A qualitative study of patient choices in using emergency health care for long-term conditions: The importance of candidacy and recursivity

PATIENT EDUCATION AND COUNSELING

卷:93

Article

Hunter, Cheryl¹  Chew-Graham, Carolyn^2,4  Langer, Susanne³  Stenhoff, Alexandra³  Drinkwater, Jessica⁴  Guthrie, Elspeth⁵  Salmon, Peter⁶ 

[1] Univ Oxford, Nuffield Dept Populat Hlth, Oxford, England

[2] Keele Univ, Res Inst, Keele ST5 5BG, Staffs, England

[3] Univ Liverpool, Dept Mental & Behav Hlth Sci, Liverpool L69 3BX, Merseyside, England

[4] Univ Manchester, Ctr Primary Care, Inst Populat Hlth, Manchester, Lancs, England

[5] Manchester Royal Infirm, Manchester M13 9WL, Lancs, England

[6] Univ Liverpool, Div Clin Psychol, Liverpool L69 3BX, Merseyside, England

关键词: Healthcare utilisation;    Primary health care;    Patient experiences;    Qualitative research;    Longterm conditions;    Unscheduled care;    Emergency healthcare;    Chronic obstructive pulmonary disease;    Asthma;    Diabetes;    Coronary heart disease;    Theory;    Candidacy;    Recursivity;    Patient decision-making;   

DOI  :  10.1016/j.pec.2013.06.001

来源: Elsevier

【 摘 要 】

Objective: We aimed to explore how patients with long-term conditions choose between available healthcare options during a health crisis. Methods: Patients in North-West England with one or more of four long-term conditions were invited to take part in a questionnaire cohort study of healthcare use. Semi-structured interviews were conducted with a sub-sample of fifty consenting patients. Data were analysed qualitatively, using a framework approach. Results: Patients described using emergency care only in response to perceived urgent need. Their judgements about urgency of need, and their choices about what services to use were guided by previous experiences of care, particularly how accessible services were and the perceived expertise of practitioners. Conclusion: Recursivity and candidacy provide a framework for understanding patient decision-making around emergency care use. Patients were knowledgeable and discriminating users of services, drawing on experiential knowledge of healthcare to choose between services. Their sense of 'candidacy' for specific emergency care services, was recursively shaped by previous experiences. Practice implications: Strategies that emphasise the need to educate patients about healthcare services use alone are unlikely to change care-seeking behaviour. Practitioners need to modify care experiences that recursively shape patients' judgements of candidacy and their perceptions of accessible expertise in alternative services. (C) 2013 The Authors. Published by Elsevier Ireland Ltd. All rights reserved.

【 授权许可】

Free