Aims: To assess the feasibility of keeping a log of diabetes-related communication in a
\ncommunity pharmacy and to explore the potential of the logs to reflect diabetes-related
\ncommunications within pharmacies. Design: A reflective log-keeping exercise (the log
\ndesigned by the researchers and provided in a booklet form) in community pharmacies of
\nany diabetes-related communication taking place between pharmacy staff and their service
\nusers, and any signposting made to and from other relevant health professionals.
\nThe study ran for four weeks. Subjects and setting: Nine community pharmacy
\nbranches of the Independent Pharmacy Care Centres PLC based in Hull, East Yorkshire
\nand North & North East Lincolnshire. Outcome measures: A description of the form
\nand nature of diabetes-related communication, taking place within the community
\npharmacy. The research team also sought feedback on the experience of keeping the log.
\nResults: Twenty-two communications were logged; twenty-one involved direct face-toface
\ncontact and one log involved a telephone conversation. Two-thirds of the communications
\ninvolved conversations with patients with diabetes, a third were with a
\npartner/family member. The conversations captured fell into five categories: sugar free
\nmedicines, blood glucose-testing metre, prescription medicines, diabetes specific education/
\ninformation and an unclassified category, respectively. The logs demonstrated that
\ncommunications can involve all members of the staff team, working independently or
\njointly across their roles in the pharmacy. Conclusion: Community pharmacies in the
\npilot study were actively involved in providing diabetes health-related information/education
\nand support. Communications involved directly assisting people with diabetes and
\nproviding information to people supporting others with a diagnosis of diabetes. We propose
\nthat the logs provide a valuable means of acquiring information about the form and
\nnature of diabetes-related communication and signposting within community pharmacy.

Smokers aged 65 and over have been identified as a priority group for smoking-cessation interventions. However, despite confirmation of the benefits of cessation in later life and compelling evidence that interventions can be effective, studies have shown that members of the primary care team often fail to target this population. If these professionals are to be encouraged to broach the subject of smoking cessation with older people, it is important that barriers to the effective provision of interventions are uncovered. This article reports findings from a qualitative study that sought to do this by exploring the knowledge, attitudes and practice of members of the primary care team in relation to smoking/smoking cessation in later life. A purposive sample of health visitors, district nurses, practice nurses and general practitioners (n = 41) working in the west of Scotland was recruited. Data were collected during face-to-face interviews using a semi-structured interview schedule. The interviews were transcribed and then analysed using content analysis procedures. While the participants were generally convinced of the benefits of cessation many believed that few older people manage to stop smoking successfully. A pessimistic view of the success rate of older smokers appeared to negatively influence practice. In addition, a number of the participants lacked confidence in their own counselling skills and/or had limited awareness of smoking cessation resources and specialist services. These factors also appeared to preclude the provision of effective smoking-cessation interventions. Finally, there was little awareness of the content of the UK Smoking Cessation Guidelines. The findings from this study, and a parallel study that explored the health beliefs of older smokers, have been used to develop smoking cessation training designed specifically for members of the primary care team who have contact with older people who smoke. The efficacy of the training is currently being evaluated.

There is a policy drive in the UK National Health Services (NHS) towards public involvement in service, education and research, with a number of national initiatives such as INVOLVE that have championed effective user input on research and development (R&D). The requisites of research governance include a balance of professional and public input, and the structures for this now exist at primary care level. There is a need for examples of how such policies can be implemented in Primary Care Trusts, and this article aims to show in detail the way in which a systematic approach to user involvement in R&D has been implemented. The PPIRes (Public and Patient Involvement in Research) project, whose progress over two years from 2003 to 2005 is reported, has been funded by NHS R&D monies allocated through a research consortium in Norfolk, and has been hosted in an NHS – academic partnership between Norwich Primary Care Trust and the Institute of Health at the University of East Anglia. The profile of volunteers, recommendations for good practice in public involvement, and the ‘facilitators and challenges’ to the programme are described.

The Canadian health care system is under increased pressure to reform. While some advocates lobby for more physicians and more resources to fix the ailing system, many reports point to another potential solution – implementing primary health care (PHC). Implementing PHC will not be easy. Even though there is substantial evidence to support the efficacy and cost effectiveness of PHC, its implementation will require substantial changes in practice. Community-based research (CBR) has the potential to be the catalyst for the type of change that is required. A multidisciplinary, multisectoral inquiry team has been funded to use CBR to reconceptualize and transform PHC service delivery in British Columbia, Canada. Although the research project is in its initial phase, it is anticipated that the research will provide new, holistic, and comprehensive frameworks for practice. This paper describes the process used to bring about these changes.

The National Service Framework (NSF) for coronary heart disease (CHD) requires that all people with established CHD are identified and managed systematically; accurate and complete electronic patient records (EPRs) are thus essential. This project aimed to first establish the completeness and consistency of recording electronic information about CHD (diagnosis, risk factor monitoring and aspirin usage) across a group of general practices and secondly, to provide feedback on their performance. The third part of the project planned to evaluate the effect of this feedback on the general practices’ electronic data recording but this is not reported in this article. Twenty-two of 26 general practices in one Primary Care Trust (PCT) participated. A random sample of 75 people with a Read code for CHD and/or who were taking one or more of five drugs used in CHD were selected from each of the 15 practices using Egton Medical Information Systems (EMIS) to manage their EPRs. The remaining seven practices used Torex electronic clinical system and from each of these practices, a random sample of 25 patients with a Read code for CHD was selected. Sample sizes were pragmatic rather than being chosen for possible statistical significance. At each practice the patients’ paper patient records and EPRs were searched for information about CHD diagnosis, risk factor monitoring and aspirin usage. Results were fedback and discussed with each individual practice and presented to the PCT. Electronic recording of CHD diagnosis was fairly complete but recording of risk factor monitoring and aspirin usage was more inconsistently recorded. Providing feedback to the general practices raised practitioners’ awareness of strengths and weaknesses in their electronic record keeping. Work to improve EPRs needs to be ongoing, to ensure that there is complete and easily accessible information about people with CHD so that their care management can be planned and implemented effectively.

Against a background of decreasing age at sexual debut, local Brook staff voiced concerns about the increase in clinic attenders under the age of 14 years, who appeared to engage in risky behaviours. This exploratory study, carried out with service providers in a young persons sexual health clinic, aimed to discover what issues staff felt were important to 11–14 year-old girls, in order that a future study be conducted with the young girls themselves. Service providers from two Brook Advisory Centres were interviewed. The interviews were semi-structured and analysed using content analysis. Many of the issues that staff identified as important to young girls mirrored current research findings with older adolescents. These were: alcohol consumption, peer pressure, low self-esteem and confidence, and a lack of knowledge around sexually transmitted infections. However, a new issue to emerge was the high proportion of young girls attending the clinic for the emergency contraceptive pill despite not knowing whether they had had intercourse or not. The study also found that staff perceived the need to understand issues from the perspective of the young girls themselves. Staff identified a necessity for improved sex education and education around peer pressure and assertiveness, whilst topics for future research which emerged from the study findings included issues of self-esteem, dynamics of peer/media pressure and why young girls feel that they need to have sex.

There is increasing concern at the amount and cost of prescribed medicines that are unused or wasted and then have to be disposed of. Previous studies have used health promotion and Dispose Unwanted Medicines Properly campaigns targeted at the patient to describe and quantify the annual cost of waste. The reasons patients return unused drugs to pharmacies have also been explored. The paper focuses on patient explanations for not needing medication; categorized as: over-collection in the past, self-management strategies, changes in medical condition, other changes in patient circumstances, or the repeat medicines policy at the surgery. The aim of the original study was to make a measurable change in prescribed medicines with a reduction in medicines wastage, whilst at the same time achieving improved standards of pharmaceutical care. Information on patient needs and behaviour came from consultation in the pharmacy monitoring forms and interview. The study was based on two medical practices in the West Midlands, UK, comparing an outer city and an inner city population. The participants were general practitioners, pharmacists and 350 repeat prescription patients. Prescriptions were issued for two three-month periods. The outcome was that 23.8% of the prescribed items were not dispensed, at a value of £13.1K, 58% of the medications that would be expected to be regularly supplied were collected. The study suggests that closer professional management at the point of dispensing and an understanding of patient experiences can help reduce the amount of unwanted medication collected by patients.

Health for all was identified by the World Health Assembly in 1977 as the desirable main social target for governments, international agencies and the global community. Primary health care was defined at Alma Ata in 1978 and was then seen as the vehicle to achieving health for all. Governments in sub-Saharan Africa embarked on processes to align their health policies and indeed implement them within the PHC framework. PHC in Africa was seen as an overall strategy for achieving health for all, rather than just as the first level of care. Thus countries restructured their entire health systems in the framework of PHC rather than focus on the first level of care only. The mid to late 1980s saw worsening economic performance which was followed by the enforcement of structural adjustment programmes, sociopolitical instability, man-made and natural disasters and the beginning of the HIV/AIDS pandemic. All these wrecked havoc on plans countries had for implementation of PHC. Within this context, the elaborate policies and plans were not fully implemented. Furthermore, there appears to have been a general underestimation of the resources required. Though there was some initial progress in improving health status as shown by some health parameters, health for all was not achieved by any of the countries.

The policy thrust in the health system in many developing countries over the last decade has been on reforming structures. This paper examines such reforms in the light of the principles of primary health care that were adopted at the Alma Ata conference in 1978 and which are re-emerging as underpinning the current WHO global policies. It concludes that many of the reforms at best did not strengthen PHC and at worst ran counter to it.

This paper presents the findings of a study designed to explore myocardial infarction (MI) survivors' experiences of their heart attack, to obtain their views on existing services and to gather ideas for a new, community-based cardiac rehabilitation initiative. Despite the increasing emphasis on the consumer ‘voice’ in health service delivery, little research has been published exploring the experience of MI from the patient's perspective. This is of particular significance given the study's location in a disadvantaged urban area where the uptake of conventional hospital-based cardiac rehabilitation is poor. The study is based on qualitative, semi-structured interviews with 20 myocardial infarction survivors in southeast Nottingham. Participants were identified from the list of those invited to participate in a local hospital's cardiac rehabilitation programme. The interviews were carried out in patient's home between one and 12 months after the MI, were tape recorded and subsequently transcribed. Thematic analysis reflected both the issues identified in the interview schedule but also some unexpected findings elucidating the survivors' own perspectives. The paper is structured around four key themes: the story of the heart attack; the way survivors' lives have changed; experiences of existing services and ideas for service development. The paper concludes that MI should be understood as a long-term rather than an acute condition and discusses the implications for service delivery.