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Rationale, aims and objective: Substituting outpatient hospital care with primary care is seen as a solution to decrease unnecessary referrals to outpatient hospital care and decrease rising healthcare costs. This systematic review aimed to evaluate the effects on quality of care, health and costs outcomes of substituting outpatient hospital care with primary care-based interventions, which are performed by medical specialists in face-to-face consultations in a primary care setting. Method: The systematic review was performed using the PICO framework. Original papers in which the premise of the intervention was to substitute outpatient hospital care with primary care through the involvement of a medical specialist in a primary care setting were eligible. Results: A total of 14 papers were included. A substitution intervention in general practitioner (GP) practices was described in 11 papers, three described a joint consultation intervention in which GPs see patients together with a medical specialist. This study showed that substitution initiatives result mostly in favourable outcomes compared to outpatient hospital care. The initiatives resulted mostly in shorter waiting lists, shorter clinic waiting times and higher patient satisfaction. Costs for treating one extra patient seemed to be higher in the intervention settings. This was mainly caused by inefficient planning of consultation hours and lower patient numbers. Conclusions: Despite the fact that internationally a lot has been written about the importance of performing substitution interventions in which preventing unnecessary referrals to outpatient hospital care was the aim, only 14 papers were included. Future systematic reviews should focus on the effects on the Triple Aim of substitution initiatives in which other healthcare professions than medical specialists are involved along with new technologies, such as e-consults. Additionally, to gain more insight into the effects of substitution initiatives operating in a dynamic healthcare context, it is important to keep evaluating the interventions in a longitudinal study design. [ABSTRACT FROM AUTHOR]

Background: Within the European Union (EU), substantial efforts are being made to achieve economic and social cohesion, and the reduction of health inequalities between EU regions is integral to this process. This paper is the first to examine how self-reported conditions and non-communicable diseases (NCDs) vary spatially between and within countries. Methods: Using 2014 European Social Survey (ESS) data from 20 countries, this paper examines how regional inequalities in self-reported conditions and NCDs vary for men and women in 174 regions (levels 1 and 2 Nomenclature of Statistical Territorial Units, 'NUTS'). We document absolute and relative inequalities across Europe in the prevalence of eight conditions: general health, overweight/obesity, mental health, heart or circulation problems, high blood pressure, back, neck, muscular or joint pain, diabetes and cancer. Results: There is considerable inequality in self-reported conditions and NCDs between the regions of Europe, with rates highest in the regions of continental Europe, some Scandinavian regions and parts of the UK and lowest around regions bordering the Alps, in Ireland and France. However, for mental health and cancer, rates are highest in regions of Eastern European and lowest in some Nordic regions, Ireland and isolated regions in continental Europe. There are also widespread and consistent absolute and relative regional inequalities in all conditions within countries. These are largest in France, Germany and the UK, and smallest in Denmark, Sweden and Norway. There were higher inequalities amongst women. Conclusion: Using newly available harmonized morbidity data from across Europe, this paper shows that there are considerable regional inequalities within and between European countries in the distribution of self-reported conditions and NCDs. [ABSTRACT FROM AUTHOR]

Background: Patient and public involvement (PPI) is a requirement for UK health and social care research funding. Evidence for how best to implement PPI in research programmes, such as National Institute for Health Research (NIHR) Collaborations for Applied Health Research and Care (CLAHRCs), remains limited. This paper reports findings from an action research (AR) project called IMPRESS, which aims to strengthen PPI within CLAHRC East of England (EoE). IMPRESS combines AR with Normalisation Process Theory (NPT) to explore PPI within diverse case study projects, identifying actions to implement, test and refine to further embed PPI. Methods: We purposively selected CLAHRC EoE case study projects for in-depth analysis of PPI using NPT. Data were generated from project PPI documentation, semi-structured qualitative interviews with researchers and PPI contributors and focus groups. Transcripts and documents were subjected to abductive thematic analysis and triangulation within case. Systematic across case comparison of themes was undertaken with findings and implications refined through stakeholder consultation. Results: We interviewed 24 researchers and 13 PPI contributors and analysed 28 documents from 10 case studies. Three focus groups were held: two with researchers (n = 4 and n = 6) and one with PPI contributors (n = 5). Findings detail to what extent projects made sense of PPI, bought in to PPI, operationalised PPI and appraised it, thus identifying barriers and enablers to fully embedded PPI. Conclusion: Combining NPT with AR allows us to assess the embeddedness of PPI within projects and programme, to inform specific local action and report broader conceptual lessons for PPI knowledge and practice informing the development of an action framework for embedding PPI in research programmes. To embed PPI within similar programmes teams, professionals, disciplines and institutions should be recognised as variably networked into existing PPI support. Further focus and research is needed on sharing PPI learning and supporting innovation in PPI. [ABSTRACT FROM AUTHOR]

There is a growing interest in island economies within Europe. In the European Union (EU) this has led to enhanced Cohesion Policy support for islands, along with a number of other regions facing geographical challenges. Because of major problems with data, comparative research on islands across different EU member states has been of limited extent. This paper explores the use of national data sets to undertake comparative cross-country analysis of islands. The paper concentrates on two member states, Greece and Britain, which have large numbers of offshore islands. Data from national population censuses are drawn upon to allow typologies of the islands to be developed. These typologies are utilised to identify similarities and differences between British and Greek islands. [ABSTRACT FROM AUTHOR]

Currently, the majority of the European housing stock falls towards the bottom of the energy efficiency rating scale on the EU Energy Performance Certificate. If governments and businesses are to successfully address ambitious CO2 reduction targets, then it will be imperative that energy-efficient measures and policies focus on existing housing. In order to understand what kind of retrofit is needed to achieve an “A” energy performance rating in social housing, the paper reports the findings of an on-going research project in the UK. The paper draws on a case study from the Technology Strategy Board's “Retrofit for the Future” competition entry in Cambridge. The upgrade strategy improved the home's energy performance rating to A, aimed to radically reduce carbon dioxide emissions (17 kg m−2 year−1) and provided affordable warmth for the tenants. In order to get an impression of the actual energy consumption in the case study, energy use behaviour of the household was observed. Based on the barriers identified in the case study, the feasibility of the current UK policy strategies (e.g. Smart Meters and Feed-in-Tariffs) to facilitate the acceptance of energy measures in social housing is discussed. [ABSTRACT FROM AUTHOR]

This paper is concerned with re-imaginings of 'Europe' following the accession to the European Union (EU) of former 'Eastern European' countries. In particular it explores media representations of post-EU accession migration from Romania to the United Kingdom in the UK and Romanian newspaper press. Todorova's (1997) notion of Balkanism is deployed as a theoretical construct to facilitate the analysis of these representations as first, the continuation of long-standing and deeply embedded imaginings of the 'East' of Europe and, second, as a means of contesting these discourses. The paper explores the way in which the UK press construct Balkanist discourses about Romania and Romanian migrants, and then analyses how the Romanian press has contested such discourses. The paper argues that the idea of the 'East' remains important in constructing notions of 'Europe' within popular media geographies. [ABSTRACT FROM AUTHOR]

This paper identifies and seeks to resolve the paradox that British social policy appears to have diverged from its EU partners in the period since membership and to have converged with that of the USA. Existing historical institutionalist approaches stress common regime characteristics of Britain and the USA in explanation of British difference from other member states. The present paper challenges such accounts and argues that the explanation lies in the transformation (and demise) of the post-Imperial/Commonwealth system of political economy in which the British economy (and related social policy) was embedded. This transformation has also produced internal problems within the British state giving rise to its reorganization with devolved Assemblies in Scotland and Wales. The final part of the paper addresses how this latter development has created a 'fault-line' in the British social policy debate with the possibility of reversing the trend toward Americanization. [ABSTRACT FROM AUTHOR]

This paper explores questions of citizenship and the role of universities in the context of the policy changes in the UK and in Europe over the last two decades. Twenty fi ve years after the political transitions in Eastern Europe, and 70 years since the end of the Second World War, Europe is more united than ever before. New political, social and economic configurations across the continent are bringing expectations and pressures to its citizens and institutions, with universities at the front of many economic and social projects. What do these new conditions mean for citizenship in the context of European universities, and how do member states respond to this changing context? The article will use England as a national case study within the EU to illustrate the tensions between the humanistic visions still carried out by many universities, although interpreted differently across the sector, and the pressures for the creation of the 'knowledge economy' that are shared at the national and transnational levels. [ABSTRACT FROM AUTHOR]

The article examines Great Britain within the context of the European Union (EU) and argues that future continuation within the international body will create political challenges within the nation. It is attested that the unity of the country’s Conservative party depends upon the Prime Minister opposing any further progress toward European integration. At the same time, the paper alleges that the Labour party and the Liberal Democrats both support further European integration, particularly the strengthening of the European Parliament. Options relevant to these varying political doctrines are presented.

This paper discusses the relationships between the migratory policies of the EU countries with more experience of immigration and their national political cultures. It focuses on France, Germany and the United Kingdom. It then looks at Italy, a relatively new country of immigration, which, with 3,000,000 legal immigrants, has become the fourth country of immigration in Europe and the first in the Mediterranean basin. In its final part it highlights the incipient process of 'communitarisation' of the immigration policies of EU countries in the last decade. This process, which has already entailed a significant convergence of their migratory policies, is expected to continue after the recent enlargement of the European Union. [ABSTRACT FROM AUTHOR]

This paper examines the right to health care. Various expressions of this right may be distinguished. These include both individual rights and social rights which could be based upon international treaties and constitutional rights. They may be found in national health legislation and, in some cases, in jurisprudence. To analyze the consequences of limiting the right to health care, a framework for judicial review has been developed which encompasses these expressions of the right to health care. The framework was used to examine legal and health policy developments in three Western and two Eastern European countries. In Italy and the Netherlands the right to health care is protected constitutionally (but on differing legal bases) while the United Kingdom does not have a written constitution. In contrast, Hungary and Poland have for many years seen the state take responsible for the provision, administration and allocation of health care services and the right to health care was guaranteed theoretically but not in practice because of the lack of (financial) means. However, the Polish Constitution explicitly anticipates possible limitations of the right to health care. What all these countries have in common is a cost containment perspective where the future will bring even tighter limits on what resources patients may consume. Despite differences in legal structure between these countries, where they seem to converge is on the consequences of putting limitations on the right to health care. The courts in Italy, the Netherlands and the UK have formulated conditions drawn from the acceptance that this right has to be judged within the context of limited resources. It may be concluded that finding a compromise between the right to health care and cost containment policies could also be an issue, Eastern European countries will have to face in the future. [ABSTRACT FROM AUTHOR]