Public involvement, both in the National Health Service (NHS) and in clinical research, is promoted as an important democratic principle. The declared aims are to reduce professional autocracy and allow a broader ownership of the research agenda; also to improve the design of, and recruitment and retention of patients to, clinical studies. There have been a number of national initiatives in the UK to improve public input to clinical research activities, but very few reports of effective and sustainable partnerships over time. This study reports the evaluation of one example, which is embedded in the NHS and university partnerships in the Norfolk area of England.

Evaluate:

• Putting principles into practice of public involvement in research over a 5 year period for one specific project (Patient and Public Involvement in Research).

• How the model contributes to, and impacts upon, all stages of the research process.

• Attitudes of the research community and lay volunteers to their mutual experiences of public involvement.

• Key factors and strengths of this project, and areas for improvement.

A mixed methods approach related to the 5 years from start of 2003 to end of 2007. This used descriptive statistics of volunteer activity, interviews with key stakeholders (13), questionnaires (53% response rate), and focus group with 10 volunteers to explore emergent themes. We analysed findings using a policy framework approach.

About 47 of the original 55 volunteers remained on the panel after 5 years. All have undertaken training, 38% have been involved in the full range of research activities offered, and 75% have attended at least one research project meeting. Some are active in governance, ethics, and advisory committees.

Both the research community and the volunteers are very positive about the project. The researchers find it provides well prepared personnel, and gives a speedy and efficient way of fulfilling the expectations of funders for lay input. The volunteers find it gives them important opportunities to influence the quality of research and thus support improvements in patient care. Areas for improvement include increasing social diversity among the volunteers, and improving feedback on input from volunteers, without which volunteers tend to lose confidence and motivation.

Long-term sustainable and valuable public input to research is possible. Key factors are committing resources, embedding the service in the infrastructure of a research consortium, and ongoing responsiveness by NHS staff and researchers. Additional activity to recruit and support access may be needed to attract people from a broad range of sociodemographic backgrounds. Some volunteers want more involvement than this model currently offers.

In many countries there is a gap between the clinical evidence for cardiovascular disease (CVD) prevention and implementation in clinical practice. Inadequate control of cardiovascular risk factors and underutilization of aspirin, statins, angiotensin converting enzyme inhibitors and β-blockers are well-established examples. The optimal approach to implementation of CVD prevention in clinical practice is still under debate. The screening and monitoring (SaM) approach is based on cyclic monitoring and individual treatment of patients with cardiovascular risk factors in the primary care setting. After achieving improvements in risk factor levels and in the use of preventive medications in a pilot study, it was decided to test the efficacy of this approach in a larger population at risk.

Five primary care clinics adopted the SaM approach. A total of 1622 patients with established CVD, diabetes mellitus or hypertension were assessed by their family physicians for cardiovascular risk factors and use of medications for cardiovascular risk reduction. Interventions were made according to accepted clinical guidelines. Cardiovascular risk factor levels and the use of medications for CVD prevention were retrospectively analyzed.

The results demonstrated significant reductions in blood pressure, hemoglobin A1c and low-density lipoprotein-cholesterol levels, as well as significant increases in the use of medications for CVD prevention.

A systematic approach to CVD reduction, with an emphasis on multiple risk factor assessment and use of preventive medications in patients at cardiovascular risk, yielded significant improvements in measures of the quality of preventive care.

The aim of this study was to prioritize hospital admissions for ambulatory care sensitive conditions (ACSCs) and interventions for future research and implementation.

Initiatives aimed at reducing hospital admission need to be targeted at those patients who could avoid admission to hospital, either by prevention, earlier detection and treatment, or by the provision of alternative types of care. Admissions for ACSCs should ideally be prevented by care provided outside hospital.

The study used a modified Delphi method to elicit the views of an expert panel. The Delphi process comprised two rounds and used a Web-based questionnaire. Participants were purposively sampled and comprised primary and community care clinicians, emergency clinicians and commissioning managers. Quantitative data were analysed to produce descriptive statistics. Qualitative data were analysed using content analysis.

A total of 36 participants responded to both rounds of the Delphi survey. The condition given top priority was dementia, not currently a widely recognized ACSC or a national priority. The proportion of admissions that could be avoided by provision of care outside hospital was the most important factor in deciding which conditions to prioritize. Access to rapid response nursing and social care at home, intermediate care beds and mental health crisis teams were identified as key interventions to reduce admissions. Analysis of qualitative data showed several themes underlying clinical decisions to admit potentially avoidable admissions.

In conclusion, the conditions selected by the panel for prioritization showed some concordance with the National Health Services’ priorities in this area; but the condition given top priority by the panel – dementia – is not currently a national priority. The panel showed a high degree of consensus around interventions that might lower the rate of avoidable admissions. The highest rated interventions involve the direct delivery of rapid access care in the community.

This study explored health visitors’ perception of their role in the universal childhood immunisation programme with particular emphasis on influencing factors and communication strategies.

The majority of parents’ consent to immunisation, but some find decision-making in this area difficult and have unmet information needs. In the United Kingdom, health visitors routinely provide immunisation information for parents, whereas general practitioners (GPs) and practice nurses tend to administer vaccines and respond to parents/carers’ questions. Research has investigated health professionals’ views and knowledge about immunisation, but less is understood about health visitors’ role and how they communicate with parents.

Following the Local Research Ethics and Research Governance permissions, all health visitors (n = 120) working in one county in the United Kingdom were invited to participate in the study. Semistructured interviews (n = 22) were undertaken using a prompt guide. The interviews were transcribed verbatim. Thematic analysis using an iterative approach was used to explore the data facilitated by NVIVO™ software.

Five themes emerged from the interviews. These were health visitors’ professional role; identity and perceived barriers and communication strategies, parents’ right to choose, confidence in measles, mumps, and rubella (MMR) vaccination and communicating with migrant families about immunisation. There were differences between the health visitors in their perceptions of their roles, skills and knowledge and communication strategies. Health visitors perceived that GPs and practice nurses took a paternalistic approach to the provision of immunisation information, while they used a parental decision-making model. Health visitors reported a loss of professional confidence following the MMR crisis.

Given the evidence that some parents find it difficult to gain the information they need about immunisation and health visitors’ acknowledgement that their usual communication models were not effective during the MMR crisis, we feel specific communication skills training is needed to enable health professionals to provide parents with appropriate decision support.

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.

The role of the primary care mental health worker (PCMHW) in providing self-help and signposting to people referred for mild-moderate anxiety and depression is currently being complemented by low-intensity workers training under the government’s improving access to psychological therapies (IAPT) programme.

This study aims to explore the experiences of five PCMHWs working in the context of a newly designed primary care mental health team in London.

Thematic analysis of participants’ written reflective papers provides a qualitative exploration of issues and concerns raised by PCMHWs during a fortnightly reflective practice group.

Themes emerging from participants’ written accounts highlight: difficulties in applying academic and skills training to the real-life world of clinical practice; difficulties in managing issues of risk and complexity; role confusion; and the need for a visible and coherent career structure.

The study highlights the psychological impact on PCMHWs of managing complex client referrals. This is discussed in the context of the high volume case turnover anticipated by IAPT training curricula. Implications for the training and education of IAPT low-intensity workers are briefly considered.

The purpose of this study was to compare return visits in 2 weeks experienced by patients using a retail nurse-practitioner clinic to similar patients using standard drop-in clinic located in a medical office.

Retail medicine clinics have become widely available. However, their impact on return visit rates compared to drop-in medical office visits for similar patients is unknown.

Medical records of primary care patients (both adults and children) seen in a large group practice in Minnesota in 2008 were analyzed for this study. Patients treated for five common conditions were selected (pink eye, sore throat, viral illness, bronchitis, and cough, n = 279). Two groups of patients were studied: those using a retail walk-in clinic staffed by nurse practitioners (n = 142) and a comparison group using regular office care for same-day visits (n = 137). The dependent variable was a return office visit within 2 weeks. Multiple logistic regression analysis was used to adjust for case mix differences between groups.

The percent of office visits within 2 weeks for these groups was 20.4 for retail drop-in patients and 27.7 for same-day medical office patients, respectively (P = 0.15). After adjustment for age, gender, visit reason, and number of office visits in the previous 6 months, no significant difference in risk of early return visits in comparison to an office-based drop-in clinic was found (odds ratio 0.83, confidence interval 0.43–1.63). Our retail nurse-practitioner clinic appeared to increase access without increasing early return visits.

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.