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Objectives To quantify service integration achieved in the national exemplar program for single call access to out of hours care through NHS Direct, and its effect on the wider health system. Design Observational before and after study of demand, activity, and trends in the use of other health services. Participants 34 general practice cooperatives with NHS Direct partners (exemplars): four were case exemplars; 10 control cooperatives. Setting England. Main outcome measures Extent of integration; changes in demand, activity, and trends in emergency ambulance transports; attendances at emergency departments, minor injuries units, and NHS walk-in centers; and emergency admissions to hospital in the first year. Results Of 31 distinct exemplars, 21 (68%) integrated all out of hours call management. Nine (29%) achieved single call access for all patients. In the only case exemplar where direct comparison was possible, a higher proportion of telephone calls were handled by cooperative nurses before integration than by NHS Direct afterwards (2622/6687 (39%) v 2092/7086 (30%): P < 0.0001). Other case exemplars did not achieve 30%. A small but significant downturn in overall demand for care seen in two case exemplars was also seen in the control cooperatives. The number of emergency ambulance transports increased in three of the four case exemplars after integration, reaching statistical significance in two (5%, -0.02% to 10%, P = 0.06; 6%, 1% to 12%, P = 0.02; 7%, 3% to 12%, P = 0.001). This was always accompanied by a significant reduction in the number of calls to the integrated service. Conclusion Most exemplars achieved integration of call management but not single call access for patients. Most patients made at least two telephone calls to contact NHS Direct, and then waited for a nurse to call back. Evidence for transfer of demand from case exemplars to 999 ambulance services may be amenable to change, but NHS Direct may not have sufficient capacity to support national implementation of the program. [ABSTRACT FROM AUTHOR]

Focuses on the importance of practicing evidence-based medicine in developing countries with few resources for health care services. Description of public health and social conditions in developing countries; Efforts toward the development of health research and reform; Formation of public health policies based on evidence-based medicine by the World Health Organization (WHO) and other groups; Details of evidence-based medicine initiatives in South Africa, China, and Nigeria.

Examines four new medical schools in Great Britain and how they are each implementing key reforms in medical education. Comparison of the four programs; Patient contact which is continued throughout the course; Academic training of research methods; How altered selection criteria is leading to a different student mix.

Presents information on a study which evaluated whether nurse telephone consultation in out of hours primary care may reduce costs compared to general practice care. Concept of nurse telephone consultation; Methodology of the study; Results and discussion; Conclusions.

Presents a research that assesses the effectiveness of a program to coordinate and support follow up care in general practice after a hospital diagnosis of myocardial infarction or angina. Participants and methodology; Main outcome measures; Conclusions.

Focuses on the approach on how primary care groups of England will provide and commission health care for a local population in England. Intention of the United Kingdom government to manage the performance of the National Health Service; Aspects of primary care; Details on a method comparing the sensitivity of indicators to monitor differences in care for the hospital treatment of myocardial infarction.

Presents a study which examined the effectiveness and safety of nurse telephone consultation in out of hours primary care. Methodology; Data and analysis; Interpretation of results.

Determines the attitude of general practitioners of Great Britain towards evidence based medicine and their related educational needs. Brief information on the perceptions of general practitioners identified in the study; Findings and analysis of results; Barriers to practicing evidence based medicine; Conclusions.

Examines the provision of out of hours primary medical care in Great Britain. Demand for out of hours medical care; Cost of night visits; Out of hours care by telephone.

Presents several letters concerning medicine. Effect of fast track admission for acute myocardial infarction; Correlation between passive smoking and otitis media with effusion; Efficacy of omeprazole for acute upper gastrointestinal bleeding.

Presents a study to examine the reasons for an increase in the demand for emergency medical services in the United Kingdom. Analysis of emergency ambulance dispatches; Assertion that people are using more specific terminology to describe emergency incidents; Method of research.

Evaluates the cost for health care services in British Columbia. Payment systems for health care services; Policy regarding earning capacity doctors; Negotiations between doctors and the government.

Focuses on a study which analyzed literature available in general practices in Great Britain, for patients with asthma, for their readability and accuracy. Use of material from 70 general practices from the Wessex Research Network; Review of the literature using the guidelines of the British Thoracic Society; Statistical information from the findings of the study; Recommendations made as a result of the findings.

Reviews the open access, online journal from the Public Library of Science, PLoS Medicine.