No / Objective: To identify factors available to general practitioners (GPs) that are predictive of mortality within a general practice-based population of heart failure patients, and to report the sensitivity and specificity of prognostic information from GPs. Methods: Five hundred and forty-two heart failure patients aged >60 years were recruited from 16 UK GP surgeries. Patients completed quality-of-life and services use questionnaires every 3 months for 24 months or until death. Factors with independent significant association with survival were identified using Cox proportional hazards regression analysis. Results: Women had a 58% lower risk of death. Patients self-reporting New York Heart Association Classification III or IV had an 81% higher risk of death. Patients aged 85+ years had over a five-fold risk of death as compared with those aged <65 years. Patients with a co-morbidity of cancer had a 78% higher risk of death. Of the 14 patients who died in a 12-month period, the GPs identified 11 (sensitivity 79%). They identified 133 of the 217 who did not die (specificity 61%). Discussion: Predictors readily available to GPs, such as patient characteristics, are easy to adapt to use in general practice, where most heart failure patients are diagnosed and treated. Identifying factors likely to influence death is useful in primary care, as this can initiate discussion about end-of-life care.

Background: The focus of this study is on how far GPs' perceptions of dementia map onto the components and contributing factors to stigma as described by Link and Phelan (2001; 2006) and Jones et al. (1984). Aim: The study explores GPs' perceptions of dementia as a stigma, develops a specific conceptualization of the stigma of dementia and considers implications for timely diagnosis. Methods: Data from twenty-three GPs in northern England were collected by semistructured telephone interviews. Within the context of a qualitative design, a combined process of grounded theory and framework analysis was adopted to collect and analyse data. Results: The findings reveal that GPs' perceptions of dementia map onto Link and Phelan and Jones' identification of contributing factors and components of stigma and may hinder timely diagnosis. Three themes emerged reflecting a dynamic process of making sense of dementia, relating perceptions to oneself and considering the consequences of dementia. Within those themes, certain categories had particular salience for GPs, namely the characteristics of the attribute, existential anxiety and discrimination. The themes and categories are inter-related and can be considered as parts of a system. Perceived lack of reciprocity could be detected in most categories which suggests that it is influential in the social construction of the stigma of dementia. Conclusion: The data suggest that current conceptualizations of stigma are insufficient to fully account for the stigma of dementia. A specific conceptualization of the stigma of dementia is proposed and the implications of GPs' perceptions for timely diagnosis are discussed.

Background The focus of this study is on how far GPs¿ perceptions of dementia map onto the components and contributing factors to stigma as described by Link and Phelan (2001; 2006) and Jones et al. (1984). Aim The study explores GPs¿ perceptions of dementia as a stigma, develops a specific conceptualization of the stigma of dementia and considers implications for timely diagnosis. Methods Data from twenty-three GPs in northern England were collected by semistructured telephone interviews. Within the context of a qualitative design, a combined process of grounded theory and framework analysis was adopted to collect and analyse data. Results The findings reveal that GPs¿ perceptions of dementia map onto Link and Phelan and Jones¿ identification of contributing factors and components of stigma and may hinder timely diagnosis. Three themes emerged reflecting a dynamic process of making sense of dementia, relating perceptions to oneself and considering the consequences of dementia. Within those themes, certain categories had particular salience for GPs, namely the characteristics of the attribute, existential anxiety and discrimination. The themes and categories are inter-related and can be considered as parts of a system. Perceived lack of reciprocity could be detected in most categories which suggests that it is influential in the social construction of the stigma of dementia. Conclusion The data suggest that current conceptualizations of stigma are insufficient to fully account for the stigma of dementia. A specific conceptualization of the stigma of dementia is proposed and the implications of GPs¿ perceptions for timely diagnosis are discussed.

No description available.

Britain's Asians are a young population and their socio-economic status is low, with racial disadvantage in housing, employment, education and health. Research on their health has usually not been conducted in its socio-economic and demographic context and there is little on their use of primary care. Three studies were conducted to investigate their relationship with primary care in Bradford. A study of general practice attenders of white/British, Pakistani and Indian origin confirmed the demographic and socio-economic differences between the groups. The former had higher rates of alcohol and cigarette consumption. For Pakistanis and Indians, fluency and literacy in English was poor. Ethnic and linguistic match between doctor and patient was more important in patients' choice of doctor than the doctor's sex. Differential employment status of Asian and white/British accounted for some of the differences in health. A study of general practice attendance showed similar rates of surgery consultations between Asians and Non-Asians; the latter made greater use of domiciliary services. Both these studies were conducted in an inner Bradford health centre with an Asian male, a white male and a white female doctor. Bradford GPs were found to perceive that Asian patients made greater use of surgery and domiciliary consultations; attended more often for trivial complaints; and had lower compliance rates than Non-Asians. These perceptions were not supported by objective data. Better qualified GPs had a smaller, and Asian doctors had a greater proportion of Asian patients on their lists. Research, and action on Asians' health, needs to take account of their poorer socio-economic status.

Britain's Asians are a young population and their socio-economic status is low, with racial disadvantage in housing, employment, education and health. Research on their health has usually not been conducted in its socio-economic and demographic context and there is little on their use of primary care. Three studies were conducted to investigate their relationship with primary care in Bradford. A study of general practice attenders of white/British, Pakistani and Indian origin confirmed the demographic and socio-economic differences between the groups. The former had higher rates of alcohol and cigarette consumption. For Pakistanis and Indians, fluency and literacy in English was poor. Ethnic and linguistic match between doctor and patient was more important in patients' choice of doctor than the doctor's sex. Differential employment status of Asian and white/British accounted for some of the differences in health. A study of general practice attendance showed similar rates of surgery consultations between Asians and Non-Asians; the latter made greater use of domiciliary services. Both these studies were conducted in an inner Bradford health centre with an Asian male, a white male and a white female doctor. Bradford GPs were found to perceive that Asian patients made greater use of surgery and domiciliary consultations; attended more often for trivial complaints; and had lower compliance rates than Non-Asians. These perceptions were not supported by objective data. Better qualified GPs had a smaller, and Asian doctors had a greater proportion of Asian patients on their lists. Research, and action on Asians' health, needs to take account of their poorer socio-economic status. / Yorkshire Regional and Bradford District Health Authority.