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Background: There are several assumptions within clinical practice about who is more or less likely to consult a health care practitioner for particular symptoms, most commonly these focus around socio-demographic characteristics. We aimed to assess the evidence for the impact of socio-demographic characteristics on consultation for back pain.Methods: We conducted a review of the literature, using systematic methods, on consultation for back pain. Using systematic searching techniques we identified peer-reviewed publications that focused on health care consultation in response to symptoms of back pain and which included data on both users and non-users of health care.Results: We identified 23 studies. Definitions of help-seeking were inconsistent across studies. The majority of the 15 studies which considered the relationship between age and help-seeking for back pain did not find evidence of an association between these two factors. Seventeen studies considered whether socio-economic position was associated with help-seeking. The evidence largely supported the conclusion of no association (13 papers). Fifteen studies included gender as a variable in their analyses, and the majority (10 papers) presented the finding of no association.Conclusions: The results from this review suggest that there is little evidence to support the common wisdom that socio-demographic characteristics impact on help-seeking in the context of back pain. As these assumptions relating to who is more or less likely to consult will ultimately affect patient care, it is important that they do not go unchallenged. [ABSTRACT FROM AUTHOR]

Background: Recruiting smokers to smoking cessation trials is challenging and participation rates are often low. Consequently, the interventions evaluated may fail to reach a broad spectrum of the target population, thus compromising the generalizability of the findings. Brief interventions, using proactive recruitment, are likely to attract a broader and more representative proportion of the population., Objective: We explored the factors that influenced recruitment into a trial evaluating computer-tailored feedback reports that aimed to help smokers to quit [the ESCAPE (Effectiveness of computer-tailored Smoking Cessation Advice in Primary Care) study] in order to investigate the possibilities for increasing recruitment into smoking cessation trials., Methods: Current cigarette smokers, identified from GP records, were invited to participate in the study. The main outcome measure was the recruitment rate, i.e. the proportion of participants who responded and were randomized to one of the intervention groups. Predictor variables included geographical region, level of deprivation, practice characteristics and the number and timing of mailings of questionnaires., Results: The recruitment rate varied by practice (2.5-19.8%) and differed significantly between regions (from 16.3% in Scotland to 8.4% in London, P < 0.001). Recruitment decreased significantly by 1.1% between the lowest and highest quintiles of deprivation (P = 0.012), measured by Index of Multiple Deprivation scores, and decreased by 1.33% for every extra 10% smokers identified within a practice population (P = 0.010). Sending reminders increased recruitment by 7.5% (P < 0.001). Multivariable analysis showed region and length of time between mailings were the main predictors of recruitment., Conclusions: Proactive recruitment methods can increase participation in smoking cessation trials and weighting the target sample in favour of more deprived areas will recruit a more representative sample. The number and timing of mailings to potential participants can also increase recruitment.

Background: Detection rates of depression in primary care are <50%. Studies showed similar outcome after 12 months for recognized and unrecognized depression. Outcome beyond 12 months is less well studied., Objective: We investigated recognition of depression in primary care and its relation to outcome after 6, 12 and 39 months., Methods: Data were used from a prospective cohort study of 1293 consecutive general practice attendees (PREDICT-NL), who were followed up after 6 (n = 1236), 12 (n = 1179) and 39 (n = 752) months. We measured the presence and severity of major depressive disorder (MDD) according to DSM-IV criteria and Patient Health Questionnaire 9 (PHQ-9) and mental function with Short Form 12 (SF-12). Recognition of depression was assessed using international classification of primary care codes (P03 and P76) and Anatomical Therapeutic Chemical (N06A) codes from the GP records (6 months before/after baseline)., Results: At baseline, 170 (13%) of the participants had MDD, of whom 36% were recognized by their GP. The relative risk of being depressed after 39 months was 1.35 [95% confidence interval (CI) 0.7-2.7] for participants with recognized depression compared to unrecognized depression. At baseline, participants with recognized depression had more depressive symptoms (mean difference PHQ-9 2.7, 95% CI 1.6-3.9) and worse mental function (mean difference mental component summary -3.8, 95% CI -7.8 to 0.2) than unrecognized depressed participants. After 12 and 39 months, mean scores for both groups did not differ but were worse than those without depression., Conclusions: A minority of patients with MDD is recognized in primary care. Those who were unrecognized had comparable outcome after 12 and 39 months as participants with recognized depression.

The study reports on a controlled evaluation of services offered to patients with a diagnosis of schizophrenia in comparison to diabetic patients and matched attenders with no chronic illness. Data were collected from one inner city London group practice, by a retrospective analysis of patients' notes over a period of 6 years. Although patients with schizophrenia attended significantly more often than other patients, clinical assessments in the surgery were rarely undertaken. Communications with hospital consultant services were rare for both chronic groups of patients but in the case of those with schizophrenia the doctor received on average only one letter every 2 years. The findings support other recommendations for a more structured approach to the care of schizophrenia in general practice with regular attention to mental state assessment and monitoring of drug treatment.