Semi-structured interviews with 28 medical specialists practising in Quebec and Ontario (Canada) to examine their views on an HTA report relevant to their specialty (prostate-specific antigen screening, electroconvulsive therapy and prenatal screening for Down's syndrome).

Medical specialists represent a particularly demanding audience for HTA producers because they are knowledgeable about current studies in their field and often contribute to the evidence base that HTA seeks to synthesize. In all three cases, specialists not only challenged specific points in the content of the HTA reports but also offered different and sometimes conflicting appraisals of the clinical relevance and policy implications. More than just the timeliness and usefulness of HTA findings are at issue. The views of specialists are grounded in a clinical understanding of what counts as evidence and how decisions should be made, a view that contrasts with the societal perspective of HTA.

HTA producers cannot afford to overlook medical specialists who play a key role in the adoption of health technologies. Establishing a transparent dialogue between producers and users of HTA reports could enrich policy recommendations.

Qualitative research in 11 case-study sites focusing on attempts by pilots funded by the initiative to embed knowledge and provision within primary care illustrating barriers faced and the ways in which these were surmounted.

Lack of intrinsic interest in clinical genetics among primary care staff was compounded by national targets that focused their attention elsewhere and by service structures that rendered genetics a peripheral concern demanding minimal engagement. Established divisions between the commissioning of mainstream and specialist services, along with the pressures of shorter-term targets, impeded ongoing funding.

More wide-ranging policy and organizational support is required if the aim of entrenching genetics knowledge and practice across the Health Service is to be realized.

We mailed 1000 questionnaires each to two random samples of patients either waiting for or who had received an arthroplasty within the preceding 3–12 months. We used linear regression to assess the determinants of patient MAWT, and content analysis to assess reasons for MAWT and ideal waiting time.

Of the 1330 responses, 1127 had MAWT data. The sample was 57% women; mean age was 70 ± 11 years. Median self-reported and actual waiting time was eight months (Spearman correlation = 0.70). Median MAWT was four months and ideal waiting time was two months. The most frequent reasons for MAWT were pain, quality of life and needing time to prepare for surgery. A longer MAWT was associated with younger age, group (waiting), a longer self-reported waiting time, better EQ-5D index, an acceptable waiting time, a perception of fairness and a view that others worse off on the list should go ahead.

Patients' views of acceptable waiting times are important for a fair process of establishing waiting time benchmarks for joint replacement.

We obtained the codes of the following bodies: Association of Naturopathic Practitioners, Association of Traditional Chinese Medicine (UK), Ayurvedic Practitioners Association, British Acupuncture Council, Complementary and Natural Healthcare Council, European Herbal Practitioners Association, General Chiropractic Council, General Osteopathic Council, General Regulatory Council for Complementary Therapies, National Institute of Medical Herbalists, Register of Chinese Herbal Medicine, Society of Homeopaths, UK Healers, Unified Register of Herbal Practitioners. We then extracted the statements referring to EBP and compared this with what the respective codes of British doctors and nurses proscribed.

Only the General Chiropractic Council, the General Osteopathic Council and the General Regulatory Council for Complementary Therapies oblige their members to adopt EBP.

This discloses double standards in UK health care which may compromise patient safety.

Data were from 11 qualitative and six quantitative studies. We updated two different non-informative prior distributions with qualitative and quantitative findings to find the posterior distribution for the probabilities that a more complex regimen was associated with lower adherence and that a less complex regimen was associated with greater adherence.

The posterior mode for the qualitative findings regarding more complex regimen and lesser adherence (using the uniform prior with Jeffreys' prior yielding highly similar estimates) was 0.588 (95% credible set limits 0.519, 0.663) and for the quantitative findings was 0.224 (0.203, 0.245); due to non-overlapping credible sets, we did not combine them. The posterior mode for the qualitative findings regarding less complex regimen and greater adherence was 0.288 (0.214, 0.441) and for the quantitative findings was 0.272 (0.118, 0.437); the combined estimate was 0.299 (0.267, 0.334).

The utility of Bayesian methods for synthesizing qualitative and quantitative research findings at the participant level may depend on the nature of the relationship being synthesized and on how well the findings are represented in the individual reports.

We report on a case study of PBMA implementation. The main source of information was two sets of semi-structured evaluation interviews conducted with senior decision-makers after each of the first two years of PBMA implementation in Vancouver Island Health Authority (VIHA), Canada. These interviews were analysed thematically, with initial coding based upon themes that had been identified in the previous stage of the research.

Many of the initial problems with PBMA implementation resolved themselves over time as participants became more familiar with the process. However, some problems needed to be addressed explicitly through changes in procedures. Establishing procedures for handling ‘must-dos’ (i.e. spending priorities, that are externally mandated) did not replace the need to define explicitly the extent of the organization's discretionary spending authority.

Faced with claims that typically outstrip available resources, health care decision-makers need a process to guide allocation decisions. PBMA has demonstrated at VIHA an ability to handle some of the key issues associated with this challenge. Our analysis has produced lessons that should facilitate future implementation but has also shown that resource allocation criteria selection and the extent of executive discretion are likely to be ongoing challenges.

Community pharmacy locations and population need indicators were used to calculate three summary measures of distributional equity across Primary Care Trust (PCT) areas (n = 152): the Gini coefficient, Atkinson Index and community pharmacies per PCT population. The indicators were adjusted for need using data from NHS GP contract Quality and Outcomes Framework disease registers, deprivation, all-cause mortality and elderly population rates.

Numbers of community pharmacies increased by 397 (4%) between 2005 and 2007 with three supermarket chains accounting for 152 (38%) of new pharmacies. Over one-quarter of PCTs experienced increases of 5% or more in community pharmacies per capita between 2005 and 2007. Gini and Atkinson indicators showed small increases in distributional equity across all population needs indicators.

Deregulation was associated with more community pharmacies per capita and a small increase in geographic equity of community pharmacy distribution at PCT level. Future research should continue to monitor how pharmacy distribution changes over time and assess the extent to which the new regulatory framework has allowed clustering of pharmacies which could result in increased inequity below PCT level.