A qualitative study of patient choices in using emergency health care for long-term conditions: The importance of candidacy and recursivity |
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Authors: | Cheryl Hunter Carolyn Chew-Graham Susanne Langer Alexandra Stenhoff Jessica Drinkwater Elspeth Guthrie Peter Salmon |
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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 |
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Abstract: | ObjectiveWe aimed to explore how patients with long-term conditions choose between available healthcare options during a health crisis.MethodsPatients 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.ResultsPatients 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.ConclusionRecursivity 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 implicationsStrategies 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. |
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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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