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This study aimed to explore the accident prevention activities of primary care organizations (PCOs) and the views of their board members regarding accident prevention. Qualitative study using semi-structured telephone interviews of 17 board members of PCOs (primary care groups and primary care trusts) in the National Health Service (NHS) Trent Region was undertaken. Accident prevention activity varied substantially between PCOs. The reduction of home hazards was a frequent focus of the PCOs’ accident prevention initiatives. Board members did not see accident prevention as their biggest priority in health improvement, although they had positive attitudes towards it. Local morbidity and NHS guidance were seen to be key determinants of PCOs’ priorities in health promotion. There was little reference to any strategic planning for accident prevention. Information to support accident prevention could be more timely and relevant to PCOs’ needs. The degree of involvement with outside agencies in accident prevention work varied substantially. Collaboration between agencies may be held back by mutual lack of knowledge and differences in culture and priorities. It was concluded that accident prevention appears to be receiving less attention in PCOs than other national health priorities. They may need more support for developing strategies for accident prevention and better provision of information so that they can identify local problems which can be addressed by preventative activities. The accident prevention plans contained in health improvement programmes should be monitored.

This paper reports the results of a study of GP costs associated with a group of nursing home patients who died at various stages during a 12‐month period. The relationship between costs per month of care, patient age and proximity to death, where sex and diagnosis are controlled for are reported. A comparison of care costs for patients in their last year of life and those who survived the course of the study is also made. The study found that those in their last year of life were significantly more expensive to care for than those who survived the duration of the study, but that there was no statistically significant difference in age. In multivariate regression analyses, it was also found that among those who died during the study care costs were unrelated to age, but significantly related to proximity to death. The study supports the contention of others (Zweifel P, Felder S, Meiers M. Ageing of population and health care expenditure: a red herring? Health Econ 1999; 8: 485–496) that health care costs are more directly related to proximity to death than age. Copyright © 2000 John Wiley & Sons, Ltd.

This paper reports the results of a study of GP costs associated with a group of nursing home patients who died at various stages during a 12-month period. The relationship between costs per month of care, patient age and proximity to death, where sex and diagnosis are controlled for are reported. A comparison of care costs for patients in their last year of life and those who survived the course of the study is also made. The study found that those in their last year of life were significantly more expensive to care for than those who survived the duration of the study, but that there was no statistically significant difference in age. In multivariate regression analyses, it was also found that among those who died during the study care costs were unrelated to age, but significantly related to proximity to death. The study supports the contention of others (Zweifel P, Felder S, Meiers M. Ageing of population and health care expenditure: a red herring? Health Econ 1999; 8: 485–496) that health care costs are more directly related to proximity to death than age. Copyright © 2000 John Wiley & Sons, Ltd.

IN a study involving seven practices, the records of 292 men found to be at high risk of a heart attack were analysed twelve months after identification, to determine how far a protocol for follow up of patients was followed and the extent to which targets for risk reduction were achieved. It was found that 248 (84.9 per cent) had a further recording of one or more risk factors after identification at the screening examin ation. Follow up was most thorough for those with a raised blood pressure, and least complete for those with raised cholesterol. Of the 205 men with an in itially raised blood pressure, 153 achieved the target of 100 mm Hg or less at follow up, representing 75 per cent of the original group and 94 per cent of those followed up. Approximately 20 per cent of smokers and heavy drinkers identified at the screening exam ination reported achieving the target of cessation and safe drinking respectively at their last follow up. Rates of change for the overweight and those with raised cholesterol were no better than might be ex pected by chance. Overall these results compare favourably with previous studies. The use of proto cols, facilitator support and the motivational effect of knowledge of risk status may all have contributed. However, even with this level of support a significant number of patients was lost to follow up. Practices should give priority to achieving optimal rates of follow up for smoking and hypertension.

Objectives: These were to find: the importance of various research skills in departments of general practice; the most useful methods of developing them; the support departments give researchers in developing skills; and what initiatives departments have made in research skills training.Methods: A postal questionnaire was sent to all members of the United Kingdom-based Association of University Departments of General Practice (AUDGP) in May 1993.Results: The response rate was 62%. Forty-five per cent were professors or senior lecturers, 32% were junior lecturers, and 23% held other posts; 77% held clinical posts. More than three quarters of responders rated eight research skills as 'important' or 'very important'. Five skills were rated by more than a third of these responders as having been covered 'not very well' or 'not at all' in their training or experience. Most responders found self-directed learning and hands-on experience helpful in developing their skills, but less than half said that discussion of their research training needs or help in planning their education in research methods had been adequate. Initiatives in research skills training included running courses, appointing a named person to address training needs and establishing trainee posts in academic general practice.Conclusions: The survey revealed areas in which research skills in departments of general practice could be improved. Individual departments have set up a variety of initiatives for raising skill levels; these may be of relevance to primary care researchers in other countries. Eur J Gen Pract 1996; 2: 62-4.

Background. Primary Care Groups and Trusts (PCG/Ts) are responsible for improving the health of local populations, but there is little evidence of their strategic involvement in accident prevention. Objective. To determine the effect of providing information on local accidental injuries to PCG/Ts on the development of accident prevention strategies. Methods. The study is a randomized controlled trial in PCG/Ts in the former Trent Region. Intervention PCG/Ts were sent profiles containing PCG/T specific information on hospital admissions for accidental injury and their costs and on accident prevention interventions. Health promotion leads were surveyed at baseline and three and fifteen months. The primary outcome was whether the PCG/T had a written accident prevention strategy. Secondary outcome measures included other accident prevention activities, prioritization of accident prevention, and knowledge and attitudes towards accident prevention. Results. At three months 38% of PCG/Ts in the intervention arm had a written accident prevention strategy, compared with 42% in the control arm [difference −4%, 95% confidence interval (CI) −31% to 25%]. At fifteen months these values were 55% in the intervention arm and 50% in the control arm (difference 5%, CI −24% to 33%). There were no statistically significant differences between the groups for any outcome measures. Conclusions. Providing profiles containing information on accidental injuries to PCG/Ts did not significantly increase the development of accident prevention strategies, however this study only had sufficient power to detect substantial changes. Larger national studies would be required to detect moderate effects of tailored packages in changing PCG/T behaviour.

OBJECTIVE: To determine the relation between morbidity from injury and deprivation for different levels of injury severity and for different injury mechanisms for children aged 0-14 years. DESIGN: Cross sectional survey of routinely collected hospital admission data for injury 1992-7. SETTING: 862 electoral wards in Trent Region. SUBJECTS: 21 587 injury related hospital admissions for children aged 0-4 years and 35 042 admissions for children aged 5-14. MAIN OUTCOME MEASURES: Rate ratios for hospital admission for all injuries, all injuries involving long bone fracture, and all injuries involving long bone fracture requiring an operation; rate ratios for hospital admission for six types of injury mechanism divided by quintiles of the electoral wards' Townsend scores for deprivation. Rate ratios calculated by Poisson regression, with adjustment for distance from nearest hospital admitting patients with injuries, rurality, ethnicity, and percentage of males in each electoral ward. RESULTS: Both total number of admissions for injury and admissions for injuries of higher severity increased with increasing socioeconomic deprivation. These gradients were more marked for 0-4 year old children than 5-14 year olds. In terms of injury mechanisms, the steepest socioeconomic gradients (where the rate for the fifth of electoral wards with the highest deprivation scores was > or =3 times that of the fifth with the lowest scores) were for pedestrian injuries (adjusted rate ratio 3.65 (95% confidence interval 2.94 to 4.54)), burns and scalds (adjusted rate ratio 3.49 (2.81 to 4.34)), and poisoning (adjusted rate ratio 2.98 (2.65 to 3.34)). CONCLUSION: There are steep socioeconomic gradients for injury morbidity including the most common mechanisms of injury. This has implications for targeting injury prevention interventions and resources.

The objective of this study was to evaluate a programme of timetabled visiting by Health Visitor Assistants (HVAs) to patients over 75 years old who were recently discharged from hospital. An outcome evaluation examined whether patients benefited in measured health status and use of services over the year of the programme. A randomly selected group of patients (the intervention group) who were allocated to the programme of visiting were compared with an equal-sized randomly selected group of patients (the control group) who had no timetabled visiting. A process evaluation examined the actions taken by HVAs during their visits and related the actions taken to patients measured health status and other characteristics. No overall benefit from the programme of visiting was found in the outcome evaluation. There was wide variation in the numbers of actions recorded for different patients. Numbers of HVAs actions were related to patients health status and sex, with more actions being initiated for those in poorer health and women. Neither age nor whether the patient lived alone were found to be related to numbers of HVAs actions. It was concluded that the lack of demonstrated overall benefit and the wide variation in actions taken on patients behalf suggest that this type of service cannot be recommended for all discharged patients over 75 years. Poor health at the time of discharge is recommended as a first choice of measure for need of support. Exchange of information between general practice and hospital about previous dependency may aid the identification of patients who need post-discharge support.

To investigate the state of health and needs of over-75-yearolds discharged from hospital and not referred to the District Nurse Service, patients in this age group who were discharged from hospital, who returned to their own or a relatives home and were not referred to the District Nurse Service were interviewed by Health Visitors during their normal post-discharge visit. Assessment was by a questionnaire on details of discharge, statutory, voluntary and informal support, physical status, disability level, ability to self-care and mental status. It was found that there was wide variation in timing of Health Visitors post-discharge visits, and most patients had had some contact with their GP before this visit. Almost half the patients were discharged from General Surgery or surgical specialties. Most patients were fairly healthy but a minority had severe disabilities. Physical status, disability level and ability to self-care were related to age and sex of the patient with older patients and women having poorer health status. Women had poorer mental status than men. It is concluded that the wide variety in health status and needs of this group of patients suggest that they should be taken into account in the planning of new discharge procedures. Closer links between the hospital, community teams and general practice are suggested