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Background The diagnosis of lower urinary tract symptoms related to suspected bladder outflow obstruction from benign prostate hyperplasia/enlargement in men is increasing. This is leading to high demand on healthcare services; however, there is limited knowledge of differences in pharmacotherapy prescribing for this condition based on geography. Objective To investigate potential variation in drug prescribing for suspected bladder outflow obstruction in Scotland, based on analysis of publicly available data, to identify trends and inform future prescribing. Study design A longitudinal register-based data study of prescribing and patient data publicly available from Scottish registries. All information is available as monthly aggregates at the level of single general practices. Setting and participants 903 (97%) general practices in Scotland, over a 50-month period (October 2015 to November 2019). Outcome measurements and statistical analysis We analysed numbers of daily doses of drugs for suspected bladder outflow obstruction prescribed per month using a Bayesian Poisson regression analysis, incorporating random effects to account for spatial and temporal elements. Results Prescriptions for suspected bladder outflow obstruction medications increased during the observation period (overall average rate of change 1.24±0.28, ranging from 0.893 in Orkney to 1.95 in Lanarkshire). While some determinants of health inequality regarding prescribing practices across health boards are consistent with those known from the literature, other inequalities remain unexplained after accounting for practice-specific and patient-specific characteristics such as deprivation and rurality. Conclusions Inequalities in prescribing for suspected bladder outflow obstruction medications exist in Scotland, partially ascribable to accepted sociodemographic and geographic factors.

Since the 1990s qualitative research methods have become an intrinsic aspect of primary care research. They have provided insight into the complexity of healthcare professionals? and patients? perspectives on health and health care, utilising a range of methods including interviews, observations, and focus groups.1 These methods require flexibility on the part of the researcher and participant in relation to time, location, and what they share of themselves. It is our view that although primary care research employs rigour when considering which method and analytical approach best fits the research context, there remains a relative neglect of the stance of the researcher and research participant relationships in the design and conduct of primary care studies. Research encounters may provide an encouraging space for individuals to discuss feelings and views. The sharing of such information can likewise be a profound and moving experience for researchers who may encounter emotions inside themselves and others ? feelings which may be challenging. Yet little has been said about emotions in primary care research. How should one deal with these? Similarly, while physical safety for participants is explicitly considered during study design and ethical review, qualitative research takes place outside a lab-based environment and requires researchers to consider their own safety too. This article discusses the emotional safety of participants and researchers and physical safety considerations for researchers by describing approaches we have used. We hope this will encourage debate within the primary care research community and by doing this will enhance research quality and enable clinicians and researchers to make more informed decisions about involving patients in qualitative research.

Introduction: Patients who have been repeatedly removed from General Practice (GP) lists, so-called “revolving door” patients in general practice have not been examined in the literature. This mixed methods study sought to define and characterise “revolving door” patients in general practice in Scotland. It investigated the impact they had on the NHS and the impact this status may have on “revolving door” patients themselves. Methods: Thirteen semi-structured interviews with Practitioner Services and GP professional key informants and one “ex-revolving door” patient were conducted and analysed using a Charmazian grounded theory approach. Patient removal data from the Community Health Index were used to construct cohorts of “revolving door” patients and link them with routine NHS data on hospital admissions, outpatient attendances and drug misuse treatment episodes. These data were analysed quantitatively and qualitatively and all the data were integrated dialectically. Results: “Revolving door” patients were removed four or more times from GP lists in six years. There was a dramatic decline in the number of “revolving door” patients in Scotland whilst the study was conducted. It appeared this was because the NHS response altered due to changes in approaches to treating problem drug use and pressure to reduce removal activity from professional bodies. The final influence was the positive, ethical, regulatory, and financial climate of the 2004 General Medical Services contract. “Revolving door” patients had three necessary characteristics: unreasonable expectations of what the National Health Service had to offer, inappropriate behaviour and unmet health needs. Problem substance use and psychiatric health problems were important. Professionals who came into contact with “revolving door” patients found it a difficult experience and they generated a lot of work. Being a “revolving door” patient impacted on the quality of care that patients received in general practice i

Introduction: Patients who have been repeatedly removed from General Practice (GP) lists, so-called “revolving door” patients in general practice have not been examined in the literature. This mixed methods study sought to define and characterise “revolving door” patients in general practice in Scotland. It investigated the impact they had on the NHS and the impact this status may have on “revolving door” patients themselves. Methods: Thirteen semi-structured interviews with Practitioner Services and GP professional key informants and one “ex-revolving door” patient were conducted and analysed using a Charmazian grounded theory approach. Patient removal data from the Community Health Index were used to construct cohorts of “revolving door” patients and link them with routine NHS data on hospital admissions, outpatient attendances and drug misuse treatment episodes. These data were analysed quantitatively and qualitatively and all the data were integrated dialectically. Results: “Revolving door” patients were removed four or more times from GP lists in six years. There was a dramatic decline in the number of “revolving door” patients in Scotland whilst the study was conducted. It appeared this was because the NHS response altered due to changes in approaches to treating problem drug use and pressure to reduce removal activity from professional bodies. The final influence was the positive, ethical, regulatory, and financial climate of the 2004 General Medical Services contract. “Revolving door” patients had three necessary characteristics: unreasonable expectations of what the National Health Service had to offer, inappropriate behaviour and unmet health needs. Problem substance use and psychiatric health problems were important. Professionals who came into contact with “revolving door” patients found it a difficult experience and they generated a lot of work. Being a “revolving door” patient impacted on the quality of care that patients received in general practice i

Introduction: Patients who have been repeatedly removed from General Practice (GP) lists, so-called “revolving door” patients in general practice have not been examined in the literature. This mixed methods study sought to define and characterise “revolving door” patients in general practice in Scotland. It investigated the impact they had on the NHS and the impact this status may have on “revolving door” patients themselves. Methods: Thirteen semi-structured interviews with Practitioner Services and GP professional key informants and one “ex-revolving door” patient were conducted and analysed using a Charmazian grounded theory approach. Patient removal data from the Community Health Index were used to construct cohorts of “revolving door” patients and link them with routine NHS data on hospital admissions, outpatient attendances and drug misuse treatment episodes. These data were analysed quantitatively and qualitatively and all the data were integrated dialectically. Results: “Revolving door” patients were removed four or more times from GP lists in six years. There was a dramatic decline in the number of “revolving door” patients in Scotland whilst the study was conducted. It appeared this was because the NHS response altered due to changes in approaches to treating problem drug use and pressure to reduce removal activity from professional bodies. The final influence was the positive, ethical, regulatory, and financial climate of the 2004 General Medical Services contract. “Revolving door” patients had three necessary characteristics: unreasonable expectations of what the National Health Service had to offer, inappropriate behaviour and unmet health needs. Problem substance use and psychiatric health problems were important. Professionals who came into contact with “revolving door” patients found it a difficult experience and they generated a lot of work. Being a “revolving door” patient impacted on the quality of care that patients received in general practice i