to ask questions.

Video consultation is a satisfactory tool for healthcare personnel, and the technology is a new, useful method, especially for the district nurses. Further, video consultation is an opportunity for healthcare personnel to learn. However, for it to work as an accepted method, the technology must function well and be user friendly. It must also be clear that it is beneficial for the patients and the healthcare personnel.

Our objective was to integrate lessons learned from perinatal collaborative care programs across the United States, recognizing the diversity of practice settings and patient populations, to provide guidance on successful implementation.

Collaborative care is a health services delivery system that integrates behavioral health care into primary care. While efficacious, effectiveness requires rigorous attention to implementation to ensure adherence to the core evidence base.

Implementation strategies are divided into three pragmatic stages: preparation, program launch, and program growth and sustainment; however, these steps are non-linear and dynamic.

The discussion that follows is not meant to be prescriptive; rather, all implementation tasks should be thoughtfully tailored to the unique needs and setting of the obstetric community and patient population. In particular, we are aware that implementation on the level described here assumes commitment of both effort and money on the part of clinicians, administrators, and the health system, and that such financial resources are not always available. We conclude with synthesis of a survey of existing collaborative care programs to identify implementation practices of existing programs.

We aimed to compare recalled information on medication use, self-care activities and pain intensity among primary care low back pain consulters with diary records of the same events.

Concerns are often expressed regarding the validity of recalled information about past experience of health events such as pain or its treatment. Comparing with information collected using daily diaries is one method of validating recalled findings.

Patients completed diaries recording their medication use, self-care activities and pain intensity each day for two weeks. Immediately following this period, patients completed questionnaires asking for recall of their medication use, self-care activities and least, worst, usual and current pain for the previous two weeks. The recalled information obtained from the questionnaires was compared with data from the daily diaries using intraclass correlation coefficients (ICC) and κ, with one-sided 95% confidence intervals.

All 29 participants returned 11 or more diaries. Validity of questionnaire-based recall for medication use and self-care activities was good, with everyone who reported use in the diaries also reporting this on the questionnaires (both κ = 1.0). However, some specific medications (eg, diclofenac) were over-reported in the questionnaires, and some self-care activities (eg, exercises) were under-reported. Combinations of pain intensity ratings were more accurate than single ratings; the mean of the recalled least, usual and current pain intensities was closest to the diary ratings (ICC 0.94, mean difference 0.13). The generalisability of these findings to other settings, recall periods and patient groups remains to be established.