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A qualitative study of patient choices in using emergency health care for long-term conditions: The importance of candidacy and recursivity
Authors:Cheryl Hunter  Carolyn Chew-Graham  Susanne Langer  Alexandra Stenhoff  Jessica Drinkwater  Elspeth Guthrie  Peter Salmon
Institution:1. Nuffield Department of Population Health, University of Oxford, Oxford, UK;2. Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK;3. Department of Mental and Behavioural Health Sciences, University of Liverpool, Liverpool, UK;4. Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK;5. Manchester Royal Infirmary, Manchester, UK;6. Division of Clinical Psychology, University of Liverpool, Liverpool, UK
Abstract:

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.
Keywords: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
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