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Background: Ready access to reliable data is essential to support decision-making in patient care planning and delivery. Health information exchange (HIE), which is fundamental to achieve this, is currently limited in many low- and middle-income countries (LMICs), reflecting the lack of prioritization of this issue and the many barriers to its successful implementation.Objective: We sought to explore and understand stakeholders' perspectives on the context of and deployment strategies for HIE in Pakistan.Method: Data collection comprised interviews with purposefully selected groups of stakeholders across Pakistan, field notes, and a critical review of key national and international policy documents.Results: We identified reports of small pockets of effective HIE existing mainly in private hospitals, but in a patchy and fragmented form overall. Many problems were attributed to the absence of effective HIE, these ranging from 'delays in retrieving records' to contributing to 'the increase in antibiotic resistance'. The mindset of policymakers, poor infrastructure, lack of finance, training and data interoperability, and health-care providers' resistance to recording consultations due to poor documentation skills and concerns about liability considerations were highlighted as major barriers to HIE. Sharing regional health information with international organizations was perceived by some participants to increase the risk of regional espionage. A clear government policy directive for evidence-based decision-making, constant supply of electricity, training, widespread adoption of common data standards and public pressure to adopt mobile technology frameworks were identified as potential facilitators of HIE.Conclusion: HIE can be achieved with the support of the federal and provincial governments coupled with financial and technical backing from international donor organizations. The transition to HIE is likely to be very dependent on improving governance capabilities and bolstering the informatics skill-base in Pakistan and indeed many other LMICs. [ABSTRACT FROM AUTHOR]

In March 2020, the World Health Organisation named the severe acute respiratory syndrome coronavirus 2 (Sars-CoV-2), which causes corona virus disease 2019 (COVID –19), as a pandemic. Pregnant women were considered at increased risk of developing severe COVID-19 after viral infection. In response maternity services reduced face-to-face consultations with high-risk pregnant women by supplying blood pressure monitors for supported self-monitoring. This paper explores the experiences of patients and clinicians of the rapid roll-out of supported self-monitoring programme in Scotland during the first and second wave of the COVID-19 pandemic. We conducted semi-structured telephone interviews with high-risk women and healthcare professionals who were using supported self-monitoring of blood pressure (BP) In four case studies during the COVID-19 pandemic. 20 women, 15 midwives and 4 obstetricians took part in the interviews. Interviews with healthcare professionals showed that while implementation occurred at pace and at scale across the National Health Service (NHS) in Scotland, implementation differed locally, resulting in mixed experiences. Study Participants observed several barriers and facilitators to implementation. Women value the simplicity of use and convenience of the digital communications platforms while health professionals were more interested in their impact on reducing workload for both women and health professionals largely found self-monitoring acceptable, with only a few exceptions. These results show that rapid change can occur in the NHS at a national level when there is a shared motivation. While self-monitoring is acceptable to most women, decisions regarding self-monitoring should be made jointly and on an individual basis. [ABSTRACT FROM AUTHOR]

There are about 5 million people in Europe who have dementia, approximately half of whom need daily care. A common reason why dementia sufferers are admitted to long-term care is because of "wandering", i.e. leaving home without informing a carer, thereby potentially putting themselves at risk. Common methods of managing wandering include locking doors or alerting carers when a door is opened. A new method of managing wandering is by using electronic location devices. These depend on the satellite-based global positioning system (GPS). People can wear a location device in the form of a watch or pendant, or carry it like a mobile phone. This offers affected individuals the possibility of safe walking, with the reassurance that they can be found quickly if lost. However, it is not known how effective this method is and its use raises questions about safety and individual civil liberties. GPS location is a potentially useful method of managing wandering in dementia and there is considerable pressure on caregivers from commercial organisations to adopt the technique. Research is therefore required to determine which people are best suited for such devices, how effective they are in practice and what effect they have on important outcomes. [ABSTRACT FROM AUTHOR]

Abstract: Background: Altered physical activity is an important feature of depression. It is manifested in psychomotor retardation, agitation and withdrawal from engagement in normal activities. Modern devices for activity monitoring (actigraphs) make it possible to monitor physical activity unobtrusively but the validity of actigraphy as an indicator of mood state is uncertain. We carried out a systematic review of digital actigraphy in patients with depression to investigate the associations between measured physical activity and depression. Methods: Systematic review and meta-analysis. Studies were identified from Medline, EMBASE and Psycinfo databases and included if they were either case control or longitudinal studies of actigraphy in adults aged between 18 and 65 diagnosed with a depressive disorder. Outcomes were daytime and night-time activity and actigraphic measures of sleep. Results: We identified 19 eligible papers from 16 studies (412 patients). Case control studies showed less daytime activity in patients with depression (standardised mean difference −0.76, 95% confidence intervals −1.05 to −0.47). Longitudinal studies showed moderate increase in daytime activity (0.53, 0.20 to 0.87) and a reduction in night-time activity (−0.36, −0.65 to −0.06) over the course of treatment. Limitations: All study participants were unblinded. Only seven papers included patients treated in the community. Conclusions: Actigraphy is a potentially valuable source of additional information about patients with depression. However, there are no clear guidelines for use of actigraphy in studies of patients with depression. Further studies should investigate patients treated in the community. Additional work to develop algorithms for differentiating behaviour patterns is also needed. [Copyright &y& Elsevier]

Telehealth makes use of information technology and telecommunication to help to provide clinical care over distances. This article outlines the potential for improving clinical care using these interventions, the current evidence base for tele-health programmes and the challenges to their efficacy. [ABSTRACT FROM AUTHOR]

BackgroundSecondary prevention and self-management of coronary heart disease (CHD) are of major importance to people who survive myocardial infarction (MI). This can be facilitated by cardiac rehabilitation (CR; the formal health service programme) and informal CHD self-help groups. Non-participation is an important issue, yet it is poorly understood. Rehabilitation difficulties and prevention challenges have been identified among people following MI, but the particular experience and perspective of CR and CHD group non-participants are largely unknown.AimThe study aimed to understand non-participation in CR and CHD self-help groups from the perspectives of the non-participants and to provide insight into their experience and that of their ‘significant others’ in rehabilitating in the absence of these resources.MethodsIn-depth interviews were conducted with 27 people who had not participated in either hospital-based CR or a CHD group, 6–14 months post-MI, and 17 ‘significant others’ in Lothian, Scotland.FindingsFactors influencing non-participation fell into three broad themes ‘No need/no point’, ‘Not worth it’, and ‘Not possible’. In the latter two categories, non-participation in these resources was often considered a ‘missed opportunity’ and needs had remained unmet. Shifts between categories could occur over time. Non-participation was linked to rehabilitation difficulties for some people and family members. Recommendations to enhance post-MI support are made. [ABSTRACT FROM PUBLISHER]

Aims: Despite identified benefits, many people do not participate in cardiac rehabilitation (CR) programmes and coronary heart disease (CHD) self-help groups when recovering from myocardial infarction (MI). Little is known about the influence of 'significant others' regarding participation, their role, and the significant others' experience of rehabilitation without these resources. This article describes research aiming to explore the role of significant others in such non-participation, and their experiences and perspectives, and, from this, identify implications for policy and practice. Methods: A qualitative study was carried out in Lothian, Scotland. In-depth interviews were carried out with 27 people who had not participated in CR and/or a CHD Group after discharge from hospital 6-14 months previously following myocardial infarction, and 17 of their nominated significant others. Findings: Significant others are influential regarding their family members'/friends' use/non-use of rehabilitation resources. However, there are important limitations upon this influence. Conclusions: Significant others should be an essential consideration in post-MI rehabilitation, as influences on rehabilitation resource participation, potentially key providers of support, and regarding their own wellbeing. [ABSTRACT FROM AUTHOR]

Aims: Despite identified benefits, many people do not participate in cardiac rehabilitation (CR) programmes and coronary heart disease (CHD) self-help groups when recovering from myocardial infarction (MI). Little is known about the influence of 'significant others' regarding participation, their role, and the significant others' experience of rehabilitation without these resources. This article describes research aiming to explore the role of significant others in such non-participation, and their experiences and perspectives, and, from this, identify implications for policy and practice. Methods: A qualitative study was carried out in Lothian, Scotland. In-depth interviews were carried out with 27 people who had not participated in CR and/or a CHD Group after discharge from hospital 6-14 months previously following myocardial infarction, and 17 of their nominated significant others. Findings: Significant others are influential regarding their family members'/friends' use/non-use of rehabilitation resources. However, there are important limitations upon this influence. Conclusions: Significant others should be an essential consideration in post-MI rehabilitation, as influences on rehabilitation resource participation, potentially key providers of support, and regarding their own wellbeing. [ABSTRACT FROM AUTHOR]

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. Study design In Scotland in 2QQ8, the advice (diagnoses; management plan(s); and safety-netting arrangements) given in audio recorded face-to-face and telephone consultations was compared with the advice recalled by patients at interview approximately 13 days later. Patients also performed a memory test. Interactions were sought between accurate recall, consultation type, and factors postulated to influence recall. Results Ten general practitioners (GPs) and 175 patients participated; 144 (82%) patients were interviewed. Patients recalled most important components of telephone and face-to-face consultations equally accurately or with only minor errors. Overall, patients presenting multiple problems (p..0.001), with brain injury (p..0.01) or low memory score (p..0.01) had reduced recall. GPs rarely used strategies to improve recall; however, these were not associated with improved recall. Conclusions Contrary to previous hospital based research, patients tended to remember important components of both face-to-face and telephone consultations -- perhaps reflecting the familiar, less anxiety provoking environment of primary care. The unsuccessful use of strategies to improve recall may reflect selective use in cognitively impaired patients. Clinicians should compensate for situations where recall is poorer such as patients presenting multiple problems or with brain injury. Patients might be advised to restrict the number of problems they present in any one consultation. [ABSTRACT FROM AUTHOR]

Background. Confidentiality is considered a cornerstone of the medical consultation. However, the telephone, previously used mainly to negotiate appointments, has become increasingly employed as a means of consultation and may pose new problems in respect to maintaining confidentiality. [ABSTRACT FROM PUBLISHER]

Background: The association between stress and morale among general practitioners (GP) is well documented. However, the impact of GP stress or low morale on patient care is less clear. GPs in the UK now routinely survey patients about the quality of their care including organizational issues and consultation skills and the General Practice Assessment Questionnaire (GPAQ) is widely used for this purpose. We aimed to see if there was a relationship between doctor morale as measured by a validated instrument, the Morale Assessment in General Practice Index (MAGPI) and scores in the GPAQ. Methods: All GPs in Lothian, Scotland who were collecting GPAQ data were approached and asked to complete the MAGPI. Using an anonymised linkage system, individual scores on the MAGPI were linked to the doctors' GPAQ scores. Levels of association between the scores were determined by calculating rank correlations at the level of the individual doctor. Hypothesised associations between individual MAGPI and GPAQ items were also assessed. Results: 276 of 475 GPs who were approached agreed to complete a MAGPI questionnaire and successfully collected anonymous GPAQ data from an average of 49.6 patients. There was no significant correlation between the total MAGPI score and the GPAQ communication or enablement scale. There were weak correlations between "control of work" in the MAGPI scale and GPAQ items on waiting times to see doctors (r = 0.24 p < 0.01). Doctors who perceived that their patients viewed them negatively also scored lower on individual communication, accessibility and continuity of care GPAQ items. Conclusion: This study showed no relationship between overall GP morale and patient perception of performance. There was a weak relationship between patients' perceptions of quality and doctors' beliefs about their workload and whether patients value them. Further research is required to elucidate the complex relationship between workload, morale and patients' perception of care. [ABSTRACT FROM AUTHOR]

Background: It is notoriously difficult to recruit patients to randomised controlled trials in primary care. This is particularly true when the disease process under investigation occurs relatively infrequently and must be investigated during a brief time window. Bell's palsy, an acute unilateral paralysis of the facial nerve is just such a relatively rare condition. In this case study we describe the organisational issues presented in setting up a large randomised controlled trial of the management of Bell's palsy across primary and secondary care in Scotland and how we managed to successfully recruit and retain patients presenting in the community. Methods: Where possible we used existing evidence on recruitment strategies to maximise recruitment and retention. We consider that the key issues in the success of this study were; the fact that the research was seen as clinically important by the clinicians who had initial responsibility for recruitment; employing an experienced trial co-ordinator and dedicated researchers willing to recruit participants seven days per week and to visit them at home at a time convenient to them, hence reducing missed patients and ensuring they were retained in the study; national visibility and repeated publicity at a local level delivered by locally based principal investigators well known to their primary care community; encouraging recruitment by payment to practices and reducing the workload of the referring doctors by providing immediate access to specialist care; good collaboration between primary and secondary care and basing local investigators in the otolarnygology trial centres Results: Although the recruitment rate did not meet our initial expectations, enhanced retention meant that we exceeded our planned target of recruiting 550 patients within the planned timescale. Conclusion: While difficult, recruitment to and retention within multi-centre trials from primary care can be successfully achieved through the application of the best available evidence, establishing good relationships with practices, minimising the workload of those involved in recruitment and offering enhanced care to all participants. Primary care trialists should describe their experiences of the methods used to persuade patients to participate in their trials when publishing their results. [ABSTRACT FROM AUTHOR]

The article reports on the competence of doctors to accurately self-assess their strengths and weaknesses in their practice in Great Britain. The current postgraduate system of appraisal, continuing professional development and, indeed, re-accreditation is based on the ability of doctors to accurately identify learning and developmental needs and to address them honestly. However, some are skeptical regarding the solid evidence to support the data generated by doctors.

Although general practice is commonly reported to be a stressful occupation, there is a culture among doctors that views seeking help as a sign of failure and endorses the image of the good doctor as one who eschews time off for sickness. In recent years there have been attempts to help general practitioners (GPs) who require support. Such facilities are used by a very small number of doctors, and it may be that some stressed doctors consider the way they feel to be typical of the majority of doctors rather than unusual. Against this background, we designed a short, self-scored questionnaire, the ‘Morale Assessment in General Practice Index’ (MAGPI), to help doctors think about the sources of stress in their lives and to give them some idea of how they compared with their colleagues. In order to test the instrument we sent it, along with the general health questionnaire (GHQ) 28, to all principals in southeast Scotland (n=875). Seventy percent replied. Using the binary scoring method for the GHQ, 31% of GPs scored 5 or above (the conventional threshold for caseness). High scores on all of the MAGPI items were significantly related to GHQ caseness. ‘Control of work’, ‘balance between work and home’, not ‘feeling valued by colleagues’ (all P<0.001), having ‘little support at home’ (P<0.01) and ‘regretting chosen career’ (P<0.05) were independently predictive of caseness on regression analysis. There were important differences in response by gender and deprivation level of practice. The MAGPI was found to be highly acceptable and to be internally consistent. [ABSTRACT FROM AUTHOR]

Although all UK general practice registrars (GPRs) are required to pass a summative assessment (SA) examination and many undertake the Membership examination of the Royal College of General Practitioners (MRCGP), it is not known to what extent success or failure in these examinations reflects the registrars' day-to-day performance or fitness to practise. In this study, we used an anonymous confidential questionnaire to get trainers in Scotland and the North East Region to rate their registrars' fitness for independent practice by using a list of essential characteristics, and to see if this perceived performance was related to success or failure in the MRCGP or SA examination. A response rate of 90% (n=250) was achieved. Trainers believed that 136 (54%) registrars were ready for partnership with no extra experience and that a further 101 (40%), while fit for independent practice, would be advised to seek further experience before taking on this role. Thirteen trainers were unwilling to employ their own registrars as a locum. Registrars who passed MRCGP were more likely to be rated highly for clinical and interpersonal skills and their work ethic, to be considered immediately ready for partnership and for partnership in the trainer's own practice (all P<0.01). Registrars who failed any part of summative assessment were less likely to be rated highly for clinical skills (all at least P<0.05) or to be considered immediately ready for partnership (P<0.001). Registrars who passed SA but were considered unsuitable for employment as locums by their trainers had important deficiencies in attitudes to patients and colleagues, willingness to accept feedback and workload management; areas not at that time measured by either SA or MRCGP. [ABSTRACT FROM AUTHOR]

Objectives These were: to describe the implementation of a scheme to extend the general practice registrar component of vocational training to 18 months in Scotland; to determine the effect of the additional attachment on registrars’ confidence and skill deficits, and compare changes in these parameters with a control group of registrars who did not extend their training, and to determine whether trainers required a different training style for experienced registrars. Subjects 35 registrars extending their training, their trainers, and 39 controls who did not extend their training. Setting Scottish training practices. Methods Pre-attachment and post-attachment questionnaires for registrars, triangulated by semistructured telephone interviews, and post-attachment questionnaires for trainers. Results Extended attachments were popular with registrars and with trainers, who felt they should be a normal part of training. Registrars with extended training declared themselves to have increased in confidence and addressed skill deficits better than controls. Projects completed were assessed as being of high quality. Trainers found 10% of registrars to have a remediable, important deficit in their skills. Conclusion Extended attachments appear to improve registrar confidence and to address knowledge deficits. However, only a minority of registrars had important remediable knowledge deficits and while such attachments may be desirable they may not be essential for most registrars. Overall the outcome appears to have been positive, and supports those who have argued for a change in the proportion of time spent in general practice training, but the scheme is expensive and it is difficult to set a value on what has been gained. Future schemes should have clear training objectives and be tailored towards these. [ABSTRACT FROM AUTHOR]

Objective: To determine patients' preferences for a shared or directed style of consultation in the decision making part of the general practice consultation.Design: Structured interview, with video vignettes of acted consultations.Setting: 5 practices in Lothian, Scotland.Participants: 410 patients (adults and adults accompanying children) attending surgery appointments.Main outcome measures: Preference for shared or directed form of video vignette for five different presenting conditions.Results: Patients varied in their preference for involvement in decision making in the consultation. Under multiple regression analysis, patients' preference was found to be independently predicted by the problem viewed (patients presented with physical problems preferred a directed approach), patients' age (patients aged 61or older were more likely to prefer the directed approach), social class (social classes I and II were more likely to prefer the shared approach), and smoking status (smokers more likely to prefer the shared approach). Those patients who were able to answer (or who thought their doctor's style similar to those in the vignettes) were more likely to describe their own doctor's style as similar to their preferred style. No major association in preference was found with sex, frequency of attendance, or perceived chronic ill health.Conclusion: Patients may vary in their desire for involvement in decision making in consultations. Although this variation seems to depend on the presenting problem, age, social class, and smoking status, these associations are not absolute, with large minorities in each group. Doctors need the skills, knowledge of their patients, and the time to determine on which occasions, with which illnesses, and at which level their patients wish to be involved in decision making. [ABSTRACT FROM AUTHOR]

It is well known that it can be difficult to persuade doctors and nurses to put evidence into practice. In order to implement evidence that in childhood immunisation larger gauge needles (blue) were less likely to provoke local reactions than smaller gauge needles (orange), all clinicians involved in immunising children working in West Lothian were sent copies of an original research article followed by reinforcement at team meetings. The article provoked a degree of controversy which led several nurses to search the literature to confirm or refute the evidence. We surveyed the clinicians before and after the intervention about their needle use. Prior to the intervention 79% used orange needles for all immunisations. After the intervention this dropped to 15% or less in children four months or older. Often clinicians continued to use orange needles in younger children, a practice they felt they could justify from alternative literature. This method of using original research articles followed by back- up meetings should be considered for other types of evidence. medical community to put into action evidence from a 'fast-tracked' research paper in that journal¹. The paper, by Diggle and Decks, showed that use of a longer (23- gauge, 25mm, blue hub) needle for childhood immunisation led to fewer local reactions than the more popularly used 25- gauge 16mm, orange hub needle. West Lothian Health Care Trust, a unique combined primary and secondary care trust, decided to take up this challenge and implement this new evidence. [ABSTRACT FROM AUTHOR]

Asthma can be difficult to diagnose in primary care. Clinical decision support systems (CDSS) can assist clinicians when making diagnostic decisions, but the perspectives of intended users need to be incorporated into the software if the CDSS is to be clinically useful. Therefore, we aimed to understand health professional views on the value of an asthma diagnosis CDSS and the barriers and facilitators for use in UK primary care. We recruited doctors and nurses working in UK primary care who had experience of assessing respiratory symptoms and diagnosing asthma. Qualitative interviews were used to explore clinicians' experiences of making a diagnosis of asthma and understand views on a CDSS to support asthma diagnosis. Interviews were audio-recorded, transcribed verbatim and analyzed thematically. 16 clinicians (nine doctors, seven nurses) including 13 participants with over 10 years experience, contributed interviews. Participants saw the potential for a CDSS to support asthma diagnosis in primary care by structuring consultations, identifying relevant information from health records, and having visuals to communicate findings to patients. Being evidence based, regularly updated, integrated with software, quick and easy to use were considered important for a CDSS to be successfully implemented. Experienced clinicians were unsure a CDSS would help their routine practice, particularly in straightforward diagnostic scenarios, but thought a CDSS would be useful for trainees or less experienced colleagues. To be adopted into clinical practice, clinicians were clear that a CDSS must be validated, integrated with existing software, and quick and easy to use. [ABSTRACT FROM AUTHOR]

We explored the potential of asthma apps to support self-management and identified preferred features that enable users to live with asthma. We recruited patients from five UK practices and social media; observed their usage of our app, administered a questionnaire and interviewed a purposive sample of patients and professionals to explore preferred features. Thematic analysis of interview was synthesised with quantitative data. A total of 111 patients used our app for 3 months. We interviewed 15 patients and 16 professionals. Participants were interested in a broad range of self-management support strategies, including action plans, monitoring with feedback, allergy/weather warnings and tailor-made running coaching. Professionals wanted to integrate patients' logs with practice records, though were concerned about data overload and risk of patient dependency. We propose a paradigm shift - from apps developed to provide features that are easy to implement technologically, to an approach in which apps are designed to deliver theoretically grounded preferred components. [ABSTRACT FROM AUTHOR]

Background: Lay health workers (LHWs) are critical in linking communities and primary healthcare (PHC) facilities. Effective communication between facilities and LHWs is key to this role. We implemented a mobile health (mHealth) system to improve communication and continuity of care for chronically ill clients. The system focused on requests from facility staff to LHWs to follow up clients and LHW referrals of people who needed care at a facility. We implemented the system in two rural and semi-rural sub-districts in South Africa. Objective: To assess the feasibility of the mHealth system in improving continuity of care for clients in PHC in South Africa. Method: We implemented the intervention in 15 PHC facilities. The clerks issued recalls to LHWs using a tablet computer. LHWs used smartphones to receive these requests, communicate with clerks and refer people to a facility. We undertook a mixed-methods evaluation to assess the feasibility of the mHealth system. We analysed recall and referral data using descriptive statistics. We used thematic content analysis to analyse qualitative data from semi-structured interviews with facility staff and a researcher fieldwork journal. Results: Across the sub-districts, 2,204 clients were recalled and 628 (28%) of these recalls were successful. LHWs made 1,085 referrals of which 485 (45%) were successful. The main client group referred and recalled were children under 5 years. Qualitative data showed the impacts of facility conditions and interpersonal relationships on the mHealth system. Conclusion: Using mHealth for recalls and referrals is probably feasible and can improve communication between LHWs and facility staff. However, the low success rates highlight the need to assess facility capacity beforehand and to integrate mHealth with existing health information systems. mHealth may improve communication between LHWs and facility staff, but its success depends on the health system capacity to incorporate these interventions. [ABSTRACT FROM AUTHOR]

Background: Lay health workers (LHWs) are critical in linking communities and primary healthcare (PHC) facilities. Effective communication between facilities and LHWs is key to this role. We implemented a mobile health (mHealth) system to improve communication and continuity of care for chronically ill clients. The system focused on requests from facility staff to LHWs to follow up clients and LHW referrals of people who needed care at a facility. We implemented the system in two rural and semi-rural sub-districts in South Africa. Objective: To assess the feasibility of the mHealth system in improving continuity of care for clients in PHC in South Africa. Method: We implemented the intervention in 15 PHC facilities. The clerks issued recalls to LHWs using a tablet computer. LHWs used smartphones to receive these requests, communicate with clerks and refer people to a facility. We undertook a mixed-methods evaluation to assess the feasibility of the mHealth system. We analysed recall and referral data using descriptive statistics. We used thematic content analysis to analyse qualitative data from semi-structured interviews with facility staff and a researcher fieldwork journal. Results: Across the sub-districts, 2,204 clients were recalled and 628 (28%) of these recalls were successful. LHWs made 1,085 referrals of which 485 (45%) were successful. The main client group referred and recalled were children under 5 years. Qualitative data showed the impacts of facility conditions and interpersonal relationships on the mHealth system. Conclusion: Using mHealth for recalls and referrals is probably feasible and can improve communication between LHWs and facility staff. However, the low success rates highlight the need to assess facility capacity beforehand and to integrate mHealth with existing health information systems. mHealth may improve communication between LHWs and facility staff, but its success depends on the health system capacity to incorporate these interventions. [ABSTRACT FROM AUTHOR]

The article presents a study related to the assessment of content and tools for smartphone applications for asthma, which appeared in a 2012 issue of the periodical "British Medical Journal." The study mentions that applications based on complementary medicine only in terms of advice they gave for emergency management were assessed. The study concluded that out of 103 applications only three contained information based on international guidelines and medication in acute asthma management.

Introduction: Telehealth has the potential to offer more convenient care and reduce travel. We aimed to systematically review studies that assessed the effectiveness of teleconsultation plus telemonitoring in the review of people with obstructive sleep apnoea hypopnoea syndrome receiving continuous positive airway pressure therapy versus face-to-face care.Methods: Following Cochrane methodology, we searched 10 electronic databases (November 2015), trial registries, and reference lists of included studies, for trials testing interventions that combined remote consultations with telemonitoring of usage/continuous positive airway pressure data. Outcomes measures were: proportion reviewed, continuous positive airway pressure adherence, symptom control, and satisfaction/acceptability and cost effectiveness.Results: From 362 potentially relevant papers, we identified five randomised controlled trials ( n = 269 patients): four from North America and one from Spain. Risk of bias was moderate in one, and moderate/high in four trials. Two trials reported number/duration of reviews with inconsistent results. The teleconsultation/telemonitoring improved continuous positive airway pressure adherence in two trials ( n = 19; n = 75); two ( n = 114 and n = 75) reported no between-groups differences. Two studies, both at moderate/high risk of bias, showed no between-group difference in the Epworth Sleepiness Score. Satisfaction was generally reported positively in all five trials; one trial reported that the teleconsultation/telemonitoring patients were 'more likely to continue' with continuous positive airway pressure therapy treatment. One study reported teleconsultation/telemonitoring as cost effective.Discussion: The evidence for teleconsultation/telemonitoring in continuous positive airway pressure users is limited; however, no safety concerns have been raised. Adequately powered, well-designed trials are needed to establish whether real-time telemonitoring and remote teleconsultation is a clinically and cost effective option for people using continuous positive airway pressure therapy. [ABSTRACT FROM AUTHOR]

The authors reflect on the use of telemedicine in managing patients diagnosed with chronic obstructive pulmonary disease (COPD). They cited the efforts of the European Commission Communication on telemedicine to emphasize the opportunities offered by telehealth in COPD management. They argued that telemedicine is suited to enable real-time remote monitoring and management of patients from their homes. The authors also acknowledged the effort of the European Commission to call for research on the efficacy of telemedicine.

Presents a letter to the editor in response to the article "Women doctors and their careers: what now?" in the Sept. 10, 2005 issue of "British Medical Journal."

The article explains the potential of telemonitoring in treating long-term diseases like congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD). Topics discussed include the Telescot-COPD randomised controlled trial revealing that telemonitoring raised the workload of community teams, telemonitoring evaluations under the Whole System Demonstrator, and the importance of advance statistical methods in enhancing telemonitoring of COPD and CHF patients.

Presents an essay on the laison between the health team and social workers in Great Britain. Discussions on family problems; Referrals for home help and occupational therapy; Attachment of social workers to general practice.

Assesses the acceptability of the use of patients first name in general practice (GP) in Great Britain. Maternal relationship of patients with physicians; Increase of consumerism of competition in GP; Use of questionnaire in determining the reactions of patients.

Introduction: Making a diagnosis of asthma can be challenging for clinicians and patients. A clinical decision support system (CDSS) for use in primary care including a patient‐facing mode, could change how information is shared between patients and healthcare professionals and improve the diagnostic process. Methods: Participants diagnosed with asthma within the last 5 years were recruited from general practices across four UK regions. In‐depth interviews were used to explore patient experiences relating to their asthma diagnosis and to understand how a CDSS could be used to improve the diagnostic process for patients. Interviews were audio recorded, transcribed verbatim and analysed using a thematic approach. Results: Seventeen participants (12 female) undertook interviews, including 14 individuals and 3 parents of children with asthma. Being diagnosed with asthma was generally considered an uncertain process. Participants felt a lack of consultation time and poor communication affected their understanding of asthma and what to expect. Had the nature of asthma and the steps required to make a diagnosis been explained more clearly, patients felt their understanding and engagement in asthma self‐management could have been improved. Participants considered that a CDSS could provide resources to support the diagnostic process, prompt dialogue, aid understanding and support shared decision‐making. Conclusion: Undergoing an asthma diagnosis was uncertain for patients if their ideas and concerns were not addressed by clinicians and were influenced by a lack of consultation time and limitations in communication. An asthma diagnosis CDSS could provide structure and an interface to prompt dialogue, provide visuals about asthma to aid understanding and encourage patient involvement. Patient and Public Contribution: Prespecified semistructured interview topic guides (young person and adult versions) were developed by the research team and piloted with members of the Asthma UK Centre for Applied Research Patient and Public Involvement (PPI) group. Findings were regularly discussed within the research group and with PPI colleagues to aid the interpretation of data. [ABSTRACT FROM AUTHOR]

The article presents a study on the use of telemonitoring device for management of uncontrolled hypertension. It informs that a randomized controlled trial of 200 participants and primary outcome of data were collected for 90 percent patients. It informs that three patients in the intervention group described anxiety as a result of self monitoring.

Introduction: Help4Mood is an interactive system with an embodied virtual agent (avatar) to assist in self-monitoring of patients receiving treatment for depression. Help4Mood supports self-report and biometric monitoring and includes elements of cognitive behavioural therapy. We aimed to evaluate system use and acceptability, to explore likely recruitment and retention rates in a clinical trial and to obtain an estimate of potential treatment response with a view to conducting a future randomised controlled trial (RCT).Methods: We conducted a pilot RCT of Help4Mood in three centres, in Romania, Spain and Scotland, UK. Patients with diagnosed depression (major depressive disorder) and current mild/moderate depressive symptoms were randomised to use the system for four weeks in addition to treatment as usual (TAU) or to TAU alone.Results: Twenty-seven individuals were randomised and follow-up data were obtained from 21 participants (12/13 Help4Mood, 9/14 TAU). Half of participants randomised to Help4Mood used it regularly (more than 10 times); none used it every day. Acceptability varied between users. Some valued the emotional responsiveness of the system, while others found it too repetitive. Intention to treat analysis showed a small difference in change of Beck Depression Inventory II (BDI-2) scores (Help4Mood -5.7 points, TAU -4.2). Post-hoc on-treatment analysis suggested that participants who used Help4Mood regularly experienced a median change in BDI-2 of -8 points.Conclusion: Help4Mood is acceptable to some patients receiving treatment for depression although none used it as regularly as intended. Changes in depression symptoms in individuals who used the system regularly reached potentially meaningful levels. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Home telehealth for chronic obstructive pulmonary disease: a systematic review and meta-analysis" in the 2010 issue.

A letter to the editor is presented in response to the article "Copy Them In," by T. Richards.

The author reflects on the question of whether there are too many female medical school graduates in Great Britain. He suggests that there are and that too many female graduates are bad for medicine, just as too many male ones have been in the past. He argues that women doctors tend to concentrate in a few specialties regarded as family friendly and tend not to become involved in certain specialties.

This article presents a letter to the editor in response to the article "My illness, my record," by T. Richards, published in the March 10, 2007 issue.

We examined symptom scores and physiological measurements from patients who were using a pilot COPD telemonitoring service. Of 33 patients recruited to the study, 19 were monitored for longer than 200 days. We identified three patterns of exacerbation, which we termed discrete (n = 5), rolling (n = 9) and over-ridden (n = 4). The association between FEV1, pulse and SpO2 and total symptom score was examined using multilevel logistic regression. The intraclass correlation coefficient for the model was high (0.36) indicating that much of the variance was due to differences between individuals, rather than within individuals. Compared to baseline, at the onset of exacerbations (n = 172) the mean pulse rate increased from 87 to 94 /min and the mean SpO2 fell from 93.6 to 92.4%. However, physiological variables did not differentiate between exacerbations and isolated bad days (n = 150). Few patient records displayed clear patterns of normality and exacerbation. Clinicians selecting patients for telemonitoring should assess the patient’s perception of variation in their symptoms and provide careful training and support whilst patients are learning to monitor their condition. [ABSTRACT FROM PUBLISHER]

Background: Digital health technologies can support primary care delivery, but clinical uptake in primary care is limited. This study explores enablers and barriers experienced by primary care providers when adopting new digital health technologies, using the example of the electronic Patient Reported Outcome (ePRO) tool; a mobile application and web portal designed to support goal-oriented care. To better understand implementation drivers and barriers primary care providers' usage behaviours are compared to their perspectives on ePRO utility and fit to support care for patients with complex care needs.Methods: This qualitative sub-analysis was part of a larger trial evaluating the use of the ePRO tool in primary care. Qualitative interviews were conducted with providers at the midpoint (i.e. 4.5-6 months after ePRO implementation) and end-point (i.e. 9-12 months after ePRO implementation) of the trial. Interviews explored providers' experiences and perceptions of integrating the tool within their clinical practice. Interview data were analyzed using a hybrid thematic analysis and guided by the Technology Acceptance Model. Data from thirteen providers from three distinct primary care sites were included in the presented study.Results: Three core themes were identified: (1) Perceived usefulness: perceptions of the tool's alignment with providers' typical approach to care, impact and value and fit with existing workflows influenced providers' intention to use the tool and usage behaviour; (2) Behavioural intention: providers had a high or low behavioural intention, and for some, it changed over time; and (3) Improving usage behaviour: enabling external factors and enhancing the tool's perceived ease of use may improve usage behaviour.Conclusions: Multiple refinements/iterations of the ePRO tool (e.g. enhancing the tool's alignment with provider workflows and functions) may be needed to enhance providers' usage behaviour, perceived usefulness and behavioural intention. Enabling external factors, such as organizational and IT support, are also necessary to increase providers' usage behaviour. Lessons from this study advance knowledge of technology implementation in primary care.Trial Registration: Clinicaltrials.gov Identified NCT02917954. Registered September 2016, https://www.clinicaltrials.gov/ct2/show/study/NCT02917954. [ABSTRACT FROM AUTHOR]

Background: Recruiting participants to a clinical study is a resource-intensive process with a high failure rate. The Scottish Health Research Register (SHARE) provides recruitment support service which helps researchers recruit participants by searching patients' Electronic Health Records (EHRs). The current study aims to evaluate the performance of SHARE in participant recruitment.Methods: Recruitment projects eligible for evaluation were those that were conducted for clinical trials or observational studies and finished before 2020. For analysis of recruitment data, projects with incomplete data were excluded. For each project we calculated, from SHARE records, 1) the fraction of the participants recruited through SHARE as a percentage of the number requested by researchers (percentage fulfilled), 2) the percentage of the potential candidates provided by SHARE to researchers that were actually recruited (percentage provided and recruited), 3) the percentage of the participants recruited through SHARE of all the potentially eligible candidates identified by searching registrants' EHRs (percentage identified and recruited). Research teams of the eligible projects were invited to participate in an anonymised online survey. Two metrics were derived from research teams' responses, including a) the fraction of the recruited over the study target number of participants (percentage fulfilled), and b) the percentage of the participants recruited through SHARE among the candidates received from SHARE (percentage provided and recruited).Results: Forty-four projects were eligible for inclusion. Recruitment data for 24 projects were available (20 excluded because of missingness or incompleteness). Survey invites were sent to all the eligible research teams and received 12 responses. Analysis of recruitment data shows the overall percentage fulfilled was 34.2% (interquartile 13.3-45.1%), the percentage provided and recruited 29.3% (interquartile 20.6-52.4%) and percentage identified and recruited 4.9% (interquartile 2.6-10.2%). Based on the data reported by researchers, percentage fulfilled was 31.7% (interquartile 5.8-59.6%) and percentage provided and recruited was 20.2% (interquartile 8.2-31.0%).Conclusions: SHARE may be a valuable resource for recruiting participants for some clinical studies. Potential improvements are to expand the registrant base and to incorporate more data generated during patients' different health care encounters into the candidate-searching step. [ABSTRACT FROM AUTHOR]

Background: An increasing number of blood tests are being performed in primary care. Informing patients of results takes up a considerable proportion of practice-staff time. The use of new technologies may be more time-efficient for staff but little is known about the acceptability to patients. Objective: To determine patient attitudes towards the use of three technologies - short message service (SMS), webpage and e-mail - for the delivery of laboratory results. Design: Structured interview. Methods: Two hundred patients were interviewed in two general practices in Lothian, Scotland. Satisfaction with current methods and preferred methods of obtaining test-results were assessed. Patients were asked about their current access to different technologies and their favourability to using such technologies for receiving results and their views on appropriate content and information security. Results were analyzed by age, sex and educational attainment using χ² test. Results: A total of 79.5% of patients had mobile phones, 53% used SMS, 46.5% had internet, and 37.5% used e-mail. E-mail, SMS and webpage was the favoured delivery system for 53.3%, 37.1% and 33.3%, respectively. Conclusion: Patients were favourable towards e-mail but not SMS or a webpage. The main concern over the three technologies was information security. New technology may be useful for delivering results but patients will have to be persuaded that any such system is reliable and secure. [ABSTRACT FROM AUTHOR]

In less than 18 months, from planning to implementation, Scotland introduced a universal form of general practitioner (GP) appraisal. This feat was achieved by early involvement of the Royal College of General Practitioners (RCGP), Trust and Health Board management, Scottish Executive, the British Medical Association, researchers and educationalists. This has resulted in a widely accepted, quality controlled, peer appraisal programme delivered by well-trained appraisers, which acts as an aid to revalidation and collates both local and national GP development needs. The process provides an important illustration of the elements required for the successful management of change within the UK health service. [ABSTRACT FROM AUTHOR]

Atrial fibrillation (AF) affects over 1.4 million people in the UK, resulting in a five-fold increased stroke risk and a three to four times greater risk of severe, disabling stroke. Atrial fibrillation, a chronic disease, requires monitoring, medication, and lifestyle measures. A self-management approach supported by mobile health (mHealth) may empower AF self-care. To assess the need to develop new mHealth self-management interventions for those with AF this review aimed to identify commercially available AF self-management apps, analyse, and synthesize (i) characteristics, (ii) functions, (iii) privacy/security, (iv) incorporated behaviour change techniques (BCTs), and (v) quality and usability. We searched app stores for 'atrial fibrillation' and 'anticoagulation', and included apps focused on AF self-management in the review. We examined app functions, privacy statements against best practice recommendations, the inclusion of BCTs using the App Behaviour Change Scale, and app quality/usability using the Mobile App Rating Scale. From an initial search of 555 apps, five apps were included in the review. Common functions were educational content, medication trackers, and communication with healthcare professionals. Apps contained limited BCTs, lacked intuitive functions and were difficult to use. Privacy policies were difficult to read. App quality rated from poor to acceptable and no app had been evaluated in a clinical trial. The review reports a lack of commercially available AF self-management apps of sufficient standard for use in healthcare settings. This highlights the need for clinically validated mHealth interventions incorporating evidence-based BCTs to support AF self-management. [ABSTRACT FROM AUTHOR]

Background: Scale-up BP was a quasi-experimental implementation study, following a successful randomised controlled trial of the roll-out of telemonitoring in primary care across Lothian, Scotland. Our primary objective was to assess the effect of telemonitoring on blood pressure (BP) control using routinely collected data. Telemonitored systolic and diastolic BP were compared with surgery BP measurements from patients not using telemonitoring (comparator patients). The statistical analysis and interpretation of findings was challenging due to the broad range of biases potentially influencing the results, including differences in the frequency of readings, 'white coat effect', end digit preference, and missing data.Methods: Four different statistical methods were employed in order to minimise the impact of these biases on the comparison between telemonitoring and comparator groups. These methods were "standardisation with stratification", "standardisation with matching", "regression adjustment for propensity score" and "random coefficient modelling". The first three methods standardised the groups so that all participants provided exactly two measurements at baseline and 6-12 months follow-up prior to analysis. The fourth analysis used linear mixed modelling based on all available data.Results: The standardisation with stratification analysis showed a significantly lower systolic BP in telemonitoring patients at 6-12 months follow-up (-4.06, 95% CI -6.30 to -1.82, p < 0.001) for patients with systolic BP below 135 at baseline. For the standardisation with matching and regression adjustment for propensity score analyses, systolic BP was significantly lower overall (- 5.96, 95% CI -8.36 to - 3.55 , p < 0.001) and (- 3.73, 95% CI- 5.34 to - 2.13, p < 0.001) respectively, even after assuming that - 5 of the difference was due to 'white coat effect'. For the random coefficient modelling, the improvement in systolic BP was estimated to be -3.37 (95% CI -5.41 to -1.33 , p < 0.001) after 1 year.Conclusions: The four analyses provide additional evidence for the effectiveness of telemonitoring in controlling BP in routine primary care. The random coefficient analysis is particularly recommended due to its ability to utilise all available data. However, adjusting for the complex array of biases was difficult. Researchers should appreciate the potential for bias in implementation studies and seek to acquire a detailed understanding of the study context in order to design appropriate analytical approaches. [ABSTRACT FROM AUTHOR]

Abstract Objectives To explore general practitioners' experiences of wellbeing and distress at work, to identify their perceptions of the causes of and solutions to distress, and to draw out implications for improving morale in general practice. Design Three stage qualitative study consisting of one to one unstructured interviews, one to one guided interviews, and focus groups. Setting Fife, Lothian, and the Borders, South East Scotland. Participants 63 general practitioner principals. Results Morale of general practitioners was explained by the complex interrelations between factors. Three key factors were identified: workload, personal style, and practice arrangements. Workload was commonly identified as a cause of low morale, but partnership arrangements were also a key mediating variable between increasing workload and external changes in general practice on the one hand and individual responses to these changes on the other. Integrated interventions at personal, partnership, and practice levels were seen to make considerable contributions to improving morale. Effective partnerships helped individuals to manage workload, but increasing workload was also seen to take away time and opportunities for practices to manage change and to build supportive and effective working environments. Conclusions Solutions to the problem of low morale need integrated initiatives at individual, partnership, practice, and policy levels. Improving partnership arrangements is a key intervention, and rigorous action research is needed to evaluate different approaches. [ABSTRACT FROM AUTHOR]

Background: While evidence from randomised controlled trials shows that telemonitoring for hypertension is associated with improved blood pressure (BP) control, healthcare systems have been slow to implement it, partly because of inadequate integration with existing clinical practices and electronic records. Neither is it clear if trial findings will be replicated in routine clinical practice at scale. We aimed to explore the feasibility and impact of implementing an integrated telemonitoring system for hypertension into routine primary care.Methods and Findings: This was a quasi-experimental implementation study with embedded qualitative process evaluation set in primary care in Lothian, Scotland. We described the overall uptake of telemonitoring and uptake in a subgroup of representative practices, used routinely acquired data for a records-based controlled before-and-after study, and collected qualitative data from staff and patient interviews and practice observation. The main outcome measures were intervention uptake, change in BP, change in clinician appointment use, and participants' views on features that facilitated or impeded uptake of the intervention. Seventy-five primary care practices enrolled 3,200 patients with established hypertension. In an evaluation subgroup of 8 practices (905 patients of whom 427 [47%] were female and with median age of 64 years [IQR 56-70, range 22-89] and median Scottish Index of Multiple Deprivation 2012 decile of 8 [IQR 6-10]), mean systolic BP fell by 6.55 mm Hg (SD 15.17), and mean diastolic BP by 4.23 mm Hg (SD 8.68). Compared with the previous year, participating patients made 19% fewer face-to-face appointments, compared with 11% fewer in patients with hypertension who were not telemonitoring. Total consultation time for participants fell by 15.4 minutes (SD 68.4), compared with 5.5 minutes (SD 84.4) in non-telemonitored patients. The convenience of remote collection of BP readings and integration of these readings into routine clinical care was crucial to the success of the implementation. Limitations include the fact that practices and patient participants were self-selected, and younger and more affluent than non-participating patients, and the possibility that regression to the mean may have contributed to the reduction in BP. Routinely acquired data are limited in terms of completeness and accuracy.Conclusions: Telemonitoring for hypertension can be implemented into routine primary care at scale with little impact on clinician workload and results in reductions in BP similar to those in large UK trials. Integrating the telemonitoring readings into routine data handling was crucial to the success of this initiative. [ABSTRACT FROM AUTHOR]

Background: Self-monitoring of blood pressure (BP) appears to reduce BP in hypertension but important questions remain regarding effective implementation and which groups may benefit most. This individual patient data (IPD) meta-analysis was performed to better understand the effectiveness of BP self-monitoring to lower BP and control hypertension.Methods and Findings: Medline, Embase, and the Cochrane Library were searched for randomised trials comparing self-monitoring to no self-monitoring in hypertensive patients (June 2016). Two reviewers independently assessed articles for eligibility and the authors of eligible trials were approached requesting IPD. Of 2,846 articles in the initial search, 36 were eligible. IPD were provided from 25 trials, including 1 unpublished study. Data for the primary outcomes-change in mean clinic or ambulatory BP and proportion controlled below target at 12 months-were available from 15/19 possible studies (7,138/8,292 [86%] of randomised participants). Overall, self-monitoring was associated with reduced clinic systolic blood pressure (sBP) compared to usual care at 12 months (-3.2 mmHg, [95% CI -4.9, -1.6 mmHg]). However, this effect was strongly influenced by the intensity of co-intervention ranging from no effect with self-monitoring alone (-1.0 mmHg [-3.3, 1.2]), to a 6.1 mmHg (-9.0, -3.2) reduction when monitoring was combined with intensive support. Self-monitoring was most effective in those with fewer antihypertensive medications and higher baseline sBP up to 170 mmHg. No differences in efficacy were seen by sex or by most comorbidities. Ambulatory BP data at 12 months were available from 4 trials (1,478 patients), which assessed self-monitoring with little or no co-intervention. There was no association between self-monitoring and either lower clinic or ambulatory sBP in this group (clinic -0.2 mmHg [-2.2, 1.8]; ambulatory 1.1 mmHg [-0.3, 2.5]). Results for diastolic blood pressure (dBP) were similar. The main limitation of this work was that significant heterogeneity remained. This was at least in part due to different inclusion criteria, self-monitoring regimes, and target BPs in included studies.Conclusions: Self-monitoring alone is not associated with lower BP or better control, but in conjunction with co-interventions (including systematic medication titration by doctors, pharmacists, or patients; education; or lifestyle counselling) leads to clinically significant BP reduction which persists for at least 12 months. The implementation of self-monitoring in hypertension should be accompanied by such co-interventions. [ABSTRACT FROM AUTHOR]

Introduction: The Bland-Altman limits of agreement method is widely used to assess how well the measurements produced by two raters, devices or systems agree with each other. However, mixed effects versions of the method which take into account multiple sources of variability are less well described in the literature. We address the practical challenges of applying mixed effects limits of agreement to the comparison of several devices to measure respiratory rate in patients with chronic obstructive pulmonary disease (COPD). Methods: Respiratory rate was measured in 21 people with a range of severity of COPD. Participants were asked to perform eleven different activities representative of daily life during a laboratory-based standardised protocol of 57 minutes. A mixed effects limits of agreement method was used to assess the agreement of five commercially available monitors (Camera, Photoplethysmography (PPG), Impedance, Accelerometer, and Chest-band) with the current gold standard device for measuring respiratory rate. Results: Results produced using mixed effects limits of agreement were compared to results from a fixed effects method based on analysis of variance (ANOVA) and were found to be similar. The Accelerometer and Chest-band devices produced the narrowest limits of agreement (-8.63 to 4.27 and -9.99 to 6.80 respectively) with mean bias -2.18 and -1.60 breaths per minute. These devices also had the lowest within-participant and overall standard deviations (3.23 and 3.29 for Accelerometer and 4.17 and 4.28 for Chest-band respectively). Conclusions: The mixed effects limits of agreement analysis enabled us to answer the question of which devices showed the strongest agreement with the gold standard device with respect to measuring respiratory rates. In particular, the estimated within-participant and overall standard deviations of the differences, which are easily obtainable from the mixed effects model results, gave a clear indication that the Accelerometer and Chest-band devices performed best. [ABSTRACT FROM AUTHOR]

Background: There are a lack of reliable data on the epidemiology and associated burden and costs of asthma. We sought to provide the first UK-wide estimates of the epidemiology, healthcare utilisation and costs of asthma.Methods: We obtained and analysed asthma-relevant data from 27 datasets: these comprised national health surveys for 2010-11, and routine administrative, health and social care datasets for 2011-12; 2011-12 costs were estimated in pounds sterling using economic modelling.Results: The prevalence of asthma depended on the definition and data source used. The UK lifetime prevalence of patient-reported symptoms suggestive of asthma was 29.5 % (95 % CI, 27.7-31.3; n = 18.5 million (m) people) and 15.6 % (14.3-16.9, n = 9.8 m) for patient-reported clinician-diagnosed asthma. The annual prevalence of patient-reported clinician-diagnosed-and-treated asthma was 9.6 % (8.9-10.3, n = 6.0 m) and of clinician-reported, diagnosed-and-treated asthma 5.7 % (5.7-5.7; n = 3.6 m). Asthma resulted in at least 6.3 m primary care consultations, 93,000 hospital in-patient episodes, 1800 intensive-care unit episodes and 36,800 disability living allowance claims. The costs of asthma were estimated at least £1.1 billion: 74 % of these costs were for provision of primary care services (60 % prescribing, 14 % consultations), 13 % for disability claims, and 12 % for hospital care. There were 1160 asthma deaths.Conclusions: Asthma is very common and is responsible for considerable morbidity, healthcare utilisation and financial costs to the UK public sector. Greater policy focus on primary care provision is needed to reduce the risk of asthma exacerbations, hospitalisations and deaths, and reduce costs. [ABSTRACT FROM AUTHOR]