Objective. To test whether type 2 diabetes patients with elevated depression scores are more often physically inactive.

Methods. Demographic features, clinical factors, level of physical inactivity and depressive symptoms were assessed in 2646 primary care patients with type 2 diabetes. Sequential multiple logistic regression analyses [odds ratio, 95% confidence interval (CI)] were performed to test the association between depressive symptoms and physical inactivity.

Results. About 48% of the respondents were physically inactive. Elevated depressive symptoms were found in 14% of the respondents. After adjustment for potential confounders, the odds for being physically inactive were almost doubled in depressed patients with type 2 diabetes 1.74 (95% CI 1.32–2.31).

Conclusions. Presence of depressive symptoms almost doubles the likelihood of physical inactivity in patients with type 2 diabetes. Longitudinal studies are needed to investigate whether physical inactivity forms the link between depression and poor disease outcomes.

Objective. Our aim was to establish and compare incidence and referral rates for foot problems in children in 1987 and 2001.

Methods. A comparison was made of two large consecutive surveys in Dutch general practice performed in 1987 (86 577 children aged 0–17 years) and 2001 (87 952 children aged 0–17 years), which were carried out by The Netherlands Institute for Health Services Research. Both surveys included a representative sample of the Dutch population. Incidence and referral rates were calculated and, data were stratified for age group and gender.

Results. Compared to 1987, in 2001 the overall incidence rate of foot problems presented to the family physician (FP) decreased substantially from 80.0 [95% confidence interval (CI) 77.0–84.7] to 17.4 (95% CI 16.5–18.3) per 1000 person-years (P < 0.0001). The incidence rate of flat feet decreased from 4.9 (95% CI 4.0–5.9) per 1000 person-years in 1987 to 3.4 (95% CI 3.0–3.8) per 1000 person-years in 2001 (P = 0.001). The distribution of referrals to other primary health care professionals and medical specialists has almost reversed in favour of primary health care professionals.

Conclusion. Total incidence rate of musculoskeletal foot problems seen by the FP has decreased substantially, between 1987 and 2001.

Methods. We used an observational prevalence study in primary care from one Staffordshire practice in 2005–2006. Egton Medical Information Systems Ltd computer database was searched for patients with two Modification of Diet in Renal Disease eGFRs separated by 3 months, HB levels and medications.

Results. From a list size of 1830 patients, 362 had two eGFRs <60; of those, 308 had a HB available. In all, 29 (9.4%) patients had NICE renal anaemia, with over-representation of diabetic patients, 13 (16%) against 16 (7%) without diabetes (P < 0.02). We found that diabetic patients were also over-represented at HB 11.0 to <12.5 g/dl, 26 (32%) with diabetes and 39 (17.6%) without (P < 0.001). Mean HB was significantly lower for the diabetic group (n = 81, 26%), 12.8 g/dl (95% Confidence Intervals (CI) 12.4–13.1) against non-diabetic group (n = 227, 74%), 13.4 g/dl (95% CI 13.2–13.6), P < 0.01. Predictors of HB on multivariate regression analysis were female gender, eGFR and diabetes (all P < 0.001).

Conclusions. Diabetic patients were more likely to have NICE defined renal anaemia in this primary care population with CKD stages 3–5. This is similar to observations in secondary care settings. We observed over-representation of diabetic patients above NICE definition at HB 11.0 to <12.5 g/dl.

Objective. To assess the effectiveness of a multiple intervention in primary care at a large scale.

Methods. A controlled before and after study in 2006 and 2007 was designed. Participants were from general practices within a geographically defined area in the middle region of The Netherlands. Participants were GPs in 141 practices in 25 peer review groups. A control group of GP practices from the same region, matched for type of practice and mean volume of antibiotic prescribing. The multiple intervention consisted of the following elements: (i) group education meeting and communication training; (ii) monitoring and feedback on prescribing behaviour; (iii) group education for GPs and pharmacists assistants and (iv) patient education material. The main outcome measures are as follows: (i) number of antibiotic prescriptions per 1000 patients per GP and (ii) number of second-choice antibiotics, obtained from claims data from the regional health insurance company. The associations between predictors and outcome measurements were assessed by means of a multiple regression analyses.

Results. At baseline, the number of antibiotic prescriptions per 1000 patients was slightly higher in the intervention group than in the control group (184 versus 176). In 2007, the number of prescriptions had increased to 232 and 227, respectively, and not differed between intervention and control group.

Conclusions. The implementation of an already proven effective multiple intervention strategy at a larger scale showed no reduction of antibiotic prescription rates. The failure might be attributed to a less tight monitoring of intervention and audit. Inserting practical tools in the intervention might be more successful and should be studied.

Aim. To identify subgroups of patients with depression who could be the focus of effectiveness trials.

Methods. Qualitative research using in-depth interviews in UK primary care. In-depth interviews with 30 participants from three stakeholder groups: 10 acupuncture patients and 10 acupuncturists—to examine the reasons why acupuncture is used for depression and 10 physicians—to elicit who would be acceptable to refer into a trial of acupuncture for depression. Interviews were transcribed and analysed using a Framework approach.

Results. The data have highlighted that the acceptability of particular treatments for depression is influenced by the individuals' illness career within their social context. In addition, the plausibility and associated acceptability of depression treatments are also closely tied to an individuals' explanatory model of their condition. Seven patient subgroups were identified who could potentially find acupuncture of particular interest and on which effectiveness trials could be focused.

Conclusions. We have identified the main reasons why people seek acupuncture for depression and the circumstances in which physicians would be willing to refer for depression were it to prove effective. We have also set out a number of potential patient subgroups who may be particularly interested participating in a randomized controlled trail of acupuncture for depression.

Objective. To explore and categorize the health concerns of adolescent girls sending unsolicited emails to a teenage girls’ magazine.

Method. We conducted a content analysis of 1000 systematic randomly selected unsolicited emails submitted to the health column of an Australian adolescent girls’ magazine over a 6-month period.

Results. Three main foci of concern were identified: Context of Concern, Health Issue of Concern and Advice Sought for Concern. Within Health Issue of Concern, there were five categories: body (47.5%), sex (31.9%), relationship (14.7%), mind (4.7%) and violence and/or safety (1.2%). Concerns within the body and sex categories ranged enormously, but frequently expressed intimate descriptions of anatomy, feelings, sexual practices and relationships. Many concerns occurred in the context of adolescents’ relationships with others. The proportion of concerns about physical or psychological symptoms or health issues commonly associated with the adolescent age group (such as health risk behaviours, mental health, pregnancy and sexually transmitted infections) was relatively small.

Conclusions. GPs and other health professionals might engage more readily with adolescent patients with a deeper understanding of the concerns that adolescents have about their bodies, relationships and overall health. Seemingly ‘trivial’ issues, such as normal puberty, could be used as discussion triggers in health consultations to help alleviate anxiety and build rapport.

Objective. This study investigates how pharmaceutical sales representative visits influenced physicians’ company-specific drug preferences and prevalence of steroid prescribing.

Methods. Observational cohort study in Funen County, Denmark, including 165 general practices visited 832 times by pharmaceutical representatives and 54 080 patients treated with asthma drugs. Visits were conducted from 2001 to 2003. Our main outcome measures were (i) company-specific drug preferences measured as the proportion of dispensings of the promoted drug among all dispensings of fixed combinations of inhaled corticosteroid and long-acting β₂-agonists and (ii) the proportion of patients receiving repeated β₂-agonist dispensings who were treated with inhaled steroids.

Results. The first visit had a statistically significant effect on the GPs’ drug preference in favour of the marketed drug [odds ratio (OR), 2.39; 95% confidence interval (CI), 1.72–3.32]. The effect on drug preference increased further after the second visit (OR, 1.51; 95% CI, 1.19–1.93), while there was no significant change after the third visit (OR, 1.06; 95% CI, 0.94–1.20). Pharmaceutical sales representative visits did not influence the overall treatment pattern with inhaled steroids (OR, 1.01; 95% CI, 0.97–1.06).

Conclusions. Pharmaceutical sales representative visits markedly increased the market share of the promoted drug, but only the two first visits had significant impact. Visits had no significant impact on GPs’ overall prescribing of inhaled steroids.

Objectives. The aim was to explore the views of GPs and patients in London and Melbourne about primary care system features which support or hinder best care for mild-to-moderate depression. The study differentiated between policy and reality ‘on the ground’.

Methods. Two round Delphi technique methodology with four panels: GPs and patients in London and GPs and patients in Melbourne, to elicit views on the extent to which system features were reflected in policy, reflected in reality and were of value for best care.

Results. Four themes were generated: system and financing, responsibility and continuity, consultations and primary care team. Patient-centred care, having sufficient time during a consultation, and the GP–patient relationship extending over time were rated highly by all panels. Panellists differentiated between policy and reality on a number of features.

Conclusions. The Australian system does not guarantee continuity of care with practitioner or practice but patients took steps to see the same doctor for depression. There was a difference in the way London and Melbourne panels responded to finance-related statements. There was a tendency for panellists to value aspects of their own system and to fail to see possibilities of other systems.

Objective. To assess cancer survivors’ perceived need for physical and psychosocial rehabilitation, whether these needs have been presented to and discussed with their GP.

Methods. A survey among a cohort of cancer survivors approximately 15 months after diagnosis. The questionnaire consisted of an ad hoc questionnaire on rehabilitation needs and the two validated questionnaires, the SF-12 and the Research and Treatment of Cancer quality of life questionnaire, the QLQ C-30 version 3.

Results. Among 534 eligible patients, we received 353 (66.1%) answers. Two-thirds of the cancer survivors had discussed physical rehabilitation needs with their GPs. Many (51%) feared cancer relapse, but they rarely presented this fear to the GP or the hospital staff. The same applied to social problems and problems within the family. Good physical and mental condition and low confidence in the GP were associated with no contact to the GP after hospital discharge.

Conclusion. Cancer survivors have many psychosocial rehabilitation needs and intervention should effectively target these needs. If this task is assigned to the GPs, they need to be proactive when assessing psychosocial aspects.