Our study demonstrates that QI methods can rapidly improve adherence to national guidelines even in settings without a formal antimicrobial stewardship program to encourage judicious antibiotic prescribing for CAP.

Background. In the UK, most people with mental health problems are managed in primary care. However, many individuals in need of help are not able to access care, either because it is not available, or because the individual's interaction with care-givers deters or diverts help-seeking. Aims. To understand the experience of seeking care for distress from the perspective of potential patients from “hard-to-reach” groups. Methods. A qualitative study using semi-structured interviews, analysed using a thematic framework. Results. Access to primary care is problematic in four main areas: how distress is conceptualised by individuals, the decision to seek help, barriers to help-seeking, and navigating and negotiating services. Conclusion. There are complex reasons why people from “hard-to-reach” groups may not conceptualise their distress as a biomedical problem. In addition, there are particular barriers to accessing primary care when distress is recognised by the person and help-seeking is attempted. We suggest how primary care could be more accessible to people from “hard-to-reach” groups including the need to offer a flexible, non-biomedical response to distress.

Unlike regions with larger Latino populations, the health care infrastructure in Cincinnati does not include linguistically and culturally appropriate services to meet the need of the growing Latino immigrant community. In order to guide development of appropriate health care services, a team of academic and community researchers collaborated on a community-based participatory research project to understand health care use, barriers to health care, perceptions of health care, and health care needs of Latino immigrants. Co-researchers administered 518 surveys and conducted focus groups with 34 Latino immigrants. Participants relied on community clinics for care more often than is seen in nationwide Hispanic samples. Results revealed significant health care barriers, which Latino immigrants attribute to language, lack of quality interpreters, documentation status, and discrimination. Results suggest that the dearth of established social support networks and health care infrastructure in new Latino growth areas exacerbate the health care obstacles experienced by Latino immigrants throughout the country.

The tremendous Latino growth combined with the challenges of living in a nontraditional migration area make Latinos, particularly those who are undocumented, a "difficult-to-reach" and understudied population in research. We describe the development and practice of an immigrant community research team created to investigate and improve research quality regarding health-related needs, beliefs, and behaviors of recent Latino immigrants living in Cincinnati, Ohio. Our community research team, Latinos Unidos por la Salud (LU-Salud), is composed of Latino immigrant community members and academic researchers working in a health research partnership. The community team members are considered "co-researchers" since LU-Salud was designed within a community-based participatory research framework where we engaged in shared decision making at each phase of the research process from design, data collection, and interpretation of findings to dissemination. The co-researcher approach promoted shared decision-making and community empowerment throughout the research process with our community members providing expertise about the "what" (Latino immigrant health-related beliefs and behaviors, questionnaire content, interpretation of data) and the "why" (to obtain perspectives from Latino immigrants who typically don't engage with academics) and our academic members bringing expertise about the "how" (research design and methods, grant funding).

Community-acquired pneumonia (CAP) is diagnosed in >1.2 million children in outpatient settings and emergency departments (EDs) each year in the United States. 1, 2 Most antibiotic prescribing for CAP occurs in the outpatient setting. In 2011, members of the Pediatric Infectious Diseases Society and Infectious Diseases Society of America published an evidence-based guideline for the management of CAP in children. The authors of the recommendations encourage prescribing narrow