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1.  General practitioners' perceptions of sharing workload in group practices: qualitative study 
BMJ : British Medical Journal  2004;329(7462):381.
Objective To explore general practitioners' beliefs and experiences of distribution of workload and teamwork between doctors in general practice.
Design Qualitative semistructured interview study.
Setting South London.
Participants 18 general practitioners from 11 practices.
Main outcome measures Perceptions and experiences of distribution of workload and teamwork between doctors.
Results Equitable distribution of workload was a common concern among general practitioners in group practices. Several ways of addressing the problem were identified, including relying on trust, creating systems of working based on explicit rules such as points' systems, and improving communication. Improvement of communication was hampered by the taboo nature of the problem.
Conclusion Resentment about perceived inequalities in workload places a further burden on general practices. The issue of working together warrants further support.
PMCID: PMC509345  PMID: 15265814
2.  Implementing evidence based medicine in general practice: audit and qualitative study of antithrombotic treatment for atrial fibrillation 
BMJ : British Medical Journal  1999;318(7194):1324-1327.
To determine the extent to which implementation of an evidence based treatment, antithrombotic treatment in atrial fibrillation, is possible in general practice.
Audit and qualitative study of patients with atrial fibrillation and an educational intervention for patients judged eligible for antithrombotic treatment.
South east England.
56 patients with a history of atrial fibrillation.
Assessment and interview to ascertain patients' views on antithrombotic treatment.
Main outcome measures
Number of patients receiving antithrombotic treatment.
Out of 13 239 patients, 132 had a history of atrial fibrillation of which 100 were at risk of thromboembolism. After the study, 52 patients were taking warfarin. Of the remaining 48 patients (of whom 41 were taking aspirin), eight were too ill to participate, 16 were unable to consent, four refused the interview, and 20 declined warfarin. Patients declining warfarin were inclined to seek a higher level of benefit than those taking it, as measured by the minimal clinically important difference. Qualitative data obtained during the interviews suggested that patients' health beliefs were important factors in determining their choice of treatment.
Patients’ unwillingness to take warfarin seemed to be a major factor in limiting the number who would eventually take it.
Key messagesAfter a structured intervention only half of a group of apparently eligible patients ended up taking warfarin for their atrial fibrillationImplementation of warfarin treatment for patients with atrial fibrillation was constrained by patients who were either too ill to take the drug or were unable to give consentThese constraints are compounded by the unwillingness of patients to reduce their risk by taking a proved drugThe number needed to treat, a key statistic in evidence based medicine, probably often overestimates the value of treatment in routine general practice and may not be sufficient to persuade patients of the benefit of treatment
PMCID: PMC27873  PMID: 10323820
6.  Effect of communicating DNA based risk assessments for Crohn’s disease on smoking cessation: randomised controlled trial 
Objective To test the hypothesis that communicating risk of developing Crohn’s disease based on genotype and that stopping smoking can reduce this risk, motivates behaviour change among smokers at familial risk.
Design Parallel group, cluster randomised controlled trial.
Setting Families with Crohn’s disease in the United Kingdom.
Participants 497 smokers (mean age 42.6 (SD 14.4) years) who were first degree relatives of probands with Crohn’s disease, with outcomes assessed on 209/251 (based on DNA analysis) and 217/246 (standard risk assessment).
Intervention Communication of risk assessment for Crohn’s disease by postal booklet based on family history of the disease and smoking status alone, or with additional DNA analysis for the NOD2 genotype. Participants were then telephoned by a National Health Service Stop Smoking counsellor to review the booklet and deliver brief standard smoking cessation intervention. Calls were tape recorded and a random subsample selected to assess fidelity to the clinical protocol.
Main outcome measure The primary outcome was smoking cessation for 24 hours or longer, assessed at six months.
Results The proportion of participants stopping smoking for 24 hours or longer did not differ between arms: 35% (73/209) in the DNA arm versus 36% (78/217) in the non-DNA arm (difference −1%, 95% confidence interval −10% to 8%, P=0.83). The proportion making a quit attempt within the DNA arm did not differ between those who were told they had mutations putting them at increased risk (36%), those told they had none (35%), and those in the non-DNA arm (36%).
Conclusion Among relatives of patients with Crohn’s disease, feedback of DNA based risk assessments does not motivate behaviour change to reduce risk any more or less than standard risk assessment. These findings accord with those across a range of populations and behaviours. They do not support the promulgation of commercial DNA based tests nor the search for gene variants that confer increased risk of common complex diseases on the basis that they effectively motivate health related behaviour change.
Trial registration Current Controlled Trials ISRCTN21633644.
PMCID: PMC3401124  PMID: 22822007

Results 1-6 (6)