Patients’ anticipated actions following transient ischaemic attack symptoms: a qualitative vignette-based study

BMC Family Practice

Research Article

Christopher Levi¹  Terry Joyce²  Parker Magin²  Daniel Lasserson³ 

[1] Centre for Translational Neuroscience and Mental Health, University of Newcastle, University Drive, 2308, Callaghan, NSW, Australia;Discipline of General Practice, University of Newcastle, University Drive, 2308, Callaghan, NSW, Australia;Nuffield Department of Medicine, University of Oxford, Oxford, Oxon, UK;

关键词: Family practice;    General practice;    Ischaemic attack, transient;    Stroke;    Delivery of health care;    Health care quality, Access and evaluation;    Health behaviour;   

DOI  :  10.1186/s12875-017-0594-4

 received in 2016-08-07, accepted in 2017-01-27,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundTransient Ischaemic Attack (TIA) requires urgent investigation and management. Urgent management reduces the risk of subsequent stroke markedly, but non-presentation or delays in patient presentation to health services have been found to compromise timely management. We aimed to explore general practice patients’ anticipated responses to TIA symptoms.MethodsThis was a qualitative study employing semi-structured telephone interviews. Participants were recruited from respondents in an earlier quantitative study based in Australian general practices. Maximum variation purposive sampling of patients from that study (on the basis of age, rurality, gender and previous experience of stroke/TIA) continued until thematic saturation was achieved. After initial interviews explored knowledge of TIA and potential responses, subsequent interviews further explored anticipated responses via clinical vignettes containing TIA and non-TIA symptoms. Transcribed interviews were coded independently by two researchers. Data collection and analysis were concurrent and cumulative, using a process of iterative thematic analysis and constant comparison. A schema explaining participants’ anticipated actions emerged during this process and was iteratively tested in later interviews.ResultsThirty-seven interviews were conducted and a ‘spectrum of action’, from watchful waiting (only responding if symptoms recurred) to summoning an ambulance immediately, was established. Intermediate actions upon the spectrum were: intending to mention the episode to a general practitioner (GP) at a routine appointment; consulting a GP non-urgently; consulting a general practitioner (GP) urgently; and attending an Emergency Department urgently. The substrate for decision-making relating to this spectrum operated via three constructs: the ‘individual set’ of the participant (their inherent disposition towards action in response to health matters in general), their ‘discriminatory power’ (the ability to discriminate TIA symptoms from non-TIA symptoms) and their ‘effective access’ to health-care services.ConclusionsPolicies to improve patients’ accessing care (and accessing care urgently) post-TIA should address these three determinants of anticipated action.

【 授权许可】

CC BY   
© The Author(s). 2017