Primary Health Care

Trisha Greenhalgh Department of Primary Care and Population Sciences, University College London, UK.Author of bestselling How to Read a Paper and Diffusion of Innovations in Health Service Organisations (Blackwell Publishing BMJ Books).

"Trish Greenhalgh is one of the international stars of general practice and a very clever thinker. This new book is a wonderful new resource for primary health care and general practice. Every general practice registrar should read this book and so should every general practice teacher and every primary care researcher."—Professor Michael Kidd, Head of the Department of General Practice, The University of Sydney and Immediate Past President of The Royal Australian College of General Practitioners"General practice in the U.K. is responsible for more patient care than ever before, and its input to medical training and research is at an all-time high. But its broadening roles and changing political context are at risk of causing an identity crisis. We are fortunate that Professor Trish Greenhalgh has brought her passion, intelligence and scholarship to bear on one of the key questions for health professionals today - what is the best of primary care about, and why is it essential for patients and doctors? She encourages debate while supporting and inspiring primary care, because she tells a modern story of a discipline whose purpose is valuable and which can rise to its new challenges. I am personally very glad to have read this timely and exciting book."—Amanda Howe, MA MD MEd FRCGP ILT(M), Professor of Primary Care & MB/BS Course Director Institute of Health University of East Anglia Norwich NR4 7TJ Norfolk"This book meets a real need for a lively, engaging and perceptive book that brings together the population with the individual perspective and describes the key concepts that underpin contemporary primary care with admirable clarity. This book deserves to become a classic and will be welcomed by enquiring undergraduates and postgraduates alike who want a book that will both challenge and inform."—Professor Andy Haines, Director, London School of Hygiene & Tropical Medicine, London, UK"This important new book by one of primary care's most accomplished authors sets out clearly the academic basis for further developments in primary health care. Health systems will only function effectively if they recognise the importance of high quality primary care so I strongly recommend this book to students, teachers, researchers, practitioners and policy makers."—Professor Martin Marshall, Deputy Chief Medical Officer, Department of Health

• Acknowledgements. Preface.Foreword.1 Introduction.1.1 What is primary (health) care?1.2 What is academic study?.1.3 What are theories – and why do we need them?2 The 'ologies' (underpinning academic disciplines) of primary health care.2.1 Biomedical sciences.2.2 Epidemiology.2.3 Psychology.2.4 Sociology.2.5 Anthropology.2.6 Literary theory.2.7 Philosophy and ethics.2.8 Pedagogy.3 Research methods for primary health care.3.1 What is good research in primary health care?3.2 Qualitative research.3.3 Quantitative research.3.4 Questionnaire research.3.5 Participatory ('action') research.3.6 Research data – and analysing it.3.7 Critical appraisal of published research papers.3.8 Systematic review.3.9 Multi-level approaches to primary care problems.4 The person who is ill.4.1 The sick role.4.2 The illness narrative.4.3 Lifestyle choices and 'changing behaviour'.4.4 Self-management.4.5 Health literacy.5 The primary care clinician.5.1 The role of the generalist.5.2 Clinical method I: rationalism and Bayes' theorem.5.3 Clinical method II: humanism and intuition.5.4 Clinical method III: the patient-centred method.5.5 Influencing clinicians’ behaviour.5.6 The ‘good’ clinician.6 The clinical interaction.6.1 The clinical interaction I: a psychological perspective.6.2 The clinical interaction II: a sociolinguistic perspective.6.3 The clinical interaction III: a psychodynamic perspective.6.4 The clinical interaction IV: a literary perspective.6.5 The interpreted consultation.7 The family – or lack of one.7.1 Family structure in the late modern world.7.2 The mother–child relationship (or will any significant other do these days?)7.3 Illness in the family – nature, nurture and culture.7.4 Homelessness.8 The population.8.1 Describing disease in populations.8.2 Explaining the ‘causes’ of disease.8.3 Detecting disease in populations.8.4 'Risk': an epidemiological can of worms?9 The community.9.1 Unpacking health inequalities I: deprivation.9.2 Unpacking health inequalities II: social networks and social capital.9.3 Unpacking health inequalities III: life course epidemiology and 'risk regulators'.9.4 Developing healthy communities I: community oriented primary care.9.5 Developing healthy communities II: participatory approaches.10 Complex problems in a complex system.10.1 Illness in the twenty-first century: chronicity, comorbidity and the need for coordination.10.2 Coordinating care across professional and organisational boundaries.10.3 The electronic patient record: a road map for seamless care?10.4 The end of an era?11 Quality.11.1 Defining and measuring quality.11.2 A rational biomedical perspective: evidence-based targets, planned change and criterion-based audit.11.3 A narrative perspective: significant event audit.11.4 A social learning perspective: peer review groups and quality circles.11.5 A phenomenological perspective: the patient as mystery shopper.11.6 A sociological perspective: Quality Team Development as organisational sensemaking.Index