Primary Health Care: Theory and Practice / Edition 1

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General practitioners and other primary care professionals have a leading role in contemporary health care, which Trisha Greenhalgh explores in this highly praised new text. She provides perceptive and engaging insights into primary health care, focussing on:

• its intellectual roots
• its impact on the individual, the family and the community
• the role of the multidisciplinary team
• contemporary topics such as homelessness, ethnic health and electronic records.

Concise summaries, highlighted boxes, extensive referencing and a dedicated section on effective learning make this essential reading for postgraduate students, tutors and researchers in primary care.


From the foreword by Julian Tudor Hart
“Trish Greenhalgh, in her frequent columns in the British Medical Journal…more than any other medical journalist spoke to her fellow GPs in the language of experience, but never without linking this to our expanding knowledge from the whole of human science.

When I compare the outlines of primary care so lucidly presented in this wonderful book, obviously derived from rich experience of real teaching and learning, with the grand guignol theatre of London medical schools when I was a student 1947-52, the advance is stunning.”


"Trish Greenhalgh is one of the international stars of general practice and a very clever thinker. This new book is a wonderful resource for primary health care and general practice. Every general practice registrar should read this book and so should every general practice teacher and primary care researcher."

Professor Michael Kidd, Head of the Department of General Practice, University of Sydney and Immediate Past President of The Royal Australian College of General Practitioners

“This important new book by one of primary care's most accomplished authors sets out clearly the academic basis for further developments in primary health care. Health systems will only function effectively if they recognise the importance of high quality primary care so I strongly recommend this book to students, teachers, researchers, practitioners and policy makers.”

Professor Martin Marshall, Deputy Chief Medical Officer, Department of Health, UK

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Editorial Reviews

From the Publisher
"Trish Greenhalgh is one of the international stars of generalpractice and a very clever thinker. This new book is a wonderfulnew resource for primary health care and general practice. Everygeneral practice registrar should read this book and so shouldevery general practice teacher and every primary careresearcher."
  • Professor Michael Kidd, Head of the Department of GeneralPractice, The University of Sydney and Immediate Past President ofThe Royal Australian College of General Practitioners

"General practice in the U.K. is responsible for more patientcare than ever before, and its input to medical training andresearch is at an all-time high. But its broadening roles andchanging political context are at risk of causing an identitycrisis. We are fortunate that Professor Trish Greenhalgh hasbrought her passion, intelligence and scholarship to bear on one ofthe key questions for health professionals today - what is the bestof primary care about, and why is it essential for patients anddoctors? She encourages debate while supporting and inspiringprimary care, because she tells a modern story of a disciplinewhose purpose is valuable and which can rise to its new challenges.I am personally very glad to have read this timely and excitingbook."

  • Amanda Howe MA MD MEd FRCGP ILT(M), Professor of PrimaryCare & MB/BS Course Director Institute of Health University ofEast Anglia Norwich NR4 7TJ Norfolk

"This book meets a real need for a lively, engaging andperceptive book that brings together the population with theindividual perspective and describes the key concepts that underpincontemporary primary care with admirable clarity. This bookdeserves to become a classic and will be welcomed by enquiringundergraduates and postgraduates alike who want a book that willboth challenge and inform."

  • Professor Andy Haines, Director, London School of Hygiene& Tropical Medicine, London, UK

"This important new book by one of primary care's mostaccomplished authors sets out clearly the academic basis forfurther developments in primary health care. Health systems willonly function effectively if they recognise the importance of highquality primary care so I strongly recommend this book to students,teachers, researchers, practitioners and policy makers."

  • Professor Martin Marshall, Deputy Chief Medical Officer,Department of Health
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Product Details

  • ISBN-13: 9780727917850
  • Publisher: Wiley
  • Publication date: 9/19/2007
  • Edition number: 1
  • Pages: 338
  • Sales rank: 1,139,756
  • Product dimensions: 6.00 (w) x 9.00 (h) x 0.70 (d)

Meet the Author

Trisha Greenhalgh Department of Primary Care and PopulationSciences, University College London, UK.

Author of bestselling How to Read a Paper andDiffusion of Innovations in Health Service Organisations(Blackwell Publishing BMJ Books).

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Table of Contents




1 Introduction.

1.1 What is primary (health) care?.

1.2 What is academic study?.

1.3 What are theories – and why do we need them?.

2 The ‘ologies’ (underpinning academicdisciplines) of.

primary health care.

2.1 Biomedical sciences.

2.2 Epidemiology.

2.3 Psychology.

2.4 Sociology.

2.5 Anthropology.

2.6 Literary theory.

2.7 Philosophy and ethics.

2.8 Pedagogy.

3 Research methods for primary health care.

3.1 What is good research in primary health care?.

3.2 Qualitative research.

3.3 Quantitative research.

3.4 Questionnaire research.

3.5 Participatory (‘action’) research.

3.6 Research data – and analysing it.

3.7 Critical appraisal of published research papers.

3.8 Systematic review.

3.9 Multi-level approaches to primary care problems.

4 The person who is ill.

4.1 The sick role.

4.2 The illness narrative.

4.3 Lifestyle choices and ‘changing behaviour’.

4.4 Self-management.

4.5 Health literacy.

5 The primary care clinician.

5.1 The role of the generalist.

5.2 Clinical method I: rationalism and Bayes’ theorem.

5.3 Clinical method II: humanism and intuition.

5.4 Clinical method III: the patient-centred method.

5.5 Influencing clinicians’ behaviour.

5.6 The ‘good’ clinician.

6 The clinical interaction.

6.1 The clinical interaction I: a psychological perspective.

6.2 The clinical interaction II: a sociolinguisticperspective.

6.3 The clinical interaction III: a psychodynamicperspective.

6.4 The clinical interaction IV: a literary perspective.

6.5 The interpreted consultation.

7 The family – or lack of one.

7.1 Family structure in the late modern world.

7.2 The mother–child relationship (or will any significantother.

do these days?).

7.3 Illness in the family – nature, nurture andculture.

7.4 Homelessness.

8 The population.

8.1 Describing disease in populations.

8.2 Explaining the ‘causes’ of disease.

8.3 Detecting disease in populations.

8.4 ‘Risk’: an epidemiological can of worms?.

9 The community.

9.1 Unpacking health inequalities I: deprivation.

9.2 Unpacking health inequalities II: social networks andsocial.


9.3 Unpacking health inequalities III: life courseepidemiology.

and ‘risk regulators’.

9.4 Developing healthy communities I: community oriented.

primary care.

9.5 Developing healthy communities II: participatory.


10 Complex problems in a complex system.

10.1 Illness in the twenty-first century: chronicity,comorbidity.

and the need for coordination.

10.2 Coordinating care across professional andorganisational.


10.3 The electronic patient record: a road map for seamless.


10.4 The end of an era?.

11 Quality.

11.1 Defining and measuring quality.

11.2 A rational biomedical perspective: evidence-basedtargets,.

planned change and criterion-based audit.

11.3 A narrative perspective: significant event audit.

11.4 A social learning perspective: peer review groups and.

quality circles.

11.5 A phenomenological perspective: the patient as mystery.


11.6 A sociological perspective: Quality Team Developmentas.

organisational sensemaking.


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