Method: A postal questionnaire was distributed to carers across Wales on three occasions approximately 18 months apart. It included the SF-12v2 together with fixed-choice and open-ended questions relating to carer demographics, carer assessment, support needs, services received and care recipient’s medical condition. A sub-sample of these carers was invited to take part in face-to-face interviews to allow for more in-depth exploration of their circumstances.

Results: The carers with chronic conditions experienced a decline in their physical health over time whereas the physical health of carers without a chronic condition remained stable. There was also evidence of carers neglecting their own health because of their caring responsibilities. Despite their health problems, over time the carers with chronic conditions received no more support than other carers.

Discussion: This article indicates that there are carers who are themselves suffering from a physical condition or conditions that suggest they are in need of care. Despite these difficulties, these carers are caring for people with quite severe conditions, without any help above that available to other carers.

Methods: 2003 cross-sectional survey and medical record review of a random sample of diabetes patients (n = 4198) in 10 US health plans across the country and their physicians (n = 1217). We characterized physicians’ diabetes care PDM preferences and practices as ‘no patient involvement,’ ‘physician-dominant,’ ‘shared,’ or ‘patient-dominant’ and conducted multivariate analyses examining their effects on the following: (1) three diabetes care processes (annual hemoglobin A1c test; lipid test; and dilated retinal exam); (2) patients’satisfaction with physician communication; and (3) whether patients’ A1c, systolic blood pressure (SBP), and low-density lipoprotein cholesterol (LDL) were in control.

Results: Most physicians preferred ‘shared’ PDM (58%) rather than ‘no patient involvement’ (9%), ‘physiciandominant’ (28%) or ‘patient dominant’ PDM (5%). However, most reported practicing ‘physician-dominant’ PDM (43%) with most of their patients, rather than ‘no patient involvement’ (13%), ‘shared’ (37%) or ‘patient-dominant’ PDM (7%). After adjusting for patient and physician-level characteristics and clustering by health plan, patients of physicians who preferred ‘shared’ PDM were more likely to receive A1c tests [90% vs. 82%, AOR: 2.05, 95% CI: 1.03—3.07] and patients of physicians who preferred ‘patient-dominant’ treatment decision-making were more likely to receive lipid tests [60% vs. 50%, AOR: 1.58, 95% CI: 1.04—2.39] than those of providers who preferred ‘no patient involvement’ in treatment decision-making. There were no differences in patients’ satisfaction with their doctor’s communication or control of A1c, SBP or LDL depending on their physicians’ PDM preferences. Physicians’ self-reported PDM practices were not associated with any of the examined aspects of diabetes care in multivariate analyses.

Conclusions: Patients whose physicians prefer more patient involvement in decision-making are more likely than patients whose physicians prefer more physician-directed styles to receive some recommended risk factor screening tests, an important first step toward improved diabetes outcomes. Involving patients in treatment decision-making alone, however, appears not to be sufficient to improve biomedical outcomes.

Method: Participants were 257 people with motor neurone disease, Huntington’s disease, multiple sclerosis and Parkinson’s.

Results: High levels of cut backs in spending predicted economic pressure for all groups. Economic pressure predicted QOL at 12-month follow-up for all groups except Parkinson’s. For Parkinson’s, predictors of QOL were long duration of illness, illness-related expenses and cut backs in spending. Cut backs in spending, and not income or expenses, were the most important predictor of economic pressure. QOL was predicted by high levels of economic pressure for most of the illness groups.

Discussion: The implications of these findings are discussed. They suggest that cut backs in spending, as opposed to income and expenses, are important factors to focus on assisting people to adjust to the changes to their financial situation that frequently occurs after developing one of these progressive neurological illnesses.

Methods: Using a grounded theory approach, in-depth and follow-up interviews with 27 chronically ill people were conducted and analysed.

Results: From the perspective of people with chronic conditions, the main challenge in everyday medication management was to develop, maintain, and adjust routines. Routines were affected by the chronic illness trajectory and a variety of barriers. Developing and adjusting routines was further complicated by inadequate information and counselling, asymmetric relationships and communication with healthcare professionals, restrictive healthcare conditions, increasing complexities in medication regimens as well as healthcare professionals’ lack of interest in the problems of chronically ill people balancing their chronic condition and medication regimen in everyday life.

Discussion: Chronically ill persons have to deal with numerous difficulties in everyday medication management on their own. They are often overwhelmed by problems related to both their medication regimen and their routines in medication (self-) management. Thus, they require individualized long-term self-management support. Future research should address the dynamic nature of chronic illness trajectories and focus on later phases of chronic conditions.

Methods: Data from the 1999 Spanish Survey on Disabilities, Deficiencies, and State of Health were used. The survey is a cross-sectional study based on a multi-stage stratified sample of all the non-institutionalized Spanish population aged over 14 years (n=59,101, 11% non-responders). Multivariate logistic regression analysis were used.

Results: 10.7% of the Spanish population suffer from an MHP. The highest prevalences were found in women, divorced/separated persons, those with a lower level of education and income, and those suffering from a chronic somatic problem. The number of days of daily activity lost was 2-fold greater among those with an MHP than among those with a chronic somatic problem. Greater use of mental health services was associated with loss of daily activity, having a higher level of education, invalidity or disability. The probability of MHP being referred from primary to mental healthcare is reduced if somatic comorbidity is present.

Conclusion: MHPs have a high prevalence and a significant repercussion on the patient’s life. An inverse relationship was found between certain risk factors for MHPs and the use of services, which suggests inequality. Problems of accessibility are identified.

Methods: A qualitative questionnaire was completed by students at the start of a primary healthcare rotation to determine existing impressions/understandings about chronic conditions. Following the revised teaching programme, a reflective essay about a home-visit to a person with chronic conditions was completed by students at the end of the rotation.

Results: Analysis of the questionnaire at the start of the rotation showed students have some knowledge of the differences between acute and chronic care, have rather negative impressions of what it means to have chronic conditions and know little of overall patient management including the work of an interdisciplinary team. Analysis of the reflective essays completed by students at the end of the rotation showed an increased understanding of chronic conditions, what it means to have a chronic condition and who supports management.

Discussion: A structured chronic conditions teaching programme including patient-as-teacher is an effective way of building knowledge and changing students’ impressions of what it means to have a chronic condition.

Methods: A narrative-based approach, with participants recruited from web sites and newsletters of two Ménière’s Societies (in the UK and in Victoria, Australia) and searches of a monthly newsletter, Spin, for letters related to the use of CAM therapies. A thematic approach to data analysis was undertaken.

Results: Twenty personal, written stories were obtained and 23 letters. Commonly, critical events or changes in the condition provided the catalyst to seek alternative treatment, and sometimes significant others (a GP, CAM practitioner, friends, family). The accounts illustrate a range and variety of journeys that participants travelled in locating satisfactory ways to manage the condition, and the essential ‘personal’ nature of the experience and perceived benefits. No single CAM solution or pathway was evident.

Discussion: The findings suggest the importance of ‘finding your own way’, having a positive outlook and being proactive in regaining control over one’s health, and the value of early recommendations to ‘perhaps try alternative/ CAM treatments’.