To explore the extent to which national policy in end-of-life care (EOLC) in England influences and guides local practice, helping to ensure that care for older people at the EOL is of a consistently good quality.

Whilst policy is recognised as an important component in determining the effectiveness of EOLC, there is scant literature which attempts to interrogate how this happens or to hypothesise the mechanisms linking policy to better outcomes.

This article reports on the second phase of a realist evaluation comprising three case studies of clinical commissioning groups, including 98 in-depth interviews with stakeholders, meeting observation and documentary analysis.

This study reveals the key contextual factors which need to be in place at micro, meso and macro levels if good quality EOLC for older people is to be achieved. The findings provide insight into rising local inequalities and reveal areas of dissonance between stakeholder priorities. Whilst patients privilege the importance of receiving care and compassion in familiar surroundings at EOL, there remains a clear tension between this and the medical drive to cure disease and extend life. The apparent devaluing of social care and subsequent lack of resource has impacted significantly on the way in which dying is experienced.

Patient experience at EOL, shaped by the care received both formally and informally, is driven by a fragmented health and social care system. Whilst the importance of system integration appears to have been recognised, significant challenges remain in terms of shaping policy to adequately reflect this. This study highlights the priority attached by patients and their families to the social and relational aspect of death and dying and shines a light on the stark disparities between the health and social care systems which became even more evident at the height of the Covid-19 pandemic.

To explore the influence of health beliefs and behaviours on diabetes management in British Indians, as successful management of diabetes is dependent on underlying cultural beliefs and behaviours.

British South Asians are six times more likely to suffer from type II diabetes than those in the general population. Yet, little research has been carried out into beliefs about diabetes among the British Indian population.

The study used semi-structured interviews, a structured vignette and a pile-sorting exercise. In all, 10 British Indians were interviewed at a General Practice in North West London.

Those interviewed were informed about their diabetes but had difficulties in adapting their diet. Themes identified included causal beliefs of diabetes, use of alternative therapies, moderation of food, adaption of exercise regimes and sources of information. All were aware of avoiding certain foods yet some still continued to consume these items. Participants expressed the need for culturally sensitive forums to help manage their diabetes.

The aim of this scoping review is to explore the evidence by which community service providers have integrated reablement models of staff training and client assessment into practice.

The concept of reablement, which has emerged during the last two decades globally, has recently been defined by health experts from 11 countries through a Delphi study. Reablement is seen as a way to support integrated frameworks that achieve person-centred, long-term care and assistance across community settings. International research indicates there is some evidence of developing models of reablement that include staff training and individual components of client assessment. However, evidence of integrating reablement into interdisciplinary practice continues to be sparse.

The review adopted the preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) approach. Inclusion criteria for the review related to community care, primary care, long-term care, and residential care. Populations of interest included service providers, interdisciplinary staff, trainers, and assessors.

A total of 11 papers were reviewed. The studies varied in their approach to reablement training and client assessment frameworks. Three studies included assessment of staff well-being. All included evidence-based, person-centred components that can be integrated across health care settings. Single disciplinary approaches were used in all studies and some included training evaluation.

This review has identified that currently reablement models are not yet embedded as frameworks for practice by community service providers in primary health care settings. Different programmes of training and assessment are being designed based on single disciplinary approaches and the context in which they are delivered. Further developmental work is required to integrate the components of discipline-specific training programmes within interdisciplinary frameworks. This will achieve not only an integrated framework for delivery across settings but also further the success of ‘ageing in place’ policy.

An exploratory study of the Cardiff Bangladeshi community in a primary care setting, prior to the development of culturally appropriate diabetes health education.

British Bangladeshis are one of the most economically deprived communities in Britain, with high morbidity and mortality rates from chronic illness. Access and use of their services is perceived by Primary Health Care Teams (PHCTs) to be difficult, due to communication and cultural barriers.

One-to-one tape-recorded interviews were held in Sylheti, Bengali or English with an age-stratified sample from the community registered with a practice in central Cardiff. The N*DIST package was used to analyse data, with ongoing discussion of emerging themes. The topics explored in these interviews were family structure and decision making within families, meal patterns, health beliefs, experiences of primary care and barriers to engaging with the outside world.

Family structure and social patterns had many similarities with those of the local community, and dietary and health beliefs also followed ‘Western’ concepts. People were anxious to be healthy, but often did not know about core primary care services. The community places value on the opinion and support of primary care professionals. However, a major cross-cutting theme was difficulty in accessing health care (especially for women), and reasons for this are discussed in the paper. With this information, the PHCT can now consider adapting itself to improve access and communication. We suggest that our methodological approach is both relevant and achievable for those working in primary care settings in our increasingly multi-cultural, ethnically mixed communities, and is not purely the province of sociologists or academics (important learning points have been identified and highlighted).

Prison health care in England, including primary care, is now incorporated into the National Health Service; the impetus for the change is in part due to concern about standards of health care within prisons. The demographic characteristics and health status of patients within prisons are relatively well understood, as are the problems faced by health care professionals. Less is known about current health care provision.

To describe the organisation of primary health care and specialised services in prisons and compare services available to different types of prison.

A piloted questionnaire was sent to the governors of all prisons in England and Wales for completion by the health care manager.

Completed questionnaires were received from 122 (89%) of 138 prisons. The survey showed a low use of information technology (IT). Problems were reported with the recruitment and retention of general nurses in more than 50% of prisons. Prisoners in category A/B (higher security) prisons had available to them a greater range of health care services compared with those in other prisons. The results suggest that provision of services for chronic diseases and improvements in IT are needed. Problems with the recruitment and retention of general nurses need addressing. The reasons why lower-security prisoners are receiving a narrower range of specialised health care services compared with higher-security prisoners need justifying.

To investigate how acceptable and feasible a school-based contraceptive clinic (SBCC) would be in a low-income South African community.

Teenage pregnancy is an important issue in South Africa, with significant health and social consequences. Issues regarding lack of confidentiality in an intimate community, unwelcoming health workers, long distances to clinics and perceptions of contraceptive side effects may all inhibit contraceptive use by adolescents. Although SBCC has been initiated and investigated in other countries, this approach is inadequately researched in South Africa.

A mixed method study was conducted to assess the attitudes of one community towards establishment of an SBCC in their area. Methods of data collection included: focus group discussions (FGDs) with teenage girls from a local high school; a key informant interview with the school principal; a structured survey, including open-ended questionnaires with randomly selected parents of teenage girls from the same community; and a documentary analysis to explore relevant legal and policy considerations.

Teenage girls, the school principal and parents with teenage daughters largely supported the idea of an SBCC, but with concerns about confidentiality, the possibility of increased promiscuity and contraceptive side effects. While legal statutes and policies in South Africa do not pose any barriers to the establishment of an SBCC, some logistical barriers remain.

To explore the current status of academic primary care research in Arab countries and investigate the barriers to its adequate implementation.

Research is an essential building block that ensures the advancement of the discipline of Family Medicine (FM). FM research thus ought to be contributed to by all family physicians; nevertheless, its development is being hindered worldwide by several challenges. The amount of research conducted by academic academic family physicians and general practitioners is scant. This phenomenon is more pronounced in the Arab countries.

An online questionnaire was emailed to all academic family physicians practicing in member Arab countries of the World Organization of Family Doctors WONCA-East Mediterranean Region.

Seventy-six out of 139 academic family physicians from eight Arab countries completed the questionnaire. Around 75% reported that they are required to conduct research studies, yet only 46% contributed to at least one publication. While 75% and 52.6% disclosed their interest in participating in a research team and in leading a research team respectively, 64.5% reported being currently involved in research activities. Of all, 56% have attended a research ethics course. Lack of training in research, the unavailability of a healthcare system that is supportive of research, insufficient financial resources, and the unavailability of electronic health records were perceived as major barriers in conducting FM research.

Although many physicians in Arab academic institutions expressed enthusiasm to conduct research projects, FM research infrastructure remains to be weak. This demonstrates the need for immense efforts from different parties particularly governments and academic institutions.

The aim of this study was to conduct a comparative follow-up assessment of clients with depressive symptoms attending monk healers or primary care clinics in Thailand.

Consecutively attending clients of three monk healing and three primary care centres who screened positive (a score of 9 or more) on the Primary Health Questionnaire (PHQ)-9 at the study site were followed up at 3 months after baseline assessment.

In 3 monk healer sites, 448 clients agreed to be screened with the PHQ-9 for depression, and 94 screened positive, and in 3 health centres 582 clients agreed to be screened, and 92 screened positive for depressive symptoms on the PHQ-9. In 2 monk healing sites, 79 clients (84%) were followed up at 3 months, and in 3 health centres, 79 clients (85.9%) were followed up at 3 months. At 3-month follow-up, mixed modelling found significant interaction effects (a time-by-condition interaction, i.e., between-group changes) on depression scores (P = <0.001). Depressive symptoms significantly decreased over time, but there was no significant difference in decline between the two groups.

Clients attending monk healers decreased more in depressive scores compared to clients attending primary care centres, though there was no group effect with respect to number of depressed clients.

To describe the process by which the 12 community-based primary health care (CBPHC) research teams worked together and fostered cross-jurisdictional collaboration, including collection of common indicators with the goal of using the same measures and data sources.

A pan-Canadian mechanism for common measurement of the impact of primary care innovations across Canada is lacking. The Canadian Institutes for Health Research and its partners funded 12 teams to conduct research and collaborate on development of a set of commonly collected indicators.

A working group representing the 12 teams was established. They undertook an iterative process to consider existing primary care indicators identified from the literature and by stakeholders. Indicators were agreed upon with the intention of addressing three objectives across the 12 teams: (1) describing the impact of improving access to CBPHC; (2) examining the impact of alternative models of chronic disease prevention and management in CBPHC; and (3) describing the structures and context that influence the implementation, delivery, cost, and potential for scale-up of CBPHC innovations.

Nineteen common indicators within the core dimensions of primary care were identified: access, comprehensiveness, coordination, effectiveness, and equity. We also agreed to collect data on health care costs and utilization within each team. Data sources include surveys, health administrative data, interviews, focus groups, and case studies. Collaboration across these teams sets the foundation for a unique opportunity for new knowledge generation, over and above any knowledge developed by any one team. Keys to success are each team’s willingness to engage and commitment to working across teams, funding to support this collaboration, and distributed leadership across the working group. Reaching consensus on collection of common indicators is challenging but achievable.

Patient and public involvement (PPI) plays a crucial role in ensuring research is carried out in conjunction with the people that it will impact upon. In this article, we present our experiences and reflections from working collaboratively with patients and public through the lifetime of an National Institute for Health Research (NIHR) programme grant; the Chronic Headache Education and Self-management Study (CHESS) which took place between 2015 and 2020.

We worked closely with three leading UK migraine charities and a lay advisory group throughout the programme. We followed NIHR standards and used the Guidance for Reporting Involvement of Patients and the Public checklist. We consulted our PPI contacts using a variety of methods depending on the phase of the study and the nature of the request. This included emails, discussions, and face-to-face contact.

PPI members contributed throughout the study in the programme development, in the grant application, ethics documentation, and trial oversight. During the feasibility study; in supporting the development of a classification interview for chronic headache by participating in a headache classification conference, assessing the relevance, and acceptability of patient-reported outcome measures by helping to analyse cognitive interview data, and testing the smartphone application making suggestions on how best to present the summary of data collected for participants. Due to PPI contribution, the content and duration of the study intervention were adapted and a Delphi study with consensus meeting developed a core outcome set for migraine studies.

The involvement of the public and patients in CHESS has allowed us to shape its overall design, intervention development, and establish a core outcome set for future migraine studies. We have reflected on many learning points for the future application of PPI.

The article seeks to provide evidence of developments in relation to the extent and type of information sharing between primary care trusts (PCTs) and other settings involved in the assessment and provision of services for older people with health and social care needs following the introduction of the Single Assessment Process (SAP) in England.

Poor communication between health and social care agencies with regard to individual service users has been an issue of concern internationally for many years. The SAP was introduced in 2001 in order to address some of the shortcomings in health and social care assessments of older people evident in the research and policy literature. An important element of this new procedure was the development of systems and practices to improve information sharing between agencies and settings.

The data were derived from a national cross sectional postal survey of SAP lead officers, responsible for implementation of the policy in geographical localities. Questions reflected the policy guidance issued by government. Data were analyzed using SPSS 14.

A response rate of 82% was achieved. Agreements regarding the transfer of information were more developed between PCTs and local authorities than with other agencies and settings. Some key elements of the SAP, as defined by the guidance, were not found to be in routine use. Traditional methods of information sharing were far more in evidence than were electronic approaches. Nonetheless, the SAP appears to offer a useful framework for improving inter-agency communication, an issue of perennial concern.

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.

The aims of the study were to describe the characteristics of meals-on-wheels (MOW) recipients, including prevalence of malnutrition amongst those who have received input from the Nutrition and Wellbeing Service (NWS) and to explore whether the NWS had an impact on the nutritional status (malnutrition risk) of recipients over time.

Support services, for example, MOW, play an important role in the prevention and treatment of malnutrition in the community. In the UK, MOW services are under threat. However, little is known about how they support the health and well-being of older people. This study reports on the characteristics of MOW recipients and investigates change in nutritional status over time.

A retrospective study of MOW recipients of nutritional concern who were offered a check through the NWS was conducted. Demographic, social and health information were gathered at the initial visit. Nutritional status (risk of malnutrition) was obtained using the validated Malnutrition Universal Screening Tool (MUST), at the initial and subsequent visits. Changes over time were investigated for recipients receiving at least two follow-up visits.

An initial visit was made to 399 MOW recipients, and 148 recipients had two or more follow-up visits. At initial screening, 177 (44%) of recipients were at medium or high risk of malnutrition. Frailty was significantly related to malnutrition risk (P = 0.049). At follow-up, there was a reduction in malnutrition risk.

The MOW service was associated with a reduction in malnutrition risk. By offering well-being visits within a MOW service, malnutrition can be identified early. Future studies into how MOW services might delay or prevent the need for support from acute health services and social care are warranted.

To examine the choices Canadian family medicine residents make for oral anticoagulation (OAC) for patients with nonvalvular atrial fibrillation (AF).

AF increases the risk of strokes. An important consideration in AF management is risk stratification for stroke and prescription of appropriate OAC. Family physicians provide the vast majority of OAC prescriptions.

We administered a survey to residents in multiple Canadian family medicine training programmes. Questions explored the experiences and attitudes towards risk stratification and choices of OAC when presented with standardized clinical scenarios. In each scenario, a novel oral anticoagulant (NOAC) would be the preferred treatment according to the contemporary Canadian and European guidelines.

A total of 247 residents participated in the survey. Most used the congestive heart failure, hypertension, age ≥ 75, diabetes mellitus, stroke or TIA (2 points) (81%) and congestive heart failure, hypertension, age ≥ 75 (2 points) or age 65-74 (1 point), diabetes mellitus, stroke or TIA, vascular disease including peripheral arterial disease, myocardial infarction, or aortic plaque, sex (female) (67%) risk stratification schemes while the preferred bleeding risk stratification scheme was hypertension, abnormal liver or renal function, stroke, bleeding, labile international normalized ratio, elderly (age ≥ 65), drugs or alcohol (84%). In the clinical scenarios, residents generally preferred warfarin in favour of NOACs, independent of training level. Residents ranked the risk of adverse events and the cost to the patient as their most and least important consideration when prescribing OAC, respectively. Therefore in patients with nonvalvular AF, Canadian family medicine residents prefer warfarin in comparison with NOACs despite the latest Canadian and European guideline recommendations. This knowledge gap may be enhanced by multiple factors, including a sometimes magnified fear of adverse events and a rapidly changing landscape in stroke prophylaxis.