Drawing on insights from both medical sociology and science and technology studies this article provides a critical analysis of the nature and status of pharmaceuticalisation in terms of the following key dimensions and dynamics: (i) the redefinition or reconfiguration of health 'problems' as having a pharmaceutical solution; (ii) changing forms of governance; (iii) mediation; (iv) the creation of new techno-social identities and the mobilisation of patient or consumer groups around drugs; (v) the use of drugs for non-medical purposes and the creation of new consumer markets; and, finally, (vi) drug innovation and the colonisation of health futures. Pharmaceuticalisation, we argue, is therefore best viewed in terms of a number of heterogeneous socio-technical processes that operate at multiple macro-levels and micro-levels that are often only partial or incomplete. The article concludes by drawing out some broader conceptual and reflexive issues this raises as to how we might best understand pharmaceuticalisation, based on our analysis, as a framework for future sociological work in this field.

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BackgroundPrimary care provision is important in the delivery of health care but many countries face primary care workforce challenges. Increasing demand, enlarged workloads, and current and anticipated physician shortages in many countries have led to the introduction of mid-level professionals, such as Physician Assistants (PAs). Objective: This systematic review aimed to appraise the evidence of the contribution of PAs within primary care, defined for this study as general practice, relevant to the UK or similar systems.MethodsMedline, CINAHL, PsycINFO, BNI, SSCI and SCOPUS databases were searched from 1950 to 2010. Eligibility criteria: PAs with a recognised PA qualification, general practice/family medicine included and the findings relevant to it presented separately and an English language journal publication. Two reviewers independently identified relevant publications, assessed quality using Critical Appraisal Skills Programme tools and extracted findings. Findings were classified and synthesised narratively as factors related to structure, process or outcome of care.Results2167 publications were identified, of which 49 met our inclusion criteria, with 46 from the United States of America (USA). Structure: approximately half of PAs are reported to work in primary care in the USA with good support and a willingness to employ amongst doctors. Process: the majority of PAs’ workload is the management of patients with acute presentations. PAs tend to see younger patients and a different caseload to doctors, and require supervision. Studies of costs provide mixed results. Outcomes: acceptability to patients and potential patients is consistently found to be high, and studies of appropriateness report positively. Overall the evidence was appraised as of weak to moderate quality, with little comparative data presented and little change in research questions over time.Limitations: identification of a broad range of studies examining ‘contribution’ made meta analysis or meta synthesis untenable.ConclusionsThe research evidence of the contribution of PAs to primary care was mixed and limited. However, the continued growth in employment of PAs in American primary care suggests that this professional group is judged to be of value by increasing numbers of employers. Further specific studies are needed to fill in the gaps in our knowledge about the effectiveness of PAs’ contribution to the international primary care workforce.

This article presents research that explores how medications are understood and used by people in everyday life. An intensive process of data collection from 55 households was used in this research, which included photo-elicitation and diary-elicitation interviews. It is argued that households are at the very centre of complex networks of therapeutic advice and practice and can usefully be seen as hybrid centres of medication practice, where a plethora of available medications is assimilated and different forms of knowledge and expertise are made sense of. Dominant therapeutic frameworks are tactically manipulated in households in order for medication practices to align with the understandings, resources and practicalities of households. Understanding the home as a centre of medication practice decentralises the role of health advisors (whether mainstream or alternative) in wellness practices.

Background: Primary health care is changing as it responds to demographic shifts, technological changes and fiscal constraints. This, and predicted pressures on medical and nursing workforces, raises questions about staffing configurations. Physician assistants (PAs) are mid-level practitioners, trained in a medical model over 2 years at postgraduate level to work under a supervising doctor. A small number of general practices in England have employed PAs. Objective: To investigate the contribution of PAs to the delivery of patient care in primary care services in England. Design: A mixed-methods study conducted at macro, meso and micro organisational levels in two phases: (1) a rapid review, a scoping survey of key national and regional informants, a policy review, and a survey of PAs and (2) comparative case studies in 12 general practices (six employing PAs). The latter incorporated clinical record reviews, a patient satisfaction survey, video observations of consultations and interviews with patients and professionals. Results: The rapid review found 49 published studies, mainly from the USA, which showed increased numbers of PAs in general practice settings but weak evidence for impact on processes and patient outcomes. The scoping survey found mainly positive or neutral views about PAs, but there was no mention of their role in workforce policy and planning documents. The survey of PAs in primary care (n = 16) found that they were mainly deployed to provide same-day appointments. The comparative case studies found that physician assistants were consulted by a wide range of patients, but these patients tended to be younger, with less medically acute or complex problems than those consulting general practitioners (GPs). Patients reported high levels of satisfaction with both PAs and GPs. The majority were willing or very willing to consult a PA again but wanted choice in which type of professional they consulted. There was no significant difference between PAs and GPs in the primary outcome of patient reconsultation for the same problem within 2 weeks, investigations/tests ordered, referrals to secondary care or prescriptions issued. GPs, blinded to the type of clinician, judged the documented activities in the initial consultation of patients who reconsulted for the same problem to be appropriate in 80% (n = 223) PA and 50% (n = 252) GP records. PAs were judged to be competent and safe from observed consultations. The average consultation with a physician assistant is significantly longer than that with a GP: 5.8 minutes for patients of average age for this sample (38 years). Costs per consultation were £34.36 for GPs and £28.14 for PAs. Costs could not be apportioned to GPs for interruptions, supervision or training of PAs.Conclusions: PAs were found to be acceptable, effective and efficient in complementing the work of GPs. PAs can provide a flexible addition to the primary care workforce. They offer another labour pool to consider in health professional workforce and education planning at local, regional ...

Much research on chronic illness, which views the experience as disruptive, is adult-focused though there is an emerging literature on children's and young people's experiences. Drawing on 31 interviews conducted with young people diagnosed with asthma in south-west Ireland, this article contributes to this literature. The sample includes boys (n = 15) and girls (n = 16) aged between 5 and 17 from the Irish Traveller community and the larger settled community. The study also explores the potential value of what might be called biographical contingency. This concept refers to the way in which a chronic illness may be an 'only sometimes' problem and takes account of the 'now you see it, now you don't' nature of a condition that varies in terms of its symptoms, meanings and consequences. In concluding, we consider the uses and limitations of this concept and the interpretivist paradigm that typically informs qualitative research on the illness experience.

Involving patients, caregivers, and citizens in health care and health policy has been recommended by international organizations for over a decade. This article focuses on developments in England under New Labour, places them in the context of broader health policy, and assesses them in the light of the limited empirical evidence. The authors consider a range of possible explanations for these developments. They suggest that we need to distinguish between individual and collective forms of patient involvement, and they chart patient and public involvement in England before New Labour and in three distinct phases under New Labour. There has been a significant extension of opportunities for individual patients and the public to communicate their views, albeit with twists and turns in the policy over time. The authors explain these developments in terms of New Labour's ideological attachment to pragmatism and the Third Way, political calculations about the need to reinvigorate political culture, and attempts to enhance cost-effectiveness. Patient and public involvement seems to be here to stay, but whether this will result in greater equity and a real shift in power away from professionals to citizens and patients is another matter.

BackgroundPhysician associates [PAs] (also known as physician assistants) are new to the NHS and there is little evidence concerning their contribution in general practice.AimThis study aimed to compare outcomes and costs of same-day requested consultations by PAs with those of GPs.Design and settingAn observational study of 2086 patient records presenting at same-day appointments in 12 general practices in England.MethodPA consultations were compared with those of GPs. Primary outcome was re-consultation within 14 days for the same or linked problem. Secondary outcomes were processes of care.ResultsThere were no significant differences in the rates of re-consultation (rate ratio 1.24, 95% confidence interval [CI] = 0.86 to 1.79, P = 0.25). There were no differences in rates of diagnostic tests ordered (1.08, 95% CI = 0.89 to 1.30, P = 0.44), referrals (0.95, 95% CI = 0.63 to 1.43, P = 0.80), prescriptions issued (1.16, 95% CI = 0.87 to 1.53, P = 0.31), or patient satisfaction (1.00, 95% CI = 0.42 to 2.36, P = 0.99). Records of initial consultations of 79.2% (n = 145) of PAs and 48.3% (n = 99) of GPs were judged appropriate by independent GPs (P<0.001). The adjusted average PA consultation was 5.8 minutes longer than the GP consultation (95% CI = 2.46 to 7.1; P<0.001); cost per consultation was GBP £6.22, (US$ 10.15) lower (95% CI = −7.61 to −2.46, P<0.001).ConclusionThe processes and outcomes of PA and GP consultations for same-day appointment patients are similar at a lower consultation cost. PAs offer a potentially acceptable and efficient addition to the general practice workforce.