Aim: To describe the scope and nature of research capacity building activity within academic departments of general practice and rural health in Australia. Method: Document review of Annual Reports for the years 2000 and 2003 of 17 university departments of general practice and rural health, funded through the Research Capacity Building Initiative (RCBI) of the Primary Health Care Research, Evaluation and Development (PHCRED) Strategy. Results: The review indicated that from 2000 to 2003, departments increased their activities in all areas of research capacity building activities. Mentoring and/or supervision other than higher degree students increased from 14 in 2000 to 266 in 2003. Twenty-two research networks involving over 1377 participants were operating in 2003. All departments were involved in collaborations either as part of grant applications, research projects or educational activities. Over 3630 people participated in 189 educational activities in 2003 compared to over 624 people attending 103 activities in 2000. Compared to $10.98 million in 2000, departments had obtained more than $15.6 million for research projects in 2003. While there were more peer reviewed papers published in 2000 (n = 178) compared to 2003 (n = 130), these 17 departments gave 187 conference presen-tations. Conclusions: This review shows that the RCBI has contributed towards a considerable increase in research activities in these university departments of general practice and rural health. This has provided a major boost to primary health care research in Australia. These activities would have been unlikely to occur without the support and assistance of the PHCRED Strategy. Clearly, the full impact of the RCBI will take some time to evolve.

The emerging UK national research network in neurodegenerative diseases and dementias aims to promote large-scale community-based studies of therapeutic interventions, based in primary care. However, trials in primary care settings can be problematic, a common difficulty being the recruitment of a large enough sample. The article discusses recruitment issues in a multi-centre randomized controlled trial of differing educational approaches to improving dementia care in general practice. Sample size calculations based on community studies of prevalence may be misleading in intervention trials which may recruit practices with atypical demography. Recruitment rates for practitioners in this study were lower than expected. Professionals excluded themselves from the study mainly due to pressures of time and staff shortages, and we detected both ambivalent attitudes to primary care research and a perception that research into dementia care was not a high priority. Evaluation of the quality of care may be perceived as criticism of clinical practice, at a time when general practice is undergoing major administrative and contractual changes. Variations in Research Ethics Committee conditions for approval led to different methods of recruitment of patients and carers into the study, a factor which may have contributed to disparate levels of recruitment across study sites. Patient and carer levels of recruitment were lower than expected and were affected partly by carers' time pressures and other family commitments, but largely by problems in identifying patients and carers in the practices. The development of research potential in primary care is at an early stage and studies reliant on patient recruitment in general practice must allow for multiple obstacles to enrollment. This is particularly relevant for studies of dementia care, where the prevalence of dementia in a demographically average population is low and the incidence very low, compared with other disabilities. Professionals may give dementia low priority in allocating practice time for research projects, and strategies to address this problem are needed.

Aim: In this article the authors illustrate using a case study approach how primary care professionals can use the combination of geodemographic data with hospital episode statistics (HES) to predict the location of people ‘at risk’ of diabetes mellitus (Type 2 diabetes) in the population of England. This approach facilitates social marketing of those ‘at risk’. Method: Geodemographic segmentation data for all households was combined with HES for 2001–2002, to predict population groups ‘at risk’ of Type 2 diabetes. Using a case study approach and quantitative data analysis techniques, a profile of the undiagnosed and ‘at risk’ population of Slough Primary Care Trust was created at town, ward and street levels. Recent literature on social marketing was applied to predicate a discussion of the theory and practice of social marketing that was most likely to succeed in dealing with the prevention of Type 2 diabetes, via the reduction of obesity and overweight in the population. Discussion: The increase in lifestyle-related diseases, such as, Type 2 diabetes that are linked with the rise in overweight and obesity and create large disease management costs for the National Health Service (NHS) are of great concern to primary healthcare professionals and governments throughout the westernized world. Until recently, public and government responses have been very reactive in respect of population groups most in need of lifestyle change. Approaches to the identification of ‘sub-populations’ most at risk of Type 2 diabetes and targeting of these is of direct relevance to the preventive work of primary care professionals. Conclusion: Geodemographic data overlaid onto official NHS and other routinely collected data, can aid the identification and targeting of groups most vulnerable to overweight and obesity, through social marketing approaches including direct mail, telephone canvassing and door-to-door communication channels.

This research describes the onset of 13 health conditions and death among 38 adults with spinal cord injuries (SCIs) and 149 adults with traumatic brain injuries (TBIs) compared to adults without disabilities in the same primary care setting, using a retrospective cohort design. The subjects were accrued from an urban and a rural practice, both affiliated with a university family medicine department. Survival analyses, using Cox proportional hazard models, were used to model the onset of each of the health conditions. The results indicated adults with SCI had an increased risk for onset of chronic obstructive pulmonary disease and depression. Individuals with TBIs had an increased risk for onset of anxiety, chronic obstructive pulmonary disease, dementia, depression, and seizures. Neither group had increased risk for asthma, cancer, coronary artery disease, congestive heart failure, diabetes, hypertension, obesity, or transient ischaemic attack. The only conditions with increased risk were those previously identified as secondary to traumatic injury. The other conditions including death did not have higher incidence among the study group, during 7–9 years of retrospective follow-up.

This study used Knowles's adult learning theory as a framework, to explore the meanings of the lived supervision experience of healthcare support workers in primary care. In this study, seven healthcare support workers participated in tape-recorded interviews, in which they described their supervision experience, yielding transcripts that were subjected to qualitative analysis. Four themes reflective of their supervision experience emerged from the data. These were the beginning; creating the space; the supervisory relationship and outcomes of supervision. The results of the study provided a clearer understanding of the meaning of supervision from healthcare support workers' perspective and additionally, support for Knowles's adult learning theory as a framework for adult learning. At the end, the findings were presented and recommendations were made in terms of primary health care practice and research.

Recent years have seen an increase in critical analyses of discourses of policy and practice. However, some argue that this form of scholarship is not central to understanding the concerns of day-to-day practice in the health care context. We propose the converse and contend that critical analyses have particularly important contributions to make because they challenge us to examine what are largely taken for granted aspects of practice. One context in which such examinations have been instructive is primary healthcare. This article is intended to further the dialogue on the ways the culture concept is taken up in health care. We use the case of culture and health to illustrate the ways discourses are taken up in local and official contexts and to demonstrate how different discourses and related institutional practices, shape individuals' relationships with others in the community context.

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.

This small exploratory study in one local area in Scotland aimed to identify health visitors' perceptions of public health nursing and the factors that influenced their capacity to adopt a broad public health role in line with current policy direction in Scotland. The literature review focused on the historical and political context of public health nursing and the extent to which health visitors across the UK have managed to shift practice towards a greater emphasis on community focused public health work. This study involved 10 qualitative interviews with practising health visitors, who had at least 2 years' experience and trained prior to September 2001 when the public health nursing course replaced the health visiting course in Scotland. Participants identified a range of barriers to local implementation of the model of public health nursing practice set out in recent national policy. Findings suggested that theoretical perspectives of public health and leadership issues for health visitors perpetuate the dominant clinical agenda in their work setting. Although participants were generally willing to develop wider public health work they identified a number of constraints related to the perceived higher value given to clinical duties. This was reinforced by the low priority given to public health work at all levels within the organization and by primary care team colleagues. The study found participants felt powerless to influence change and were frustrated by unrealistic expectations of their ability to develop their public health nursing role without adequate support and planning infrastructure. Dominant themes that emerged from the investigation reinforce the need for effective leadership and application of social science theory to enable public health nurses to challenge the perceived dominant biomedical approach to public health in primary care.

National Health Service (NHS) Direct is a 24-h patient-led telephone advice service, based in England and Wales, which aims to help callers self-manage problems and reduce unnecessary demands on other NHS provision. Despite its rapid expansion as a source of health information and advice, little empirical work has investigated its impact and effectiveness. This paper reports on a study that aimed to evaluate the contribution of NHS Direct to the quality of care and its impact on health services within one part of the United Kingdom (UK). A postal survey of callers who had contacted NHS Direct between June 2004 and January 2005 with abdominal pain or cough and/or sore throat was conducted. Of 268 callers, over 90% reported they had followed the advice given by NHS Direct to self-care or to contact another health service. Fifty-one of the callers were referred to an Accident and Emergency department and, of these, 39 (76%) received a prescription and 20 (39%) were admitted to hospital. One hundred and forty-four callers were referred to a General Practitioner (GP) and, of these, 88 (61%) received a prescription and 21 (15%) were admitted to hospital. Of the 69 callers advised to self-care, 47 (68%) reported that they did not receive any further intervention while 18 (26%) reported they had subsequently contacted a GP and been given a prescription for medication. The paper concludes that most referrals made by NHS Direct to another health service were justified by the interventions received by patients. However a significant minority (26%) of callers referred to GPs did not receive any further intervention and there was some duplication of service use. Health professionals need to be aware that patients might have previously contacted another health service and provide advice on effective use of services.