Preferences and wishes of patients is an important indicator of primary health care provision, although there are differences between national primary care systems.

The aim of this paper is to describe and evaluate the preferences and values of Hungarian primary care (PC) patients before accessing and to analyse their experiences after attending PC services.

In the Hungarian arm of the European QUALICOPC Study, in 2013–2014, information was collected with questionnaires; the Patient Values contained 19 and the Patient Experiences had 41 multiple-choice questions.

The questionnaires were filled by 2149 (840 men, 1309 women) using PC services, aged 49.1 (SD ± 16.7) years, 73% of them having chronic morbidities. Women preferred to be accompanied and rated their own health better. Patients in the lowest educational category and women visited their GPs more often, and they are consulted more frequently by other doctors as well. Men, older and secondary educated people reported more frequently chronic morbidities. Longer opening hours were preferred by patients with higher education. The most preferred expectations were availability and polite communication of doctors, not pressures on consultation time, clear instructions provided during consultations, shared decisions about treatments and options for consultations, the knowledge of the doctors concerning the living conditions, social and cultural backgrounds of patients, updated medical records, short waiting times, options for home visits, wide scope of professional competences and trust in the doctor.

Wishes, preferences of patients and fulfilment were similar than described in other participating countries of the study. Although there are room to improve PC services, most of the questioned population were satisfied with the provision.

Obesity is a major public health issue because of its increasing prevalence and impact on health. The management of overweight and obesity has been a government priority for many years. However, overweight and obesity management at a local level has often been ineffective. Although there is a need to examine obesity strategies and policies for local populations, there is currently no readily available framework for evaluating local obesity strategies. We therefore developed a framework, the Imperial College Obesity Strategy Assessment Framework (IC-OSAF), for examining the content of local obesity strategies.

We adapted two previous policy analysis frameworks (Bardach’s Eightfold Path Framework and Collins’ Health Policy Analysis Framework) and used these with information from national guidelines to develop an obesity strategy analysis framework. We then piloted this framework using the obesity strategy for one London primary care trust (PCT).

The framework was applied successfully and helped identify limitations and omissions in the PCT obesity management strategy.

The IC-OSAF is a practical, easy-to-use tool for the analysis of local obesity management strategies. The framework can help identify gaps and limitations in strategies to help reduce variations in obesity management between PCTs.

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 explore the experiences of older adults participating in strength and balance exercise programmes and understand participants’ rationale for programme uptake and completion.

Regular physical activity, specifically strength and balance exercises, has been shown to improve health and well-being and reduce the risk of falling in older adults. With the number of people living into older age increasing, understanding older people’s experiences of strength and balance programmes and what encourages their take-up and completion is extremely important. This paper reports on the qualitative experiences of older adults that previously participated in ProAct65+, a randomised controlled trial of Falls Management Exercise (FaME) programme and Otago Exercise Programme (OEP) versus usual care.

Ten general practices in Nottinghamshire and Derbyshire, England, who participated in the ProAct65+ trial were approached to take part. Using maximum variation sampling (age, gender, falls history, fear of falling and trial arm) we recruited, via the practices, 30 people that had participated in the FaME (n = 15) or OEP (n = 15) trial arms. Participants were interviewed in their own homes. Interviews were audio-recorded, transcribed verbatim and thematically analysed.

We identified five themes: choice of exercise programme; commitment, discipline and motivation; benchmarking, feedback and monitoring; benefits of the exercise programmes and reactions to the end of the programmes. There were four sub-themes within the benefits theme: pleasure and boredom, social interaction and isolation, physical benefits, and knowledge and understanding.

This study has outlined the experiences and identified specific barriers and facilitators to uptake and completion of falls-prevention exercises by older adults. The perspective and experiences of these participants is important if programmes are to be designed to meet the needs of the target population. Insights from this study will enable commissioners to develop and provide appropriate falls-prevention exercise programmes that encourage high uptake and programme completion.

The aim of this pilot study is to evaluate a Japanese version of brief Cognitive Behavioral Therapy for Insomnia (CBT-I) and contribute to primary care which leads to prevention of a lifestyle-related disease or a psychiatric disorder.

A single-arm study in nine patients with chronic insomnia who were under the pharmacotherapy was executed. The Insomnia Severity Index (ISI), the Athens Insomnia Scale (AIS), and the European Quality of Life 5 Items (EQ-5D) were assessed at the beginning of intervention, at the end of intervention, and after 12 weeks.

There were no patient dropouts nor adverse events. The average change in ISI score was −7.33 (95% CI: −10.31 to −4.36) at post-treatment and −6.11 (95% CI: −8.20 to −4.03) at the 12-week follow-up point (Cohen’s d = 2.25). The AIS score improved as well, and the EQ-5D score improved after 12 weeks. The safety and efficacy of the brief CBT-I were suggested.

Patient safety is a key priority for healthcare systems. Patient safety huddles have been advocated as a way to improve safety. We explored the feasibility of huddles in general practice.

We invited all general practices in West Yorkshire to complete an online survey and interviewed practice staff.

Thirty-four out of 306 practices (11.1%) responded to our survey. Of these, 22 practices (64.7%) reported having breaks for staff to meet and eight (23.5%) reported no longer having breaks in their practices. Seven interviewees identified several barriers to safety huddles including time and current culture; individuals felt meetings or breaks would not be easily integrated into current primary care structure.

Despite their initial promise, there are major challenges to introducing patient safety huddles within the current context of UK general practice. General practice staff may need more convincing of potential benefits.

Childhood immunisation is a critically important public health initiative. However, since most vaccines are administered by injection, it is associated with considerable pain and distress. Despite evidence demonstrating the efficacy of various pain management strategies, the frequency with which these are used during routine infant vaccinations in UK practice is unknown.

This study aimed to explore primary care practice nurses’ (PNs) use of evidence-based pain management strategies during infant immunisation, as well as barriers to evidence-based practice.

A questionnaire was developed and distributed to nurses throughout the UK via convenience sampling in paper and online formats. Questions assessed the frequency of pain management intervention use during infant immunisation and barriers to their use.

A total of 255 questionnaire responses were received. Over 90% (n = 226) of respondents never used topical anaesthetics or sweet solutions during immunisations, while 41.9% advised breastfeeding occasionally (n = 103). Parent-/caregiver-led distraction was the most frequently used intervention, with most nurses using it occasionally (47.9%, n = 116) or often (30.6%, n = 74). Most practices had no immunisation pain management policy (81.1%, n = 184), and most PNs’ previous training had not included pain management (86.9%, n = 186). Barriers to intervention use included lack of time, knowledge and resources. Excluding distraction, pain management strategies were infrequently or never used during infant immunisation. Key barriers to using evidence-based strategies were lack of time, knowledge and resources.

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.

To validate the Roth score as a triage tool for detecting hypoxaemia.

The virtual assessment of patients has become increasingly important during the corona virus disease (COVID-19) pandemic, but has limitations as to the evaluation of deteriorating respiratory function. This study presents data on the validity of the Roth score as a triage tool for detecting hypoxaemia remotely in potential COVID-19 patients in general practice.

This cross-sectional validation study was conducted in Dutch general practice. Patients aged ≥18 with suspected or confirmed COVID-19 were asked to rapidly count from 1 to 30 in a single breath. The Roth score involves the highest number counted during exhalation (counting number) and the time taken to reach the maximal count (counting time).

Outcome measures were (1) the correlation between both Roth score measurements and simultaneous pulse oximetry (SpO2) on room air and (2) discrimination (c-statistic), sensitivity, specificity and predictive values of the Roth score for detecting hypoxaemia (SpO2 < 95%).

A total of 33 physicians enrolled 105 patients (52.4% female, mean age of 52.6 ± 20.4 years). A positive correlation was found between counting number and SpO2 (rs = 0.44, P < 0.001), whereas only a weak correlation was found between counting time and SpO2 (rs = 0.15, P = 0.14). Discrimination for hypoxaemia was higher for counting number [c-statistic 0.91 (95% CI: 0.85–0.96)] than for counting time [c-statistic 0.77 (95% CI: 0.62–0.93)]. Optimal diagnostic performance was found at a counting number of 20, with a sensitivity of 93.3% (95% CI: 68.1–99.8) and a specificity of 77.8% (95% CI: 67.8–85.9). A counting time of 7 s showed the best sensitivity of 85.7% (95% CI: 57.2–98.2) and specificity of 81.1% (95% CI: 71.5–88.6).

A Roth score, with an optimal counting number cut-off value of 20, maybe of added value for signalling hypoxaemia in general practice. Further external validation is warranted before recommending integration in telephone triage.

Although there is existing activity within the NHS and local communities to support self-care there has been no previous attempt at integration across a Primary Care Trust (PCT). The Joining Up Self-Care (JUSC) study aimed to implement and evaluate such a programme.

Three self-care support modules for members of the public, together with a training course for primary care teams, were developed with, and implemented in, one PCT. The modules related to disease prevention (community-based coronary heart disease (CHD) prevention), care of people with long-term conditions (a disease-specific self-care skills training course for asthma) and the management of minor ailments aimed at mothers of children aged 3 months to 12 years (the ‘Pharmacy First’ service plus information booklets and campaigns). Postal questionnaires were completed by participants in CHD prevention (178), management of asthma (76) and minor ailments management (92), and by controls. A general population survey (n = 540) provided a comparison group for the CHD module and assessed general awareness of local self-care support. Four focus groups were held with mothers of young children. An audit of general practitioner (GP) records was conducted for consultations for minor ailments. Structured telephone interviews were conducted with 51 local health professionals and nine members of staff from the PCT.

Participants in the CHD module reported significantly more risk-reducing behaviours. Participants in a disease-specific Expert Patient Programme (EPP) for people with asthma rated the course positively, were subsequently more confident about discussing asthma with their doctor and had fewer concerns about their asthma medicines. Most users of the ‘Pharmacy First’ minor ailments scheme reported positive feedback and an intent to use the service again in the future. There were no significant differences in numbers of GP consultations for minor ailments between intervention and control groups. Health professionals were generally positive about encouraging self-care. Many felt they were already doing this but had insufficient time to implement it. A Local Enhanced Service (LES) was successful in engaging local general practices with self-care. Some organizational development relating to self-care occurred within the PCT but integration across different directorates was not achieved.

The JUSC programme was associated with changes in self-reported CHD risk reduction behaviours, in confidence to manage asthma and fewer concerns about medication, and with more positive attitudes towards consulting a pharmacist for minor ailments. Key principles for future PCT self-care strategies were identified. Further work is needed to embed support for self-care across the PCT as an organization.

To assess the ‘Okay to Stay’ plan to investigate if this reduces visits to emergency departments, unplanned admissions and elective admission to hospital in elderly patients with long-term health conditions.

The incidence of long-term conditions is rising as the elderly population increases, resulting in more people from this group attending emergency departments and being admitted to hospital. Okay to Stay is a simple plan for people with long-term conditions to help them remain in their own home if they suffer an acute exacerbation in their health. It was co-designed with professional and patient representatives with the aim of empowering patients and their carers to more effectively manage their long-term conditions.

Data from 50 patients (20 males, 30 females, mean baseline age 77.5 years) were compared 12 months before implementation of the plan and in the subsequent 12 months, with the significance of effects assessed at the 5 per cent significance level using t-tests.

Visits to emergency departments were reduced by 1.86; unplanned emergency admissions were reduced by 1.28 and planned elective admissions were raised by 0.22 admissions per annum. The reduction in visits to the emergency department was significant (p = 0.009) and the reduction in emergency admissions was significant (p = 0.015). The change in elective admissions was not significant (p = 0.855). The Okay to Stay plan is effective in reducing visits to the emergency department and unplanned hospital admissions in people with long-term conditions. This is a positive step to supporting vulnerable and complex patients who are cared for at home, and facilitates the recognition by the individual of the possibility to stay at home with the support of health professionals. There are potential cost benefits to the investment of initiating an Okay to Stay plan through the avoidance of visits to the emergency department and non-elective admissions to hospital.

The present study aimed to describe the experience of district nurses (DNs) in using a clinical decision support system (CDSS) and the safe medication assessment (SMA) tool during patient visits to elderly care units at primary health care centres.

In Swedish primary health care, general practitioners (GPs) prescribe and have the responsibility to regularly review older adults’ medications, while DN (nurses specialised in primary health care) play an important role in assessing older adults’ ability to manage their medications, detecting potential drug-related problems and communicating with patients and GPs about such problems. In a previous feasibility study, we found that DNs who use a combination of a CDSS and the SMA tool identified numerous potentially harmful or dangerous factors and took a number of nursing care actions to improve the safety and quality of patients’ medication use. In telephone interviews, patients indicated that they were positive towards the assessment and interventions.

Individual interviews with seven DNs who worked at six different primary health care centres in Region Stockholm were carried out in 2018. In 2019, an additional group interview was conducted with two of the seven DNs so they could discuss and comment on preliminary findings. Qualitative content analysis was used to analyse the interview transcripts.

Findings: Using the tools, the DNs could have a natural conversation about medication use with older adults. They could get a clear picture of the older adults’ medication use and thus obtain information that could facilitate collaboration with GPs about this important component of health care for older adults. However, for the tools to be used in clinical practice, some barriers would have to be overcome, such as the time-consuming nature of using the tools and the lack of established routines for interprofessional collaboration regarding medication discussions.

To explore the perceptions of general practitioners (GPs) regarding their role and their collaboration with district nurses (DNs) in the management of leg ulcers in primary healthcare.

Earlier research regarding the treatment of leg ulcers in a primary care context has focussed primarily on wound healing. Less is known about GPs’ understandings of their role and their collaboration with DNs in the management of leg ulcers. Since the structured care of patients with leg ulcers involving both GP and DN is currently rather uncommon in Swedish primary care, this study sets out to highlight these aspects from the GP’s perspective.

Semi-structured individual interviews with 16 GPs including both private and county council run healthcare centres. Thematic analysis was used to analyse the data.

Four themes were identified. The first theme: ‘role as consultant and coordinator’ shows how the GPs perceived their role in wound care. In the second theme: ‘responsibility for diagnosis’ the GPs’ views on responsibility for wound diagnosis is presented. The third theme: ‘desire for continuity’ is based on the GPs’ desire for continuity concerning various aspects. In the fourth theme: ‘collaboration within the organisation’ the importance of the organisation for collaboration between GPs and DNs is presented.

The GP’s often work on a consultation-like basis and feel that they become involved late in the patients’ wound treatment. This can have negative consequences for the medical diagnosis and, thereby, lead to a prolonged healing time for the patient. Shortcomings regarding collaboration are mainly attributed to organisational factors.

Primary health care provision in terms of quality, equity, and costs are different by countries. The Quality and Costs of Primary Care (QUALICOPC) study evaluated these domains and parameters in 35 countries, using uniformized method with validated questionnaires filled out by family physicians/general practitioners (GPs).

This paper aims to provide data of the Hungarian-arm of the QUALICOPC study and to give an overview about the recent Hungarian primary care (PC) system.

The questionnaires were completed in 222 Hungarian GP practices, delivered by fieldworkers, in a geographically representative distribution. Descriptive analysis was performed on the data.

Financing is based mostly on capitation, with additional compensatory elements and minor financial incentives. The gate-keeping function is weak. The communication between GPs and specialists is often insufficient. The number of available devices and equipment are appropriate. Single-handed practices are predominant. Appointment instead of queuing is a new option and is becoming more popular, mainly among better-educated and urban patients. GPs are involved in the management of almost all chronic condition of all generations. Despite the burden of administrative tasks, half of the GPs estimate their job as still interesting, burn-out symptoms were rarely found. Among the evaluated process indicators, access, continuity, comprehensiveness, and coordination were rated as satisfactory, together with equity among health outcome indicators. Financing is insufficient; therefore, many GPs are involved in additional income-generating activities. The old age of the GPs and the lack of the younger GPs generation contributes to a shortage in manpower. Cooperation and communication between different levels of health care provision should be improved, focusing better on community orientation and on preventive services. Financing needs continuous improvement and appropriate incentives should be implemented. There is a need for specific PC-oriented guidelines to define properly the tasks and competences of GPs.