Background: The government set a series of targets to reduce health inequalities in England by 2010. Primary care has an important role in reducing health inequalities. The aim of the study was to assess the impact of general practice on reducing area-based health inequalities. Methods: Analysis of differences in achievement on clinical indicators between practices in Spearhead and non-Spearhead Primary Care Trusts (PCTs) using data from the Quality and Outcomes Framework (QOF) for 2004/05 and 2005/06, practice characteristics and Spearhead status of PCTs. The study used data on 8339 primary care practices in England. Unweighted mean reported achievement on subset of 26 clinical indicators was calculated. The study analysed differences in achievement by Spearhead status and deprivation in both years and the change between years. Multiple regression analysis of relationship between Spearhead status, income deprivation, reported achievement and other factors also were carried out. Results: Practices in Spearhead PCTs performed worse than practices in non-Spearhead PCTs in both years but showed greater improvement. Among the most deprived practices, there were no differences in QOF achievement between Spearhead and non-Spearhead PCTs. Previous year’s achievement was the strongest predictor of performance. Conclusion: The narrowing in performance between practices in Spearhead and non-Spearhead PCTs may have indirectly contributed to a reduction in area-based health inequalities but the differences are small. The lack of difference between the most deprived practices in Spearhead and non-Spearhead PCTs suggest that area-based initiatives to tackle inequalities have not yet had an observable impact on deprived practices. Unobserved factors explain most of the variation in achievement.

Background: The objective of this study was to evaluate the metric properties of a selection of items of the Primary Care Assessment Tool (PCAT) included into 2006 Catalonia Health Survey and adapted to evaluate experiences of primary care (PC) under population perspective. Methods: This was a cross-sectional study. The study population was composed of non-institutionalized residents of Catalonia over 15 years of age (n = 12 933). The instrument used was a 10-item selection of the adult user’s version of the PCAT (PCAT10-AE). We assessed internal consistency, correlation between items and performed exploratory factor analysis and external validity analysis. Results: The instrument presented adequate internal consistency (0.72). All items showed acceptable correlation with other items that constitute the scale. The single extracted factor explained 64% of the common variance in the responses, allowing the construction of a global index for evaluation of PC. We observed an association between better evaluation of PC and more satisfaction with the health system. Conclusions: Metric analysis supported the integrity and general adequacy of this very short tool included in a population health survey. The global index proposed could be a good measure for assessing and monitoring the adequacy of part of the PC experiences in first-contact care and person-focused care over time, under population perspective. On the other hand, the loss of content as a consequence of the selection of items, suggesting use of the expanded versions of the PCAT-AE whenever a global evaluation of PC is desired and it is possible.

Background: Belgium legalized euthanasia in 2002. Physicians must report each euthanasia case to the Federal Control and Evaluation Committee. This study examines which end-of-life decisions (ELDs) Belgian physicians label ‘euthanasia’, which ELDs they think should be reported and the physician characteristics associated with correct labelling of euthanasia cases, the awareness that they should be reported and the reporting of them. Methods: Five hypothetical cases of ELDs: intensified pain alleviation, palliative/terminal sedation, euthanasia with neuromuscular relaxants, euthanasia with morphine and life-ending without patient request were presented in a cross-sectional survey of 914 physicians in Belgium in 2009. Results: About 19% of physicians did not label a euthanasia case with neuromuscular relaxants ‘euthanasia’, 27% did not know that it should be reported. Most physicians labelled a euthanasia case with morphine ‘intensification of pain and symptom treatment’ (39%) or ‘palliative/terminal sedation’ (37%); 21% of physicians labelled this case ‘euthanasia’. Cases describing other ELDs were sometimes also labelled ‘euthanasia’. Factors associated with a higher likelihood of labelling a euthanasia case correctly were: living in Flanders, being informed about the euthanasia law and having a positive attitude towards societal control over euthanasia. Whether a physician correctly labelled the euthanasia cases strongly determined their reporting knowledge and intentions. Conclusion: There is no consensus among physicians about the labelling of euthanasia and other ELDs, and about which cases must be reported. Mislabelling of ELDs could impede societal control over euthanasia. The provision of better information to physicians appears to be necessary.

Background: Injury is the number one public health problem in Lithuania in terms of disability adjusted life years lost. The trauma system plays an important role in injury statistics. The objective of this article is to describe and assess the performance of Lithuanian trauma sector. Methods: The framework for assessing the performance of health systems proposed by Murray and Frenk (2000) was employed. Results: The primary intention criterion—to reduce the number of trauma cases, injury related mortality and disability rates by 30% by 2010—is well defined. The Lithuanian whole-trauma sector does not substantially contribute to improving the health of the population. The legitimate expectations of the community—respect of persons in terms of dignity, autonomy, confidentiality, client orientation—do not correspond with the responsiveness of the trauma service. Financing of the trauma sector does not correspond with the magnitude of the injury problem. Lithuanian trauma service is decentralized. There is no trauma leadership in the country. There is no national policy for unintentional injury prevention and control, no specialized injury research institute, no system of trauma centres, and no Injury Surveillance System in Lithuania. There is no such specialty as Emergency Medicine as of 2009. A political and public will to reform the trauma sector is not sound. Conclusion: The performance of the decentralized Lithuanian trauma sector does not match with the primary intention criterion and does not correspond to the needs of people. Lithuanian trauma service has to be conceptualized and changed to inclusive.

Background: The Patient Assessment of Chronic Illness Care (PACIC) 20-item questionnaire measures how chronic care patients perceive their involvement in care. We aimed to adapt the measure into Danish and to assess data quality, internal consistency and the proposed factorial structure. Methods: The PACIC was translated by a standardised forward–backward procedure, and filled in by 560 patients receiving type 2 diabetes care. Data quality was assessed by mean, median, item response, missing values, floor and ceiling effects, internal consistency (Cronbach’s α and average inter-item correlation), item-rest correlations and factorial structure was assessed by confirmatory factor analysis (CFA). Results: The item response was high (missing answers: 0.5–2.9%). Floor effect was 2.7–69.2%, above 15% for 17 items. Ceiling effect was 4.0–40.4%, above 15% for 12 items. The subscales had average inter-item correlations over 0.30 and CFA showed high factor loadings (range 0.67–0.77). All had α over 0.7 and included items with both high and low loadings. The CFA model fit was good for two indices out of six (TLI and SRMR). Conclusions: Danish PACIC is now available and validated in primary care in a type 2 diabetes population. The psychometric properties were satisfactory apart from ceiling and floor effects. We endorse the proposed five scale structure. All the subscales showed good model fit, and may be used for separate sum scores.