Barriers to referral in patients with angina: qualitative study.

OBJECTIVES

To explore barriers to patients being referred for possible revascularisation.

DESIGN

Qualitative study using semi-structured interviews.

PARTICIPANTS

16 patients aged under 75 years with stable angina and their doctors.

SETTING

General practice in Toxteth, Liverpool.

RESULTS

Fear of both hospitals and medical tests was common and largely hidden from the doctors. Patients felt they were old, had low expectations of treatment, viewed angina as a chronic illness, and knew little about new developments in angina treatment. Patients and doctors had difficulty in recognising angina symptoms that were not textbook definitions amid multiple comorbidity. Patients saw doctors as busy and did not want to bother them with their condition. Cultural gaps and communication difficulties existed despite all but one patient having English as their first language.

CONCLUSIONS

Listening to patients is vital to address inequitable access to health services: how patients are treated by doctors today affects acceptability of referral tomorrow. Primary care groups in deprived areas should work with communities to address local fears. This will involve collaboration between primary, secondary, and tertiary care. Cultural gaps exist between patients and doctors in deprived areas, and diagnostic confusion can occur particularly in the presence of other psychological and physical morbidity. Adequate time and resources-for example, education for doctors and patients and provision of interpreters-need to be provided if inequitable access to revascularisation procedures is to be addressed.