'Too much, too late': mixed methods multi-channel video recording study of computerized decision support systems and GP prescribing.

Objective: Computerized decision support systems (CDSS) are commonly deployed to support prescribing, although over-riding of alerts by prescribers remains a concern. We aimed to understand how general practitioners (GPs) interact with prescribing CDSS in order to inform deliberation on how better to support prescribing decisions in primary care.

Materials And Methods: Quantitative and qualitative analysis of interactions between GPs, patients, and computer systems using multi-channel video recordings of 112 primary care consultations with eight GPs in three UK practices.

Developing novel evidence-based interventions to promote asthma action plan use: a cross-study synthesis of evidence from randomised controlled trials and qualitative studies.

Background: Long-standing randomised controlled trial (RCT) evidence indicates that asthma action plans can improve patient outcomes. Internationally, however, these plans are seldom issued by professionals or used by patients/carers. To understand how the benefits of such plans might be realised clinically, we previously investigated barriers and facilitators to their implementation in a systematic review of relevant RCTs and synthesised qualitative studies exploring professional and patient/carer views.

Effectiveness of holistic interventions for people with severe chronic obstructive pulmonary disease: systematic review of controlled clinical trials.

Background: Despite a well-recognised burden of disabling physical symptoms compounded by co-morbidities, psychological distress and social isolation, the needs of people with severe chronic obstructive pulmonary disease (COPD) are typically poorly addressed.

Aim: To assess the effectiveness of interventions designed to deliver holistic care for people with severe COPD.

Methods: We searched 11 biomedical databases, three trial repositories (January 1990-March 2012; no language restrictions) and contacted international experts to locate published, unpublished and in-progress randomised controlled trials (RCTs), quasi-RCTs and controlled clinical trials (CCTs) that investigated holistic interventions to support patients with severe COPD in any healthcare context.

The challenge of recruiting in primary care for a trial of telemonitoring in asthma: an observational study.

Aim: Achieving target recruitment in randomized controlled trials (RCTs) is challenging. This paper compares our experience of recruiting for an RCT with the predictions made in our proposal.

Methods: Participating UK primary care practices searched their computer databases to identify patients (12 years and over) with asthma who may be poorly controlled.

Continuity, but at what cost? The impact of telemonitoring COPD on continuities of care: a qualitative study.

Background: Continuity of care is widely regarded as an important marker of quality in the management of patients with long-term conditions. New services that integrate telemonitoring into care pathways have potential to change aspects of continuity in both positive and negative ways.

Aims: A telemonitoring service for patients with chronic obstructive pulmonary disease (COPD) was introduced in Lothian, Scotland, in 2009.

Effecting change in primary care management of respiratory conditions: a global scoping exercise and literature review of educational interventions to inform the IPCRG's E-Quality initiative.

This discussion paper describes a scoping exercise and literature review commissioned by the International Primary Care Respiratory Group (IPCRG) to inform their E-Quality programme which seeks to support small-scale educational projects to improve respiratory management in primary care. Our narrative review synthesises information from three sources: publications concerning the global context and health systems development; a literature search of Medline, CINAHL and Cochrane databases; and a series of eight interviews conducted with members of the IPCRG faculty. Educational interventions sit within complex healthcare, economic, and policy contexts.

Clinical implications of the Royal College of Physicians three questions in routine asthma care: a real-life validation study.

Background: Annual recording of the Royal College of Physicians three questions (RCP3Q) morbidity score is rewarded within the UK 'pay-for-performance' Quality and Outcomes Framework.

Aims: To investigate the performance of the RCP3Qs for assessing control in real-life practice compared with the validated Asthma Control Questionnaire (ACQ) administered by self-completed questionnaire.

Methods: We compared the RCP3Q score extracted from a patient's computerised medical record with the ACQ self-completed after the consultation.

Clinical and cost effectiveness of mobile phone supported self monitoring of asthma: multicentre randomised controlled trial.

Objective: To determine whether mobile phone based monitoring improves asthma control compared with standard paper based monitoring strategies.

Design: Multicentre randomised controlled trial with cost effectiveness analysis.

Setting: UK primary care.

Prioritising the respiratory research needs of primary care: the International Primary Care Respiratory Group (IPCRG) e-Delphi exercise.

Background: Community-based care, underpinned by relevant primary care research, is an important component of the global fight against non-communicable diseases. The International Primary Care Research Group's (IPCRG's) Research Needs Statement identified 145 research questions within five domains (asthma, rhinitis, chronic obstructive pulmonary disease (COPD), smoking, respiratory infections).

Aims: To use an e-mail Delphi process to prioritise the research questions.

Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study.

Objectives: To understand the perspectives of people with severe chronic obstructive pulmonary disease (COPD) as their illness progresses, and of their informal and professional carers, to inform provision of care for people living and dying with COPD.

Design: Up to four serial qualitative interviews were conducted with each patient and nominated carer over 18 months. Interviews were transcribed and analysed both thematically and as narratives.

Piloting tele-monitoring in COPD: a mixed methods exploration of issues in design and implementation.

Background: In 2008 NHS Lothian implemented a COPD tele-monitoring service incorporating a touch-screen computer for daily recording of symptoms and weekly oximetry and spirometry measurement. Data were transmitted by secure broadband link to a call centre where trained workers monitored data and contacted clinicians according to an agreed algorithm.

Aims: To explore the perceptions of patients and professionals about the pilot implementation of the COPD tele-monitoring service.

Understanding what asthma plans mean: a linguistic analysis of terminology used in published texts.

Aim: To identify from the literature what terms are used for 'asthma plans', with what meaning, and in what context(s).

Methods: Linguistic analysis of a selected body of asthma literature from 1989-2009.

Results: A wide range of asthma plan terminology was evident, with terms such as 'action plans', 'self-management plans' and 'treatment plans' being applied inconsistently and synonymously.

Understanding what helps or hinders asthma action plan use: a systematic review and synthesis of the qualitative literature.

Objective: To understand better what helps and/or hinders asthma action plan use from the professionals and patients/carers perspective.

Methods: Systematic review and qualitative synthesis (using meta-ethnography).

Results: Nineteen studies (20 papers) were included in an analysis of patients/carers' and professionals' views.

Comparison of the accuracy of patients' recall of the content of telephone and face-to-face consultations: an exploratory study.

BACKGROUND To comply with an action plan patients need to recall information accurately. Little is known about how well patients recall consultations, particularly telephone consultations increasingly used to triage acute problems. PURPOSE OF STUDY This was an exploratory study to measure how accurately patients recall the content of face-to-face and telephone consultations and what factors may be associated with accurate recall.

Living and dying with severe chronic obstructive pulmonary disease: multi-perspective longitudinal qualitative study.

Objectives: To understand the perspectives of people with severe chronic obstructive pulmonary disease (COPD) as their illness progresses, and of their informal and professional carers, to inform provision of care for people living and dying with COPD.

Design: Up to four serial qualitative interviews were conducted with each patient and nominated carer over 18 months. Interviews were transcribed and analysed both thematically and as narratives.

Developing and testing search strategies to identify patients with active seasonal allergic rhinitis in general practice.

Aim: We sought to assess the accuracy of different search terms to identify individuals with active seasonal allergic rhinitis (SAR) in general practice.

Methods: A reference search strategy was developed to identify patients with active SAR. This was applied through inspection of electronic health records of patients aged 15-45 years in a 10% random sample of a general practice database.

Summary of the consultation on a strategy for services for chronic obstructive pulmonary disease (COPD) in England.

The Consultation on a Strategy for Services for COPD in England is the culmination of five years' work by respiratory specialists from all disciplines, as well as representatives from the voluntary sector, patients, carers and planners. It has been led by the Department of Health in England and the joint National Directors for the programme, Professor Sue Hill and Dr Robert Winter. The Strategy outlines service standards for providers of COPD care and is complementary to the UK National Institute for Health and Clinical Excellence (NICE) guidelines on the management of COPD.

Systems for the management of respiratory disease in primary care--an international series: United Kingdom.

Introduction: The UK National Health Service (NHS) is essentially publicly funded through general taxation. Challenges facing the NHS include the rise in prevalence of long-term conditions and financial pressures. NATIONAL POLICY TRENDS: Political devolution within the UK has led to variations in the way services are organised and delivered between the four nations.

From awareness to involvement? A qualitative study of respiratory patients' awareness of health service change.

BACKGROUND Despite the policy rhetoric, patient involvement in health service decisions remains limited. Highlighted barriers include a concern that most patients are unable to see beyond personal aspects of their care in order to contribute meaningfully to health service development, and a perception that professionals do not welcome patient involvement. OBJECTIVES We aimed to explore respiratory patients' awareness of changes in local health service provision and provide insight into health professionals' attitudes to engaging patients.

The International Primary Care Respiratory Group (IPCRG) Research Needs Statement 2010.

Aim: Respiratory diseases are a public health issue throughout the world, with high prevalence and morbidity. This Research Needs Statement from the International Primary Care Respiratory Group (IPCRG) aims to highlight unanswered questions on the management of respiratory diseases that are of importance to practising primary care clinicians.

Methods: An informal but inclusive consultation process was instigated in 2009.

The quality, safety and content of telephone and face-to-face consultations: a comparative study.

Introduction: Telephone consulting is increasingly used to improve access to care and optimise resources for day-time work. However, there remains a debate about how such consultations differ from face-to-face consultations in terms of content quality and/or safety. To investigate this, a comparison of family doctors' telephone and face-to-face consultations was conducted.