Objectives. We explored GPs' experiences of managing patients with chronic pain from a South Asian community in Leicester.

Methods. Qualitative semi-structured interviews were conducted with GPs from practices in two primary care trusts within Leicester. Eighteen GPs (11 males and 7 females) were interviewed in this study.

Results. Several emerging themes were identified from the data including consulting behaviour, presentation of pain, GPs personal challenges, psychosomatic interpretations and communication. Overall, GPs find that managing South Asian patients with chronic pain can be challenging as a consequence of the way in which patients present with pain. Difficulties for GPs were created not only by language differences but also by cultural differences, which were not seen in second or third generation South Asians. GPs felt that self-management was difficult to address, and compliance with medication difficult to determine. In such consultations, GPs perceived that patients were more likely to present with psychosomatic symptoms.

Conclusions. Cultural influences play an important role in the consultation process where patients' behaviour is often bound in their cultural view of health care. Patients' presentation of their condition makes diagnosis difficult but can also lead to miscommunication. Whether South Asian people are more likely to present mental health problems as chronic pain is not clear and warrants further investigation.

Objective. To validate this framework in clinical practice.

Methods. We used an action research approach, helping five diverse general practices in the South of Scotland to implement the care framework. The process and outcomes were evaluated using in-depth interviews (18 patients and their family carers and 49 health professionals), participant observation and an ongoing dialogue between the practices, the research team and the original user groups.

Results. Practices implemented the framework in a variety of ways. In general, they used their own customized cancer register to improve communication within the practice and began to offer proactive care from a diagnosis of cancer, not just when the disease became advanced. Local innovations included an intranet-based register, information sheets and regular multidisciplinary meetings. Patients, family carers and professionals suggested that the framework had helped achieve continuity of care, teamwork, proactive care and improved support and information for patients and carers.

Conclusions. Proactive personalized care can be improved in primary care for patients with cancer and their family carers through flexible adoption of a framework to embrace key characteristics of good care, as perceived by patients and carers, throughout the illness. Practices can achieve this by choosing approaches suited to their setting, experiences, structure and resources.

Aim. This study investigates how often ICS are prescribed without a proper indication and how big the diagnostic problem is caused by inappropriate prescription and use of ICS.

Methods. All patients referred to a primary care diagnostic centre during 6 months who used ICS without a clear indication were included. Their GPs were questioned about the reasons for prescribing ICS. If still no diagnosis could be assessed, GPs were advised to stop ICS and renew spirometry after a steroid-free period of at least 3 months. After 1 year, the use of ICS was evaluated and the diagnoses were reassessed.

Results. Of all referred patients (2271), 1171 used ICS, 505 (30%) without a clear indication. After 1 year, final results showed that 11% of all patients originally using ICS had no indication to use ICS and had successfully ceased using this mediation. For 15%, the reasons for using ICS remained unclear.

Conclusions. Overtreatment with ICS in primary care seems to be considerable, which falsely labels patients as asthmatic and which generates unnecessary costs and possible side effects. The awareness of GPs of the need for proper diagnostic testing before prescribing ICS needs to be improved. Overtreatment with ICS in primary care patients can be diminished by systematically supporting the GP in the diagnostic procedures and decision making.

Methods. A study of the content of electronic medical records (EMRs) in pre- and post-disaster periods linked to an enquiry using self-reported questionnaires administered 3 weeks and 18 months post-disaster. The disaster (explosion of a firework depot in Enschede, The Netherlands) caused 23 deaths, about 1000 people injured and 1200 people who had to relocate. Sample included survivors (N = 922) who participated in two surveys and whose data could be linked to EMRs of GPs. A comparison of reported morbidity in ‘infrequent’ (a maximum of three times in men and four times in women in the first two post-disaster years) and ‘more frequent attenders’ (frequency determined post-disaster) in general practice examined in relation to health status (measured by diagnoses in EMRs, symptom checklist and quality of life instrument) was the main outcome measure.

Results. Infrequent attenders reported approximately three times as few contacts as more frequent attenders in the pre-disaster year (P < 0.001). Multivariate logistic regression analyses revealed that infrequent attenders were likely to be younger, less depressed, have better subjective health and physical functioning and exhibited more hostile behaviour (measured by questionnaire). Infrequent attenders were less often personally bereaved by the disaster, but more often relocated, and had a lower prevalence of psychological problems pre- and post-disaster although this increased stronger (by 10-fold).

Conclusions. Both groups showed the same type of psychological problems post-disaster, but differed in the frequency of contacting the GP.

Objective. To evaluate the impact on readiness to change of an educational intervention on management of depressive disorders based on a modified version of the Prochaska model in comparison with a standard programme of continuing medical education (CME).

Methods: This is a randomized controlled trial within primary care practices in southern Tehran, Iran. The participants included 192 general physicians working in primary care (GPs) were recruited after random selection and randomized to intervention (96) and control (96). Intervention consisted of interactive, learner-centred educational methods in large and small group settings depending on the GPs' stages of readiness to change. Change in stage of readiness to change measured by the modified version of the Prochaska questionnaire was the main outcome measure.

Results. The final number of participants was 78 (81%) in the intervention arm and 81 (84%) in the control arm. Significantly (P < 0.01), more GPs (57/96 = 59% versus 12/96 = 12%) in the intervention group changed to higher stages of readiness to change. The intervention effect was 46% points (P < 0.001) and 50% points (P < 0.001) in the large and small group setting, respectively.

Conclusions. Educational formats that suit different stages of learning can support primary care doctors to reach higher stages of behavioural change in the topic of depressive disorders. Our findings have practical implications for conducting CME programmes in Iran and are possibly also applicable in other parts of the world.

Objective. To elucidate doctors' motives for non-participation in, and subjective barriers to, general practice research.

Methods. German GPs that had opted out of a quality assessment project involving electronic patient records (EPRs) were mailed a questionnaire regarding their attitudes towards general practice research and their specific objections to the current project. A sub-sample of doctors was interviewed. Their statements were coded and classified with regard to the reasons given for non-participation and possible motivating factors.

Results. The survey response rate was 37% (96/263); 21 GPs completed an additional qualitative interview. Nearly all respondents (88/96) considered general practice research to be important, but 58% had not previously participated in research projects and 56% would not do so in the future. Nearly half (47/96) were opposed to having data extracted from their EPRs. The qualitative analysis revealed deep concerns related to the collection of EPRs (e.g. potential misuse of data, being subject to control or resulting computer problems). Some GPs expressed concerns about recruiting their own patients for the study. Some doctors complained of not being sufficiently recognized as a partner or not having a voice in the research process.

Conclusion. Doctors' negative attitudes, concerns and ambivalent feelings should be addressed in recruitment strategies, especially when the analysis of EPRs or direct patient contact is required. Some doctors do not participate in research out of principle and will be very difficult to convince.

Aims and methods. The aim of the paper is to make a proposal for the future development of the discipline in CEE countries. The proposal is based on reports on an invitational conference that was organized for the key representatives of family medicine from CEE countries. For the purpose of this paper, additional information about the situation was gathered from literature reviews, country visits and personal interviews.

Results. Information shows that although family medicine has been formally recognized and introduced in university curricula, there is a very big difference in its academic position. Postgraduate training has been established in all CEE countries, according to the European Directive. Quality measures such as the development and implementation of guidelines and the re-certification procedure have also been formally introduced, but its quality varies. The key areas of concern are atomization of practices, unsatisfactory payment systems, lack of academic infrastructure and unsatisfactory continuous professional development. On the other hand, examples of good practice exist and need to be promoted.

Conclusion. There is a need for continuous exchange of expertise within the countries. The paper will serve as a discussion paper for the next meeting of experts from CEE countries.

Objectives. To investigate the impact of the RRW on participants' skills, confidence, interest in research and research activity.

Methods. Cross-sectional postal survey in 2006 of five groups of registrars who participated in the annual workshop in 2002–2006 (response rate: 64%; 77 of 121). Outcome measures included research experience and skills prior to and after the workshop; impact of the workshop on capacity, confidence, attitude and interest in research; and research involvement as measured by publications and grant funding.

Results. Self-reported research skills increased over time for the whole group (two-way analysis of variance: P = 0.047), most significantly for registrars with little or no research experience (P < 0.001) and research project participants (P = 0.003). The impact of the workshop on capacity, confidence and interest in research was rated highly (mean 3.5–4.0 ± 0.1 on a five-point scale). Two-thirds of the survey respondents had been research active, 34% presented their findings at conferences, 25% published in peer-reviewed journals and 31% received research funding. Eighty-four per cent of respondents indicated a high interest in undertaking research in the future. All survey respondents recommended the workshop to other registrars.

Conclusions. The RRW provides a useful model for effective research training for interested general practice trainees. Such training has the potential to increase knowledge of research methods, which might augment future research activity in general practice.

Representation of audible and visual data into written form is an interpretive process which is therefore the first step in analysing data. Different levels of detail and different representations of data will be required for projects with differing aims and methodological approaches. This article is a guide to practical and theoretical considerations for researchers new to qualitative data analysis. Data examples are given to illustrate decisions to be made when transcribing or assigning the task to others.